Theoretical Basis for Centering Groups

Why Groups?

Groups are an entirely different experience, for both patient and care provider, than individual appointments. Groups are extremely effective in helping people meet their goals and providing support.

Values of groups include:

• Improved understanding as members share common life experiences
• Community-building
• Positive peer influence
• Increased motivation to learn and change
• Cost-effective, efficient use of provider time
• Support for participants and their family
• Problem-solving skill development
• Enjoyable experiences for patients and providers

Centering is built on the basic premise that care is most effectively and efficiently provided in groups that are facilitated rather than taught. These groups are never referred to as class, which connotes a didactic model of teacher/student interaction.

Within groups there is the potential to develop many relationships which has been shown to contribute to therapeutic and healing activity as well as behavior change.

Interestingly, the first reference to group health care dates from 1903, so group care is a tried-and-true method of care delivery.

Groups in Health Care Reform

The Institute of Medicine in its 2001 publication, Crossing the Quality Reform, listed 6 aims for the improvement of health care.

1. Safe: avoiding injuries to those we are intending to help
2. Effective: providing services based on scientific knowledge to all those likely to benefit and refraining from providing services to those not likely to benefit
3. Patient-centered: care that is respectful and responsive to individual preferences, needs, and values, and letting these values guide all clinical decisions
4. Timely: care that reduces waits and harmful delays both for providers and recipients
5. Efficient: care that avoids waste of supplies, equipment, ideas, and energy
6. Equitable: care that does not vary in quality because of personal characteristics such as gender, ethnicity, geography, socioeconomic status

Table comparing the Ten Rules for Redesign with the Essential Elements of the Centering model

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The Benefits of Groups

Benefits to the Provider

• Continuity of Care
• More time with patients
• Sharing of responsibility for outcomes with the patient
• Efficient way to share information
• Opportunity for discussion that leads to informed consent
• Motivated patients
• Integration of the care component with time for education and community development
• Efficient use of time
• Content integrated into care along with other needed services such as: WIC, substance abuse counseling, nutrition counseling, etc.
• Better outcomes

Benefits to the Patient

• Sharing of joys and concerns with others who are experiencing similar health events
• More time with provider
• Opportunity to be active in care provision through self-care activities
• Support for behavior change
• Involvement of family members/partners if desired
• Efficient use of time
• All appointments are scheduled and predictable
• All care happens within the group space, minimizing the wasted time and possible confusion of accessing services
• Culturally appropriate care
• Participation in a program that leads to greater sense of empowerment and community building
• Better outcomes
• Exposure to lots of information including topics of a sensitive nature

Benefits to the Agency

• Care is fully reimbursable
• Frees exam rooms for other paying procedures
• Addresses issues of access
• Maximizes time of support personnel e.g. social worker, counselors, interpreters)
• Attractive program to the community leads to favorable publicity
• Reduces traffic and confusion in the clinic
• Leads to better outcomes for patients
• Patients report high satisfaction with the model as do providers

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