CENTERING CARE START UP
Click Here to download a PDF version of the Start Up Information Packet
Centering Healthcare Institute (CHI) is dedicated to helping sites successfully implement Centering care into practice. The Model Implementation Plan (MIP) was developed after more than a decade of observation and feedback from practice sites. The resulting design partners Centering experts with site key stakeholders for a more efficient and effective experience.
To consider whether Centering group care is a good fit for your practice site, it is important to understand the Centering model of group care and have discussion with a wide range of individuals from the practice. At a minimum, the health care providers, administrative leadership and clinic manager should have an understanding and interest to proceed.
In order to start Centering in a practice, the following steps should be followed:
- Review all the descriptive information provided in this packet.
- Contact CHI
- Complete and submit the Readiness Assessment Tool (click here to start) Include key stakeholders who can help complete the assessment.
- A CHI representative will contact you to review your information and discuss the options for starting Centering in your practice setting.
The following areas are important to consider before implementation of Centering into a practice setting. The information provided is offered as general guidance and will be a helpful way to think about starting to provide care in a different way.
- Group Space
Appropriate space is an important part of recruiting and retaining patients in group care. If the space is attractive, comfortable, and private it will promote a good experience for care providers, patients, and families.
Details to consider:
Dedicated space to hold a circle of 16 – 20 chairs with room left over (about 25’ X 25’ or 625 sq. ft)
Accessible and private
- Population Size
The goal for CenteringPregnancy is to have at least one group of 10 to 12 women start each month. Approximately 200 new prenatal patients or deliveries/year will support one group starting each month. For CenteringParenting, plan for 5 - 7 mother/baby pairs and for Lifecycle groups, plan for 10 to 14 participants.
- Provider Involvement
It is not necessary that every healthcare provider in a practice participate in Centering. However, a minimum of 2 provider teams is needed to provide stability over time. Additionally there should be a significant percentage of the total providers i.e., more than half, to insure the best success. When there is good participation in Centering, people will view it as being a normal part of care in the practice.
Patient recruitment into groups will be impacted by this factor. If most or all the care providers are participating in groups, patients and staff view this as acceptance and commitment to Centering.
- Administrative Participation & Support
The organization or practice leadership provides direction for operations and finance that will be impacted by Centering. The commitment to change and budgeted resources include:
- Staff time for planning, implementation and ongoing operation and evaluation
- Materials and food for Centering group visits
- CHI annual membership
- Training for new providers and staff
- Ongoing continuing education for providers and staff
The Model Implementation Plan (MIP) is designed to provide sites with an individualized but systematic approach to successfully start and run Centering groups.
With the guidance and support of a Centering expert, the practice site will follow a carefully designed process to plan, implement and sustain the Centering model. CHI's national office staff provide support services to the consultant and the site throughout the implementation. The time line may vary depending on the needs of the site.
- Site Contracts with CHI
CHI Consultant assigned to work with the practice from start up through Site Approval Steering Committee forms and completes work preparing for System Redesign visit
- System Redesign on-site visit by CHI Consultant scheduled
Unlimited telephone and email support
- Basic Facilitation Training Workshop (2 days)
On-site training may be provided for 15 or 25 care providers and co-facilitators
For small practice sites, training offered at workshops held nationally
Facilitator materials and guides are provided for all providers and co-facilitators
- Groups Start
Start-up materials are provided for the first 50 participants
Consultation is provided before and after groups as needed
- Advanced Facilitation (Level 2) Training Workshop (1 day)
On-site training may be provided for 15 or 25 experienced Centering care providers and co-facilitators
For small practice sites, training offered at workshops held nationally
- Site Approval
Assessment of Model Fidelity, Evaluation and Sustainability
The site's MIP consultant will help with preparation for Site Approval
On-site visit and consultation for evaluation and response to any identified issues
Continued communication with consultant
Networking with the Centering community throughout the U.S.
Two-year commitment to provide consultation, training, support and materials to successfully implement Centering models of care. Actual pricing may vary and CHI will work with your site to match the MIP approach with your needs.
Model Implementation Plan - $20,000
- 2 on-site visits: System Redesign and Site Approval
- CHI membership - 2 years
- Unlimited email and/or phone consultation for 2 years
- Start-up materials
2014 Training Component Options
- On-site training for 15 or 25 people
• Basic Facilitation for 15 - $11,250: for 25 - $18,750
• Advanced Facilitation for 15 - $6,750: for 25 - $11,250
- Individual registration at a CHI workshop, held nationally
• Basic Facilitation $850/person
• Advanced Facilitation $500/person
Travel expenses for CHI Consultants and Faculty are included.
Multi-site practices should contact CHI to discuss MIP options including sharing components between two or more sites and opportunities for cost savings as well as incremental implementation over a period of time.
Other Start Up Costs
Equipment and supplies to support group care visits
Group space renovations or improvements
Ongoing Centering Operation Costs
Participant Notebooks - $22 each
Food for each group session - cost varies
Centering Coordinator time - at least 4 hours/ week (more for large sites)
Training for future staff, providers - Workshop fee + travel
Ongoing training for experienced facilitators
Annual CHI site membership (2 years included with the MIP)
Selection of a Steering Committee is an early step in the implementation process. The shift from individual visits to group visits is a major change and will impact every aspect of a clinical practice setting.
The Steering Committee is actively involved from the start up process through the ongoing monitoring of activity. Initially the group will meet at close intervals and over time the meeting schedule can be adjusted to meet the needs of the practice site.
Steering Committee Members
The committee should be a group of approximately 6 – 8 individuals with representation of the following work groups:
- Administrator: person who has responsibility for overseeing the logistics of care to the designated population
- Credentialed provider: one or two providers who will have responsibility for providing care in groups
- Nurse or medical assistant: person who has responsibility for supporting care for the patients in the designated population
- Front desk clerk: person who is a first-line of contact with the patients and who will oversee the scheduling of the groups
- Support staff: agency staff people who might have significant contribution to the running of groups or the support of the patient population. Could include: social worker, nutritionist, parent educator, etc
- Consumer: strongly recommend to have a consumer from the designated population
- Other: might include agency administrator, residency director, etc
This position needs released administrative time to carry out the responsibilities and help assure the success of the implementation. The coordinator should be a front line staff person such as a nurse who has good organizational and communication skills. They will work with the clinic manager and providers to set agendas and establish work plans.
- Convene the Steering Committee for regular meetings, usually every two weeks for the first few months
- Execute decisions of the Committee
- Oversee the logistics for implementation of the groups
- Oversee basic evaluation of the groups, collecting and collating patient evaluations
- Work with the CHI site consultant on challenges
Features of the group space should include:
- Easy access
- Comfortable size for group process
- Nearby restroom
- Limited furniture to not crowd space
- If shared use, easy to set up and take down
Other features to consider for a comfortable atmosphere:
- Art work (may come from your groups’ photos or activities)
CHI strongly encourages practices to complete a sample schedule for one year in advance to understand how the space, provider’s schedules, and patient flow will be affected.
CenteringPregnancy groups are referred by the month in which the women are due. The July group is for those women whose babies are due in July. Plan the July group to have its last session (Session 10) the end of June or first week in July so women are able to complete the series before they deliver.
CenteringPregnancy groups are every 4 weeks for 4 sessions, then every 2 weeks for 6 sessions. Groups can be scheduled more than one time per day. One time slot can be used twice, alternating weeks of the month to avoid overlap when groups meet every two weeks.
Sample CenteringPregnancy schedule: One new group per month in three time slots.