Centering: better care thanks to power of the group

What is CenteringCare?

CenteringCare is a care model based on three pillars: medical care, interactive learning, and peer support. Clients receive guidance in a fixed group instead of individual consultations. In CenteringPregnancy, for example, this is a group of pregnant women under the care of a midwife. And in CenteringParenthood, for example, it is a group of young parents with a baby within youth health care.

The format of the meetings

The meetings will cover basic medical care, standard check-ups, and vaccinations. But they are also encourage learning from each other's knowledge and experiences, such as certain complaints, sleep problems, nutrition, or the situation at home. The group has been set up to promote social contact. As a care provider, you support the same group over a longer period of time. For proper preparation and implementation of group care, support is available through the CenteringCare Foundation, such as training courses, supervision meetings, and implementation materials.

Why is Centering an important model of care?

Several studies have shown that Centering improves health outcomes, reduces pressure on the health care system, and increases satisfaction among clients and care providers.

Improved care outcomes and reduced pressure on the health care sector

• Studies show that group care leads to pregnant women and young parents feeling more supported and exhibiting healthier behaviour, such as breastfeeding, drinking less alcohol, and quitting smoking.
• Pregnant women receiving group care are less likely to develop high blood pressure. Fewer interventions are also needed, such as pain relief or augmentation of labour.
• Young parents are less likely to be admitted to the emergency unit with their child.
• This will ease pressure on health care and reduce costs.

Benefits for the client

• Clients are better prepared for what is to come, such as childbirth and parenthood.
• Hearing about others’ experiences normalises the challenges they face themselves.
• The trusted group provides a safety net of people nearby to fall back on. This is especially valuable for people who are new to a neighborhood or who have a small social network.
• Through mutual contacts and affirmation, the support they receive from the group, and the insights gained from group discussions, they develop greater self-confidence.

Benefits for the health care provider

• Much more is discussed in the group in a more accessible way than is possible in a one-to-one consultation.
• Difficult topics, such as domestic violence, come up for discussion by everyone because the group, rather than the individual, is addressed.
• The care provider learns more about the concerns clients have and the solutions they come up with themselves.
• Increased job satisfaction.

Emerging from practice

Sharon Schindler Rising, an American midwife, founded CenteringCare in 1995. Her one-to-one consultations kept overrunning because there was a lot to discuss. Moreover, she found herself having to give many different pregnant people the same information over and over again. She moved her consultation to her packed waiting room and discovered how valuable the dynamics and experiences within a group are. Rising published about group care, after which the Centering Healthcare Institute in the US further developed the model.

In the Netherlands, it was also a (former) midwife who introduced CenteringCare: Marlies Rijnders, researcher at TNO Child Health. Since 2012, TNO has been working with the Centering Netherlands Foundation to implement and further develop the care model in practice.

CenteringZorg successfully expands

Now CenteringPregnancy and CenteringParenthood have been included in RIVM's 'recognised interventions' database. An important next step is further expansion into other branches of medicine. Group care is of great value when lifestyle plays an important role. And when frequent medical examinations are required, such as periodic check-ups for chronic illnesses. A Centering pilot for people with diabetes type 2 in Meppel led, among other things, to an improved lifestyle, greater control over disease progression, and better treatment adherence. A study on CenteringCare within oncology is ongoing in Belgium.

Different care model, different approach

The biggest challenge with CenteringZorg is that it is a systemic change: truly client-centred with an enabling role for care providers and a different organisational set-up. For example, health care practices need space for group meetings, as well as a corner for individual check-ups. As CenteringPregnancy is an accepted component of antenatal care, with a standard care fee, midwives need to know how to provide this form of care. TNO and CenteringZorg Nederland are therefore working with several midwifery schools to incorporate CenteringZorg.