Clinician Beliefs and Experiences Surrounding Delivery of Centeringparenting Group Well-child Care

Background: Group well-child care (GWCC) is an innovative model for pediatric primary care in the early years of life. Benefits of GWCC are increasingly well-documented and far-reaching, ranging from increased time spent on anticipatory guidance and improved timeliness of immunizations to enhanced social support structures for parents. CenteringParenting is a GWCC model that provides a curriculum to educate parents on healthy child development, effective parenting, and self-care through nine group sessions from birth to 24 months. Prior studies have demonstrated that parents participating in CenteringParenting believe the model is desirable and feasible, specifically for a minority, low-income population. However, limited research exists focused on provider experiences with and perceptions of CenteringParenting. This study aims to qualitatively assess provider beliefs and experiences surrounding delivery of CenteringParenting curriculum, the trauma-informed nature of both GWCC and CenteringParenting, and perceived barriers to successful implementation.

Methods: Semi-structured phone interviews were conducted with CenteringParenting providers at federally qualified health centers (FQHCs), non-profit health centers and hospital-based practices across the U.S. Participants were identified via voluntary-response sampling. Interviews were recorded, transcribed, and uploaded to Dedoose for analysis. Three investigators coded the transcripts using an inductive thematic approach. Through an iterative process of coding, thematic development and review, consensus was reached across a majority of coders for all themes.

Results: Analysis yielded four emergent thematic categories: the trauma-informed nature of GWCC and CenteringParenting; adaptability of CenteringParenting curriculum; challenges related to delivery of GWCC and CenteringParenting; and the need for systems-level buy-in to achieve successful CenteringParenting implementation. Providers felt that aspects of both the group care model itself and the CenteringParenting Curriculum uniquely encouraged positive parenting, psychological safety and social support, which providers perceived as trauma-informed in nature. They valued the ability to adapt the CenteringParenting curriculum and visit structures, and often felt the need to do so in order to make the curriculum more accessible and culturally relevant. Although providers identified concerns about their ability to combat misinformation or discuss highly personal topics in the group setting, they ultimately found that these issues were not as prevalent as they had anticipated. Finally, providers unanimously described the need for systems-level support for successful CenteringParenting implementation, including the need for dedicated personnel, funding, and space.

Conclusion: The GWCC model and CenteringParenting curriculum offer the opportunity to deliver care that providers perceive to be trauma-informed and malleable enough to meet the unique needs of their patients. Experiences of providers in this sample surrounding the psychosocial components of CenteringParenting complement existing literature on positive experiences and outcomes in parent-child dyad GWCC participants. Future studies may explore ways in which this novel method of healthcare delivery can further embrace a trauma-informed framework and address identified barriers to implementation so that the model can successfully serve more families.