A New Model for Well-Child Check Ups

As the medical system in this country changes, some leading providers are experimenting with unique and innovative approaches to patient care. Among them, is UNC's family practice that is offering both prenatal care and well-child care in a group setting and in a private setting.

"We call it CenteringParenting, and it is a natural extension of our CenteringPregnancy groups (prenatal care groups), but other moms have joined the groups when their newborn was of similar age," says Kathy Trotter, Certified Nurse Midwife, Family Nurse Practitioner and Assistant Professor of UNC's Department of Medicine. "Parent satisfaction in these groups is quite high," continues Kathy. Instead of the traditional well-child check-up where moms have only ten to fifteen minutes to ask questions, women who participate in this group have over an hour with their provider. They sit and share experiences and questions regarding their child. "They are able to see and hear other parents concerns, which helps them know others are going through similar situations, and they learn from each other," she adds. Trotter reports that moms often feel empowered by the experience. They get reassurance from the group that they are doing a good job, and they can share a piece of information or advice with others.

The groups aren't question and answer, or classroom style. Rather, the group is facilitated by a medical professional. "The way the group is facilitated is a very important concept in this model. Parents know the right answer many times, or can help each other, so the medical professional is really leading that process of sharing, making sure the correct information is revealed as part of it," says Trotter.

The basics of the well child visit are present as well. But again, the care is part of the group experience. Parents are taught how to check their baby's weight, head circumference and length, which they do at the beginning of every visit. The facilitator provides an agenda for the meeting, but parents can write in any issue for inclusion. After forty minutes in the group setting, the parents and children take a snack break. During this time the parents talk, while the provider visits each individual child for a private exam. Immunizations are given at the end of the session and the next appointment is set up per the traditional visit schedule.

"Most of our groups have four to five babies. But I can have as many as eight in a group. I have five different groups at present, the oldest of which are eighteen months and the youngest of which are just three months," says Trotter.

"In today's medical system, providers can't charge for the educational portion of a visit. This is a great, cost effective model for us. We have motivated parents who keep their appointments and make sure their kids are immunized. Parents are not in the ER for unnecessary visits because they learn a lot about fever, signs of illness, and more during the prevention and education parts of our sessions. What's more, we get to know the families better and the parents even meet up outside of the session. It's challenging to think out of the box when it comes to healthcare, but it's fun and stimulating too," says Trotter.