Newly arrived refugees and immigrants often face enormous challenges as they integrate into American society. Their hurdles can include past trauma, loss, language and culture barriers, isolation, poverty and disability. Significant adjustment is required to adapt to daily living and the health care system is unfamiliar and complex. As we care for a growing immigrant and refugee community, we are pushed to think creatively about how to meet their needs despite these barriers. This grant project will help us better serve refugee and immigrant families by taking an evidence-based care model and tailoring it to the unique linguistic and cultural needs and preferences of refugee and immigrant communities. Using a Centering model of care for prenatal care, postpartum care and early childhood development, we will combine health assessment, interactive learning and community building to support positive health behaviors, drive better health outcomes and effectively address social determinants of health.
We will implement CenteringPregnancy group prenatal care targeting Afghan and other immigrant communities in South King County, as well as all low-income female patients. The women in the group, all due around the same time, will meet for 10 prenatal visits, with each visit lasting 90 minutes to two hours. At each group, moms will take their own weight and blood pressure, receive individual time with the provider for the health assessment, and participate in facilitated group discussion and interactive activities on important and timely health topics and other topics of importance to the group, such as nutrition, common discomforts, stress management, labor and delivery, breastfeeding and infant care. The group will be a trusted place where these moms and their providers can relate with each other on a much deeper and more meaningful level by sharing their questions, fears, hopes, knowledge and experience of pregnancy, birth and family care in a linguistically and culturally appropriate environment. Relationships between group members can be formed which can build community, bringing women out of isolation and into a community that supports them through the birthing and parenting process.
We will implement CenteringParenting group postpartum and early childhood development care targeted to immigrant and refugee communities. The first group will be for Afghan women, so it follows a highly successful CenteringPregnancy pilot that Afghan refugee women have specifically requested be continued with CenteringParenting. This group will promote optimal postpartum care and early childhood development by bringing Afghan moms and their same-age infants together with their health care providers in a safe and supportive environment to ask questions and monitor their own health goals as well as the health and development of their baby. Topics discussed in the CenteringParenting group will include stress management, nutrition and weight, and family planning. Group activities, discussions, and parent materials will reinforce healthy choices for the entire family. Although we will start CenteringParenting with Afghan women, we intend to expand to other immigrant and refugee groups.
Additional care team members will be trained as Centering facilitators by January 2020. The CenteringPregnancy group will start by July 2019, facilitated by staff that have already been trained, and by March 2020 additional staff will be trained to facilitate the group visits. In-person, language-congruent professional interpretation services will be provided during both the CenteringPregnancy and CenteringParenting group visits. While additional staff will be trained in the Centering model, we have several staff already trained so will be ready to start the CenteringPregnancy and CenteringParenting groups upon notice of grant award.
The CenteringParenting component of our project builds on the success of a one-year CenteringPregnancy pilot project for Afghan refugees at our Midway clinic. Dr. Shoshana Aleinikoff, along with three other family physicians, led the project’s implementation and the results have exceeded their expectations. The pilot was exceptionally well-received by the Afghan community and resulted in improved birth outcomes and strong social cohesion among group participants.
Before starting the pilot, the need for building community was identified by our providers as well as other community organizations working closely with refugee women. Dr. Aleinikoff and other staff solicited community input through meetings with community-based organizations such as Refugees NW and the New Arrivals Working Group, talking with patients, and conducting focus group sessions. We learned that Afghan men may take issue with their exclusion from the group, and the Afghan women we want to reach could be at risk if their husbands suspected them of having secretive meetings. Community members recommended that before starting the group, we hold one session where we invite Afghan men and women together to explain why our CenteringPregnancy groups are for women only. Despite our anxiety about this conversation, the Afghan men were incredibly supportive. When we asked for questions or comments, the men responded, “No doctor in Afghanistan ever cared for our wives this way, thank you for thinking about what is best for them.”, and “Why is the group only two hours long? Can’t it be longer? Our wives need this!”. By having groups exclusively for women, without interpreting and filtering by husbands, we have learned of a handful of domestic violence and other mental health and physical health concerns that did not surface in standard visits.