Barely controlled chaos: Getting through a Session One

Centering session 1s remind me of being a ballerina. You know how they look so light and ethereal and like they’re floating on air? But the reality is, ballerinas are tough as nails and strong as bulls. They can dance on bleeding feet and cramping muscles through physical exertion that would impress an Olympic triathlete, yet they make it look soooooo easy.



That’s what it feels like to do a Centering Session 1. Facilitators are nervous and worried about how the group will go. They have to get through a pile of three-minute physical assessments of patients they may never have met before, which often (because of gestational age) involve genetic testing and blood draws at the same visit. They have to make patients feel at home in a strange new environment, orient them to an unusual new way of healthcare, and cover the gigantically important-yet-complex topic of nutrition in pregnancy. Yet they have to make the patients think that this is all soooo comfortable and easy that they will just love it here and they should come back to the next session.



Here are some things that I hope may help:



1. I highly, highly recommend flipping the order of the first session. Do introductions first, and then do the check-in and physical assessment. If you do the check-in and physical assessment first, then for that first ½ hour the patients are awkwardly sitting in a circle with people they don’t know in a situation they’re not used to. In my experience, the co-facilitator is too busy with check-in stuff to do an adequate job of “hostessing” and making sure small talk continues throughout that time.



What are you talking about, “flipping the session”?



I didn’t make this up, by the way, I learned it from Peggy Dublin, a wonderful CHI consultant. She recommends starting with the circle-up and doing introductions and a brief orientation to Centering first. Then talk to them about how sessions usually go, and show them how to check-in and do their self-assessment. Then, tell them we’re going to take a break for everyone to do their self-assessment and see the provider (and, I usually explain that this part takes a little bit longer at this session than it will in the future, because the patients are getting used to the process and we’re learning about the patients too, and I thank them for their patience in advance). Then, while we’re doing that, the patients have an easier time chatting with each other because they have at least been introduced.



2. What is in the Centering orientation? The Centering Facilitators’ Guide covers these, but here are the highlights:

• Thank the patients for being brave enough to try a new way to get their prenatal care! Acknowledge that it takes some courage to try something new and unknown, so you appreciate you being here.
  
• Emphasize that this is their prenatal care – no other visits unless they have an unanticipated need in between sessions. They’re going to get everything here that you would have gotten in those individual visits in an exam room – labs, checkups, tests, etc.
  
• Review schedule of sessions, and how it follows the same prenatal care schedule that individual care does.
   
• What happens at the mat – how the provider handles questions there:  She may just answer them if they are quick and unique to that person; She may ask to see them in an exam room after the group if they require privacy or a physical exam; But 99% of the time she’ll ask if it’s OK if we discuss that in the group. Emphasize here that even though we’re discussing the question in the group, the patient should let us know if their question wasn’t adequately answered or if they think their concern wasn’t addressed well enough. We don’t want anyone leaving here without all their concerns addressed.  

After the break, when you do all the check-in and physical assessments, I like to spend as much time as possible on questions and concerns from the group. My hope is that this will show the patients that we respect and care about those questions and will take our time to help them with them.



But, you also have to make sure you make time for the guidelines and try not to sound like a teacher while you discuss them.



After all that, is there time for nutrition and goals? If you’re lucky, but in my experience, often not. If you do, here are some ideas for goals:

• The facilitators’ guide covers using the Self Assessment Sheets for goals & “What’s Most Important” in the Moms’ Notebook. 
• Our founder, Sharon Schindler Rising, swears by the “cups and beads” activity. This one is also described in the facilitators’ guide. Although, now they tend to be pompoms or buttons or whatever they’re including in the Leaders’ Kits now.  
  

And then there’s nutrition. I have a really hard time with nutrition, because my focus in a first session is to make Centering seem comfortable and appealing so that the patients will feel good and want to come back. But, the nutrition practices of our patients are often so bad that it’s hard to find ways to be positive, and the last thing I want to do is berate them for making bad food choices. So, it can be discouraging. But, here are some ideas -

• The Mom’s Notebook has the food diary and serving sizes pages, that you could review with the group. I tend not to focus a lot on the notebook, however, because I don’t want it to seem like a class with a textbook kind of thing.  
  

• The facilitators’ guide has some ideas that I’ve never used (“Build a Healthy Meal” and “Food Choices”) that could be fun.
• Margie from CHI suggested one once - she draws a continuum on a flip chart and asks people for examples of the healthiest person they know (people usually suggest Michelle Obama, a famous athlete, etc), and then draws a door at the opposite end that is “Death’s Door.” She then asks for examples of behaviors/actions that move them along the continuum towards one end or the other. 
• Once at a workshop, a pair of folks made up an activity that I really like. They had everyone name something that they like to eat that’s healthy, and something that they like to eat that’s not healthy. They wrote them up on the board as people named them. Then they discussed how we could make the foods that are in the “unhealthy” column healthier. This generated a really nice, positive conversation.
• Our favorite activity that we do in the Greenville clinic is to hand out paper plates and markers during break time and have patients draw (NOT WRITE) what they had for dinner last night on them. Then we go around and discuss each meal – what was healthy about it and what could have made that meal even healthier. Although it feels a little like kindergarten when you’re doing arts-and-crafts, it generally produces a really fun conversation and you find out who are the closet artists in the group. 

GOOD LUCK!