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For kids and parents, pilot program at St. Luke's offers strength in numbers

Katie Pehling, a registered nurse, supervises as Julee Connely (left) and Shaphan Connely take the temperature of their son Ethan, 2, while participating in family group visits at the St. Luke's pediatric clinic Wednesday afternoon in Duluth. (Clint Austin / / 2
Mary Ann Marchel holds a book for Jerry and Carrie Thompson of Superior as they read with their 2-year-old daughter, Taryn, while participating in a family group visit at the St. Luke's pediatric clinic Wednesday afternoon in Duluth. (Clint Austin / / 2

Crying babies, stressed parents, kids screaming at the sight of a needle -- those are some of the images that spring to mind when one thinks of taking a child to the pediatrician.

This is not that sort of visit.

The sounds of happily playful toddlers and chatty adults mix together in the reception area of St. Luke's Pediatrics Associates in the hospital's Campus Building A on a recent afternoon. Eight adults and three 2-year-olds are seated in a circle on the floor.

Stacy Seminara holds her first child, Jackson, as Dr. Heather Winesett examines the child's foot. Taryn Thompson looks at a picture book that mental health professional Mary Ann Marchel has brought as mom and dad -- Jerry and Carrie Thompson -- look on. Shaphan Connely holds first child Ethan while mom Julee Connely takes his temperature with registered nurse Katie Pehling standing nearby.

This was an unofficial visit, a reunion of sorts, for three couples -- Seminara's husband, Robert Irrgang, was unable to attend this session -- who were strangers until they met for their children's four-month checkups.

They comprise the first group in a pilot project spearheaded by Winesett, Marchel and Pehling. Instead of individual visits to Winesett, all three families come at the same time, discussing issues together as their infants, and later toddlers, have time to play and bond. At the end, each couple and child gets an individual exam.

"In the traditional model, they'd probably spend, on a good day, 15 minutes with me total to do everything," Winesett said.

"I think, in this model, they spend about an hour and 30 minutes to two hours long, and maybe only 5 or 10 of it is with me individually."

They meet after normal clinic hours, so there's plenty of space to spread out, and so working parents can fit the visits into their schedules.

'A lot more fun'

The pilot program officially ended with the visit at age 2. But the parents say they want to have a group visit when the children turn 3 -- if not before.

"That seems too long (to wait)," Seminara said.

"Maybe we could get together informally," Julee Connely said.

"We could have a flash mob at the doctor's office," Carrie Thompson added, as the others laughed.

Unlike the other two couples, the Thompsons have been through this before. Their older children are 12 and 8. But in the group, they were reminded of things they had forgotten, Jerry Thompson said.

And it was a different experience, Carrie Thompson said.

"It was a lot more fun," she said.

"I feel like we had more time to talk about the things that were important," Carrie Thompson added. "It was really reassuring to find out that other people were having the exact same issues at the exact same time."

The group model has been tried before in other places. It was first studied in the early 1980s, according to a March 2010 article in the journal Family Medicine, then went dormant for several years. But traditional well-child visits aren't entirely satisfactory, the article said, citing studies revealing that 94 percent of parents report one or more unmet needs in those visits.

The Family Medicine article told about a study of well-child visits at the University of North Carolina's Family Medicine Center beginning in 2006 with largely positive results.

Creating 'a safe space'

The St. Luke's project is similar to the North Carolina model. After traditional visits at 2 weeks and 2 months, the group forms at 4 months and continues through visits at 6, 9, 12, 15, 18 and 24 months.

A major difference is the addition of Marchel, an associate professor in early childhood studies in the University of Minnesota Duluth's Department of Education.

The idea is to address not just the child's physical development but also the early relationship between parent and child, and to let parents know that they are not alone, Marchel said.

"It can be a very isolating experience that evokes a lot of emotion," she said. "So I think the power of a situation like this is that it creates a safe space for parents to be held so that they can hold their children."

The hope, Marchel and Winesett say, is eventually to apply the group well-child model to at-risk parents. Winesett has had preliminary meetings with groups such as the Lincoln Park Children and Families Collaborative to try to figure out how that might work, she said.

Play time at the doctor's

But the pilot groups at St. Luke's -- a second is underway, and plans are in the works for a third --largely were focused on addressing logistical issues, Winesett said. Should the individual exams be at the beginning or the end of visits? How would Marchel and Pehling fit in? Would people be satisfied with the care they were getting? Would they get all of their questions answered?

The answer to the last question was 'yes,' Shaphan Connely said.

"Being able to ask any question you possibly can think of, and then have five, six answers, and they're all exactly what you needed --I thought that was great," he said.

And there was another advantage.

"Typically, when 15-month-olds and 18-month-olds come to see me, there is not a lot of happiness and laughter," Winesett said.

But by that age, the toddlers in the group were seeing the visit to the doctor's office as play time, she said.

It remained the same as they grew older, Julee Connely said.

"He's not at all scared about coming to the doctor's office," she said of Ethan. "Today, I'm like, 'Oh, we're going to go to the doctor's office and see the other kids.' And he was like, 'Kids! Kids!' He was so excited."