Population & Public Health Program Summary Report -Final

Population & Public Health Program Summary Report -Final ____________________________________________________________ Date: June 30, 2011 Manager: Dar...
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Population & Public Health Program Summary Report -Final ____________________________________________________________ Date: June 30, 2011 Manager: Darlene Girard

MOH Lead: Lynne Warda

Strategic Priority Area (Check One) Communicable Disease Control X Healthy Parenting & Early Childhood Development

Immunization Tobacco Reduction

Mental Health Promotion

Physical Activity Promotion

Healthy Nutrition

Healthy Sexuality & Harm Reduction

Injury Prevention

Environmental Health

Surveillance

Tuberculosis

Program Goal(s): To support families to experience a healthy pregnancy and birth and to continue to support parents to provide the safest and healthiest environment in which their children will be raised.

Key Partners: Healthy Child Manitoba, Manitoba Health-Aboriginal and Northern Health Office, Assembly of Manitoba Chiefs, Women’s Health Program, Child Health program, Manitoba Centre for Health Policy, University of Manitoba Faculty of Nursing, Manitoba Child Care Association, Kivalliq Inuit Centre, Northern Medical Unit, Parent Child Coalitions

Epidemiology Data (Rates, Analysis, Trends etc.): The following table is duplicated from the 2009/2010 Community Health Assessment Report. The Early Childhood and Maternal Health Section of the report presents several indicators of both the determinants and outcomes of early childhood and maternal health in Winnipeg. The indicators provide part of a picture of the behaviors, physical and social environments, which are know to affect the health outcomes of newborns and their mothers. To full report can be accessed at http://www.wrha.mb.ca/research/cha2009/index.php. 2010 indicators for positive Families First Screens and enrollment in the Families First program are found in the indicator section related to Families First

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Winnipeg Regional Health Authority AT A GLANCE Current Rate

Previous Rate

Range of Current Estimages *** (low CA-high CA)

Teen Births* (Per 1000 females age 15-19 years)

24.0/1000 2001/02-2005/06

30.0/1000 1996/97-2000/01

6.7 – 79.8/1000

Pre-term Births* (Of live births born in under 37 weeks)

8.0% 1996/97-2000/01

7.6% 2001/02-2005/06

6.7 – 10.0%

Maternal Alcohol Use**

12.1% 2006

11.8% 2003

2.6 – 24.8%

Maternal Smoking**

20.5% 2006

20.8% 2003

6.6 – 42.8%

Maternal depression & anxiety disorders (Combined)**

15.8% 2006

13.4% 2003

12.2 – 19.5%

Newborns born to families with Financial Difficulties**

19.2% 2006

19.7% 2003

6.6 – 47.4%

18.4 2006

18.5 2003

4.1 – 45.0%

Positive Families First Screen**

24.8% 2006

23.4% 2003

11.6 – 53.9%

Enrollment in the Families First Program** (percentage of positive screens)

20.1% 2006

21.9% 2005

N/A

Newborns born to mothers with Less than Grade 12 Education**

*Rates for Teen births are age-adjusted to the Manitoba population and rates for Pre-terms births are adjusted according to the sex of the baby in the 1st time period of the rate/event calculation; all remaining rates are percentages of respondents from the Families First data. **These data are from the Families First Screening form. The Families First program provides a continuum of services including home visiting for selected families from the prenatal period through to school entry. Eligibility is determined through a screening and assessment process which collects data for key prenatal and family factors. ***CA=Community Areas Detailed definitions including data sources and ICD-9 CM diagnostic codes are available in Appendix A. N/A=data not available

The Early Development Instrument (EDI) 2008/2009 Provincial Report illustrates the “readiness for school” of Kindergarten children in Manitoba, based on results from the EDI. Readiness for school is a baseline of children’s readiness to begin grade one. As children’s readiness for school is influenced by their early years, and the family and community factors that shape children’s early childhood development, EDI results are a reflection of children’s early years and the strengths and needs of children’s communities. Community-level EDI reports are developed for the 26 parent child coalitions in Manitoba. These reports are grouped by where children live ie Rural RHA or Winnipeg CA. These reports can be viewed at www.healthychild/edi/edi_reports. We can look at the “Not Ready Results” ie the proportion of children whose scores fall within the bottom 10th percentile of EDI scores to look at domains of childhood development where we are losing ground. From a provincial perspective, in 2008/2009 29.1 percent of kids were not ready in more than one domain of childhood development (Winnipeg’s rate according to Terra Johnston, Provincial EDI Coordinator is 30%) and 14.6 percent were not ready in 2 or more domains of child development. From 2006 to 2009 there was no statistically significant change in these results however the percentage of children in Manitoba who are Not Ready in one or more or two or more domains is significantly higher than the Canadian baseline percentages. The 2009/2010 Community Health Assessment page 171: http://www.wrha.mb.ca/research/cha2009/files/Determinants.pdf also contains further EDI results.

General Program Monitoring Activities and Results: 2

Over the past year, what key program initiatives (or activities) were implemented and what were the results? Service Area Description: PHN Postpartum Home Visiting In partnership with the birthing hospitals, and midwifery practice groups, Public Health Nurses receive postpartum and infant referrals to provide a continuum of nursing services in the community following an infant’s birth. The PHNs’ services are described and guided by a set of standards and clinical practice guidelines which have been developed over the past 10 years. The services are both by telephone contact and in home services. Public Health Nurses provide a family focused service, beginning the day after hospital discharge which includes physical assessments for the postpartum woman and newborn infant; breastfeeding support; teaching and anticipatory guidance regarding perinatal mental health; child care & infant nutrition; family assessment and linkages to community resources including Families First services. Prenatal One to one support: families in transition to parenthood will have the information, tools and resources they need to improve pregnancy, birth healthy babies and prepare for early parenting (April 2011 draft for PHN Prenatal Services Service Delivery Standards and Clinical Practice Guidelines). Public Health Nurses respond to self-referrals from pregnant women and adolescents, through Healthy Baby Benefit applications, and from prenatal referrals from health care staff at St. B ACF and HSC Women’s OPD. Through telephone contact and home visiting, they assess and support families with nursing assessments, anticipatory guidance, teaching, counseling and referrals related to prenatal health and family health topics, including breastfeeding, smoking cessation, healthy nutrition, perinatal mental health and linkage with Families First Home Visitors as indicated. Home Phototherapy Partnership services between physicians, midwives, pediatricians, Children’s Hospital Emergency Department, Children’s Hospital Laboratory Services, and Public Health Nurses to provide a safe inhome phototherapy alternative to hospital care for eligible infants who require phototherapy for uncomplicated neonatal hyperbilirubinemia. Public Health Nurses provide in home services which include newborn assessment, phlebotomy, anticipatory guidance and teaching regarding infant care and nutrition often with a focus on breastfeeding support, and consultation and collaboration with the family’s pediatrician. Prenatal classes PHN led group education for prenatal information or childbirth education classes are held in every community area to match about 8% of the pregnant population. The classes usually consist of 10 to 12 pregnant women and their birthing partners, and usually are held once a week for six weeks prenatally with a postpartum gathering following the birth of the babies. The topics for prenatal classes include health promotion related topics such as breastfeeding, preparation for parenting, child care and nutrition as well as education for skill and knowledge development about childbirth. Families First The goal of the program is to systematically reach out to families with children prenatal to age five and to offer resources and support based on their strengths and individual circumstances. The focus of the program is on enhancing parents’ capacities to provide a safe, nurturing, caring and responsive environment for children to grow up in.

Healthy Parenting Early Childhood Development Database Working collaboratively with the Surveillance & Epidemiology Team, the current HPECD reports have

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been replicated and enhanced to the Jasper Server upon the recommendation by eHealth. The HPECD database was not efficient when running reports that contain large amounts of data. The HPECD also lacked the ability to save reports electronically, and did not capture all problematic records with missing or incorrect data which proved to be frustrating for the users. BridgeCare Refugee Clinic Beginning in October 2010, the BridgeCare clinic began to refer all families who are pregnant or have children under the age of 5 to the PHN in CA where the family permanently resides. The PHN’s role is to meet with the family to complete the Families First screen and Parent Survey and then to work with the family to ensure a healthy pregnancy, promote breastfeeding, promote positive early childhood development through positive parenting and support the family to make healthy lifestyle choices. Referrals as appropriate are made to supports and services in the community including Families First Home Visiting, Healthy Start for Mom and Me and Healthy Baby, Triple P, Early Learning and Child Care Centers, Harvest, and others Healthy Baby Community Support Programs Healthy Baby Community Support Programs are delivered in partnership with 30 community based organizations in the Winnipeg Health Region. Public Health Nurses and Community Nutritionists provide professional support during group sessions as well as provide individual follow-up as needed. The programs provide pregnant women and new parents with practical information and resources on maternal/child health issues, benefits of breastfeeding, healthy lifestyle options, parenting ideas, infant development and strategies to support the healthy physical, cognitive and emotional development of children. Maternal and Child Health Services (MACHS) Relocation Initiative In 2007, the Minister of Health established the Maternal and Child Healthcare Services Task Force, as a means of action to improve maternal and child healthcare services in Manitoba. The report to the minister from MACHS (September 2008) identified 25 short and longer term initiatives to improve care, access and outcomes in maternal and child healthcare services in Manitoba. The “Relocation Initiative” falls within the area of Addressing Service Gaps. A “gap in service” was identified for women who must relocate temporarily to larger centers to give birth or obtain specialized obstetrical care. These women are not receiving adequate services and support related to a healthy pregnancy once they reach urban locations. They often experience loneliness, boredom and isolation. The recommendation was that expectant women who relocate from First Nations, Inuit, Metis and rural remote communities have access to a coordinated system of prenatal and social support services. The goal is to ensure that women and their families who temporarily relocate to Winnipeg to give birth, will have the information, resources and support that they need to promote a healthy pregnancy, a positive birth experience and prepare for early parenting.

In August 2010, the WRHA MACHS Relocation Initiative Steering Committee was established to provide leadership and direction to the development of the action research and service delivery model. In September 2010, with available funding from MB Health, the WRHA hired 1.5 EFT PHNs, on a oneyear term basis, to work on the development and implementation of a service delivery model for expectant women and their families who must temporarily relocate to Winnipeg to give birth. One EFT PHN is working directly with MB Health on MACHS initiatives. The initial focus of the .5 EFT PHN was on working with the CNS to develop Prenatal Service Delivery Standards and Clinical Practice Guidelines.

Triple P Parenting Triple P is a universal parenting support strategy for parents with pre adolescent children. It encourages

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positive, caring relationships between parents and their children. With positive parenting, healthy children develop through strong, nurturing relationships, good communication and positive attention. In partnership with the provincial government Healthy Child Manitoba Office, Public Health Nurses and Families First home visitors are trained as “primary care” Triple P providers. Data is not presently collected on the frequency that the interventions and resources from Triple P are used. HCMO has a total of 150 of our staff that have been trained as “primary care” Triple P providers. This is also known as Level 3, which is intended to be a narrow focus parenting skills training for parents with specific concerns about their child’s behavior or development that require consultations or active skills training. It is intended that the staff will implement the interventions outlined by this training as appropriate with families they come in contact with through their general practice. One PHN and one home visitor have recently been trained in Group Triple P which is intended to be broad focus parenting skills training targeting parents of children with more severe behavior problems. This PHN and home visitor will be implementing the group approach in the River East area only at this time but other providers are trained to deliver the group session in various areas of the province.

Breastfeeding Evidenced based literature strongly links breastfeeding to health promotion and chronic disease prevention in infants and their mothers. Increasing initiation and duration of breastfeeding has been identified as a deliverable with Manitoba Health since 2005 with the goal of improving the health of our population as a whole, through this upstream health promotion and disease prevention strategy. Breastfeeding clinics and support groups are one area where PHN’s are available to parents who identify the need for consultation on specific issues they are experiencing with breastfeeding. They can also participate in the groups available, which the literature supports as increasing the duration of breastfeeding through the peer support networks. Support for breastfeeding is also provided through home visiting, prenatal class curriculum, and incorporated into healthy baby/healthy start group initiatives.

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Policy

Partnership

Results Program

Indicator

Practice

Goal/Standard

(Check One) PHN Post Partum Home Visiting Further integration of the Families First Screen and Parent Survey into the PHNs family assessment process during initial postpartum telephone contacts and postpartum home visits Healthy Beginning Standards-Contact 1 The PHN will contact the PP family the day after discharge for an initial PP assessment. At this time PHN will articulate the role of the PHN and offer a HV to occur within 7 days of discharge.

PHN Post Partum Home Visiting Striving for Excellence (SFE)workshops provided for all community area offices

PHN Post Partum Home Visiting PHNs and most of the TMs attended the workshops, with resulting plans identified to enhance integration of the screen and survey into the usual family assessment process to enhance access for Families First services. Impact of the SFE workshops will be reflected in the 2010 and 2011 HPECD data base reports.

1) # of families who received contact by PHN

1) 6891(88%) families received contact by the PHN

2) # of families who received contact the day after discharge

2) 6041(77%) were contacted by the PHN the day after discharge

3) # of days between discharge and initial PHN home visit

3) Day 0 – 25 (0.3%) families were visited Day 1 – 3933 (50%) Day 2 – 1195 (15.3%) Day 3 – 375 (4.8%) Day 4 – 207 (2.7%) Day 5 – 116 (1.5%) Day 6 – 63 (0.8%) Day 7 – 41 (0.5%) No Home Visit – 1554 (19.9%) (Complete reports available on request) 1. HPECD 2010 Key Indicators report 2. Families First Standards Report 3 3. Families First Standards Report 2

Prenatal PHN Prenatal Visiting The PHN accepts all prenatal referrals via central intake or selfreferral.

Prenatal

Prenatal

# of Prenatal Referrals received

1730 Prenatal Referrals received in 2010

The PHN initially contacts all prenatal families with a phone call and/or home visit within 2 weeks of receiving the referral. If the prenatal referral has

# of days between receipt of referral and first contact

Data not collected at this time





















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been identified as a priority contact, such as for a woman living in a medical boarding home, then contact will be within 2 regular working days of receiving the referral.

Review of PHN prenatal services using an equity lens for prioritization and scope

Home Phototherapy Ongoing service Prenatal classes Review of resources for PHN led prenatal classes in accordance with the Douglas College Lamaze Curriculum

Implementation of a consistent prenatal classes curriculum – Douglas College Lamaze Curriculum

1.Recommendatio ns of process for prenatal referral and response by PHNs, including revised prenatal referral form and prenatal pamphlet

1. Yet to begin

2. Description of PHN referral response and followup with prenatal clients

2. Preliminary description of PHN prenatal services under development through the use of the HEAT tool and consultation with PHNPC working group- work is on hold awaiting CNS availability

3.Development and piloting of Service Delivery Standards and Clinical Practice Guidelines for PHN Prenatal Services

3. Draft service delivery standards and clinical practice guidelines are being piloted by one PHN through the MACHS Relocation Initiative.

4. Development and implementation of PHN prenatal services caremap

4. Caremap development to be initiated following completion of the PHN Prenatal Service Delivery Standards and Clinical Practice Guidelines

# of referrals received

65 Home Phototherapy referrals received in 2010

Prenatal classes Each office has a full set of equipment, supplies and DVDs in accordance with the recommended resources

Prenatal classes This work has been on hold during 2010

Implementation workshops are attended by PHNs DC Lamaze curriculum is the only curriculum





























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throughout all PPH community area offices

Online Prenatal Education: A New Life was reviewed and posted onto WRHA Home Page under link for Public Health

Families First Program

Standard #1 – Families First Screens (FFS) will be completed for all births.

Standard #2 – Parent Surveys will be completed for all positive FF screens and all late entry referrals

Standard #3 – Families that score are offered FF Home Visiting Services as

used by WRHA PHNs Number of prenatal series delivered in 2010

40 prenatal series were delivered with 397 families served. Teams reported that due to H1N1 and the uncertainty regionally around teaching prenatal classes last spring, many classes were cancelled.

Number of ‘hits’ to the online course are counted.

No data at present

2010 Key Indicators WRHA (data not clean)



1) # of pp referrals

1) 7809 pp referrals to PH

2) # of live births

2) 7741 live births (FFS )are not filled out on stillbirths/miscarriages)

3) # of FFS completed

3) 6472 (83%) have a FFS completed

1) # of PP referrals who screen positive(includes score of > 3 risk factors and clinical positive)

1) 1662 (26%) pp referrals had FFS that scored positive showing > 3 risk factors or clinical positive

2) # of Parent Surveys completed

2) 1079 Parent Surveys completed (65% of positive screens).

1) # of Negative Parent Surveys completed (score < 25)

1) 361 (35%) of parent surveys scored negative (25).

2) # of Families

2) 329 families were enrolled in the



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close as possible to the Parent Survey, but no later than 2 days after completion of the Parent Survey Process

HPECD Database Program Reporting

1) To establish HPECD database documentation

enrolled in the program

program

3) # of Families declined the program

3) 161 declined the program

HPECD Database Program Reporting

HPECD Database Program Reporting

1) Created data dictionary and user manual for HPECD data elements and identified the mandatory data elements.

1) Documentation information will be valuable in the implementation of Momentum application

At this time we cannot track the timeliness of offering the program within 2 days of completing the Parent Survey.



Ensured that mandatory data element reports were captured in the quality check reports

2) To establish routine reports for HPECD and CA Team Managers

3) To establish routine report submission to Healthy Child Manitoba (HCM)

2) Creation of key indicators report by Community Area and calendar year for 20062010

2) With key indicators report available, the Team Manager was able to share results to the CA which provided PHN context regarding program activity and the importance of submitting their monthly summary forms accurately.

Approval for the creation of the electronic prenatal log on Excel. Report by CA, calendar year for 2008 to present is available.

With the prenatal log now being entered electronically, we have created a basic report by CA and fiscal year for 20082010.

3) Creation of a spreadsheet to compile FFHV monthly statistics by identifying CA, month, early and late entry families.

3)

With the FFHV monthly statistics available by early entry/late entry, we are able to submit this information to Healthy Child Manitoba.







Submission of quarterly activity reports to HCM for 2008, 2009,

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2010, with the intent to re-submit the data once it has been cleaned.

BridgeCare Refugee Clinic With client consent, referral of all families who are pregnant or have children less than 5 years of age to Public Health PHNs contact all clients referred within two weeks Healthy Baby Program PHNs and CNs provide professional support at weekly or biweekly community based Healthy Baby Sites

# of referrals received

1 referral received in 2010

# of referrals that resulted in contact by the PHN

No data available

# of Healthy Baby sites in Winnipeg region in 2010

31 sites

# of sessions PHNs participated in 2010

On average 92 sessions per month( MIS Stats)

# of group sessions CNs participated in

MACHS Relocation Initiative









On average 46 sessions per month( MIS stats)

# of individual PHN home visits related to Healthy Baby sessions

On average 23 per month.

2010 Achievements

WRHA Relocation Initiative Steering committee established August 2010.









PHN Prenatal Service job descriptions developed and 2 PHNs hired in September 2010 Provincial MACHS Relocation Initiative Working Group established in October 2010.

Breastfeeding Meeting the criteria identified by the “The Baby Friendly Initiative” (BFI) which provides a proven framework from Unicef/WHO that supports and promotes improved outcomes in breast feeding, thereby contributing to

Breastfeeding Fulfilling the requirements the 10 steps identified in the document from the Breastfeeding Committee of Canada, “The Integrated 10 Steps Practice Outcome

Breastfeeding Presently all PHN’s receive 2 days of breastfeeding orientation on entry to practice in the general program which meets the BFI criteria for direct service providers. A course is offered yearly through the WRHA PH program to provide advance breastfeeding education to nurses working in the WRHA. Posters to alert the public and other health care providers to services available in the breastfeeding clinics and support groups

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increasing overall population health.

Triple P Triple P is utilized as an effective enhancement to present parenting services delivered by the PPH program.

Indicators for Hospitals and Community health Services “

have been produced and are presently being distributed. A process is in place to identify and develop a strategy towards achieving other criteria outlined in the BFI Integrated 10 Step document which will include enhancing data collection to monitor progress towards achieving the goals.

Triple P 1) # of families receiving Triple P interventions through PHN’s and FF HVtr

Triple P Data not compiled and analyzed at this time.

Over the past year, what equities considerations have been implemented? Prenatal -Utilization of the HEAT tool in description and prioritization of potential PHN services with prenatal clients. -WRHA participation in the MACHS Relocation Initiative

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Over the past year, what evaluation & research projects has the program been involved in? Prenatal MACHS Relocation Initiative Action Research Proposal Development In collaboration with Maureen Heaman et al, the development of the CIHR PHSI proposal, "Reducing inequities in access to and use of prenatal care in the Winnipeg Health Region through health system improvement"

Families First Striving for Excellence: The FFPC has been working in small groups in order to resolve issues that are submitted through PH staff. The Striving for Excellence (SFE) working group stemmed out of an issue paper where staff were concerned with low enrollment into the FF program. The HPECD monthly summary and guidelines for completion of the monthly summary were revised to include a comments column for PHNs to provide more details as to why families were unreceptive or refused to participate in the Parent Survey process or enroll in the program. The time frame that PHNs are to complete the FF screen, parent survey, and enroll the family on the program was decreased to 7 days from hospital discharge and reflected in FF standards #1 and 2 within the Winnipeg region. The “SFE road show” was held in 6 community area pairings during the period of May until September. The content of the workshop included sharing the FF program evaluation results (2010), a brainstorming session as to “What is a strong community (what do you want for families/children in your community)”, a review of the vision, goals and guiding principles for the FF program, introduction and rationale for the new standards, and a review of the revised HPECD monthly summary. Towards Flourishing: Improving the Mental Health among New Mothers in the Families First Home Visiting Program: The Towards Flourishing Project is a joint research effort between the Winnipeg Regional health Authority, the University of Manitoba and Healthy Child Manitoba, funded by the Public Health Agency of Canada. The overarching goal of this project is to improve mental health among women in the Manitoba Families First Home Visiting Program. The goal of the first phase of the project was to develop a comprehensive health strategy to improve the mental health of women in the program. CADs, PHNS and FF home visitors from River Heights, St. Boniface, and Pt. Douglas community areas participated in Phase 1 of the project which focused around mental health literacy training and training in mental health promotion. (Refer to Mental Health Promotion Summary for more information). The Families First Program Evaluation was released in June 2010. Strong positive improvements were experienced by families as a result of participating in the program. Improvements included: Increased positive parenting (ES: 0.80); decreased hostile parenting ( ES: -0.53); improved psychological well-being includes improved purpose in life ( ES: 0.49), Improved environmental mastery (ES: 0.76), improved self acceptance (ES: 0.79); increased social support (ES: 0.65) and increased neighborhood cohesion (ES: 0.42). The evaluation report recommended a focus on engagement and retention in the program as well as a focus on quality improvements. The full report is available at http://www.gov.mb.ca/healthychild/familiesfirst/ff_eval2010.pdf TM HPECD was actively involved in editting of the report. Healthy Baby The Healthy Baby program evaluation was released in November 2010. Participation in the Healthy Baby Community Support Programs appears to be associated with 4.0 to 5.7 % increase in adequate prenatal care and 10 to 21% increase in breastfeeding initiation. Receipt of the prenatal benefit was associated with 1.4 – 9.0% reduction in low birth weights; 0.4% to 6.0% reduction in preterm births and 10 to 21% increase in breastfeeding initiation. Key recommendations included ensuring that all low income women receive the income supplement given that 25% of women receiving income assistance during pregnancy did not receive the prenatal benefit. The report also recommended a focus on improving participation in the community support programs as only 22% of women on income assistance, 18% of women in low income areas and 21% of teen mother participated in the community support programs during the study period. The full report is available at http://mchp-appserv.cpe.umanitoba.ca/reference/Healthy_Baby.pdf. The TM HPECD participated on the Manitoba Centre for Health Policies Advisory Committee related to the report. TM HPECD participated in Advisory committee. EDI

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The TM HPECD and a Clinical Nurse Specialist participated on the MCHP Advisory Committee for the “Early Development Instrument (EDI) in Manitoba: Linking Socioeconomic and biological vulnerability at Birth to children’s Outcomes at Age 5”. The report is due the fall of 2011.

Breastfeeding The clinics have been a point of access for a study at the University of Manitoba to develop a diagnostic tool related to breast feeding and yeast. Another study is presently proposed by the university through the breastfeeding clinics to assess the optimum introduction of iron into an infant’s diet and the proposal is presently being processed through WRHA ethics review.

What key initiatives (or activities) are being planned for next year? Partners

Policy

Program

Potential Risk, Benefits or Opportunities

Practice

Initiative or Activity Being Planned

(Check One) PHN Post Partum Home Visiting Review and updating of the 2001 Healthy Beginnings Postpartum Manual, and the associated HPECD service delivery standards and clinical practice guidelines

PHN Post Partum Home Visiting

Prenatal Completion and implementation throughout PPH Community Areas of the PHN Prenatal Service Delivery Standards and Clinical Practice Guidelines





Development, completion, and implementation of new prenatal referral form and associated process Development, completion and implementation of new PHN prenatal caremap Building on Maureen Heaman’s research around improving access to prenatal care, explore alternate approaches to improving access for vulnerable families through midwifery and the Healthy Baby program and Street connections.



Risk if not done, is that PHN practice is being directed and guided by service delivery standards and clinical practice guidelines which may no longer be congruent with current evidence and best practice.

Currently significant amounts of PHN time is being spent on documentation of prenatal visits.







Home Phototherapy

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Development of evidence – informed standards and clinical practice guidelines for PHNs’ screening assessment of newborn hyperbilirubinemia



Risk if not done, is that PHN practice is being guided by clinical practice guidelines which are not congruent with current evidence nor best practice.



Review and revise Home Phototherapy document (Management of Hyperbilirubinemia in the combined hospital-community home phototherapy program) to clarify statements as service delivery standards, clinical practice guidelines, and operational guidelines.



Prenatal classes Reactivation of the above Douglas College related initiatives.



Implementation of Centralized Prenatal Class Referral System

For Winnipeg residents this will improve access to information about variety of prenatal classes offered within the Winnipeg region and will simplify process for registration in WRHA classes.

Implementation of Online Prenatal Education option

Will provide pregnant families with an alternative source of prenatal education.





Families First “SFE road show” to continue to share with staff community area key indicators.



The FFPC small working group on staff training related to the FF program has identified the educational needs/topics for Team Managers, Lead Role PHNs, Case Manager PHNs, and FF Home visitors. A plan is being discussed as to the best way to implement this training.



Implementation of tier 2 and 3 curriculum training for all home visitors and lead roles.



Staff from the 3 pilot sites will be participating in phase 2 of the Towards Flourishing project beginning June 2011.



A small working group at the FFPC is currently working on evaluation questions for a FFPC evaluation. This information will be shared at the September meeting.



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Healthy Parenting Early Childhood Development Database 1) Currently working on enhancing the HPECD Monthly Summary Form to incorporate Late Entry Monthly Summaries.



2) Finances have been secured and work will proceed with the development of the new HPECD database through Momentum. An advisory group has been established.



3) Waiting for the approval from the privacy officer re: addition of data elements to the prenatal referral log to capture information related to the MACHS initiative. Strategic Plan for HPECD Program Continue to engage in a process to develop/update the strategic plan for HPECD



A strategic plan will enable us to optimize use of existing resources to improve outcomes for children and families.



MACHS Relocation Initiative Continue to develop the Action Research Proposal to guide the development and implementation of the service delivery model.





Begin to implement prenatal services to women who temporarily relocate to Winnipeg to give birth.



As part of the Provincial MACHS Relocation Initiative Referral Process working group, develop a universal prenatal referral process for women who temporarily relocate to give birth. Continue to identify resource needs related to service delivery



Develop an evaluation framework for the project and begin to implement



Breastfeeding Establish a regional multidisciplinary steering committee with representation

Breastfeeding If we do not intervene to improve breastfeeding, rates may continue to decline below the national average at 6 months of age. This has the potential risk of



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from the stakeholders along with a champion from each community area quadrant to provide a framework, direction and support for the implementation of the BFI at the regional and community level. 1. Establish in each community area a communication strategy to provide consistent information sharing, including relevant community health partners and agencies. 2. Propose levels of education within six months of commencing employment/service 3. Systematically collect data on breastfeeding duration (has been included in data base currently under development).

increasing maternal and infant morbidity and mortality, negatively affecting population health. We have an opportunity to improve those rates and outcomes through following through on the strategies identified.

Healthy Baby Program











In partnership with Healthy Child Manitoba, will share the results of the Healthy Baby Program Evaluation to CA PH teams as well as review standards and guidelines related to program delivery.

What are some of the promising and/or best practices that the program should consider implementing or piloting in the future? PHN Post Partum Home Visiting -Consider alternatives to traditional methods of delivering postpartum services incorporating an equity lens. -Explore inter-professional approaches to working with socio-economically disadvantaged postpartum families to foster health equity. -Consider participation in evaluation and research activities such as: Replicating the Canadian study regarding the effect of delayed newborn weighing on breastfeeding outcomes; replicate or expand upon the 2006 Canadian study about predictors of acceptance of postpartum public health home visits including perceived and measured benefits of this service.

Prenatal -Participation in outcome evaluation project related to the PHNs Prenatal Services Service Delivery Standards and Clinical Practice Guidelines -Advocacy for better access to midwifery services in Manitoba -Centering Pregnancy model of prenatal service delivery

Prenatal classes Partnering with Ontario’s Best Start prenatal classes evaluation initiatives to contribute to the evidence regarding effectiveness and impact of prenatal classes.

Triple P -Support PHNs and Home Visitors to effectively incorporate Primary Care Triple P in to practice

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-Exploring the benefits and resource implications of training more PHNs to deliver Triple P at a group level rather than the primary care model. Group Triple P is intended to be broad focus parenting skills training targeting parents of children with more severe behavior problems it has the potential to allow equities considerations.

General Comments This report was compiled in collaboration with the CNSs, PH Coordinator, and the Epidemiology and Surveillance team. Collectively, completion of this report collectively took more than 10 hours. Thank you everyone for your thoughtful contributions.

Who should receive a copy of this report? • • • • •

PPH Leadership team PPHOT PPHMT PPH/MOH Directors group Dr. Catherine Cook

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