Canadian Public Health Association Halifax, June 3, 2008 Enhancement of Prenatal Programming for First Nations: Two Approaches to the Roll-Out of the Maternal Child Health Program

Maternal Child Health Program (MCH) 2005 Federal budget new health investments to improve the health of Aboriginal People Maternal Child allocated $110M over 5 years (Up Stream investment) – Goal is to support pregnant First Nations Women and families with infants and young children to reach fullest developmental and lifetime potential

MCH Program Description cont: Provide Home Visits by nurses and lay family visitors during pregnancy, postpartum and early childhood Links children and families with special needs to services Enhances Health Promotion programming Returns safe birthing closer to the communities/enhancement of traditional beliefs and practices

Two Regions, Two Different Approaches Atlantic Region: population 27K over four provinces – Family Health Team made up of AHSOR, FASD, CPNP, Injury prevention and MCH – Co management Structure Mi’kmaq and Maliseet Atlantic Health Board (MMAHB) Child and Youth Health Advisory Committee

Presentations to and support from both All Chiefs and MMAHB Mandated to have a minimum of one project per province Full participation of MMAHB Child and Youth Health Advisory Committee Agreement of the C&Y committee to support the following: – Max 150K per project – Min one project per province – To cluster wherever possible – Funds to support planning Atlantic Region Process

Proposal handbook based on baseline data requirements and goals of the program Need a combined population of 400 as minimum for project Facilitated workshop to review proposal handbook 6 projects approved: 2 stand alone and 4 cluster All received funds to support development of project workplan Atlantic Region Roll-out

All projects have coordinators in place Each cluster has coordinator plus HV in each site All participants have been offered Growing Great Kids HV training as the platform for programming (used in NS) Several sites have integrated their program with FASD/CPNP programming to provide seamless services Project implementation Atlantic

Ensure staff are trained Full implementation of home visiting program Develop and or enhance linkages with the provinces Look at projects for communities without MCH program Provide training to any communities that are interested Annual networking sessions Looking Forward Atlantic

Population on-reserve 65K in 204 communities Community population range 30-2, remote-isolated /isolated 78 semi-isolated 81 non-isolated ECD Program unit comprises MCH,FASD and AHSOR Guided by Tripartite Health MOU-FNIH/Province/FN leadership Council BC Region Demographics and Organization

BC Region Process Ad hoc committee from interested communities – Development of selection criteria – Funding criteria – TOR for ongoing Advisory Committee Regional Advisory Committee – Communities, FN organizations, gov’t staff, technical experts – 2 rounds of funding allocation

BC Region Roll-out Round 1 – minimum population of 80 (age 0 – 6) Round 2 – Smaller communities, less capacity Selection based on service gaps, funding inequities, feasibility, variety 16 sites selected (6 cluster + 10 individual) serving 43 communities Funding levels $75,000 - $250,000

BC Project Implementation Workplans completed Family visitors in place Training offered, including: – Invest in Kids – Motivational Interviewing – Ages and Stages screening

Looking Forward in BC Addition of 3 – 5 new projects Doula training Ongoing training – basic, case management, enrichment Annual resource fair Development of new advisory based on tripartite relationships

Recommendations/ Lessons Learned Provide training earlier Provide suggestions for activities between hiring and training Significant support required for some communities to develop and implement Need for early exploration of linkages and partnerships and clarification of roles

Recommendations/ Lessons Learned (cont) Successful implementation depends on stable nursing support Program addresses needs and is enthusiastically received