Presentation for the Shiseido Social Welfare Foundation Study Tour in 2016

Friday October 14, 2016

Focus: Information regarding programs that support women and families during pregnancy and the postpartum period provided Child, Youth & Family Community Health, Island Health.

Our Context:

  • Service provision to population of Vancouver Island
  • Vancouver Island population, 2014: 759,725
  • South Island population, 2014: 372, 463
  • Vancouver Island births / year: approx. 6,000
  • South Island population: approx. 3,000

Our Program: Child, Youth & Family Community Health (CYFCH), Island Health

  • Government funded; for the most part clients are not charged for service
  • Public Health Nurses provide the majority of services that support perinatal women & families
  • Other areas of CYFCH: Speech, Audiology, Nutrition, Dental, Nursing Support Services and Nursing

Geographical Overview:

  • Health Units across Vancouver Island
  • Greater Victoria
  • Salt Spring Island Unit
  • Peninsula Health Unit
  • Saanich Health Unit
  • Victoria Health Unit
  • Esquimalt Health Unit
  • West Shore Health Unit
  • Sooke Health Unit
  • Lake Cowichan Health Unit
  • Duncan (Margaret Moss) Health Unit
  • Ladysmith Health Unit
  • Nanaimo Health Units (2)
  • Qualicum / Parksville Health Unit
  • Port Alberni Health Unit
  • Campbell River / Courtney
  • Tofino / Ucluelet Health Unit
  • Port McNeill Health Unit
  • Port Hardy Health Unit
  • Gold River Health Unit
  • Comox Valley Health Unit

Public Health is defined as the organized efforts of society to keep people health and prevent injury, illness and premature death. It is a combination of programs, services and policies that protect and promote the health of all Canadians. (Public Health – Community Health Nursing Practice in Canada: Roles and Activities (2010) Canadian Public Health Association. )

There is substantial evidence to suggest that development of the infant and young child – neurologically, physiologically, psychologically and emotionally – plays a significant role in determining their lifelong physical, mental and social health and well-being (Model Core Program Paper: Healthy Infant and Child Development, (2009), BC Ministry of Health Living and Sport)

Principles/Fundamental Approaches

Principles/fundamental approaches for a model health authority prevention program for reproductive health and disability prevention are:

  • A women-focused perspective within a family context that respects the social and cultural context of women’s experience as well as the role and support of fathers, partners and family members
  • A health-promoting prevention focus aimed at women and men during their childbearing years.
  • Empowerment of women through provision of information on evidence-based practices to make informed decision related to all aspects of reproductive health
  • Application of an equity lens and responsiveness to the needs and issues of vulnerable women, vulnerable families, women who are victims of violence, Aboriginal people, people who are immigrants and from diverse cultural groups, people with disabilities, and people who are gay, lesbian or transgendered.
  • Multi-sectorial and multi-disciplinary collaboration by community, regional and provincial partners.
  • Accessible, flexible and high quality services,
  • A population health approach which takes into account social, economic and environmental determinants of health, including protective factors, risk factors, and vulnerable populations.
  • Advocacy for integration of best practices by local and regional partners
  • A culture of evidence-based practice, surveillance and continuous quality improvement
  • Gender-sensitive research and evaluation to strengthen decision-making

(Model Core Program Paper: Reproductive Health and Prevention of Disabilities, (2009), BC Ministry of Health Living and Sport)

All services are provided within a trauma informed and culturally aware foundation.A trauma informed practice takes place within an environment where clients do not experience further traumatization of a re-traumatization and where they can make decisions about their treatment needs at a pace that feels safe to them. Relational practice is also a priority for CYFCH staff which means that optimal service is provided to clients with the context of an open, transparent and trusting relationship.

ProgramsSupporting Women and Families During Pregnancy and the Postpartum Period.

1)Right from the Start

“The mission of the Right From the Start program is to direct public health resources to promote the health and wellness of pregnant women, new mothers, babies to two years of age and families using a population health approach that seeks to raise the health status of those most in need.”

Four interrelated components:

  • a) Prenatal Services
  • Goal: To identify and intervene on psychosocial, environmental and lifestyle risk factors that impact the health of pregnant women and their families.
  • Universal
  • Population based screening for depression, substance use & vulnerability
  • Prenatal breastfeeding support
  • Enhanced
  • Collaborative hospital pre-admission planning
  • Telephone health assessment, education and referrals
  • Brief intervention counselling
  • Self-support interventions for perinatal depression
  • referrals
  • b) Postpartum Services
  • Goal: To assess health and safety of postpartum women and newborns, to identify psychosocial, environmental and lifestyle risk factors; and to provide family-centred public health interventions
  • Universal
  • Telephone health assessment and education
  • Contact with families within 24 to 48 hours of hospital discharge
  • Newborn hearing screening
  • Enhanced
  • Hospital discharge planning with maternity care providers
  • Infant feeding assessments and interventions
  • Brief intervention counselling
  • Self-support interventions for perinatal depression
  • Public health dental, hearing, speech & language services
  • c) Breastfeeding Support Services
  • Goal: to promote and support exclusive breastfeeding to six months as the optimal way of feeding infants. Thereafter infants should be receiving complementary food with continue breastfeeding to two years and beyond. To provide accessible, standardized, high quality breastfeeding support and education that meets the 10 best practice of Baby Friendly.
  • Breastfeeding Clinics:
  • West Shore Health Unit; Monday afternoon
  • Saanich Health Unit: Thursday morning
  • Victoria health Unit: Friday afternoon
  • The majority of nurses have taken extra breastfeeding counselling education and a few PUBLIC HEALTH NURSEs have their International Board Certified Lactation Consultantcertification
  • Clients can attend health unit breastfeeding clinics or PUBLIC HEALTH NURSEs can go to clients’ homes as needed
  • All health units sell non-electric breast pumps at cost
  • Most health units have electric breast pumps to loan to clients for one week
  • d) Family Visiting Services
  • Goal: To support healthy child development, improve parenting outcomes and maternal life-course, improve maternal and child mental health, and prevent child maltreatment.
  • Enhanced
  • Family visiting based on vulnerability screening and nursing knowledge
  • BC Healthy Connections Program

2)BC Healthy Connections Project; Nurse Family Partnership

  • Nurse Family Partnership
  • A program of prenatal and infancy home visiting for young, socially disadvantaged, first time mothers
  • This program has been evaluated in three randomized controlled trials in the United States
  • BC Health Connections Project
  • A randomized control trial of the Nurse Family Partnership Program
  • In Canada, a team of researchers at McMaster University are working collaboratively with public Health Nurses, supervisors and other stakeholders in BC to adapt all program materials to meet the needs of Canadian mothers and their families.
  • Goals:
  • To improve pregnancy outcomes by helping women improve their prenatal health and life style choices
  • To improve child health and dev3lopment by helping parents provide competent early care of their children.
  • To improve parental life-course by helping mothers develop a vision for the kind of life they want for themselves and their children and by helping them make choices consistent with their values around planning subsequent pregnancies, finishing their education and finding work.
  • Target: low income, primip women, under the age of 25 years in early pregnancy (first contact must take place prior to 29 weeks gestation)
  • Program based on work done by psychologist Dr. David Olds in 1977
  • Public Health Nurses practice from a strength based approach utilizing guidelines that frame the detailed visit-by visit continuum.
  • ‘NFP’ PUBLIC HEALTH NURSEs provide intensive contacts with the women from before 28 weeks gestation until the infant is two years old.

3)Her Way Home

  • A program developed by a collaboration of 30 community agencies in the greater Victoria areawho identified a need for a program supporting women with substance use issues.
  • Goal: to improve pregnancy outcomes and healthy infant development for pregnant or parenting women impacted by substance use
  • Service is provided from a trauma informed and non-judgmental lens
  • Prenatal education offered weekly
  • Hospital tours offered in anticipation of labour and delivery
  • Immunizations are offered weekly
  • General Practitioner and a Nurse Practitioner alternate weekly to provide primary care
  • Staffing:
  • Two case managers work with clients individually
  • One outreach worker who tries to connect with ‘hard to reach’ clients
  • One Public Health Nurse

4)Prenatal Outreach Programs (also known as ‘Best Babies’)

  • Purpose: to provide education, information, support and social connections for women experiencing health and/or lifestyle challenges during pregnancy, birth and the transition to parenting.
  • Primary goal: improved maternal and infant health
  • Attendance: women and their partners can attend as soon as they are pregnant to six weeks postpartum. Many agencies offer a follow up program until 6 months postpartum.
  • Women and partners attend weekly
  • Staffing:
  • Outreach workers
  • Nutritionists
  • Public Health Nurses
  • Target Population: pregnant and early postpartum women, specifically Aboriginal women, immigrant women, teens, single parent women and women experiencing family violence, poverty, addictions, food insecurity, social and/or geographical isolation, and emotional or cognitive difficulties
  • Program is provided by community agencies in partnership with Child, Youth & Family Community Health Public Health Nurses and Nutritionists; an integral part of the community system of services for the early years
  • Participants receive lunch, bus vouchers, grocery vouchers, vitamins and parking passes for the hospital
  • Modules have recently been developed to help provide consistency across the various programs
  • Many programs offer immunizations
  • Community Agencies:
  • Saanich Neighbourhood Place
  • Esquimalt Neighbourhood House
  • Fernwood Community Centre
  • Victoria Neighbourhood Friendship Centre
  • Beacon Community Services (Sidney)
  • Boys and Girls Club Services West Shore
  • Quadra Village Community Centre
  • Her Way Home
  • University of Victoria

5)Baby Talk

  • Purpose: to provide a group whereby education, information, support and social connections for all women with infants aged 0 to 6 months is provided
  • Goal: improved maternal and infant health
  • Attendance: varies by health unit
  • 10 week session
  • Open; women can attend for as long as they wish until their infant is 6 months old
  • Many community agencies and libraries offer programs for families with children over 6 months of age.

6)Perinatal Depression/Anxiety Program

Purpose: to support women and their families who are struggling with depression and/or anxiety (PPD/A) andprovide referrals to appropriate health providers (physicians, counsellors, community agencies)

Goal: mentally healthy parents who are aware of strategies and can identify their supports to maintain their mental wellness

Case Finding:

  • The Edinburgh Postnatal Depression Scale (EPDS) is provided to women at six weeks postpartum or, if contact cannot be made, at the 2 month immunization appointment.
  • Clients are asked on an ongoing basis how they feel emotionally
  • Depending on the outcome of the EPDS and/or client report, the client is provided ongoing support by a Public Health Nurse
  • Public Health Nurses make referrals to Primary Care Providers, counsellors
  • Public Health Nurses provide ongoing ‘listening visits’

Four support groups facilitated by 2 Public Health Nurses each

  • Locations:
  • Saanich Neighbourhood Place
  • Victoria Health Unit
  • West Shore Health Unit
  • Sooke Health Unit
  • Perinatal women can attend the support group until their infant is 12 months old

7)Transcutaneous Bilirubin (TcB) Monitoring

  • Infants are screened in the mother/babe unit with a transcutaneous bilirubin monitor at 72 hours of life or at discharge, whichever comes first.
  • Discharged infants > 18 hours of life and < 144 hours of life who screen in the low-intermediate zone are referred to Public Health Nursing for another screening the following day.
  • Health unit screening results dictate follow up:
  • Low risk: infant is discharged from the program
  • Low Intermediate Risk: infant returns to the health unit for follow-up the next day if the infant is < 144 hours old.
  • High or High Intermediate Risk: Infant is referred to the hospital lab for serum bilirubin and the Primary Care Provider is informed of the results.

8)Immunization Clinics

  • Clients coming to the health unit for their infant’s immunizations at 2 months, 4 months, 6 months, 12 months and 18 months are assessed for supports or services needed.

9)Hearing Screening for Newborns

  • Infants are screened for hearing deficits in hospital prior to discharge
  • Infants identified are followed up by the Audiology program for further treatment and referral if needed

10)Mother’s Story

  • An approach to client care rather than a separate program
  • An approach to care provided to perinatal women who have vulnerabilities and will be followed by Public Health Nursing for as long as there is need.
  • Intentionally acknowledges the woman as the expert of her life and the Public health Nurse as someone who is invited to join the journey, offering a specialized body of knowledge.
  • Reinforces an evidence based practice platform that is: woman centred, trauma informed, culturally safe and responsive to women’s needs
  • Optimizes the women’s strengths as well as the Public Health Nurse’s scope.
  • Charting is done with the client’s input

11)Resources:

  • Our Special Journey: Pregnancy Passport
  • Child Health Passport
  • Baby’s Best Chance
  • Toddler’s First Steps
  • BC Healthy Families Website:
  • HealthLink BC Website:

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