November 26, 1998

To:Board of Health

From:Dr. Sheela Basrur, Medical Officer of Health

Subject:Healthy Parenting Program

Purpose:

This report presents the feasibility of modelling Public Health's Healthy Parenting Program on programs similar to the Welcome Baby Support Program in the former City of Etobicoke.

Source of Funds:

Not Applicable.

Recommendation:

It is recommended that the Board of Health refer this report to the Community and Neighbourhood Services Committee.

Background:

The Budget Committee on March 30 and 31 and April 2 and 3, 1998, submitted to the Strategic Policies and Priorities Committee and Council the 1998 Revised Capital and Operating Budget Estimates. At that time, the Budget Committee requested that the Commissioner of Community and Neighbourhood Services report to the Community and Neighbourhood Services Committee on the feasibility of modelling Public Health's Healthy Parenting Program on programs similar to the Welcome Baby Support Program in the former City of Etobicoke.

In view of the Board of Health's primary responsibility for public health programs, this report is submitted through the Board for transmittal to the Community and Neighbourhood Services Committee.

Discussion:

At the present time, there are three programs offered in the former City of Etobicoke for young mothers: Healthy Babies, Healthy Children (city-wide), Parents Helping Parents (city-wide) and Welcome Baby (Etobicoke). While they share some similarities, these programs are distinctly different. Through planning and collaboration, together they provide comprehensive service that meets a broad range of need.

Healthy Babies, Healthy Children Program

The Healthy Babies, Healthy Children Program is a joint Ministry of Health/Ministry of Community and Social Services prevention and early intervention initiative. This provincially funded program is administered and delivered by Public Health.

The Healthy Babies, Healthy Children Program provides education and support to high risk mothers and their child(ren) throughout Toronto. All families are screened (prenatally or at birth). Those identified as "at-risk" are assessed by a Public Health Nurse and referred for follow-up by a Lay Home Visitor, a Public Health Nurse and/or other community resources as necessary. A Healthy Babies, Healthy Children community network maintains an inventory of services and identifies gaps in order to ensure that families have access to a full range of community services. (See Appendix A for program details)

Healthy Parenting Program "Parents Helping Parents"

The "Parents Helping Parents" Program is a municipally funded program which began operation in 1983 in the former City of Toronto. Funding was enhanced in 1998 in order to expand this program city-wide and to supplement the Healthy Babies, Healthy Children Program which only provides 13 home visits to high risk families over a two year period.

The "Parents Helping Parents" program is an intensive peer education program in which Lay Home Visitors provide support to high risk families in their homes. Each Lay Home Visitor is paired with a Public Health Nurse. Together they evaluate and plan for the child's progress. Healthy Babies, Healthy Children clients who require more intensive support than the allotted 13 home visits receive additional home visits through the "Parents Helping Parents" funding. In the "Parents Helping Parents" program families receive approximately 90 home visits over a three year period (see Appendix B for program details).

Research has consistently demonstrated positive outcomes in programs that have used paraprofessionals who have employed intensive long term home visiting, i.e. - weekly or bi-weekly for at least one year and up to five years.

Welcome Baby Program

The Welcome Baby Support Program has operated in the former City of Etobicoke since 1986. It is an incorporated non-profit organization governed by an elected Board of Directors. Program co-ordination is provided by one part-time paid co-ordinator. This program is funded through a municipal grant, corporate and service club donations and special event fundraising.

The community-based program links young women who need support and help during their pregnancy and the first year of their baby's life with trained volunteers. Welcome Baby volunteers offer emotional support to young mothers through frequent visits and phone calls (4-6 hours per week). The program provides information and referral to appropriate community services as the mother requires them (see Appendix C for program goals and details).

Although Welcome Baby and the Healthy Babies, Healthy Children and "Parents Helping Parents" programs share similar goals and objectives regarding informing and supporting parents and linking them to resources, they differ in target group, delivery strategy and focus. The Welcome Baby Support Program targets only young moms and delivers service by utilizing volunteers that focus on friendly support. The Healthy Babies, Healthy Children Program and the "Parents Helping Parents" program target all high risk families and deliver service by utilizing paid Lay Home Visitors who can be paired with parents on the basis of ethno-cultural background. The programs focus on education and support to promote optimal child development. The Welcome Baby program targets only young moms and delivers service by utilizing volunteers that focus on friendly support. Unlike Healthy Babies, Healthy Children or "Parents Helping Parents", it does not provide service to all high risk new mothers in the community and does not extend beyond the child's first year of life.

Conclusion:

The "Parents Helping Parents" program enhances the Healthy Babies, Healthy Children program. The provincial government has designed the Healthy Babies, Healthy Children program a Lay Home Visitor model of service delivery. Therefore, in order to provide service that produces the best possible outcomes and ensures continuity of service to this vulnerable client group, "Parents Helping Parents" also uses a Lay Home Visitor model. Consequently, it is not feasible to model "Parents Helping Parents" on a volunteer model similar to Welcome Baby.

These programs co-exist and support one another, thereby providing young mothers in Etobicoke with a comprehensive level of service. Welcome Baby is represented on the Healthy Babies, Healthy Children Network and accepts referrals from Public Health for young moms in need of friendly support. Public Health provides training and consultation to Welcome Baby volunteers and accepts referrals for women in need of specific education and a more intensive level of support.

Contact:

Joanne Cooper, Healthy Babies, Healthy Children Co-ordinator

Tel:392-7408

Fax:392-0713

Dr. Sheela V. Basrur

Medical Officer of Health

Appendix A

HEALTHY BABIES, HEALTHY CHILDREN PROGRAM

The goal of the Healthy Babies, Healthy Children Program is "to promote optimal physical, cognitive, communicative and psycho social development in children who are at-risk". The objectives are "to increase access and use of needs-based services and to support children who are at-risk, to increase effective parenting ability in high risk families, and to increase the proportion of high risk children achieving appropriate developmental milestones".

The components of the Program are:

1. to screen all families with children (prenatally or at birth) who are at-risk for physical, cognitive, communicative and/or psycho social problems;
2. to link families with identified needs to community services;
3. to provide lay home visiting services for high risk families who would benefit from such services;
4. to develop and maintain a network of health and social service providers to ensure that families (prenatally to age 6) who are at-risk have access to a range of prevention and early intervention services; and
5. to identify a case manager from the most appropriate agency for all high risk families.

Representatives from Toronto Public Health and lay home visiting programs across the province produced the Provincial Healthy Babies, Healthy Children Guidelines for the Curriculum for Training Lay Home Visitors, incorporating best practices and resources.

Appendix B

HEALTHY PARENTING PROGRAM "PARENTS HELPING PARENTS"

The objectives of the Parents Helping Parents Program are:

1. to better enable the parent to cope with socioeconomic stressors during the child's infancy;

2.to increase the parent's knowledge and practice of developing a home environment which will stimulate the child's physical, cognitive, emotional and social development;

3. to increase the parent's knowledge and practice of developing a positive parent/child interaction, in terms of its quality and its ability to promote child development;

4.to increase the parent's knowledge of infant/child health and development issues;

5. to improve child competencies in physical, cognitive, emotional and social skills;

6.to increase parent's knowledge and promote the use of community resources;

7. to facilitate the opportunity for the Parents Helping Parents Home Visitors to gain job experience and to promote their own personal development; and

8. to facilitate access, through advocacy and supportive accompaniment, to available community supports.

Building on the strength of their own experience, and on skills developed during intensive training, Home Visitors share information on child development and health needs. They also demonstrate a series of activities designed to stimulate the child's development. As well as giving practical support and information about parenting, Home Visitors provide emotional support to parents and link them with community resources. The ethno-cultural backgrounds and experience of the Home Visitors facilitate rapport-building with the parents. Parents develop a repertoire of parenting skills that help promote successful parent-child interactions in the first years.

Evaluations have shown that paraprofessional intervention has a positive impact on maternal child interaction and a variety of maternal and child health outcomes. It is particularly successful at promoting home environment conducive to the child's physical, cognitive, emotional and social development.

Appendix C

WELCOME BABY SUPPORT PROGRAM

The following information about the Welcome Baby Support Program is based on the description of the Program in the Organization Manual (1998).

The goals of the program are:

1. to reduce the isolation and stress on first time single mothers, 21 years of age and under, during pregnancy and in the first year of their baby's life; and

2.to work with young mothers to create a home environment conducive to the physical, emotional and psychological well-being of her child and herself.

To achieve these goals, Welcome Baby undertakes the following:

1. identify and contact high risk young pregnant women who can benefit from volunteer support during the pre-and post-natal period;

2.recruit and train volunteers who are prepared to support these young women;

3. provide ongoing training on pre-, neo- and post-natal support and related topics for the community volunteers; and

4.increase the awareness of life skills programs for young mothers.

Co-operation with other agencies such as the Children's Aid Societies, Toronto Public Health and George Hull Centre, has been important to the success of Welcome Baby. As a community-based service, Welcome Baby often works with these agencies, and depends heavily on their resources for volunteer training, referrals and support for young mothers.