Ministry Reports

Healthy Babies Healthy Children Report Card

A. What is Healthy Babies Healthy Children ?

A child's early years - from before birth to six - are very important. Healthy babies are more likely to develop into healthy children, and healthy children are more likely to grow up to be healthy adolescents and healthy adults.

The Healthy Babies Healthy Children program helps all children in Ontario have a healthy start in life. The Ministry of Health and Long-Term Care (MOHLTC) launched Healthy Babies Healthy Children in 1998. The program offers all families with new babies information on parenting and child development and delivers extra help and support to those families who would benefit. Delivered by the province's 37 public health units, Healthy Babies Healthy Children provides :

Screening/assessment for pregnant women (through prenatal programs or by their doctors), for all new mothers (by nurses in hospital or by midwives); and for families with children up to age six (by the parents themselves or by their doctors).
A phone call from a public health nurse to every new mother shortly after her baby is born, offering information and a home visit.
Home visiting services by a public health nurse or lay home visitor ¹ for families who would benefit.
Referrals to services in their communities, such as breastfeeding, nutrition and health services, play and parenting programs, and child care services, for all families with children up to age six.

¹In Healthy Babies Healthy Children, a lay home visitor is defined as someone from the community who is an experienced mother and who has had special training in helping other parents care for their children and use community resources.

As well, the program encourages more communication among community services, to help make it easier for all families with young children to get the services they want and need.

B. Does Healthy Babies Healthy Children work ?

In March 2000, the Ministry of Health and Long-Term Care (MOHLTC) asked researchers from Applied Research Consultants (ARC) and the University of Guelph to evaluate Healthy Babies Healthy Children. Is it achieving its goals ? Are its services helping children and families ? To answer these questions, the research team talked to 6,222 families across Ontario. They interviewed 3,526 public health nurses and lay home visitors who deliver Healthy Babies Healthy Children services and others who are familiar with the program. They also conducted in-depth studies to find out how the program was working in 12 health units.

The research took more than two years. This Report Card on Healthy Babies Healthy Children summarizes the findings.

C. Is Healthy Babies Healthy Children reaching all families in Ontario ?

In 2001, 88 per cent of mothers with new babies in Ontario consented to be screened either before or shortly after the baby's birth. In 15 health unit areas, 100 per cent of families with new babies were screened. In 30 health unit areas, more than 90 per cent of families with new babies participated.

Across the province, more than 80 per cent of families with new babies also received a phone call from a public health nurse shortly after leaving hospital. All but four health units said they could provide Healthy Babies Healthy Children services in all the languages required by parents.

This means that almost all families in Ontario with very young children have had some contact with Healthy Babies Healthy Children, regardless of culture or location.

D. Is Healthy Babies Healthy Children successful at finding the families who could benefit from more help and support ?

When Healthy Babies Healthy Children first began, the program designers thought they would be able to identify families who would benefit from extra help and support by screening pregnant women and new mothers. Some families were missed in the initial screening. However, during the phone call to every new mother, public health nurses were able to find those families who would benefit from the services.

Based on experience with Healthy Babies Healthy Children so far, about seven per cent of all Ontario families with new babies can benefit from extra help and support.

E. Are families who would benefit from the Healthy Babies Healthy Children home visiting service using it ?

Healthy Babies Healthy Children is supposed to offer home visiting services to those families among this seven per cent who would benefit most from these services. Home visiting consists of regular visits from a public health nurse and a lay home visitor. How many visits a family receives, and how often, is decided with the family. On average, families requiring this service receive a 1.2-hour home visit every 18 days.

The researchers found that the program appears to have stabilized, with the equivalent of seven per cent of Ontario families with newborns receiving home visits. Initially, all sorts of families received home visits. In 2002, as health units refined their procedures, 59 per cent of the families receiving two or more home visits were the families who staff thought would benefit the most from the visits (compared to 46 per cent in 2001).

F. Are families being referred to services in the community ?

Healthy Babies Healthy Children refers many Ontario families with young children to a wide range of community services.

In 2001, Healthy Babies Healthy Children staff made 31,479 formal referrals for 14,378 families who would benefit most from these services. One-third of all formal referrals were to breastfeeding, nutrition, prenatal and infant health services. Sixteen per cent were to parenting programs and services; 15 per cent were to medical services, child therapy and development programs; 12 per cent were to social, economic and related family supports; and 25 per cent were to "other" services.

In addition, program staff made 88,704 informal recommendations, connecting families to supports and services by letting families know what services are available, or directing them to those services. The services they recommended were: parenting services and programs (32 per cent of all referrals), breastfeeding, nutrition, prenatal and infant health services (24 per cent), medical services and child development programs (eight per cent), social, economic and related family supports (five per cent), and "other" services (30 per cent).

In summary, Healthy Babies Healthy Children is connecting many families to local services who might not get connected otherwise.

G. Are the services available? Do families use the services ?

Recommendations and referrals are important, but are the services available ? Do families actually use them ?

Most of the service providers who were interviewed, thought there were more services for families with children up to age six than there were before Healthy Babies Healthy Children began. In addition, service providers noted that more culturally and linguistically appropriate services were also available for those families. With Healthy Babies Healthy Children, more families who need extra help and support are being connected to community services and supports.

Are there enough services for families ? Not always. About 68 per cent of health units said that some families still have problems getting appropriate services. Service providers reported that waiting lists for services have grown and families and service providers may become discouraged by long waits. When families were placed on long waiting lists for services, most health units (84 per cent) kept the families in the Healthy Babies Healthy Children program until the other services became available. On the other hand, service providers also reported that some families do not want the services. Lack of transportation, culture and language were additional barriers for some families.

H. Are services for families with young children more integrated ?

Healthy Babies Healthy Children is expected to work with other local organizations to increase service integration. Integration means that agencies coordinate their services and plan new services together. By working this way, agencies can minimize overlap, shorten waiting lists and develop whatever new services families need.

Are services more integrated now ? Yes, there has been progress. Agencies in many communities report that since Healthy Babies Healthy Children began, there are fewer gaps and less overlap in services, and fewer misguided referrals. Agencies are communicating more and coordinating and planning services better than before.

In the communities where services are more integrated, service providers report that the Healthy Babies Healthy Children program is also more effective. In their view, families and local agencies tend to be more aware of the program, families tend to receive more fitting referrals, and services for families tend to be better.

I. What impact has Healthy Babies Healthy Children had on children and families ?

Healthy Babies Healthy Children is supposed to improve child health, parenting skills and families' use of services. Is it succeeding ?

When researchers compared families who received Healthy Babies Healthy Children home visiting with similar families who did not receive home visiting, they found better child and family health among home visiting families. Among home visiting families :

Children scored higher on most infant development measures, including self-help, gross motor skills, fine motor skills and language development.
Parents had a stronger sense of connection with community services and felt more confident about their parenting.
Families took advantage of community services and had more contact with public health nurses and other early years professionals.

J. Do families like Healthy Babies Healthy Children services ?

Families with new babies said that they like receiving a phone call from a public health nurse soon after getting home from the hospital. More than 90 per cent found the nurse's information helpful and 66 per cent found it very helpful.

Families who received home visits said that they liked the service. Almost all said it increased their confidence in their parenting ability and helped them do practical things, such as calming or caring for their baby.

Families also said that they liked being connected to local services, particularly parent groups.

Almost all families were satisfied with Healthy Babies Healthy Children services and felt they had been treated with sensitivity and respect. Over 90 per cent of home visiting families said that Healthy Babies Healthy Children staff understood their family's needs and believed in the family's abilities and 88 per cent said that they felt they had a reasonable amount of control over the services they received. They also reported that being involved with the program helped them develop knowledge and skills, reduce stress, increase their sense of support and be more a part of the community where they live.

The families' only complaint was that they could not always get some of the local services they wanted, such as child care.

K. What do public health nurses and lay home visitors think about Healthy Babies Healthy Children ?

The public health nurses and lay home visitors who work with families were overwhelmingly positive about Healthy Babies Healthy Children, and its impact on families. Almost 97 per cent of the people who work with families every day felt that the program helped families be more aware of their strengths and needs, and be more willing to use services.

L. Overall, is Healthy Babies, Healthy Children making a difference ?

Yes. Since Healthy Babies Healthy Children began :

Families receiving home visits liked the services and thought they were making a difference in their lives.
Services for families with young children have increased.

More families with children up to age six are getting local services and supports and more of these families are getting culturally and linguistically suitable services.

There are fewer gaps in services and less service overlap.
There are fewer misguided referrals.
Agencies are working together to better coordinate, plan and streamline their services to do a better job of helping families.

It is too early to know the full impact of Healthy Babies Healthy Children on children's lives, but the early indications are that more children in Ontario are getting a healthier start in life. To find out more about the longer term results, the Ministry of Health and Long Term Care recently asked the researchers to continue their work. When the children described here reach kindergarten, a follow-up study will look at how well they are doing and whether Healthy Babies Healthy Children continues to make a difference in their lives.

June 2003