Peer Support Program in

Manitoba’s First Nation Strengthening Families Maternal

Child Health Initiative

Wanda Phillips-Beck RN, BN, MSc

Michele Tully, RN, BN.

Assembly of Manitoba Chiefs

1. Manitoba Story – the SF-MCH

Initiative

2. Peer Support Program

3. Evaluation of Peer Support

“Manitoba Strengthening Families Maternal Child Health

Program” - Community Ownership and Determination

Communities need to own their own health

programs and processes

In January and February of 2011, the Health

Council of Canada held a series of seven regional

sessions across Canada to learn what programs

and strategies are making a difference in the

health of Aboriginal mothers and young children.

The goal of the report is to create a better

understanding of; and tp support for programs and

initiatives that have the potential to reduce health

disparities between Aboriginal and non-

Aboriginal Canadians.

Understanding and Improving Aboriginal Maternal and Child

Health in Canada

The First Nations Maternal Child Health Program evolved from the First Ministers Meeting September 2004 with a commitment to Maternal Child Health.

Funding announcement in Spring of 2005 at special meeting of First Ministers & FN&I leaders

At the National level, First Nations (AFN) involved in discussions in the development of an overall program framework.

4

In Manitoba, consultations took place FNIH Regional

office, with participation from regional senior

management team, nursing and community program

staff to determine location of MCH program and the

regional structure of program.

Initially located within the Nutrition and Diabetes Unit

in Community Programs Directorate.

Integration efforts were taking place within the

Community Programs Directorate within FNIH

As a result of this integration effort, early contact was

initiated with the Assembly of Manitoba Chiefs

regarding the implementation of MCH program in MB.

Invite extended to SCO and MKO – two other PTO’s

in Manitoba.

Initial meeting, it was determined that First Nations

should have immediate participation in the regional

roll out of the program.

Same year AMC released the Health and Wellness

Strategy – A 10 Year Plan for Action 2005-2015.

6

Emphasized the need to “include First Nations

community as a full partner in all planning and

decision making process that fosters collaboration and

consultation to restoring self-governing authorities”.

Initial rounds of consultations determined that an MCH

Steering Committee would be involved in overall

implementation of the program.

A joint call for nominations was issued by the Grand

Chief of AMC and Regional Director in 2005.

An “Advisory Committee” consisting of community

members in Maternal and Child Health, Child Services

or Community Health was formed.

A decision was made by the newly formed Advisory

Committee that the Nurse position be housed at the

AMC as a “demonstration” project - First Nation

participation in program development.

Assembly of Manitoba Chiefs

Peer & Practice Support Team

First Nation Inuit Health

Admin Support Team

FN-Maternal Child Health Advisory

Committee

14 Strengthening Families Maternal Child Health Communities

Peer & Practice Support Funding/Admin Support

14 funded First Nation Communities in Manitoba

14/63 First Nation Communities (22%)

49/63 First Nation Communities do not have a program

(78%)

First Nations have developed a Strengthening Families

Information Management (SF-IMS)/Documentation

System to support communities and Peer Support

Program.

11

That every First Nation Community in Manitoba have

strong, healthy, supportive First Nation families living

a holistic and balanced lifestyle

Major Program Objectives:

Empower Families

Promote the physical, emotional, mental and spiritual well being of women children and families.

Promote trusting & supportive relationships between parent/child, care provider/family, and resource to resource

Increase communities capacity to support Families

12

Home Visiting program for Prenatal women and

families with children 0-6 years age

Nurse or Professional Supervisors & professionally

trained home visitors

Provide 1:1 education and information to families

◦ Bonding/Attachment

◦ Child Development

◦ Parenting & traditional parenting in today’s world

◦ Setting and working goals

◦ Discovering & incorporating the strengths of our cultures

Voluntary Participation

It is a quality assurance and assessment program

designed by the AMC Practice Support Team

It is a system of support built directly into the program

at three levels: individual, community & regional.

We examine a number of “program delivery elements”

and processes.

It involves the application of consistent protocols

addressing multiple delivery processes.

It has the potential to roll out nationally (if we all

delivered a similar program model)

Enhance program effectiveness.

Empower Community Program Staff

Improve maternal and child health outcomes

by enhancing program effectiveness at the community level.

Ultimately, better programs, better services to

families, better outcomes for program

families

Participation

◦ Community level staff are involved in the entire process, from

setting agenda to planning for system improvement.

◦ Mentoring for new supervisors, so that community level

support continues and is built into every day practice. (Parallel

process).

Inclusiveness

◦ Community leadership and staff are involved, all

communication is through the health director.

Accountability

◦ Bilateral, lateral, within Nation, (community staff to leadership) Nation to Nation.

1. Peer Support is oriented towards meeting the

needs and expectations of community programs.

2. Focus on system and processes.

3. Dependent on data for analysis of service

delivery processes (e-SF-IMS).

4. Team approach for problem-solving and quality

improvement.

Peer Support Program is a strategy designed to assist communities in achieving a high standard of program outcomes, leading to improved outcomes for program families.

Evolved from our vision, goals, objectives.

Utilizes our Regional Program Standards as our

foundation (See poster).

Began with Quality Assurance Plan – developed in

2006/07 by the AMC Nurse Program and Practice

Advisor.

It involved 3 years of development: from consultation,

standardization, development of tools (paper &

electronic), training, and finally to implementation in

2009.

Began as Pilot Project to provide professional support

& technical assistance to 5 communities within the

West Region Tribal Council area.

Evolved into a comprehensive Peer Support Program

providing Quality Assurance support to all 14

Strengthening Family Communities in Manitoba -

2009/10.

Team Members: Peer Resource Specialist & Peer

Support Specialists with advanced training in Quality

Assurance Certification with Great Kids Inc.

Quality Assurance is a term that originated in market

based services. It involved monitoring and improving

services to customers.

Peer Support is essentially the same, with emphasis on

improving outcomes by supporting community based staff

and programs to function at an optimal level, within their

capacity, and at key intersecting points common to all

programs. (Screen, Assessment, Home Visiting etc.)

Key difference here is SUPPORT, not monitoring.

SF-MCH communities

Assembly of Manitoba Chiefs

Regional Team

Nurse Program Advisor (Wanda)

Nurse Peer Resource Specialist (Michele)

Peer Support/Administrative Assistant (Joyce)

SF-MCH Advisory Committee First Nation community based workers with

experience in MCH or children’s programs.

Nominated by Peers/First Nation communities

First Nation Inuit Health Program Manager MCH

CYD Team Leader

Initial community communication

Initial letter of explanation sent to the community 6 weeks

before visit

On-Site Visit

1-2 days depending on the size of community.

Follow-up Communication

Follow-up letter/communication detailing program

“Strengths” and “Opportunity for Growth” sent within 2

weeks

Follow-up site Visits

Review SF-IMS Data with program staff

(activities/documentation).

Shadow Home visitors completing a home visit with a

program family, delivering curriculum utilizing

communication strategies

Shadow Nurse/Supervisor completing a Family

Assessment

Shadow Nurse/Supervisor providing Reflective

Coaching with a Home Visitor.

Utilize consistent forms to observe critical home

visiting practice standards (communication

strategies/interventions/daily do’s).

Take data/observations & synthesize all of the

information,

Relate and connect this information back to program

standards

Debrief assessment with program staff

Develop recommendations jointly with program staff,

health director &/or community members on how they

can strive toward program excellence.

A report follows within two weeks with a period for

planned implementation for recommendations.

Visiting each community based on their community level

(1-2 days duration).

Available by phone, mail and e-mail for continued support

between visits

Each Community is unique – frequency of contact can change

and affected by staff turnover

Working collaboratively with the SF-MCH Community

Staff and Health Directors

Assist in organizational planning for the program

Providing guidance program direction

Developing and implementing community QA processes

Frequency and Levelling of Peer Support

Level I, II, III, IX.

Level I – more frequent visits to Level IX less frequent visits

Eliminates geographical/demographical disparities between

communities

Determined by:

Self-evaluation process completed annually

Program Standards (2007,2010)

Quality/Quantity of Data in SF-IMS (QA quotient)

Implementation of Peer Support Recommendations

or by Community Request

Peer Support Specialists Reports to:

Community Health Director

Community MCH Supervisors

PSN Team Leader (Michele)

Peer Resource Specialist Reports to

Assembly of Manitoba Chiefs

Advisory Committee

Evaluation Team

Standardization of basic program elements (creation of

regional program standards)

Implementation and adoption of Program Standards by all

Communities

Creating a means of assessing where communities are;

and supporting communities to meet the practice

standards

Develop a consistent means of collecting data (electronic

is best)

The evaluation of the Peer Support Program

highlighted:

◦ Increased community voice at regional level

◦ Increased quality of home visiting program

◦ Increased capacity of program staff to deliver HV

◦ Improved quality of data collection/documentation

◦ Decreased/minimization of program drift

◦ Program staff reported they felt supported by AMC

Regional Program and Practice Support Team

Strength-Based - build on community Strengths.

Solution Focused – focus on improvement/not the

barriers.

Realistic Expectations – provide information to

community programs regarding opportunities for

improvement

Peer Support Framework has been developed to

demonstrate the relationship between all stakeholders

and the Peer Support Process

Pee

r S

upport

Pro

cess