Selection and Use of Health Services for Infants' Needs by Indigenous Mothers in Canada: Integrative Literature Review.

In Canada, Indigenous infants experience significant health disparities when compared to non-Indigenous infants, including significantly higher rates of birth complications and infant mortality rates. The use of primary health care is one way to improve health outcomes; however, Indigenous children may use health services less often than non-Indigenous children. To improve health outcomes within this growing population, it is essential to understand how caregivers, defined here as mothers, select and use health services in Canada. This integrative review is the first to critique and synthesize what is known of how Indigenous mothers in Canada experience selecting and using health services to meet the health needs of their infants. Themes identified suggest both Indigenous women and infants face significant challenges; colonialism has had, and continues to have, a detrimental impact on Indigenous mothering; and very little is known about how Indigenous mothers select and use health services to meet the health of their infants. This review revealed significant gaps in the literature and a need for future research. Suggestions are made for how health providers can better support Indigenous mothers and infants in their use of health services, based on what has been explored in the literature to date.

Adapting, piloting and evaluating complex public health interventions: lessons learned from the Nurse-Family Partnership in Canadian public health settings.

INTRODUCTION: The Nurse-Family Partnership (NFP) is a home-visit program for young and first-time, socially and economically disadvantaged mothers. Evidence from three United States randomized controlled trials (RCTs) on the effectiveness of this intervention at improving pregnancy outcomes, improving child health and development, and increasing maternal economic self-sufficiency is robust. However, the effectiveness of the NFP in Canada, with its different health and social care context, needs to be determined. The purpose of this article is to describe the complex process for moving the NFP from the research arena to full implementation in Canada. METHODS: This process of evaluation in Canada includes (1) adapting the intervention; (2) piloting the intervention in small-scale feasibility and acceptability studies; and (3) conducting an RCT and process evaluation through a study called the British Columbia Healthy Connections Project (BCHCP). This large-scale evaluation also creates an opportunity to expand the NFP evidence base by conducting an additional study to examine potential biological mechanisms linking intervention and behavioural outcomes in children. RESULTS: Adaptation of the NFP home-visit materials is a continuous process. A pilot project determined that it was feasible to enrol eligible women into the NFP. This pilot also determined that, in Canada, it was most appropriate for public health agencies to implement the NFP and for public health nurses to deliver the intervention. Finally, the pilot showed that this intensive home-visit program was acceptable to clients, their family members and health care providers. Through the BCHCP, the next steps - the RCT and process evaluation - are currently underway. The BCHCP will also set the foundation for long-term evaluation of key public health outcomes in a highly vulnerable population of families.

TITRE: Adaptation, mise à l'épreuve et évaluation d'interventions complexes en santé publique : leçons tirées du Nurse-Family Partnership dans le secteur de la santé publique au Canada. INTRODUCTION: Le Nurse-Family Partnership (NFP) est un programme de visites à domicile destiné aux nouvelles jeunes mères défavorisées sur le plan socioéconomique. Les données issues de trois essais contrôlés randomisés (ECR) américains ont solidement démontré l'efficacité des interventions quant à l'amélioration de l'issue de la grossesse, de la santé et du développement des enfants ainsi que de l'autonomie économique des mères. Cependant, l'efficacité du NFP dans le contexte canadien des services de santé et des services sociaux, qui diffère de celui des États-Unis, reste à déterminer. Cet article vise à décrire le processus complexe suivi pour adapter la recherche sur le NFP et mettre ainsi en oeuvre ce programme au Canada. MÉTHODOLOGIE: L'évaluation menée au Canada se divise en trois étapes : 1) adaptation de l'intervention, 2) mise à l'épreuve de l'intervention dans des études de faisabilité et d'acceptabilité à petite échelle et 3) réalisation d'un ECR et d'une évaluation du processus dans le cadre de l'étude intitulée British Columbia Healthy Connections Project (BCHCP). Cette évaluation à grande échelle permettra d'enrichir la base de données probantes du NFP par la tenue d'une étude supplémentaire sur les mécanismes biologiques susceptibles de témoigner de la relation entre l'intervention et les effets sur le comportement des enfants. RÉSULTATS: L'adaptation de la documentation du NFP pour les visites à domicile est un processus continu. Un projet pilote a montré la faisabilité du recrutement des femmes admissibles au NFP. Il a aussi révélé qu'il était préférable au Canada que le NFP soit mis en oeuvre par les organismes de santé publique et que les infirmières et infirmiers en santé publique (ISP) s'occupent des interventions. Enfin, il a montré que ce programme intensif de visites à domicile a bénéficié d'une réception positive de la part des clientes, des membres de leur famille et des fournisseurs de soins de santé. Les prochaines étapes ­ à savoir l'ECR et l'évaluation du processus ­ ont été entamées dans le cadre du BCHCP. Ce projet jettera les bases d'une évaluation à long terme des principaux résultats en matière de santé publique concernant des familles hautement vulnérables.

Health care and social service professionals' perceptions of a home-visit program for young, first-time mothers.

INTRODUCTION: Little is known about health care and social service professionals' perspective on the acceptability of long-term home-visit programs serving low-income, first-time mothers. This study describes the experiences and perspectives of these community care providers involved with program referrals or service delivery to mothers who participated in the Nurse-Family Partnership (NFP), a targeted nurse home-visit program. METHODS: The study included two phases. Phase I was a secondary qualitative data analysis used to analyze a purposeful sample of 24 individual interviews of community care providers. This was part of a larger case study examining adaptations required to increase acceptability of the NFP in Hamilton, Ontario, Canada. In Phase II (n = 4), themes identified from Phase I were further explored through individual, semi-structured interviews with community health care and social service providers, giving qualitative description. RESULTS: Overall, the NFP was viewed as addressing an important service gap for first-time mothers. Providers suggested that frequent communication between the NFP and community agencies serving these mothers could help improve the referral process, avoid service duplication, and streamline the flow of service access. The findings can help determine key components required to enhance the success of integrating a home-visit program into an existing network of community services. CONCLUSION: The function of home-visit programs should not be viewed in isolation. Rather, their potential can be maximized when they collaborate and share information with other agencies to provide better services for first-time mothers.

TITRE: Points de vue de professionnels de la santé et des services sociaux sur un programme de visites à domicile destiné aux jeunes mères d'un premier enfant. INTRODUCTION: On sait peu de choses sur ce que pensent les professionnels de la santé et des services sociaux des programmes à long terme de visites à domicile pour les nouvelles mères à faible revenu. Cette étude fait état des expériences et des points de vue de fournisseurs de services communautaires qui orientent les mères participant au Nurse-Family Partnership (NFP) ­ un programme de visites à domicile par une infirmière auprès de cette population cible ­ vers le programme lui-même ou qui interviennent directement dans le cadre de celui-ci. MÉTHODOLOGIE: L'étude s'est déroulée en deux phases. La phase I a consisté en une analyse secondaire de données qualitatives issues d'un échantillon de 24 entrevues individuelles dirigées avec des fournisseurs de soins communautaires, cette démarche s'inscrivant dans le cadre d'une étude de cas plus vaste réalisée à Hamilton (Ontario, Canada) et destinée à examiner les moyens à mettre en oeuvre pour accroître la recevabilité du NFP. La phase II, à laquelle ont pris part 4 participants, a consisté en une description qualitative des 3 thèmes relevés lors de la phase I, thèmes qui ont été approfondis au moyen d'entrevues individuelles semi-structurées menées auprès de certains fournisseurs de soins de santé et de services sociaux communautaires. RÉSULTATS: Le NFP est perçu dans l'ensemble comme un programme comblant une lacune importante dans les services dispensés aux nouvelles mères. Des échanges fréquents entre le NFP et les organismes communautaires offrant déjà des services à ces mères pourraient contribuer à en améliorer le processus d'orientation, à éviter leur chevauchement et à en faciliter l'accès. Ces résultats contribuent à mieux définir les composantes nécessaires au succès de l'intégration d'un programme de visites à domicile au réseau déjà en place de services communautaires. CONCLUSION: Le rôle des programmes de visites à domicile ne doit pas être envisagé isolément. Au contraire, le potentiel de ceux-ci est optimisé par la collaboration et l'échange d'information avec d'autres organismes afin d'offrir de meilleurs services aux mères d'un premier enfant.

Utilization of the Canadian Incidence Study of Reported Child Abuse and Neglect by child welfare agencies in Ontario.

INTRODUCTION: The purpose of this study was to analyze how child maltreatment surveillance data from the Canadian Incidence Study of Reported Child Abuse and Neglect (CIS) is used by senior child welfare decision makers. METHODS: This triangulation mixed-methods study included quantitative and qualitative methods to facilitate an in-depth exploration from multiple perspectives. We interviewed Ontario child welfare decision makers to measure utilization of the CIS in policy development. RESULTS: The majority of respondents were aware of the CIS data. Decision makers reported using these data to determine resource allocation, understand reported maltreatment trends and validate findings at their own agencies. Urban agencies used the data more than did rural agencies. CONCLUSION: This study is the first to triangulate data to understand and improve utilization of child maltreatment surveillance data. The study participants indicated considerable appreciation of the data and also provided ideas for improvements across the surveillance cycle.

The role of public health in addressing child maltreatment in Canada.

Child maltreatment is a significant health and social issue given its prevalence across the general population and the significant short- and long-term outcomes associated with maltreatment in childhood. There is a need for a comprehensive, collaborative and multisectoral approach for identification, prevention and intervention of this complex issue. Within this multisectoral collaboration, it is essential for public health in Canada to define its role in addressing and preventing child maltreatment. This commentary summarizes how public health can address the issue of child maltreatment in Canada by specifically: 1) measuring the magnitude of maltreatment through public health surveillance systems such as the Canadian Incidence Study of Reported Child Abuse and Neglect; 2) identifying modifiable risk factors; 3) identifying and evaluating community-based interventions to prevent violence; and 4) implementing evidence-based primary prevention strategies.

Cervical nodal metastasis of squamous cell carcinoma of unknown origin: indications for withholding radiation therapy.

The records of patients with pathologically confirmed metastatic squamous cell carcinoma involving cervical lymph nodes who were treated at the Mayo Clinic between January 1965 and December 1987 were reviewed. In 117 patients a primary tumor could not be discovered. Of these, 24 patients underwent curative resection of all gross disease by neck dissection or excisional biopsy. All 24 patients presented with unilateral adenopathy. Their median age was 63 years. Eighteen patients were men. Fourteen patients were in clinical stage N1; six, N2a; three, N2b; and one, N3. Six patients had grade 1 or 2 nodal metastases; 14, grade 3; and 4, grade 4. Gross or microscopic evidence of extracapsular tumor extension was noted in eight patients. All patients were followed until death or for a median of 8.5 years (range, 3.3-20.4 years). A squamous cell carcinoma of the upper aerodigestive tract subsequently developed in only one patient (4%) within 5 years of operation. In six patients (25%), a recurrence developed in the dissected neck a median of 3 months (2.4 months-6.6 years) after operation. Five of these patients had extracapsular extension, and four had pathologic Stage N2a or higher neck disease. Both patients with pathologic Stage N1 disease who had recurrences in the dissected neck had extracapsular extension. Delayed, contralateral neck metastases in an undissected neck developed in two patients. The 5-year overall and cause-specific survivals for all 24 patients were 66% and 74%, respectively. Extracapsular extension was a predictor of neck recurrence, control of disease above the clavicles, cause-specific survival, and overall survival. Patients with pathologic Stage N1 neck disease with no extracapsular extension can be managed by surgery alone. Patients with pathologic Stage N2 or higher neck disease or extracapsular extension should be considered for postoperative, adjuvant radiation therapy.