CLSC Métro, Montreal, Quebec

Imagine that you're pregnant and need the services of many different specialists to help you have a healthy pregnancy. Wouldn't it be great if they were all located under one roof? For the women of downtown Montréal, Quebec, this dream has become a reality through the Maternal Child and Family Program offered by local CLSCs. CLSCs (Centre Local de Services Communautaires) are health care organizations funded by the Province of Quebec that focus on health promotion and disease prevention. Each CLSC provides access to a range of health professionals such as nurses, social workers, registered dietitians, doctors, dental hygienists and educators. Lia Sanzone is the Acting Maternal Child and Family Program Coordinator and has occupied various roles in the program for 14 years.

The purpose of the Maternal Child and Family Program is to support the health of women throughout their pregnancy and support families in raising a healthy baby. In addition to the funding received by the province, the program receives funding from the Public Health Agency of Canada through the Canada Prenatal Nutrition Program (CPNP). The CPNP funds enhance the services offered by the CLSC to better serve pregnant women experiencing poverty or other conditions of risk and to hire a part-time registered dietitian.

The program also receives funding from La Fondation OLO, a Quebec based organization which provides funding to over 140 CLSCs throughout the province to offer food supplements to pregnant women living in poverty. Through the OLO program, participants are supplied with milk and egg coupons as well as prenatal vitamins. Lia explains, "The idea is to provide enough calories and protein to make sure our moms are eating well and the baby is born with a healthy birth weight."

Participants join the program by going directly to their CLSC and/or through referrals from outside services, such as hospitals, clinics, unemployment services, or the Department of Youth Protection. Women are assessed through an initial home visit; any mother who may be at risk for nutrient deficiencies or a low weight gain during pregnancy, has a history of delivering a low birth weight baby, or is experiencing depression and/or poverty is eligible to receive food coupons and services. All women, whether they are eligible to receive the OLO coupons or not, are encouraged to meet with a nurse and other health care professionals once a month to discuss health related issues. Women are encouraged to come to the CLSC, but arrangements are made to visit them at home if that is not possible. As well, if transportation to the clinic is a problem, taxi coupons are provided. Outside of monthly visits, women can drop in or call the centre to receive any of the services they have been assessed for or if they have any further questions.

At the CLSC Métro, program participants come from many different social and cultural backgrounds including a large number of Asian and Arab immigrants. Other participants faced with issues of poverty include large numbers of students. While the CPNP funds support the inclusion of women experiencing poverty and other conditions of risk, there are also a lot of financially stable and highly educated women who attend the CLSC's Maternal Child and Family Program. "Many of the families have already built secure social networks, but when they come, they realize that they are meeting wonderful people from other cultures," Lia explains. Being a part of this mixed population of people provides a unique opportunity for participants to learn from the experiences of others and make new friends.

The Maternal Child and Family Program also offers a 6-week series of prenatal courses in French, English, and Chinese. All program participants are encouraged to bring a partner or support person with them to these sessions. The courses are facilitated by nurses, dietitians and social workers and topics include: labour and delivery, sexuality, community resources, baby care, maternal and newborn nutrition, communication, and breast feeding. The program also plans to include a session focussing on the role of the father.

When a child is born in Quebec, the CLSC is notified and a nurse visits the family within 3 days of the child coming home. At this point, the family is encouraged to attend a growth development clinic where they can receive free vaccines required for the baby. It is also recommended that the family attend postnatal classes offered by the Maternal Child and Family Program.

An 8-week series of infant stimulation group sessions is offered to mothers with children from 0-6 months old. At these sessions, topics as varied as vaccines, infant crying, infant massage, childhood illnesses, dental hygiene, and introducing solids food are discussed. Upon completion of these classes, additional infant stimulation group sessions are offered to mothers with children from 6-12 months old and 12-18 months old.

CLSC staff may follow the children as long as they are in school, including at the University level. Lia explains, "The beauty of it is that we have nurses in schools, so we see children in elementary school and highschool. As we saw the baby when it was born, it's a very interesting sort of continuity."

Lia expands on the benefits of working within a team of health professionals: "I enjoy my work immensely ... It is wonderful in the end to see the families grow and overcome challenges. It's a very satisfying experience when you see the whole (multi-disciplinary) team working together." The CLSCs' team-based approach seems like an appropriate way to support moms and families in forming a new "team" with their babies.