REACHING CANADIAN COMMUNITIES
![Canada Prenatal Nutrition Program. (CPNP)](../images/cpnp_banner_e.gif)
Overview
What CPNP
Projects Look Like
CPNP and the
Community
Learning Through
Experience
Collective Wisdom
A Base to Build
On
Overview of the Canada
Prenatal Nutrition Program's Individual Project - Questionnaire
Report
This brief report sums up what CPNP project representatives -
the people on the ground in CPNP-funded initiatives - told Health
Canada in the Individual Project Questionnaire
(IPQ). As a snapshot, it portrays the key
characteristics of projects across Canada. These initial
findings confirm that CPNP is a strong force in Canadian
communities: prenatal nutrition projects do fill important service
gaps; they can be an agent for change in the communities where they
operate; and they have an impressive ability to lever local support
- be it in the form of volunteer hours, financial or other in-kind
contributions.
CPNP is responding to a growing need in the community.
Recent trends show that pregnancies are again on the rise amongst
our teenagers. Every baby born in Canada deserves the best
possible start. We need to learn as we go, continually
improving the quality and effectiveness of our interventions and,
by extension, the next generation's chances of a healthy
life. We need more young parents to feel the confidence that
comes with understanding the value of good nutrition and the
"know-how" to provide it to themselves and their
families.
CPNP
Projects:
Some quick facts and figures
The IPQ response rate was outstanding - 85% overall,
with seven provinces achieving a 100 % rate. In a nutshell,
project staff told us that in 1996-97:
- 14,668 clients were served through 238 projects - about 64
clients per project, 11 more than the planners predicted
- 330 new community projects were spun off as a direct result of
CPNP projects
- 9,533 referrals were made by project workers to other services,
primarily prenatal classes, but also clothing banks, health
services and parenting courses
- 1,219 participants contributed back to projects through
volunteer, paid and other work.
About this Report
The CPNP evaluation consists of two complementary tools: the
program-oriented Individual Project Questionnaire (IPQ),
for project representatives, and the Individual Client
Questionnaire (ICQ), for program participants.
The IPQ portion of the survey forms the basis of this Report,
which looks at CPNP projects: how they respond to local needs,
their key features, and a host of implementation issues. The
Report is purely descriptive, since few conclusions can be drawn
about program impacts until the ICQ data analysis is
complete. What it offers is an early "snapshot" of
projects country-wide in 1996-97, based on the questionnaire
responses of project representatives.
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What CPNP Projects Look
Like
Who delivers
CPNP?
Who is served?
What projects
offer
Participation
Staffing and
time
Cost per client
Funding sources
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Who delivers CPNP?
- one out of three projects is delivered through a community
agency or coalition, one out of three through a government
agency, and just over one out of six through a
community-based government agency
- in British Columbia, 70% of CPNP projects are housed
in community agencies (e.g., Pregnancy Outreach Programs,
or POPs) - at the other end of the spectrum is Quebec,
where over two-thirds of projects operate from government
agencies (mainly Centres locaux de santé communautaire, or
CLSCs)
- in Atlantic provinces, community coalitions
are the main delivery agencies
- project delivery sites include agency offices (highest
overall, at 28%), health centres, family centres, schools,
community and drop-in centres, hospitals and friendship centres,
among others
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Who is served?
- nearly 80% of projects target pregnant women living in poverty,
teens, those who abuse alcohol or drugs, or live with violence, and
women who are isolated
- other client groups are women with gestational diabetes (served
by 59% of projects), Aboriginal women living off reserve (39%) and
on reserve (14%), and immigrant and/or refugee women (34%)
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What projects offer
- 72% of the projects, including the stand-alones, use CPNP funds
to provide previously unavailable services; others have increased
the number of clients they serve or enhanced their offerings, or
both
- over 90% of projects provide food supplements; between 60% and
70% offer vitamin supplements, one-to-one dietary counselling,
dietary assessment and breastfeeding support; and about half offer
group dietary counselling, one-to-one lifestyle counselling, food
preparation training/other educational activities, and
transportation
- most projects offer 5 or more services, many offer 10 or more,
and 12 projects offer a full slate of 15 services, suggesting a
comprehensive, holistic approach to prenatal nutrition
- Quebec-based projects, mainly operating from within CLSCs, tend
to focus on food supplementation
![back to: What CPNP Projects Look Like](../images/top.gif)
Participation
- an average of 64 women accessed each project in 1996-97, for a
grand total of 14,668 clients
- nationally, CPNP clients use prenatal care for an
average of 4.6 months, with the longest attachments being in PEI
and the Yukon (6 months)
- postnatal care is used for an average of 2.9 months
nationally, with attachment lasting up to 8 months (in the
Northwest Territories), and as little as about 1.4 months (BC)
![back to: What CPNP Projects Look Like](../images/top.gif)
Staffing and time
- paid staff members work 29.6 hours a week on average,
in-kind staff work 8.2 hours, and volunteers and advisory
staff 2.8 and 2.7 hours respectively
- paid personnel account for about 60% of total staff hours
per week, in-kind staff for approximately 25%, and volunteers
(often former participants) for about 5%
- where CPNP provided more than half of the project's funding
(55% of projects), the two most common staff positions are
those of project coordinator and nutritionist/dietitian
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Cost per client
- per-client spending varies according to project
structure - it is highest in stand-alone projects (about
$1,200) and lowest in add-on situations ($300-$900), perhaps
reflecting higher program development cost or more intensive
services in the stand-alone model
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Funding sources
- about 40% of projects receive most or all of their
funding from CPNP
- another 34% of projects receive up to half of their funding
from CPNP - for most of these, CPNP funding accounts for
20% or less of their total budget
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CPNP and the Community
From their reports, many CPNP projects are forming integral
connections to the communities they serve. They have been
successful in finding the right "fit" within existing
service and agency networks (complementarity being the key), and
are managing to capitalize on opportunities for joint planning and
partnership development, leading to better overall coordination of
services.
A well-defined
niche
Part of a bigger
whole
Partnership-building
Community
ownership
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A well-defined niche
CPNP projects fill a distinct gap in their communities.
Project workers say there is little or no duplication of services
at any jurisdictional level. This is because:
- three times out of five, CPNP projects are their
community's only source of prenatal nutrition services;
- many of the other prenatal nutrition services available in
communities are not specifically designed for CPNP
clientele - e.g., tending to draw "middle to high income,
educated, married, non-Native participants" - or not
easily accessible due to location, hours, cost, or lack of
transport or child care;
CPNP projects:
- directly target those women who are most at risk of having
unhealthy babies because of poor health or nutrition
- tailor their services to client needs - offering fresh foods,
vitamin supplements, vouchers, social support, nutrition
counselling, postnatal information/classes, and training in food
preparation (e.g., community kitchens)
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Part of a bigger whole
- CPNP projects made over 9,500 referrals to other
agencies and services in 1996-97, more than 1,300 of them to
prenatal classes
- projects also made about 2,400 referrals to clothing banks,
health services and parenting courses - about 800 referrals to
each
- there were 2.7 service spin-offs for every project -
330 new programs in all
- resource libraries and clothing banks were the most common
spin-offs - together, they account for over 100 new programs
![back to: CPNP and the Community](../images/top.gif)
Partnership-building
- CPNP projects form multiple partnerships within the community -
an average of four per project in 1996-97
- most often, the partnerships are with health professionals (65%
of projects), 50% of projects with not-for-profit groups, and 30%
to 40% of projects with individuals, schools, other government
agencies and businesses
- least common are partnerships with substance abuse agencies,
friendship and drop-in centres, and service clubs (all less than
20%), suggesting there is room for more collaborative work
- there are practical reasons for entering into partnerships -
most often they are said to increase service awareness and access
in both directions, and to afford clients more comprehensive
services; resource-sharing, joint planning and increased
coordination are also given as reasons
Breastfeeding a Driving Force in High
River
While health professionals topped the list of CPNP partners,
unique joint efforts are at work in some communities. For
example, a car dealership in High River, Alberta, provides a free
car seat to any mom who belongs to the community's
"Healthy Moms, Healthy Babies" project, and who has
breastfed her baby for six months or longer.
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Community ownership
- more than $440,000 innew money came into CPNP projects
from community sources in 1996-97 - $3,000 per project on average -
not including the discounts on goods and services given by many
local businesses
- 897 in-kind contributions were recorded - among them,
426 donations of space, 211 of materials and 130 of
food/supplements.
- 1,118 participants - about one in every seven - gave back time
and energy to their projects as volunteers
- 45 participants contributed their efforts to CPNP through paid
work
![back to: CPNP and the Community](../images/top.gif)
Learning Through Experience
These results suggest that the decision to fund prenatal
nutrition projects for high-risk mothers is starting to pay
off. With client questionnaire (ICQ) data still to come, it
is too early to talk about birthweight outcomes, or initiation of
breastfeeding. Nevertheless, the preliminary findings are
encouraging.
But even without all the facts in, there is plenty to be pleased
about. For example:
- the program's flexible, client-driven approach -
leaving it to provinces/territories, municipal authorities and
communities to determine how best to utilize CPNP funding.
This has worked well, ensuring local autonomy and tailored
services.
- the impressive number of additional programs, activities
and services that have spun off in many Canadian communities,
thanks to the presence of CPNP projects;
- the in-flow of resources that might otherwise have gone
untapped, from various community sources - witness the monies,
in-kind donations and the dividends in volunteer time and energy
reported across the country;
- the benefits of community partnerships, which raise
awareness and increase access on all sides, and strengthen the
ability of the community as a whole to close service gaps;
- finally, the diverse learning reported by local project
workers - innumerable little revelations, hard-earned through
experience, that make us wiser about our work day to day.
Some of these "lessons learned" are included below.
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Collective Wisdom
Here's some of what some project representatives
said about...
... the benefits of client involvement in
program planning and development:
"We found that by letting the clients determine where they
wanted to meet us, we had greater success in follow-up and
participation in the program."
... the quality of client-worker relationships
as a key to project success:
"The relationship between the outreach worker and the
client is paramount ... her warmth and caring do more to shift
habits than videos and information."
... the learning and opportunities that arise in
peer support groups:
"The sewing and cooking classes have had may informal
discussions on childbirth, breastfeeding, child care, etc., that
probably wouldn't have happened without the bonding that
generally occurs during the course of these classes."
... patience required to collaborate
effectively, the twin challenges of marketing the
program and motivating clients, and the importance of training
volunteers and outreach workers:
"It is important to develop a strong, ongoing promotion to
keep referrals coming in. Most of our referrals were made
directly by participants."
"The program needs to be adaptable.' Topics, time of
season, length of session... can change, based on what the group
wants."
... the need for client follow-up:
"Regular follow-ups foster trust and facilitate future
interaction when the client is in need."
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A Base to Build On
Data Sources
Reviewing these findings, it is clear that CPNP staff members
are committed, hard-working and creative. In just a short
time, many CPNP projects have been firmly embedded in communities -
with a surprising number of referrals, spin-offs and
partnerships. The need is evident for CPNP services for
high-risk women, a clientele so under-served in the past.
CPNP projects show enterprise, as project staff actively seek
out new ways to provide benefit to clients. For the program
to profit from what staff and volunteers have learned, experiences
must be widely shared.
At the time the IPQ study was conducted, many of the CPNP
projects were still in start-up phase, with processes in
development, and partnerships still being forged.
Nevertheless, even the early results of analysis presented here
clearly show that CPNP projects are a strong force in Canadian
communities, and in the lives of the women they serve.
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Data Sources
Health Canada. 1996/97 Individual Project Questionnaires,
Canada Prenatal Nutrition Program. Unpublished report
prepared by Barrington Research Group Inc. (Calgary, Alberta),
1997.
Wadhera, Surinder and Millar, Wayne J. "Teenage
Pregnancies, 1974 to 1994," Health Reports, Winter
1997, Vol. 9, No. 3. Statistics Canada.
For more information, contact: Community Based Programs
Health Canada
Jeanne Mance Building
Address Locator: 1909C2
Ottawa, Ontario
K1A 1B4