Focus Group on Maternal-Newborn Health Services and Programs EASTERN ONTARIO COUNTIES Prepared by France Morin and Debbie Aylward, Perinatal Consultants Champlain Maternal Newborn Regional Program INTRODUCTION The Champlain Maternal Newborn Regional Program (CMNRP) is conducting focus groups as part of one of its strategic priorities focused on enhancing the transition of maternal-newborn care from hospital to community. The focus groups are one of the activities of the CMNRP Mapping Maternal Newborn Services Workgroup. CMNRP is pleased to present a summary report of key findings and recommendations from the focus group that was conducted at the Eastern Ontario Health Unit in Casselman on October 26 th , 2016 from 13:30 to 16:00. A total of 19 health care providers from various organizations that provide maternal- newborn health services and/or programs 1 in the Eastern Ontario Counties participated. Those include: Stormont, Dundas, Glengarry, Prescott/Russell and Akwesasne. The purpose of this focus group was to: 1) confirm and identify additional maternal-newborn health services and/or programs currently available in this community; 2) explore the views of participants about the strengths, challenges and gaps of existing services and programs in relation to access, navigation and continuity of supports; and 3) identify opportunities for improvement and make recommendations to improve the current system. The focus group was divided into four parts. Notes were taken and the session was audio-recorded in order to accurately capture participants’ contributions. Information from the notes and the recording were reviewed, collated and presented in this report. PART 1 – Document Current Maternal-Newborn Health Services & Programs Prior to attending the focus group, participants received a list of maternal-newborn health services and programs that were identified by CMNRP through searches of portals ( thehealthline.ca ; 211.ontario ) and websites of organizations as well as telephone calls with key informants. Copies of this list were available at the session to use as a reference. In the first part of the session, participants were asked to briefly identify services and programs that were missing from the list and those who were no longer available. They were encouraged to submit any additions or modifications to the list to the facilitator following the session. An updated copy of the list of maternal-newborn health services and programs can be found in Appendix A. 1 For the purposes of this focus group, “maternal-newborn health services and programs” included services and programs offered during pregnancy, birth and the first few months after birth (up to 3 months). CMNRP Focus Group – Eastern Ontario Counties. Oct. 2016 Page 2 PART 2 – Identify Strengths, Challenges and Gaps in Maternal-Newborn Health Services & Programs Participants were tasked to identify strengths, challenges and gaps in current maternal-newborn health services and programs in their community. Participants were asked to consider how easy it is to access these services and programs, how people navigate between them and how the services are meeting the needs of childbearing families. Key findings from this exercise are presented below in Table 1. TABLE 1 - STRENGTHS, CHALLENGES AND GAPS IN MATERNAL-NEWBORN HEALTH SERVICES AND PROGRAMS Participants identified the bolded areas as applicable to all perinatal periods (prenatal, labour & birth and postnatal). PRENATAL LABOUR & BIRTH POSTNATAL • • • Strengths Availability of health service Families receive health services Postnatal home visits from public health options close to home nurses (Healthy Babies Healthy Children • Increasing capacity of services • Collaboration with hospitals and [HBHC] Program) (NP-led clinics, Family physicians, Public Health Unit with discharge • Good collaboration with Children`s Aid Community Health Centers) process (HBHC screens done by Society (if early referral made) • Increasing links within the region public health nurses, discharge • Watch Me Grow Program – great • Provision of client-centred care teaching re: car safety, resource → freedom of choice breastfeeding) • Collaboration with various community • Lactation consultants available in services (e.g. Public Health, Ontario Early some centers Years Centers, Groupe Action, Valoris) • Hospital visits by Akwesasne • Fast access to Nurse Practitioner Health Services (HBHC screens) Challenges • Lack of knowledge of available • Lack of knowledge of available • Lack of knowledge of available services services and programs in services and programs in hospitals and programs in hospitals and in the hospitals and in the community and in the community (HCPs & community (HCPs & families) (HCPs & families) families) • Lack of breastfeeding knowledge of • Access to preferred prenatal • Fragmentation of care (across physicians services (e.g. midwifery care) boundaries) i.e. PHU and primary • Location of certain services • Delayed referral to services (e.g. care provider “Winchester • Service available but not used (e.g. NPs CAS) *Community resources and triangle” during prenatal and postnatal period) HCPs may not be aware of • Transfer is required if • Lack of knowledge of scope of practice referral process (prenatal complications arise or a higher of HCPs (e.g. midwives, NPs) assessment) level of care (maternal/newborn) • Lack of referrals to HBHC program by • Lack of referrals to HBHC is required, if staffing issues exists midwives and other primary care program by midwives and other *separation of mother and baby providers primary care providers • Lack of breastfeeding knowledge • Increase influx of Quebec patients • Lack of knowledge of scope of of physicians (i.e. • Referral to wrong services (OCTC vs practice of HCPs (e.g. midwives, supplementation) private clinic) NPs) • Increase influx of Quebec patients • Summary discharge or birth record not • Lack of breastfeeding provided to primary care providers knowledge of physicians • Fragmentation of care (across • Inconsistent practices and boundaries) i.e. PHU and primary care services offered by similar provider) “Winchester triangle” organizations (e.g. HBHC screen) • Services provided by wrong HCP (e.g. NP • Fragmentation of care (across following complex pediatric cases) boundaries) i.e. PHU and • Lack of collaboration between NP and primary care provider pediatricians • “Winchester triangle” • Increase influx of Quebec patients CMNRP Focus Group – Eastern Ontario Counties. Oct. 2016 Page 3 PRENATAL LABOUR & BIRTH POSTNATAL Gaps • Lack of education of HCPs (e.g. • No mass transit; access to services • No mass transit; access to services Family Medicine residents have limited (esp. out of region limited (esp. out of region services) limited exposure to prenatal services) • MDs see all antepartum patients but not clinics and OB/GYN rotations in • Lack of lactation consultant baby postpartum (Hawkesbury)* Delayed hospital) services in hospital or lack of access to HCPs for infant care. • Lack of prenatal services offered knowledge/referral to LC services by FPs and NPs if they exist • Lack of referral to appropriate services • Lack of collaboration between HCPs • No mass transit; access to services limited (esp. out of region services) • No prenatal breastfeeding discussions(MDs)*Culture gap PART 3 – Recommendations to Improve Maternal-Newborn Health Services & Programs Participants were then divided into groups and tasked with identifying 3 ways to improve services and programs for one of following time periods: prenatal, birth and postnatal (1 st week and 2nd week to 3 months). Participants were asked to think about services/programs that could be created, enhanced or improved. A representative from each table was invited to share the recommendations generated by their group. Ideas and suggestions are presented below in Table 2. CMNRP Focus Group – Eastern Ontario Counties. Oct. 2016 Page 4 TABLE 2 - OPPORTUNITIES FOR IMPROVEMENT OF MATERNAL-NEWBORN HEALTH SERVICES AND PROGRAMS PRENATAL LABOUR & BIRTH POSTNATAL • Prenatal and parenting education • Improve communication amongst Postnatal : 1 st week during preconception period various health care services. Ensure • Explore funding opportunities for a mobile that the information provided to Suggested strategies: transition clinic that offers services similar to expectant parents at prenatal classes o Mandatory preconception the services being offer by the Monarch Clinic reflects current clinical practices. education classes to be offered in in Ottawa (e.g. maternal and newborn high schools and post-secondary • Standardize breastfeeding education assessment, jaundice/bilirubin evaluations, education agencies (college, and information provided to lactation support, special procedures such as university) childbearing families. wound care, staple removal) o Communication by LHIN and Public • Bridge gaps in services for high-risk • Explore the creation of a resource (e.g. portal Health Units with schools. populations in rural centers. (website), document) for health care providers o Public awareness campaign led by Suggested strategies: and childbearing families with up-to-date information on maternal-newborn services Public Health Units o Explore regional approach to and program (specifically breastfeeding o sharing specialty resources (e.g. Promotion of existing programs services). that are currently underutilized pediatricians, RTs) • (e.g. Triple P Positive Parenting o Explore ways to access specialty Ensure that culturally appropriate