Evaluation of CPNP and CAPC by PHAC

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The Public Health Agency of Canada (PHAC) released their CPNP and CAPC evaluation report in March covering the years 2015-16 to 2019-20.C

Between 2015-2016 and 2019-2020, PHAC spent approximately $82.5 million per year on CAPC and CPNP activities through the CAPC and CPNP grants.

The report findings show that CAPC and CPNP complement provincial and territorial programs with minimal to no overlap or duplication, enabling a wraparound approach to service provision across different jurisdictions. Variation in levels of complementarity across jurisdictions in Canada is seen by key informants as contingent of differing provincial and territorial priorities. The Joint Management Committees (JMC) between PHAC and territorial governments are seen as playing an important role in coordinating programming to reduce health inequities and in supporting prenatal health and early childhood development.

The majority of CAPC and CPNP projects are reaching the PHAC-identified target populations and are appropriately sited in communities with socio-economic or school readiness vulnerabilities. Program participants identified receiving positive benefits from attending the programs in the areas of gaining knowledge and skills, improving health behaviours, health, and wellbeing.

Key informants drew attention to their perceptions that needs and challenges experienced by program participants are becoming increasingly complex, and identified a need for specialized support for many families beyond the capacity and training of project staff. The onset of COVID was identified as an additional stress for families and put strain on programs to find ways to provide required support for families.

The report identifies several opportunities for PHAC to further inform and support CAPC and CPNP programs, such as enhancing PHAC’s leadership role in facilitating and coordinating the development and sharing of knowledge and capacity building resources, and strengthening communication between CAPC and CPNP and other PHAC programs situated within their Health Promotion and Chronic Disease Prevention Branch (HPCDPB).

The CAPC and CPNP delivery model offers flexibility to projects to tailor programming to the needs of their participants, and to leverage additional funding and in-kind resources from other sources (e.g. provincial government). One of the biggest challenges has been caused by twenty years of static funding, which now provides 33% less purchasing power when adjusted for inflation.

The three main recommendations of the report are:

1.    In the context of the upcoming renewal of CAPC and CPNP, the Health Promotion and Chronic Disease Prevention Branch should review program objectives to ensure they continue to be relevant, and address the needs of target populations. As part of this review, it is recommended that the Health Promotion and Chronic Disease Prevention Branch consider ways to strengthen and improve information sharing amongst stakeholders and partners, and better integrate this as a key activity for funded projects.

2.    Based on the decision taken with respect to program objectives, the Health Promotion and Chronic Disease Prevention Branch should examine alternative program delivery model(s) that would optimize program reach and best enable the achievement of the established program objectives. The report notes, “By considering alternative delivery models, PHAC may discover opportunities to continue to support prenatal health and early childhood development programming within community-based organizations, while offering the flexibility to respond to emerging needs of at-risk populations. Such considerations should also reflect the objectives and target populations of the two programs.”

3.    The Health Promotion and Chronic Disease Prevention Branch should examine opportunities to strengthen communication and coordination with the Joint Management Committees on investments related to supporting the health of at-risk pregnant individuals, as well as young children and their families.

The report notes:

·      Research shows that approximately one quarter of Canadian kindergarten children are at risk in at least one area of development prior to entering Grade 1.

·      These risk conditions can predict literacy and numeracy outcomes throughout childhood and are connected with adverse health and social outcomes in later life, such as chronic disease, poor mental health and lack of economic participation.

·      Vulnerable subpopulations include children who live in low-income neighbourhoods with a high proportion of foreign-born residents, or who live in neighbourhoods with lower overall educational attainment.

·      Demonstrated correlations between low birth weight and parents that live in low-income neighbourhoods or have lower educational attainment. Low birth weight is a contributing factor to children being at risk in certain areas of development and at higher risk of developing physical, cognitive and behavioural problems.

·      Early investments have been shown to be cost-effective in addressing long-term health, social, economic and environmental inequities. “For instance, a recent Canadian study found a return on investment of $4.5 in adult social services in adulthood for every dollar invested in early childhood development. Furthermore, at a societal level, interventions focused on supporting early childhood development have been linked to economic growth and prosperity.”

In 2018, PHAC conducted a survey with parents and caregivers participating in CAPC projects, as well as participants in CPNP projects, to better understand whether the programs are reaching target populations and helping participants to achieve positive results. Findings from the surveys illustrate that the programs are generally reaching PHAC’s target populations, and additionally, approximately one quarter of CPNP participants also identified as being an Indigenous person or having lived in Canada for less than ten years. 7% of CPNP participants identified as a teenage parent, notably higher than the 2% of teenage parents and caregivers identified in the general population.

Findings from the 2018 CAPC and CPNP surveys demonstrate that the majority of participants (over 80%) reported that the programs had helped them gain knowledge and skills, adopt healthy behaviours, and improve their health and wellbeing. The majority of parents and caregivers felt that participation in a CAPC project improved their parenting knowledge and skills, including how children change as they learn and grow, as well as how to keep their children healthy and safe. A significant proportion of CAPC participants reported adopting positive health behaviours because of their participation in a project, including having more people to talk to when they need support, more confidence in their parenting skills, a better relationship with their children, greater ability to handle challenges, using new programs and services, preparing healthier meals, and a greater ability to cope with stress. These results were particularly noted by participants who were recent immigrants to Canada.

Most CPNP participants reported that that they had adopted positive health behaviours because of their involvement with a project, including breastfeeding their baby, having more people to talk to when they needed support, having more confidence in their parenting skills, having an improved ability to cope with childbirth, using new programs and services, making healthier food choices, and being better able to cope with stress. About three quarters of participants reported that they limited their exposure to second-hand smoke and took prenatal or multivitamins more regularly. Of the 25% of CPMP participants who reported smoking while pregnant, more than half of this group reduced their smoking and almost a third quit smoking during their pregnancy.

The majority of CAPC participants reported that their health and wellbeing had improved because of their participation in a project, with participants who identified as Indigenous reporting even greater benefits. The majority of participants reported perceptions of improved mental health for themselves and for their children.

The majority of both CAPC and CPNP participants (over 90%) reported that they had felt welcomed and accepted, that their personal and cultural beliefs were respected, that they had received valuable information for making decisions, and that staff had responded to their concerns and helped them to get the resources they needed.

Items to note:

·      Several CAPC and CPNP participants identified with multiple socio-economic characteristics that may place them at risk, which may subsequently increase the complexity of the challenges they experience.

·      Opportunities remain to enhance coordination and knowledge sharing with other PHAC programs, as well as between projects, stakeholders, and jurisdictions to provide projects with resources to help participants address their challenges.

·      Resources must recognize and reflect the diversity among CAPC and CPNP participants.

Finally, the report concludes by reiterating:

·      “The CAPC and CPNP model provides a flexible platform for program delivery in order to meet the needs of target populations across Canada. Additionally, projects have been successful at leveraging funds and in-kind resources from other sources.”

·      “Static funding for the last twenty years has resulted in a situation where projects have 33% less purchasing power when CAPC and CPNP funding is adjusted for inflation. This may have affected the extent to which projects were able to provide services to their communities.”