Multisectoral service hubs for children and families

TEAM
Jessica Ball, MPH, PhD, University of Victoria
Kenneth A. Moselle, PhD.
Pauline Janyst, MA.
Audrey Wilson, Executive Director, Laichwiltach Family Life Society

Community partners:
Lil’wat Nation
Treaty 8 Tribal Association
Tl’azt’en Nation
Laichwiltach Family Life Society

Project background

A persistent challenge for families is the fragmented system of services they need to navigate to support their children's wellness. Systems of services and supports tend to be divided according to jurisdiction, professional specialization, private/public, on-reserve versus off-reserve, client’s age and needs, and other criteria. Myriad of other factors further drives a wedge between services that might otherwise be seen as part of a whole.

There is widespread acceptance in the population and public health sectors around the world that health is more than the absence of disease, and that health outcomes have multiple determinants. In order to address health concerns and promote wellness, many causal factors must be addressed. Multisectoral service hubs are designed to improve timely, affordable access to health promotion, chronic disease prevention, primary health care, clinical ancillary services for children and families, and support for lifestyle changes and improved living conditions. Streamlined and timely access to a range of services increases a service systems capacity to respond to the complex array of issues that outreach workers are likely to encounter. For example, when a community health worker conducts a well-baby visit they may identify family members facing serious health and lifestyle challenges. The worker’s capacity to move a range of services into place needs to be assured through good inter-professional communication and program integration. If services for a community are co-located or at least collaborative, the likelihood that a family can access needed services in a timely manner and receive appropriate follow-up increases. Responsibility rests with organizations such as the First Nations and Inuit Health Branch of Health Canada to influence policy and funding to create the intersectoral partnerships necessary to impact both proximal (or immediate) and more distal (or environmental) determinants.

Among critical determinants of life outcomes, healthy child development is widely recognized as one key determinant of a person’s future health. Many cultures, including Indigenous cultures, have long held a holistic concept of wellness that includes the spiritual, mental, physical, and emotional wellness of all family members within a healthy ecological system. This holistic view strongly supports embedding early childhood development programs with service hubs that can address both the needs of young children and their primary caregivers in their home and community environments. One study in this project area by Dr. Ken Moselle and Jessica Ball synthesized research findings to show that knowing one's mother tongue and one's cultural traditions contributes to child health outcomes.

Project outcomes

Projects within this area have advanced the conceptual rationale for multi-service hubs and offered evidence of how and where they can be effective. Projects have

Underscored a view of health as multiply- and often over-determined by proximal and distal factors
Illustrated how cluster analysis of research findings about the ecological embeddedness of focal health problems facing a particular population of children (e.g., Indigenous children) can help to identify a select number of determinants that must be targeted in order to promote health and prevent chronic disease
Shown that efforts to intervene before the problems have become entrenched or clinically irreversible would, of necessity, need to reach back into the period of early childhood development (including the prenatal period). Health antecedents can be placed meaningfully on trajectories that trace back to the period of early childhood.
Identified key components of a 'complete' set of programs that would address the clusters of determinants that over-determine the emergence of a constellation of health issues in a particular population (e.g., Indigenous children)
Set out parameters for integrated and intersectoral strategies for health promotion and chronic disease prevention within First Nations and Inuit contexts
Discussed promising practices and models, highlighting key components for successful implementation.

In one project, conducted by Dr. Ken Moselle and Jessica Ball for the Healthy Child Development Program of Health Canada, it was found that many of the proximal factors affecting key health issues for Indigenous children could be addressed in existing programs, but these programs need to be integrated and coordinated. Analysis of the objectives, essential components, and service recipients of existing programs for children and families can overlapping program targets, service recipients, and professional roles, pointing to where integration might be achieved.

Early childhood programs as 'hook & hub'

Although integration and inter-sectoral coordination involving Indigenous early childhood development programs are not yet prevalent, some First Nations communities have demonstrated novel approaches to bringing multiple programs and services together. By forging collaborative relationships among practitioners and administrative staff of different types of services, communities have both physically (in the same facility or nearby) and virtually united diverse support services.
One seminal study in this project area documented how three First Nations constructed their hubs with programs for babies and a community kitchen for Elders at the centre, as a ‘hook’ to bring families into a safe space, and then gradually added programs and services as community members became receptive and funds became available. This became known as the “hook and hub” model. Programs such as Aboriginal Head Start can also serve as focal points for coordinating the broader system of health and community programs. 'Inter-sectoral' and 'integrated' approaches can also optimize requirements for cultural safety and have various capacity development and motivational impacts on communities.

Reports

View all reports and resources related to this project.