Page 9 : Evaluation of the Aboriginal Head Start in Urban and Northern Communities Program at the Public Health Agency of Canada

Appendix B. Case studies

Purpose of the case studies

Between October and November 2011, 13 case studies were conducted to collect community-level information about the implementation and impact of the AHSUNC. A complete technical report on the case studies, which contains the detailed analysis that led to the results presented in this summary, is available upon request from the Public Health Agency’s Evaluation Services (evaluation@phac-aspc.gc.ca).

Methodology

Approach

A case study approach was selected because of its potential to provide insight into how this program is delivered in a variety of community settings.

Selection criteria for AHSUNC Sites

Sites were invited to participate based on their geographic characteristics (isolated, rural, remote and urban), the Aboriginal populations they reached (Inuit, Métis and/or First Nations) and by the Public Health Agency Region in which they are located.

The following methods were used to collect data at participating sites: site document review, Public Health Agency file review, on-site observations, site coordinator interviews (10 semi-structured interviews), teacher interviews (10 semi-structured interviews), parent questionnaires (101 responses) and parent group interviews at three sites (three semi-structured group interviews).

Selection criteria for non-AHSUNC sites

To provide contextual program information, a selection of non-AHSUNC early childhood programs were visited in British Columbia, Alberta and Nova Scotia. These sites were selected in consultation with regional Public Health Agency staff. Selection criteria included: (1) available to provide service to Aboriginal children aged three to five years, (2) provides Head Start and/or early child development programming and (3) does not receive AHSUNC funding.

Non-AHSUNC site data sources

Data collected from non-AHSUNC sites included interviews with the site coordinator (N=3), teachers (N=3) and in two cases, observation of the program.

Summary of main findings from the case studies

Six program components

Six components guide AHSUNC program implementation. The six components provide an orienting framework upon which local sites build. Each component was demonstrated to varying degrees at each site.

• Despite challenges to implementing the language and cultural component, this component is implemented at every site and highly valued by parents.
• Parental involvement varies across the sites. A few sites have parent councils that direct the program. Sites without a parent liaison worker describe this component as more challenging to implement than those with such a worker. Most parents did not describe the impact of the program on themselves as parents.
• Education and school readiness is a clear focus of every site and a wide range of school readiness programming was observed and described by parents, teachers and coordinators. Support for curriculum development and meeting the needs of children with special needs are two areas that seem to be a challenge for several sites.
• The nutrition component was observed and described at each site. In many cases, this extends beyond provision of food to nutrition education and referrals to food sources.
• The sites offer social support to children and their families in several ways, however, this is not currently tracked or measured.
• The sites are engaging in two health promotion strategies: (1) creating supportive environments and (2) developing personal skills. There is less evidence that the projects have engaged the remaining three health promotion strategies, namely (1) building public health policy, (2) strengthening community actions and (3) reorienting health services.

Factors for successful delivery

Several factors were identified across cases that seem to contribute to successful delivery, namely: stable staffing, low cost, transportation, alignment with local schools, operating as a hub and scope for innovation within the six components.

Main challenges that sites face

Staff and parents identified several challenges to program delivery, including funding levels, limited hours of programming and enrolment.

Lessons on the impacts sites may be having on individuals, families and communities

Information from the sites suggests that several dimensions of individual and community capacity are being strengthened. In addition, some areas for further measurement or strengthening were observed.

Parent participation is well supported and leadership development opportunities are available. The sites appear to have less reach to the broader community, including Elders.

Skills development of staff and children were described extensively, ranging from personal health knowledge to school readiness. At a few sites, parents described gaining an increased awareness of their child’s needs, increased confidence and new friendships. Hiring parents to become teachers was an important theme in several communities that illustrated the transformative potential of the sites.

Some leveraging of funds has contributed to wage enhancements or supplies at half of the sites. In-kind contributions from local public health authorities, schools and Aboriginal organizations also form an important support to the program. Leveraging of knowledge at the regional level is supported by Public Health Agency staff and through provincial meetings, however, there was interest in an increase in knowledge exchange across the country.

Formal links to Public Health Agency programs did not appear present at most of the sites. All of the sites had formal links with the local public health authority. This was described as having many benefits for the AHSUNC children such as provision of vision, hearing and dental screening, as well as information and teaching related to injury prevention and nutrition. The next most common link has been with municipal governments or self governing Aboriginal organizations.

Limited links were observed with post secondary research institutions, corporate organizations, philanthropic organizations, provincial or federal early child development initiatives or service providers.

By design and intent, the program is a form of action on several determinants of health, such as personal health practices, culture and early child development. While it is not clear whether the sites routinely support families or other community members’ assessments of root causes, a few sites are advocating changing systemic barriers that they have observed families facing.

Conclusions from the case studies

Reflecting on the main findings, what are their implications for the overarching program evaluation, of which these case studies are one component?

1. Sites are a platform that responds to multiple Public Health Agency priorities.

Each site demonstrated that they were actively integrating the Public Health Agency priorities of reducing health disparities by acting on the determinants of health, injury prevention, healthy eating, active living (obesity prevention), mental health promotion and basic public health practices such as hand-washing and tooth brushing.

2. Mechanisms are in place to support information exchange among sites in each region, however links to other early child education programs are less common.

Integration with provincially run early child development programming and Health Canada’s Aboriginal Head Start On-Reserve program and links to training and research institutions, could increase the reach and influence of AHSUNC and also enrich AHSUNC sites (e.g. through access to funding, curriculum supports and knowledge exchange). However, the lack of formal networking between most AHSUNC sites and provincially funded early child development programs and the Aboriginal Head Start On-Reserve program suggests that there is potential for greater synergy among federally, provincially, territorially and municipally funded programs. There is potential for AHSUNC sites to influence other programs that might reach Aboriginal children. Conversely, there is potential for AHSUNC sites to learn from non-AHSUNC sites, for example about trends in program delivery, curriculum development, governance and fundraising.

3. Challenges with enrolment and parent feedback suggest that there may be value in revisiting the design of the program as demographics and family needs may have shifted since the program was first introduced.

The case studies did not include interviews with Aboriginal families that have chosen not to enrol their children so it is difficult to understand why the sites were not full. This is an area that warrants further study.

4. Program performance tracking should be broadened to periodically assess the program’s impact longer term outcomes.

While projects described a variety of methods in place to track children’s progress, there was less information about how the projects are reaching and impacting parents and the broader community. Individual and community capacity building, knowledge development and exchange and social support seem to be important dimensions of the program that have received limited attention in performance tracking.