2015-16 CAPC—CPNP and Associated Activities Evaluation

The 2015-16 CAPC-CPNP and Associated Activities Evaluation, completed in March 2016 covered the Community Action Program for Children (CAPC), Canada Prenatal Nutrition Program (CPNP) and associated activities for the period from April 2010 to March 2015. The evaluation was undertaken in fulfillment of the requirements of the Financial Administration Act (FAA) and the Treasury Board of Canada's Policy on Evaluation(2009).  The President of the Agency approved the final Evaluation report, along with a management response and action plan, in March. These have now been posted on the PHAC website and can be accessed here.

We report here on key elements of the Executive Summary of the Evaluation Report.

The purpose of the evaluation was to assess the relevance and performance of the CAPC, the CPNP and associated activities within the Public Health Agency of Canada (Agency).

The evaluation focused on activities funded under the CAPC and the CPNP as well as maternal and child health knowledge development and exchange activities under the Centre for Health Promotion. It also covered the Agency's role in a variety of associated activities.

The Agency, through the Health Promotion and Chronic Disease Prevention Branch, conducts a range of maternal and child health activities that focus on upstream prevention, looking at common risk factors related to health disparities. The Agency provides national leadership on key maternal and child health issues, with particular emphasis on addressing the needs of vulnerable populations through the following activities: community-based programming, knowledge development and exchange, and surveillance.

All activities are undertaken in collaboration with partners in other government departments, the provincial and territorial governments, the academic community, non-governmental organizations, and local community-based organizations.

The Agency allocated approximately $90 million for these activities in 2014-2015. Over the five-year period covered by this evaluation (April 2010 to March 2015), expenditures for all program activities totaled approximately $450 million.

CONCLUSIONS—RELEVANCE

1. Continued Need

The Evaluation demonstrated that CAPC, CPNP and associated activities continue to be relevant programs and activities in Canada as many threats to maternal and child health in Canada persist. Conditions of risk (such as low income, low education, Indigenous status, single parents, recent immigrants and teen parents) can negatively impact the health and wellbeing of families. The Agency investments in the CAPC, CPNP and associated activities support the services/programs, and associated partnerships, and knowledge development and exchange, related to the needs of these at-risk families. Research in population health indicates that these types of upstream investments in children early on in life have the greatest potential for improving their health and wellbeing in the future.

1. Alignment with Government Priorities

The report found that CAPC, CPNP and associated activities continue to be relevant in their contribution to the priorities of the Government of Canada and the Agency. These investments reduce health disparities for at-risk mothers and children and strengthen public health, thereby contributing to the overall Government of Canada priority to safeguard Canadian families and their communities. This priority is mirrored in various Agency planning and reporting documents. The CAPC and CPNP are part of the means by which the Government of Canada fulfills its international commitments to the United Nations Convention on the Rights of the Child and the Millennium Development Goals.

1. Alignment with Federal Roles and Responsibilities

The report found that it is appropriate for the federal government and the Agency to continue to administer its maternal and child health programs and associated activities. Existing legislative and program authorities speak to the federal role and provide the Agency with a mandate to provide national leadership, engage in surveillance, and share knowledge and best practices. While provinces and territories have the primary responsibility for maternal and child health, the Agency's role is complementary as the Government of Canada is playing a supporting role where there is a demand to: address an issue of national scope, fill gaps for a vulnerable population, and complement provincial and territorial directions.

CONCLUSIONS – PERFORMANCE

1. Achievement of Expected Outcomes (Effectiveness)

The report concluded found that, for CAPC and CPNP funded organizations, community partnerships have led to enhancements in program delivery with participants having greater access to local health and social service networks. Investments in maternal and child health have led to multi-sectoral and multi-jurisdictional partnerships that, in turn, have facilitated the design and dissemination of various valuable knowledge development and exchange activities. In collaboration with stakeholders, a variety of knowledge products to address gaps in community-based resources have been designed and developed through the Division of Children and Youth or DCY (formerly known as the Division of Children, Seniors and Healthy Development). There is an opportunity to formalize a strategic plan to continue to ensure complementarity with resources for health professionals and parents produced by other stakeholders and to optimize limited knowledge development and exchange resources.

The report also noted that a significant proportion of families reached by the CAPC and CPNP funded organizations are living in conditions of risk and many are affected by multiple risks. The proportion of vulnerable individuals represented among participants exceeds the rate at which these populations are represented in the general population. An analysis of qualitative data collected from participants and funded organization staff indicates that the CAPC and CPNP funding has contributed to organizations having a positive impact on the short-term health and wellbeing of participants and their families. However, it was noted that the mix of funded organizations for the CAPC and CPNP has been stable over the last twenty years or so and there are potential gaps in terms of program reach (geographic distribution, wait lists, etc.) and that there may be further opportunities to analyse a variety of data sources to explore gaps and optimize program reach.

1. Demonstration of Economy and Efficiency

An assessment of the economic impact of the CAPC and CPNP demonstrated that funded organizations have successfully acquired additional funding and in-kind resources through their relationships with other partners. Through relatively small Agency investments to engage strategic partnerships with external stakeholders, the JCSH, HBSC survey, the CPSS and the CPSP have produced significant knowledge development and exchange products.

The report noted that the recent centralization of the administration and management of the CAPC and CPNP has allowed the Agency to gain efficiencies. Realigning the management of the programs has led to the streamlining of governance structures and internal processes, such as performance measurement. There is a current performance measurement strategy for the CAPC and the CPNP and efforts have been made to collect performance data across all program areas. Data collection tools and approaches have been refined over time to reduce the reporting burden on the stakeholders.

RECOMMENDATIONS

Recommendation 1

Recognizing that many players have a role in developing and disseminating knowledge products on maternal and child health in Canada, formalize and implement a knowledge development and exchange strategic plan to ensure complementarity and optimization of Agency resources.

Recommendation 2

Review demographic data (including GIS data) to better understand population trends and changes and explore opportunities to optimize program reach.

Cindy Grewal Blaison, PHAC Senior Program Officer, Western Region, reports that work has begun on both of these recommendations and that more information about these projects will be available in the near future.

2015 CAPC and CPNP Participant Surveys

To support the Evaluation process, the Public Health Agency of Canada (PHAC) conducted participant impact studies of randomly selected participants in both the CAPC and CPNP programs throughout Canada.

More than 223,000 parents, caregivers and children participate in the Community Action Program for Children (CAPC) every year at one of the 415 projects across Canada, and more than 51,000 participants the Canada Prenatal Nutrition Program (CPNP) at one of the 280 projects across Canada.

In the two studies, both CAPC and CPNP were found to have a positive impact on the development of knowledge, skills and positive health behaviours of the parents/caregivers and children who attend.

The CAPC Parent/Caregiver Study and the CPNP Participant Study were conducted by PHAC to examine the following questions:

• What is the demographic and risk profile of CAPC/CPNP respondents in this study?
• To what extent have respondents and their children gained development in knowledge, skills and health behaviours to support maternal, child and family health (CAPC)/maternal and infant health (CPNP)?
• Are improvements in knowledge, skills and health behaviours related to the level of participant exposure to the program, demographic characteristics, or the types of CAPC/CPNP services received?
• To what extent are CAPC/CPNP projects implementing practices to help parents and children feel welcomed and respected?

To answer these questions, a paper-based, self- administered survey was completed by:

• A sample of primary caregivers in select CAPC projects during a one- month period (May 2015). Outcome areas examined by the survey included:
  • Parenting Knowledge and Skills;
  • Parent Support;
  • Child Knowledge and Skills; and
  • Experience with the Program
  • A sample of prenatal and postnatal participants in CPNP projects during the same month (May 2015). Outcome areas examined by the survey included:
    • Nutrition and Healthy Eating
    • Prenatal Health
    • Baby Care
    • Parent Support
    • Experience with the Program

Sixty-two (62) randomly selected CAPC projects across Canada participated in the study.

Surveys from 1,387 respondents were included in the analysis related to the parent/caregiver outcomes and 1,043 surveys were included in the analysis of the child outcomes.  The CAPC program was found to be having a positive impact on the development of knowledge, skills and positive health behaviours.  CAPC respondents report improvements in their own knowledge, skills, support and confidence, as well as improvements to their children’s social and emotional skills, language and literacy, and skills related to their health and wellbeing.  By helping participants improve their knowledge and skills, and in promoting the adoption of positive health practices, CAPC is contributing to the health and well-being of vulnerable children and their families. Detailed findings can be found here.

Ninety-four (94) randomly selected CPNP projects across Canada participated in the study.  Surveys from 1,792 respondents were included in the analysis.  The CPNP program was found to be having a positive impact on the development of knowledge, skills and positive health behaviours to support maternal and infant health.  Program participants with certain demographic characteristics tend to benefit more from participating in the program and the full range of programs offered by CPNP is helping to ensure participants receive the knowledge, skills and support they require. For the full report click here.