Methods

A survey of providers was used to identify programs, services, and resources for positive parenting in the KFL&A area. A questionnaire developed by the Region of Waterloo Public Health8 (Appendix B) was used with permission as the survey tool. Items were edited to adapt them to local circumstances, and to the framework for the environmental scan. The survey sought to identify and describe all of the programs, services, and resources from organizations identified as meeting the following criteria:

1. Providing services to children between birth and 18 years of age, or parents in the prenatal period,
2. Operating in the public or private sector, including those that provide therapeutic or health-related services, and
3. Known or thought to provide activities identified by the framework defined for this scan (Section 1.3).

Such programs, services, and resources are defined in this scan as activities. An activity was considered to be any planned process linked to resources and intended to achieve a change or outcome in an intended population.

For each positive parenting activity identified by respondents, the questionnaire asked: name of the activity, elements of positive parenting addressed, intervention strategies, mode of delivery (individual, group, or self-directed), how the activity was led, target group, area served, cost, collaboration with other organizations on the activity, and drivers that informed the development of the activity.

Organizations surveyed

A preliminary list of organizations was generated by the KFL&A Public Health Parenting Working Group. Member agencies of the KFL&A Child & Youth Services Planning Committee and of the Parenting Alliance were added, as appropriate. To identify additional organizations, the 211ontario.ca program inventory website was searched for services in the KFL&A area, using the term "parenting". The resulting list of organizations was reviewed for completeness by the Family Health Division and School Health Team Parenting Working Group, and by management in the Family Health Division. Executive members of the Child & Youth Services Planning Committee were asked to review the list and suggest changes or additions. The list of 126 organizations invited to take part in the survey is in Appendix C.

Survey administration

The survey was conducted online using FluidSurveys between February 4, 2013 and March 11, 2013. The chief executive officers or directors of the agencies selected to be part of the survey were called by phone and asked for the contact information of the person in the agency best suited to complete it. The identified contact person was sent an invitation email with a link to the online survey (Appendix D). Two reminder notices were sent to non-responders and responders with incomplete surveys at one-week intervals (Appendix E). Up to three phone calls were made to non-responders.

Ethical Considerations

The data collected in this scan were related to the provision of service only. Responses were identified by agency. Participation in the survey was voluntary. The project underwent internal scientific review as required by KFL&A Public Health Policy & Procedure IV-600.

Inventory and description of resources

An inventory was designed to meet the first research question, and provide a record of the positive parenting programs, services, and resources which currently exist in KFL&A for parents of children prenatal to 18 years.

Selected data on the activities identified in the survey were imported into a MS Excel spreadsheet and formatted for use as a resource inventory by stakeholders. The inventory lists the following information for each activity: sponsoring agency, activity name, elements of positive parenting addressed, population health strategies used, age range of children served, cost, and whether the activity is offered in collaboration with other agencies.

Each activity was assigned a number to represent it in subsequent tables and analyses. Where the same activity was provided by more than one agency, the number remained the same but a letter was appended to designate that it was a shared activity. Keys to the assignment of numbers to activities are provided in Appendices F and G.

Gap analysis

The second research question aimed to assess the extent to which existing programs, services, and resources support a comprehensive population health approach to positive parenting, thereby identifying and describing apparent gaps. This question was refined by asking three more specific questions.

Objective 1: Which strategies and elements of a comprehensive approach to positive parenting are covered, how and to what extent?

The five strategies to positive parenting are defined in Section 1.3. The frequencies of activities in each age group and using each strategy were tabulated. A subsequent table was created to cross-tabulate the five strategies by age group. Using the numbers assigned in Appendix G, activities were entered into the cell appropriate to the strategy used and the age range of the children targeted by the activity. Inspection of the table revealed whether there were any empty cells, which would represent a strategy and target group for which no activities existed.

The six elements of a comprehensive approach to positive parenting are defined also in Section 1.3. The frequencies of activities incorporating the elements were tabulated. A subsequent table was created to cross-tabulate the six elements by age group. Using the numbers assigned in Appendix G, activities were entered into the cell appropriate to the element included and the age range of the children targeted by the activity. Inspection of the table revealed whether there were any empty cells, which would represent an element and target group for which no activities existed.

To provide further description of the scope of services and access to them, additional analyses were done as follows: costs associated with activities using individual intervention or parent skills training strategies, training or professional status of leaders of positive parenting activities, impetus for the development of positive parenting activities, and media channels used for the parent information campaigns. Frequencies or cross-tabulations, as appropriate, were done to present these results.

Objective 2: Which priority populations are covered by activities for each population health approach?

A final list of priority populations was created by combining priority populations (target groups) identified by the responding agencies with those drafted by the KFL&A Public Health Child Health team during the development of this project. A table was created to cross-tabulate priority populations by age group for each of the five population health strategies. Activities were grouped by population health strategy, which determined the appropriate table. Within the table, activities were entered into the cell appropriate to the priority population and the age range of the children served, using the numbers assigned in Appendix G. Inspection of the five resulting tables revealed whether there were any empty cells, which would represent a priority population and age range for which no activities existed.

Objective 3: Are positive parenting activities located where those who need them are?

Proximity to need implies that positive parenting activities are located in areas in which the priority groups they target live.

The following hypotheses were developed and were considered testable through mapping:

• Children generally at increased risk can be identified through the Early Development Instrument (EDI). This measures children's readiness for learning at school in relation to developmental benchmarks. There are five general domains: physical health and well-being; social competence; emotional maturity; language and cognitive development; and communication skills and general knowledge. Activities will tend to be located where EDI scores show greatest vulnerability.
• Programs which target low income families should be located in areas of greater social and material deprivation.

These maps were created through GIS mapping. Assessment of proximity to need was done by inspection of the results.