By Minister Tim Sale

As public policy makers, we continually strive to develop policy approaches that will best serve the public – both individuals and families in need, and society as a whole. In the social policy field, we have seen many changes over the last 10 to 15 years, such as the movement from a "handout" to more of a "hand up" approach. But most social policies are still developed within bureaucracies, the result being relatively rigid programs that require individuals to "fit" the program parameters, rather than the converse.

The reality, of course, is that people’s life experiences vary widely, so as social policy makers we are striving towards a more socially inclusive policy approach – one which appreciates and respects various life experiences and the different responses individuals and families will have to social programs. The development of this new approach is not only to help ensure social inclusion for all citizens, but also to provide people with the opportunity to help influence the development of programs and services that will best meet their needs.

In Manitoba, the centrepiece of our Government’s social policy is a child-centred framework, founded on the concept of social inclusion and the integration of economic justice and social justice for all families. To advance the integration of these two pillars of justice and enhance support to children, youth and families, a Healthy Child Committee of Cabinet was established in March 2000.

The committee is comprised of the following Ministers: Energy, Science and Technology (Chairperson); Family Services and Housing; Health; Justice and Attorney General; Aboriginal and Northern Affairs; Status of Women; Education and Youth; and Culture, Heritage and Tourism. Under the direction of this inter-departmental cabinet committee and a corresponding Deputy Minister Committee, Healthy Child Manitoba implements Manitoba’s child-centred policy within and across departments.

Healthy Child Manitoba’s vision is to achieve the best possible outcomes for Manitoba’s children. Guiding principles that underlie this initiative include the development of programs that are community-based and inclusive – two principles that are fundamental to the success of every program.

The objectives of Healthy Child Manitoba are to:

• Develop, fund and evaluate innovative initiatives and long-term strategies to improve outcomes for Manitoba’s children;
• Coordinate and integrate policy, programs and services across government for children, youth and families using early intervention and population health models;
• Increase the involvement of families, neighbourhoods and communities in prevention and early childhood development services through community development; and,
• Facilitate child-centred public policy development and knowledge exchange across departments and sectors, through evaluation and research on key determinants and outcomes of children’s well being.

In recognition of the critical early years in a child’s life, the priority focus is on the period from conception through infancy and the preschool years. We know that the first five years of life represent the most rapid period of growth and learning that a human will experience. As such, this stage provides a unique window of opportunity to do "the right stuff." By focusing investment and support on this period, governments have the opportunity to affect both immediate benefits to children and long-term benefits to society. Manitoba’s commitment to early childhood development is demonstrated by our increased investment in this area – $40 million since April 2000. And while our government is prioritizing investment in these early years, it is also forming partnerships with many non-profit agencies and foundations to help build a provincial culture that puts children and families first.

Perhaps the program which best demonstrates the social inclusion approach is our Healthy Baby program. Under this program, the Manitoba Prenatal Benefit is available to all eligible pregnant women in the province, including First Nations women on reserve. This benefit provides up to $80 per month to assist low-income women to meet their nutritional needs during pregnancy. The second component of Healthy Baby, the Community Support Programs, provide pregnant women and new mothers with an informal, supportive learning environment. These programs are developed to suit local community needs and often include such things as nutritional counselling and information about breast-feeding, parenting, child development and community supports.

Our FAS Strategy promotes healthy lifestyles for pregnant women through education and public awareness campaigns. The Strategy also includes the STOP FAS program for women struggling with addictions and motherhood. This one-on-one mentoring program is based on a best practice model and is delivered through community health organizations. A central feature of the program is that the mentors are community women who themselves have faced significant life challenges and who, through extensive training, are prepared to mentor women at risk. The successes of the program have resulted in services being expanded in Winnipeg and Northern Manitoba. The FAS Strategy also provides funding support to community organizations that work with and advocate for families with children with FAS.

The Parent-Child Centred Approach brings together parents, community organizations, school divisions, and health professionals in coalitions to support parenting, improve child nutrition and literacy, and build capacity to help families in their communities. To date, 26 Parent-Child Centred Coalitions have been established across the province. Each coalition determines the unique form their activities will take, based on the needs of their region. Activities may include home visiting programs, family resource centres, parenting programs, and mobile toy or book lending services.

An excellent example of building community capacity is the Winnipeg area of River-East, where Community Connectors have been hired from the school neighbourhood to liaise with families to assess individual and community needs. The Connectors are trained in outreach services, literacy, diversity issues, group facilitation skills, and community resources.

It is important to acknowledge that the Parent-Child Centred approach and the building of parent-child coalitions involve challenges: reaching the grassroots, involving the most at-risk populations, and breaking down cultural, social, economic, and geographic barriers. It is equally important to note, however, that in meeting these challenges we create new allegiances in communities and draw in stakeholders who were formerly excluded. The result is more effective programming to meet local needs.

Community supports to families with young children are also provided through home visiting programs. BabyFirst is a community-based intervention delivered through the regional health authorities which, through the use of a universal screening process, identifies families in need of significant parenting support. These families are offered the support of a home visitor or "mother mentor" until the child reaches age 3. These mentors are paraprofessionals who establish trusting and nurturing relationships with the parents to help them with the fundamentals of caring for a new baby, developing new family routines, positive parenting and problem-solving skills, and accessing community resources. The mentors strive to build the parents’ confidence and abilities in order to achieve the best outcomes for the child.

Further along the continuum of services to young children is the Early Start program. Similar to BabyFirst, Early Start offers home visiting support to families with preschool-aged children attending daycare. In 25 daycares around the province, Early Start workers are available to visit families to provide support and information about parenting skills, accessing community resources, and increasing their children’s school-readiness.

Research results have demonstrated positive outcomes for both home visiting programs, including improvements in parents’ ability to provide more nurturing and stimulating environments. In 2002/03, three regions in Manitoba are pilot-testing an integrated BabyFirst/Early Start home visiting model.

The cornerstone of Manitoba’s child-centred public policy is that of quality child care. In many ways, quality child care represents social inclusion at its best by providing a universal, stimulating, educational and safe environment. And while all children can benefit from quality child care, research has shown that it is children in families with the fewest resources and under the greatest stress who will benefit the most. Manitoba is currently implementing a Five Year Plan for Child Care, based on a report by a regulatory review committee and feedback from over 24,000 Manitobans.

As indicated earlier, the focus of Healthy Child Manitoba has been on children in the preschool years. There is, however, recognition of the importance of supporting children in the middle and adolescent years as well. Healthy Schools bridges health and education in a Healthy Schools-Healthy Communities model to improve the wellness of children and families. This model is being further refined through consultations with regional health authorities and school divisions, and funding will be provided to projects that demonstrate broad partnerships and community involvement.

Healthy Child Manitoba has also been working with Manitoba Education and Youth to develop a strategy for Healthy Adolescent Development. Directed at youth aged 12 to 19, the strategy has the prevention of teen pregnancies as one of its primary focuses. A new initiative under this strategy is the establishment of a teen health clinic located within a high school in a Winnipeg area with high teen pregnancy rates. The clinic provides after-hours primary health care to local youth.

In addition to the programs outlined above, Healthy Child Manitoba also includes a Community Capacity Fund that provides funding to smaller community projects that are expected to have lasting effects. One example of such a project was Building Towards Inclusion – a "train the trainer" project to build a cadre of volunteers who can assist organizations to ensure that all their programs provide inclusive environments for children with mental disabilities. Among other projects supported through this Fund are the nationally recognized Roots of Empathy program and the health clinic for teens mentioned earlier.

Healthy Child Manitoba has also established a Provincial Research and Evaluation Strategy which includes program evaluations, partnerships for population-based research, specialized evaluations, and community capacity building and knowledge exchanges. As part of our commitment to a socially inclusive approach, what we learn from this research and evaluation, we share with the community, and in turn, the needs of the community influence the research agenda for Healthy Child Manitoba.

Key Lessons

Through all that we have done and are doing in Manitoba to help support children and families, we have learned some key lessons:

• Intersectoral work is complicated and challenging for public servants, but community development work is even more complicated and challenging for community representatives, many of whom are also working and parenting.
• Community development and the building of inclusive models takes time, patience and constant reinforcement.
• Process is as important as a final product. Don’t wait to "be finished" – celebrate process!
• Those with the greatest needs have the greatest barriers to their involvement, so support them!
• Time, support, and patience creates movement;
• Movement creates momentum; and
• Be ready for it…because momentum creates advocacy!

Whether as parents, community members, researchers, public servants, political leaders, or all of the above, we are all members of our society and are therefore responsible for building a province which gives each of our children the best future possible. As our understanding of human development continues to evolve, we will continue to change and adapt our policy approaches to better support children and families to be the best they can be. However, in our efforts to "do the right things," we must not lose sight of the fact that those who know best how to achieve that goal are not only found in the hallways of government buildings, but also in community centres, neighbourhood clinics, parent/teacher associations and private living rooms.

Tim Sale is currently the Minister of Energy, Science and Technology with the Manitoba Government. As the former Minister of Family Services and Housing, he was asked to chair the Health Child Committee of Cabinet. He has retained this role in his new portfolio, thereby linking the needs of the province in the future with the development and well-being of its youngest citizens today.

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