Page 5: Evaluation of the Aboriginal Head Start in Urban and Northern Communities Program at the Public Health Agency of Canada

2. Background and context

This section provides a description of the mandate, activities and resources of the AHSUNC program within the Public Health Agency.

2.1 Connection between early childhood development programming and health

Evidence shows that early childhood development programs focusing on the cognitive, language and social skills of children from birth to six years can contribute to optimal development of children with respect to school readiness, academic performance and employment prospects later in life. Research demonstrates long-term returns on investments made in the early childhood years, particularly in the education, employment, health care and justice systems. Early childhood development programs with the greatest success focus not only on the academic and cognitive skills, but also on skills related to: forming self identity, learning through play, experimentation and group activity, learning how to learn, learning self-motivation and learning social skills.^{Footnote 33} Importantly, in the lifecycle of learning and skills development, the development of cognitive and non-cognitive abilities go hand in hand with one providing the basis for further development of the other^{Footnote 44}.

Figure 2 presents a diagram of the impact of early childhood development programs on cognitive development, social skills, health and families. It explains how programs addressing these areas can impact on future health, educational and social outcomes. ^{Footnote 55} The AHSUNC program shares similar objectives.

Figure 2: A model of impacts of early childhood development programs

Source : Anderson 2003

In addition to building on current evidence in early childhood development, AHSUNC brings special focus to the importance of culturally relevant programming for Aboriginal children and communities. An effective community-based approach responds to local needs and builds on local strengths. Aboriginal children face unique circumstances that put them at higher risk for health and social problems later in life. Effective programming must be tailored to their unique cultural and historical context. Margo Greenwood (2005), the Academic Lead of the National Collaborating Centre for Aboriginal Health, describes this interplay between early childhood development, culture and health:

Therefore AHSUNC takes a population health approach, embracing culture as a core determinant of health.

2.2 Overview of the AHSUNC program

Program profile

The AHSUNC program is an early childhood development initiative for Aboriginal preschool children and families living off-reserve. Through contribution funding provided by the Public Health Agency, Aboriginal community organizations design and deliver holistic programs to enhance the spiritual, emotional, physical and social well-being of Aboriginal children under six and their families. The program targets three distinct groups of Aboriginal people living in urban and northern communities: First Nations living off-reserve, Métis and Inuit. The AHSUNC program is delivered through the Public Health Agency’s Regional Operations by way of contribution agreements with project recipients, which are typically Aboriginal organizations.

The AHSUNC program began in 1994-95 and was initially designed as a four-year pilot program. It was renewed as an ongoing initiative in 1999-2000, with annual A-base funding of $24 million. Since then, it has received several increases focussed on time-limited enhancements and currently runs on $36.3 million of A-base funding plus $5 million of time-limited funding that is due to expire in 2014-15.

The AHSUNC projects run free of charge to participants and are typically centre-based preschool programs for three- to five-year-old children, running three to four half-days per week, nine months per year, between September and June. Some sites also provide programming for younger children, from zero to two years of age. Within the centre-based programming model, an educator provides structured early childhood development activities to children in accordance with the six components of the program (health promotion, nutrition, education, Aboriginal culture, parental involvement and social support). Nutritious snacks and/or meals are provided to the children each day. A standard curriculum does not exist at the national level, so educational activities are designed at the site level and vary across the country. Sites operating centre-based programming must, in most cases, be licensed by their provincial/territorial jurisdiction and must therefore maintain the correct number of certified early childhood educators and ratios of teachers to children.

In addition to centre-based programming, there are a number of other models used within the program. Some sites offer a home visiting component, whereby project staff will visit families in their homes, providing information and counselling to parents, and educational activities for children. Other program activities include workshops and skill development sessions for parents, joint parent and child workshops and special cultural events and activities for families.

There are several distinct features of the AHSUNC program.

• It is intended to reach vulnerable populations of Aboriginal children most at risk for poor early childhood development outcomes.
• It targets not only children, but also their families and communities.
• There is a strong emphasis on parental involvement in the program. Parents are recognized as the primary and most influential teachers in a child’s life and the intent is that they are integrated into all components of the program (planning, implementing and participating in program activities). A parent advisory council plans and oversees activities within most sites.
• Aboriginal culture and language are woven into the design and delivery of the program. The program is based on a holistic model that recognizes the multi-dimensional aspects of well-being for Aboriginal children.
• To the greatest extent possible, project staff is hired from within the Aboriginal community.
• There is strong pan-Canadian consistency in program design. Each project must incorporate six core program components (health promotion, nutrition, education, Aboriginal culture, parental involvement and social support) into its program design. Each project must also adhere to the following set of national guiding principles.
  1. Support the spiritual, emotional, intellectual and physical growth of each Aboriginal child.
  2. Support and encourage each Aboriginal child to enjoy life-long learning.
  3. Support parents and guardians as the primary teachers and caregivers of their children.
  4. Empower parents to play a major part in planning, developing, operating and evaluating the project.
  5. Recognize and support the role of the extended family in teaching and caring for Aboriginal children.
  6. Include the broader Aboriginal community as part of the project throughout all of its stages, from planning to evaluation.
  7. Make sure the project works with and is supported by other community programs and services.
  8. Make sure the resources are used in the best way possible in order to produce measurable and positive outcomes for Aboriginal children, their parents, families and communities.
• Within the context of this pan-Canadian consistency, projects are locally tailored to the needs and assets within their communities. This approach enables projects to adapt to and address the unique circumstances of their community.
• The program is based on an empowerment model through which local ownership and decision making are encouraged and fostered. This means that the program design is flexible to allow for local recipients to make their own decisions about project governance, management and implementation. This is in keeping with the Government of Canada’s direction to promote self-governance and self-determination among Aboriginal populations.

Theory underpinning the program

Although AHSUNC program documents do not refer to an explicit theory guiding the program’s design, it is well aligned with Bronfenbrenner’s ecological systems theory.

The overall objective of the AHSUNC program is to provide Aboriginal children living in urban and northern communities with a positive sense of self, a desire for learning and opportunities to be successful as young people. In keeping with the ecological systems theory, this is accomplished through targeted activities at three levels: the child; the parent and the family; and the community.

The child

The AHSUNC program aims to expose children to positive early childhood experiences. Through the health promotion and nutrition activities, children are expected to gain knowledge and skill in practicing health-promoting behaviours and eating healthy foods. Through age-appropriate early education activities, children learn the social, emotional, physical and cognitive skills required for an effective transition into the school system. Children participating in the program develop knowledge and pride in their heritage and self-identity through the promotion of Aboriginal culture and language. Through positive interactions with their parents and their educators, children develop a positive sense of self and confidence in their abilities. For children with emotional, social, or physical delays and challenges, the AHSUNC program provides referrals and connections with community resources.

The parent and the family

The AHSUNC program recognizes the strong influence of parents and family on the well-being of a child and targets activities to the parents of children enrolled in the program to help ensure a positive home environment outside the program. Through workshops, training and participation in activities, the goal is for parents to have positive interactions with their children and gain skill in positive parenting practices. It is presumed that these skills will be transferable to other children in the family, fostering a ripple effect from the program into the broader family network. Parents are also expected to gain knowledge, skills and confidence to secure employment and/or further their education. Through referrals and connections with community resources, parents are able to access support for personal challenges affecting the well-being of their families.

The community

The AHSUNC program recognizes that the success of children and their families is influenced by the broader community in which they live. In this context, the program aims to create a responsive and supportive community network for Aboriginal children and their families. This is accomplished by creating partnerships and working relationships with service providers and professionals to increase awareness of the unique circumstances of the Aboriginal families in the community, and to build community policies and structures that support Aboriginal children and their families to achieve health and well-being.

Program governance

The Public Health Agency’s Health Promotion and Chronic Disease Prevention Branch is responsible for AHSUNC programming and budgetary authority, as well as for ongoing monitoring of accountability and financial administration.

Within the Health Promotion and Chronic Disease Prevention Branch, responsibility for the AHSUNC program is divided between the Centre for Health Promotion and Regional Operations. The Division of Childhood and Adolescence within the Centre for Health Promotion provides support to the Aboriginal Head Start sites, including training, national coordination and national communications and networks. It also provides secretariat support to the National Aboriginal Head Start Council.

Regional Operations administers the AHSUNC program by way of contribution agreements with project recipients, which are typically Aboriginal organizations. In addition to administering contribution agreements, Regional Operations staff also monitor sites to ensure program quality, performance and financial accountability. AHSUNC regional program consultants provide direct program development assistance to AHSUNC sites and work with provincial and territorial Aboriginal advisory bodies established in each Region to implement and promote AHSUNC. They also coordinate regional training initiatives and support ongoing performance measurement activities. For this evaluation, they also assisted with some data collection activities.

The following structures are involved in the overall governance of the program.

Governance structures composed of Public Health Agency staff

National Working Group

The Public Health Agency National Working Group provides strategic and technical planning for the program. The group has monthly teleconference calls and meets twice a year to discuss programming issues and operational matters and identify possible interventions to address them. The National Working Group consists of national and regional program consultants who administer AHSUNC and a regional children’s program manager.

Aboriginal Head Start Evaluator’s Network

In 2007, the AHSUNC Evaluator’s Network,^{Footnote 1515}a pan-regional and national network of analysts dedicated to performance measurement for the AHSUNC program, was created. The network’s responsibility is to plan, design and implement pan-regional and national performance measurement tools and initiatives to inform senior management and support evaluation. The Aboriginal Head Start Evaluator’s Network also contributes to the dissemination of results emerging from these initiatives. The Aboriginal Head Start Evaluator’s Network consists of national and regional analysts with representation of AHSUNC program consultants and program area managers.

Governance structures composed of Public Health Agency staff and program stakeholders

National Aboriginal Head Start Council

The intended role of the National Aboriginal Head Start Council is to provide a community perspective and a forum for discussion among community representatives and AHSUNC program staff. The National Aboriginal Head Start Council was established to provide advice and expertise on the development of national policies, national-level evaluation, research priorities and other activities relating to the AHSUNC program. The National Aboriginal Head Start Council is made up of AHSUNC community representatives and Public Health Agency staff: the AHSUNC national program manager, a regional manager and a regional program consultant. AHSUNC community members on the National Aboriginal Head Start Council are affiliated with an AHSUNC site, are of Aboriginal ancestry and are elected by provincial and territorial AHSUNC bodies, such as regional advisory committees, to represent them at the national level.

Regional governance structures

At the Regional Operations level, there are governance structures to provide advice on program delivery. Some of these include representatives from provincial and territorial governments and Health Canada’s First Nations and Inuit Health Branch. Each AHSUNC project has a connection to a Regional Advisory Committee and several have a Parent Advisory Council.

2.3 Aboriginal Head Start programs within the Health Portfolio

The Aboriginal Head Start On-Reserve program, administered by Health Canada, First Nations and Inuit Health Branch, is a sister program to the AHSUNC program delivered by the Public Health Agency.

The federal government has assumed responsibility for health and social programs for First Nations people living on-reserve. Off-reserve education and health care services fall within provincial and territorial responsibility. One key difference between the two Aboriginal Head Start programs is that the Public Health Agency funds early childhood development programming for Aboriginal children and their families living off-reserve while Health Canada funds early childhood development programming for Aboriginal children and their families living on-reserve. As such, the Public Health Agency’s AHSUNC program provides specialized programming in areas where other preschool programs are provided for the general population including Aboriginal and non-Aboriginal children.

Similarities between the two Aboriginal Head Start programs delivered by the Public Health Agency and Health Canada include the following.

• Both programs are community-based and deliver services through Aboriginal organizations with priorities determined at a local level.
• Both programs have common objectives, focussing on child health and well-being that extends beyond a school readiness program by providing health promotion programming from a holistic perspective. As well, they share the same six components, including the promotion of Aboriginal culture and language.
• Both programs can be delivered in a variety of settings. Programming can be centre-based, delivered through outreach/home-visiting service, or a combination of the two.
• In both cases, Head Start programming is provided in addition to child care programming that is funded through other programs. In on-reserve First Nations communities, daycare programs are funded through Aboriginal Affairs and Northern Development Canada as well as Human Resources and Skills Development Canada, while off-reserve these are funded by provincial/territorial and local programs.

Differences between the programs include target group, delivery model, funding mechanism, operating environment and funding levels as outlined in Figure 3 below.

Comparing the reach of AHSUNC and the First Nations and Inuit Health Branch’s Aboriginal Head Start On-Reserve program shows that, based on the numbers of young Aboriginal children in 2006 (89,000 off-reserve and 40,290 on-reserve), Aboriginal Head Start On-Reserve reaches a higher proportion in their target group (Figure 4). First Nations children living on-reserve are four times as likely to participate in a federally-funded Aboriginal Head Start program compared with Aboriginal children living off-reserve. As demonstrated in Figure 4, 70 per cent of young Aboriginal children live off-reserve while 30 per cent of young Aboriginal children live on-reserve. In terms of budgets, the AHSUNC program receives 40 per cent of the overall federal Aboriginal Head Start funding, while Aboriginal Head Start On-Reserve program receives 60 per cent.

Figure 4: Comparison of on- and off-reserve Aboriginal Head Start program populations and budgets

Source : Streich 2011

2.4 AHSUNC program budget and resources

The AHSUNC program receives an annual allocation of approximately $41.3 million per year (Figure 5). Of this, $36.3 million is ongoing funding and $5 million is funding which is due to sunset in 2014-15. Details on contribution funding are provided in Appendix D.

From the inception of the AHSUNC program in 1994-95 to 2001-02, it was resourced at $22.5 million per year, and the program reach was approximately 3,200 children per year. In 2002-03, the AHSUNC program received an increase in funding, totalling $36.3 million (a 60 per cent increase). This was the last increase to ongoing project funding to date. Over the next few years, the AHSUNC program reach increased to about 4,500 children per year (an approximate 40 per cent increase). This reach has remained relatively stable over the last five years at an average of 4,640 children per year.

In 2007-08, the program received an additional five million dollars in time-limited funding, bringing the total funding to $41.3 million dollars per year. Due to the time-limited nature of the funding, it was set aside as a separate fund aimed at improving program delivery (e.g. training) and was not used to increase program reach.

Figure 5: Approved annual funding allocations for the Aboriginal Head Start in Urban and Northern Communities program

Source: Public Health Agency, Office of the Chief Financial Officer

2.5 Differences between the federal and provincial/territorial activities in early childhood development

Within Canada there is a wide range of federal, provincial/territorial and local programs and services related to early childhood development for both young and older children. At the provincial/territorial and local level, some of these programs include early childhood education for Aboriginal children. This section outlines the key differences between the federal role and the role of provinces and territories.

Federal government activities

The Government of Canada is involved in the following key activities in the area of early childhood development:

• transfers to provinces and territories
• transfers to individual Canadians
• surveillance
• programming for special populations
• targeted programming within the general Canadian population.

Transfers to provinces and territories

Federal involvement in early childhood development has a long history, going back as far as World War II when the Dominion Provincial Wartime Agreement encouraged provinces to provide care for the children of women working during the war. In 1966, the Canada Assistance Plan was created, allowing the federal government to match provincial and territorial funding for poverty prevention programs, such as child care initiatives for low-income families.

Since the end of the Canada Assistance Program in 1996, the federal government has committed itself to a number of different programs and agreements (listed below) under which provincial and territorial transfers are directed towards early childhood development objectives through block funding under the Canada Social Transfer program. In 2008, approximately $1.1 billion was transferred under these programs.

• Early Childhood Development Initiative (2000). Annual funding is used to provide programs to promote infant and maternal health, improve parenting and community supports and strengthen early learning and child care.
• Multilateral Framework Agreement on Early Learning and Child Care (2003). Funding under this program is focused exclusively on programs for preschool-aged children.
• Child Care Spaces Initiative (2007). This program provides incentives to employers to create workplace child care.

Transfers to individual Canadians

In 2006 the federal government introduced the Universal Child Care Benefit, a monthly cash benefit for parents with a child under the age of six in a household.

Surveillance

The Government of Canada conducts studies to monitor the health and well-being of Canadian children through the National Longitudinal Study on Children and Youth developed jointly by Human Resources and Skills Development Canada and Statistics Canada, and the Aboriginal Children’s Survey.

Programming for special populations

The federal government provides funding for early childhood development programs for Aboriginal populations and populations within federal jurisdiction such as military personnel, federal prisoners, as well as refugees and immigrants to Canada.

Aboriginal populations

Four federal departments deliver early childhood development programs to Aboriginal people: Health Canada, the Public Health Agency, Human Resources and Skills Development Canada and Aboriginal Affairs and Northern Development Canada.

• Public Health Agency
  • The Aboriginal Head Start in Urban and Northern Communities program, to First Nations off-reserve, Métis and Inuit in urban and northern communities.
  • The Community Action Program for Children, Canada Prenatal Nutrition Program and the Fetal Alcohol Spectrum Disorder Initiative are delivered in off-reserve communities across Canada.
• Health Canada
  • Health Canada funds community-based and culturally-relevant programs to improve health outcomes for First Nations and Inuit mothers, infants, children and families. These programs include: Maternal and Child Health, Fetal Alcohol Spectrum Disorder, the Canada Prenatal Nutrition Program and the Aboriginal Head Start On-Reserve program.
  • In the north, maternal and child health programs enhance disease prevention and health promotion activities provided by the provincial/territorial governments.
• Aboriginal Affairs and Northern Development Canada
  • Provides funding to First Nations communities for on-reserve schools and off-reserve tuition fees.
  • Administers the Urban Aboriginal Strategy within selected cities across Canada (early childhood development is a component of some of the funded projects).
  • Provides funding in Alberta and Ontario to provide daycare services on-reserve that are comparable to the services offered by the provincial government to people living off-reserve.
• Human Resources and Skills Development Canada
  • Administers the First Nations and Inuit Child Care Initiative, which has a focus on providing access to child care services to First Nation and Inuit children of parents attached to the labour market.

Populations within federal jurisdiction

• The Department of National Defence supports 43 Family Resource Centres in Canada and abroad.
• Correctional Services Canada provides mother-child programs that allow preschool age children to reside with their mother in federal institutions, with the option of attending preschool programs in the community or in the prison facility.
• The Ministry of Citizenship and Immigration offers reimbursement for child care fees for children from six months to six years of age to help newcomer parents attend language instruction classes.

Targeted programming within the general Canadian population

The Public Health Agency operates the Canada Prenatal Nutrition Program and the Community Action Program for Children, both of which target vulnerable families living in low-income or high-risk circumstances.

Provincial and territorial government activities

Under the Canadian Constitution,^{Footnote 1616} health, education and welfare (income support and social services) fall within the jurisdiction of the provincial and territorial governments. Provincial and territorial governments (and to varying degrees their municipalities) are responsible for the design and delivery of these social services. Children’s services, including early childhood development and child care programming, fall within this area of social policy and service delivery.

In contrast to the federal role, the current provincial and territorial role involves:

• providing the legislative, policy and regulatory framework within which early childhood development programs run (e.g. child care and preschools)
  • providing operating grants to early childhood development centres to encourage service expansion
  • providing fee subsidies to early childhood development centres to enhance affordability for low-income families
• delivering kindergarten and pre-kindergarten programs within public school systems
• delivering some targeted early childhood development programming.

Legislative, policy and regulatory early childhood development framework

The delivery of early childhood development programs falls primarily within the private and non-profit sectors. Provinces and territories provide the policy framework within which early childhood development centres and programs are run. In addition, provinces and territories increase accessibility to early childhood development programming by providing incentives for private operators to open new centres and by subsidizing fees for low-income families. While provinces vary in the level of funding and support they provide for early childhood development programming, all jurisdictions have increased spending on this issue over the last five years. The province of Quebec has the highest funding levels for early childhood centres (Les Centres de la Petite Enfance) and a low, government-established fee of seven dollars per day per child. Regardless of provincial and territorial policy frameworks and subsidies, the delivery of early childhood development programming falls primarily within the sphere of the private sector, leaving the choice of cost, clientele, locations and programming to private operators.

Kindergarten and pre-kindergarten programs

The exception to the private sector having primary responsibility for delivering early childhood development programming is the delivery of kindergarten programs in provincial and territorial public school systems. Six out of 13 provincial and territorial jurisdictions provide full-day kindergarten to five-year-old children and the remaining seven provide partial-day programs. Ontario has extended full-day programming to four-year olds in 20 per cent of its schools and several jurisdictions have expanded access to three- and four-year olds in at-risk circumstances. In British Columbia, StrongStart BC offers free school-based early learning programs for parents and children from birth to five years in 60 school districts throughout the province.

The trend to recognize the importance of the early years and to expand public school programs is growing as policy-makers, academics, parents and educators align in their view that early childhood programs should be structured to ensure all children start school ready to succeed. In Learn Canada 2020: Joint Declaration, Provincial and Territorial Ministers of Education,^{Footnote 1717} the preschool years were named as the first of four pillars of lifelong learning, and the ministers stated that high quality early education should be available to all children.

Targeted early childhood development programs

In addition to the activities discussed above, provincial and territorial governments deliver other programs and services for children and families for the entire Canadian population, including Aboriginal people:

• early childhood development support programs
• family resource centres to provide support services to parents
• child health programs specifically for babies, expectant mothers and children with special needs.

With the proportion of First Nations people living off-reserve in Canada rising (with the large majority residing in major urban centres), increasing demands for programs and services are being placed on provincial and local governments. This includes the need for programs and services for Aboriginal children and their families. Some of these needs are served through networks of provincial/territorial and local child care programs and family resource centres. In some provinces there are networks of Aboriginal services providers (such as Friendship Centres and Aboriginal child care providers) providing culturally-specific services to Aboriginal children and their families with support for Aboriginal language and culture.

Provincial and territorial health, social and education services serve Aboriginal children and families to varying degrees depending on the population distribution, but especially in major urban centres where the majority of off-reserve Aboriginal people reside. However, in some provinces, especially those with larger Aboriginal populations (including Ontario, Manitoba, Saskatchewan, Alberta and British Columbia), specific services have been targeted to Aboriginal children and families, generally involving Aboriginal organizations in service delivery. For example:

• The Government of Ontario has extensive programs through its Ministries of Children and Youth Services, Health and Aboriginal Affairs. The primary program focusing on young Aboriginal children is the Aboriginal Healthy Babies-Healthy Children program, which has the goal of helping all Aboriginal children to get the best start in life.
• In British Columbia, the Ministry of Children and Family Development is responsible for provincial Aboriginal early learning and child care programs. In 2002, the Ministry took the lead with seven other provincial departments to develop a new vision for early childhood development. One of the priorities was to build capacity in Aboriginal communities so that they could develop and implement early intervention strategies. A budget of eight million dollars was allocated to the Aboriginal Education Childhood Development Strategy to establish a system of early childhood development services in Aboriginal communities. By 2004, 41 projects had been funded and by 2007, dozens of projects had been created with Aboriginal organizations off-reserve and in on-reserve First Nations communities.
• In the territories and the northern areas of the provinces where large percentages of the population are Aboriginal, all services have to accommodate the needs of Aboriginal families and children who do not live in First Nations (on-reserve) communities where the First Nation delivers services.