A Bundle of Joy - REAL STORIES

"Bundle of Joy," a prenatal education, nutrition and support program for young mothers, has gone through several incarnations at Carlington Community and Health Services. With steady learning and refinements -- and an increasingly bleak financial picture for teen mothers -- the program is more successfully focussed than ever on the highest-risk teens. One graduate, back in school with a 14-month-old, is now a valuable apprentice and role model. When she says, "If I can breastfeed, so can you," the younger mothers listen.

Pregnant teenagers are already struggling against well-known odds; but in 1992 Ottawa's Young Single Parent Support Network found that two-thirds of their clientèle actually had five or more risk factors (a history of abuse or neglect, substance abuse in the family, unstable living situation, low income, living in public housing, incomplete education, disability, no help from family, little or no help from father of child).

After 1995's welfare cuts, the Interchange group (which brings together workers and residents from Ottawa's largest public housing project, Bellevue Manor) started signalling panic about single teen mothers. "Ottawa Housing staff would go into apartments and find literally nothing in the cupboards. Sue Taylor (a full-time chaplain for the area) would get calls from young moms with no food, no diapers, they'd quit breastfeeding and they had no formula. It was the same with our medical team, and they were having fits," relates Ali Black, Health Promotion Coordinator at Carlington Community and Health Services.

Ponna Sambasivan, the centre's Community Nutritionist, had been working for some time on a prenatal education program called the Stork Club, drawing on a model from North Kingston CHC. The first group in 1993 fell short of meeting the needs of a mixed group of mainstream teens and older newcomers their questions and values were too different. The next session was advertised just for teens, through high schools and public health nurses. After twelve weeks of education on topics they chose from the Stork Club curriculum, actual kitchen practice and nutrition supplements, this group evolved into a collective kitchen and friendly support network.

It was still hard to say that the very neediest teens had been reached "although they were all on social assistance, it was more the ones who already had their act together enough to get here," says Black. "We could see we just had to do offsite delivery, and we had to offer several ways to hook the most vulnerable new moms."

Now the program is offered right in a local public housing community. The activities include cooking and eating together, a drop-in, workshops on prenatal and perinatal issues, and a new Baby Cupboard with emergency necessities. When participants don't show up for a scheduled session, one or the other of the leaders goes upstairs to fetch them. Both Cathy McCurdy (a mental health outreach worker) and Sharon Dunn (CCHS youth counsellor) have knocked on doors and found the mothers who need us most. McCurdy organizes van transportation for a small group from another high-need location, Belair Court.

About $3000 for the expensive extra food and vitamins comes from Health Canada, thanks to Sambasivan's involvement with the Young Single Parents Network and an advisory committee for the Canadian Prenatal Nutrition Program.

Although she's an evangelist for breastfeeding, Sambasivan doesn't expect 100% success, and she's worried about the moms who can't afford formula. "A public health dietitian in our network did a needs assessment at food banks and found very little for young moms. There may be samples of formula but then it's hard to offer the baby a consistent diet. When they asked the Ottawa Food Bank, their answer was that individual food banks have not asked for formula. They'll be getting the letters now..."

"I would never have been ready for labour without you," said one 15-year-old. "I can air my feelings here," says another mother. "I get all I can out of it while I'm here," says a third, who got so frustrated recently that she broke her knuckles -- on the wall, fortunately, rather than on her two-year-old.

The Bundle of Joy program is very much a partnership. The recreation centre provides free space. The Tenants, Association and CCHS run the Baby Cupboard, to which the chaplaincy and food bank contribute supplies. The chaplain and housing staff are alert to potential recruits during all their outreach. A lunch program for preschoolers runs under the auspices of the chaplaincy and the Social Action Network of local churches. Its large volunteer component lets residents give back to the community.

Within the health centre, a range of staff give their expertise to the program. The nurse practitioner holds a medical drop-in at Bellevue on the same morning, so that she can see sick children on the spot and do education when she's not busy one-on-one. Specialists in early childhood education, youth and mental health issues all contribute counselling, crisis work and education.

How do we know this is the right thing to do? "Look at the stats," says Black. Prenatal nutrition has a direct impact on birth weight and brain size. Infant nutrition is critical to basic growth and development and functioning. Early childhood intervention supporting parents at risk will prevent abuse and prevent delays in child development. And social support networks are proven to contribute to general health status. For this specific program, both internal and third-party evaluation are tracking the impact regular internal evaluation has been especially important to knowing when and how to change tactics. "With the highest risk people, you have to be really accessible and adaptable," says Black.