In the interest of population-based responsibility, health and social services establishments (HSSEs) are expected to
establish more working partnerships with organismes communautaires Famille (OCF – community-based family
organizations). Some OCFs offer a service called ‘relevailles,’ which consists of providing a home-visiting postnatal
support program that adapts to the needs of each family, in order to listen, encourage, inform, and support day-to-day
organization. The use and impacts of this service, as well as the collaborations surrounding its implementation in local
networks of services provided by health and social services establishments, remain largely unknown

Bisset, Sherri

Blais, Régis

Deshaies, Marie-Hélène

Mbourou Azizah, Ginette

Montigny, Francine de

Ouimet, Mathieu

Parent, André-Anne

Roch, Geneviève

White, Deena

English

CorpusUL

                                Use of ‘Relevailles’ ‘Relevailles’ and Intersectoral Collaborations Brief Report  CONTEXT AND KEY ISSUES In the interest of population-based responsibility, health and social services establishments (HSSEs) are expected to establish more working partnerships with organismes communautaires Famille (OCF – community-based family organizations). Some OCFs offer a service called ‘relevailles,’ which consists of providing a home-visiting postnatal support program that adapts to the needs of each family, in order to listen, encourage, inform, and support day-to-day organization. The use and impacts of this service, as well as the collaborations surrounding its implementation in local networks of services provided by health and social services establishments, remain largely unknown.  AIM AND OBJECTIVES Aim: To evaluate relevailles services provided by four OCFs and the intersectoral collaborations they maintain with HSSEs to consolidate services in the postnatal period.  Specific objectives: 1) To evaluate the utilization profile of relevailles services provided by OCFs in terms of continuity, productivity, and comprehensiveness;  2) To explore variations in the use of relevailles based on OCF organizational characteristics, user family characteristics, and the needs expressed while registering for relevailles.   HIGHLIGHTS • OCFs serve a clientele within a wide socio-economic range, presenting mainly respite and support needs in caring for a baby. Data on users showed that 64% had more than one child, the average age of babies at registration was 3.6 months, and 46% of parents were informed of the service by a health professional. • Classifying relevailles activities into four profiles helps situate the specifics of the service and the comprehensiveness of the tasks performed at home by perinatal assistants, thereby improving complementarity with the health sector. • On average, there were 89 days between the first and last relevailles visit, with an average of 9.2 visits per family. This very high relational continuity is an asset in developing a relationship of trust. • Despite a limited number of perinatal assistants per OCF, productivity, expressed at the family level, was around 4 visits per month.  • Use of relevailles services is mainly associated with the characteristics, taken individually, of the organizations and with those of the families. None of the variables studied served to predict the use of relevailles.  REFERENCE FRAMEWORK The use of relevailles services was evaluated using an adaptation of the conceptual framework developed by Borgès Da Silva et al. (2011), inspired by Starfield (1998). It is based on three dimensions: continuity, productivity, and comprehensiveness of services (Figure 1).  • Relational continuity: services provided by the same perinatal assistant over time • Concentration of visits: average number of visits/family and elapsed time between the first and last visit OCFs’ ability to generate a volume of services in relation to available resources Range of tasks performed during each visit, out of the basket of possible tasks Figure 1. Reference framework  Adapted from Borgès Da Silva et al. (2011) Productivity  Continuity of services  Comprehensiveness  2                    Figure 2. Needs expressed by families during registration for relevailles (n=134)  010203040506070809010067.2%62.7%34.3%27.6% 23.1% 23.1% 20.9% 17.9% 17.2%11.2% 9.0% 8.2% 6.7%0.0% 0.0%Percentage of familiesExpressed needsNeeds expressed by user families The needs expressed during registration mainly concerned rest/respite (67.2%) and support for the different needs of the baby (62.7 %) (Figure 2).  Table 1. Characteristics of user families (n=134) Characteristics  Size  (%) n* Requesting parent is female 98.5 131 Requesting parent is an immigrant 21.6 29 Single parent family 16.5 22 Schooling completed by the mother       Primary 7.4 7    Secondary/Vocational 19.1 18    College/University  73.4 69 Informed of the service by a professional Regular access to other sources of support Multiple pregnancy Presence of other children 45.7 94.0 13.5 64.2 59 126 18 86 Net family income for the current year    Up to $40,000 53.5 38  $40,001 to $80,000 29.6 21  $80,001 and more 16.9 12  M [SD] Age of the requesting parent (years) 32.2 [10.1] Baby’s age at outset of relevailles (months) 0.3 [0.3] i.e. 3.6 months      *Excluding missing values RESULTS Characteristics of user families • 134 families received 1,235 relevailles visits. • 64.2% of families served had 1 to 10 other children. • Almost all of the requesting parents were women, who were 32 years old on average. • The average age of the babies for whom relevailles were initiated was 3.6 months. • 45.7% of parents were informed of relevailles by a professional. • Families had diverse socio-demographic characteristics and included targeted and universal clienteles (Table 1).   METHOD • Compilation of anonymized survey data by the four OCFs regarding the use of relevailles services • Registration forms, visit records • Collection period from August 15, 2013 to August 15, 2014 • Descriptive analyses and multilevel regressions (SAS 9.3®) 3              86.5%82.0%100% 100%93.1%020406080100OCF1 OCF2 OCF3 OCF4 TotalPercentage of visits OCFI = standard error9.65.58.912.79.202468101214OCF1 OCF2 OCF3 OCF4 TotalAverage number of visits OCFI = standard errorConcentration of visits The average number of days between the first and last visit varied from 51.0 to 118.8, with an average of 89.1 days.  The average number of visits per family per OCF varied from 5.5 to 12.7, with an average of 9.2 visits (Figure 4).  Relational continuity On average, 93.1% of visits were made by the same perinatal assistant (Figure 3).  Organizational characteristics of OCFs • 2 OCFs have from 1 to 4 perinatal assistants; 2 have between 5 and 8 perinatal assistants. • 2 OCFs provide less than 1,000 hours of relevailles per year; 2 provide 1,000 to 2,000 hours per year. • 1 OCF limits relevailles to families with a baby under six months; 3 OCFs limit relevailles to families with a baby under one year of age. • 2 OCFs operate in a territory with fewer than 100 inhabitants/km2; 1 OCF in a territory with 100 to 1,000 inhabitants/km2; 1 OCF in a territory with over 1,000 inhabitants/km2. Figure 3. Percentage of visits associated with the perinatal assistant for a family per OCF  Figure 4. Average number of visits for a family per OCF Use of relevailles CONTINUITY OF SERVICES Continuity of services is operationalized through relational continuity and concentration of visits.  4          Figure 6. Classification of profiles of tasks performed during visits with families  3.84.04.53.84.10,00,51,01,52,02,53,03,54,04,55,0OCF1 OCF2 OCF3 OCF4 TotalAverage number of visitsOCFI = standad error0,010,020,030,040,050,060,070,080,090,0100,0OCF1 OCF2 OCF3 OCF4 Total7.120.058.84.828.414.350.037.34.826.950.015.019.120.926.210.057.118.72.4 5.0 3.914.35.2Percentage of familiesOCFInstrumental profile Coaching profile Nanny profile Balanced profile Combination of profilesCOMPREHENSIVENESS • Classifying visits according to the tasks performed by perinatal assistants resulted in the identification of four visit profiles: 1) instrumental (e.g. domestic chores); 2) coaching (e.g. information on resources); 3) nanny (e.g. caring for the baby/other children); 4) balanced (tasks from all categories). For the families for which 50% of the completed tasks cannot be associated with a visit profile, a category called “combination of profiles” was created. • The proportions of visit profiles differed from one OCF to another (Figure 6). Overall, the instrumental and coaching profiles were the most prevalent. PRODUCTIVITY The average number of visits per month for a family per OCF varied from 3.8 to 4.5 with an average of 4.1 visits (Figure 5).  Figure 5. Average number of visits per month for a family per OCF 5              Variations in use depending on family characteristics, family needs, and organization characteristics Significant associations (p<0.05) between indicators of use and different potentially explanatory variables are summarized in Table 2, but none of these variables predicts the use of relevailles.      Collaborations: Stéphane Turcotte, M.Sc., Biostatistician, Centre de recherche du CHU de Québec-Université Laval Christophe Tremblay, B.A., M.S.W. Student, Research Assistant, Centre de recherche du CHU de Québec-Université Laval Idrissa Beogo, Ph.D., Postdoctoral Fellow, Université Laval, Faculté des sciences infirmières Marie-Isabelle Lefrançois, B.A. Student, Research Assistant, Centre de recherche du CHU de Québec-Université Laval    STRENGTHS AND LIMITATIONS • The strong partnership of trust with OCFs made it possible to collect survey data on the use of relevailles services offered by these family sector organizations.  • The forms used to collect the data, although developed with the support of relevailles experts, could not be validated beforehand as it was one of the first studies on the subject.  For more information:  Geneviève Roch Genevieve.Roch@fsi.ulaval.ca 418-656-2131 ext. 13345  Roxane Borgès Da Silva roxane.borges.da.silva@ umontreal.ca 514-343-6111 ext. 17286   Research Team: Geneviève Roch, R.N., Ph.D., Université Laval, Faculté des sciences infirmières Roxane Borgès Da Silva, Ph.D., Université de Montréal, Faculté des sciences infirmières Marie-Hélène Deshaies, M.A., Research Professional, Centre de recherche du CHU de Québec-Université Laval Régis Blais, Ph.D., Université de Montréal, Département d’administration de la santé, École de santé publique Ginette Mbourou Azizah, Ph.D., Université Laval, Faculté des sciences infirmières Sherri Bisset, Ph.D., Université de Montréal, Département de médecine sociale et préventive, École de santé publique Francine de Montigny, R.N., Ph.D., Université du Québec en Outaouais, Département des sciences infirmières André-Anne Parent, Ph.D., Université de Montréal, École de service social, Faculté des arts et des sciences Mathieu Ouimet, Ph.D., Université Laval, Département de science politique, Faculté des sciences sociales Deena White, Ph.D., Université de Montréal, Département de sociologie, Faculté des arts et des sciences  This project is funded by the Canadian Institutes of Health Research (CIHR) in partnership with the Canadian Institute for Health Information (CIHI) and the Public Health Agency of Canada (PHAC), with an in-kind contribution from the Québec Regional Office of the Public Health Agency of Canada and from the Ministère de la Santé et des Services sociaux of Québec.  Funding Reference Number: GIR-127074  Thank you to our collaborators: Association pour la santé publique du Québec, Réseau des Centres de ressources périnatales, Fédération québécoise des organismes communautaires Famille, representatives of participating organizations and institutions.    Table 2. Potential associations by indicator     Indicators Family characteristics Expressed needs Organization characteristics Continuity of services –  Concentration of visits Average number of days between the first and last visit per OCF   Number of perinatal assistants Multiple pregnancy   Average number of visits per family Age of requesting parent Information on health, diet, baby development  Eligibility rules based on baby’s age Multiple pregnancy   Other psychosocial difficulties   Productivity Average number of visits/month/family Regular access to other sources of support   Comprehensiveness Utilization profiles   Density of the region of intervention   Number of perinatal assistants  August 18, 2016 ISBN: 978-2-9816016-3-6 (PDF) Québec: Centre de recherche du CHU de Québec-Université Laval    

Use of relevailles : relevailles and intersectoral collaborations : brief report.

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Use of relevailles : relevailles and intersectoral collaborations : brief report.

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