Ontario’s Healthy Babies Healthy Children Screen tool: identifying postpartum families in need of home visiting services in Ottawa, Canada

Abstract

Intervention: Across Ontario, the Healthy Babies Healthy Children (HBHC) postpartum screening tool is routinely used to identify families with potential risk of negative development outcomes for children. Research question: To identify screening questions associated with subsequent high-risk in-depth assessment (IDA) in order to prioritize services. Methods: Ottawa families who gave birth (2013–2016) consented to the postpartum HBHC Screen (N = 29,162). Maternal socio-demographics, perinatal indicators, and 36 questions assessing pregnancy/birth, family, parenting, infant development, and health professional observations were analyzed for association with a high-risk IDA using regression analysis. Results: Upon first screen, 51% of families scored two or more risks. Most commonly, labour/delivery complications (27%), previous loss (26%), health professional concerns (22%), and mental illness (17%) were identified. Among IDA completions, 41% were assessed as high risk and this proportion increased when screened with 4+ risks. Characteristics associated with high-risk IDA among families scoring two or three included the following: maternal age ≤ 19 years (aRR = 2.0, 95% CI 1.50–2.80), 20–29 years (1.3, 1.12–1.53), ≥ 35 years (1.2, 1.04–1.45); combination breast and formula feeding on discharge (1.2, 1.03–1.37); < 18 years old at birth of first child (1.7, 1.13–2.43); single parent and no partner involved (1.6, 1.07–2.33); high school incomplete (1.8, 1.45–2.35); newcomer support needed (1.8, 1.43–2.17); financial concerns (1.6, 1.27–2.14); history of mental illness (1.2, 1.01–1.33); and parent disability (1.7, 1.09–2.78). Conclusion: While offering the IDA when scoring 2+ risks is a provincial requirement, practices of increasing effort toward contacting families screened with 4+ risks are substantiated. An adapted approach to prioritize families screened with two or three risks is described.