Background
Early childhood experiences make a critical difference in children’s development and in their health and well-being both during childhood and when they are adults. Adverse early experiences- such as unstable caregiving, deprivation of love or nutrition, and stresses associated with neglect and maltreatment, greatly increase the likelihood of poor health across the entire lifecourse (Chan, 2013). One critical foundation for healthy child development is a stable, responsive, and nurturing caregiving who provides opportunities to learn. Supportive human relationships promote and protect a child’s physical and mental health, behaviour, and learning across his or her lifetime (Centre on the Developing Child, 2010, 2016; Chan, 2013).Public health nurses (PHNs) in the Healthy Babies, Healthy Children (HBHC) program are in a unique position to make positive impacts on child development and family outcomes. PHNs work with families who are usually dealing with many powerful stressors and determinants of health, including poverty, unsafe housing, unemployment, racism, addictions, mental illness, domestic violence, which increases the risk of poor child development. They begin working with families early, often starting in pregnancy, which is a key time to influence early child development- another determinant of health.

Since 2011, many PHNs continue to be certified in using tools to assess the quality of a caregiver-infant interaction.The use of reliable and valid measures for assessing caregiver-infant interaction quality provides clinicians and researchers with strategies for identifying unusual caregiving practices and intervening to enhance early relationships of high-risk dyads. The accurate and appropriate assessment of caregiver-infant interaction is critical for early recognition of problematic relations and for informing suitable interventions to improve the relationship (Tryphonopoulos, LeTourneau&DiTommaso, 2016). Even though the NCAST PCI scales can improve parent-child relationships when they are used as intended, training on how to use the tools over the past five years, has not translated into using them in PHN practice. Therefore, there was a need to look more broadly at factors that may be influencing the use of these scales in practice.

The project
The primary goals of the fellowship were to increase my knowledge, skills and expertise of research methodology appropriate to exploring barriers and facilitators of knowledge translation, strategies and tools to address barriers and increase facilitators, and research skills including conducting a literature search, using a critical appraisal tool,and summarizing my findings. The focus of this advanced clinical practice fellowship was to explore the barriers and facilitators of using NCAST PCI scales in PHN practice within the HBHC program, at the Grey Bruce Health Unit (GBHU). The knowledge-to-action (KTA) framework helped inform and organize objectives in this fellowship. Working with Amy Faulkner, public health librarian, was important and valuable to accessing the resources needed to developing and revise research questions, searching databases, retrieving and reviewing articles, and selecting critical appraisal tools. Public Health Ontario’s MetaQAT critical appraisal tool and accompanied training supported my objectives to appraise evidence. An environmental scan with NCAST master trainers from nine health units contributed to my understanding of the barriers and facilitators experienced by other PHNs in the province. Facilitating a focus group with the HBHC home visiting PHNs in my organization was an exciting and humbling experience, and provided a wealth of useful information that helped me with developing recommendations for addressing current barriers to practice. Regular collaboration with members of my mentorship team was critical to helping me organize, interpret and code the data I obtained through the environmental scan interviews and focus group. I was able to work with our Health Data Analyst and consult with the Ministry of Children and Youth Services and associates,to work towards custom-building a report to capture the extent to which NCAST PCI scales are being implemented based on the age of children in the home visiting program. It is hoped this will be useful to monitor implementation of the PCI scales within and outside our health unit, and provide useful feedback to individual PHNs.

The short, medium and long term outcomes of this fellowship consisted of enhancing my own learning as mentioned above, improve the implementation of NCAST PCI scales in PHN practice at the Grey Bruce Health Unit, and ultimately, improve parent-child relationship and child development outcomes. Through this fellowship, I was able to identify barriers to using NCAST PCI scales in PHN practice within my own organization, and provide some recommendations for the organization to address moving forward. Sustainability will be reinforced through the ongoing work of improving implementation efforts by the PHNs, Master trainer, the program and organizational support. My own learnings will be sustained by continuing to support and facilitate evidence-informed public health practice across programs at the Grey Bruce Health Unit, disseminating my learnings, and ongoing professional development education and opportunities.

I am very honored and grateful for being offered this opportunity by the RNAO and I would like to thank my primary mentor, Sarah Ellis, R.N., B. Sc. N., M.Ed. (Program Manager)for her support and guidance. A special thank you to my leadership team Shannon Johnston (PHN and NCAST Master trainer), Lindsay MacDermid (Program Evaluator), Lisa Prowd (PHN and RNAO Fellow), Virginia McFarland (Health Data Analyst), Berni Candelero (Niagara Region Public Health), Nancy DelMaestro (Middlesex-London Public Health), and May Tao (Toronto Public Health), for facilitating my fellowship activities.Special thanks also to RNAO, MOHLTC, MCYS, the Master Trainer Community of Practice, and the Grey Bruce Health Unit, for supporting this exciting learning opportunity.