Pregnancy is an important transition in a woman's life and those around her: a new beginning filled with joy and hope for the future. Yet, raising young children in Iyiyuuschii can become an extremely challenging undertaking, especially for parents living in unacceptably trying conditions, such as crowded housing, chronic unemployment, food insecurity, and family violence. Home visiting programmes have demonstrated their efficiency in improving the health of families facing similar stressors, but little is known about their viability in Northern Aboriginal contexts. Thus, in order to test the feasibility of such programmes in Iyiyuuschii, the Cree Board of Health is now piloting a Cree adaptation of the SIPPE model entitled A MASKUPIMATSIT AWASH (AMA), or 'Strong and healthy children' in Cree.
We first reflected carefully on how best to adapt the SIPPE model to the uniqueness of our population while preserving the integrity of the programme 'essential ingredients'. Local consultations were then conducted to identify pilot communities; a stepwise implementation process was later initiated in three selected sites.
Adapting the SIPPE to our context called for the following programme adjustments: 1. Universality: All families have access to AMA services; 2. Cultural safety: Home visitors are Cree paraprofessionals; understanding Cree language & culture is vital for developing trusting relationships with families; 3. Continuity of care: AMA goes beyond home visiting; it combines the benefits of interdisciplinary practice, collaborative approaches to care & integration of local services and programmes for families. Pilot communities are at various stages of deployment but their realities are comparable: Local facilitating factors include an existing tradition of inter-professional collaboration and polyvalence, families' openness to home visiting, and the extra financing for implementation. Main challenges relate to the concomitant reorganisation of the CHB infrastructures, the difficulties in recruiting qualified staff and the emotional strain felt by home visiting staff.
We will continue AMA implementation in the pilot communities but with enhanced sensitivity to the limits posed by the regional reform. Participatory evaluation will be initiated, to enable project replication (implementation) and to ensure that AMA's adaptations are not threatening programme efficiency (outcome).