HANSARD

NOVA SCOTIA HOUSE OF ASSEMBLY

STANDING COMMITTEE

ON

HEALTH

Tuesday, February 10, 2026

 

 

COMMITTEE ROOM

 

 

Early Years Programs from Public Health

 

 

 

 

Printed and Published by Nova Scotia Hansard Reporting Services

 

 

HEALTH COMMITTEE

Danny MacGillivray (Chair)

Adegoke Fadare (Vice-Chair)

Hon. Susan Corkum-Greek

Ryan Robicheau

Nick Hilton

Lisa Lachance

Rod Wilson

Hon. Iain Rankin

Hon. Derek Mombourquette

 

[Adegoke Fadare was replaced by Hon. Brian Wong.]

 

 

In Attendance:

 

Gordon Hebb

Chief Legislative Counsel

 

Robin Dann

Legislative Committee Clerk

 

 

WITNESSES

 

Nova Scotia Health Authority

Marcia DeSantis, Senior Director, Population and Public Health

Katherine Malec, Early Years Manager, Central Zone, Public Health

Jen MacDougall, Early Years Manager, Science and System Performance

Dr. Ryan Sommers, Senior Regional Medical Officer of Health, and Senior Medical Director Population and Public Health

 

 

HALIFAX, TUESDAY, FEBRUARY 10, 2026

 

STANDING COMMITTEE ON HEALTH

 

1:00 P.M.

 

CHAIR

Danny MacGillivray

 

VICE-CHAIR

Adegoke Fadare

 

 

THE CHAIR: I'd like to call the meeting to order. This is the Standing Committee on Health. I am Danny MacGillivray, MLA for Pictou Centre. I'm the Chair of this committee. Today we'll hear from representatives from the Nova Scotia Health Authority regarding Early Years Programs from Public Health. Just a reminder to please set your phones to silent. You don't have to touch your microphones; the staff will adjust those as needed.

 

I'll ask the committee members to introduce themselves now for the record by stating their name and constituency, please. We'll start to my left.

 

[The committee members introduced themselves.]

 

THE CHAIR: For the purposes of Hansard, I also recognize the presence of Chief Legislative Counsel Gordon Hebb to my left and Legislative Committee Clerk Robin Dann to my right.

 

As mentioned, the committee topic is Early Years Programs from Public Health. I'd like to welcome the witnesses here this afternoon for taking the time to attend. We appreciate it. I believe there are some opening remarks. We'll start with Dr. Sommers.

 

DR. RYAN SOMMERS: Thank you for the opportunity to meet with you today and discuss the Nova Scotia Health Public Health's Early Years program. I'd like to begin by highlighting a reality faced by many health care providers and families in Nova Scotia. Picture a first-time parent in Nova Scotia: pregnant, motivated, and deeply committed to doing right by their child. At the same time, they may be dealing with low income, housing instability, long wait times for mental health supports, or the absence of a primary care provider. None of these challenges exists in isolation. Together, they create chronic stress during pregnancy and early parenting.

 

Research shows that the first 1,000 days of life, from pregnancy to just after the child's second birthday, are the most critical for influencing lifelong health, learning, and well-being. Experiences during this period shape brain development, stress regulation, and resilience. Sustained stress without adequate support can become biologically embedded, leading to increased demands on health, education, and social systems later in life.

 

In Nova Scotia, approximately one in four children enters school with a developmental vulnerability that limits their ability to fully benefit from the education system. Addressing these challenges later is significantly more costly than early prevention. These outcomes are not due to poor parenting. They reflect gaps in early support during the most sensitive period of human development: those first 1,000 days.

 

Early Years is more than just a social support program. It is a targeted, evidence-informed investment that strengthens families early, reduces avoidable stresses, and improves developmental outcomes when the return on investment is the greatest. Decades of research and thousands of studies have shown that early childhood interventions generate substantial long-term savings through reduced health care use, improved educational outcomes, lower involvement with child protection and justice systems, and increased economic participation in adulthood.

 

With this context, I'll turn it over to Marcia DeSantis, my co-lead, to outline how the Early Years program operates and why it is among the most effective investments across the health, education, and social systems in Nova Scotia.

 

THE CHAIR: Ms. DeSantis.

 

MARCIA DESANTIS: Dr. Sommers has outlined the “why” behind Public Health's Early Years work, and I'd like to give a brief overview of what that looks like in practice.

 

Public Health is structured to deliver on the Health Protection Act, as well as the Public Health Standards and Protocols set by the Department of Health and Wellness. We provide programs and services that focus on creating supportive environments, places where Nova Scotians can make the healthy choice the easy choice where they live, learn, work, and play. Our work is underpinned by evidence-based practices, continuous quality improvement, and is grounded in health equity.

 

Four years ago, government launched Action for Health, which calls on us to address the factors that influence health and well-being, strengthen community-based health supports, and enhance Public Health and health promotion through partnership and collaboration. Early Years achieves this by aligning the right resources with the right families, offering services that meet individual needs, and ensuring that no pregnant person or new parent is left behind.

 

Some families require little support while others face multiple overlapping challenges that make parenting, attachment, and healthy growth and development more difficult. Early Years works with families to determine their needs and then offers tailored services to support them. These supports are offered through three foundational programs: Healthy Beginnings, Enhanced Home Visiting, and our newest program, the Nurse-Family Partnership, which was launched in the Eastern Zone in March of 2024. Nurse-Family Partnership is an internationally recognized, evidence-based program that supports families with the greatest need. In June of 2025, Nova Scotia became the first in Canada to offer this program province-wide. This is a significant achievement that establishes us as one of the pre-eminent Early Years programs in Canada.

 

Nova Scotia's Early Years program is also leading in other ways. We are the first Atlantic province to develop clear, evidence-based service and nursing standards. We offer services without barriers to entry, fees, or geographic limitations which gives every family a chance to be supported and achieve better health outcomes.

 

We look forward to your questions and sharing more about our Early Years program. Thank you for the opportunity to speak to you about this important work. At this time, I'll pass it back to you, Chair.

 

THE CHAIR: Thank you for the opening remarks. It's my oversight, I should have asked earlier for the other two witnesses to please introduce themselves, starting with Ms. MacDougall.

 

[The witnesses introduced themselves.]

 

THE CHAIR: Thank you all very much. We'll now start with questioning. It's 20 minutes for each caucus. We'll follow that with a second round of approximately 10 minutes; questions will wrap at 2:50 p.m. I'll start with the NDP and MLA Wilson.

 

ROD WILSON: Thanks for coming. I'm looking forward to learning more. A quick question: It was introduced in 2023, the program. Is it available across the province in all four zones?

 

THE CHAIR: Ms. DeSantis.

 

MARCIA DESANTIS: Yes, it is. Nurse-Family Partnership, Healthy Beginnings, and the Enhanced Home Visiting programs are all offered program-wide. We phased in our introduction of Nurse-Family Partnership for several reasons. One, because to match the nursing resources required to meet the needs, given the workforce, we opted to phase it in, and also to develop the program very robustly within Nova Scotia. We started in Eastern Zone in March of 2024. In January of 2025, both Northern Zone and Western Zone came online, and in June of 2025, Central Zone began the Nurse-Family Partnership program.

 

ROD WILSON: We all know there's a nursing shortage across the country. Certainly this is a specialty type of nursing. Are you fully staffed, or how many vacancies do you currently have for your program?

 

MARCIA DESANTIS: Our entire Early Years complement for the province is roughly - sorry, the entire complement for Public Health across the province is about 700. For Early Years, it runs between 215 to 220 employees. The vacancy rate in December was 7.7 percent, which is much lower than the peak vacancy rate of 26.9 percent when we started to expand our services. We've made great progress in terms of our recruitment efforts.

 

ROD WILSON: So some vacancies. Do you plan to keep the program, which sounds fantastic, at the current staffing or do you have any plans to upscale? What would that take if that's your plan?

 

MARCIA DESANTIS: As positions become available, we are continuing to recruit and fill nursing vacancies for our Early Years programs, including the Nurse-Family Partnership. When we looked at what our complement might be that we would need for the program, we looked at population data. Nurse-Family Partnership is a program that's offered to clients who have significant overlapping needs, the highest risk families. We looked at Nova Scotia data to assess what that might look like for us. Based on what we had from population health data, it was roughly 8 percent of pregnant women who might be eligible and meet the criteria for Nurse-Family Partnership.

 

With phased implementation, we have continued to recruit nurses as each zone goes live. We have not maxed out our nursing capacity to take clients in, but we are in sort of a place right now where we're purposefully pausing and assessing proactively what our needs will be going forward. We are staffed sufficiently right now and will continue to assess that. That may mean that we actually have to move resources across the streams of work - so Early Years nurses, Healthy Beginnings may go into NFP - with additional training, of course - or back into Healthy Beginnings, just depending on the client needs, or if a vacancy becomes available in one area and there's a client demand in another area, we may look at moving vacancies.

 

ROD WILSON: I just want to double-check - you're not at capacity. Is that correct? If you're not at capacity, is that leading to wait times to access the program in any part of the province?

 

MARCIA DESANTIS: By “not at capacity,” I mean that we have more nurses lined up to take on more clients. We have right now, I believe, about 120 or 130 families enrolled. We have 120. I think it's up from when we pulled that number a couple of weeks ago. We have capacity to do that, so there is no wait-list to come into the program right now.

 

There are lots of nuances around how we enrol clients into the program. If you would like more details on that, I think one of my colleagues could share as well.

 

ROD WILSON: One of the things that must be difficult for nurses given the high rates of child poverty, the cost of living, food and nutrition, rent - what happens when your nurses in the programs meet a mom who can't buy the formula or they're going to be short on rent? We see this every day in our constituencies. How does the nurse deal with that, or what are their resources? I'm sure that's got to be happening, that moms who depend on formula can't afford it or they're short on rent and they're on unpaid maternity leave. How does the nurse respond to that situation?

MARCIA DESANTIS: I'm going to turn that over to Jen.

 

THE CHAIR: Ms. MacDougall.

 

JEN MACDOUGALL: It's a daily challenge for our nurses, especially those working with the Nurse-Family Partnership program. Some of the factors that we see clients coming into the program for are related to income, housing, and food insecurity. Our nurses in NFP and our other Healthy Beginnings program as well, build relationships with community partners to support and help navigate clients to those additional supports.

 

Family resource centres are a large partner for us. We can sometimes bridge those gaps in the interim, but where we're the consistent nurses who work with NFP families, it's the same nurse who works with families from the prenatal period through until the child's second birthday, so they become the consistent touchpoint for that family to navigate health system supports and community supports.

 

It depends on the family, but the nurses are well versed in the supports that are available in their communities to help connect.

 

ROD WILSON: Is that stressful for the nurses? Having been a nurse in similar - it's kind of a combination of beg, borrow, and steal to try to meet your clients' needs. How do the nurses find that? It must be a stressor in the workplace.

 

JEN MACDOUGALL: It's a heavy burden on the nurses to help navigate and to hold the stories of families who are experiencing such challenges. One of the things in the Nurse-Family Partnership structure that we have built in - it's part of the international core model elements of the program - is a reflective supervision - reflective practice - where the nurses in the program are supported by team leads who are also trained and carry a small caseload for NFP. They have an hour structure every week where they can debrief and share some of those challenges and get support from the team lead.

 

Additionally, with our team leads who hold their caseloads and support the nurses, we also support them through colleagues of ours with psychiatry who support the team leads to be able to support the nurses in reflective practice. We have what we call the parallel process where the team leads are supported to be able to support the nurses, and the nurses are supported to be able to support the families and the parents nurturing their babies.

 

[1:15 p.m.]

 

ROD WILSON: Do the nurses find that infant feeding - whether it's breastfeeding or formula - is a challenge? If they do, what resources are available in the community? Are there enough resources to support feeding, whether it's breastfeeding, across the province?

 

THE CHAIR: Ms. Malec.

 

KATHERINE MALEC: Our public health nurses in all streams of the service are very skilled at supporting infant feeding, whether that is breastfeeding or formula feeding as well. I think part of the benefit of our services is that they are free and accessible, and we will travel to the client's home. That can reduce some barriers there with accessibility. It's really, client-led and -driven, because we do have other opportunities in community settings. In Central Zone, for example, there are about 30 drop-ins at various libraries and family resource centres, several of which have private space to be able to support families if that's more comfortable than the home.

 

In terms of navigating those typical challenges with initiating mostly breastfeeding, for example, our nurses are well equipped to support and counsel families through their feeding journey and navigate those challenges.

 

ROD WILSON: In November, we heard of an infant feeding clinic that was closed when the nurse practitioner left. Has that nurse practitioner been replaced? Are you familiar with that clinic? Has it been reopened?

 

KATHERINE MALEC: I wouldn't be able to speak to the specifics of that, where it would fall under primary care; however, with that, we did have an opportunity to strengthen some collaboration between Public Health and primary care partners, where we were looking at ways we can improve access, as well as streamline some supports. That work is still continuing, and we're looking forward to being able to share that shortly.

 

THE CHAIR: MLA Wilson, with about 10 minutes remaining.

 

ROD WILSON: It sounds like a fantastic program. How long is the Nurse-Family Partnership program currently funded for?

 

MARCIA DESANTIS: The Nurse-Family Partnership program was part of a strategic bundle of funding that Public Health received. We would have started receiving funding in 2023, which was our start-up phase to go live. It has not been moved to our core lead-sheet funding yet, but it is still funded under a strategic HTO: Health Transformation Office bundle. We're in the process of waiting to see what comes from budget deliberations for out years.

 

ROD WILSON: It's not in core funding, so it's funded year to year?

 

MARCIA DESANTIS: It is. It is a strategic initiative, so there are a number of Health Transformation Office strategically funded priorities. Public Health put forward a business ask for Early Years, so the enhancements we're talking about here today, and some of our oral health as well, to support our topical Fluoride Varnish Program and working with municipalities around fluoridation. It's part of that bundle. As I understand, we had a budget out until 2026-27 and potentially beyond, but it will depend on what we hear from government.

 

ROD WILSON: Just so I'm clear: You have funding until the end of next business year, or nothing past this year?

 

MARCIA DESANTIS: Correct. Funding right now in our funding letters is until the end of this fiscal.

 

ROD WILSON: Worst-case scenario, there could be no funding in the new budget for your program.

 

MARCIA DESANTIS: That would be worst-case scenario.

 

ROD WILSON: I hope that worst-case scenario doesn't come true. Of course, evaluation of Public Health is important. I'm just wondering what your performance indicators are. What time will you measure it, and will it be available to the public?

 

MARCIA DESANTIS: I can start with that. It's very important for us to - with bringing on the Nurse-Family Partnership, we also redesigned our Early Years program. In my opening remarks, I would have shared a bit about establishing our new clinical standards and prenatal and postnatal pathways. We've essentially redesigned the full Early Years programs. With that, it's very important for us to ensure that we are monitoring and evaluating our progress to ensure we're meeting the needs of the families who really need our services the most.

 

In addition to redesigning our clinical standards, we have expanded the nursing scope of practice. With that, we have a public health information system, and we have built into that what's called the Family Health Module so that we can gain information. Not all of the information has been moved into that because we're still in the process of building that Family Health Module. Each of our managers monthly are tracking a number of things related to client enrolment, uptake, number of visits, what we're seeing on our screening in terms of risks and needs. All of that helps inform whether or not we need to shift our approach or even consider recruiting in different places or moving resources to make sure that we are staffed adequately to meet those needs.

 

ROD WILSON: My understanding is that the program ages out at age two, correct? - for the families when the child reaches two? If that's correct, what happens when there are issues identified in those first two years that are obviously not resolved when the family ages out by the age of the child?

 

JEN MACDOUGALL: As part of the introduction of the Nurse-Family Partnership program, we recognized that to have the greatest impact, the earliest prenatal point of contact is the best. We started to track our prenatal referrals and work with partners to increase our prenatal referral rate so that we could ensure that we're finding the right clients for the program who need it the most as early as possible so that a lot of those supports and working with families to reach their goals can start before the baby arrives.

 

Because it's a long-term program and we work on the premise that every parent wants to be the best parent they can be, the nurses build their plan of care around their heart's desire - what their best hopes are for themselves and their families. It's long-term, so you build on the small steps and goals. It's a process from prenatal to age two. Throughout that time, the visits look at maternal health, the environmental health, supports from family and community, preparation for parenting. Through those visits, oftentimes the nurse will identify an area of interest or a goal for the family and work with them specifically on those things, but also connect with other supports in the community and in the health system. It's an ongoing process.

 

As the child reaches two, a few months before that, the transition takes place to let go and connect with other age-appropriate supports and services, depending on their strengths and needs. It's built into the program to ease out of NFP and to ease into other supports, depending on the needs that would come after the child turns two.

 

KATHERINE MALEC: In addition, NFP falls under our Early Years program, and that's available to the age of five. If there is ongoing, or if there are questions, or concerns, and pieces that clients want to, we are willing and gratefully accept any of those calls and reach out until the child is five years old. Just in absence of the structured program that NFP delivers.

 

ROD WILSON: Just so I can understand, what happens when the family reaches - the child's two. The issues with rent, food, costs, what are the resources within Healthy Beginnings that actually help the everyday affordability for that family that probably haven't changed or have gotten worse?

 

JEN MACDOUGALL: It depends on the family. Some of the supports that are put in place during the two-and-a-half years, they may continue beyond the second year. It's early days with the program, but we are seeing successes as we reach almost the two-year mark for some of the earliest folks in the program. Securing housing: there have been supports that the nurses have provided and connected with others where someone was unhoused before and they secured housing before the baby arrives. Some of those early success stories have happened, but still, after the two years, things can change for families depending on the external factors in their lives. It's really recognizing what goals are still to be met, who can support them, and really ensuring that that plan is in place for the family when the nurse steps out to support another new referral.

 

MARCIA DESANTIS: I think it's important to recognize that Early Years is one piece of Public Health. We also have a lot of attention and teams focused on working in our area called Healthy Communities. Addressing poverty requires a multi-pronged approach. We're hearing stories at the individual client level, for example, in Early Years or sometimes in our youth health centres or in other outreach programs, but we also work on policy options to address housing and income and food insecurity.

 

Our local teams work very closely with municipalities to understand the core housing needs and provide input into housing planning and housing strategy with a lens of health - how do those things determine health outcomes for people? We've also worked with the Departments of Education and Early Childhood Development and Opportunities and Social Development around food strategies: food gardens, food literacy. Green space planning is another piece of work that we actively engage municipalities with.

 

I think it was raised earlier - really knowing your community assets. We don't do this work in isolation. Public Health is one player, but there are many community assets that exist. I know each of the local teams has . . .

 

THE CHAIR: Order. Another 20 minutes has expired. Thank you.

 

We'll move on to the Liberal caucus and MLA Mombourquette.

 

HON. DEREK MOMBOURQUETTE: Thank you all for being here and for the work that you do to support families each and every day. It's wonderful.

 

My colleague mentioned it too, and it is going to be a big conversation moving forward in the next couple of weeks - the size of the deficit that this province has. We hear a lot of concern from communities across the province around important programs that people access. You indicated that you have not heard anything past this year. Are you concerned that there may be cuts coming, potentially, that could impact the programs that support families?

 

THE CHAIR: Ms. DeSantis.

 

MARCIA DESANTIS: From a public health perspective, our role is really prevention, promotion, and upstream work - what we call, always, upstream work. Focusing on the social determinants of health, we know that what makes people sick is very much their life experiences versus access to health care services or even their own biology. It's sort of an ounce of prevention. From a public health perspective, we always continue to advocate for putting money into programs and services that reduce long-term health spending and access to health services.

 

Public Health has what I would consider a relatively small budget in comparison to some of the more acute care and ambulatory care services. In the past, we have - very recently, with the enhancements to the Nurse-Family Partnership program, we've been very successful in continuing to grow our programs and services. I would say we eagerly wait to hear what comes of the budget. We will respond to whatever that decision is.

 

DEREK MOMBOURQUETTE: I appreciate that. It's going to be a pretty significant conversation across the board, really, in the next couple of weeks. We're all interested to see, and we're all concerned that programs like this could be in jeopardy. I hope I'm wrong.

 

[1:30 p.m.]

 

I do want to talk a bit about Cape Breton. I'm from Cape Breton. It wouldn't be a committee if I didn't ask a question about Cape Breton.

 

I just want to get an update - we have services in Sydney, of course. I'm in Sydney - it's the second largest municipality in the province - but I'm always interested in communities outside of the larger centres as well. Are families accessing programs like in the Eastern Zone? There are lots of examples across the province outside of HRM and CBRM. If you want to elaborate: Are folks utilizing the program who may not be in the larger urban centres?

 

THE CHAIR: Ms. MacDougall.

 

JEN MACDOUGALL: I'm from the Eastern Zone as well. Yes, I think the introduction of Nurse-Family Partnership in the Eastern Zone initially as a pilot was really to look at that rural-urban mix and to test out how the program would work there in hopes that we could scale and spread, and we have been able to. We have nurses providing service in all areas of Cape Breton. It sometimes means significant travel, depending on where the client lives. We track that travel time and visit time so that we can work with the nurses to manage their caseloads that include the travel. Certainly, working with communities throughout Cape Breton, and everyone has access to all of our services, not just Nurse-Family Partnership, but Enhanced Home Visiting and Healthy Beginnings as well.

 

DEREK MOMBOURQUETTE: We do our best to support families all across the Island. You're absolutely right that it would be similar - it could be in Clare or anywhere else. It's a drive. I'm happy to hear that families are accessing the programs. I appreciate the work that you're all doing, because it's not easy, especially this time of year. That's for sure.

 

I have a couple of questions now around the Enhanced Home Visiting program that offers the services of community home visitors, professionals trained to support parenting skills and child development by following the evidence-based curriculum. How many community home visitors are working in each of the four health zones?

 

THE CHAIR: Ms. Malec.

 

KATHERINE MALEC: I'd have to recall for all of the health zones how many there are. There are currently about 500 families enrolled across the province and they are well supported by the community home visitors.

 

DEREK MOMBOURQUETTE: That's actually very good information - 500 families. My follow-up question is: You're supporting 500 families. Are there people on a wait-list? Are there people looking to get into the program? If you had more resources, how many more families could you support through the program?

 

KATHERINE MALEC: Currently, we do not have wait-lists. What we do use for - the community home visits are weighted caseloads. Because of the natural flux in people's lives, they may need more intensive support at the earlier stages, and then a little bit less as they move along in the journey. That's how we would manage caseloads for the community home visitors at that time. With the community home visitors as well, there's still a Public Health nurse who's attached to that for the nursing scope of service until the family's complete by the age of three.

 

DEREK MOMBOURQUETTE: Actually, by the age of three, that's when you're really starting to get into - I was involved, during my time in government, around child care. You get into the three-year-olds and four-year-olds. If you want to elaborate: How are you working closely with the Department of Education and Early Childhood Development or with other departments as they make that transition? That is key.

 

There are lots of supports that families access in my community and communities across the province, but if you can elaborate a bit - you get to that limit where it's time to transition. Generally, those partnerships, who are you working with? What supports do you encourage families to take at that point?

 

KATHERINE MALEC: It depends on the family and their individual circumstances. Our nurses and community home visitors are well versed in the communities they support. People are arranged via network, knowing, in terms of child care, for example, and really helping the families navigate the applications and the process of doing that. A lot of our staff as well will help in terms of applying for financial assistance or subsidies to afford daycare costs and helping to offset that. That's a big piece of that work in that early childhood piece.

 

As we did speak to earlier today, a lot of the work and curriculum for a child is developing the skills and supportive factors for those families during that time. That benefit of building with the Growing Great Kids curriculum, for example, that's using Enhanced Home Visiting - all help toward those, what with the research showing reductions in some of those challenges later once entering into the school system.

 

DEREK MOMBOURQUETTE: We also know that historically, Nova Scotians from marginalized communities have experienced racism and discrimination within the health care system and haven't received the same level of care as others. It's unfortunate.

 

In 2023, the government released the Health Equity Framework, which provided a guide to reduce and eliminate racism and discrimination within the health care system. I just want your feedback on it. How do the Early Years pregnancy and parenting services help achieve the goals that are set out by that framework?

 

MARCIA DESANTIS: We're quite familiar with the Health Equity Framework that was released. It calls on health systems to look both at how we support clients and what the experience of staff in the health system is, and at how we create better policies to address health equity. Health equity is foundational to public health work. As I mentioned a little bit earlier, our work is really focused on those social determinants of health - the things like employment and income, poverty, race, and social isolation.

 

The Early Years program is very well aligned to applying the principles of health equity. When new families or pregnant women are referred to us, either through self referral or from their provider or a community group or organization, there's a series of interactions with a public health nurse to really understand what their life experience has been and where some of those factors have impacted them. That really helps us establish if this is a family who would be best suited to Enhanced Home Visiting - maybe don't need very much support - or if this is a family who requires a few touchpoints with a public health nurse, or if this is a family who requires the intensive support through frequency and dose of the Nurse-Family Partnership program. It's really those equity-based factors that help us establish which stream of service to engage the family in.

 

I would say, to answer your question in a much shorter way, that the application of a health equity lens in public health programs and services is a given for us. Much of the support we provide to those families is aligned with not just their physical supports but also the social, emotional, and other supports that they may need.

 

DEREK MOMBOURQUETTE: I appreciate that very much. My next question - the Atlantic Provinces Economic Council's August 2025 report found that Atlantic Canada has some of the most unhealthy populations in the country, unfortunately. The report shows that mental illness and chronic disease rates in the region are above the national average, which places a more than $30-billion burden on the health care systems here in the region. Can you elaborate on how the programs address the concerns and risks to chronic illnesses in the early years?

 

THE CHAIR: Dr. Sommers.

 

RYAN SOMMERS: It's been well known for several decades now that we have a number of chronic diseases and health issues in our province and our section of Canada. As I alluded to in my opening statement, there's significant evidence showing that if you can invest heavily in this first 1,000 days, you have a huge impact on the health and well-being of those individuals later in life. The biggest things that we've seen from what our Early Years programs can do, whether it's the mental and social supports, are that they do a huge effort in terms of preventing the use of health care services like going to ERs or urgent care centres.

 

We also know that those investments, even though they take some time, have a huge impact on educational outcomes. We know that by investing in this program early, it does have huge impacts on the health of the population. Looking at other studies from all over the world, these impacts can - we've seen people with lower rates of chronic disease. We see higher rates of completion of high school. We see less involvement with the justice system. Even through this small amount of investment at the beginning, we've seen huge return on investment down the road.

 

This is one of the reasons why we particularly like this program so much. We know we're going to have a huge impact on the overall health and well-being of our population in the years to come.

 

DEREK MOMBOURQUETTE: Listen, I appreciate the answer. You're right. It does play a huge impact on families in those early years. We see it - I've been doing this now for almost 15 years, and you see when these supports can get to people early on, you're absolutely right. You see kids go through the system who graduate who were at risk. It's such an important foundation for them.

 

We've seen across the province many Nova Scotians have advocated for midwifery services. My question is around what Public Health is doing to help to address a call for more. Do your programs play a part in that?

 

RYAN SOMMERS: Public Health does not have a direct role when it comes to that particular type of health care service. I always like to explain Public Health as focused on prevention, promotion, and protection of health. When we get more into the specific clinical services, we don't necessarily have a role in that.

 

Our system - our public health system - is developed to work with any kind of provider out there. Whether it's a family doctor or nurse practitioner, if it's midwifery, if it's going to be obstetricians or gynecologists, we will work with them. But we don't have direct involvement in dictating those services. That would be under more involvement with primary care and the acute care system.

 

DEREK MOMBOURQUETTE: Okay, that's important to know as well. My next question is around - when the Nurse-Family Partnership was announced, it was compared to similar models in British Columbia and Ontario. My first question is: What design elements did the Province here take from other provinces, and how does your program differ?

 

JEN MACDOUGALL: We were fortunate to have decades of research to model our program after for Nurse-Family Partnership in Nova Scotia. We did look closely at B.C. and Ontario's models. We knew that with the B.C. clinical trial, they saw reductions in maternal substance use, in IPV exposure, and in behavioural challenges in children. They also saw improvements in child language development and maternal income from employment. Those were some of the outcomes that they saw.

 

We are confident in the replication of the program, based on the core model elements and the structure. We should see similar results. We do have our new Family Health Module, as mentioned previously, so we have the ability to monitor some of those pieces as we move forward with NFP in Nova Scotia.

 

THE CHAIR: MLA Mombourquette with three minutes and 50 seconds remaining.

 

DEREK MOMBOURQUETTE: Three minutes and 50 seconds - I'll see if I can get a question and answer in. It's okay. I'll be back. (Laughter) I think that's great to have the ability to collaborate with the other provinces and build a model that is more adapted to here.

 

You mentioned that there are 500 families, the number of people who are working, how you're doing it. Can you talk a bit about how you're measuring the outcomes overall?

 

JEN MACDOUGALL: I can speak to the Nurse-Family Partnership and how we're measuring. I mentioned the earlier the better. We are measuring when we receive the referrals - encouraging more referrals to come to us as early as possible. They can come from primary care providers, from community organizations, or self-referrals. Our target is that we would have 60 percent of families enrolled by 16 weeks' gestation.

 

We're also looking at the number of eligible families enrolled in the program. Our target for that is 75 percent. Those are some of the kind of fidelity of the program reports that we're looking at.

 

[1:45 p.m.]

 

We're also looking at pregnancy health outcomes - birth weight, substance use, maternal health outcomes, breastfeeding rates - within all of that, and as well, how we're supporting our team. The education that the nurses receive, the frequency of the reflective supervision, case conferences, attrition, and caseload numbers - we're monitoring all of that. But really, I think the most important piece within all of this is the parent-child relationship. We're looking at the strengths of each family and building on the strengths that they have and building confidence in their ability to parent, even within complex and stressful situations.

 

We know that the early years and infants who have consistent, responsive caregivers are better able to regulate emotionally, and they do better throughout the lifespan. That's the basis of all of our programs, really, in Public Health - Enhanced Home Visiting, Healthy Beginnings, and Nurse-Family Partnership. I think that's what sets us apart. The nurses provide many typical public health nursing-scope services, but it's the training and the tools they use to really assess and work with families on that parent-child relationship that is the game changer and really builds resilience over time.

 

THE CHAIR: MLA Mombourquette with a minute and five seconds remaining.

 

DEREK MOMBOURQUETTE: We're not going to get a question and answer. I'll just finish off by saying thanks. We'll see you in the next round.

 

This is actually a great committee. I learned a lot from this. We'll probably have some follow-up questions with my office, because we deal with a lot of families who come to us. We do our best to support them, but also, we always want to steer people in the right direction.

 

I think it's a great program, and we'll see you in the next round. I'll pass it over to my colleagues.

 

THE CHAIR: We'll move on to the PC caucus. We'll start with MLA Robicheau.

 

RYAN ROBICHEAU: Thank you, everyone, for the answers so far. It's been quite informative for me. How does Early Years help support new parents who are struggling to get by? A bit more detail.

 

THE CHAIR: Dr. Sommers.

 

RYAN SOMMERS: There are a couple of ways in which Early Years is supporting our families. Obviously, the advantage of these programs is that it's a regular touchpoint. You have a consistent health care provider, a public health practitioner who supports individuals for a significant amount of time. The other major advantage of this program is that, as you've heard already, we have a role in connecting people to existing community resources and referring and navigating how to access those resources.

 

In particular, what our team of public health practitioners is doing is everything from prenatal information to support. We've already heard about supporting infant feeding and nutritional support. There's a big emphasis on healthy development and healthy relationships in supporting the parents. We also need to focus on the parents. There's an emphasis on their mental health and well-being.

 

The big thing is being a connector to existing community resources. That can be anything from - whether it's resources from municipalities, or it could be resources from the family resource centre, accessing services within the health care system like mental health and addictions or primary care.
 

I have to mention this as well: We actually talk a lot about supporting our core programs around vaccinations. We talk about the importance of infant and child immunizations as well.

 

These are just some of the examples of how we're supporting our clients. I welcome my colleagues if they have anything else to add.

 

THE CHAIR: Ms. MacDougall.

 

JEN MACDOUGALL: I think the way our services are offered is also a way that supports families who are struggling to get by. We offer services in the home primarily, and in the community, which reduces the transportation barrier and accessibility barriers for some. I think that's also unique for us. It's different from other providers in the health system, as we can provide care in the home. Often, when you're in the home, you're able to assess what's going on. You can build the trusting relationship that really allows for more quality interventions to follow.

 

RYAN ROBICHEAU: You mentioned that 500 families were enrolled across the province, which is quite big. During the process, what are the most common needs that you've seen among the eligible population?

 

THE CHAIR: Ms. Malec.

 

KATHERINE MALEC: Five hundred families are currently enrolled under the Enhanced Home Visiting stream of our program. Our Healthy Beginnings stream is open to all. As such, it ebbs and flows. It's not time-limited beyond that five-year process.

 

I would say it depends on which stage we first have the touchpoint with public health. In the prenatal period, a large piece of need and work has been in not just supporting families for upcoming birth and changes to the families but really helping to pair and support people with access to resources that they may not have. This looks like touchpoints with the family resource centre, food banks, clothing banks - equipping people with familiarity with their own communities for where they can get support where there are struggles. That has been a big piece of that work, in addition to the anticipatory guidance that comes in the prenatal period.

 

Postnatally, at the very onset, infant feeding is a huge piece of the support and work that's delivered by the nurses. With that, in those early weeks there are a number of ongoing and timely coordinated supports for infant feeding, as well as pieces of growth and development and supporting the entry into parenthood and sustained changes in family dynamics. Pieces like that would be from the onset.

 

THE CHAIR: Ms. DeSantis.

 

MARCIA DESANTIS: Perhaps I'll just add that there are a number of assessments and screening tools that we use to look at a wide range of issues that families may have. We might talk to them about harm reduction or substance use. They may express to us that they'd like to go back to high school and get their high school diploma. It may be accessing social supports. All of the things that we ask them help us really hone in on what may be some risk factors that we could support them with.

 

Support could be in various ways. It could be education information. It could be navigating to another service provider that can fulfill that gap or that need for the family. That in-home support with a routine nurse provides an opportunity to explore some of those things in greater detail and understand what the families really need and want, and then, as part of a continuum of care, help get them to the others that could provide more support.

 

For example, one of the things we look at is self-described mental health. Does Mom have a history of anxiety or depression? How do we support that mom in ways that we can? A great number - I think 43.5 percent of people self-describe a history of depression, anxiety, or other mental health issues. Our nurses work alongside that family to provide support, coping, and resiliency strategies. What our data is showing us right now is that about 6 percent of those or fewer are being referred off to clinical mental health.

 

We're there supporting the families in a place where they can accept that support because we can spend the time to build the relationship. It benefits not just that family but also the health system, because we're reducing the flow of people into a clinical diagnostic care. If they need that, that's the path that we navigate them to, but with our supports through our assessments and the nurses building that relationship, we can help identify what their particular needs are and bridge them into other services if needed.

 

RYAN ROBICHEAU: That's fantastic. I'm from Clare and we're very fortunate with our attachment rate to primary care. For other communities that might not be as fortunate, how does Early Years support families without access to primary care?

 

RYAN SOMMERS: We do know that a number of our clients are impacted by not having regular access to a primary care provider. We do know that the health system is responding and supporting those families as they go through their pregnancy journey. They may not have a regular primary provider with us, but we do have our public health nurses through these programs as someone who can really focus heavily on the health promotion, the education, and resilience, but also help them navigate how to access local supports.

 

Depending on what part of the province you're in, Public Health has worked closely with our partners in primary care to help set up routes to care, pathways to care, without having to use acute care or emergency or urgent care. Depending on the region, we have existing relationships where we can help navigate someone. There's also access to virtual care, whether it's virtual urgent care or those on the Need a Family Practice Registry - we can access those as well. We've been able to work with our local zonal primary care partners to try to identify ways to connect those individuals.

 

As I mentioned in my previous response, the nurses are doing a lot when it comes to supporting the health promotion needs of individuals, but they also have a clinical lens. They can actually be a guide and support our clients and families to the necessary service that they need at that time. It's really great to have these public health practitioners and nurses here, because they do have a clinical lens and they know where those resources are.

 

RYAN ROBICHEAU: My last question, which could be a good follow-up with the previous one: Emergency departments in the province usually cover quite a large area. For example, Yarmouth covers my area as well. How does Early Years lighten the load for emergency departments, mental health services, and other parts of the system?

 

RYAN SOMMERS: We are very cognizant of putting additional stresses on our colleagues in emergency medicine. My wife is an emergency doctor, and I hear a lot about some of the stresses on their system on a regular basis.

 

I think the big things we're providing our families are health education and skill building - to give them the capacity to decide what the right resources to use are. There's a right time and a right place to go to emerg. I think a lot of members of our community will look to that as a resource and it may not necessarily be the best use of those health care services. (Inaudible) people actually address those questions as well.

 

A big thing that we're doing is identifying what resources are out there and where they can seek care. It's also important to know that the work they're doing through health promotion is addressing their stresses or concerns. As a primary care provider as well, one of the biggest things I'm providing patients is reassurance. The greatest thing about this program is you have a regular connection with a nurse or home visitor who can provide that reassurance and help address your concerns and anxieties. We know a lot of times when people go to an emerg setting, it could be handled in a different place.

 

This is one of the big things we're looking at in some of our programs. We've already mentioned the Nurse-Family Partnership program. There's evidence around how that has had a big impact on decreasing use of EDs. Really, the beauty of this model is that we're finding the resources in the community and connecting people to those resources to ensure that they're going to the right provider at the right time.

 

THE CHAIR: MLA Corkum-Greek.

 

HON. SUSAN CORKUM-GREEK: This has already been so informative. I find myself scribbling like a madwoman over here. My late grandmother was a long-time registered nurse at Fishermen's Memorial Hospital in Lunenburg. She used to say, “Well, you've got the writing of a doctor.” (Laughter) Unfortunately, I didn't have the other qualifications.

 

This topic is such a very deeply held personal passion for our Minister of Health and Wellness. There have been references to the very considerable evidence of the value of these Early Years investments. Minister Thompon would say that that is absolutely proven out by her experiences, including in public health, during her career. Literally, from some of my earliest meetings as brand-new colleagues in a new government in 2021 and thereafter, she was, “This is where we need to make investments.”

 

It resonated with me, but it resonated with me in a different way, not as a health professional, but as an individual who is a parent. I remember I would say - and most of us, I think, in this room who are parents would say - it's the most important role we'll fulfill in our lives. I'm really hoping I don't screw it up too much.

 

[2:00 p.m.]

 

Becoming a parent - in my case, becoming a new mom - for all the joy and anticipation, is not necessarily as natural as the Pampers ad would make it look. I found it hard; I found it jarring; and with my first child, I did not realize that I was in the embrace of a postpartum depression. At that time, it was our local baby nurse, Sue Hinton - now happily retired - who picked up on it. Frankly, by the time I - well, if I had an appointment for a baby check-in with my doctor, it was probably the afternoon. The baby was sleeping. I also had a colicky child. It was a real mix. But the baby was sleeping, and I had managed to comb my hair, perhaps for the first time in days - and I'm really not exaggerating here. I could put on my face for members of my own extended family, but that nurse, she picked up on something.

 

I recognize that I was well supported on the whole. I didn't have many of what we know can be other extenuating circumstances tied to income and other resources. I know how important having that individual, who became very good - I mean, this precedes this program, but she used to just drop by after she got her spider sense. She'd just show up at the door. I'm sure she was noting seeing milk-splattered shirts, but not in a judgemental way - in a caring and compassionate way that helped to identify the true situation that I was in.

 

I can remember - this was some time ago now in my life. You're at the hospital again. You're overwhelmed by all the newness of this blessed, but very big and heavy, event in your life. It was, “Yes, the public health nurse - the baby nurse - will get in touch with you.” That was our route in.

 

Earlier there was a comment about self-referral. I'd like to have a better understanding of how Nova Scotians can connect, but equally, the outward effort to connect them, realizing that too often we internalize - like, “I've got to buck up here.” Knowing that getting resources to people is what really makes a difference - if someone could please speak to that?

 

THE CHAIR: Ms. DeSantis.

 

MARCIA DESANTIS: My late grandmother was also a nurse. She was a community health nurse and delivered lots of babies in small towns. I have that family association myself, and two of my children are now nurses.

 

I think what you're talking about is very important and has informed some of the redesign of our program. Earlier we alluded to the shift to prenatal referrals. What does that mean? I would say heading into the pandemic - before the pandemic - oftentimes the first interaction we would have was after delivery. We would have nurses who would go to one of the mat. child centres and meet with the family there.

 

We realized through assessment, evaluation, and looking at some quality improvements and literature that getting connected to women in the prenatal period gave us a runway to establish the relationship and start to look for some clues about what might be coming for them. We've worked very hard over the last few years to shift to prenatal referrals, which looks a little bit different in different areas.

 

One of my colleagues mentioned the close working relationship with primary care and mental health. In Western Zone, they moved a little bit earlier, actually, to prenatal referrals. They had worked quite closely there with primary health care to map out what are you doing in the prenatal period, what is Public Health doing, what is mental health doing, and how do we connect that client to the right people at the right time?

 

We've done a fair bit of work shifting to prenatal referrals, because often after birth, you're very tired. You're often overwhelmed. You're trying to figure out infant feeding. We know the importance of that early parenting connection, so we've moved to prenatal referrals. We've done a great amount of work with our colleagues in primary care, but we've also now said, “Hey, if you're pregnant, you can reach out to us.” We've done a bit of promotion and information sharing about that. There's lots of information on the Nova Scotia Health website about it. That early intervention - it's where the magic happens, right? Before Mom is exhausted with a colicky baby, we've established a relationship and can support the mom.

 

THE CHAIR: Ms. MacDougall with a minute and 10 seconds remaining.

 

JEN MACDOUGALL: Thank you for sharing your story. It resonates.

 

I think our shift to restructure having contact with all - setting our standard to say a minimum contact in the prenatal period and an offer of a visit in the postnatal period, regardless of your circumstances, really allows us to do a thorough assessment and not make any assumptions about what might be needed or what might not be needed. For the nurses, it's really an art and science of assessment - being able to have conversations to observe what's going on, to be really astute to those things so that they can identify when something might be off. That's something that we're really proud of - that we've restructured in that way so that we have something for everyone and we can tailor services to meet the needs.

 

THE CHAIR: MLA Corkum-Greek, there are 10 seconds remaining.

 

SUSAN CORKUM-GREEK: We'll wait until the next round. Thank you.

 

THE CHAIR: Thank you very much. We'll move on to round two. There will be 14 minutes per party this time.

 

We'll once again start with the NDP and MLA Lachance.

 

LISA LACHANCE: I wanted to ask some questions about early childhood assessments, because of course the early years are critical, particularly when we're thinking of different developmental issues. I'm wondering, do the nurses in this program have training on fetal alcohol spectrum disorder?

 

THE CHAIR: Ms. MacDougall.

 

JEN MACDOUGALL: We do have a list of mandatory training for our public health nurses. The key areas are mental health and addictions, trauma- and violence-informed care, cultural safety, and humility. Within that, there are pieces, but we do recognize that that's an area where there are always ongoing opportunities to develop those competencies and learning.

 

LISA LACHANCE: What I was going to ask too - in our province, we have a lack of ability to assess for fetal alcohol spectrum disorder. Previously, families accessed the centre of excellence in Moncton in New Brunswick. I understand that's no longer the case. The IWK Health Centre doesn't really have any capacities.

 

With FASD, what would a nurse do if they were concerned that that assessment needed to take place?

 

THE CHAIR: Ms. Malec.

 

KATHERINE MALEC: As with FASD and any other clinical situation requiring further assessment, our nurses in the home would redirect to primary care, and if they did not have a primary care provider attached, would find different avenues of support to facilitate that referral for further assessment. Given that we do have a clinical background, we do have the ability to recognize when there is a need for further assessment. The long-standing relationship that we can have with families allows us to provide ongoing support in helping them navigate through the health system, various appointments, next steps, and walking with the family during that process.

 

LISA LACHANCE: The program sounds really important and impressive. Not to take away from that, but I still would continue to advocate for the fact that we need to have the capacity to do FASD assessments in this province. It's a very complex developmental issue. We simply don't know what is happening with young people in this province.

 

I also wanted to ask about autism and early assessments. Often - not always, but often - it's within that age range that some of the first signs of autism become visible. We have really long wait times for autism assessments in the preschool years. I'm wondering: For families in this program who are perhaps more vulnerable than other families, what happens when there's a concern about autism? I recognize the referral to public primary health, but is there the ability for the family to be highlighted as a particularly vulnerable family who should have access to assessments?

 

THE CHAIR: Dr. Sommers.

 

RYAN SOMMERS: I think it's important to realize this program is primarily founded in health promotion. If there are clinical concerns of any nature, whether it's developmental or some other chronic health issues, our nurses will work closely with primary care to help complete that assessment. With things like autism and fetal alcohol spectrum disorder, I totally agree with you. There's a need to ensure we have the proper resources in place and services, especially with the fetal alcohol spectrum disorder. It's a challenging diagnosis to make.

 

What our nurses are probably seeing are those very early stages. A lot like we see in primary care, you're going to see undifferentiated disease. We won't get those very early signs of something not matching what that normal development might be, whether it's failure of the child to have appropriate gaze with their eyes, or if it's language development. One thing to remember is these nurses are going to start seeing the very broad type of developmental challenges. They're not necessarily going to be involved with making that formal diagnosis, but working with our local primary care, working in primary care, working with pediatrics to do that full assessment. Maybe I'll let my colleagues include more to comment on - more of the community resources when it comes to early childhood development and these types of issues.

 

JEN MACDOUGALL: Within the NFP program, we do have ages and stages developmental assessment that is implemented at regular intervals. That does allow the nurses to identify when something might need a referral. The benefit of having the nurse in the home in those early periods is to be able to refer early. Oftentimes the wait-lists are longer, and if a child is approaching school age - not to diagnose or treat, but to identify when something requires further follow up. There's a standardized way that we do that in NFP.

 

LISA LACHANCE: (Inaudible), I think that accompaniment was very important. I think we - Nova Scotia - I think we still have - and we'll find out more in Estimates - about 1,600 under-fives on the autism assessment wait-list which basically means that lots of children who have been identified with this developmental vulnerability that was referred to earlier end up starting school, ideally progressing through ages and stages without the benefit of having not only the assessment but the early intervention which is the reason why you want an early assessment.

 

I want to just say that one of the reasons why I can picture this program so well is that I became a parent in Ontario when the Early Years strategy was in place; that was zero to six. I can tell you that I'm pretty sure it was day one when we had our son at home - he was 11 months when we brought him home. We literally went to the Early Years centre because we were like, “What do we do?” Of course, that parent-child relationship is particularly important when a child has had a transition from a foster family to an adoptive family.

 

My question is: Are adoptive families able to participate in this program?

 

KATHERINE MALEC: Yes, all families, caregivers who are looking for support - it's open to all Nova Scotians.

 

LISA LACHANCE: I think you just answered my second question which was around family care. It sounds like if you're a person with a child under two in your care, you can access this program.

 

[2:15 p.m.]

 

I also wanted to ask - my colleague asked a couple of questions around the Health Equity Framework. To address some of the specific communities in the province of Nova Scotia, how many people are able to offer services in French? I'm also thinking about Arabic. I'm also wondering about for queer and trans families and African Nova Scotian communities. What's that spectrum of outreach that you have within the program?

 

KATHERINE MALEC: As we know, as well, and what we're seeing is that our population is very diverse and growing in diversity in Nova Scotia. A huge piece of our work relies on partnerships and engagement and engaging in equity-deserving populations. Lots of the work that we do - I'll speak specifically for Central Zone. We have a large newcomer population, so we do have most of our resources translated. We have them available in multiple languages based on what we know to be predominant.

 

We also utilize our translation services quite significantly. That can either be with in-home interpretation support or in-person interpretation support in whatever modality that they're meeting, as well as apps. We have InSight interpretation apps that we use quite regularly. We do have strong relationships with ISANS and the Halifax Refugee Clinic as well to either partner in delivering some programming, such as prenatal, and learning how to best navigate and support some of the families.

 

I think I'll hand it to Jen.

 

JEN MACDOUGALL: I think you covered it. Yes, I think the nature of our work and the training of our staff - the targeted outreach and service delivery, just identifying families who may experience barriers; offering flexible access points in different ways to meet families where they are, in their homes or communities or virtually; translation services, as mentioned; and adapting practices to be respectful of diverse cultures and using inclusive language, family structures, and parenting norms. Care is delivered with an awareness of that impact - the impact of past and present trauma and systemic oppression - creating environments that are physically and psychologically safe and reducing some of those systemic barriers just by the way that we offer our service.

 

THE CHAIR: Ms. DeSantis.

 

MARCIA DESANTIS: Just two things that I'll add. The first is that Public Health has a set of core competencies. Health equity and social justice is one of them. We've invested a good amount of energy in identifying options to build cultural competency so that we have some knowledge when interacting with clients. There's always work to do. A number of our staff have recently participated in a cultural competency training offering through Dalhousie University that's being assessed. It's for health care providers.

 

The other thing I would say is that we are actively trying to diversity our workforce. We're looking at our recruitment strategies so that we have a complement of staff who look like and may understand our population more. Just a brief encounter that I had - one of the team leads at the Nurse-Family Partnership in Central Zone is from the African Nova Scotian community, and she shared with me that one of her first clients was mixed-race and had said to her how thankful she was to have someone who looked like her whom she could build a trusting relationship with.

 

We know that it's very important to build a workforce that is reflective of our population that we're serving and continue to train all of our staff to step into that work.

 

THE CHAIR: MLA Lachance, one and a half minutes remaining.

 

LISA LACHANCE: I want to go back to the issue of postpartum depression. I know in Nova Scotia, we have one of the highest rates in the country. Obviously, this would be a key way to support parents who are experiencing that. Again, I guess my question is: Knowing that some of the most vulnerable families are involved in this, less able to probably self-advocate for access to care, is there basically a fast track? Is there a prioritized way for a parent identified through this program as potentially having postpartum depression to access community-based mental health services? Across the province - I mean, at Cape Breton Regional Municipality there are still hundreds of days of waiting time before they would ever - this period would pass.

 

I'm just wondering about the prioritization.

 

JEN MACDOUGALL: We use the Edinburgh Postnatal Depression Scale screening tool at regular intervals as well, and our nurses are trained in the use of that. Again, it's the early identification and understanding at what point a referral is needed and helping to support that. Our nurses work closely with mental health and addictions and primary care . . .

 

THE CHAIR: Order. We'll move on to the Liberal caucus. MLA Mombourquette.

 

DEREK MOMBOURQUETTE: I'll kick off my questioning with child care and the importance of child care - affordable child care, accessible child care across the province.

 

My question is: In your experience working with families, how important is it to have access to child care and affordable child care?

 

THE CHAIR: Dr. Sommers.

 

RYAN SOMMERS: Obviously that is probably one of the most significant things we can do to help families in our province when it comes to their health and well-being. Having children access child care - in essence, it is an early childhood development intervention as well. There are opportunities to work and socialize. You're working with people trained in early child development. They are providing the supports as well.

 

From the family perspective, having access to child care that's accessible, whether it's by geography or by cost, is also huge. It allows - whether it's for the mental health and well-being of the parents or it allows them to enter the workforce, those are extremely important for their own health and well-being. It's really important right now in a time when we're having income insecurity, housing insecurity, and food insecurity. It does have direct benefits on the health of families as well. This is something we see with our work with our Early Years program and also with our work with another program in Public Health called Healthy Communities. We see it as an essential determinant of health in our communities.

 

DEREK MOMBOURQUETTE: A follow-up, and the reason I asked that question - the goal was to have an average of $10-a-day child care by this year, an agreement that was signed back in 2021. It was a five-year plan. It was based on average, because we knew some families were still in a position where they couldn't afford even the $10-a-day child care.

 

I guess for me - how important is it for the Province to reach that average $10-a-day child care?

 

RYAN SOMMERS: I can't speak specifically around the details of that particular funding program, but I can emphasize that when we see families and see communities that have access to child care, it does have an impact on the children's health. We know that some families are going to be challenged by that. We know from evidence that the children do benefit and the families benefit as well, and the communities can benefit by having those services in place.

 

DEREK MOMBOURQUETTE: A follow-up question for that as well: You're supporting 500 families across the province. Are you dealing with any of those families who are having barrier access - any kind of barriers that are set up in communities where there's no access to child care at this point?

 

THE CHAIR: Ms. Malec.

 

KATHERINE MALEC: Yes, it is a reality that we know of difficulty in Nova Scotia. I can speak in Central Zone as well - a lot of our newcomer families as well are having a tricky time navigating some of those pieces. So yes, we are seeing that.

 

DEREK MOMBOURQUETTE: Yes, it's an important conversation. The goal was 9,500 seats, an average of $10 a day - there were some pretty big investments that were put forward back then, and now, well, the current government may not meet the targets. We do whatever we can, regardless of what side of the floor we sit on, to make sure we can do whatever we can for our kids.

 

That is a huge one, and I hope we get there. I think it's absolutely necessary and critical for families to have access to it and to make sure that it's affordable for people, whether they can pay $10 a day or if they need to pay less.

 

We had a question on child care. I'm going to get into again the deficit and the budget. One of my questions is: What kind of impact would it have if you saw a decrease in your funding as a result of what we're seeing as a historic deficit that the government is going to have to try to tackle?

 

THE CHAIR: Ms. DeSantis.

 

MARCIA DESANTIS: I think what we're talking about here today - we have other major streams of public health work that also happen in Public Health. That could be anything from emergency response to infectious diseases or health hazards. It could be regular infectious disease case and contact management. Our work spans healthy public policy and advocacy, things around affordability, substance use, sexual health: a wide range of programs and services that are offered at a population level, at a community level, and at an individual level.

 

I think impacts to funding reductions would mean that we would have to take a look at what our legislated responsibilities are under the Health Protection Act. Thinking back to COVID days, we very much relied on our business continuity plan to identify those programs and services that we cannot stop or slow. It would mean our looking across our portfolio and identifying areas to reduce resources to ensure that we meet the mandatory programs that we're required to offer.

 

DEREK MOMBOURQUETTE: When I ask these questions, it's not trying to put anybody on the spot. I think it's an important conversation. I've been part of a government coming in back in 2014-15, when we were coming into a pretty significant deficit. You're into decisions to make sure that you're not impacting the programs that people count on. In this case, it's three times the size. You have a $1.5-billion deficit for a population of 1 million people.

 

These are conversations and questions that we're asking multiple departments around the fact that these programs are so critical. As you said, if it's not this program, what program may be in jeopardy? What staffing may be in jeopardy? Ultimately, we've just seen this deficit balloon over the last five years.

 

I'll do a follow-up question: What would it look like to receive more funding? How many more families could you help? What would be the ideal budget for this program specifically that you could help more families, you could provide more services?

 

MARCIA DESANTIS: At the outset of the Early Years funding ask, I mentioned we took a phased approach. Our budget over, I think, the five years that we put in, was set to expand each year. Right now, we're in the part of the program, or the phased implementation, where we continue to have capacity to take new families in. Should we see a significant increase in need or demand, it would mean that we would either have to prioritize enrolment or cap enrolment. We're not there. We're taking stock of those services, and our intention was to add additional multidisciplinary positions: perhaps infant feeding specialists, social workers. We know there's lots of workforce demand, so reserving our nursing staff to do the core nursing work. The vision would include bringing other disciplines into the team and to expand our nursing complement.

 

DEREK MOMBOURQUETTE: How much time do I have left, Chair?

 

THE CHAIR: Five minutes, 40 seconds remaining.

 

DEREK MOMBOURQUETTE: I'll just ask a couple of quick questions. These are just specific to the program. What are the necessary qualifications to become a community home visitor?

 

KATHERINE MALEC: It's post-secondary, either early childhood education, human sciences, as well as a minimum of one year experience working with families and children.

 

[2:30 p.m.]

 

DEREK MOMBOURQUETTE: A follow-up to the child care question - I have another one here. You kind of alluded to it, that there's a challenge. Of those families - you say you're working with 500 families. It doesn't have to be an exact number, but of those families, how many of them are struggling to find child care across the province right now?

 

KATHERINE MALEC: I don't know if I'd be able to make an estimation of that. I do know that it is a reality in several of the communities that we face. To your point, even $10 for some families is out of reach.

 

DEREK MOMBOURQUETTE: My next question is around public awareness. I'm learning a lot today as an MLA. I've heard of some of the programs before, of course, and there's been a lot of conversation around the table about what the future looks like and what else we can do to support families.

 

As an elected representative, when families come in, what is the best way for me or my staff to say, okay, this family - we deal with a lot of housing issues. We see the child care barriers in particular cases, and we see some of the challenges of parents becoming parents. We try to support them however we can, but ultimately, as I said, we want to steer people in the right direction. What can we be doing as MLAs to help support the important work that you're doing?

 

RYAN SOMMERS: It's a great question. One thing I should note is we refer to a lot of our organizations in the community, and the ones that we refer to the most are family resource centres. I live in the Truro area; the one that's known up there is Maggie's Place. It's a really important partner when it comes to understanding what resources are available in the community. We are usually advertising our services through the health care system, but our family resource centres are probably one of our biggest partners and champions to get the word out there. We do have a number of pamphlets, information, documents, and websites that we can make available to the committee afterwards - just some basic stuff for your own constituents.

 

From my perspective, it's our health care providers and then family resource centres, number one, who are our biggest champions out there. If someone's going to a play group, that's going to open your door to a variety of services, whether it's from Public Health or from Nova Scotia Early Childhood Development Intervention Services or if it's from access to food banks. Connecting with your existing family resource centre is one way to understand how we support our Early Years populations.

 

DEREK MOMBOURQUETTE: It's an important question, because I want to do whatever - and I'm sure we all want to do whatever we can to support the work. You said there's no cap at this point, so you could actually take on additional families. I think there's approximately - I could be wrong. I'm getting this information - about 7,500 births a year across the province. You're supporting 500 families now. Do you see that number growing with a better budget? Do you see that growing yourself? Are there ways that we can help support if there are families who are actually looking to access that?

 

MARCIA DESANTIS: There are 120-plus families enrolled in Nurse-Family Partnership. That is the most intensive support that we offer. There are 500 families enrolled in Enhanced Home Visiting, and the third stream is Healthy Beginnings, which really plays the touchpoint role. For those who maybe don't end up in either of those other two programs, they maintain service at need for parents and their young families. We have capacity in those programs at this time.

 

We are thinking about what happens when we don't have capacity in those programs. Do we have the ability to perhaps shift resources to one area of the province that's seeing an increased need? Do we shift resources? Do we refine the criteria for who qualifies for a program like Nurse-Family Partnership? Do we look for options to bring forward additional funding requests? I think all of those strategies are on the table for us as we go forward, but again, we're really tracking the demands and the needs and mapping out proactively toward the future to see what our capacity or needs might be.

 

DEREK MOMBOURQUETTE: Thanks for all the work that you do. I hope that you can continue to do the work.

 

THE CHAIR: I'll move on to the PC caucus. I'll start with MLA Wong.

 

HON. BRIAN WONG: This has been a real education. I can't tell you how much I appreciate it as a dad of two children and going back and looking at what we went through as parents. It's nice to know that there's work progressing.

 

I know my colleague across the floor has focused a lot on the deficit. There's no doubt our government is concerned with the deficit, but those investments went to good things with historic improvements in health care; last year alone, our government invested $7.3 billion in health care, almost 50 percent of our health care budget.

 

Along with that, things we would not have had - we had an improvement. We had 2,600 more surgeries than we've ever had before; we wouldn't have had that. We reduced the surgical wait-list by 27 percent; we wouldn't have had that without those investments. We added 60,000 more primary care appointments that we would not have had without those investments. Those are things that we celebrate. That's where the money is going. We're investing in Nova Scotians.

 

What are the successes that you've had? What are the things that are top of mind for you that you've seen improvements or key milestones in the Early Years program and the Nurse-Family Partnership?

 

THE CHAIR: Ms. DeSantis.

 

MARCIA DESANTIS: Maybe I'll start by saying we are relatively new in the Nurse-Family Partnership game. We take referrals of pregnant women, and then we follow them until the child is two years old. We haven't graduated anyone from our program yet. We have lots of testimonials from families about the value of the support that has been provided to them, but I think based on the fidelity of the program itself - and I think some of these numbers were given earlier - things like a 48 percent reduction in child abuse and neglect, that leads to better health outcomes for baby and family; 58 percent reduction in ER visits for accidents and poisonings; 50 percent reduction in language delays at 21 months.

 

The list goes on: 82 percent increase in months employed - those are the parents. We're not just serving the children and that critical bond, but getting parents to finish their education and become gainfully employed; 61 percent fewer arrests in the mother; 59 percent reduction in child arrests at age 15. Those are the outcomes that have been studied and proven with the Nurse-Family Partnership. This program, the value of it now is in its infancy. It's the sustained continuation of this program and service that will help our population see those protective health factors for both the parents and the children.

 

BRIAN WONG: That kind of brings me right into my next question which is about the transitioning piece. One of you spoke about the Early Years, the Healthy Communities, SchoolsPlus, the Department of Opportunities and Social Development. What does it look like coming out of those first two years? What does that transitional phase look like for the parent and the child, and what does it look like administratively? How does that information get passed on from one program that goes into the next one, to the next one, and follows this child and family right through school?

 

MARCIA DESANTIS: I mentioned earlier that there are complex, wicked social problems that face us in terms of affordability, poverty, and food insecurity that require multi-pronged approaches. We're talking about Early Years and how we support young families through NFP until two years, out to five years for Healthy Beginnings as they transition into schools. We've worked closely with our partners in education at the department around the School Food and Nutrition Policy which is another big success in terms of health and learning outcomes. We know that kids who are fed do better in school. Kids who do better in school graduate. Kids who graduate go on to become gainfully employed.

 

It's not just the transition from Early Years to school, but it's all those other promotion and prevention supports that are offered. We work with municipalities on free recreational programming for those who can't afford it. What that means is kids who are physically active and are fed at school go on to be healthier learners.

 

It's not a one-pronged approach; it's a multi-pronged approach to addressing that. Those are some of examples of other places that Public Health works. We also have youth health centre coordinators. That falls outside of our Early Years program, but in high schools, we provide very similar supports to young teens, at another very important age. The Early Years are what I would describe as the first kick at the can, and those middle years are the second opportunity.

 

BRIAN WONG: I was very fortunate in my previous career to be an administrator, principal at the elementary, middle school, and high school levels. I could always go back and look at the progression of that child and the interventions and stuff that had taken place. That's on that back-office piece. How does the health information or data that you've collected in the early years follow through? When a child or family is 15 years along, how do you look back and how do you track the data?

 

MARCIA DESANTIS: I think it's a very good question, and I think what we see is that the early intervention in those protective factors leads to those better education and health outcomes. I know that there is some data that exists - the name is not coming to my mind - that we could certainly pull and share with you. It points to how we get kids through school and across the stage at graduation. That requires a lot of support, some of which is Public Health and some is not Public Health. I would have to pull the information - you probably know the information better than me.

 

BRIAN WONG: I don't want to keep beating the wet paper bag. What I was looking for is: How do you track the information? If a child has fetal alcohol spectrum disorder, and it's part of the interventions they get throughout their life, how do you - in the help is what I was asking. I shall pass this on to my colleague at the end.

 

THE CHAIR: MLA Hilton.

 

NICK HILTON: In my 20-year nursing career, I actually spent two years with Public Health, both years with the immunization team and the Enhanced Vision Screening Program team. I have a lot of good memories there. At the same time, it's so much different from acute care settings, and the public views it so differently from acute care settings. Sometimes, you could ask someone in the public what Public Health does, and they wouldn't be able to tell you. At the same time, I have really good examples of years down the road where that work has made life easier for certain constituents or certain residents in my community.

 

I was in a meeting not that long ago when we were talking about the HPV program. We're not too many years away from seeing a number of those strains of HPV being non-existent in Nova Scotia. That work is going to, down the road, save us money. I know that the Department of Health and Wellness and the minister feel really strongly about the work that you guys are doing around the early childhood years. I think I can safely say that we're going to be very supportive of that going forward.

 

Something you said in your opening remarks, and you've mentioned before, Dr. Sommers, is the 1,000 days. If I was talking to my residents and trying to tell them the importance of the programs that you offer in those 1,000 days, maybe you could just share - what would I specifically say is important for them to hear, and how would they be engaged in what Public Health offers at the same time?

 

THE CHAIR: Dr. Sommers.

 

RYAN SOMMERS: I think the challenge with Public Health at times is explaining the work we do and getting it to resonate with people. I think most people understand what the factors are that result in a healthy child, whether that's a loving home, access to safe food, daycare, whatever it may be. When we try to explain this to the public, we try to explain in the language that they can resonate with. I think we all have seen in our own families and our own friends and neighbourhoods those who have the means to succeed. It makes a huge difference. Part of explaining this is so that we know that disease is not random. We know that certain parts of the population have certain overlapping challenges that they deal with. Those challenges can get in the way of someone having a really fruitful childhood.

 

[2:45 p.m.]

 

I think the best way to explain this, if you talk to families and think about those situations and what does result in an ideal childhood, what they see in terms of those kids who do succeed, what are they? I think the big thing that you can do from the Public Health perspective - like I said, we'll share some of our resources with you, but there are a lot of existing resources in our community family resource centres. Connecting with them, people, regardless of their background, I think have a good understanding of what family resource centres do. I took my kids to Maggie's Place in Truro for the play groups. You understood the importance of those social interactions with other kids, and also interaction with other parents.

 

The challenge is trying not to make it too medicalized but also explain - I think most Nova Scotians want to see their children thriving and being healthy. That's something regardless of our backgrounds, we all want to see that happen. Trying to explain to people what things make a healthy childhood, and we know some people don't have that, and that there are resources through the health care system, through Public Health, and through the resource centres to help address those. I hope that answers your question.

 

THE CHAIR: Ms. MacDougall.

 

JEN MACDOUGALL: I think when we think about the first 1,000 days, one of the grounding pieces that we keep within our programs is the baby at the centre and the family at the centre. Infant mental health is a really important topic within our programs and to think about when you're speaking with people invested in this work, thinking about brain development and what's formed in the earliest days, that sense of safety and trust, the ability to regulate stress and emotions, and that foundation of attachment. It really teaches babies how to experience the world and how to show up in the world. We know early adversity, without those buffering relationships, increases vulnerability.

 

When we can focus on that parent-child relationship and the consistent, responsive caregiving, we know the impacts are long-lasting. In middle school that might show up through peer relationships, learning and attention capacity, ability to handle frustration and problem-solve. In adolescence, we know that's the foundation of your identity formation and risk-taking behaviours, and then in adulthood, relationship patterns, your mental and physical health, and your parenting capacity. A lot of what we do is responding to the needs of parents, but it's also preventing the next generation when we look at building healthy brains. That translates through the life course.

 

THE CHAIR: MLA Hilton, with one minute remaining.

 

NICK HILTON: It's not very often I get to ask my questions last. Now I see why I don't like it. (Laughter) You've answered most of them, which has been phenomenal. There's so much more information I'd love to hear from you guys. I don't even know what to do with my one minute, except to say thank you so much for coming in today and sharing this work. We hope, as a caucus and as a committee, to be able to share the information we've received here today with our residents, with our communities, in a positive way, and hopefully send some more referrals your way.

 

THE CHAIR: With that, I'll ask the witnesses if they have any closing remarks. Ms. DeSantis.

 

MARCIA DESANTIS: I don't have anything formally prepared, but I think that if you have a constituent who comes to you, and they are pregnant or have a young family, and they're seeking some support, put them on to the Nova Scotia Health Authority website or provide - we have local Public Health offices in all zones. That's an entrance to connect with a nurse who can help sense what they might need.

 

THE CHAIR: I appreciate all your time from the witnesses this afternoon. Your expertise was very much appreciated. You're free to leave now.

 

We do have some committee business to take care of. Would the committee like to have a two-minute break? We'll take a two-minute break.

 

[2:50 p.m. The committee recessed.]

 

[2:54 p.m. The committee reconvened.]

 

THE CHAIR: Order. With committee business, we have - the first item is two pieces of correspondence received from the IWK Health Centre regarding requests for information from September 9, 2025. I think everyone has the correspondence. The IWK Health Centre was not the applicable organization to answer, so they sent along the information of some folks with the Nova Scotia Health Authority who may be better suited to answer the questions. Does the committee wish to follow up on this inquiry with the Nova Scotia Health Authority? MLA Lachance.

 

LISA LACHANCE: Yes, please. I had written to the committee clerk to ask about that after that lack of an answer from the IWK Health Centre, so yes, I think that would be great.

 

THE CHAIR: Everyone else okay with that? Okay, we'll go ahead and we'll ask for that information. We also received correspondence from the Canadian Mental Health Association. Is there any discussion on that? Hearing none, we'll move on to the third item.

 

The House of Assembly is likely to be open on February 23^rd - the Budget Estimates. The next meeting of the Standing Committee on Health - we don't meet during Budget Estimates. Would the members prefer to postpone or cancel the March meeting? Would anyone like to speak to that?

 

NICK HILTON: I'll move we cancel the March meeting and move it to May.

 

THE CHAIR: Okay, any discussion on that? Do we call for a vote on that?

 

GORDON HEBB: It's up to you. If everybody agrees, you don't need a vote.

 

THE CHAIR: We have consensus? Okay. We're okay with that then? We'll cancel the March meeting.

 

Our next meeting will be April 14^th at 1:00 p.m. The topic will be Improvement of Health in Women and Gender-diverse Individuals. The witnesses will be the IWK Health Foundation, the IWK Health Centre, the Nova Scotia Health Authority, and Kim White.

 

This meeting is now adjourned.

 

[The committee adjourned at 2:55 p.m.]