Integrated maternal and child health services provide holistic and comprehensive support for mothers and their children to attain good health and wellbeing.
Singapore, 22 September 2023 – Studies have shown that the first 1,000 days of life is the period when the foundations of optimum health, growth and neurodevelopment across the lifespan are established. Recognising that early detection of risk factors, provision of preventive care and support for parents or caregivers through screening and early intervention is important for the child’s development and wellbeing, the National Healthcare Group Polyclinics (NHGP) piloted the Enhanced Maternal Baby ToddleR And Child SurvEillance (EMBRACE) programme at Yishun Polyclinic in September 2020, providing holistic and comprehensive support to improve the health outcomes of mother and child. NHGP has since expanded the programme to all its seven polyclinics, benefitting close to 53,000 patients.
Strengthening mother and child dyad
During immunisations and childhood developmental screening for the child, EMBRACE integrates maternal and child health services to strengthen the mother and child dyad in the same visit to the polyclinic. For instance, nurses will provide health education such as giving nutritional advice and imparting parentcraft skills so that the mother and/or caregiver learn the essential skills of taking care of a child. Mothers will also be screened for potential postnatal depression symptoms, receive follow-up care if they have a history of Gestational Diabetes Mellitus (GDM) and supported in their breastfeeding journey.
In particular, the EMBRACEPLUS programme, a component of EMBRACE, focuses on identifying at-risk children aged 0 to 3 years old from low-income families, to help address their health, social and financial issues. Research has shown that socioeconomic status is a key factor influencing the development and wellbeing of children and their quality of life. Children from families of low socioeconomic status are at high risk of being exposed to poor health relevant behaviour and lifestyle. These families are often compounded with life stressors such as chronic or unstable unemployment and single parenthood. These may make it harder for parents or caregivers to provide responsive care for their children, compromising their child’s general medical needs such as medical or vaccination appointments.
Studies have also shown that families with fewer economic, educational and psychological resources are less able to provide an environment that supports their children’s cognitive growth and development. These effects are cumulative and can impact one’s life course in the long run.
Considering the needs of at-risk children from low-income families, and the lack of an integrated maternal and child programme that is catered to their needs and challenges, EMBRACEPLUS was conceived to address medical, care and financial needs when the mother child dyads arrive at the polyclinic for the child’s immunisation and childhood developmental screening.
Comprehensive Screening to Identify Patients with Needs
Dr Chen Shiyun, Family Physician, Associate Consultant, Yishun Polyclinic and Programme Lead for EMBRACE shared, “The EMBRACE programme provides comprehensive and holistic healthcare services to improve the health outcomes of mothers and their children. In particular, EMBRACEPLUS gives at-risk children from low-income families a good head start. These families usually have more stresses which may contribute to the child having developmental issues. As such, we have been partnering organisations to build an ecosystem of support for these families. The integration of comprehensive screening, early intervention and network of community support has helped to optimise developmental outcomes for children, as well as provide support for mothers.”
A dedicated nurse in EMBRACEPLUS will follow up with the mother-child dyad to ensure that the child complete his or her Childhood Developmental Screening (CDS) and Childhood Immunisations Programme, identify and address the medical, care and/or financial needs as well as to provide care coordination services for mothers who may be experiencing PND and/or GDM. The team also works with social and community partners on programmes such as KidSTART to provide a supportive ecosystem for continuity of care.
“Being the first point of contact for patients, it is important for nursing staff to learn the tactics of administering screening questions so as to identify patients who require assistance and offer appropriate follow-up actions. To better attend to the children and their family’s needs, we have conducted training on interviewing skills and scenario-based training to equip the nurses with problem-solving skills to handle challenging situations,” said Ms Wendy Ong, Senior Nurse Manager and Nursing Lead for EMBRACE.
Supporting New Mothers with breastfeeding issues
Recognising that new mothers may likely face issues with breastfeeding, NHGP launched the Lactation Support Service across all NHG Polyclinics in July 2023. The latest addition to its suite of maternal health services, it aims to improve breastfeeding care, continued family and community support, as well as give encouragement and support to mothers. The mothers are identified when they share their issues during their children’s immunisation and developmental screening appointment, or when they book an appointment to see the doctor.
During the 40-minute in-depth consultation, the trained lactation nurse will assess the mothers and provide breastfeeding advice as well as hands-on demonstration for mothers with breastfeeding difficulties such as latching, engorgement problems or clogged milk ducts.
To create a more relaxed ambience for mothers during a consultation session, Ang Mo Kio Polyclinic is the first NHG Polyclinic to roll out a dedicated lactation support room. The room is furnished with soft lighting and lilac walls, providing a soothing and calming effect that helps make breastfeeding easier. The lactation nurses are also equipped with breastfeeding education materials such as models, charts and brochures to guide mothers on how to breastfeed successfully.
As of August 2023, 100% of mothers who utilised the NHGP Lactation Support Service have continued with their breastfeeding journey successfully.
Achieving Favourable Health Outcomes
Between September 2020 to July 2023, close to 400 at-risk families in EMBRACEPLUS were identified with needs, and more than 96% of these families have received medical, social and/or financial support from NHGP. For postnatal depression, about 2% of the mothers were screened positive for postnatal depression. Of which, 82% received timely interventions for psychoeducation and supportive therapy in NHGP. For mothers with GDM, 84% did not progress to pre-diabetes and Type 2 diabetes within one year, after NHGP’s interventions.
Moving forward, the EMBRACE team will continue to build stronger ties with regional social partners and strengthen integrated maternal and child health delivery for the at-risk group.
“We are investing more in upstream measures to help families keep healthy. This is in line with the Healthier SG effort on preventive health. In due course, NHGP hopes to address adolescent mental health needs as this is a rising concern in Singapore,” added Dr Chen Shiyun.
