Healthy Babies Healthy Children Service Levels and Update on Provincial Review

Transcription

1 HL27.02 REPORT FOR ACTION Healthy Babies Healthy Children Service Levels and Update on Provincial Review Date: June 4, 2018 To: Board of Health From: Medical Officer of Health Wards: All SUMMARY Healthy Babies Healthy Children (HBHC) is an evidence-based prevention and early intervention home visiting program designed to support families with children at risk for poor growth and development outcomes from the prenatal period until the child's transition to school. It focuses on supporting optimal prenatal health, child development, positive parent-child relationships, and positive parenting skills. The program includes screening, assessment, and blended home visiting (by a Public Health Nurse and a Family Home Visitor). Boards of Health are mandated to deliver HBHC as part of the Healthy Growth and Development Standard of the Ontario Public Health Standards (1). An Aboriginal HBHC program is also provincially funded and delivered directly through agencies including Native Child and Family Services in Toronto. In 2016, the Ministry of Children and Youth Services (MCYS) commissioned a third party review of the HBHC program. This report provides an update on Toronto's current service levels, an overview of the provincial review, and highlights changes to Toronto Public Health (TPH) program areas as a result of the review. Exciting initiatives aimed to support families that are most at risk for adverse childhood outcomes are also highlighted in this report. RECOMMENDATIONS The Medical Officer of Health recommends that: 1. The Board of Health receive this report for information. HBHC Service Levels and Update on Provincial Review Page 1 of 6

2 FINANCIAL IMPACT The HBHC program is 100 percent funded by the Ministry of Children and Youth Services. Toronto receives $19.2 million annually for the delivery of the HBHC services within this envelope. There is no financial impact associated with this report. DECISION HISTORY On January 25, 2016, the Board of Health received a report on the Healthy Babies Healthy Children service levels and directed the Medical Officer of Health to explore additional funding opportunities and report back. COMMENTS Research clearly indicates that the early years are a critical period in a child's development and set the trajectory for health and well-being well into adulthood. HBHC promotes optimal child development through implementation of evidence-based prevention and early intervention strategies, and through coordination of services and support in an effective integrated system of collaborative partnerships. Update on Current Service Levels In 2017, there were 32,749 births in Toronto. TPH provided in-depth assessment for 2,902 families and conducted 39,760 home visits to 3,278 families who were identified as having infants and young children at-risk for poor development outcomes. This is consistent with the birth rate and service levels in As requested by the Board of Health, TPH explored additional funding opportunities through programs that align with the HBHC mandate within relevant provincial ministries. However, HBHC does not meet the eligibility criteria of these programs. Provincial Review The HBHC program is administered by MCYS and is delivered by 36 public health units in Ontario. In , the total provincial funding is approximately $92.9 million. MCYS provides program direction to boards of health through the Healthy Babies Healthy Children Program Protocol, 2018 (2). The program was designed to help children get a healthy start in life by providing support to families from the prenatal period until the child s transition to school. It is a family-centred, voluntary program, and utilizes a strength-based approach with families. HBHC Service Levels and Update on Provincial Review Page 2 of 6

3 MCYS commissioned a province-wide third party review of the HBHC program in The review assessed whether the existing HBHC delivery model best met the needs of Ontario families and identified opportunities to address program sustainability and alignment with the mandate of MCYS. The review included stakeholder engagement and a review of current service delivery and funding models. TPH participated in stakeholder engagement through staff surveys, on-site visits, staff focus groups and a Medical Officer of Health interview. TPH clients were also selected for focus groups and surveys. In September 2017, MCYS announced their intention to incorporate the HBHC Review results into the modernized Ontario Public Health Standards and continue with the existing program funding. In October 2017, the executive summary of the review was released. The review found that HBHC is aligned with the mandate of public health, clients are very satisfied, and the program is highly relevant for them. In addition, several elements of the program were found to be supportive of improved child health outcomes. These included engaging clients early in their pregnancy period, working with the most vulnerable families, and conducting higher frequency home visits with a staffing model of both public health nurses and experienced and well trained paraprofessional home visitors. When implemented, these mechanisms will result in a more comprehensive service to support child and family outcomes and improved current service metrics. Since the release of the review results, TPH participated in the revision of the HBHC Protocol, which came into effect on January 1, 2018 (Appendix 1). Minimal changes from the 2012 HBHC Protocol were identified in this process. Currently, a program reference document to guide HBHC operational processes is in development. TPH is actively contributing to the program reference document by participating in provincial workgroups led by MCYS. These workgroups will focus on the areas informed by the MCYS Review results such as use of technology and strengthening the program's ability to support the complex needs of some families. Key Priorities for TPH Building on the findings from the provincial review and in light of no enhanced funding, a number of new opportunities and initiatives aimed at optimizing the existing funding level are underway. These include introducing new approaches to service delivery for strengthening collaboration and partnerships and enhanced use of technology to support both program referral earlier in the parenting experience as well as service delivery. TPH is implementing the Nurse-Family Partnership (NFP) pilot in partnership with four Ontario public health units. This is an evidence-based program that provides services to young, vulnerable first-time mothers under the age of 21 years to improve pregnancy and child health outcomes, and develop economic self-sufficiency. In 2016, there were HBHC Service Levels and Update on Provincial Review Page 3 of 6

4 560 Toronto mothers under the age of 21 who gave birth (3). Systematic evaluations have shown, that a strong PHN/family partnership leads to improvements in prenatal health, child health and development, maternal employment, and school readiness. There is also a reduction in child maltreatment, juvenile delinquency, and criminal activity. The NFP program also provides improved resources and nurse interventions to combat Intimate Partner Violence (IPV). Statistics indicate that one in five teens in Canada experiences IPV (4), and NFP is helping to address this issue as a component of the Toronto Public Health Intimate Partner Violence Action Plan (5). In addition to targeting the most vulnerable prenatal population through NFP, TPH is also developing a comprehensive prenatal strategy to bring the HBHC program to more prenatal clients earlier in their parenting journey. During the prenatal period, parents are generally more open to acquiring new knowledge and support and are ready to learn. Capitalizing on this important window of opportunity, nurses and family home visitors are able to form strong relationships and support parents to develop effective parenting skills and create a healthy and nurturing environment for the family, which ultimately is the foundation to healthy child growth and development. Honoring the Indigenous culture, and traditional approaches and practices, TPH and Native Child and Family Services Toronto (NCFST) have committed to a collaborative working relationship to jointly provide a range of responsive services for Indigenous families. Preliminary data shows that Indigenous clients who had previous children apprehended were able to continue to parent their current child, clients who were homeless at entry to the program were able to find housing and continue to parent, and clients with long term substance use issues were able to continue to parent. In some cases, previously apprehended children were returned after the current positive parenting episode. The partnership with NCFST provides TPH with an opportunity to build relationships and support Indigenous families with complex needs and be better able to support healthy outcomes for their children. Partnering with Mount Sinai Hospital, St. Joseph's Health Care Centre, Michael Garron Hospital and Life with a Preterm Baby program, TPH is involved with an exciting research study that supports parents of premature infants as they transition from hospital Neonatal Intensive Care Units (NICU) to home. The pre-term birth rate in Toronto is higher than the provincial average and these infants are at greater risk for delays in their infant and child development. The goal of this pilot project is to improve the life course trajectory of this population of pre-term infants by providing their parents and caregivers with enhanced knowledge, skills, and psycho-social support as they enter the HBHC program. Toronto Public Health is exploring potential opportunities to integrate the HBHC program into a broader range of settings including Child and Family learning centres, now known as EarlyON centres. In collaboration with Toronto Children's Services, TPH is actively engaged in the transformative re-design of this system which is planning a range of community based programs and services, aimed at supporting all children to achieve the best possible start in life. HBHC Service Levels and Update on Provincial Review Page 4 of 6

5 Finally, TPH is also supporting more Toronto birthing hospitals to implement digitalization of the HBHC Screening Tool through a partnership between MCYS and the Better Outcomes Registry & Network (BORN) Ontario. This enhances the current process and minimizes human error as it eliminates manual data collection, faxing, and re-entry of information into the TPH information system. Electronic and mobile documentation is also being implemented across the HBHC program to maximize operational efficiencies and improve quality of service provision. Remote access for staff to utilize web-based resources and to complete online program documentation is resulting in increased time available for direct client service. Toronto Public Health remains committed to delivering the highest level and quality of HBHC service possible with the goal of improving child development outcomes with Toronto's most vulnerable families. Staff will continue to identify and implement quality improvement initiatives, maximize available resources, and orient service delivery to individuals and families as early as possible in their prenatal and parenting experience. CONTACT Carol Timmings, Director, Child Health and Development, Toronto Public Health Phone: , Carol.Timmings@toronto.ca So-Yan Seto, Associate Director, Healthy Babies Healthy Children, Child Health and Development, Toronto Public Health Phone: , So-Yan.Seto@toronto.ca SIGNATURE Dr. Eileen de Villa Medical Officer of Health ATTACHMENTS Appendix 1: Ministry of Health and Long-Term Care - Healthy Babies Healthy Children Program Protocol, 2018 HBHC Service Levels and Update on Provincial Review Page 5 of 6

6 REFERENCES 1. Ontario. Ministry of Health and Long-Term Care Ontario public health standards: requirements for programs, services, and accountability. Toronto, ON: Queen's Printer of Ontario. 2. Ontario. Ministry of Children and Youth Services Healthy Babies Healthy Children Program Protocol, Toronto, ON: Queen's Printer of Ontario. 3. Public Health Unit Analytic Reporting Tool (Cube), BORN Information system, BORN Ontario. Information accessed on April 28, Price, E.L., Byers, E.S., Sears, H.A., Whelan, J. & Saint-Pierre, M. (2001). Dating violence among New Brunswick adolescents: A summary of two studies. Fredericton, NB: Muries McQueen Fergusson Centre for Family Violence Research. 5. Toronto Public Health. Toronto Public Health Action Plan on Intimate Partner Violence against Women. September, HBHC Service Levels and Update on Provincial Review Page 6 of 6