2 Carlton Street, Suite 1306
Toronto ON M5B 1J3
Tel: (416) 595-0006
Fax: (416) 595-0030
E-mail: info@alphaweb.org
Providing leadership in public health management
Mr. George Zegarac,
Assistant Deputy Minister of Children and Youth Services
14th Floor,
56 Wellesley Street West
Toronto ON M5S 2S3
Re.
May 4, 2011
Healthy Babies, Healthy Children Policy Changes
On behalf of member Medical Officers of Health, Boards of Health and Affiliate organizations
of the Association of Local Public Health Agencies (alPHa) I am writing to thank you for joining
the alPHa Board of Directors’ meeting on April 15, 2011 to speak with us about changes that
have recently been made to the Healthy Babies, Healthy Children (HBHC) program policies, and
to share some of the materials referred to during the discussion.
As you are aware, HBHC is a program that our members view as critically important, in that it
represents the earliest possible opportunity to identify children who may be exposed to a host of
social and economic risk factors that are known to have cumulative negative impacts on health
and development throughout the lifespan. Despite its indisputable value, this program has been
chronically underfunded by the Province and gradually eroded by a decade of political neglect.
Premier McGuinty’s clear commitment to children’s wellbeing was therefore a source of
optimism, which was greatly reinforced by Dr. Charles Pascal’s report on early learning, With
our Best Future in Mind. We saw the Province’s quick response to it in the form of
implementing full-day kindergarten for 4 and 5 year-olds as an encouraging first step in a full
commitment to the recommendations on early child development laid out in that report.
Over the past two years, alPHa’s members have taken the initiative to engage in collaborative
discussions on how the services delivered by public health – most notably HBHC – might be
integrated into the “seamless and integrated system to support children from 0 to 12 years old
and their families” envisioned by Dr. Pascal. These included a day-long visioning exercise on
Best Start and Family Centres with the Ontario Municipal Social Services Association (OMSSA)
in 2010 and our own Public Health Supporting Early Learning and Care seminar this past
February, which brought together medical officers of health, Assistant Deputy Ministers from
Health Promotion, Health and Long-Term Care and Children and Youth Services and directors
from our family health programs. The proceedings of the latter event will be shared with you by
the planning group and I believe you will agree that the collaborative thinking and planning that
is occurring on the ground is inspiring.
Page 1/3 With all of these encouraging signs, we were therefore surprised to learn about the policy
changes to the HBHC program as outlined in the March 22 memorandum from MCYS, which
linked them to the Government’s Best Start initiative and the policy framework for Best Start
Child and Family Centres. The decisions made appear to have been made with insufficient
consultation with public health experts in the field, as they are not reflective of our perspectives
on this link.
While we are supportive in principle of the intended improvements to the screening tools and
reduction of duplication of processes, the decision to remove the universal foundation of HBHC
to make it a targeted program is inconsistent with the evidence and best practices, and is one we
cannot support. It is in fact our chronic inability to deliver it as a universal program that has been
the source of greatest frustration, and it is very difficult indeed for us to see the decision to
abandon this approach as an “improvement”.
In the extensive compendium of evidence that accompanied With Our Best Future in Mind, Dr.
Pascal states, “home visiting programs that are closely aligned with a platform of programs for
young children and families that can function as a broad outreach, may be most effective in
promoting early childhood developmental goals (Council on Community Pediatrics, 2009; Daro,
2005). 1
On February 9th, we also heard evidence that countries with the best child development outcomes
– and Canada is quickly falling behind on many measures - were those with core platforms of
universal accessibility and outreach. Consequently, we see the decision to remove the existing
universal post-partum phone call and home visit as a requirement of HBHC as a step in the
opposite direction of what is supported by evidence and best practice. It is certainly in direct
opposition to the original intent of the program.
We are particularly concerned that the most identifiably universal new component is a printed
information package for new parents prior to hospital discharge. This type of passive
intervention is regarded as among the least effective means of outreach for a wide variety of
reasons.
The improvements to screening tools could be a positive step, and we agree that it is important to
“quickly and effectively identify and support vulnerable children and families so those who need
help the most can access services more quickly." This can only be achieved with more
collaboration among the decision-makers and the experts with the proper skills and means to
apply these tools, and we appreciate that public health will be part of that discussion. We also
look forward to further clarification on the enhanced Public Health Nurse training and
strengthened home visiting components, which we also see as positive steps.
We do appreciate that the HBHC program is receiving attention at this time and are pleased that
its connection with Ontario’s ambitious early years strategy has been recognized. "With Our Best
1 An Updated and Annotated Summary of Evidence – A Compendium to: With Our Best Future in Mind Implementing Early Learning in Ontario June 2009
Page 2/3 Future in Mind" speaks to the need for better coordination across Ministries and integrated
service planning. We have been engaged in many discussions since the release of that report that
have demonstrated a clear willingness by the public health, social services and government
sectors to meet this need. It is unfortunate that the HBHC changes were not linked in to these
discussions in a practical way, but we hope that it is not too late to do so now.
Once again, I thank you for taking the time to discuss our concerns with you in person. I am
enclosing the materials that you requested as well as a selection of others that we feel would be
useful for your review. We look forward to continuing this dialogue to ensure that Ontario
continues to provide the best start possible for all of its children.
Sincerely,
Valerie Sterling
President
Copy: Hon. Laurel Broten, Minister of Children and Youth Services
Hon. Deb Matthews, Minister of Health and Long-Term Care
Dr. Arlene King, Chief Medical Officer of Health
Ms. Nancy Matthews, Assistant Deputy Minister, Service Delivery Division, Ministry of
Children and Youth Services
Encl.
Page 3/3 alPHa
Association of Local
PUBLIC HEALTH
Agencies
2 Carlton Street, Suite 1306
Toronto ON M5B 1J3
Tel: (416) 595-0006
Fax: (416) 595-0030
E-mail: info@alphaweb.org
Providing leadership in public health management
July 21, 2010
Hon. Laurel Broten
Minister, Children and Youth Services
14th Floor
56 Wellesley Street West
Toronto, Ontario M5S 2S3
Dear Minister Broten:
Re. Healthy Babies Healthy Children Program
On behalf of member Medical Officers of Health, Boards of Health and Affiliate organizations of the
Association of Local Public Health Agencies (alPHa) I am writing to provide you with background
information regarding the Healthy Babies Healthy Children (HBHC) Program. I hope that this material will
be useful to you in preparation for our meeting on July 28.
The Ontario Public Health Standards make it very clear that children’s growth and development are
critically important factors in health throughout the lifespan, which are in part dependent on reaching
accepted milestones in their ability to learn, understand and communicate. This standard reflects the
incontrovertible evidence that demonstrates the magnitude of early child development in setting the
foundation for lifelong learning, behaviour and health.
The Healthy Babies Healthy Children program was conceived as a means to ensure that every child (prenatal to age six) born in Ontario that may be at vulnerable to physical, cognitive, communicative and
psychosocial risk factors to healthy development could be identified, assessed and connected to the
interventions that are designed to prevent associated adverse developmental outcomes.
It was also designed as a means to draw existing service providers – such as child care resource centres,
peer support groups, mother and infant programs, women’s shelters, counseling services, Aboriginal
programs and many others – into integrated local networks that would more effectively link at-risk families
to the services that meet their particular needs. This collaborative and flexible approach to promoting
optimal early development in vulnerable children was met with unreserved enthusiasm within the public
health community, whose stock-in-trade is early intervention to prevent adverse outcomes.
The potential of the HBHC program appeared to be well recognized in its earliest years, as significant
funding increases were granted by the Province between 1998 and 2002. Since that time however, overall
funding of this program has stagnated, with the total amount currently provided not significantly higher
than it was eight years ago. As costs have steadily increased over this period, our members have watched
the slow erosion of a program that never achieved the universality that was originally intended.
Ministry funding for this program has never met the actual costs of meeting the mandated standards of the
program, nor have modest and sporadic increases kept pace with predictable annual cost increases. This
has been an ongoing and significant concern, which has been expressed frequently to the Provincial
government without a satisfactory response or resolution. Health units have managed in the meantime to
continue to deliver this crucial program to the best of their abilities through local subsidies, reduction of
….. /2
Hon. Laurel Broten
July 21, 2010
Page 2 of 2
services, targeting only the highest risk families, and gapping of full-time equivalents. These strategies are
no longer sufficient, and some of our members are now faced with laying off experienced public health
staff, thereby cutting off the stable and ongoing relationships upon which at-risk families and their children
depend.
We acknowledge that this is a very difficult time for the Ontario government as it seeks to tackle a
formidable deficit and restore Ontario’s once enviable economy. We strongly believe that it is because of
this reality and not despite it that adequate funding of programs like HBHC is essential.
Investing in children is in fact a cornerstone of your Government’s Open Ontario plan to return to
prosperity. Much is made of the implementation of full-day learning for 4- and 5-year olds as well as the
commitment to step into the funding void left by the federal government to ensure the preservation of child
care spaces. Investments in early childhood education, child care and the Ontario Child Benefit are also
cited in the Plan as the “foundations of the Poverty Reduction Strategy” and “effective tools for breaking
the cycle of intergenerational poverty”.
These are clear demonstrations that your Government understands the long-term value of investing in
children, with additional support for those living in poverty. We hope that this understanding will lead to
renewed efforts to ensure that public health units can meet the standards set out in the HBHC program and
that it can finally achieve its intended goals. The success of this program is predicated on the capacity to
carry out a screening of all families with newborns in order to ensure that all vulnerable children can be
identified and benefit from available services as early as possible.
We recognize that you have been Minister of Children and Youth Services only for a short time, and would
like to take this opportunity to share a selection of letters, resolutions and reports on the subject that have
been submitted to the Province during the last nine years, which together paint a clear picture of the strain
that the underfunded HBHC program is putting on the local public health agencies whose mandate it is to
carry it out. We ask that you carefully review these materials, and understand that the chief complaint is
not that a lack of resources is preventing public health units from fully delivering the program, but rather
that the inability to deliver the program is having measurable and deleterious effects on tens of thousands
of Ontario children.
Our meeting on July 28th will give us the opportunity to discuss the next steps required to ensure that the
Healthy Babies Healthy Children program receives the support that is necessary from the Province to meet
its own standards and to achieve the goal of giving all of Ontario’s children the best possible start in life.
Sincerely,
Valerie Sterling,
President
Copy: Hon. Leona Dombrowsky, Minister of Education
Hon. Margarett Best, Minister of Health Promotion
Hon. Deb Matthews, Minister of Health and Long-Term Care
Dr. Arlene King, Chief Medical Officer of Health (Ontario)
Allison Stuart, Assistant Deputy Minister, Public Health
Enclosures
2001 alPHa RESOLUTION NO. A01-5
TITLE:
Healthy Babies, Healthy Children Program Funding
SPONSOR:
Association of Ontario Public Health Business Administrators
WHEREAS the Province of Ontario announced in 1997 the introduction of the Healthy Babies, Healthy
Children Program; and
WHEREAS the Healthy Babies, Healthy Children Program is included within the Mandatory Health
Programs and Services Guidelines, Family Health; and
WHEREAS the Healthy Babies, Healthy Children Program addresses a vital need for early childhood
development and supports future health, as described in the Mustard/McCain Early Years report; and
WHEREAS the Province committed in 1997 to funding the Healthy Babies, Healthy Children Program at
100%; and
WHEREAS the current funding levels for Health Units are insufficient to meet the Mandatory Programs
and Services Guidelines;
NOW THEREFORE BE IT RESOLVED that the Province be called upon to fully fund all Healthy
Babies, Healthy Children Program direct costs, current and future, and to fully fund the indirect costs
related to the operation and administration of this Mandatory Program in a manner consistent with
funding formulas for other Mandatory Programs;
AND FURTHER that Boards of Health not be called upon to subsidize this program.
Status of Resolution:
Endorsed by the alPHa membership June 12, 2001
!iF Region cf Peel
WM~lllil
1M qoll.
REPORT
General Committee
DATE:
January 12, 2004
SUBJECT:
HEALTHY BABIES HEALTHY CHILDREN PROGRAM FUNDING SHORTFALL
FROM:
Peter H. Graham, Commissioner of Health
Dr. David McKeown, Medical Officer of Health
RECOMMENDATION
That the Regional Chair meet with the Minister of Health and Long-Term Care and the
Minister of Children’s Services to request full funding to deliver the Healthy Babies
Healthy Children Program in Peel at the required level of service;
And further, that a copy of the report of the Commissioner of Health and the Medical
Officer of Health titled, “Healthy Babies Healthy Children Program Funding Shortfall”,
dated January 12, 2004 be forwarded to the Minister of Health and Long-Term Care, the
Minister of Children’s Services and to local Members of Provincial Parliament.
REPORT HIGHLIGHTS
• Healthy Babies Healthy Children is a Province wide program, funded 100% by the
Ministry of Health and Long-Term Care
• Provincial allocations for Peel have not been adequate since the year 2000
• Severe under-funding has required major service modifications and reductions
• Peel residents are not receiving the service to which they are entitled
• 2004 projected shortfall estimated to be one million dollars
• Recommend Regional Council advocate for full Provincial funding
DISCUSSION
1. Background
The Healthy Babies Healthy Children program (HBHC), is a Province wide, Provincially
funded prevention/early intervention program designed to give children a better start in life.
It was developed to ensure all Ontario families with children up to age six, have access to
comprehensive universal screening, assessment, intervention and linkage to community
resources needed to ensure optimal childhood development. The program was introduced
in 1998. Although the program is considered 100% funded by the Province, Regional
Council is reminded that the Region of Peel is responsible for funding indirect costs such as
rent, human resources, etc. and in 2004 it is estimated that those costs will be $495,000.
In 2000, Peel’s program was fully implemented and had approval and full funding for 87 Full
Time Equivalents (FTE) of staff. Since then, the Province introduced a number of new
components and although some financial increase was provided to implement them, base
program funding has not kept pace with annual salary and benefit increases.
January 12, 2004
-2-
HEALTHY BABIES HEALTHY CHILDREN PROGRAM FUNDING SHORTFALL
2. Funding History
Previous reports to Regional Council in 2001 and 2002, described the growing gap between
Provincial funding levels and the Regional budget required to provide the services mandated
by the province. Annually discussions with the Ministry occur and although the Province has
provided some additional funds over the past 3 years, they have been insufficient to address
the serious shortfall that exists and that is doubling annually.
Since 2001, the financial shortfall between the Regional budget and the Provincial allocation
has grown from $125,000 to $525,000 per annum. The projected shortfall for 2004 is
$1,000,000, (due to salary and OMERS increases) equivalent to 15 FTE Public Health
nurses, or 17% of program staff.
This funding shortfall has a direct impact on the amount of service that can be provided to
Peel residents. Service to the public has been reduced as a result, as outlined below.
Service cutbacks have been made so as to have the least impact on families most at risk.
3. Service Implications
Prenatal and Postpartum Screening and Assessments are provided. All families receive
postpartum telephone contact 48 hours after hospital discharge. Families determined to
have risk factors are offered a home visit by a Public Health Nurse. Utilizing the risk based
strategy those without risk factors are mailed a resource package and advised to call if they
need a postpartum visit. This is contrary to the Ministry guidelines which direct health units
to offer all families, regardless of risk factors, a post partum home visit at the time of the
telephone contact.
Universal Post Partum Visits are not being provided in the Region of Peel. The Ministry
target for post partum visits is 75% of families with a newborn. In 2000, when the program
was fully funded, 52% of Peel’s new families received this visit. However, in 2003, the
funding shortfall reduced the target to 7%, so only 1000 of the 14,200 Peel families with
newborns received this visit.
In Depth Family Assessments are to be provided to families identified ‘at risk’ for poor child
development outcomes. The Ministry target projects 12% of the population would be eligible
for this service; however, in the Region of Peel, 14.6% of families actually meet the ‘at risk’
criteria for this assessment. This is higher than the Provincial estimate due to the Region’s
cultural and socio-economic diversity.
Given that nine Public Health Nurses had to be gapped in 2003 to operate within Provincial
approved funding, only 7%, or half of those families identified, could receive this service.
There is currently a six to ten week wait list for families to receive the In-depth Family
Assessment. Compounding this extensive waiting period for families is recognition that the
wait, itself, reduces the families’ receptiveness to the program. This creates a missed
window of opportunity to reach vulnerable families.
The Home Visiting Program is designed to assist overburdened and vulnerable families
only. Families are provided long term support by the Public Health Nurse who completed
the In-depth Family Assessment and a Family Visitor. To ensure families who need the
service the most receive it, this program component has been fully preserved despite the
funding shortfall.
January 12, 2004
-3-
HEALTHY BABIES HEALTHY CHILDREN PROGRAM FUNDING SHORTFALL
4. 2004 Program Funding
To date negotiations with the Province to obtain adequate funding to deliver the full Health
Babies Healthy Children program has not been successful. There is acknowledgment that
Peel’s situation is not unique. Other large jurisdictions such as Toronto and York are
experiencing similar constraints. That being said, there is no indication that a substantial
increase in funding will be forthcoming this year.
CONCLUSION
The Healthy Babies Healthy Children program is facing a funding crisis in Peel. Provincial
under-funding has eroded key components of service delivery, compromising child
developmental outcomes. It also creates frustration for residents when services publicized
across the Province are not available to parents in Peel. Efforts to date by staff to rectify this
situation have not been successful. Therefore, it is recommended that the Regional Chair meet
with the Minister of Health and Long-Term Care and the Minister of Children’s Services to
request that Peel’s residents receive their fair share with the goal of achieving full program
funding in 2004.
Peter H. Graham
Commissioner of Health
David McKeown, MDCM, MHSc, FRCPC
Medical Officer of Health
Approved for Submission:
__________________________________________
R. Maloney, Chief Administrative Officer
Authored By:
c.
Anne Fenwick
Legislative Services
APPENDIX IX
January 12, 2004
-1-
HEALTHY BABIES HEALTHY CHILDREN PROGRAM FUNDING SHORTFALL
APPENDIX IX
March 28, 2007
Via Electronic Mail
Honourable Mary Anne Chambers
Minister of Children and Youth Services
14th Floor, 56 Wellesley Street West
Toronto, Ontario M5S 2S3
Dear Minister Chambers:
On behalf of the Board of Health for the North Bay Parry Sound District Health Unit, I wish to express
the concern of the Board relative to the 2007 preliminary Ministry approved operating base budget for
Healthy Babies Healthy Children program. Continued funding shortfalls threaten the capacity of our
Healthy Babies Healthy Children program to promote the optimal health of young children in this
district. I am requesting that you direct the appropriate Ministry staff to undertake a review of the
funding allocation to the base operating budget for this Health Unit.
Our Healthy Babies Healthy Children preliminary budget allocation for 2007 is $954,400. This
allocation is identical to the closing 2006 base allocation which increased by 1.05% or $10,000 in 2006.
This amount does not begin to support negotiated wage settlements for 2006 and 2007 settled at 3% for
each year. In addition, other direct operating costs as recognized by the Ministry of Children and Youth
Services are subject to annual inflationary increases which have not been reflected in the budget
allocation to date.
I understand that funding allocations historically are based upon factors such as population size, indices
of needs and cost of providing services. While the north is disadvantaged by the population factor, the
indices of needs as evidenced by lower education and poorer health status as well as the increased cost
of providing service in rural and northern areas must be given greater consideration in the formula
applied.
It is noted that Ontario Budget 2007: Backgrounder: Expanding Opportunities For Children and
Families dated March 22, 2007 indicates the current budget proposes to “expand the Healthy Babies
Healthy Children program with an ongoing investment of more than $5 million to support the needs of
as-risk families with children. The expanded program would address the health and social needs of
these families through early intervention and intensive follow-up so that children arrive at school with
the skills and abilities to succeed”. It is the position of the North Bay Parry Sound District Health Unit
that existing program elements require adequate cost of living increases prior to applying new funding to
expand an existing program.
Page 1 of 2
The Board of Health’s concerns are reinforced in the attached Board resolution. Your attention to this
pressing matter is appreciated.
Yours truly,
Original signed by
Mac Bain, Chairperson
Board of Health
Enclosure (1)
c. Honourable George Smitherman, Minister of Health & Long-Term Care
Dr. George Pasut, Acting Chief Medical Officer of Health, Public Health Division, Ministry of Health & Long-Term Care
Maggie Allan, Director, Strategic Initiatives Branch, Ministry of Children and Youth Services
Monique Smith, M.P.P., Nipissing Contingency Office
David Ramsay, M.P.P., Timiskaming – Cochrane Constituency Office
Norm Miller, M.P.P., Parry Sound Constituency Office
Anthony Rota, MP, Nipissing – Timiskaming Constituency Office
Tony Clement, MP, Parry Sound – Muskoka Constituency Office
Ontario Boards of Health
Member Municipalities
Page 2 of 2
January 17, 2007
Honourable Mary Anne Chambers
Minister of Children and Youth Services
14th Floor, 56 Wellesley St. W.
Toronto, ON M5S 2S3
Dear Minister Chambers:
On behalf of the Simcoe Muskoka District Board of Health I am writing to indicate our grave
concerns related to the financial challenges the Simcoe Muskoka District Health Unit’s Healthy
Babies Healthy Children program (HBHC) is experiencing. Funding shortfalls continue to
threaten the capacity of the Healthy Babies Healthy Children program to promote the health
and well-being and prevent disease and disability of the families with young children residing
in Simcoe County and the District of Muskoka. We are asking that adequate funding takes
place to promote both the universal and targeted aspects of the program.
The Healthy Babies Healthy Children program is an innovative province-wide prevention and
early intervention program delivered through health units across Ontario in order to promote
the optimal development of all children (prenatal to age 6 years). It is a proven prevention and
early intervention program based on the understanding that positive early childhood
experiences have positive long-term impacts on the physical and mental health of individuals.
It is the goal of the Board of Health to ensure all families have equitable and timely service
delivery related to the Healthy Babies Healthy Children program.
The Ministry of Children and Youth Services 2006 budget allocation of $2,345,800 for Simcoe
Muskoka District Health Unit reflects a $10,000 base increase, or a limited 0.4% increase to
base budget from 2005. It is unreasonable to expect the HBHC program to deliver services in
2007 based on a relatively unchanged 2005 budget. This funding shortfall is presently
threatening the capacity of the HBHC program to deliver services adequately. Unfortunately,
communications with Ministry of Children and Youth Services consultants has not brought
about any relief, and other health units in the province are also challenged by service
demands and insufficient budget allocations.
Correspondence sent to Ministry of Children and Youth Services Strategic Initiatives Branch
Director November 18, 2006 indicating the 2006 grant of $2,345,800 was insufficient to
operate the program at expected levels for 2007 along with indicating concerns with the ability
to balance the budget for 2006. Correspondence received back to the Director of Family
Health Service indicated it is the ministry’s expectation that the health unit delivers the HBHC
program within the funding allocated and that health units who have requested funds to
balance 2006 budgets will not be made available.
It is critical the Ministry of Children and Youth Services recognizes the costs associated with
delivering the program on an annual basis. Both salary and operating costs have continued to
increase without base budget increases taking place. This has resulted in positions not being
filled leaving service delivery needs unmet. Workload continues to be a challenge and
waitlists have been developed. Minimal spending on resources/supplies and staff
development will occur throughout 2007. The Board of Health urges the Ministry of Children
and Youth Services to critically review and revise the funding formula to adequately reflect the
actual costs associated with delivering the Healthy Babies Healthy Children program.
Healthy Babies Healthy Children is an innovative and effective health promotion, early
intervention program for the citizens of Ontario, specifically the children and their families.
Simcoe Muskoka District Health Unit is proud to provide service to enhance the growth and
development of all children universally and at high risk for developmental challenges. It is
hoped that you will encourage funding at levels which will see to it that the objectives of the
Healthy Babies Healthy Children Program are sufficient in order to be met.
Thank you for your consideration of this matter. We look forward to your response at your
earliest convenience.
Sincerely,
Dennis Roughley
Chair, Board of Health
CG:CS:ba:clt
Copies to:
Hon. Jim Watson, Minister of Health Promotion
Hon. George Smitherman, Minister of Health and Long-Term Care
Hon. Tony Clement, MP, Parry Sound-Muskoka
Hon. Helena Guergis, MP, Simcoe-Grey
Hon. Peter Van Loan, MP, York-Simcoe
Mr. Bruce Stanton, MP, Simcoe North
Mr. Patrick Brown, MP, Barrie
Mr. Joe Tascona, MPP, Barrie-Simcoe-Bradford
Mr. Norm Miller, MPP, Parry Sound-Muskoka
Mr. Garfield Dunlop, MPP, Simcoe North
Mr. Jim Wilson, MPP, Simcoe-Grey
Dr. George Pasut, Acting Chief Medical Officer of Health
All Ontario Health Units
Mrs. Carolyn Shoreman, Director, Family Health Service, Simcoe Muskoka District Health Unit
425 University Avenue, Suite 502
Toronto ON M5G 1T6
Tel: (416) 595-0006
Fax: (416) 595-0030
E-mail: mail@alphaweb.org
Providing leadership in public health management
Hon. Dalton McGuinty
Premier of Ontario
Legislative Bldg
Rm 281
Queen's Park
Toronto, ON M7A 1A1
March 4, 2009
Dear Premier McGuinty,
Re.
alPHa Resolutions on Poverty Reduction
On behalf of member Medical Officers of Health, Boards of Health and Affiliate organizations of the
Association of Local Public Health Agencies (alPHa) I am writing to congratulate you on the recent
introduction of Bill 152, the Poverty Reduction Act and to inform you of resolutions related to poverty
reduction that were passed by the membership of alPHa at its October 2008 meeting.
We believe that these interventions will be essential components of the broader government strategy to
act decisively to alleviate the effects of poverty, most notably its significant detriments to health.
The resolutions are attached and summarized as follows:
A08-9
Back-to-School and Winter Clothing Allowances for Children in Families on Social
Assistance
We are urging the provincial government to continue to issue both the back-to-school and the winter
clothing allowances; and that these allowances be paid 100% by the Province of Ontario. Spreading these
amounts across the annual total virtually guarantees that these dollars will be used for things other than
seasonal clothing, as social assistance rates are presently insufficient to cover the basics.
A08-10
Ontario Poverty Reduction Strategy
This resolution calls for a government commitment to implement a coordinated, long-term poverty
strategy with targets, timelines, a dedicated budget and ongoing evaluation in order to achieve sustained
results, including meeting a target of reducing 2005 poverty rates by 25% by 2012 and 50% by 2017.
alPHa endorses the content and recommendations of the Campaign 2000 discussion paper, A Poverty
Reduction Strategy for Ontario. We congratulate your government for producing the plan, and now urge
you to implement the strategy in order to start achieving real reductions in poverty levels that have
remained unacceptably constant since the pledge to eliminate child poverty in Canada was made in the
House of Commons 20 years ago.
A08-11
Poverty Reduction Strategy Linked to Healthy Babies Healthy Children Program
Base Funding
The Association of Local Public Health Agencies urges the Government of Ontario to ensure that the
Cabinet Committee on Poverty Reduction identifies the HBHC Program as a critical intervention in the
poverty reduction strategy. This program is slowly eroding due to ongoing funding inadequacy, and this
is a direct threat to the long-term health of our youngest and most vulnerable citizens.
A08-12
Provincial Dental Program
The Association of Local Public Health Agencies (alPHa) urges the provincial government to
immediately implement the dental program for low income families as promised in the 2008 provincial
budget.
Once again, we congratulate you for the commitment that you have made and the steps that you have
already taken to begin to address the intolerable level of poverty that exists in Ontario. I look forward to
working with you to achieve the aims of these resolutions as part of an effective and measurable reduction
of poverty and concrete improvement in quality of life for all Ontarians.
Sincerely,
ORIGINAL SIGNED
Linda Stewart,
Executive Director
Copy The Honourable Deb Matthews, Chair, Cabinet Committee on Poverty Reduction,
Minister of Children and Youth Services
The Honourable George Smitherman, Minister of Energy and Infrastructure
The Honourable Margarett Best, Minister of Health Promotion
The Honourable Chris Bentley, Attorney General
The Honourable David Caplan, Minister of Health and Long Term Care
The Honourable Kathleen Wynn, Minister of Education
The Honourable Dwight Duncan, Minister of Finance
The Honourable Madeliene Meilleur, Minister of Community and Social Services
The Honourable John Milloy, Minister of Training, Colleges and Universities
The Honourable Michael Chan, Minister of Citizenship and Immigration
The Honourable Jim Watson, Minister of Municipal Affairs and Housing
MPP Bas Balkissoon, Parliamentary Assistant, Minister of Health and Long Term Care
MPP Bruce Crozier, Chair of the Committee of the Whole House
MPP Carol Mitchell, Parliamentary Assistant to the Minister of Municipal Affairs and Housing
MPP David Orazietti, Parliamentary Assistant to the Minister of Education
MPP Lou Rinaldi, Parliamentary Assistant to the Minister of Agriculture,
Food and Rural
Affairs
Enclosures
ALPHA RESOLUTION A08-9
TITLE:
Back-to-School and Winter Clothing Allowances for Children in Families on Social
Assistance
SPONSOR:
Hastings and Prince Edward Counties Board of Health
WHEREAS
the province has implemented the Ontario Child Benefit with monthly payments
scheduled to begin in July 2008; and
WHEREAS
the implementation of the Ontario Child Benefit will restructure social assistance and the
back-to-school and winter clothing allowances will be eliminated from Ontario Works
(OW) and Ontario Disability Support Program (ODSP) benefits; and
WHEREAS
the back-to-school and winter clothing allowances serve a specific need for families
receiving social assistance; and
WHEREAS
families receiving social assistance do not have adequate finances and will not
have sufficient monthly income to allow them to save money to address these
particular needs; and
WHEREAS
families receiving social assistance and purchasing school supplies and winter
clothing for their children will have even less ability to purchase healthy foods;
NOW THEREFORE BE IT RESOLVED THAT the Association of Local Public Health Agencies call
upon the provincial government to continue to issue both the back-to-school and the winter clothing
allowances;
AND FURTHER THAT these allowances be paid 100% by the Province of Ontario.
ACTION FROM CONFERENCE:
Moved:
Seconded:
M. Leduc (Eastern Ontario)
J. Albanese (Northwestern)
Resolution CARRIED
ALPHA RESOLUTION A08-10
TITLE:
Ontario Poverty Reduction Strategy
SPONSOR:
Board of Directors of the Association of Local Public Health Agencies
WHEREAS
strong associations between poverty and risks to health, including low birth
weight, infant mortality, respiratory conditions, obesity, oral health,
developmental outcomes, and a range of chronic diseases have been repeatedly
demonstrated; and
WHEREAS
almost one in every six Ontario children is growing up in poverty and 132,000 rely on
food banks every month 1 , despite Ontario’s status as one of the most prosperous
jurisdictions in the world; and
WHEREAS
there is clear evidence that a strong economy alone is not enough to significantly reduce
overall poverty rates; and
WHEREAS
there has been no change in child poverty rates in Canada since a 1989 all-party House of
Commons resolution to end child poverty in Canada by the year 2000 was passed; and
WHEREAS
the November 2007 Liberal Throne Speech contained a pledge to establish government
targets for reducing poverty within the next 12 months; and
WHEREAS
the Ontario Government has responded by establishing the Cabinet Committee on
Poverty Reduction, tasked with developing “poverty indicators and targets, and a focused
strategy on reducing child poverty and lifting more families out of poverty; and
WHEREAS
successful poverty reduction strategies have been implemented in the United Kingdom
and Ireland that have reduced child poverty by 25% between 1999 and 2004 in the former
and the overall poverty rate to less than 5% in the latter;
NOW THEREFORE BE IT RESOLVED THAT the Association of Local Public Health Agencies
(alPHa) call for a government commitment to implement a coordinated, long-term poverty strategy with
targets, timelines, a dedicated budget and ongoing evaluation in order to achieve sustained results,
including meeting a target of reducing 2005 poverty rates by 25% by 2012 and 50% by 2017.
AND FURTHER THAT alPHa endorse the content and recommendations of the Campaign 2000
discussion paper, A Poverty Reduction Strategy for Ontario.
ACTION FROM CONFERENCE:
Moved:
Seconded:
V. Sterling (Toronto)
R. Pellizzari (Peterborough)
Resolution CARRIED
1
Campaign 2000, A Poverty Reduction Strategy for Ontario
ALPHA RESOLUTION A08-11
TITLE:
Poverty Reduction Strategy Linked to Healthy Babies Healthy
Children Program Base Funding
SPONSOR:
Simcoe Muskoka Board of Health
WHEREAS
in the winter of 2008, the Government of Ontario announced the establishment of The
Cabinet Committee on Poverty Reduction, led by the Honourable Deb Matthews to
develop a focused poverty reduction strategy by the end of 2008 to ensure all have
increased opportunities for success; and
WHEREAS
“Ontario’s Poverty Reduction Plan” (Government of Ontario, 2008) identified that The
Best Start Plan is designed to make sure that children are ready to learn by the time they
start Grade One, and that “the Plan includes: The Healthy Babies Healthy Children
program that gives families with new babies information on parenting and child
development from before birth up to age six”; and
WHEREAS
the Healthy Babies Healthy Children (HBHC) Program’s vision is consistent with the
government’s vision and commitment to poverty reduction; and
WHEREAS
HBHC Program public health nurses identify risks that prevent healthy child
development and achievement of optimal potential including parental high risk situations
(e.g. substance misuse, mental illness, poverty, housing and food instability); and
WHEREAS
through the HBHC ongoing intensive home visiting program public health nurses provide
counselling, health teaching, case management, referrals and coordination of services;
and
WHEREAS
public health nurses and lay home visitors promote healthy birth outcomes, teach healthy
child growth and development, enhance parents’ self-esteem and provide them with
referrals to community programs that enhance the child’s optimal potential and facilitate
opportunities for success; and
WHEREAS
HBHC program benefits are likely to have the most positive and far-reaching impacts on
low-income families due to a strong association with developmental risk factors; and
WHEREAS
HBHC base funding and minimal annual increases over the past several years have been
insufficient to maintain service levels under this program; and
WHEREAS
the HBHC Program has been identified as a 100% funded program through the Ministry
of Children and Youth Services;
NOW THEREFORE BE IT RESOLVED THAT the Association of Local Public Health Agencies urge
the Government of Ontario to ensure that the Cabinet Committee on Poverty Reduction identifies the
HBHC Program as a critical intervention in a poverty reduction strategy;
AND FURTHER THAT the Government of Ontario recognize that the HBHC Program provides
services that Ontario’s families require, particularly low income families, that assist families to overcome
the impact of poverty, provide children with a healthy start in life, and enhance opportunities for life-long
success contributing to a strong Ontario economy;
Resolution A08-11 continued
AND FURTHER THAT the Government of Ontario provide a significant increase to base funding to
cover the full costs of delivery for all eligible clients for HBHC Programs along with annual increases to
maintain service delivery to complement the poverty reduction strategy;
AND FURTHER THAT the Association of Local Public Health Agencies utilize the results of the
HBHC alPHa survey conducted with its member boards of health to inform the development of an
advocacy strategy focused on funding for the Healthy Babies Healthy Children (HBHC) Program;
AND FURTHER THAT the Association of Local Public Health Agencies work in partnership with other
agencies or organizations regarding further advocacy strategies in support of the HBHC program.
ACTION FROM CONFERENCE:
Moved:
Seconded:
D. McKeown (Toronto)
V. Blackmore (Middlesex-London)
Resolution CARRIED AS AMENDED
ALPHA RESOLUTION A08-12
TITLE:
Provincial Dental Program
SPONSOR:
Toronto Board of Health
WHEREAS
low income Ontarians in need of dental care to relieve pain and suffering require assistance
now;
NOW THEREFORE BE IT RESOLVED THAT the Association of Local Public Health Agencies
(alPHa) urge the Ministry of Health and Long-Term Care, the Provincial Poverty Reduction Committee
and the Premier of Ontario to immediately implement the dental program for low income families as
promised in the 2008 provincial budget.
ACTION FROM CONFERENCE:
Moved:
Seconded:
R. Pellizzari (Peterborough)
B. Hughes (Timiskaming)
Resolution CARRIED
Healthy Babies Healthy Children Program
Survey Summary Report
April 2009
Contact:
Linda Stewart
Executive Director
Association of Local Public Health Agencies
416-595-0006 x 22
linda@alphaweb.org
Healthy Babies Healthy Children Program
Survey Summary Report
Introduction
On April 17, 1997, Premier Mike Harris announced the Healthy Babies Healthy
Children (HBHC) program to be funded with $10 million. The program was originally
positioned as a partnership between public health, and the Ministries of Health and
Community and Social Services. The Program was transferred to the Ministry of
Children and Youth Services (MCYS) in 2003 when that Ministry was formed.
alPHa has letters on file dating back to December 1997 expressing concern about
the level of funding for the program. In 1998, ANDSOOHA determined that $75
million was needed for the program to be successful province-wide and led an
advocacy campaign to secure more funding. In May of that same year, the
government announced an increase in funding for HBHC to $50 million by 2000-01.
A history of the program funding is in the following chart.
HBHC Program Funding
HBHC
Program
Change
Budget
1997-98 (1)
MOHLTC $10,000,000
$
%
1998-99 (1)
MOHLTC $20,000,000
$10,000,000 100.00%
1999-2000 (1) MOHLTC $37,000,000
$17,000,000
85.00%
2000-01 (1)
MOHLTC $50,000,000
$13,000,000
35.14%
2001-02 *
MOHLTC $81,473,200
$31,473,200
62.95%
2002-03 *
MOHLTC $67,299,300 -$14,173,900 -17.40%
2003-04 *
MOHLTC $67,660,900
$361,600
0.54%
2004-05 *
MCYS
$69,160,900
$1,500,000
2.22%
2005-06 *
MCYS
$78,326,200
$9,165,300
13.25%
2006-07 *
MCYS
$80,879,000
$2,552,800
3.26%
2007-08 *
MCYS
$86,339,000
$5,460,000
6.75%
2008-09 *
MCYS
$86,339,000
$0
0.00%
2009-10 *
MCYS
$86,493,500
$154,500
0.18%
(1) Source: Government announcements on file at alPHa
* Source: Government of Ontario Budget Estimates
published on line at:
http://www.fin.gov.on.ca/english/budget/estimates/
Year
Ministry
Since its original announcement, funding issues at the local level for the HBHC
program have been ongoing. According to MCYS staff today, the funding as it was
transferred to MCYS was intended to cover program delivery only and the attendant
administrative and overhead costs were already covered by local public health
units. In the summer of 2008, alPHa surveyed the health units to better
HBHC Survey Results
1 of 7
April 29, 2009
understand current issues with the HBHC program. The survey data was updated
in March 2009 to include final 2008 figures.
Twenty-eight of the 36 health units (78%) responded to the survey that was sent
out on August 4, 2008. Data was collected for the past 5 years, 2004 to 2008. Of
the 28 respondents, only 3 (11%) responded positively to the statement, “In
general, and considering the funding increase from MCYS in 2007-08, my health
unit has received enough funding for the HBHC program from MCYS to cover costs
of the services required in the community.” These health units all have had steady
or declining birth rates over the past 5 years. Birth rates, however are not a good
predictor of funding sufficiency. Of the remaining 25 PHUs who state that the HBHC
funding from MCYS does not cover the costs of the services required in the
community, 7 have declining, 4 have flat, and 14 have increasing birth rates.
Costs
Looking at total costs (all staff: program, supervisory and administrative support
plus overhead); PHUs spend on average, 87% for staff and 13% for overhead to
support the HBHC program. The following graph shows the trends for FTEs and
salaries and benefits for the past five years. FTEs peaked in 2006 and then
declined, while salaries and benefits continued to rise.
80,000,000
830
70,000,000
820
60,000,000
810
50,000,000
800
40,000,000
817
30,000,000
790
823
813
807
FTEs
Salaries & Benefits
Total HBHC Staff
780
770
20,000,000
779
10,000,000
760
0
750
2004
2005
2006
Total FTEs
2007
2008
Total Salaries & Benefits
The trend above is primarily due to trends for program delivery staff. The next
graph shows that the total numbers of program staff have risen and fallen over the
five years, while costs for program staff have steadily increased.
HBHC Survey Results
2 of 7
April 29, 2009
70,000,000
700
60,000,000
690
680
50,000,000
670
40,000,000
689
30,000,000
660
695
686
679
20,000,000
FTEs
Salaries & Benefits
HBHC Program Staff
650
640
652
10,000,000
630
620
0
2004
2005
2006
FTEs
2007
2008
Salaries & Benefits
The following graph shows that PHUs have chosen to reduce support staff in a
period that saw steady growth in overall program costs.
HBHC Support Staff
84
4,400,000
83
83
82
81
81
4,200,000
80
80
79
4,100,000
79
78
77
4,000,000
76
76
75
3,900,000
74
73
3,800,000
2004
2005
2006
FTEs
HBHC Survey Results
3 of 7
2007
2008
Salaries & Benefits
April 29, 2009
FTEs
Salaries & Benefits
4,300,000
The total number of supervisory staff has increased slightly over the five years as is
shown in the following chart.
6,000,000
54
5,000,000
52
50
4,000,000
48
3,000,000
52
2,000,000
48
46
1,000,000
49
46
FTEs
Salaries & Benefits
HBHC
Supervisory Staff
44
44
42
0
40
2004
2005
2006
FTEs
2007
2008
Salaries & Benefits
Funding
In 2008-09, the Ministry of Children and Youth Services provided $62.5 million in
funding for HBHC programming to the 28 public health units that responded to the
survey. Funding has increased each year between 2004 and 2007. Funding
flattened after 2007-08. A number of health units commented that they have been
relying on annual one-time grants from MCYS to supplement the base funding. In
2008-09 one-time grants amounted to an additional $1.4 million for 16 of the 28
PHUs. The following table shows the total funding provided to the 28 PHUs for
HBHC for the past 5 years.
MCYS Funding for HBHC Program
Program Funding
Average Program Funding
Annual Increase Program Funding
PHUs Receiving One-time Grant
One-Time Grant
Average One-time Grant
Total MCYS Funding
HBHC Survey Results
2008
$62,470,310
$2,231,083
2.2%
16 (57%)
$1,412,076
$88,255
$63,882,386
4 of 7
2007
$61,146,857
$2,183,816
4.0%
16 (57%)
$2,133,744
$133,359
$63,280,601
2006
$58,789,328
$2,099,619
5.8%
15 (54%)
$1,464,494
$97,633
$60,253,822
2005
$55,568,803
$1,984,600
12.9%
8 (29%)
$259,539
$32,442
$55,828,342
April 29, 2009
2004
$49,215,476
$1,757,696
10 (36%)
$1,683,670
$168,367
$168,367
Several of the PHUs that responded to the survey supplement the HBHC funding
with funding from other sources. In 2008-09, on average, 11 PHUs spent almost
$233,000 in funding from other sources. The total funding from other sources for
all 11 PHUs was $2.4 million in 2008-09. Contributions from other sources for the
past five years are provided in the following table. In most cases the other source
was the health unit’s core program funding, 25% of which is contributed by
municipalities. Only one health unit reported that they had requested additional
funding from their municipality/region to support the HBHC program. The
municipality/region involved has supported the program with $1.3 million over the
past 4 years.
Funding Contributions from Other Sources
PHUs using Other Funding Sources
Total
Average
Increase
2008
11 (38%)
$2,448,875
$222,625
9.6%
2007
10 (38%)
$2,234,976
$223,498
10.8%
2006
12 (43%)
$2,016,895
$168,075
36.2%
2005
8 (29%)
$1,481,236
$185,155
8.8%
2004
9 (32%)
$1,361,656
$151,295
Looking at a subset of 25 PHUs for which the data was complete, total funding
shortfalls have been between $1.5 and $3.7 for the past five years.
25 PHUs
Total Costs
MCYS Funding
Shortfall
2008
2007
2006
2005
2004
61,241,650 59,064,548 55,888,451 54,401,502 49,791,319
57,919,281 56,641,445 54,430,768 52,234,828 46,070,841
3,322,369
2,423,103
1,457,683
2,166,674
3,720,478
Services Provided
This section looks at the health units ability to achieve the standards set by the
HBHC Program. Between 2004 and 2007, the average number of live births for the
28 health units grew by about 1% per annum. However individual health unit
experience varied. Eight health units had numbers of births drop up to 6.5%
between 2004 and 2007 while 13 experienced increases between 5% and 19%.
During this period, the total number of newborns screened with a Parkyn
postpartum screening tool rose from 93,655 to 98,303, the rate of increase,
steadily slowed down, starting at 2.2% in 2004 and decreasing to .94% by 2007.
The percent of total live births screened rose from 92.8% in 2004 to 94.4% in
2007.
Standard for prenatal screening: 25% of pregnant women screened using
a Larson prenatal screen. Between 2004 and 2007, the number of health units
screening more than 25% of prenatal women with a Larson grew from 56% to 64%
for the 28 health units that responded. The number of women screened increased
from 16,508 to 22,195 in that time period.
Standard for post-partum telephone contacts: 100% within 48 hours of
discharge. The number of health units able to achieve at least 90% within 48
HBHC Survey Results
5 of 7
April 29, 2009
hours of discharge steadily grew from 2004 to 2006 from 37% to 50%. In 2007
that number dropped to 39%. The total number of contacts made followed suit
with a rise from 77,817 to 80,742 and then a drop to 79,303 in 2007.
Standard for post-partum home visits: 75% of families. No health units met
this standard in the period from 2004 to 2007. Over the 4 years covered by this
survey, the average percentage of post-partum visits provided remained steady at
approximately 53%. The total number of visits declined from 44,704 to 38,176
during this time period. The range in 2004 was 32.5% to 72%. That had changed
to 20% to 74% in 2007.
Standard for in-depth assessments: 12% of families. The average number of
families receiving in-depth assessments ranged from 10% to 11.5% between 2004
and 2007. The number of health units able to meet or exceed the standard
dropped from 33% in 2004 to 28% in 2007. Approximately half of the health units
are able to provide in-depth assessments for between 5% and 10% of families.
Standard for referrals to home visits: 100% of families undergoing indepth assessments. The number of heath units able to achieve this standard has
been falling since 2004. The percentage of health units able to achieve at least
80% of the standard between 2004 and 2007 is:
2004 – 87%
2005 – 91%
2006 – 80%
2007 – 80%
Standard for referrals: 75% of high risk families. The numbers achieving this
standard has greatly decreased since 2004. The percentage of health units
achieving 75% or more of high risk families being referred is:
2004 – 58%
2005 – 16%
2006 – 18%
2007 – 9%
For the same time period, the number of health units achieving at least a 55%
referral rate is:
2004 – 84%
2005 – 58%
2006 – 64%
2007 – 46%
Health Unit Concerns
When asked to describe their cost pressures and challenges, health units identified
the following in the survey:
HBHC Survey Results
6 of 7
April 29, 2009
•
Cost pressures associated with staff - wage increases; travel expenses; high
turn over (especially where there are growing numbers of high risk families);
training costs.
•
Demographic challenges – rapid population growth; growing numbers of high
risk families; culturally diverse communities.
•
Geographic challenges: “Costs related to time and travel are a particular
issue for this health unit as we are primarily rural, spread over a large
geographic area, with many of our high risk families living in isolated
locations”; HBHC staff tend to pick up the slack in underserviced areas.
•
Many health units talked about maintaining wait lists and cutting weekend
services
•
Only a few health units have reduced staffing levels, but many have been
gapping positions for years and are reaching the end of their ability to
continue to do so.
•
Some noted that with anticipated increased costs due to the updated
program standards, health units will no longer be able to subsidize the HBHC
program.
Conclusion
The Healthy Babies Healthy Children Program is very important to public health. It
is clear that Health units have been subsidizing HBHC programs in their local
communities. While some service targets are close to being met by all health units,
home visits are clearly a challenge. The vast majority of health units state that
they do not have enough funding to provide all of the HBHC program services
required in their communities.
HBHC Survey Results
7 of 7
April 29, 2009
Background on the Healthy Babies Healthy Children Program (HBHC)
•
Governance:
o introduced by the MOHLTC 1998;
o transferred to the Ministry of Children & Youth Services 2003.
•
Vision: “Every child (prenatal to age six) in Ontario will be provided with
opportunities to achieve his/her optimal potential…”
•
Goals include:
1. to promote optimal physical, cognitive, communicative, and psychosocial
development in children through a system of effective prevention and
early intervention services for families;
2. to act as catalyst for a coordinated, effective, integrated system of services
and supports for healthy child development and family well being.
•
Universal component:
a. all mothers delivering in Ontario may consent to telephone contact by a
Public Health Nurse (PHN) within 48 hours of hospital discharge - PHN
provides initial screening/assessment by phone, then every family offered
a postpartum home visit;
b. enables identification of families at risk for challenges with infant growth
and development (based on known indicators), and links all families with
early intervention opportunities in the community.
•
Targeted component:
a. further risk factors (e.g. mental health concerns, isolation, insufficient
support), are assessed through the HBHC in-depth assessment;
b. if present, on-going home visits will be offered by both a PHN and Lay
Home Visitor (LHV).
•
Program interventions by PHNs and LHVs focus on the pivotal role of the
parent, aiming to optimize child health & development by:
a. increase parenting capacity;
b. decrease parental stress;
c. increase parental support;
d. reducing family isolation;
e. Integrating community programs and services.
These interventions include:
a. developmental education of parent & screening of child;
b. health teaching;
c. counseling/support;
d. demonstrations/modeling;
e. referrals;
f. Linking with community supports.
•
HBHC in Context
•
“The Early Years Study 2, Putting Science into Action” (McCain, Mustard &
Shanker, 2007) presents comprehensive evidence that:
o children’s cognitive, communicative, social and emotional abilities are
established between 0 – 6 years, prior to entering Grade 1;
o interventions to support parents not only influence “nurture”, but we are
now beginning to understand that even “nature”, or our genetic
programming, can be modified in this critical window of brain
development through epigenetic modifications;
o Significant numbers of children of all social economic levels are not
receiving the experiences necessary for healthy early brain development.
•
HBHC capacity continues to be eroded due to insufficient government funding
(inadequate from the outset, steady decline since 2006, and funding now frozen).
From a 2008 Association of Local Public Health Agencies survey:
o significant and increasing gaps in HBHC staffing;
o Health Units across Ontario are unable to meet HBHC vision and goals;
o In particular, high-risk home visits have been reduced.
•
HBHC services support and empower families to link with many other services
that facilitate healthy growth & development, including:
o Best Start;
o Ontario Early Years Centres;
o Canadian Prenatal Nutrition Programs;
o Mental Health Programs;
o Health care providers;
o Early identification programs.
•
HBHC, as a universal and targeted program, enhances school readiness in the
domains identified in the Early Development Instrument:
o physical health and well-being;
o social competence;
o emotional maturity;
o language and cognitive development;
o communication skills;
o General knowledge.
•
To be effective for Ontario’s children, HBHC must be:
o integrated within a system of early childhood programs and strategies;
o have a strong provincial lead but also support from all government levels;
o allow participation from all sectors of society;
o be adequately funded to fulfill its mandate…
Unicef’s 2008 “Child Care Transition” report failed Canada on 9/10 measures of
whether young Canadians have the best opportunities in early childhood – Ontario
needs to heed the message and ensure we appropriately invest in the early years.
Evidentiary support for HBHC:
Prenatal
o healthy pregnancies and births are associated with healthy growth and
development (McCain, Mustard & Shanker, 2007)
o Poor birth outcomes such as delivery of low birth weight (LBW) infants,
may have a negative impact on child health and development, and are
associated with an increased risk for maltreatment (Lee et all, 2009)
o A randomized controlled trail examined effectiveness of an intensive
prenatal home-visitation program in decreasing negative birth outcomes
among socially disadvantaged women and teens. Weekly supervision was
provided. Home visitation focused on providing families with healthy
prenatal lifestyle teaching, social support and linkages to community and
medical services. Results from this study provided evidence that the risk
of delivery of a LBW baby was significantly reduced for those provided
with home visits, and further reduced if visits were provided at a
gestational age of ≤ 24 weeks. Prenatal home visiting, with a focus on
social support, health education and linkages with community services has
the potential to lead to healthy births outcomes (Lee et al., 2009).
Postnatal – Universal component
o Although the lowest socioeconomic group has the highest proportion,
children at risk exist in all socioeconomic groups and the largest number
are found in the middle class: thus programs must be universal to identify
and intervene (McCain, Mustard and Shanker, 2007, p. 46)
Postnatal - Targeted
o An infant’s environment and early relationships are critical to healthy
growth and development: factors including maternal depression,
substance abuse and family violence have long term ramifications on the
quality of future social interactions, behaviors, mental health problems,
learning and development in the child (McCain, Mustard and Shanker,
2007).
o Clients who are socially and geographically isolated often particularly
benefit from home visiting programs that assist families in meeting their
needs (McLean, Mustard & Shanker, 2007, p. 50).
o There is strong evidence that home visiting is associated with the
enhancement of parenting skills (Hahn, Mercy, Biluka &Briss, 2005).
o A review of the effectiveness of home visits identified the following positive
maternal/child health outcomes: improved child growth and health,
improved parenting skills, reduced risk of physical abuse, reduced
maternal stress, and improved child developmental scores and behavioral
function. Effective programs were intensive (weekly or biweekly), long
term (1-5 years), using trained visitors with ongoing supervision, and
service was focused on client’s needs (Douglas, et al, 1997).
Healthy Babies, Healthy Children Program to Undergo
Service Cuts Due to Lack of Funding
IMMEDIATE RELEASE
Monday, January 12, 2009
Stratford – The Healthy Babies, Healthy Children program is undergoing changes to its
services starting Monday, January 19, 2009. The changes will include cuts to services
due to provincial funding for the program. “We are very disappointed to have to make
these changes,” says Pat Jarvis, Public Health Manager. “Healthy Babies, Healthy
Children is an important service to families in our community.”
The main change involves reducing the staff allocation to the HBHC program. Due to the
staffing cutback, there will be the following service cuts:
• We will no longer offer a postpartum home visit to all second-time mothers.
• We will no longer be calling new mothers on the weekends and on statutory holidays
to provide support after they leave the hospital. New parents will receive a call on the
next business day instead.
Healthy Babies, Healthy Children is run by the Perth District Health Unit and celebrated
its 10th anniversary in 2008. The program is for expectant parents and families with
children ages 0 to 6. The program is best known for the home visits provided by public
health nurses to new parents after a baby is born.
The HBHC program has not received an increase in funding from the Ministry of Children
and Youth Services over the past few years to cover cost of living, salary and benefit
increases for program staff. “The flatline of funding has presented ongoing challenges for
us as we try to provide the full range of HBHC services to young families,” says Jarvis.
“We deeply regret cutting services that are intended for all parents in our county.”
The Perth District Health Unit has corresponded with the Ministry and asked for a
funding increase but the request was denied. The strain on the program is also being felt
at other public health units across the province. “From what we understand, we are not
alone in having to make HBHC program cuts due to funding issues,” explains Jarvis.
If people have concerns about these service cuts, you are asked to either call the Health
Unit’s Health Line or call your local MPP’s office directly to express your concerns.
For more information, please call Health Line at 519-271-7600 ext 267. Listowel area
residents call 1-877-271-7348 ext 267.
– 30 –
Media Contact: Rebecca Hill, Communications Manager
519-271-7600 ext 279 or email: rhill@pdhu.on.ca
January 21, 2009
Honourable Deb Matthews
Minister of Children and Youth Services
14th Floor, 56 Wellesley St. W.
Toronto, ON M5S 2S3
Dear Minister Matthews:
On behalf of the Simcoe Muskoka District Board of Health I am writing to indicate our
continued serious concerns related to the financial challenges the Simcoe Muskoka District
Health Unit’s Healthy Babies Healthy Children (HBHC) Program is experiencing. Funding
shortfalls continue to threaten the capacity of the HBHC Program to promote the health and
well-being and prevent disease and disability of the families with young children residing in
Simcoe County and the District of Muskoka. We are asking that adequate funding be provided
for 2009 and into the future to uphold the mandated universal and targeted aspects of the
program. We are also asking that the 2008 over-expenditure of approximately $30,000 be
covered through a one-time grant.
The persistent funding inadequacies for the HBHC Program over the last several years have
eroded the fundamental components of the program. Since 2005, the respective increases to
Simcoe Muskoka District Health Unit’s base budget have been 2.7 percent for 2006, 2.5
percent for 2007 and 0.8 percent increase for 2008. It has been shared by the Director of
Early Learning and Development of the Ministry of Children and Youth Services (MCYS) that
the 2009 budget for Simcoe Muskoka District Health Unit will remain at $2,419,133 with a zero
percent increase. This will directly result in the program being overspent by approximately
$50,000. The Board of Health has taken the unprecedented step of approving the
maintenance of the current staffing level to ensure ongoing delivery of the program.
The financial stressors have impacted significantly on this program. This has included gapping
of positions when staff members are off for a temporary period of time and/or the elimination
of positions completely. A supervisory position and two administrative positions have been
removed. There has been a reduction of 8 FTE of Public Health Nurse time due to the
opportunities for employment across the agency, and Family Home Visitor time has been
reduced by 0.7 FTE. There has been limited uptake of voluntary reductions in number of days
worked by non-union staff when offered. The Let’s Grow information packages to families with
children under the age of six are no longer being distributed. Waitlists for families in need of
ongoing HBHC home visiting have resulted in families waiting at least eight weeks or more for
service.
Strategies to further streamline operations will continue to take place. The 48-hour postpartum
phone calls by public health nurses will be eliminated on weekends and statutory holidays,
with possible impact of approximately 500 new mothers out of 4700 receiving a call after 48
hours.
The Board of Health urges the Ministry of Children and Youth Services to critically review and
revise the funding formula to adequately reflect the actual costs associated with delivering the
Healthy Babies Healthy Children Program.
Healthy Babies Healthy Children is an innovative and effective health-promotion, earlyintervention program for the citizens of Ontario, specifically children and their families. Simcoe
Muskoka District Health Unit is proud to provide service to enhance the growth and
development of all children universally and those at high risk for developmental challenges.
We urge you to provide funding at levels which will ensure the objectives of the HBHC
Program are met.
Thank you for your consideration of this matter. We look forward to your response at your
earliest convenience.
Sincerely,
Original Signed by
Dennis Roughley
Chair, Board of Health
DR:CS:ba:clt
c.
Hon. Margarett Best, Minister of Health Promotion
Hon. David Caplan, Minister of Health and Long-Term Care
Hon. Tony Clement, MP, Parry Sound-Muskoka
Hon. Helena Guergis, MP, Simcoe-Grey
Hon. Peter Van Loan, MP, York-Simcoe
Bruce Stanton, MP, Simcoe North
Patrick Brown, MP, Barrie
Hon. Aileen Carroll, MPP, Barrie
Norm Miller, MPP, Parry Sound-Muskoka
Garfield Dunlop, MPP, Simcoe North
Jim Wilson, MPP, Simcoe-Grey
Julia Munro, MPP York-Simcoe
Dr. David Williams Acting Chief Medical Officer of Health
Linda Stewart, Executive Director, alPHa
All Ontario Health Units
Carolyn Shoreman, Director, Family Health Service, Simcoe Muskoka District Health
Unit
March 10, 2010
Honourable Laurel Broten
Minister of Children and Youth Services
14th Floor, 56 Wellesley St. W.
Toronto, ON M5S 2S3
Dear Minister Broten:
On behalf of the Simcoe Muskoka District Health Unit (SMDHU) Board of Health I am writing
to express our concern regarding the serious impact that insufficient funding of the SMDHU’s
Healthy Babies Healthy Children (HBHC) Program is having on the provision of service
delivery. This is a 100 per cent funded Ministry of Children and Youth Services Program that
is also mandated within the Ontario Public Health Standards. We urge you to provide
adequate funding of the HBHC Program to promote both the universal and targeted aspects
of this program.
The HBHC Program is delivered through health units across Ontario in order to promote the
optimal development of all children (prenatal to age 6 years). It is a prevention and earlyintervention program based on the understanding that early childhood experiences have longterm impacts on the physical and mental health of individuals. The SMDHU’s HBHC Program
provides service delivery throughout a geographical area of 8,731 square kilometers.
The Ministry of Children and Youth Services 2009 budget allocation to the SMDHU was
$2,419,133, which reflected a zero percent increase to base budget from 2008 funding levels.
These funding shortfalls continue to undermine the capacity of the HBHC program to meet
the goals of the program and deliver services adequately. The service planning schedule
achievements continue to be impacted and program standard performance targets will
continue to not be met. Unfortunately, communications with Ministry of Children and Youth
Services consultants has not brought about any relief and other health units in the province
are also challenged by service demands and insufficient budget allocations.
It is critical that the Ministry of Children and Youth Services recognizes the costs associated
with delivering the HBHC Program on an annual basis. Both salary and operating costs have
continued to escalate over time without respective increases to base budget. Non-allowable
expenditures such as administration costs including payroll, purchasing, human resource
personnel, general reception and office space also continue to rise. Negligible increases to
base budget allocations over the past several years by the Ministry of Children and Youth
Services has resulted in significant impacts on SMDHU’s HBHC Program, including the
following: reduced services to children and families overall, waitlists for families in high-risk
situations (such as those with mental health concerns, intimate partner violence, isolation,
financial/food shortages, parenting concerns/stressors, physical health challenges and young
single parents), the elimination of weekend coverage for postpartum telephone calls, the
gapping or elimination of public health nurse and family home visitor positions, minimal
spending on resources, supplies and staff development, and increased staff workload
,,, 2
HBHC is an innovative and effective health promotion, early intervention program for prenatal
and postpartum woman, infants, children and their families in Ontario. Simcoe Muskoka
District Health Unit is proud to provide such an important service to enhance the growth and
development of all children universally and at high risk for developmental challenges. With
this in mind, our Board of Health urges the Ministry of Children and Youth Services to critically
review and revise the funding formula to adequately reflect the actual costs associated with
delivering the HBHC Program. It is hoped that you will provide sufficient funds that will
facilitate achievement of the goals and objectives of the HBHC Program.
Thank you for your consideration of this matter. We look forward to your response at your
earliest convenience.
Sincerely,
Original signed by
Dennis Roughley
Chair, Board of Health
DR:CS:mk
Copies to:
Hon. Margarett Best, Minister of Health Promotion
Hon. Deb Matthews, Minister of Health and Long-Term Care
Ms. Aileen Carroll, MPP, Barrie
Mr. Norm Miller, MPP, Parry Sound-Muskoka
Mr. Garfield Dunlop, MPP, Simcoe North
Mr. Jim Wilson, MPP, Simcoe-Grey
Dr. Arlene King, Chief Medical Officer of Health
All Ontario Boards of Health
Linda Stewart, Executive Director, alPHa
Mayor Dave Aspden, City of Barrie
Mayor Ron Stevens, City of Orillia
Warden Cal Patterson, County of Simcoe
District Chair Gord Adams, District of Muskoka
alPHa RESOLUTION A09-6
TITLE:
Preschool Speech and Language Program Budget
SPONSOR:
Thunder Bay District Health Unit
WHEREAS
Ontario’s Poverty Reduction Plan (Government of Ontario, 2008) identified that
The Best Start Plan is designed to help ensure that children are ready to learn by
the time they start Grade One, and that the Plan includes provision of preschool
speech and language services at neighbourhood Best Start hubs to increase
access; and
WHEREAS
Speech and language skills are essential to a child’s healthy development, ability
to communicate, learning readiness, academic and literacy success; and
WHEREAS
Preschool Speech and Language Services are directly linked to the Ontario
Public Health Child Health Standard Requirements; and
WHEREAS
The Ministry of Children and Youth Services’ objectives for the Preschool Speech
and Language (PSL) program are to identify and serve the estimated 10% of
children in the preschool population with speech and language disorders; lower
the average age of identification to 24 months; eliminate waiting lists; provide
parents with direct access to the system; provide common speech and language
assessment protocols; provide interventions appropriate for the age and needs of
the child; and provide services as close to home as possible; and
WHEREAS
Preschool Speech and Language Services are funded by a variety of different
funding sources and are offered by different agencies with varying
accountabilities, resulting in duplication of infrastructures and uncoordinated
services for children and their families; and
WHEREAS
A child’s need for speech and language services can continue after the age of
five, and may begin at any point during childhood; and
WHEREAS
There is little consistency regarding levels and model of service delivery across
the province when a child makes the transition from Preschool Communication
Services to school based services; and
WHEREAS
Children living in the north and other underserviced areas are frequently
excluded from access to speech and language services because of unique
barriers such as transportation costs and remote locations; and
WHEREAS
It has been demonstrated that schools are the most appropriate and effective
services providers for children past the age of five;
THEREFORE BE IT RESOLVED THAT alPHa urge the Ministry of Children and Youth Services
to increase the 2009/2010 funding for preschool speech and language programs to continue to
deliver services at current levels at a minimum;
AND FURTHER THAT special consideration is given to communities that include a high urban
aboriginal preschool population;
AND FURTHER THAT the Ministry of Children and Youth Services take a leadership role in
reviewing the current funding structures for preschool speech and language services throughout
the province of Ontario with a view to increasing accountability;
AND FURTHER THAT the Ministers of Health & Long-term Care and Health Promotion work
with the Minister of Education and Training, and the Minister of Children and Youth Services to
ensure school boards of Ontario are recognized as the appropriate provider of speech and
language services to Ontario’s children;
AND FINALLY THAT a smooth transition to school based speech and language services be
achieved by supporting the school boards of Ontario to provide speech and language services,
and funding school boards to do the same.
ACTION FROM CONFERENCE:
Moved: M. Harding (Thunder Bay)
Seconded: V. Blackmore (Middlesex-London)
Resolution CARRIED AS AMENDED
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