September 1, 1999

TO:Board of Health

FROM:Dr. Sheela Basrur, Medical Officer of Health

SUBJECT:Healthy Babies, Healthy Children Program Update

Purpose

This report provides an update on Toronto Public Health's Healthy Babies, Healthy Children program, including the expansion of the "at-risk" component, the introduction of the new postpartum component, and its linkage with Family Health programming.

Funding Sources

The Healthy Babies, Healthy Children program is 100% provincially funded through the Ministry of Health. Toronto Public Health received $4.6M in the 1998/99 fiscal year to provide the "at-risk" component of the program. As part of the Province's commitment to increase funding for this program to a total of $50M provincially, Toronto's 1999/2000 fiscal year allocation was increased to $9.1M. In addition, in March of this year, the Province announced a $17M commitment to introduce a postpartum component. For 99/2000, the city's allocation is $1.7M. This brings the city's total Healthy Babies, Healthy Children funding for the year 99/2000 to $10.8M.

There are no direct financial implications for the City of Toronto.

Recommendation

That this report be received for information.

Background / History

The Healthy Babies, Healthy Children (HBHC) program is a joint Ministry of Health and Ministry of Community and Social Services program administered through the Office of Integrated Services for Children. This prevention and early identification and intervention initiative, which began in 1998, is intended to improve the well-being and long term prospects of children. This program fulfills part of the Family Health requirements of the Mandatory Programs and Services Guidelines for Boards of Health. Public Health Departments lead the community planning process for HBHC, in partnership with the Ministry of Community and Social Services Regional Offices and other community organizations that serve families with young children.

All four Regions in Toronto Public Health are well positioned to implement the HBHC program with Family Health programs that respond to the issues of postpartum, breastfeeding, and parent education and support. In particular, Toronto Public Health has developed considerable expertise in the area of postpartum follow up. For example, the former City of Toronto's "Contracting In Project for Shortened Length of Postpartum Hospital Stay" and East York's "Babies First Week Home" project have recently been evaluated, providing a wealth of information and experience for planning and implementing HBHC and related Family Health programs. The information is also being shared with the Province to support their development of program guidelines and training manuals.

Toronto Public Health works in collaboration with the Toronto HBHC Implementation Committee and six HBHC local networks to plan this program in accordance with established provincial guidelines. The program is implemented throughout the city by staff from Toronto Public Health and a number of contracted community agencies.

Discussion

The overall vision of the Healthy Babies, Healthy Children program is guided by the knowledge that a safe and nurturing environment, adequate nutrition, and secure mother-infant attachment is directly linked to a child's neurological development and the recognition that all families benefit from parenting information and support.

By the end of this year, this program will include an "at-risk" component and a postpartum component. The implementation of the "at-risk" component began last year and will continue to be phased in over the next several years. The postpartum component will be implemented this fall.

"At-Risk" Component

Initial funding for the HBHC program focused on identifying "at-risk" families after birth and linking them with appropriate community resources. Lay home visiting and service co-ordination is provided to families who would benefit from such services. Healthy Babies, Healthy Children local networks maintain an inventory of community services for families with children 0 - 6 years of age. This inventory is used to provide staff with referral information and to assist local networks to identify and plan for gaps in service.

The increased provincial funding expands the "at-risk" component by increasing the intensity of home visiting to better meet the needs of each HBHC family and by providing Public Health Nurse home visits to augment Lay Home Visitor home visits. Prenatal clients and families with young children who may not have been identified at birth will also receive HBHC support.

To implement the "at-risk" component, Toronto Public Health is currently in the process of hiring Public Health Nurses and Lay Home Visitors, bringing the total number of PHN and Lay Home Visitor staff allocated to providing the "at-risk" component to 62 and 45.5 respectively. Funding to contracted agencies is also being expanded. Increased service will be phased in over several months as staff are hired and trained and as methods of early identification of children 0 to 6 years are further developed.

Postpartum Component

The goal of the new Healthy Babies, Healthy Children postpartum component is to provide every mother and newborn with the support they need to make a healthy adjustment in the first few weeks of their baby's life and to ensure that all families have access to parenting information and parenting support that is responsive to their needs.

This goal will be achieved by providing all families with support and access to services immediately following the birth of a child. A continuum of care from the hospital to the community for all mothers and newborns is therefore essential. Funding for the hospitals will provide mothers with the option of staying in hospital for up to 60 hours following a normal birth. Public Health funding will provide mothers with a telephone call within 48 hours of their day of discharge and, if requested by the mother, a Public Health Nurse home visit.

Toronto Public Health is currently in the process of hiring an additional 37 Public Health Nurses related to this component. Implementation is set to begin October 4, 1999 (date established by Ministry of Health for province-wide implementation).

Linkage with Family Health Program

It is important to note that Healthy Babies, Healthy Children is only one of the requirements in the Family Health program of the Mandatory Programs and Services Guidelines. While HBHC utilizes a number of health promotion strategies, including home visiting and community partnerships, it does not include the depth and breadth of public health promotion strategies that are essential to achieving all of the objectives of the Family Health program and in addressing the needs of families. In addition, to maximize use of resources and ensure continuity of care for families, both components of the HBHC program will be fully integrated into Toronto Public Health's Family Health programming.

Family Health programming currently varies significantly throughout the Regions. Consequently, full integration will take some time and will proceed as Family Health programming is reviewed and harmonized. Nevertheless, some integration is already occurring. The examples below and the case studies in Appendix A illustrate this.

 Reproductive health is the first step towards a healthy pregnancy and a healthy baby. Public Health staff consult with schools to ensure an appropriate reproductive health curriculum is in place for teenagers. Staff work with other professionals, the media, community groups and workplaces to support healthy pregnancies. Prenatal programs such as Healthiest Babies Possible and Canada Prenatal Nutrition and Support Programs work toward reducing the low birth weight rate and promoting healthy pregnancies. These programs offer an important opportunity to identify Aat-risk" mothers and babies prior to birth; thereby linking families to the Healthy Babies, Healthy Children program as early as possible.

Telephone services that provide information, support, and referral services to individuals and families, as well as breastfeeding clinics, counseling, and community programming and parent group education are just a few of the Family Health programs that enhance the home visiting support provided through Healthy Babies, Healthy Children. Similarly, the introduction of the universal postpartum component is expected to significantly increase community awareness of and demand for these Public Health services.

Conclusions

There is now clear research evidence that the early years of a child's life are critical to their brain development and future readiness to learn. The HBHC program supports parents to establish a secure parent-baby attachment and to develop effective parenting skills.

Toronto Public Health is well positioned to work with the community to plan and deliver this essential program. Toronto Public Health is currently in the process of implementing both the "at-risk" and postpartum components in a manner that integrates them into Family Health. This will ensure that Family Health programming for all families with young children in Toronto is comprehensive and meets their needs.

Contact Name:

Susan Makin

Regional Director, North Region

Tel:392-7408

Fax:392-0713

Joanne Gilmore

Acting Healthy Babies, Healthy Children Manager

Tel:392-7451

Fax:392-1483

Dr. Sheela V. Basrur

Medical Officer of Health