STAFF REPORT
February 14, 2000
To: Board of Health
From: Dr. Sheela Basrur, Medical Officer of Health
Subject: Background Information on the Children's Action Plan and Youth Violence Prevention Initiatives
Purpose:
This report provides background information on the initiatives recommended by the Children and Youth Action
Committee (CYAC) to address some of the current gaps in service and unmet needs in the children and youth segment of
Toronto's population. This information is provided to assist the Board of Health in its deliberations during the 2000 budget
process.
Financial Implication and Impact Statement:
An additional $2,621,000 will be required for the year 2000 Public Health Operating budget to fund the Public Health
initiatives recommended in the "Action Plan for the Children's Report Card 1999"and in the "Follow-up Initiatives
Addressing Youth Violence." These initiatives are not part of the Toronto Public Health 2000 Operating Budget and cannot
be absorbed within current resources. The annualized impact would be $3,797,300. Public Health will seek Provincial cost
sharing which, if successful, will reduce the net cost for the City of Toronto.
Recommendation:
It is recommended that the Board of Health receive this report for information.
Council Reference/Background/History:
At the Board of Health meeting on January 21, 2000, The Board of Health adopted in principle the report entitled
"Children's Action Plan and Youth Violence Initiative: Budget Implication for Public Health." In addition, the Board of
Health requested the Medical Officer of Health to submit a report to the Board through the Budget Subcommittee to
prioritize the proposed programs outlined in the aforementioned report, based on comments made during consideration of
this matter along with evidence of information regarding Public Health best practices.
Comments and/or Discussion and/or Justification:
The Children and Youth Action Committee developed an Action Plan in response to social and health needs identified by
the Toronto Report Card on Children. The Action Plan contained recommended initiatives to improve the health and
well-being of Toronto's children.
This report provides background information and categorizes the proposed initiatives in order to provide information for
the Board of Health for its deliberations during the budget approval process. The CYAC initiatives may be grouped into
three categories:
(1) Harmonizing Public Health services across the City:
This would enable children with similar needs to have access to the same level of supportive services across the city. The
initiatives that fall into this category are:
(a) Expansion of the One on One mentoring program for children at risk
(b) Expansion of Child Nutrition Program
(c) Expanded access to Prenatal Nutrition Program
(d) Expansion of the delivery of Rainbow Fun, a physical activity program for preschoolers
(e) Expansion of the school-based violence prevention program
Currently these programs are offered in some areas of the City but due to lack of resources, Toronto Public Health is
unable to respond to identified needs and community requests in unserved areas.
(6) New programs to achieve greater compliance with Provincial Mandatory Health Program and Service Guidelines:
These programs would enable Toronto Public Health to achieve greater compliance with mandatory programs in areas
currently with very low or zero compliance. The CYAC initiatives that comprise this grouping are:
(a) the Social Marketing Campaign on Pre-pregnancy Health;
(b) the establishement of a Peer Nutrition Worker Program;
(c) the multi-strategy physical activity program for children across the ethno-racially diverse communities of Toronto; and
(d) the needs assessment and review of best practices leading to the integration of mental health components in Family
Health programs
(5) Programs that address identified local needs:
These include:
(a) the development of a coordinated response to children with hearing and vision problems;
(b) the internet-based youth violence prevention resource;
(c) the interactive, multimedia, web-based youth violence prevention tool; and
(d) establishment of an Early Dental Decay Prevention Program
As the budget process progresses it may be necessary for members of the Board of Health to collaborate with CYAC
members to establish criteria for deciding on 2000 priority initiatives.
Please see Appendices 1 to 13 for additional information on each initiative. This information identifies the following for
each initiative: target group; Mandatory Health Program and Service Guideline that the initiative responds to; whether
Public Health is a sole provider or partner; evidence of need; evidence to support the recommendation, and impact if
initiative is not funded.
Conclusions:
This report provides the Board of Health with background information on the public health initiatives put forward by the
CYAC. As the budget process progresses, it may be necessary for members of the Board of Health to collaborate with
CYAC members to establish criteria for deciding on 2000 priority initiatives.
Contact Name:
Dr. Hazel Stewart
Regional Director
West Region
Toronto Public Health
Tel: (416) 392-0442
Fax: (416) 392-0713
Dr. Sheela V. Basrur
Medical Officer of Health
Attachments:
Appendix No. 1 - Expanded Access to Prenatal Nutrition Programs
Appendix No. 2 - Social Marketing Campaign On Pre-pregnancy Health
Appendix No. 3 - Develop a multi-strategy program model for young children's physical activity
Appendix No. 4 - Expand the delivery of Rainbow Fun
Appendix No. 5 - Peer Nutrition Worker Program
Appendix No. 6 - Child Nutrition Programs
Appendix No. 7 - School Age Children's Vision and Hearing
Appendix No. 8 - Early Childhood Dental Decay Prevention Program
Appendix No. 9 - Public Health School-based Violence Prevention Program
Appendix No. 10 - Internet-based Youth Violence Prevention Resources
Appendix No. 11 - Interactive, Multimedia Web-based Youth Violence Prevention Tool
Appendix No.12 - Expansion of Children At-Risk Mentoring Program
Appendix No. 13 - Children's Mental Health
Appendix No. 1
CYAC Recommendation:
Expanded Access to Prenatal Nutrition Programs
The CYAC proposes to increase the number of women attending Canada Prenatal Nutrition Programs by 10% by expanding services in 18 sites and
creating services in 9 new sites.
Target Group:
High risk pregnant women
Mandatory Health Programs & Services, Compliance Level, and Liability:
Reproductive Health; Equal Access
Non-Public Health Providers:
A few Prenatal nutrition Programs operate without direct Public Health support.
Evidence of Need:
1. Prenatal Nutrition Programs target high risk pregnant women. There are approximately 400,000 births per year in Canada. It is estimated that 10% of
these births (41,000) are at risk due to poor health and poor nutrition of the mother. (Perinatal Education Program of Eastern Ontario, 1998).
2. The low birth weigh rate for Toronto was 6.5% for total births in 1997; this is 60% higher than the provincial target of 4% by 2010. (Local Planning
Data for Reproductive and Child Health, 1999).
3. Many of the existing 21 Prenatal Nutrition Programs have reached capacity and cannot accept any more pregnant women.
4. Toronto Public Health is experiencing an increase in referrals to the Prenatal Nutrition Programs with the expansion of the Healthy Babies, Healthy
Children Program to include a prenatal component.
Evidence to Support Recommendation:
1. Investments in the health and wellbeing of the mother help and ensure the birth of a healthy infant. Prenatal nutrition, social support, and
comprehensive health care are important for good birth outcomes, particularly for mothers living in high risk conditions (Steinhauer, 1996 as cited in
Ontario Coalition of CAPC/CPCP Projects, 1999).
2. Preliminary data from a national evaluation of Prenatal Nutrition Programs conducted by Gail Barrington, Barrington Research Group, Calgary, AB.,
indicate that the number of Participants increased dramatically over 1996-1997. Data also indicated that over 80% of the programs are reaching pregnant
women who are isolated, live in poverty, experience violence or are teenagers, (Ontario Coalition of CAPC/CPNP Projects, 1999)
3. Pregnant women who experience poverty are less likely to be well-nourished, suffer more stress and anxiety, and experience higher rates of family
violence than middle-class women. All of these are risk factors for low birth weight. (National Council for Welfare, 1997 as cited in Ontario Coalition of
CAPC/CPNP Projects, 1999).
Impact of Not Being Funded:
1. Many current programs have already reached capacity and have waiting lists.
2. In some current sites, program attendance is expanding beyond the site and staff's capacity.
3. Increase in Program Referrals in 1998/99 due to Healthiest Babies Possible Prenatal Nutrition Counselling Program (offered city-wide since
September, 1998).
4. Year 2000 expansion of Healthy Babies, Healthy Children Program to include a Prenatal component, will also increase program referrals.
5. Quality of service is currently inconsistent between sites and this will continue without enhancement of PHN, Dietician and outreach resources.
6. Some existing programs have had to reduce the dollar value of their food support for individual women due to volume of program attendance. While it
is anticipated that the Federal Government will increase its portion of funding to the Canada Prenatal Nutrition Program, this will not include funding for
Public Health staff/resources. In order to continue to provide the level of in-kind support necessary to achieve the goals of the CPNP Program, Public
Health enhancements will be needed for 9 new programs in Toronto.
Appendix No. 2
CYAC Recommendation:
Social Marketing Campaign On Pre-pregnancy Health
To help give all our children a good start, the CYAC proposes increasing awareness of the factors affecting the health of newborns through a
multi-facetted communications campaign aimed at all women of childbearing age and their partners, using targeted information disseminated through
physicians, health centres, workplaces and schools, as well as radio ads, subway, streetcar and bus shelter posters.
Target Group:
All women of childbearing age and their partners.
Mandatory Health Programs & Services, Compliance Level, and Liability:
Reproductive Health
Non-Public Health Providers:
No
Evidence of Need:
1. There are more Toronto residents in their primary reproductive years than the provincial average (Toronto Public Health, 1999).
2. The low birth weight rate for Toronto was 6.5% for total births in 1997; this is 60% higher than the provincial target of 4% by 2010. (Local Planning
Data for Reproductive and Child Health, 1999).
3. In 1995 the rate of neural tube defects was 4.9 per 10,000 live births (Local Planning Data for Reproductive and Child Health, 1999).
4. Currently, in Toronto although messages related to healthy lifestyle behaviours are promoted, no social marketing campaigns currently exist focussing
on preconceptional health.
Evidence to Support Recommendation:
1. The birth weight of an infant is related to the preconceptional and gestational health of the mother (Ontario Ministry of Health as cited in Toronto
District Council, 1999).
2. A child's development is greatly influenced by pre-existing health conditions in pregnancy e.g. tobacco and alcohol use, nutrition (Cefalo, RC, & Moos,
M, 1995 as cited in Best Start, Community Action for Healthy Babies, 1999).
3. People need to have information about the impact that healthy lifestyle choices and health status can have on conception, pregnancy, and birth
outcomes (Cefalo, RC, & Moos, M, 1995 as cited in Best Start, Community Action for Healthy Babies, 1999).
4. There is growing evidence that social marketing campaigns are best suited to increase awareness of health related issues and influence behaviour
change at the population level. People go through a variety of stages before they change their behaviour (increasing awareness, attitudinal change,
behaviour change). Social marketing campaigns that address that these steps can greatly improve the success rate of health promotion programs (Ontario
Ministry of Health, 1992 as cited in Best Start, Community Action for Healthy Babies, 1999).
5. With Respect to preconceptional health, Best Start Barrie and the Simcoe County District Health Unit developed a social marketing campaign which
included preconceptional messages, booklets, displays, pamphlets and information sessions. As part of a midway project survey conducted during the fall
of 1995, central evaluations for the Best Start demonstration program included questions about preconception health and effectiveness of the billboard as
a media channel. In a randomly selected survey of women in Barrie and other communities, respondents in Barrie were more aware of the "be healthy
before pregnancy message" (24% - 11.7%) and the "eat well before pregnancy message" (9.5% - 3.3%) (Best Start, Community Action for Babies,
Collections of Interventions: Practices and Products).
Impact of Not Being Funded:
1. Increased pre-pregnancy awareness of the factors affecting the health of newborns in the community-at-large will not occur
2. Dissemination of preconception information through physicians, health centres, work places and schools will not occur.
3. Opportunity to impact on pre-pregnancy health behaviour changes through awareness-raising will be missed.
Appendix No. 3
CYAC Recommendation:
Develop a multi-strategy program model to maximize young children's physical activity across the ethno-racially diverse communities of Toronto
Target Group:
Within the selected ethno-racially diverse pilot community(ies): primary school children (3-8 years); parents, teachers, children's program workers.
Within the selected ethno-racially diverse pilot community(ies): local schools, daycare centres, family resource centre, Boys & Girls club, recreation
centre.
Mandatory Health Programs & Services, Compliance Level, and Liability:
Chronic Disease Prevention
Non-Public Health Providers:
Project planning & coordination, and as appropriate, program delivery by local PHN.
Evidence of Need:
1. The skills, confidence and habits which support lifelong physical activity are laid in early childhood. Inactive children and youth are much more likely
to be sedentary as adults than children and youth who are active. (McCain & Mustard, 1999; Health and Welfare Canada, 1993; American Alliance for
Health, Physical Education, Recreation and Dance).
2. 60% of Canadian children do not meet average fitness standards for their age, and children do 75% less exercise today when compared to children in
the year 1980. (Ontario Physical and Health Education Association, 1996).
3. The Canadian Medical Association reports that in the past 15 years, the prevalence of obesity has grown by more than 50% in Canadian children 6-11
years old. (Lechy, O., 1994).
4. Children are being raised in a "culture of inactivity" in which close to 70% of adults are classified as inactive. Increasingly, technological advances
influence all aspects of home and work life, increasing the time spent in passive versus active pursuits as a regular part of daily life. (Canadian Fitness
and Lifestyle Research Institute, 1995).
Evidence to Support Recommendations:
A multi-strategy approach implemented through schools and recreation programs are effective in increasing physical activity among children (Brown, G.,
1999; Harrell, J.S., 1996; Parcel, G.S.., 1989).
Impact of Not Being Funded:
Both the strong interdivisional partnership (Public Health, parks & Rec., Children's Services) which is committed to a Vision for Physically Active
Children and Families will lack the resources to undertake the development and implementation of a program model that is based on best practices and is
appropriate to ethno-racially diverse communities. This pilot of a multi-strategy community intervention to maximize children's physical activity is
planned for Fall 2000.
Appendix No. 4
CYAC Recommendation:
Expand the delivery of Rainbow Fun to all licensed child care programs and other organizations serving children.
Target Group:
The approximately 100,000 young children aged 3-8 years, living in the City of Toronto.
Children's Program Workers
Mandatory Health Programs & Services, Compliance Level, and Liability:
Chronic Disease Prevention
Non-Public Health Providers:
Public Health conducts the training.
Other Community partners deliver the program to children.
Evidence of Need:
1. The skills, confidence and habits which support lifelong physical activity are laid in early childhood. Inactive children and youth are much more likely
to be sedentary as adults than children and youth who are active. (McCain & Mustard, 1999; Health and Welfare Canada, 1993; American Alliance for
Health, Physical Education, Recreation and Dance).
2. 60% of Canadian children do not meet average fitness standards for their age, and children do 75% less exercise today when compared to children in
the year 1980. (Ontario Physical and Health Education Association, 1996).
3. The Canadian Medical Association reports that in the past 15 years, the prevalence of obesity has grown by more than 50% in Canadian children 6-11
years old. (Lechy, O., 1994).
4. Children are being raised in "culture of inactivity" in which close to 70% of adults are classified as inactive. Increasingly, technological advances
influence all aspects of home and work life, increasing the time spent in passive versus active pursuits as a regular part of daily life. (Canadian Fitness
and Lifestyle Research Institute, 1995).
Evidence to Support Recommendations:
1. Two of the resources developed and promoted by Public Health Rainbow Fun Physical Activity Program for Young Children, and Moving on the Spot:
a Series of 5 Minute Stretch & Movement Sessions have been evaluated by external consultants, and have been found to be effective in increasingly
physical activity amongst young children.
2. Public Health's work in physical activity promotion amongst young children and their families/caregivers has led to the development of effective
inter-Departmental partnerships between Children's Services, Parks & Rec., and has resulted in increased physical activity programming in child care and
Parks & Rec. program across the City.
Impact of Not Being Funded:
Expansion of programs for young children, which have been shown to increase children's physical activity, will not be possible. Only a fraction of this age
group (3-8 years) has been reached, thousands more children (in child care, Toronto District School Board, Scouts and Guiding organizations, unlicensed
ESL child care settings, etc.) could benefit from program expansion.
Appendix No. 5
CYAC Recommendation:
Peer Nutrition Worker Program
The CYAC proposes the establishment of the Peer Nutrition Worker Program to reach over 700 parents and 1,200 children often missed by traditional
nutrition programs.
Target Group:
Parents of children aged 0 to 6 years
Mandatory Health Programs & Services, Compliance Level, and Liability:
Chronic Disease Prevention; Equal Access
Non-Public Health Providers:
Toronto Public Health is involved in a number of peer support initiatives, such as the lay home visitor component of the Healthy Babies, Healthy Children
Program, but these are focused on a different target audience than this proposed initiative (i.e. High risk populations) and do not offer intensive nutrition
and skills-based training.
Toronto Public Health supports only one other peer education initiative that is focussed on food and nutrition, The Community Food Advisor Program.
This program is based only in the former North York and has enjoyed limited success due to the fact, in part, that the peer educatiors are unpaid so there
is a high turn-over rate.
Evidence of Need:
A study of economically disadvantaged preschoolers in Ontario found that children are not eating according to nutrition recommendations: the minimum
recommendations of milk (2 cups a day) and fruits and vegetables (5 servings a day) were not being met and "other foods" (foods of little nutritional
value) contribute 20% of children's caloric intake1.
Evidence to Support Recommendations:
1. Many nutrition professionals recognize that peer educators can "connect" with people from the same neighbourhoods, cultural groups or socioeconomic
backgrounds in ways that middle-class professionals cannot. Peer-led nutrition programs have been successful with senior where, under the guidance of
public health nutritionists, peer educators have used presentations, home visits, grocery tours (i.e. Food selection education) and written articles to reach
other seniorsi
2. The most effective strategies for increasing fruit and vegetable consumption in people four years of age and older used longer, more intensive
interventions rather than one or two contactsii
3. Behavioural change strategies are most effective when they use a set of learning experiences, they are personalized for a particular target group, they
use social support or peer involvement and they use an empowerment approach that includes personal controliii
4. The Waterloo Regional Health Unit's Community Nutrition Worker program began in 1988 and targets high risk, low income young families using a
peer education and community development model. This program was evaluated in 1990iv, although the evaluation was limited. Some of the successes
and challenges that were documented include:
(a) There was a large number of people reached.
(b) The approach of hands-on skill development, as opposed to a more didactic form of nutrition
(c) Information dissemination, was seen to be more effective with the target group
(d) Participants indicated that the project had encouraged them to make positive changes in their eating habits; however, low income levels were major
barrier to healthy eating.
Impact of Not Being Funded:
1. Currently Toronto Public Health is doing very little to meet the needs of parents of toddlers and preschoolers in terms of nutrition education and food
skills programs.
2. This program has the potential to effectively meet the needs of Toronto's ethnically and culturally diverse communities.
3. It is estimated that through this program, a total of approximately 720 parents of over 1,200 young children will be reached per year in training
programs, but the outreach will be greater through the use of ethno-specific media sources.
Appendix No. 6
CYAC Recommendation:
Child Nutrition Programs
The CYAC proposes that Council reaffirm its commitment to healthy children and good nutrition by restoring its funding to cover 24% of the expanded
Child Nutrition Program.
Target Group:
Children and youth, elementary school-aged, plus some possible expansion to include adolescents
Mandatory Health Programs & Services, Compliance Level, and Liability:
Chronic Disease Prevention
Evidence of Need:
1. The Canadian Association of Food Banks reported that food bank use in Canada doubled in the past decade, and that children are consistently
over-represented in food bank lines: according to their report, 40.8% of food bank recipients were under the age of 18 years; whereas, children only
make-up just over 25% of the total population6
2. A 1997 study of 351 low income Scarborough residents reported that 51% of respondents said they thought their children were often or sometimes
hungry but they couldn't afford to buy more food7 (Scarborough Hunger Coalition, 1997).
3. The 1998 National Longitudional Study of Children and Youth (NLSCY) of 23,000 randomly selected Canadian families found that 1.2% (206)
families experience hunger as a result of extreme disadvantage. Single-parent families, families on social assistance, Aboriginal families and families
living in Canada's large urban centres were most likely to experience hunger. Furthermore, the children in families reportedly experiencing hunger also
reported a higher prevalence of poorer health statusvi (McIntyre, Connor, Warren, 1998)
4. A study of economically disadvantaged children ages 7-9 years in Ontario found that children are not eating according to nutrition recommendations:
children may be at risk of inadequate calcium intake and have a tendency towards overweight despite calorie levels below recommended levelsvii (Evers,
1995).
5. Children may arrive at school hungry for a number of reasons, other than lack of access to food: parents leave early for work and are unable to
supervise the morning meal; children may eat early to attend before school care and may be hungry by school time; children may skip meals to stay slim
and children who participate in extra-curricular activities may be too rushed to eat breakfast.
6. The Toronto Child Nutrition Programs are not based on a charity model: community members, concerned parents and educators are essential to
program development, implementation and sustainability and contribute significantly to the funding for the programs.
Evidence to Support Recommendations:
1. Research suggests that breakfast omission affects children's performance of cognitive tasks, especially those involving memory, although the effects of
modifying factors are unknown; participation in school breakfast programs in some setting has been shown to increase school attendanceviii (Pollitt, 1998).
2. A morning meal contributes to both the quality and quantity of the total daily intake of energy, protein, carbohydrate and important vitamins and
minerals, such as calcium & iron.
3. Critics of Child Nutrition Programs argue that these programs are only necessary for "poor, hungry children" and that the programs should be
"targeted". The problems with this approach are: 1) it is difficult to "screen" children to determine whether they will be eligible for such a program; 2) the
screening process itself could deter children from entering the program, and 3) the program and the children who attend it could be labelled or
stigmatized. The alternative to this approach is universal programs. This approach does not single children out as poor or needy, so the obvious advantage
is that there is no labelling or stigmatization. It has been recommended by child development experts that, "… (we) press for true universality in children's
programs … This principle applies to children's programs across the developmental years from parenting programs, to sports and arts programs to peer
counselling"ix (Offord, 1999)
4. A best practices, project is currently being undertaken by the Canadian Living Foundation wit support from Health Canada and the Toronto model is
being studied in this project.
Impact of Not Being Funded:
1. Toronto is not currently meeting its obligations under the agreed upon funding formula for the Child Nutrition Programs (i.e. The 24% municipal
contribution has dropped to 17.8%)
2. The nutritional quality of the foods offered in the programs will be compromised without adequate municipal funding; this is important since studies of
disadvantaged children in Ontario indicate that children may be at risk of inadequate calcium intake and are not meeting the minimum recommendations
for vegetable and fruit intake.
3. Without additional municipal funding, there will be no capacity for increasing access to the Child Nutrition Program, despite the high demand and the
need for universality of the Program; the projected estimates for the 1999/2000 school year, based on funding applications submitted in May 1999, are
that over 53,000 meals and snacks will be served in about 310 programs (in approximately 200 sites) across Toronto.
Appendix No. 7
CYAC Recommendation:
School Age Children's Vision and Hearing
The CYAC proposed of the Department of Public Health initiate a research program to develop a sound basis for addressing children's hearing and vision
problems, and report to the CYAC with recommendations regarding effective strategies to identify and support those children.
Target Group:
School-age children
Mandatory Health Programs & Services, Compliance Level, and Liability:
Child Health
Non-Public Health Providers:
Representatives from local health organizations and the School Board are meeting to review next steps in relation to the hearing and vision problems
identified in the school.
Evidence of Need:
1. A recent study on one inner city school in the former City of Toronto identified that some children were disproportionately affected by hearing and
vision problems. The extent of these problems among Toronto children is unknown at present.
2. As part of the research program, a needs assessment will be conducted to identify the perceived extent of the issue.
Evidence to Support Recommendations:
The research program itself will determine the most effective way to identify and support children with vision and hearing problems.
Impact of Not Being Funded:
Gap exists. Unable to address identified issue.
Appendix No. 8
CYAC Recommendation:
Early Childhood Dental Decay Prevention Program
The CYAC proposes the establishment of an Early Childhood Dental Decay (ECC) Prevention Program.
Target Group:
Children aged 0-5 years
Mandatory Health Programs & Services, Compliance Level, and Liability:
Child Health
Non-Public Health Providers:
Counselling around ECC prevention is available to clients who have the capacity to pay private practitioners. Universally accessible ECC Prevention is
not available.
Evidence of Need:
1. "Early childhood caries (ECC) is a serious health problem in disadvantaged communities in both developing and
industrialized countries" (Davies, 1998).
4. One study found that ECC is found in 8.6% of all pre-school children (Abbey, 1994).
5. In low-income families, "as many as 56% of the children between 24 and 36 months of age had dental caries" (Blen and Jones, 1999).
6. "8% of infants between 12-23 months of age … and 17% of children aged 2 to 4 years were affected by caries" (Low et al, 2000).
7. Of children presenting for emergency care at the Montreal Children's Hospital dental department "70% of toothache and 48% of dental infections …
were found in children aged 1 to 5 years (Low et al, 2000).
8. "… the pain and discomfort that accompanies early childhood caries has social and nutritional implications" (Titley, 2000).
9. In a study of 77 children with ECC (mean age of 44 months), "48% of children complained about their teeth … 43% had problems eating certain food
… 61% ate sparingly or did not finish what was served … 35% did not sleep will" (Low et al, 2000).
10. Children who experience early childhood caries tend to experience caries later in both primary and permanent dentition" (Low et al, 2000).
11. Currently no mechanism exists for accessing preschool children at risk for ECC or their parents.
Evidence to Support Recommendations:
1. "… early childhood caries entirely preventable" (Titley, 2000).
2. "The relatively high prevalence of early childhood caries could have been prevented by appropriate preventive strategies" (Blen and Jones, 1999).
3. "Population-based public health approaches are more likely to reach the target population groups at risk of developing ECC than individual, private
practice-based approaches".
4. (Weintraub, 1998).
5. "Primary preventive measures should be applied during the ante and immediate post-natal periods". (Davis, 1998).
6. "Early screening … could identify infants and toddlers who are at risk of developing ECC …" (Ismail, 1998).
7. "Currently, appropriate data are not available for ECC …" (Horowitz, 1998).
8. One component of the Early Childhood Caries prevention Program involves an extensive literature review of ICC and ICC Prevention Programs to
develop evidence-based prevention strategies.
Impact of Not Being Funded:
1. 8.6% of all pre-school are at risk for medical problems such as pain, infection and malnutrition caused by feeding problems and dental problems such
as early tooth loss and future dental caries.
2. Costly and extensive treatment of ECC will continue to be needed. The average cost of treating a child with advanced ECC is over $1,000 (DIS Report,
City of Toronto, 1999).
3. Since the children affected are very young (from 12 months of age) the treatment is lengthy and invasive and these children usually must be placed
under a general anesthetic which causes additional health risks.
Appendix No. 9
CYAC Recommendation:
Public Health School-based Violence Prevention Program
The CYAC proposes to expand program currently in 8 high schools in former Toronto to 8 additional school sites in Scarborough, East York, Toronto,
York, North York and Etobicoke
Target Group:
Grade 9 students and their parents
Mandatory Health Programs & Services, Compliance Level, and Liability:
Injury Prevention/Substance Abuse Prevention Program
Non-Public Health Providers:
Centre for Addiction and Mental Health
Evidence of Need:
1. A number of observations made by the Research Group on Drug Use in 1999:
(a) many youth have early involvement with drugs
(b) along with drug addiction, 33% of youth were known to face legal problems at time of treatment (Research Group on Drug Use, 1999)
3. A recent study of Ontario students showed that the average age of first use for alcohol and tobacco is approximately 12 (Grade 7), while the average
age for first marijuana use is about 14 (Grade 9) (Injury Prev./Substance Abuse Prev. Plan)
4. In Toronto, There is an increase in cannabis use among youth; cannabis use is the second most prevalent program after alcohol cited by youth in
treatment. There is also an increase in the popularity of cocaine and crack among intravenous drug users and increase in the use of drugs including
Appendix No. 10
CYAC Recommendation:
Internet-based Youth Violence Prevention Resources
Target Group:
Youth, parents and service providers
Mandatory Health Programs & Services, Compliance Level, And Liability:
Injury Prevention/Substance Abuse
Non-Public Health Providers:
Partnership with Community Information Centre of Metropolitan Toronto
Evidence of Need:
1. Lack of access to accurate, reliable, up to date information on violence prevention programs.
2. Lack of current relevant information of best practices.
3. A similar product is available (Streetwise) and is in great demand in Toronto and Canada.
Evidence to Support Recommendations:
1. Halton Health Unit, Community Access Survey found that 65% of residents have access to the internet and nearly 30% of residents access health
information on the internet. The City of Toronto home page has 6 million hits per month.
2. Toronto Public Health website had 47,000 hits per month.
3. Internet increasingly available through Public Libraries and schools
Impact of Not Being Funded:
No accurate, reliable, up to date information on youth violence prevention programs.
Appendix No. 11
CYAC Recommendation:
Interactive, Multimedia Web-based Youth Violence Prevention Tool
Target Group:
Students and educators
Mandatory Health Programs & Services, Compliance Level, And Liability:
Injury Prevention/Substance Abuse
Non-Public Health Providers:
Partnership with Market Link, Centre for Addictions and Mental Health
Evidence of Need:
1. Difficulty in developing and delivering youth appropriate violence prevention material.
2. Current service levels are overtaxed by organization and budget changes.
3. As Public Health staff become less available in the classrooms, interactive, internet-based curriculum can respond to the need for accurate violence
prevention education.
4. Increasing incidents of school-based violence, schoolyard bullying, school dropout, youth depression and suicide.
Evidence to Support Recommendations:
1. CAMH had developed a similar product (Virtual Party) to address substance abuse.
2. Increasing level of traffic visiting TPH's website.
3. Increasing reliance on the internet as a widely accessible source of information for community agencies (206 youth serving agencies in Toronto).
4. Increasing use of internet in schools (total of 815 elementary and secondary schools).
Impact of Not Being Funded:
No interactive, multimedia web-based youth appropriate violence prevention tool
Appendix No. 12
CYAC Recommendation:
Expansion of Children at Risk Monotoring Program
The CYAC support the addition of one staff person to help create 3 new mentoring programs, including one program based in the private sector (program
transferred from Health City Office without resources therefore need staff person to maintain existing program).
Target Group:
Children between 5 and 12 years of age.
Mandatory Health Programs & Services, Compliance Level, And Liability:
Injury Prevention/Substance Abuse
Non-Public Health Providers:
Partnership with Rotary Club, Centre for Addiction and Mental Health, School Boards, Kiwanis Boys and Girls Club, local community
Evidence of Need:
Increasing incidents of school-based violence, schoolyard bullying, school dropout, youth depression and suicide.
Evidence to Support Recommendations:
1. Strong evidence of the influence of a positive, one-on-one relationship with an adult on development of self-esteem and confidence in at risk students.
2. One on One Mentoring Program is based on Mentoring USA which have been evaluated. This evaluation shows that children in Grades K-8 improve
their self-esteem, broaden their vision of opportunities and apply themselves in school. It increases quality of life for both volunteers and children and
increase academic performance in students.
3. The evaluation of the Big Brothers/Big Sisters in Hamilton looked at academic performance and psychological measures with impressive results.
Impact of Not Being Funded:
Elimination of existing program in 6 schools serving 45 children (29 mentors from the City, 16 mentors from the Rotary).
Appendix No. 13
CYAC Recommendation:
Children's Mental Health
The CYAC proposes the initiation of a needs assessment and review of best practices to determine how best to integrate mental health programs into
Family Health programs. The CYAC also proposes the immediate updating of the "Learning Through Play From Birth to Three Years" calendar and other
parent-education tools for promoting mental health among children.
Target Group:
Children from birth to 12 years
Mandatory Health Programs & Services, Compliance Level, And Liability:
Child Health
Non-Public Health Providers:
Children's Health Network; Sick Children's Hospital
Evidence of Need:
Early Years Study provided strong evidence that the early years of development from conception to age six set the base for competence and copying skills
that will affect learning, behaviour and health through life. Negative experience in the early years including severe neglect or absence of appropriate
stimulation is likely to have decisive and sustained effects (McCain and Mustard; 1999).
Evidence to Support Recommendations:
1. The Learning Through Play Birth to Three Calendar":
(a) 3583 copies has been distributed to 40 organizations in Toronto from January 1999 to May 1999
(b) is incorporated into the Federal Government's training manual for "Nobody's Perfect", a national parenting program
(c) has been distributed internationally in India, Sri Lanka, Caribbean, Asia, El Salvador and Africa
2. Parenting has major effect on the early stages of child development. Parents who embodied a rational, responsive approach that included reasoning
with the child, had the best outcomes in terms of the child's cognitive and behavioural development (Chao & Willms forthcoming).
Impact of Not Being Funded:
1. The "Learning Through Play Calendar Birth to Three Calendar" will not be revised and translated to 11 languages.
2. Children's mental health needs will not be addressed in an effective and comprehensive manner.
References
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Infant Dental Care - by Keith C. Titley, DDS [Oral Health, January 2000, page 3]
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Prevention of Early Childhood Caries - by A. Ismail [Community Dental Oral Epidemiology 1998;26(1 Suppl):49-61]
Early Childhood Caries: a Synopsis - by GN Davies [Community Dental Oral Epidemiology 1998;26(1 Suppl);106-16]
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Primary Incisor Decay Before Age 4 as a Risk for Future Dental Caries - by TA al-Shalan; PR Erickson; NA Hardie [Pediatric Dentistry 1997 Jan-Feb;
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