2 Carlton Street, Suite 1306 Toronto ON M5B 1J3 alPHa Tel: (416) 595-0006 Association of Local Fax: (416) 595-0030 PUBLIC HEALTH E-mail: [email protected] Agencies Providing leadership in public health management

July 21, 2010

Hon. Laurel Broten Minister, Children and Youth Services 14th Floor 56 Wellesley Street West Toronto, 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 (pre- natal 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 Page 2 of 2 July 21, 2010

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. , 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 REPORT WM~lllil General Committee 1M qoll.

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 David McKeown, MDCM, MHSc, FRCPC Commissioner of Health Medical Officer of Health

Approved for Submission:

______R. Maloney, Chief Administrative Officer

Authored By: Anne Fenwick c. 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. , 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: [email protected]

Providing leadership in public health management

Hon. Dalton McGuinty March 4, 2009 Premier of Ontario Legislative Bldg Rm 281 Queen's Park Toronto, ON M7A 1A1

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: M. Leduc (Eastern Ontario) Seconded: 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 month1, 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: V. Sterling (Toronto) Seconded: 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: D. McKeown (Toronto) Seconded: 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: R. Pellizzari (Peterborough) Seconded: 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 [email protected] Healthy Babies Healthy Children Program

Survey Summary Report

Introduction

On April 17, 1997, Premier 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 Year Ministry 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/

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.

Total HBHC Staff

80,000,000 830

70,000,000 820

60,000,000 810

50,000,000 800

40,000,000 790

823 FTEs 817 813 30,000,000 807 780 Salaries & Benefits 20,000,000 770 779 10,000,000 760

0 750 2004 2005 2006 2007 2008

Total FTEs 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 HBHC Program Staff

70,000,000 700

60,000,000 690

680 50,000,000 670 40,000,000 660 695 FTEs 30,000,000 689 686 679 650

Salaries & Benefits 20,000,000 640 652 10,000,000 630

0 620 2004 2005 2006 2007 2008

FTEs 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

4,400,000 84 83 4,300,000 83 82 81 4,200,000 81 80 80 79 4,100,000

79 78 FTEs 77 4,000,000 SalariesBenefits & 76 76

3,900,000 75 74 3,800,000 73 2004 2005 2006 2007 2008

FTEs Salaries & Benefits

HBHC Survey Results 3 of 7 April 29, 2009 The total number of supervisory staff has increased slightly over the five years as is shown in the following chart.

HBHC Supervisory Staff

6,000,000 54

5,000,000 52

50 4,000,000 48 3,000,000 52 46 FTEs

2,000,000 49

Salaries & Benefits 48 44 46 1,000,000 44 42

0 40 2004 2005 2006 2007 2008

FTEs 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 2008 2007 2006 2005 2004 Program Funding $62,470,310 $61,146,857 $58,789,328 $55,568,803 $49,215,476 Average Program Funding $2,231,083 $2,183,816 $2,099,619 $1,984,600 $1,757,696 Annual Increase Program Funding 2.2% 4.0% 5.8% 12.9% PHUs Receiving One-time Grant 16 (57%) 16 (57%) 15 (54%) 8 (29%) 10 (36%) One-Time Grant $1,412,076 $2,133,744 $1,464,494 $259,539 $1,683,670 Average One-time Grant $88,255 $133,359 $97,633 $32,442 $168,367 Total MCYS Funding $63,882,386 $63,280,601 $60,253,822 $55,828,342 $168,367

HBHC Survey Results 4 of 7 April 29, 2009 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 2008 2007 2006 2005 2004 PHUs using Other Funding Sources 11 (38%) 10 (38%) 12 (43%) 8 (29%) 9 (32%) Total $2,448,875 $2,234,976 $2,016,895 $1,481,236 $1,361,656 Average $222,625 $223,498 $168,075 $185,155 $151,295 Increase 9.6% 10.8% 36.2% 8.8%

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 2008 2007 2006 2005 2004 Total Costs 61,241,650 59,064,548 55,888,451 54,401,502 49,791,319 MCYS Funding 57,919,281 56,641,445 54,430,768 52,234,828 46,070,841 Shortfall 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 in- depth 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: [email protected]

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, early- intervention 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. , 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 early- intervention program based on the understanding that early childhood experiences have long- term 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