Renewal of the Healthy Babies, Healthy

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Report to/Rapport au :
Ottawa Board of Health
Conseil de santé d’Ottawa
August 20, 2012
20 août 2012
Submitted by/Soumis par :
Dr./Dr Isra Levy,
Medical Officer of Health/Médecin chef en santé publique
Contact Person / Personne ressource:
Vera Etches, Associate Medical Officer of Health / Médecin adjointeen santé publique
Clinical Programs / Direction des programmes cliniques
Ottawa Public Health / Santé publique Ottawa
613-580-2424, ext./poste 23675, [email protected]
CITY WIDE / À L’ÉCHELLE DE LA VILLE
Ref N°: ACS2012-OPH-CP-0001
SUBJECT:
RENEWAL OF THE HEALTHY BABIES, HEALTHY CHILDREN
PROGRAM
OBJET :
RECONDUCTION DU PROGRAMME BÉBÉS EN SANTÉ, ENFANTS
EN SANTÉ
REPORT RECOMMENDATIONS
That the Board of Health for the City of Ottawa Health Unit approve:
1. Ottawa Public Health’s endeavours to maintain a universal connection with
all postpartum parents through the Healthy Babies, Healthy Children
Program, as outlined in this report; and
2. That staff report in Q3 of 2013 on the Healthy Babies, Healthy Children
Program status.
RECOMMANDATIONS DU RAPPORT
Que le Conseil de santé de la circonscription sanitaire de la Ville d'Ottawa
approuve :
1. que Santé publique Ottawa se force à garder contact avec tous les parents
après la naissance d'un bébé par l'intermédiaire du programme Bébés en
santé, enfants en santé;
2. que le personnel doive produire un rapport au troisième trimestre de 2013
sur l'état du programme Bébés en santé, enfants en santé.
EXECUTIVE SUMMARY
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The Healthy Babies, Healthy Children (HBHC) program is at risk of cutting services to new
parents due a lack of support and investment.
This program, which provides families with supports required for parenting as well as more
intensive home visiting services for those at risk of poor health outcomes, has in the last decade
seen significant increases in client numbers and case complexities. In 2011 alone, 96 per cent
of nearly 9,000 new mothers were contacted, public health nurses spoke with 5,700 new
mothers directly, and 4,400 postpartum home visits were made. Despite these demands, the
program has not received the commensurate increases in financial investment needed to meet
its core requirements.
The Ottawa Board of Health’s advocacy efforts to increase funding from the Ministry of Children
and Youth Services (MCYS), the Ministry responsible for HBHC funding and mandate, have yet
to yield results. Furthermore, it is anticipated that instead of investing in the program, the MCYS
is pursuing a policy direction that would see the program restricted only to families identified –
during their hospital stay – as at risk for poor health outcomes.
This anticipated change in MCYS program guidelines raises concerns among Ottawa Public
Health (OPH) staff as evidence demonstrates that universal programs for infants and children
less than six years of age lead to positive health outcomes. Furthermore, a critical component of
HBHC’s success to date has been the universal postpartum telephone call which promotes and
protects infant and maternal health by providing a health screening and assessment for all
families within 48 hours of hospital discharge following the birth of a child. Without a universal
telephone health call, postpartum families who experience difficulties following hospital
discharge, may be missed. This may result in poor short- and long-term health outcomes and
increased social and financial costs.
Within this context of strict budgetary constraints and imminent changes to MCYS program
guidelines, OPH conducted a third-party program review to find efficiencies and to help decide
where best to allocate resources. Despite implementing the recommendations of the review,
without additional resources it is anticipated that by 2013 the universal postpartum phone call
will not be possible.
In order to address the impending service reductions, OPH has re-organized the program and
developed a plan that intends to maintain a universal connection with all postpartum parents
through the HBHC program. This includes seeking new resources and funding. OPH will explore
potential revenue sources.
RÉSUMÉ
Le programme Bébés en santé, enfants en santé (BSES) risque d’avoir à réduire ses services
offerts aux nouveaux et futurs parents en raison d’un manque de soutien et de subventions.
Le programme, qui offre aux familles de l’aide au soin des enfants et des services plus intensifs
de visites à domicile pour les familles à risque de mauvaise santé, a connu une augmentation
de sa clientèle et de la complexité de ses cas au cours de la dernière décennie. En 2011
seulement, 96 % des nouvelles mères ont été jointes (sur un total de près de 9 000), des
infirmières en santé publique ont parlé directement avec 5 700 nouvelles mères, et 4 400 visites
postnatales à domicile ont été effectuées. Malgré l’augmentation de la demande, le programme
n’a pas vu ses subventions augmenter de façon proportionnelle à ses besoins.
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Les efforts du conseil pour convaincre le ministère des Services à l’enfance et à la jeunesse
(MSEJ) d’augmenter le financement de BSES, dont il est responsable, n’ont pas encore porté
fruit. De plus, on croit que le MSEJ, plutôt que de favoriser le programme, est en train d’adopter
une orientation stratégique qui le restreindrait aux familles ayant été classées, lors de leur
séjour à l’hôpital, comme étant à risque de mauvaise santé.
Ce changement anticipé aux lignes directrices des programmes du MSEJ pose problème, car
les données démontrent que les programmes universels pour les bébés et les enfants de moins
de six ans mènent à un meilleur état de santé. De plus, un élément vital du succès de BSES à
ce jour est l’appel téléphonique postnatal systématique, qui contribue à la santé de la mère et
de l’enfant en offrant à toutes les familles un bilan de santé dans les 48 heures suivant leur
congé de l’hôpital après un accouchement. Sans cet appel, des familles éprouvant des
difficultés après leur congé pourraient être laissées pour compte, ce qui provoquerait une
détérioration de la santé à court ou long terme et une augmentation des coûts financiers et
sociaux.
En raison des contraintes budgétaires et des changements imminents aux lignes directrices des
programmes du MSEJ, Santé publique Ottawa (SPO) a fait mener un examen du programme
par une tierce partie pour faire des économies et déterminer où distribuer les ressources.
Toutefois, même en appliquant les recommandations de l’examen, on anticipe qu’en l’absence
de nouvelles ressources, les appels postnataux systématiques cesseront d’être possibles d’ici
2013.
Pour composer avec les réductions de service imminentes, SPO a réorganisé le programme et
élaboré un plan pour maintenir une connexion avec toutes les familles en période postnatale
par l’entremise du programme BSES. Ce plan comprend la recherche de financement, de
nouvelles ressources et de sources de revenu potentielles.
BACKGROUND
Since the Ontario government launched the Healthy Babies, Healthy Children (HBHC) program
in 1998, Ottawa Public Health (OPH) has provided a telephone call from a public health nurse
within 48 hours of discharge from hospital after the birth of a new baby, the offer of a
postpartum home visit and the provision of more intensive home visiting where risks were
identified (Document 1).
In May 2011, Supporting Perinatal Mental Health, Prevention and Early Identification of
Postpartum Mood Disorders Report (ACS2011-OPH-CP-0001) was presented to the Board of
Health. This report highlighted potential negative health impacts related to pending changes in
the HBHC program as directed by the Ministry of Children and Youth Services (MCYS), the
ministry currently responsible for the HBHC mandate and funding. Despite the Board of Health’s
advocacy efforts to the MCYS, it is anticipated that the MCYS will move forward with the
direction that the postpartum phone call and the offer of a home visit will no longer be a
requirement for all families (Document 2). Rather a service only for families identified as at risk
for poor health outcomes during their hospital stay.
This anticipated change in MCYS program guidelines raises concerns among OPH staff. There
are a number of health issues - postpartum mood blues, breastfeeding challenges and infantile
jaundice - that peak in the first few days following discharge from the hospital. The universal
postpartum telephone call is one of the only local services, especially on the weekend, which is
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available to all families during this critical period. This seamless service ensures that clients with
newborns have access to Ottawa Public Health every day of the week, including statutory
holidays.
In addition, universal programs that support early childhood development for infants and
children less than six years of age, such as promotion of parenting that strengthens attachment
with parents, reading to children, and positive interactions with adults, lead to positive health
outcomes (Document 3).
The postpartum telephone call to all families within 48 hours of hospital discharge enables OPH
public health nurses to:
- Provide parenting support and education
- Screen for postpartum depression (PPD). Thirteen per cent of all new mothers
experience PPD, representing approximately 1,100 women annually in Ottawa.
- Assess maternal and infant health, at times preventing re-hospitalization
- Promote breastfeeding success
- Recruit clients into the Baby Friendly Initiative (BFI) surveillance as per OPH’s plan to
achieve BFI designation in accordance with the Ministry of Health and Long-Term Care
Accountability Agreement
Without a universal postpartum telephone call, families with newborns who did not present
health and social challenges in hospital, but who experience difficulties following hospital
discharge, may be missed. This may result in poor short- and long-term health outcomes and
increased social and financial costs. Over the past five years in Ottawa, more than 1,700
families – 330 clients per year on average – were identified as “no or low-risk” through an inhospital assessment. Yet, they were admitted to long-term HBHC home visiting following the
universal telephone call and assessment by a public health nurse. Under the MCYS proposed
changes, these families would not have received a postpartum call and would not have received
key supports to infant health and parenting.
DISCUSSION
HBHC program review
Given the anticipated MCYS changes, tight budgetary constraints and OPH’s endeavours to
maintain universal postpartum contact, a program review was conducted. The review was
conducted by KPMG and included collecting information from staff, clients, stakeholders and
peer health units (Document 4). Despite efficiencies gained through the review, resources to
maintain a universal connection with all postpartum families through a telephone call remain
limited. Without additional resources, it is projected that by 2013 it will not be possible to contact
all families following hospital discharge.
Proposed plan to maintain a universal connection with all postpartum parents
In comparison to other local public health agencies, OPH has a lower proportion of clients
enrolled into the HBHC program during the prenatal period. In 2011, approximately 12 per cent
of families were screened prenatally by OPH versus the provincial average of 23 per cent.
Because of strong linkages and referrals from local hospitals, OPH has historically relied on
making contact with new parents in the postpartum period. However, it is important to reach
families earlier, not only to optimize pregnancy outcomes, but to establish a solid client and
service provider relationship that extends into the postpartum period.
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Further to Board of Health approval, OPH will endeavour to achieve funding for this initiative
from partner agencies and private sponsors. It is projected that this initiative will accommodate
approximately 1,000 pregnant women annually as well as assist in the delivery of the
postpartum phone call to new parents following hospital discharge. This initiative would
strengthen OPH collaboration with partners who are currently serving pregnant women with unmet needs for breastfeeding support and postpartum depression interventions.
In order to maintain the universal nature of the HBHC program, program investments are
needed. Without additional resources, the following service reductions may occur in order to
maintain universal contact with all postpartum families:
-
-
Reducing or discontinuing the Well Baby Drop-Ins, which provide an opportunity for new
parents to consult with a public health nurse and meet with other local families on a
regular basis.
Decreasing the number of positions funded by the program, which would impact services
offered by HBHC and the number of clients that could be served
LEGAL IMPLICATIONS
There are no legal impediments to the implementation of the report recommendations.
FINANCIAL IMPLICATIONS
There are no financial implications in implementing the recommendations of this report.
TECHNOLOGY IMPLICATIONS
There are no technology implications in implementing the recommendations of this report.
BOARD OF HEALTH STRATEGIC PRIORITIES
The recommendations in this report support the Board of Health Strategic Priorities:
- Increase access to services for populations facing health inequities (C1)
- Increase programming to support healthy child development (D4)
TERM OF COUNCIL PRIORITIES
The recommendations in this report support the Term of Council Priority: Healthy & Caring
Communities.
SUPPORTING DOCUMENTATION
Document 1 – HBHC progamming and services
Document 2 – Correspondence to the Minister of Children and Youth Services
Document 3 – Health impacts of universal programs that support early childhood development
Document 4 – HBHC program review and efficiencies
DISPOSITION
Ottawa Public Health, in collaboration with community partners and City of Ottawa Departments,
will seek new resources and funding to maintain a universal connection with all postpartum
parents through the Healthy Babies, Healthy Children Program.