Ministry of Children and Youth Services Update of Best Start

February 1, 2007Council of Ontario Medical Officers of Health

Association of Local Public Health Agencies

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What is Best Start?

Goals

Children in Ontario will be ready and eager to achieve success in school by the time they start Grade 1.

Ontario will be an international leader in helping all children realize their social, intellectual, economic and physical potential.

• Best Start is a major redesign of services in terms of how families and children are supported from birth through to Grade 1. In the long-term, Best Start will lead to the development of an integrated comprehensive system of services that will:

• help children be successful in school.• help prevent children from requiring services that target high risk

children e.g. child welfare, youth justice.• invest wisely to help ensure that future generations of Ontarians are

prepared to be part of a highly adaptable and competitive economy.

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Our Comprehensive Approach Human Development and Education

SUCCESSFUL ENTRY TO ADULTHOOD AND WORK

• A prosperous Ontario

• Healthy, educated, involved citizens

LIFE LONG LEARNING

TRAINING & POSTSECONDARY

ELEMENTARY/SECONDARY

BEST START

AGE 0 6 18 ADULTHOOD

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Best Start on the Ground

• Helps all children – regardless of individual economic or social circumstances.

• Early and on-going screening of all children to identify potential issues, needs, and risk – which in turn will help focus the planning and services offered by community service providers.

• An integrated approach – seamless from the child and family’s perspective – that brings together pre-school, JK, SK, quality child care, public health, and parenting programs, with explicit links to children’s mental health, children’s treatment centres and child welfare.

• Early learning and care hubs that act as the central place in the

community where children and parents will go for screening, assessment and access to services. An ideal location for the hub is an elementary school.

• Flexible at the local level to help meet the needs of different communities: Aboriginal, Francophone, urban, rural, northern, new immigrant, etc.

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Best Start on the Ground – Community Hubs

Child Welfare

Developmental Services

Children’s Mental Health

Children’s Treatment

Centres

Core Functions:Screening & Assessment: Communication and

Social/Emotional IssuesHBHC and Public Health

Nutrition ProgramsParenting Programs

Child CarePre-School

JK/SKPreschool Speech and Language

Infant HearingRecreation Services

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How Are We Going to Get There?

• Best Start is a comprehensive, long-term strategy to enhance the healthy development and early learning of Ontario’s children, which is being implemented in phases.

• Phase One of the Best Start Plan is focusing on three key priorities:

• Enhancing the quality of Ontario’s early learning and care system;

• Improving the accessibility and affordability of Ontario’s early learning and care system; and

• Enhancing Ontario’s system of early identification and intervention.

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How Are We Going to Get There?

Key Phase One Best Start components:

• An expansion of child care for children enrolled in Junior and Senior Kindergarten with moderate expansion of the system for children 0-4 years, as well as wage improvements for child care workers in the regulated sector.

• Three demonstration projects that will fast-forward the 10+ year vision.

• Other components included in Phase One:• Expert Panel on Early Learning Framework;• Expert Panel on Quality and Human Resources;• Expert Panel on the 18 month well baby visit;• Establishment of the proposed College of Early Childhood Educators;• Service restoration/funding enhancements for Healthy Babies Healthy

Children, Preschool Speech and Language, and Infant Hearing Programs;• Move to a child care income test to determine eligibility for child care fee

subsidies;• Development of a simplified model for funding child care operators; and • Measurement for progress and results using the Early Development

Instrument.

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How Are We Going to Get There?

• Phase Two will involve the implementation of the full Best Start vision across the province, including:

• Community hubs that will pull together screening, assessment and treatment, child care and parenting programs, and will have direct links to other children’s services such as mental health and speech and language resources.

• Preschool early learning program for children ages 2.5 to 4, at no cost to parents for 2.5 hours/day for 10 months every year and increased for the before and after school hours.

• Other programs and strategies including the implementation of the enhanced 18 month developmental review and evaluation using primary care providers for every child in Ontario, and a post-partum mood disorders strategy.

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Best Start – Updates

Enhanced 18 Month Well-Baby Visit

• Expert Panel has released their final report “Getting it Right at 18 Months…Making it Right for a Lifetime.” • Copies of the report can be downloaded from

http://www.children.gov.on.ca

• Mandate of the Expert Panel: development of a report to provide the basis for a provincial strategy to support standardized developmental assessment at 18 months of age for each child in Ontario.

• Membership to the Expert Panel consisted of representation from pivotal organizations in child health and healthy child development, Ministry of Children and Youth Services and the Ministry of Health and Long-Term Care.

• Recommendations were reviewed by Ministry of Children and Youth Services (MCYS) in partnership with the Ministry of Health and Long-term Care (MOHLTC) and the Ministry of Health Promotion (MHP)

• The province is responding to the panel’s recommendations and has created an Implementation Advisory Committee and Working Group.

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Best Start – Updates

Enhanced 18 Month Well-Baby Visit (cont’d)• The panel made two overarching recommendations which provide

the context for the further recommendations:• MCYS and MOHLTC dedicate appropriate resources and work

collaboratively to implement an Enhanced 18 Month Well-Baby Visit;• MCYS and MOHLTC establish an implementation group comprised of

people with expertise in primary care, healthy child development, professional education, and data measurement and evaluation.

The Expert Panel’s six specific recommendations are:1. Provide parents and providers with tools to support an Enhanced 18

Month Well-Baby Visit.2. Build effective partnerships among parents, primary care providers,

and community resources.3. Provide information, education, and support for primary care

providers.4. Encourage timely access to services and manage wait times.5. Describe the developmental health status of our children.6. Evaluate the impact of the Enhanced 18 Month Well-Baby Visit.

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Best Start – Updates

Best Start Demonstration Communities

•Our Best Start demonstration communities of Timiskaming, the rural areas of Lambton and Chatham-Kent, and Hamilton’s East end have been doing a tremendous job of accelerating the implementation of the full vision of Best Start.•Throughout 2006-07, approximately 24 hubs will become operational across the 3 demo sites, including Francophone- and Aboriginal-specific hubs.•Demonstration sites are accelerating the implementation of key components of Best Start:1. Enhanced 18 Month Well-Baby Visit

• Pilot an enhanced 18 Month Well-Baby Visit, promoting collaborative models for the delivery of the enhanced 18 Month Well-Baby Visit.

2. Postpartum Mood Disorder (PPMD)• Over the next year, they will include activities focused on PPMD as we recognize that supporting

parental mental health is a crucial aspect of all strategies aimed at improving child outcomes. 3. HBHC

• Lambton and Chatham-Kent with be further community integration, providing HBHC services in their hubs.

4. PSL & IH• Enhanced Preschool Speech and Language and Infant Hearing Program services to Grade One

entry.5. Early Learning Framework6. System Integration•Learning and best practices from the evaluation of these three demonstration communities will inform broader provincial Best Start strategies responding to needs of public health.

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Best Start – Moving Forward

Preschool Speech & Language, Infant Hearing and HBHC

Funding enhancements Announced by Minister Chambers on January 28, 07.

• Total increased investment for PSL is $4.2M in order to:• Reduce existing waitlists,• Improve training in the areas of language and literacy, and• Expand service to Grade 1 entry for children who do not attend SK.

• Total increased investment for IHP is $1.1M• Extend all services to children with identified permanent hearing impairment to

Grade 1 entry.• New Blind-Low Vision Early Intervention Program $1.8M

• The new Blind-Low Vision Early Intervention Program will provide a support program for preschool children who are blind or have low vision, and their families.

• Family-centred services will be available through this program for children from birth to Grade 1.

• Total increased investment for HBHC is $2.5M, which began in 2006• To support the universal screening of Ontario's newborns through home visits

by public health nurses to new mothers who require or request them. • Since 2004, a total of $10.85M additional investments have been made.

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Best Start Moving Forward

Community Planning – Next Steps

• The next step for community planning is the development of strategies to move the local system forward along the system integration continuum.

• Best Start networks are a key driver for the next step of Best Start implementation – system integration.

• The community hub is a venue for delivering an integrated system of services.

• To move forward with system integration, communities need to consider:• How best to align planning process and delivery models so as to maximize

the benefits of collaborative planning and avoid service duplication where possible;

• Shared service priorities and areas of potential collaboration; and, • How to streamline delivery in a way that improves access and outcomes

for children and their families.

• Addendum to the Implementation Planning Guidelines developed by the MCYS as a tool to support communities in moving forward with system integration.

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The success of the HBHC program is our comprehensive strategy and reach, through the various components of the program undertaken by the PHUs:

1. Prenatal Component

2. Universal Component

3. High Risk Home Visiting Component

4. Early Identification Component

5. Service Planning and Coordination

Healthy Babies Healthy Children

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HBHC – Components and Tools

Discharge

Post Partum ContactPhone Contact

Home Visit

AssessmentsBrief

In-depth

Screening

Postpartum

Early ID

Prenatal Service Delivery

Service Planning

Home Visiting

Referral

Service Delivery

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• The Integrated Services for Children Information System (ISCIS) is a case management system that supports the HBHC program and can be used for electronic charting.

• At present many PHUs are successfully using ISCIS for electronic charting in varying levels of paperless operations. Those PHUs who wish to implement electronic charting, our staff and the ISCIS group are ready and able to assist you in these endeavours.

• Aside from a case management system, ISCIS tracks large numbers of statistical data elements and service targets permitting the tracking of provincial and PHUs annual achievements.

• New HBHC-ISCIS Reporting sub system (IRSS 2), a decision support reporting system for the HBHC program, was implemented in April 2006. Hands on training was provided in May 2006. The initial Data Mart introduced was Post Partum Contact. The Post Partum Home Visiting and Postpartum Screening Data Marts will become available March 2007.

HBHC - ISCIS

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ISCIS Statistical DataThe Ministry has a number of program standards:

1. Prenatal - 25% of women screened using a Larson2. PP Contact – 100% of families contacted within 48 hours of

discharge.3. PP Home Visit – 75% of families receive a home visit4. In-depth Assessment – 12% of families complete an In-depth

Assessment

HBHC – Program Standards

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HBHC – Program Standards

Prenatal - 25% of women screened using a LarsonProvincial average: 20%

14,41616,073

20,268

23,995

-

10,000

20,000

30,000

2002 2003 2004 2005

Wo

men

17%14%

13%

20%

Women Screened Using a Larson

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0%

25%

50%

75%

100%

HBHC – Program Standards

Prenatal - 25% of women screened using a LarsonProvincial average: 20%

Women Screened Using a Larson

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HBHC – Program Standards

108,493

116,893

120,161121,971

100,000

105,000

110,000

115,000

120,000

125,000

2002 2003 2004 2005

Liv

e B

irth

s S

cree

ned

92.6%

88.9%

83.1%

93.1%

Live Births Screened with a Parkyn

Postpartum – 100% of live births screened with a Parkyn Provincial Average: 93.1%

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HBHC – Program Standards

Postpartum Contact – 100% of families contactedProvincial Average: 96%

88,347 95,594 97,020

18,378 21,526 18,825 19,309

86,681

-

40,000

80,000

120,000

160,000

2002 2003 2004 2005

Fam

ilie

s

114,41995.8%

109,87394.1%105,059

97.4%

116,329

96.1%

Families Contacted After Discharge

Contacted within 48 hours

Contacted after 48 hours

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HBHC – Program Standards

Postpartum Contact – 100% of families contacted within 48 hours of Discharge

Provincial Average: 80%

0%

25%

50%

75%

100%

Algom

a

Brant

Chath

am-K

ent

Durha

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rn

Elgin

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Thom

as

Grey-

Bruce

Haldi

man

d-Nor

folk

Halib

urton

Halto

n

Hamilt

on

Hastin

gs

Huron

Kingst

on

Lam

bton

Leed

s

Mid

dles

ex-L

ondon

Niaga

ra

North

Bay

Par

ry S

ound

North

weste

rn

Ottawa

Oxfor

dPee

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Perth

Peter

boro

ugh

Porcu

pine

Renfre

w

Simco

e M

usko

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Sudbu

ry

Thun

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ay

Tim

iska

min

g

Toro

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Wat

erlo

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Wel

lingto

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Win

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Families Contacted within 48 hours of Discharge

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HBHC – Program Standards

49,448 49,34353,637 53,965

0

20,000

40,000

60,000

2002 2003 2004 2005

Fa

mili

es

Families Receive a Postpartum Home Visit

Postpartum Contact Home Visit – 75% of families receive a postpartum home visit

Provincial Average: 45%

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HBHC – Program Standards

Postpartum Contact Home Visit – 75% of families receive a postpartum home visit

Provincial Average: 45%

0%

25%

50%

75%

100%

Families Receive a Postpartum Home Visit

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HBHC – Program Standards

In-depth Assessment – 12% of families complete an In-depth Assessment

Provincial Average: 10%

0%

4%

8%

12%

16%

20%

24%

Families Complete an In-depth Assessment

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Postpartum Mood Disorder (PPMD)• The outcomes in the three demonstration sites will inform a

broader HBHC strategy to respond to needs related to parental mental health.

Enhanced 18 Month Well-Baby Visit• Collaboration with the Enhanced 18 Month Well-Baby Visit to

encourage families to consider participation.Update 2003 HBHC Consolidated Guidelines

• Update and revise the guidelines, including a review of evidence based practices.

ISCIS Enhancements• ISCIS Reporting Sub System (IRSS) Data Marts.• eParkyn.• Remotes assess/entry.

Best Start• System integration at the Best Start planning tables.

Multi Ministry Activities (MOHLTC, MHP and MCYS)• Clarification of funding responsibilities.• Program expansion/funding enhancements.

HBHC – Potential Next Steps

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Ontario’s Best Start Plan

Thank you

……Moving Forward