ISSUE
The Healthy Babies Healthy Children program is a mandated program under the Ontario Public Health Standards (OPHS), and is funded 100% through the Ministry of Children Community and Social Services (MCCSS). In 2020, due to the COVID-19 pandemic, HBHC program services were significantly altered across the province as staffing resources were redeployed to support the COVID response.
The HBHC program is an evidence based early intervention home visiting program designed to improve outcomes for children at risk of poor growth and development. The HBHC program aims to support the most vulnerable and marginalized families in our community through blended home visiting including nursing, social work and peer support. Entry into the HBHC programs occurs through screening and referral at three stages: Prenatal; Postpartum; and Early Identification. The HBHC screen identifies a family experiencing a need, issue or risk that may compromise healthy child development; and/or parenting ability; and who may benefit from a more thorough evaluation and receipt of HBHC program services or other community services. HBHC staff utilize standardized assessments and evidence-based interventions to work on family centred goals and develop a Family Service Plan that monitors the progress and achievement of those goals. The HBHC program staff support families with:
- healthy pregnancy and prenatal care
- developing a positive relationship with their child
- promoting child’s growth and development
- connecting families to resources and programs within their community
- working together with families to help give their child the best start in life
BACKGROUND
In March 2021, the WECHU received communication from the MCCSS requesting the restoration of HBHC services for the 2021-2022 fiscal year. Health Units were asked to submit their service delivery plans and financial forecast to MCCSS by April 14, 2021 for review and consideration. Where staff were redeployed to other services supporting the pandemic, health units were asked to consider alternative staffing models including the use of social workers and other professional staff to support program delivery and identified service goals.
The WECHU’s service delivery plan recognizes the continued redeployment of nursing staff to support COVID-19 vaccination and case and contact management well into the 2021 calendar year. As such an alternate model of blended home visiting will be implemented utilizing social workers as the family case coordinators supporting all family service plans and goals. Limited nursing staff, including a registered lactation consultant will be incorporated into blended home visiting related to: prenatal health, healthy attachment, optimal growth and development, and breast feeding goals and will consult as an expert related to screening and assessment. Other supports for blended home visiting include a registered dietician to support nutrition and food security and family home visitors.
The WECHU has retained minimum service levels for HBHC over the course of the pandemic. Key priorities for families in Windsor-Essex remain as mental health, substance use and housing stability. HBHC staff have reported an increase in mental health complexity among clients and increased severity for those with pre-existing anxiety and depression. This may be attributed, at least in part, to the financial strain, isolation, and general uncertainty caused by the pandemic, as reported by some clients. This interim model will allow the WECHU the opportunity to meet full program implementation while maintaining program fidelity and support increased risks associated with substance use and poor mental health.
2021/2022 Budget
The MCCSS funds not only the Healthy Babies Healthy Children Program Initiative but also the Nurse Practitioner Program Initiative. The MCCSS has combined the budget for these program initiatives for purposes of reporting. As such, the WECHU will adopt a consistent approach.
To address the continued need to have the WECHU nurses more focused on the COVID-19 case and contact management and vaccination efforts, the FTE composition of the Healthy Babies Healthy Children Program Initiative will change throughout the fiscal year. Initially, the Program will be more heavily supported by social workers. This support will shift as nursing support can be reintegrated in the latter part of 2021.
A summary of the FTEs by quarter are as follows:
| FTE |
Q1 |
Q2 |
Q3 |
Q4 |
| Manager |
2 |
2 |
2 |
2 |
| Health Promotion Specialist |
1 |
1 |
1 |
- |
| Nutritionist |
1 |
1 |
1 |
- |
| Public Health Nurse |
6 grading down to 4 |
4 |
9 |
15 |
| Family Home Visitor |
4 |
4 |
4 |
4 |
| Social Worker |
2 grading up to 10 |
10 |
10 |
4 |
| Support Staff |
1.5 |
2.5 |
2.5 |
2.5 |
*FTE estimates are approximate and subject to change based on program needs and pressures throughout the year.
Regarding the Nurse Practitioner Program Initiative, one (1) nurse practitioner FTE will be retained throughout the entire year. This FTE will provide limited support to COVID-19 vaccination efforts. Quarterly reporting will reflect the reallocation of applicable salaries and benefits for time expended on Ministry of Health Programs.
The 2021/2022 expenditure budget for all programs funded by the MCCSS is detailed below:
| Item |
April 1, 2021 to March 31, 2022 |
April 1, 2020 to March 31, 2021 |
Change |
| Salaries and benefits |
2,639,041 |
2,722,600 |
(83,559) |
| Operating expenditures: |
|
|
|
| Mileage |
60,000 |
63,000 |
(3,000) |
| Professional development |
25,000 |
10,400 |
14,600 |
| Program supplies |
150,000 |
83,841 |
66,159 |
| Purchased services |
20,800 |
15,000 |
5,800 |
| Total operating expenditures |
255,800 |
172,241 |
83,559 |
| Total budget |
2,894,841 |
2,894,841 |
- |
For the 2021/22 fiscal year, the fluent staffing complement results in a change in the salaries and benefits financial statement caption of $83,559. Offsetting this are is an increase in the operating budget, most notably the following financial statement captions:
- Professional development of $14,600 – Increase in professional development to address the needs of FTEs that are new to the Healthy Babies Healthy Children Program Initiative as well as the needs of those returning to this program in the latter part of 2021.
- Program supplies of $66,159 – Increases in program supplies for the Healthy Babies Healthy Children Program Initiative to address the need to review and refresh resources and revitalize the program. Additionally, there will be an augment in information technology hardware and software to address increased FTEs. The program area will also continue to review equipment requirements for work-from-home as well as ensuring field staff are more mobile, in that they can document client interactions in the field.
PROPOSED MOTION
Whereas, the Windsor-Essex County Health Unit receives grants from the Ministry of Children, Community and Social Services to fund the Healthy Babies Healthy Children and Nurse Practitioner Program Initiatives, and
Whereas, the total budget for the Healthy Babies Healthy Children Program Initiative and the Nurse Practitioner Program Initiative combined is $2,894,841 for the period April 1, 2021 to March 31, 2022,
Now therefore be it resolved that the Windsor-Essex County Board of Health approve the budget as presented by Administration for the period April 1, 2021 to March 31, 2022.
