Board of Health Meeting Documents

Prepared By:

Healthy Schools Department - Immunization

Date:

September 21, 2023

Subject:

Seasonal Influenza and COVID-19 Season 2023/2024

BACKGROUND

Influenza (flu) Vaccine

The Windsor-Essex County Health Unit (WECHU) plays a key role in the implementation of the Ministry of Health’s Universal Influenza Immunization Program (UIIP) which offers influenza vaccine free of charge each year to all individuals six months of age and older who live, work, or attend school in Ontario.

Under the UIIP, the provincial supply of influenza vaccine doses is received from the Ontario Government Pharmacy (OGP) in predetermined increments dependent on vaccine availability. The WECHU receives influenza vaccine shipments from OGP and is responsible for the distribution to health care providers and facilities in the community. Allocation to providers is based on total community allocation, number of clients to be served, past usage by the provider, available fridge space, and the proportion of high-risk clients the provider is responsible for. Community Immunization Providers (e.g., primary care providers, hospitals, long-term care homes (LTCH) and retirement homes (RH)) order influenza vaccine from the WECHU, starting in September.

COVID-19 Vaccine

In July 2023, the Ontario Ministry of Health, recommended that Ontarians aged 5 years and older delay getting a COVID-19 booster until the fall. Receiving a booster dose in the fall, as respiratory season commences, will maximize protection against COVID-19 outcomes when peak circulation of the virus is likely to occur with other seasonal respiratory viruses.

Currently, the WECHU is administering primary doses of COVID-19 vaccines at their in-house clinics at the Windsor and Leamington offices. The Healthy Schools Immunization Team is supporting families of school aged children this summer by offering COVID-19 education and immunizations to individuals who want to be vaccinated at upcoming School Readiness Events.

In addition, any pharmacy that is participating in the annual UIIP is encouraged to also participate in the COVID-19 vaccine administration program. Pharmacies who have been approved to administer COVID- 19 vaccine are required to have a cold chain inspection on the vaccine refrigerator(s) that will be storing publicly funded influenza vaccines.

CURRENT INITIATIVES

Throughout the year, the WECHU has completed 366 vaccine fridge inspections throughout Windsor and Essex County (WEC) for health care providers, pharmacies, agencies, long-term care and retirement homes planning to administer influenza and COVID-19 vaccines this fall.

Eighty-four out of 120 local pharmacies that applied to manage and administer fall vaccines were approved by the Ontario Ministry of Health to provide both influenza and COVID-19 vaccine. Thirty-six pharmacies that were approved to provide influenza did not apply to administer COVID-19 vaccine.
Participating pharmacists may only administer publicly funded influenza vaccine to individuals 2 years of age and older. While pharmacists can administer COVID-19 vaccine for individuals 6 months and older, they generally administer COVID-19 vaccine to individuals 2 years and older.

In preparation for, and over the course of the respiratory virus season, the WECHU maintains ongoing communication with all health care providers and pharmacies and relays information about the timelines for vaccine availability. Tailored information packages including vaccine product information, ordering information, and promotional materials are also compiled and distributed to providers by the WECHU each influenza season.

Community immunization providers are encouraged to help increase access and uptake of influenza and COVID-19 vaccines by offering co-administration of COVID-19 and influenza vaccine. To support widespread availability of both the influenza and COVID-19 vaccine in our community, the WECHU is working collaboratively with many community partners, including hospitals, operators of congregate living facilities, and primary care, to identify service gaps and opportunities to increase vaccine uptake. The WECHU will be supporting COVID-19 vaccine clinics, with a focus on prioritized populations and high-risk individuals; individuals attending these clinics will also have an opportunity to receive influenza vaccine at the same time.

The Ontario Ministry of Health has indicated that the timeline for the influenza and COVID-19 vaccine rollout will be aligned in the coming months. Initial inventory shipments are expected by the end of September/early October. The first allocation would target vaccine administration in hospitals, long-term care, and retirement homes. The second allocation would target high-risk groups for influenza and COVID- 19 related complications or hospitalization. The third allocation targets the entire population and is expected in November.

The WECHU will be running a communication campaign from October to December to raise awareness of the risks of contracting seasonal respiratory illnesses (e.g., influenza and COVID-19), and the importance of getting vaccinated, especially for individuals who are part of a high-risk group. Targeted, organic social media ads and print materials, and articles will be developed to communicate key messages.

Prepared By:

Chronic Disease and Injury Prevention Department

Date:

September 21, 2023

Subject:

Windsor-Essex Community Opioid and Substance Use Strategy Update

BACKGROUND

The Windsor-Essex Community Opioid and Substance Strategy (WECOSS) was established in 2018 by the Windsor-Essex County Health Unit (WECHU) to bring together leadership representatives from across the region to address increasing rates of opioid use and overdose. The WECOSS is a four-pillar approach that leverages the knowledge and resources of more than 40 agencies and individuals with lived experience to address the harms of substance use at the community level through Prevention and Education, Harm Reduction, Treatment and Recovery, and Enforcement and Justice interventions.

Since the Strategy began, an Annual Report has been released as part of the WECOSS’ commitment to information sharing. The purpose of each Annual Report is to highlight the work being done to address substance use in the community through the collaborative efforts of our WECOSS partners. In 2021, an evaluation of the WECOSS was conducted by engaging members and the public to assess the level of awareness and early impact of the WECOSS in the community. The findings from this evaluation were used to form recommendations as presented in the WECOSS Modernization (2021) to guide the pathway forward for the WECOSS, including highlighting priority areas, and emphasizing a collective impact approach.

CURRENT INITIATIVES

Each of the four WECOSS pillars develops and implements at least one project per year, which are outlined in Annual Reports. In 2022, the development of these projects were guided by the six priority areas for focus and action. Future initiatives will continue to address and expand upon these priorities as the Strategy evolves.

The Addressing Substance Use in Corrections Reintegration Supports project was a key initiative undertaken in 2022 by the Enforcement and Justice Working Group. This involved collaborating with the South West Detention Centre, Windsor Probation and Parole, and the Canadian Mental Health Association Windsor-Essex County Branch. The goal of the project was to improve access to substance use and harm reduction supports and services for justice-involved individuals who had a history of problematic  substance use.

Through this project, 179 individuals were engaged, 138 of which were justice-involved individuals and 41 of which were justice system staff. This highlighted that justice-involved individuals released from custody required more knowledge and information in six (6) key areas:

• Housing support;
• Job skills or help getting a job;
• Community support groups;
• Help with obtaining identification;
• Referral to mental health and substance use services;
• Referral to withdrawal management or treatment for substance use

Additionally, justice-involved individuals expressed that their preferred methods for obtaining this information included one-on-one discussions with staff at intake, appointments, or during education sessions.

FUTURE PLANS

The findings from Addressing Substance Use in Corrections Reintegration Supports project resulted in the development of a wallet card resource containing information on more than 35 relevant supports and services. These will be distributed by various partners involved in the project and other relevant law enforcement partners to people involved with the justice system. There is also opportunity to work with partners to develop the necessary policies and procedures to facilitate discussions about relevant supports for successful reintegration. To support the educational needs of justice system staff, a hub of resources and educational materials was also compiled and will be made available through the WECOSS website.

Substance use supports and harm reduction approaches are critical for justice-involved individuals, especially during release from custody as this is when individuals are at an increased risk for drug-related deaths.¹ Additionally, addressing the basic needs of justice-involved individuals who use substances can aid in successful reintegration following incarceration.²

Subsequent work will focus on addressing barriers and building trust with people who use substances to enhance coordination between law enforcement and health services. To facilitate this, an online inventory of more than 200 local substance use, addictions, and mental health services will be designed through an ongoing WECOSS Treatment and Recovery Pillar Working Group project. The inventory will assist service providers in making referrals to relevant services for their clients.

References

1. Cooper, J. A., Onyeka, I., Cardwell, C., Paterson, E., Kirk, R., O’Reilly, D., & Donnelly, M. (2023). Record linkage studies of drug-related deaths among adults who were released from prison to the community: A scoping review. BMC Public Health, 23(1), 826. https://doi.org/10.1186/s12889-023-15673-0
2. McKiernan, A. (2017). Supporting reintegration in corrections by addressing problematic substance use: An environmental scan. Canadian Centre on Substance Use and Addiction. Retrieved from:   https://www.ccsa.ca/sites/default/files/2019-04/CCSA-Reintegration-Corr…- Environmental-Scan-2017-en.pdf
    

PREPARED BY:

Planning and Strategic Initiatives Department

DATE:

September 21, 2023

SUBJECT:

Annual Service Plan Q2 2023 Reporting

BACKGROUND/PURPOSE

In 2018, the Ontario Ministry of Health (MOH) introduced a new Annual Service Plan (ASP) that Health Units are required to submit each year. In order to ensure a single and integrated approach to planning the Planning and Strategic Initiatives (PSI) department worked with the Information Technology (IT) department to align our planning system with the provincial Ontario Public Health Standards requirements.

CURRENT INITIATIVES

Q2 Intervention Work Plan Progress

Project Leads have provided individual progress reports for work plans in their programs for Q2, 2023. The 2023 Operational Plan Reporting – Q2 Status Report indicates that:

• For external client facing programs, there are 138 workplans in progress and 83% are on track.
• For internal organizational programs, there are 38 workplans in progress, 2 were completed, and 63% are on track.

Plan Development for 2024

Planning for 2024 began in July, 2023. Program descriptions, planned major activities, and priority population groups have been updated. Program leads have also begun to create their individual workplans with expected completion this Fall.

2023 Operational Plan Reporting 
Q2 STATUS REPORT

Reporting Structure

This report provides a status summary for intervention work plans (IWP) in the 2023 Annual Service Plan that were in progress during Q2 (April 1 to June 20).

The project lead for each active IWP was asked to provide a progress report on their work. The status updates consisted of the following categories:

• On Target (the intervention is progressing at the planned pace)
• Variance (the intervention is behind the planned pace)
• Complete (the intervention has been completed)
• Deferred (current work on the intervention has been stopped – with potential to continue next year)
• Cancelled (the intervention will no longer occur)

If the intervention was identified as ‘Variance’, ‘Deferred’, or ‘Cancelled’, a reason was provided. In these cases, the most relevant reason was selected from the following list:

• Adjusted Program Priorities (program priority alterations resulted in changes to the IWP)
• Human Resource Issue (staffing circumstances resulted in changes to the IWP)
• Partnership Limitations (external partner(s) did not to meet their obligations)
• Public Health Emergency (a significant emergency resulted in changes to the IWP)
• Internal Resource Limitation (financial, material, or internal support limitations resulted in changes to the IWP)
• External Resource Limitation (External financial, material, or internal support limitations occurred with partnerships, collaborations, funding, or regulations)

It is important to note that reporting reflects a summary of progress made on interventions based on the predetermined milestones for the intervention. This does not necessarily represent the amount or scope of work captured under each program.

Operational Plan Status Summary

Part 1: External Community Facing Programs

Overall Quarterly Status Summary

There were 138 external interventions in progress in Q2 2023, and 115 (83%) of the interventions were on target.

Figure 1 displays the percentage of interventions that were on target, reported a variance, deferred, cancelled, or were completed.

Board Members Present:

Renaldo Agostino, Joe Bachetti, Fabio Costante, Fred Francis, Michael Horrobin, Judy Lund, Angelo Marignani, Michael Prue, Rob Shepley

Board Member Regrets:

Hilda MacDonald, Robert Maich

Administration Present:

Dr. Ken Blanchette, Dr. Mehdi Aloosh, Kristy McBeth, Eric Nadalin, Dan Sibley, Linda Watson, Lee Anne Damphouse

WECHU Guests:

Joanne Hegazi, Manager, Healthy Schools   
Marc Frey, Manager Planning & Strategic Initiatives

RECORDING SECRETARY: L. Damphouse

SUBMITTED BY: K. Blanchette

APPROVED BY: WECHU BOH – November 20, 2023

ISSUE/PURPOSE

Human Papillomavirus (HPV) is a very common virus that can cause many types of cancers. HPV can infect both males and females. Without immunization, approximately 3 out of 4 people will have at least one HPV infection in their lifetime 2. The Ontario government covers the cost of the HPV vaccination series for students in Grade 7-12 through the school-based immunization program.  The WECHU offers this vaccine to all grade 7 students in Windsor and Essex County schools each year. In Ontario, this vaccine is also available for free to men who have sex with men, individuals who identify as gay or bisexual, and some people who identify as transgender, up to the age of 26. For individuals not meeting these criteria, the vaccine can be purchased privately with a prescription. The HPV-9 vaccine currently used in the province is approximately $645 for a complete series ($215/dose)[i]. This cost may be covered through some private insurance plans, but would be considered prohibitive for many individuals considering vaccination.

Each year 3,800 new cancer cases in Canada are attributed to HPV; by 2042, this number will increase to 6,600[ii]. HPV infection increases the risk of developing six different types of cancer. Cervical cancer is almost exclusively caused by HPV and is the leading cause of most oropharyngeal cancers. It usually takes years after being infected with HPV for oropharyngeal cancer to develop, and not all oropharyngeal cancers are caused by HPV. While population-level Ontario data on the incidence of oropharyngeal cancers caused by HPV has only just begun to be collected, research has shown that the incidence of oropharyngeal cancers caused by HPV has increased in Canada since 2000. [iii] [iv]

As a part of an equity-based initiative, all strategies to reduce cervical and other cancers must consider health disparities and minimize existing barriers, such as cost, to be effective. The 2019–2029 Canadian Strategy for Cancer Control and the Action Plan for the Elimination of Cervical Cancer in Canada, 2020-2030 address the health inequities and barriers in accessing preventative care such as HPV vaccination that are experienced by rural and remote communities, people with low income, recent immigrants, First Nations, Inuit and Métis and other populations, such as LGBTQ2S+ individuals. 

The HPV vaccine product currently used in Ontario as a part of the publicly funded vaccine program, is authorized for use by the manufacturer in males and females aged 9 to 45 years old. The National Advisory Committee on Immunization (NACI) recommends this vaccine for all individuals between the ages of 9 to  26. According to Health Canada, HPV vaccination is recommended for females aged 9 to 45 and for males aged 9 to 26. For best protection from the vaccine, it should be administered before an individual becomes sexually active.

The current provincially funded vaccination schedule provides limited access to this free of charge important vaccine,  and creates a missed opportunity for an important preventative, protective, and evidence based public health strategy. 

BACKGROUND

HPV infection does not often show symptoms and can be spread easily by intimate skin to skin contact. In some cases, symptomatic HPV infections may even clear up on their own without treatment over time. Some infections cease to disappear and can lead to cancer. Certain high-risk HPV strains (i.e., types) can cause cervical cancer and are often associated with cancers of the penis, anus, vulva, vagina, mouth, and throat. Certain low-risk strains can cause warts. The virus can be passed from an infected mother to baby before and during birth. Newborns with HPV are at risk of developing respiratory papillomatosis. 

The current HPV vaccine used in Ontario can protect against nine strains of HPV infection. Vaccination works best when it is received prior to exposure to HPV and will not protect against existing HPV infections or HPV strains not included in the vaccine. Additional prevention activities for women include receiving regular Pap tests (the current recommendation in Ontario is a Pap test every 3 years[v]), even after receiving HPV vaccine. Since 2007, 99 countries and territories have developed comprehensive human papillomavirus vaccination programs. In 2019, a Canadian study demonstrated strong evidence that HPV vaccination prevents infections, genital and anal warts, and precancerous lesions at a population level. The impacts were seen in both females and males. [vi]

The best way to prevent HPV is getting the HPV vaccine. Not only is immunization the best preventative strategy, it’s also cost effective. In a recent study, it was found that the Return on Investment for HPV vaccination was consistently above 1 (range: 1.4–3.58), which means for every dollar spent on HPV vaccination up to 3.58 dollars are saved.[vii]

PROPOSED MOTION

Whereas, the NACI recommends HPV vaccination in all individuals ages 9 to 26, inclusively, and 

Whereas, the Government of Canada’s HPV vaccination rate coverage target of 90% is based on disease reduction targets, program impact, disease characteristics, achievability, and jurisdictional variation in vaccination programs, as well as quality and effectiveness of the vaccine, and

Whereas, HPV vaccination is an evidence informed, cost-effective strategy to reduce related cancer risks, and

Whereas, the HPV vaccine is a critical component of the Action Plan for the Elimination of Cervical Cancer in Canada, 2020-2030 which aims to eliminate cervical cancer by 2040, and

Whereas, the WECHU’s current HPV vaccination coverage rate for individuals 12-17 years old is 61.47%.

Therefore be it resolved that the Windsor-Essex County Board of Health recommends that the Province of Ontario extend the coverage for HPV vaccine through the publicly funded vaccine schedule to include all individuals up to the age of 26 (at minimum), and to eligible individuals from all high-risk populations (age limit based on product monograph). 

Further that the Windsor-Essex County Board of Health recommends local health care providers in Windsor and Essex County engage all clients under the age of 45 and parents/guardians of children in grades 6-12 to discuss: HPV vaccine status, review the benefits of HPV vaccination, and discuss options for those eligible and unvaccinated/undervaccinated.

PREPARED BY:

Environmental Health

DATE:

June 15, 2023

SUBJECT:

Food Handler Training

BACKGROUND/PURPOSE

The Ontario Food Premises Regulation 493/17 requires all operators of food premises to ensure that there is at least one food handler or supervisor onsite who has completed food handler training during every hour in which the premises is operating. Food handler training and certification must be obtained from an Ontario public health unit or another provider that is recognized by the Ontario Ministry of Health, and in accordance with the requirements outlined in the Food Safety Protocol, 2019  and the Operational Approaches for Food Safety Guideline, 2019.

The number of infractions in which a certified food handler was not onsite, in the most two years, during a public health inspection in Windsor and Essex County (WEC) is summarized in the table below.

The Environmental Health (EH) department offers a free online Food Handler course, in English, French, Spanish, Chinese and Arabic languages. There is also a Food Handler manual providing course material to help individuals prepare for the exam. The manual is available to in English and French that individuals can purchased for $10 and can be picked up at one of the Windsor-Essex County Health Unit offices.

In-person certification exams are made available throughout WEC, in multiple languages, for a $10 fee. Individuals must register online to book their exam. A certification card is issued when a grade of 70 percent or higher is achieved and is valid for five years. This year WECHU has offered 28 exam sessions to date. An emerging challenge that the WECHU has identified are individuals registering to attend for examination, fulfilling one of the open spots, and not attending (average actual attendance is 72% of the available space). Based on this recent trend, we have adjusted exam registration capacity to ensure the classes are full at all times. We are also exploring opportunities to utilize larger spaces to accommodate more individuals at a time, that can be efficiently proctored with an efficient writer to proctor ratio.

DISCUSSION

In the fall, Public Health Inspectors (PHIs) will begin issuing fines to food premises operators who are non-compliant with the O. Reg. 493/17 requirement to have at least one certified food handler onsite during every hour in which the premise is operating. In accordance with  (items 248 and 249) of the Provincial Offenses Act, charges will be issued for the total amount of $385 ($305 set fine, plus $75 victim fine surcharge and $5 fee) Schedule 41 Ontario Provincial Penalties  O. Reg. 161/00: VICTIM FINE SURCHARGES under Provincial Offences Act, R.S.O. 1990, c. P.33. In the months leading to this deadline, operators will be provided with education and appropriate notice of this upcoming enforcement action. The EH department will continue increase the number of exam dates available throughout WEC locations to satisfy any additional demand that arises. 

PREPARED BY:

Infectious Disease Prevention (IDP)

DATE:

June 15, 2023

SUBJECT:

Sexual Health Campaigns in IDP

BACKGROUND/PURPOSE

Syphilis is a sexually transmitted and blood-borne infection (STBBI) of public health significance. Although syphilis is largely preventable, data for these infections in Windsor and Essex County (WEC) is showing cause for concern. Syphilis cases are steadily increasing. Over the past 5 years, the WEC crude incidence rate of syphilis (infectious, latent, and other) increased from 13.52 cases/100,000 population in 2018 to 17.37 cases/100,000 population in 2022. This is an increase of 28.55%. In comparison to provincial rates, the crude incidence rate of syphilis (infectious, latent, and other) in Ontario increased from 20.02 cases/100,000 population in 2018 to 35.51 cases/100,000 population in 2022, which is an increase of 77.37%. Congenital syphilis, the transmission of syphilis to a baby during pregnancy or childbirth, has also become increasingly more prevalent in Canada in recent years. (Public Health Agency of Canada, 2021). Locally, three congenital syphilis cases have been reported in WEC.

Most syphilis cases have been found in men, although women are also at risk. Of the 396 cases of syphilis that occurred in WEC from 2018-2022:

• 80.30% were male, 19.19% were female, and 0.51% were transgender;
• Age ranged from 18 to 75 years, with a median age of 39 years; and
• 4.55% of syphilis cases were co-infected with HIV based on iPHIS risk factors.

Risk factors for syphilis include: unprotected sexual activity (especially in men who have sex with men), sexual contact with an identified case of syphilis, sexual contact with an individual from a jurisdiction with an elevated prevalence of syphilis, previously tested positive for syphilis, HIV, or other sexually transmitted bloodborne infections, born to an individual who tested positive for syphilis during pregnancy, and being classified as a member of a vulnerable population engaging in unprotected sex (vaginal, anal, and oral), men having sex with men, and having sex with anonymous and/or multiple partners (Public Health Agency of Canada, 2021). This increasing trend of engaging in anonymous sex with partners found on the internet has created challenges in being able to notify contacts of exposure.

CURRENT INITIATIVES

Public health campaigns play a strategic role in society by raising awareness of important health issues and encouraging groups and individuals to seek information and services. With increased prevalence of syphilis and other sexually transmitted infections, like MPox (previously known as Monkeypox), IDP is developing a sexual health strategy that include various initiatives and platforms to address the issue.

The strategy aims to reach the broader community with an emphasis on reducing stigma, prevention, increasing public knowledge about syphilis, encourage individuals to get tested and know that it can be treated with antibiotics. Recognizing that June is Pride Month, IDP will be kicking off a MPox advertisement (ad) in the Summer Issue for Windsor Life Magazine (see Appendix A). Social media posts on WECHU’s Facebook and Instagram platforms will also push out critical messages about virus transmission, symptoms, testing, and vaccine availability that align with Public Health Ontario’s initiatives, alongside the Gay Mens Sexual Health Alliance. These efforts directly contribute to getting community members vaccinated and helping people access reliable and trustworthy information. The MPox ad will also be published in the 2023 Come OUT & Play Guide to support our local Windsor-Essex Pride Fest, which IDP will partake in as a vendor in August 2023. MPox vaccines, along with sexual health education, will be available at the event.

Moreover, IDP has collaborated with the Healthy Schools department and Merck to organize a Healthcare Provider Breakfast event that will be held on June 15, 2023. Dr. Mehdi Aloosh and Dr. Shanker Nesathurai will be shedding light on the increasing syphilis numbers in WEC. Kim Kirkpatrick, a Nurse Practitioner from Sexual Health Windsor, will also be presenting about the recent syphilis trends and resources available in the community in relation to syphilis. One of the objectives of the event is to emphasize the importance of testing and treating syphilis in the community. Aligning with the Healthcare Provider Breakfast event, a syphilis ad is also underway that focuses on removing the stigma from sexual health and promoting STI testing in the community. The syphilis ad will be included in the July/August issue of the Biz X Magazine, and social media posts will parallel this initiative. The campaigns are carefully crafted to address the demographic changes in WEC in relation to sexual health.

References

Public Health Agency of Canada. (2021, 11). Infectious syphilis and congenital syphilis in Canada, 2020. 2021. Retrieved from https://www.canada.ca/en/public-health/services/publications/diseases-c…

Appendix A
MPox Advertisement

PREPARED BY:

Chronic Disease & Injury Prevention

DATE:

June 15, 2023

SUBJECT:

May 2023 – Monthly SafePoint Site Operations Update

BACKGROUND/PURPOSE

Overview

• SafePoint officially opened on Wednesday, April 26th, 2023, serving clients 7 days per week between the hours of 10:00 a.m. – 6:00 p.m.
• As part of the Resolution passed at the City of Windsor Council meeting on February 3rd, 2023, the Board of Health committed to providing updates, at regular intervals, about the ongoing operations at SafePoint to the City of Windsor.

Application Status

• Currently, as of May 31st, the respective applications to Health Canada and the Ministry of Health for the Consumption and Treatment Services (CTS) site remain under review.

CURRENT INITIATIVES

Operational Data

Since SafePoint opened on April 26th, there have been 74 client visits amongst 32 unique clients, with no overdoses reported on-site to date. Additional details about the clients served and services provided at SafePoint during the month of May are presented in Tables 1-3.

Client Experience Narrative

Beyond the number of client visits recorded in the month of May, SafePoint continues to demonstrate that the services being offered are having a positive impact on clients, as highlighted through the following narrative:

Anonymous Client #1

A client initially visited SafePoint for the first time in May for issues related to substance use, which impacted the relationship with their family. They returned to visit the site a few times per week to express their gratitude for the support they received from the SafePoint staff. The client recently informed staff that they had not used substances for more than a week due to the care they received at SafePoint. They have since been able to reconnect with their child.

FUTURE PLANS

• Since opening at the end of April, public open house tours continue to be offered every Friday from 8:30 a.m. – 9:30 a.m. as part of the commitment to community engagement.
• In this time, there have been 4 facilitated tours, with a total of 21 visitors. This included some people from the general public as well as community agencies who have brought their clients to visit the facility and provide feedback.
• The WECHU and HDGH staff are continuing efforts to raise awareness about the services being offered at SafePoint as well as engaging with service providers to reach potential clients. SafePoint staff attended the SouthWest Detention Center’s Health Fair on June 1 to provide information to justice-involved individuals about the programs and services being available at SafePoint.

PREPARED BY:

Communications Department

DATE:

June 15, 2023

SUBJECT:

April 15, 2023 – May 14, 2023, Communications Update

BACKGROUND/PURPOSE:

Provide regular marketing and communication updates to the Board of Health.

Data Notes can be provided upon request

Media Exposure Overview Graph

Notes: During the time frame of April 15 – May 14, we experienced three peaks in media exposure:

Wednesday, April 19 – We issued a Media Advisory and hosted a media event at SafePoint, where the official launch date was announced. This resulted in a total of 29 news stories.

Friday, April 21 – We issued a news release announcing the hiring of the new Acting Medical Officer of Health, which resulted in 11 news stories.

Friday, April 28 – We issued a news release announcing COVID-19 policy updates for staff and clients (e.g., removal of masking requirements and active symptom screening). This resulted in a total of 13 news stories.

Website Overview Graph

Notes: During the time frame of April 15 – May 14, website visitor traffic remained consistent when compared to the previous March 18 to April 14 timeframe.

Social Media Overview Graph

Note: On April 20, 2023, Twitter removed the Blue Verification Checkmark from user profiles and introduced a tiered system which involved payment for various types of verification. This resulted in many users leaving the platform, which may account for the change in our followers. The WECHU applied for a grey checkmark which denotes a verified government agency, which is now displayed on our account.

DISCUSSION

The Communications Department worked closely with the Chronic Disease & Injury Prevention team to announce the opening of SafePoint, which included planning a media event and a series of public open houses.

A Media Advisory was issued on Tuesday April 18, inviting the media to an on-site event on Wednesday April 19. The media event was attended by representatives from all six of the major local news outlets, and yieled 29 news stories which highlighted the public open houses as well as the official first date of service. The WECHU also issued a News Release to the General Subscribers list in MailChimp to notify the public of the open house sessions.

To further communicate the public open houses, two social media posts were issued on the WECHU’s Facebook and Twitter platforms, using a poster designed by the Communications Department Graphic Designer.

PREPARED BY:

Healthy Schools Department

DATE:

June 15, 2023

SUBJECT:

Update on Healthy Eating/Food Literacy Activities in WEC Schools

BACKGROUND/PURPOSE

Directed by the Ontario Public Health Standard’s School Health Guideline (2018), the mandate of the WECHU Healthy Schools team is to improve the health and well-being of school-aged children and their families across Windsor and Essex County. The WECHU works with schools to support the implementation of the Health and Physical Education Curriculum and the adoption of programs, practices, and policies that enable students to practice making healthy choices. To ensure that programming meets the needs of school communities and builds on identified strengths, the WECHU consults and collaborates with students, parents, teachers, principals, school administrators, and school boards.

There are 168 local schools supported by the Healthy Schools team. Using a health equity approach to target the most vulnerable children and families, our program uses a two-pronged approach to service delivery: targeted and universal. In our targeted program, schools identified as higher needs are assigned a nurse who they can connect with directly. In our universal program, lower-needs schools can contact the Healthy Schools Program by phone or email for support. All schools are provided with WECHU-developed resources throughout the school year, which are also accessible from our WECHU School Health webpage.

Schools that identify healthy eating or food access as a priority during our annual school needs assessment, work School Health staff to create a targeted School Health Action Plan for support. The Action Plans are developed using the principles of Ontario’s Foundations for a Healthy School. Food literacy was introduced into Ontario’s Science and Technology Curriculum in 2022. As a result, our programs are being reviewed and developed in support of the new curriculum elements.

CURRENT INITATIVES

Supporting the Ontario Student Nutrition Program in Windsor and Essex County Schools

The Ontario Student Nutrition Program- Southwest Region (OSNP-SW) is a meal and snack program designed to ensure children have access to healthy food and beverages throughout the school day. The program is housed within the Victoria Order of Nurses (CON) Windsor-Essex site. These programs are run locally by students, parents, and volunteers, and are funded through multiple sources including provincial funding, grants, and local community groups, organizations, and fundraising. In the 2022/23 school year, 93 schools in Windsor-Essex enrolled in the OSNP, reaching approximately 29,000 students. The WECHU supports the OSNP locally by advocating for and supporting new schools to enter the program.

“You’re the Chef” Food Skills Program Training

You’re the Chef (YTC) is a food skills program that educators or volunteers can provide to students after being trained by a WECHU Registered Dietitian. Two sessions of You’re the Chef (YTC) Training were offered in March 2023 following requests from three schools. Interested schools who are identified as higher need, but lack sufficient funds to run this program, are granted start-up funds from the WECHU after training to purchase food or supplies. Trained schools can borrow YTC kits from the WECHU that contain kitchen equipment, and all certified instructors are given access to the YTC online portal for continued support.

Food Neutral Toolkit

The WECHU is in the process of creating a Food Neutral Toolkit for administrators and educators to understand the food neutrality approach and to implement it in their schools and classrooms. This new approach will create a supportive, positive eating and learning environment. The toolkit will be piloted in selected higher needs schools this fall, and then revised and released to all schools in March 2024 for Nutrition Month.

Board Members Present:

Renaldo Agostino, Joe Bachetti, Fabio Costante, Fred Francis, Judy Lund, Hilda MacDonald, Michael Prue, Rob Shepley

Board Member Regrets:

Robert Maich, Angelo Marignani

Administration Present:

Dr. Ken Blanchette, Dr. Mehdi Aloosh, Dr. Shanker Nesathurai (virtual), Lorie Gregg, Kristy McBeth, Eric Nadalin, Dan Sibley, Linda Watson, Lee Anne Damphouse

WECHU Guests:

Michael Janisse, Manager, Communications

RECORDING SECRETARY: L. Damphouse

SUBMITTED BY: K. Blanchette

APPROVED BY: WECHU BOH - September 21, 2023

2023 Workplan and Meeting Schedule

2024 Workplan and Meeting Schedule

No scheduled board meeting

ISSUE/PURPOSE

Approval of the annual audited financial statements.  This includes:

• The annual audited financial statements for the Windsor-Essex County Health Unit for the year-ended December 31, 2022 (Appendix A)
• The annual audited financial statements for the Windsor-Essex County Health Unit Ministry of Children, Community and Social Services Program Initiatives for the year-ended March 31, 2023 (Appendix B)

(Hereinafter referred to collectively as “the annual financial statements”).

BACKGROUND

Paragraph 59(2) of the Health Protection and Promotion Act R.S.O. 1990 states that “A board of health shall cause to be prepared statements of its financial affairs in each year including but not limited to, (a) an annual statement of income and expenses; (b) an annual statement of assets and liabilities; (c) an annual estimate of expenses for the year.”

The annual financial statements are audited by KPMG LLP, independent external auditors appointed by the Corporation of the City of Windsor.  On June 8, 2023, the Audit Committee of the Windsor-Essex County Board of Health (Audit Committee) convened to review the annual financial statements and audit findings report with Administration and KPMG LLP.  The Audit Committee has recommended the financial statements for approval to the Board of Health (Board). KPMG LLP is prepared to issue, pending approval by the Board, an unmodified audit opinion on the annual financial statements. 

Windsor-Essex County Health Unit (WECHU)

The enclosed is a summary analytical review addressing material changes in the annual audited financial statement captions year-over-year.

Statement of Financial Position

• Cash and short-term investments decreased 7,926,699.  Refer to the Statement of Cash Flows for details.
• Accounts receivable increased $2,546,835 primarily due to the following:  a) Increase in amounts receivable from the Province of Ontario of $2,188,711 over 2021.  This increase relates to an augment in funding approvals on account of COVID-19 General ($1,627,499) and COVID-19 Vaccination ($480,800) based upon Q2 2022 financial reporting.  b)  Increase in other receivables of $308,864.  The increase related to an amount receivable from the County of Essex of $264,704 for 2022 contributions, and $14,840 for interest receivable from the WECHU’s financial institution on account of our average outstanding cash balances for December 2022.
• Due to Province of Ontario decreased $2,676,659.  This balance is comprised of:

Of noteworthy mention is the following:

• In the period January to March of 2023, $882,238 was clawed back by the Ministry of Health (MOH) on account of the 2022 settlement.  The remaining, will be clawed back upon completion of the settlement review.
• A proportion of the 2021 Settlement was clawed back in advance of the MOH’s final review being completed.  The total amount of the claw back was $2,409,783.
• Completion of the 2019 and 2020 settlement reviews resulting in a claw back of settlements of $508,636 and $1,398,669 respectively. 
• Due to Municipalities decreased $1,798,243.  This balance is comprised of:

** The 2022 Budget contemplated a two (2) percent increase in the funding from the MOH.  The actual 2022 funding approval from the MOH was only one (1) percent.

The following amounts were paid to the Obligated Municipalities in 2022:

• The 2021 Settlement relating to the 2021 Cost-Sharing Mitigation Funding of $1,260,800;
• The 2020 Settlement of $337,007;
• The 2019 Settlement of $1,286,730.
• Trade accounts payable decreased $215,336.  Changes in this financial caption varies on an annual basis due to the timing of vendor invoicing.  The 2021 balance included an amount outstanding to OMERS on account of December 2021 contributions of $273,201.  
• Accrued payroll and deductions decreased $228,521.  On December 31, 2021, $107,577 was outstanding to employees represented by the Ontario Nurses Association on account of retroactive compensation increases for the collective bargaining agreement that expired April 1, 2021.  In addition, liabilities were recognized on account of certain labour related matters that arose in 2021 but were settled in 2022 of $191,497. 
• Deferred revenue decreased $441,844.  Fluctuations in deferred revenue year-over-year typically relate to the nature and timing of grant funding.  The decrease is primarily attributed to School-Focused Nurses funding.  At December 31, 2021, deferred revenue attributed to this grant funding amounted to $439,134 compared to $14,078 at December 31, 2022. 
• Tangible capital assets increased $3,160,779.  The net increase is attributed to:  i) Tangible capital asset additions of $3,442,533; ii) Amortization expense of $281,754.  Of the tangible capital assets acquired in the year, $3,431,595 were funded by the Ministry of Health using Mandatory Program funding (70%), and $10,938 were funded using Ontario Seniors Dental Care Program funding (100%). Refer to note 9 for additional details.
• Prepaid expenses decreased $76,253.  The decrease in this financial caption is primarily attributed to the timing of the payment of licenses for the WECHU’s document management licenses (M-files).  For the year-ended December 31, 2021, M-files licences for 2022, amounting to $99,616 were prepaid in advance of year-end.  M-files licenses for 2023, amounting to $99,616 were paid after the December 31, 2022, year-end.

Statement of Operations and Accumulated Deficit:

• Increase in Revenue from the Province of Ontario of $530,021.  The increase is attributed to the following:
  • Increase in approved base funding for Mandatory Health Programs Funding in the amount of $116,432 or one (1) percent for the period April 1, 2022 to December 31, 2022.
  • Increase in approved base funding for Ontario Seniors Dental Care Program (OSDCP) in the amount of $530,025 for the period April 1, 2022 to December 31, 2022.  Actual revenue earned for 2022 amounted to $1,936,350 based upon total admissible expenses, representing a $261,650 increase from 2021.   
  • Increase in One-time funding of $151,939. This is attributed to:  a) COVID-19 Vaccination Program funding in the amount of $4,051,134; b) COVID-19 General Program funding in the amount of $895,410; c) School-Focused Nurses Initiative funding in the amount of $1,857,824; d) Temporary Retention Incentive for Nurses funding in the amount of $603,013;  e) Mitigation funding in the amount of $1,260,800; f)  Public Health Inspector Practicum Funding in the amount of $40,000.
• Increase in Other Revenue of $595,945.  The increase is attributed to the following:
  • Increase in Interest income in the amount to $75,910 as interest rates were higher than 2021.
  • Increase in Miscellaneous in the amount of $119,702.  This increase is primarily attributed to the recovery of building occupancy costs from the OSDCP in the amount of $120,630.
  • Increase on Other grants in the amount of $299,678.  This increase is primarily attributed to the timeframe surrounding the IPAC Hub funding.  IPAC Hub funding commenced in October of 2021 and continued for the entirety of 2022.
  • Increase in Vaccine reimbursement in the amount of $93,606 (ISPA).  Total number of vaccinations given in 2022 were 15,329 as compared to 5,013 in 2021.

The Ministry of Health funds the WECHU to a maximum of 70% of admissible expenditures.  Admissible expenditures for the purposes of the Ministry of Health Settlement Process is defined below:

• Decrease in Expenses of $3,328,290.  Notable decreases include:
  • Decrease in Salaries and Benefits in the amount of $2,774,735.  Notable decreases from 2022 include:
    • Decrease in FTEs year-over-year.  On January 1, 2022, total FTEs amounted to 299.  On December 31, 2022, total FTEs amounted to 283.
    • Total payments on account of overtime, and retroactive payments for the 2021 fiscal year amounted to $1,314,435.  Overtime and retroactive payments for the 2022 fiscal year amounted to $329,346.
  • Increase in Legal, Audit and Consulting in the amount of $516,416. Notable increases from the prior year include:
    • Increase in legal of $221,521 over 2021 including the following:  i)In 2022, $24,118 was expended on legal advice for the review of the Consolidated Bi-Laws of the Board of Health for the WECHU and other legal matters involving the WECHU’s responsibilities under the Health Protection and Promotion Act (HPPA).  ii) In 2022, $10,461 was expended on legal advise pertaining to the recruitment of a Medical Officer of Health (relating to immigration and licensing).  iii) In 2022, increase in legal fees paid on account of general corporate matters and certain labour related matters in the amount of $173,665. 
    • Increase in consulting of $210,452 over 2021 including the following:  i) Increase in amounts paid to the Acting Medical Officer of Health on account of professional services rendered over 2021 of $198,407 (2022 – 12 months; 2021 – 4 months).  ii)  In 2022, the WECHU contracted an Acting Chief Executive Officer (CEO) while recruitment was underway for a permanent CEO.  The total amount paid on account of those professional services was $12,044 (approximately 6 weeks).
  • Decrease in Purchased Services in the amount of $1,244,910. Notable decreases from prior year include:
    • $192,677 was expended in 2021 for augmented vaccination support for the COVID-19 Vaccination clinics. 
    • $330,350 was expended in 2021 for augmented temporary support staff for call centre activities relating to COVID-19.
    • $686,498 was expended in 2021 for augmented case and contract management support.

Windsor-Essex County Health Unit Ministry of Children, Community and Social Services Program Initiatives

The annual audited financial statements for the Windsor-Essex County Health Unit Ministry of Children, Community and Social Services Program Initiatives include financial information for the Nurse Practitioner Program and the Healthy Babies Healthy Children Program for the period April 1, 2022 to March 31, 2023.

The enclosed summary analytical review addresses material changes in financial statement captions year-over-year.

Statement of Financial Position:

• Due from the Windsor-Essex County Health Unit:  Refer to the statement of cash flow for details on the decrease of $304,599 from March 31, 2022.
• Due to Ministry of Children, Community and Social Services:  The amount outstanding is as follows:
  • Settlement for the year-ended March 31, 2023, in the amount of $266,688;
  • Settlement for the year-ended March 31, 2022, in the amount of $734,310.  This settlement will be clawed back in fiscal 2023/2024.

Statement of Operations and Accumulated Deficit:

• Salaries and benefits increased $476,268 from the comparative period, April 1, 2021 to March 31, 2022.  In the comparative period, substantial nursing resources were deployed to support COVID-19 pandemic-related activities.  This continued until July of 2022, when these staff were returned to the Healthy Babies Healthy Children Program.  
• Mileage increased $19,190 compared to the fiscal year ended March 31, 2022.   This increase is consistent with the return of nursing resources to the Healthy Babies Healthy Children Program in July of 2022. 
• Program supplies decreased $30,961 compared to the fiscal year-ended March 31, 2022.  In the comparative period, the WECHU implemented an electronic information management system to support this Program of $35,361.  The cost was inclusive of implementation and licensing fees. 

A summary of the settlement with the Ministry of Children, Community and Social Services is as follows:

PROPOSED MOTION

Whereas, at the June 8, 2023, meeting, the Audit Committee of the Windsor-Essex County Board of Health reviewed the annual audited financial statements and recommended them to the Board for approval,

Now therefore be it resolved that the Windsor-Essex County Board of Health approve:

The annual audited financial statements of the Windsor-Essex County Health Unit for the year-ended December 31, 2022; and

The annual audited financial statements for the Windsor-Essex County Health Unit Ministry of Children, Community and Social Services Program Initiatives for the year-ended March 31, 2023.

ISSUE/PURPOSE

To ensure that should matters arise during months where the Windsor-Essex County Board of Health do not have a regularly scheduled meeting, that any required decision making can occur and to ensure that there are no interruptions in operations, projects or services.

PROPOSED MOTION

Whereas, Article 16, Execution of Documents, By-Law #1, Governance, articulates the delegation of responsibility to bind the Windsor-Essex County Health Unit (WECHU) for a particular agreement; and

Whereas, it is expedient for the Board of Health (BOH) to pass a resolution incorporating specific delegations of authority as permitted by Article 16;

1. The Board may at any time and from time to time direct the manner in which and the person or persons who may sign on behalf of the Board for a particular agreement.  More specifically:
   
   1. Agreements relating to the sale, acquisition, or lease of real property shall be signed by one of the Chair, Vice-Chair or Treasurer and the CEO or designate.
   2. Agreements relating to borrowing (By-law No. 2, Section 8:  Borrowing) shall be signed by one of the Chair, Vice-Chair or Treasurer and the CEO or designate.
   3. Agreements relating to the data sharing shall be signed by the MOH and the CEO or designate.
   4. All other agreements that are operational in nature shall be signed by the CEO or designate.

Now therefore be it resolved that the Windsor-Essex County Board of Health (BOH) delegate authority to the Joint Board Executive Committee (JBEC), which consists of the BOH Chair, the Vice-Chair and the Treasurer to act on behalf of the BOH and bind the Windsor-Essex County Health Unit (WECHU) on matters until such time as the BOH convenes at its next regularly scheduled meeting. If any such matters require discussion/approval by the BOH, an emergency ad-hoc meeting will be scheduled.

Please contact us if you require this in an alternate format.

PREPARED BY:

Chronic Disease and Injury Prevention (CDIP)

DATE:

May 18, 2023

SUBJECT:

First Responder Resilience Curriculum Project

BACKGROUND/PURPOSE

In 2016, the Workplace Safety & Insurance Act, Post-Traumatic Stress Disorder (1997) was amended by Bill 163, Supporting Ontario’s First Responders Act, Post-Traumatic Stress Disorder (2016), requiring employers of first responders' (FR) to develop and implement post-traumatic stress disorder prevention plans.

The Ministry of Labour then issued a call for proposals for the Occupational Health, Safety, and Prevention Innovation Program (OHSPIP) in 2017-2018. In response, the Windsor-Essex County Health Unit (WECHU) worked closely with local first responder organizations to submit a successful proposal outlining six project commitments. One key commitment involved working with St. Clair College to investigate the feasibility of developing a mental health educational module to support the resilience of first responders during their post-secondary training.

The first phase of the project was completed in December 2020 and involved a needs assessment to identify core mental health and resilience topics to embed within the existing college-based curriculum. Key informant interviews were conducted with 29 representatives from policing or law enforcement, fire and rescue, paramedic, and emergency healthcare. More than 30 post-secondary representatives and mental health providers were also consulted. The analysis highlighted the need to develop educational materials across four themes, which were: a) Resilience & Coping, b) Mental Health Literacy, c) Help Seeking and Intervention, and d) Role Preparation.

CURRENT INITIATIVES

In the Fall of 2021, The WECHU transitioned into the module content development and implementation phase of the project. A total of twenty lessons were developed for the four modules, which included the creation of powerpoint slide decks, case studies, lesson plans, various multimedia and interactive components, and activities. Throughout this project phase, key stakeholders were consulted regularly in the development and review of material. The four modules and the associated 20 lesson topics are presented in Table 1.

As of March 31st 2022, all module content has been shared with post-secondary stakeholders engaged in the project, including instructors and program administrators from St. Clair College and the University of Windsor. Selected content has been piloted in two post-secondary courses at St. Clair College and positive feedback was received from both instructors and students. The module content is currently at various states of review and implementation in local post-secondary first responder programs. The specific programs as well as the number of students typically enrolled are highlighted in Table 2.

FUTURE PLANS

The WECHU has completed its commitment as part of the Occupational Health, Safety, and Prevention Innovation Program (OHSPIP) project work. Some of the programs listed above have expressed intent for a formal incorporation of module content into their curriculum for upcoming curriculum review cycles. Additionally, there are more than 1,500 individuals are currently employed as municipal or provincial law enforcement officers, paramedics, and firefighters across Windsor-Essex County, and there has been expressed interest from local organizations to expand implementation to in-service voluntary firefighters. The WECHU will continue to remain informed about the implementation status for post-secondary instutitions and first responder organizations, impact of the modules on curriclum design, outcomes of assessment and evaluation initiatives, and impacts on students and working first responder professionals.

References

1. Ministry of Advanced Education and Skills Development College Enrolment Statistical Reporting system. (2022). College enrolment [Dataset]. Government of Ontario. https://data.ontario.ca/dataset/college-enrolment
2. University of Windsor (n.d.) Headcount | Office of Institutional Analysis. Retrieved March 17, 2023, from https://www.uwindsor.ca/institutional-analysis/307/headcount.

^[a] From available data for 2021/2022 and 2022/2023 academic years from referenced data sources.