Board of Health Meeting Documents

Board Members Present:

Joe Bachetti, Dr. Ken Blanchette, Mark Carrick, Dr. Deborah Kane, Judy Lund, Bill Marra, Gary McNamara, Dr. Carlin Miller, Hilary Payne, Gord Queen, John Scott, Michelle Watters​

Board Member Regrets:

Paul Borrelli, Richard Meloche, Ed Sleiman

Administration Present:

Theresa Marentette, Dr. Wajid Ahmed, Nicole Dupuis, Lorie Gregg, Kristy McBeth, Dan Sibley, Lee Anne Damphouse

WECHU Presenters: 

Eric Nadalin, Manager, CDIP

RECORDING SECRETARY:

SUBMITTED BY:

APPROVED BY:

Proposed Motion

Whereas, the federal government has passed the Cannabis Act, 2017 to legalize non-medical cannabis, coming into effect on October 17th, 2018, and

Whereas, the Ontario government has amended the provincial Cannabis Act, 2017 to permit a privatized retail model in Ontario, and

Whereas, cannabis smoke contains many of the same carcinogens, toxins, and irritants found in tobacco smoke with the added psychoactive properties of cannabinoids like THC, and

Whereas, increased density and clustering of cannabis retailers may result in increased access, consumption, and increased risk for chronic disease, mental illness, and injury, and

Whereas, Ontario municipalities will have the one-time opportunity to OPT OUT of cannabis retail outlets in their communities, and

Now therefore be it resolved that, the Windsor-Essex County Board of Health encourages all Windsor-Essex municipalities to OPT OUT of the cannabis retail model as proposed by the provincial government in their respective communities.

FURTHER that the Windsor-Essex County Board of Health encourages the provincial government to establish limits on the number of retailers in a geographic area to prevent clustering and reduce retail outlet density.

FURTHER that, the Windsor-Essex County Board of Health for the Windsor-Essex County Health Unit encourages provincial government to set additional regulations with respect to the proximity of retail outlets in relation to areas which may unfairly target vulnerable populations.

FURTHER that, the provincial government provide local public health units with dedicated funding for public education and health promotion activities as well as the enforcement of cannabis-related regulations under the Smoke-free Ontario Act and FURTHER that the Windsor-Essex County Board of Health for the Windsor-Essex County Health Unit encourages all Windsor-Essex municipalities to amend existing smoke-free by-laws to include “cannabis” in the definition, and expand spaces where the use of substances is prohibited (e.g., cannabis consumption venues or vape lounges).

FURTHER that, previous Resolutions passed by the Windsor-Essex County Board of Health are shared with the newly elected provincial government.

FURTHER that the Windsor-Essex Board of health suggests the province providing for the ability of municipalities to create licensing and zoning regulations, which would be reflective of the unique needs of individual communities in addition to increasing the number and distance of buffer zones proposed for retail outlets from vulnerable areas.

AND FURTHER that this resolution be shared with the Honorable Prime Minister of Canada, local Members of Parliament, the Premier of Ontario, local Members of Provincial Parliament, Minister of Health and Long-term Care, Federal Minister of Health, the Attorney General, Chief Medical Officer of Health, Association of Local Public Health Agencies, Ontario Boards of Health, Ontario Public Health Association, the Centre for Addiction and Mental Health, and local community partners.

Appendix

Municipal engagement activities to date

Proposed Motion

The WECHU Leadership Team recommends:

That the 2019 Cost Share Budget, as presented, requiring a 3.23 percent increase in funding from the Ministry of Health and Long-Term Care and a 5 percent increase in funding from the Obligated Municipalities, the Corporation of the City of Windsor, the Corporation of the County of Essex and the Corporation of the Township of Pelee, be approved.

That total Cost Shared expenditures net of offset revenue for 2019, in the amount of $19,902,586, be approved.

That total expenditures for 2019 relating to the Vector-Borne Disease program, in the amount of $350,000, be approved.

That total Healthy Babies Healthy Children Program Initiative expenditures, in the amount of $2,755,841, be approved.

That total Nurse Practitioner Program Initiative expenditures, in the amount of $146,617, be approved.

That total Related Program expenditures, in the amount of $3,469,870, be approved.

Prepared By:

Lorie Gregg, Director of Corporate Services

Date:

September 6, 2018

Subject:

Q2 Financial Results

Background

The Leadership Team of the Windsor-Essex County Health Unit (“the WECHU”) monitors financial results on an on-going basis for the following programs:

• Mandatory programs funded to a maximum of 75% (“Cost-Shared”) by the Ministry of Health and Long-Term Care (“MOHLTC”) and the Corporation of the City of Windsor, the Corporation of the County of Essex and the Corporation of the Township of Pelee (hereinafter referred to as the “Obligated Municipalities”);
• Related programs such as Vector-Borne Diseases and Small Drinking Water Systems, funded on a cost-shared basis to a maximum of 75% by the MOHLTC and certain surrounding municipalities within the geographic boundaries of Windsor and Essex County;
• Related programs funded 100% by the MOHLTC;
• Related programs funded 100% by the Ministry of Children and Youth Services (“MCYS”);
• One-time business cases.

The second quarter financial report to the Board includes a budget to actual comparison and narrative for material variances for all programs listed. Forecasted financial results will be presented as a part of the Q3 and Q4 reporting.

Cost-Shared Program Financial Results

The following is the financial information for the Cost-shared programs including Vector-Borne Diseases and Small Drinking Water Systems for the second quarter of 2018.

For the period January 1, 2018 to June 30, 2018, cash flows on account of the 2018 program year for this program are as follows:

For material variances where the financial captions percentage spent exceeds 50%, an explanation has been provided:

• Benefits: Expenditures in this financial caption relate to amounts paid/payable by the WECHU on account of medical, dental and extended health benefits as well as amounts paid on account of certain other payroll remittances (i.e. OMERS contributions, CPP, EI, EHT, WSIB). The dollar negative variance is not material and will be monitored over the remainder of the fiscal year with any remaining negative variances funded by the Salaries financial statement caption.
• Association and Membership Fees:  Expenditures in this financial caption relate to memberships in an association or other group by virtue of professional requirements or to support initiatives associated with Public Health.  The majority of Association and Membership Fees are paid earlier in the fiscal year.  For the remainder of the year, fees will be lower and thus tracking will be in line with budget as the year progresses.
• Publications:  Expenditures in this financial caption include costs of subscriptions.  The dollar value of this negative variance is not material and will be monitored and offset by other underutilized financial captions as the fiscal year progresses.
• Building Maintenance:   Expenditures in this financial caption relate to amounts paid on account of building maintenance, grounds keeping and house keeping supplies.  At June 30, 2018, the negative variance of $9,254 resulted from:  i) annual elevator maintenance fees for the period May 1, 2018 to April 30, 2019 of $8,546 were paid; ii) grounds keeping costs for snow removal are typically higher in the first half of the fiscal year compared to the latter half (3 months of service from January to March of 2018 compared to 2 months of service from November to December of 2018); iii) additional costs incurred on account of unplanned HVAC repairs.  
• Insurance:  Expenditures in this financial caption include costs associated with general liability insurance, property insurance, director and office insurance coverage as well as cyber coverage.   Insurance premiums are paid at the beginning of the year.  There will be no further insurance premiums in 2018 and this financial caption should remain underspent at year-end.

Risks:  Of noteworthy mention when considering the financial information above are the following:

• Status of collective bargaining agreements – Collective bargaining agreements with CUPE (contract expired December 31, 2017) and ONA (contract expired March 31, 2018) remain outstanding.  As such, the WECHU may be required, dependent upon the results of negotiations, to make retroactive payment for contractual increases not yet reflected in the year-to-date financial results disclosed above.
• Status of other labour related matters – Other labour related matters (i.e. pay equity; impacts associated with grievances) which remain unsettled, have not be reflected in the year-to-date financial results above given the uncertainty associated with the settlement of those matters.

Healthy Babies Healthy Children Program Financial Results

The Healthy Babies/Healthy Children Program is funded through the Ministry of Children and Youth Services.  This program supports 27.0 FTEs comprised of managers (2), nurses (17), family home visitors (4), social worker (1), and support staff (3).  The objective of the program is to ensure a healthy future for children and their families.

For the second quarter of 2018, the HBHC program is $92,277 underspent due in part to staffing vacancies associated with leaves of absence (i.e. maternity leaves, unpaid absences, etc.).  
Refer to the Risks discussion noted in the Cost-Shared Program Financial Results section of this report, as this would be relevant to this program.

Nurse Practitioner Program Financial Results

The Nurse Practitioner Program is funded through the Ministry of Children and Youth Services.  This program supports 1 FTE (nurse practitioner).  The objectives of the program are to promote healthy pregnancy, birth and infancy for children, improve parenting and family supports, strengthen early childhood development, learning and care.

The 2018 budget submission to the MCYS includes a one-time grant request for $5,210 representing the forecasted overage in Salaries and Benefits for the year-ending December 31, 2018.  As at the date of this report, our one-time funding request has not been approved.  The WECHU will continue to monitor this unfavourable variance and anticipate that it will ultimately be funded by the Cost-Shared Budget.

Financial Information for Related Programs Funded 100% by the MOHLTC

The 2018 Annual Service Plan and Budget Submission included a budget of $1,529,700 for Healthy Smiles Ontario (“HSO”), inclusive of the $120,900 augment approved by the MOHLTC on May 7th, 2018.

At June 30, 2018, the net underspent budget amounted to $79,974.  Material variances are detailed below:

• The base funding approval of $120,900 included an addition of 1 FTE (dental assistant) of $71,471 Salaries and benefits that the WECHU would not operationalize until such time as an approval was received.  The budget impact of this deferral resulted in an approximate underspend of $35,735. 
• In Q2 of 2018 additional Program Supplies costs of $16,425 were incurred on account equipment replacements.
• Purchased services were underspent at June 30, 2018, due to the following:  i) The May 7th, 2018 augment to base funding included additional funding for purchased services of $36,400 for contract dentistry.  The WECHU is currently in the process of completing the requisite policy work to procure the services of a contract pediatric dentist.  It is anticipated that this dentist will be in place by Q4 of 2018.  ii) The WECHU had only 2 contract dentists for Q1.  A third contact dentist was added in March of 2018 servicing our Leamington dental clinic; iii) Fees paid to contract dentists are typically one month behind.
• Offset revenue of $6,300 was earned in Q1 of 2018 on account of the sale of three autoclaves using a third party auction site as required by the WECHU policies and procedures for disposing of tangible capital assets.

Refer to the Risks discussion noted in the Cost-Shared Program Financial Results section of this report, as this would be relevant to this program.

Enclosed above is the financial information associated with the WECHU’s requirements to:

• Comply and adhere to the Electronic Cigarettes Act:  Public Health Unit Guidelines and Directives: Enforcement of the Electronic Cigarettes Act;
• Comply and adhere to the Smoke-Free Ontario Strategy:  Public Health Unit Tobacco Control Program Guidelines and the Directives:  Enforcement of the Smoke-Free Ontario Act. 

At June 30, 2018, the total unspent budget amounted to $17,135.  The most notable variance relates to the Professional Development financial caption.  In Q1 of 2018, an individual was sent to a non-violence conflict resolution train-the-trainer course amounting to $4,180.  The unfavourable budget variance in the Professional Development financial caption continues to be monitored with any remaining budget overage to be offset against the favourable variance Program Supplies financial caption.

Refer to the Risks discussion noted in the Cost-Shared Program Financial Results section of this report, as this would be relevant to this program.

A description of other related programs is included below:

Chief Nursing Officer Initiative:  Under the Organizational Requirements of the Ontario Public Health Standards, the Chief Nursing Officer role serves to enhance health outcomes of the community at individual, group and population levels:  i) Through contributions to organizational strategic planning and decision making; ii) By facilitating recruitment and retention of qualified, competent public health nursing staff; iii) By enabling quality public health nursing practice.  This funding envelope supports 1 FTE meeting certain qualifications as required by the Ontario Public Health Standards.  At June 30, 2018, there are no negative variances to report on.

Enhanced Food Safety – Haines Initiative:  Base funding for this initiative supports the enhancement of the Board of Health’s capacity to deliver the Food Safety Program as a result of the Provincial Government’s response to Justice Haines’ recommendations in his report “Farm to Fork:  A Strategy for Meat Safety in Ontario”.  At June 30, 2018, there are no negative variances to report on.  It is anticipated that these funds will be fully expended by Q4 of 2018.

Enhanced Safe Water:  Base funding for this initiative supports the enhancement of the Board of Health’s capacity to meet the requirements of the Safe Water Program Standard under the Ontario Public Health Standards.  At June 30, 2018, there are no negative variances to report on. It is anticipated that these funds will be fully expended by Q4 of 2018.

Harm Reduction Program Enhancement:  Base funding for this initiative supports the Board of Health in the activities associated with its Local Opioid Strategy.  More specifically it supports 2.5 FTEs dedicated to working on activities associated with:  i) Our local opioid response; ii) Naloxone Distribution and Training; iii) Opioid Overdose Early Warning and Surveillance.   At June 30, 2018, there are no negative variances to report on.

Infection Prevention Control Nurses Initiative:  Base funding for this initiative supports one additional infection prevention and control nursing FTE having certain qualifications.  At June 30, 2018, negative variances of $4,273 have resulted as salaries and benefits for this position have exceeded the approved funding.  Negative variances will be absorbed by the Cost-Shared Budget.

Infectious Disease Control Initiative:  Base funding for this initiative supports the hiring of infectious diseases control positions (4.5 FTEs) and supporting these staff to monitor and control infectious diseases.  They serve to enhance the Board of Health’s ability to handle and coordinate increased activities related to outbreak management.  At June 30, 2018, there are no negative variances to report on.
Needle Exchange Program Initiative:  Base funding for this initiative supports the purchase of needles and syringes, and their associated disposal costs, for the Board of Health’s Needle Exchange Program.  At June 30, 2018, there are no negative variances to report on.

Social Determinants of Health Nurses Initiative:  This initiative was established to support 2 public health nursing FTEs with specific knowledge and expertise in social determinants of health and health inequities issues, and to provide enhanced supports internally and externally to the Board of Health to address the needs of priority populations impacted most negatively by the social determinants of health.  At June 30, 2018, negative variances of $7,098 have resulted as salaries and benefits for these positions have exceeded the approved funding.  Negative variances will be absorbed by the Cost-Shared Budget.

Refer to the Risks discussion noted in the Cost-Shared Program Financial Results section of this report, as this would be relevant to these programs.

Financial Information for Related Programs Funded 100% by the MOHLTC

Mandatory Programs:  Potassium Iodide Distribution Program:  One-time funding to improve nuclear emergency preparedness and increase knowledge amongst residents living within the primary and secondary zone of the Fermi 2 nuclear generating station.  Eligible costs include Potassium Iodide pill packs, and staff salaries, project materials, printing and postage associated with the distribution of KI packs and ongoing communication campaigns.  It is anticipated that funds will be utilized by March 31, 2019.

Mandatory Programs:  Public Disclosure System:  One-time funding must be used to update software and inspection forms to meet the new disclosure requirements under the Ontario Public Health Standards.  Eligible costs include software update, disclosure, and migration.  Implementation of the disclosure system is planned for November of 2018 and will require 3rd party resources as well as internal resources for support (i.e. Information Technology; Healthy Environments).  It is anticipated that funds will be utilized by March 31, 2019.

Needle Exchange Program Initiative:  One-time funding for extraordinary costs associated with delivering the Needle Exchange Program.  Eligible costs include purchase of needles/syringes and associated disposal costs.  One-time funds were expended in Q3 of 2018.

Public Health Inspector Practicum Program:  One-time funding must be used to hire the approved Public Health Inspector Practicum positions.  Eligible costs include student salaries, wages and benefits, transportation expenses associated with practicum positions, equipment and educational expenses.  The practicum placements commence in May and conclude in August annually.  It is anticipated that these funds will be utilized in Q3 of 2018.

Vector-Borne Diseases Program:  Enhanced Mosquito Surveillance:  One-time funding must be used for an enhanced surveillance program.  Eligible costs include salaries for students, supplies and additional equipment, identification and testing expenses, promotional costs and mileage.  It is anticipated that these funds will be utilized by Q4 of 2018 with the conclusion of this year’s surveillance program.

Capital:  One-time funding must be used to assist with costs to complete the capital planning requirements for a Stage 2 – Business Case submission.  Utilization of these funds is dependent upon the status of the work being completed internally and by third party consultants based upon the direction from the WECHU’s Board. 

Approved by:

Theresa Marentette

Prepared By:

Lorie Gregg, Director of Corporate Services

Date:

August 29, 2018

Subject:

Q2 Reporting

Background

The Windsor-Essex County Health Unit (“the WECHU”) administers programs that are funded in whole or in part by the Ministry of Health and Long-Term Care and Ministry of Children and Youth Services (hereinafter referred to collectively as “Ministries”).  Quarterly, the WECHU is required to report to the Ministries the year-to-date budget to actual financial results for those programs as well provide forecasted annual financial results.

Q2 Reporting

The Q2 reporting to the Ministries include the following:

• Q2 2018 Standards Activity Reports as of June 30, 2018 submission to the Ministry of Health and Long-Term Care;
• Healthy Babies Healthy Children Quarterly Financial Report – 2018 2nd quarter submission to the Ministry of Children and Youth Services;
• Prenatal and Postnatal Nurse Practitioner Program Financial Report – 2018 2nd quarter submission to the Ministry of Children and Youth Services

Approved by:

Theresa Marentette

Prepared By:

Darcie Renaud, Performance Improvement & Accountability Coordinator (PIAC), Planning & Strategic Initiatives (PSI) Department

Date:

August 14, 2018

Subject:

Quarter #2 Planning Report

Background

Following the completion of the 2018 planning cycle and the submission of the new Annual Service Plan (ASP) required by the Ministry of Health and Long Term Care (MOHLTC), the Planning and Strategic Initiatives (PSI) department undertook an assessment of its planning processes in order to look for ways to better align our planning approach with the MOHLTC requirements in the development of new planning and reporting structure for 2019 and beyond.

Current Initiatives

Planning for 2019

The PSI department worked with the Information Technology (IT) department to align our planning system with the MOHLTC requirements to ensure a single, integrated approach to planning for 2019. Changes to the process include the incorporation of Ministry terminology, the inclusion of intervention performance indicators, and increased planning support for staff and managers. The PSI department has provided several planning training sessions with staff and management from all divisions. Work with managers and departments has continued over the summer months to align the 2019 organizational planning outcomes with the MOHLTC requirements, in order to maximize efficiency and ensure consistency across the organization.

Reporting Structure

The MOHLTC has yet to provide standard reporting structures for the ASP. Upon receiving the updated reporting templates and guidelines the PSI department will work with the IT department to integrate these requirements into the planning system.

Consultation

The following individuals contributed to this report:

• Kristy McBeth, Director, Knowledge Management
• Marc Frey, Manager, Planning & Strategic Initiatives

Approved by:

Theresa Marentette

2018 Q2 WECHU Strategic Plan Progress - At a Glance

Communication and Awareness

Organizational Development

Partnerships

Evidence-based Public Health Practice

Communication and Awareness

Partnerships

Organizational Development

Evidence-Based Public Health Practice

Prepared By:

Darcie Renaud, Performance Improvement & Accountability Coordinator (PIAC), Planning & Strategic Initiatives (PSI) Department

Date:

July 12, 2018

Subject:

Strategic Plan Q2 Report

Background

The 2017-2021 WECHU Strategic Plan allows our organization to identify key roles, priorities and directions and sets out what we plan to accomplish, how we plan to do it, and how our progress will be measured. The plan is based on four strategic priorities: Communication and Awareness, Partnerships, Organizational Development, and Evidence-Based Public Health Practice.

In early 2018, the Planning and Strategic Initiatives department implemented a corporate tracking system to monitor Strategic Plan performance and to provide quarterly and annual updates to the BoH. In the first quarter of 2018, progress was made on a number of objectives, while more work was needed to move others forward. 

Current Initiatives

In the second quarter of 2018, progress continued on most of the strategic objectives.  The 2018 Q2 Strategic Plan Progress Report provides updates on each objective with corresponding next steps (see appendix A). 

Consultation

The following individuals contributed to this report:

• Kristy McBeth, Director, Knowledge Management
• Marc Frey, Manager, Planning & Strategic Initiatives
• Ramsey D’Souza, Manager, Epidemiology & Evaluation
• Michael Janisse, Manager, Communications
• Jennifer Johnston, Health Promotion Specialist, Planning & Strategic Initiatives
• Jessica Kipping-Labute, Policy Advisor, Planning & Strategic Initiatives
• Dave Jansen, Performance Improvement and Accountability Coordinator, Planning & Strategic Initiatives

Approved by:

Theresa Marentette

Prepared By:

Jenny Diep, Health Promotion Specialist

Date:

August 30, 2018

Subject:

Supervised Injection Services (SIS) Community Consultation Project

Background

Locally in Windsor-Essex County (WEC), we are facing increased morbidity and mortality related to the use of opioids and other drugs.  There were 382 opioid-related emergency department visits in WEC in 2015, which is 3.6-times greater than in 20031.  The rate of opioid-related emergency department visits in Windsor was 2.8-times greater than the rate in Essex County.  There were 24 opioid-related deaths in WEC in 2015; 19 deaths were in the city of Windsor¹. Furthermore, the number of hepatitis C cases, a blood-borne infection, increased from 143 reported cases in 2016 to 181 reported cases in 2017².  In 2017, out of the 164 confirmed cases that reported at least one risk factor other than unknown, injection drug use was reported by 62% of cases (101 cases)³.  There have been 211 documented needle-related calls from January 1, 2014 to February 5, 2018 to local municipal service (3-1-1), predominantly in downtown Windsor⁴.  Number of needle-related calls have significantly increased, from 43 in 2016 to 121 in 2017 (City of Windsor, 3-1-1 calls)⁴.

Overdose Prevention Sites (OPS) and Supervised Consumption Services (SCS)

In December 2017, in response to overdose-related deaths, Health Canada announced that it would provide temporary class exemptions to provinces and territories demonstrating evidence of an urgent public health need. This allowed for possession and use of controlled substances on exempted sites, known as OPS. This provided a space for people to consume drugs in a safe environment, where staff or volunteers can provide overdose response measures as required. This interim measure allowed communities to plan for a long-term solution, such as a SCS.

A SCS is a legally sanctioned site that provides a location where people can bring their own illicit substances to consume under safer conditions and supervised by trained workers who can respond to an overdose as needed⁵. A SCS includes SIS, and offers treatment, health, and social services for people who are ready to stop or reduce their drug use. An OPS may not have these services in place as a temporary site, while a SCS aims to connect people who use drugs to health and social services. A SCS reflects harm reduction principles, which recognizes that individuals with substance use issues may not wish or be able to abstain from substance use, and thus, seeks to minimize the harms associated with drug use⁶. It is a part of Health Canada’s Canadian drugs and substances strategy. Benefits of SISs, as acknowledged by the Government of Canada⁷, include:

• Reduced overdose-related morbidity and mortality^8,9;
• Reduced injecting and discarding of needles in public space⁹;
• No evidence of increased drug-related crime or loitering or rates of drug use⁹;
• Increased access to withdrawal management and treatment services and other health and social services^5,9;
• Reduced transmission of blood-borne infections, such as hepatitis C and HIV, through decreased needle sharing^8,9; and
• Reduced health care costs, ambulance calls, use of emergency departments, and hospital admissions^8,9.

Prior to the establishment of a supervised consumption site (SCS) and also a requirement of Health Canada’s application for exemption under Section 56.1 of the Controlled Drugs and Substances Act, community engagement is essential to informing the need and feasibility for a SIS and predicting its success⁵.  Similar projects have been conducted in London, Toronto, Hamilton, and Waterloo in Ontario.  These projects similarly reflect such projects in British Columbia.

Locally, organizations have expressed interest in applying for a SCS in Windsor.

Current Initiatives

As part of the Windsor-Essex Community Opioid & Substance Strategy (WECOSS) under the Harm Reduction Pillar, the Windsor-Essex County Health Unit (WECHU) is leading the Supervised Injection Services Community Consultation Project (SIS-CC) to assess the need and acceptability of SIS in WEC.  The study will:

• Explore the need for SIS in WEC;
• Explore the design, potential locations, and conditions under which an SIS would be preferred by potential clients and stakeholders in Windsor; and
• Assess community perceptions of SIS and identify any concerns and strategies to mitigate such concerns.

This project will involve a mixed methods approach (i.e., quantitative and qualitative):

1. Analysis of local surveillance data. Existing surveillance data regarding morbidity and mortality related to opioid and substance use, including hepatitis C rates, public discarding of needles, health care service use related to opioid use, and harm reduction service use.
2. In-person surveys with people who inject drugs (PWIDs). The 45-minute survey explores drug use and injection practices, perceptions of SIS and its implementation (e.g., policies, hours, location), experiences of overdose, health and drug treatment. Peer researchers will be trained to recruit and administer the survey. Peer researchers are hired staff who have had lived experience with injection drug use, and may more likely be able to build a rapport with potential participants to complete the survey.
3. Public Online survey with the Windsor-Essex County community. The 5-minute online survey involves questions related to perceptions of drug use and SISs and its implementation. This survey may identify additional needs outside of Windsor, and thus, inform future community consultation projects.
4. Interviews with key informants. A 30-minute interview will be conducted with identified key informants and community leaders including harm reduction service providers, local politicians, key leaders from community service agencies/organizations, advocacy groups and emergency services from Windsor.
5. Focus groups with key stakeholder groups. A 1.5-hour focus group will be conducted with individuals from key stakeholder groups that have an interest in drug-using populations and can be affected by or affect policy and implementation (or non-implementation) of SIS.  These include first responders (police, fire, and emergency medical services), representatives from municipal government departments, community services agencies/organizations, and community, neighbourhood and business groups from Windsor.

The project will be promoted through social media and the Health Unit and WECOSS websites, which is currently being developed.  More information about SIS, SCS, OPS, and the project will be provided on the WECOSS website.

An application to the University of Windsor Research Ethics Board (REB) has been submitted and pending final approval we expect to launch the survey in late September with data collection continuing to the end of 2018.

References

1. Windsor-Essex County Health Unit. (2017, June). Opioid misuse in Windsor-Essex. Retrieved from https://www.wechu.org/about-us/reports-and-statistics/opioid-misuse-windsor-essex-county.
2. Windsor-Essex County Health Unit. (2018). Monthly infectious disease report – February 2018. Windsor, ON: Windsor-Essex County Health Unit.
3. Data Source: Integrated Public Health Information System (iPHIS), Ministry of Health and Long-Term Care [extracted 2018 Jun 8]
4. Data Source: City of Windsor, 3-1-1 calls [extracted 2018 Feb 05]
5. Government of Canada. (2017, July 6). Supervised consumption site: Guidance for application form. Retrieved from canada.ca.
6. Canadian Mental Health Association. (2018). Harm reduction. Retrieved from https://ontario.cmha.ca/harm-reduction/.
7. Government of Canada. (2017, May 26). Statement from the Minister of Health – Health Canada authorizes four new supervised consumption sites. Retrieved from https://www.canada.ca/en/health-canada/news/2017/05/statement_from_themi....
8. Ng, J., Sutherland, C., & Kolber, M.R. (2017). Does evidence support supervised injection sites. Canadian Family Physician, 63(11), 866.
9. Kennedy, M.C., Karamouzian, M., & Kerr, T. (2017). Public health and public order outcomes associated with supervised drug consumption facilities: A systematic review. Current HIV/AIDS Reports, 14(5), 161-183. https://doi.org/10.1007/s11904-017-0363-y

Approved by:

Theresa Marentette

Prepared By:

Jessica Kipping-Labute

Date:

September 10, 2018

Subject:

“Vote for Health” Municipal Election Survey

Background

Municipal governments and elected representatives can shape the health of communities through the design and delivery of local policies, programs, and services.  Working with partners and decision makers to achieve these outcomes is part of the Ontario Public Health Standards (OPHS), and is one objective of the Windsor-Essex County Health Unit’s (WECHU) 2017-2021 Strategic Plan. 

Under the Foundational Standard of the OPHS, Public Health Units (PHUs) are to share reports, advisories, and healthy public policy recommendations.  As well, PHUs are to contribute to policy work aimed at reducing barriers to positive health outcomes. Specifically, leading, supporting, and participating with stakeholders on policy development to decrease health inequities. In the Program Standards PHUs are to use data to influence and inform the development of local healthy public policies.

Current Initiatives

On September 5th, the WECHU launched ‘Vote for Health’, a voluntary survey distributed to all local council and mayoral candidates running in the upcoming 2018 municipal election. The survey asks about how municipal candidates would prioritize their efforts based on seven identified local health priority areas. These areas include dental health, substance misuse, food insecurity, mental illness, built environment, and climate change. These priority areas were identified based on local data, results from the WECHU’s 2016 Community Needs Assessment, and the Association of Local Public Health Agencies’ (alPHa) Municipal Election Policy Priorities document. This approach was adapted with permission from the Simcoe Muskoka District Health Unit and modified to specifically address locally relevant aspects. The results of the survey will be posted on WECHU’s website in late September. The information collected from municipal candidates does not necessarily reflect the views of the WECHU, but instead provides an opportunity for candidates to share their views on local public health issues with the community.

The purpose of the survey is to:

• Raise awareness of local public health issues.
• Provide an opportunity for municipal candidates to share their views on these public health issues.
• Provide residents with municipal candidate’s views on these public health issues to support informed decision-making when voting in the October municipal election.

Support the development of healthy public policy during and after the election period.

Consultation

The following individuals contributed to this report:

• Kristy McBeth, Director, Knowledge Management Division
• Marc Frey, Manager, Planning & Strategic Initiatives Department

Approved by:

Theresa Marentette

Prepared By:

Communications Department

Date:

July 4, 2018

Subject:

June Media Relations Recap Report

June Media Coverage

Story Source

Media Coverage

News Release and Media Advisories

Stories Reported by the Media

AM 800

Blackburn News

Canada.com

CBC News

Chatham This Week

CTV News

Essex Free Press

Wallaceburg Courier Press

Windsor Star

Windsorite.ca

The following individuals contributed to this report: Jennifer Jershy and Michael Janisse

Prepared By:

Communications Department

Date:

August 1, 2018

Subject:

July Media Relations Recap Report

July Media Coverage

Story Source

Media Coverage

News Release and Media Advisories

Stories Reported by the Media

AM 800

Blackburn News

CBC News

CTV News

Prepared By:

Communications Department

Date:

September 7, 2018

Subject:

August Media Relations Recap Report

August Media Coverage

Story Source

Media Coverage

News Release and Media Advisories

Stories Reported by the Media

AM 800

Blackburn News

CBC News

CTV News

Windsor Star

Windsorite.ca

The following individuals contributed to this report: Jennifer Jershy and Michael Janisse

Board Members Present:

Gary McNamara, Joe Bachetti, Mark Carrick, Dr. Deborah Kane, Judy Lund, Richard Meloche, Gord Queen, Ed Sleiman, John Scott, Michelle Watters

Board Member Regrets:

Dr. Ken Blanchette, Paul Borrelli, Bill Marra, Dr. Carlin Miller, Hilary Payne

Administration Present:

Dr. Wajid Ahmed, Lorie Gregg, Theresa Marentette, Kristy McBeth, Dan Sibley, Lee Anne Damphouse

Administration Regrets: 

Nicole Dupuis

Guests: 

J. Lee, A. Wesley-James, S. Pulickal (Colliers Project Leaders)

RECORDING SECRETARY:

SUBMITTED BY:

APPROVED BY:

Prepared By:

Communications Department

Date:

June 4, 2018

Subject:

May Media Relations Recap Report

May Media Coverage

Story Source

Media Coverage

News Release and Media Advisories

Stories Reported by the Media

AM 800

Amherstburg River Town Times

Blackburn News

Canada.com

CBC News

CTV News

University of Windsor News

Windsor Star

Windsorite.ca

Yahoo News

The following individuals contributed to this report: Jennifer Jershy and Michael Janisse

Prepared By:

Debbie Silvester, Manager Healthy Families

Date:

June, 2018

Subject:

Background

The WECHU’s official road to Baby Friendly Designation started in 2012. However, the promotion and support of breastfeeding has been an integral part of the programs and services provided to pregnant and breastfeeding women and their families for decades.

In 2012, the Ministry of Health and Long-term Care added the Baby Friendly Initiative (BFI) as an accountability indicator for the Family Health standard. The ministry provided guidelines for the process based on the Breastfeeding Council of Canada’s (BCC) Baby Friendly Designation process.

The purpose of the Baby Friendly Initiative is to protect, promote and support breastfeeding. It ensures pregnant families and families with infants have the information they need to make an informed decision on how to feed their infants. It supports not only families who choose to breastfeed but also those who cannot or choose not to breastfeed.  It encourages community partners to work together to promote breastfeeding and ensure families have consistent evidence based breastfeeding information as well as local program and services to help families when they need additional breastfeeding supports.

Current Initiatives

Journey Milestones:

• May 2012 – Implementation of an external BFI multidisciplinary committee
  • Windsor Essex Baby Friendly Initiative and Healthy Families Committee was formed, comprised of community partners who provide services to pregnant and breastfeeding families (e.g., WECHU Healthy Families Department, local birthing hospitals, LaLeche League, Building Blocks for Better Babies, local Doulas, Early On Centres etc.).
• August 2012 -  BFI Self-Appraisal Assessment completed
  • The Self-Appraisal was used to identify gaps and develop an overarching plan for the WECHU to achieve BFI designation.
• Throughout 2013 – Development of BFI policy and Review of all Healthy Families Resources
  • An eLearning module was created to supplement the BFI Policy.
  • All healthy families teaching tools and client resources were reviewed for BFI compliance.
• May 2014 – Annual corporate BFI Policy and eLearning modules launched
  • All health unit staff and board members completed the eLearning module and signed off on the BFI Policy. In addition, BFI leads were identified within each department.
• April 2015 –Document Review forwarded to BCC Lead Assessor
  • It included a copy of all current Healthy Families teaching and client resources.
• September 2015 - Process to gather local breastfeeding rates initiated
  • Began obtaining consents from postpartum moms prior to hospital discharge to contact them in 6 months to complete an infant feeding survey.
• March 2016 -  Documentation Review finalized and Pre-Assessment Visit booked for Nov. 22, 2016
  • September through November 2016 – All Health Unit staff and board members were provided with education and resources in preparation for the Pre-Assessment Visit.
• October 2016 – Initial analysis of infant feeding surveys completed
  • Local breastfeeding rate were required for the Pre-Assessment Visit.
• November 22, 2016 – Pre-Assessment Visit
  • During the visit the Lead BCC BFI Assessor interviewed staff from every department along with several of our direct care staff from the Healthy Families department. The Lead Assessor also visited one of our community programs and contacted several of our clients.
  • In December the BCC Lead Assessor provided a report with requirements and recommendation that needed to be addressed before the WECHU was ready for the External Assessment Visit.
•  March 2017 – External Assessment Visit booked for November 21, 22, and 23, 2017
  • BCC Lead Assessor approved the Health Unit’s plan to address the recommendations as outlined during the Pre-Assessment Visit and booked the External Assessment Visit.
• June 14 2017 – A community event held for community partners
  • Information was provided on BFI and how community partners could support BFI messages with their prenatal families and families with young children.
• September 2017 -  Second analysis of infant feeding surveys completed
  • Update of local Breastfeeding rates were required for the External Assessment Visit.
• September through November 2017 – All staff and board members prepared for External Assessment Visit
  • All staff, senior management and board members were provided with education and resources in the event they were interviewed by a BCC Assessor.
• November 21, 22, and 23, 2017 – External Assessment Visit
  • Lead BCC assessors and two additional BCC assessors visited all three health unit sites and conducted staff interviews, reviewed resources, attended community programs and contacted clients. The BCC assessors where impressed with how knowledgeable and prepared the health unit staff were during the interviews.
  • In December, as with the Pre-Assessment Visit the health unit was provided with a report that outlined additional requirements that needed to be addressed prior to receiving the BFI designation. Additional requirements included improving communication with our community partners about BFI and ensuring that spaces in the community WECHU utilizes for maternal and newborn programming are supportive of BFI and the WHO code.
  • March 2018 -  Health unit submitted plan to address concerns outlined in the External Assessment report.
• April 13, 2018 – Received BFI Designation
  • The Lead Assessor reviewed the plan, requested clarification on resources to be distributed and education materials. Officially awarded the BFI designation after the Health Unit’s response.

While the Healthy Families Department lead the journey, it took all health unit board members, senior management, managers and staff working together to achieve Baby Friendly Designation. Community partners also played a significant role.  Without their willingness to incorporate key BFI messages into their programming; distribute BFI compliant resources; or work directly with us to improve access to community breastfeeding resources we would never have been able to meet all the requirements for Baby Friendly Designation.

Next Steps:

Receiving Baby-Friendly designation ends one leg of our journey and begins another. Re-designation is required every 5 years. We will continue to:

• Support families to make an informed decision about feeding their babies.
• Support breastfeeding anytime, anywhere.
• Promote breastfeeding as the normal way of feeding a baby.
• Promote exclusive breastfeeding for the first six months of a baby’s life, and continued breastfeeding for up to two years and beyond.
• Provide breastfeeding education and supports to pregnant and breastfeeding families.
• Provide individual education and supports to families who cannot or choose not to breastfeed their babies.
• Provide annual education to health unit staff, senior management and board member on key baby-friendly messages. 
• Monitor local breastfeeding rates and collaborate with community partners to develop strategies to improve breastfeeding outcomes.

Consultation:

The following individuals contributed to this report:

• Debbie Silvester, Healthy Families Manager
• Cathy Bennett, Healthy Families Manager
• Amanda Ellard-Ryall, Healthy Families Manager

Reviewed by:

Nicole Dupuis, Director Health Promotion

Approved by:

Theresa Marentette, Acting CEO

Prepared By:

Jennifer Johnston, Social Determinants of Health – Health Promotion Specialist, Planning and Strategic Initiatives Department

Date:

June, 2018

Subject:

Background

The Ontario Public Health Standards (OPHS) outline the minimum expectations for public health programs and services and direct what Boards of Health are required to do. The new modernized OPHS specify that Boards of Health must demonstrate that they are focusing efforts to increase opportunities for health disadvantaged groups to achieve higher levels of health and well-being. Achieving greater health equity in our community has the potential to increase the effectiveness of public health programs and services.

To advance this work, the WECHU’s Planning and Strategic Initiatives Department has developed a corporate health equity strategy. The strategy will help the organization more strategically document efforts, identify areas of opportunity, measure progress, and share successes. 

Based on results from the most recent Board of Health self-evaluation survey, health equity was also identified as an area requiring more information, training, and support. Reviewing the Health Equity Strategy will help increase Board of Health members’ understanding of this topic. An education session on health equity is being planned for the Board of Health in July of this year. 

Current Initiatives

The OPHS provide detailed expectations concerning what Boards of Health are required to do, but they do not include how these should be met. The WECHU’s Health Equity Strategy describes how the organization plans to address these requirements. It is a plan that supports all staff and the Board of Health to build health equity consideration into planning and service delivery.

The WECHU’s Health Equity Strategy is informed by an extensive literature review, consultations with experts in the field of public health equity action, and shaped by staff feedback. It is intended to direct organizational priorities around health equity and outline a shared understanding of equity focused approaches. To increase the effectiveness of the Health Equity Strategy, a detailed action plan is included. This action plan is based on a yearly quality improvement process, enabling the WECHU to continually revise specific approaches to better meet the needs of our staff and the community. This plan is being widely communicated to staff within the organization and will be included as a part of the health equity education session planned for the Board of Health this year.

Consultation:

The following individuals contributed to this report:

• Kristy McBeth, Director, Knowledge Management Division
• Marc Frey, Manager, Planning & Strategic Initiatives Department

Approved by:

Theresa Marentette, Acting CEO