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2013 Community Health Check-Up

Message from the Commissioner & Medical Officer of Health

Welcome to Check-Up 2013! We continue to make a difference in the lives of Durham residents of all ages. For more detailed information check out our 2013 Performance Report and 2013 Annual Health Statistics. You can find our 2014 program priorities in our 2014 Health Plan. To assist and support you with healthy living, contact us, browse our website, ‘Like’ us on Facebook and ‘Follow’ us on Twitter. Once again, here’s to your good health and well-being!

Robert Kyle, BSc, MD, MHSc, CCFP, FRCPC, FACPM


In this issue...



Strengthening healthy child development

Healthy child development is a key indicator of health. Eighteen-months of age is a critical age for assessing key developmental milestones and for addressing concerns prior to school entry. The Health Department’s “Don’t Wait and See with a Child’s Development” campaign highlights the importance of this developmental stage.

The aim of this campaign is to encourage parents/caregivers to take an active role in monitoring and supporting their child’s growth and development, with the Enhanced 18-Month Well-baby Visit being a key component of this campaign.

The Enhanced 18-Month Well Baby Visit is a provincial government strategy to support standardized developmental review and evaluations for each child in Ontario. This evaluation is done at 18-months in consultation with primary health care providers. It is also one of the last regularly scheduled visits coupled with immunization, and potentially the last time children are seen by a primary health care provider before they enter school. The visit is designed to build strong partnerships among primary health care providers, parents and community services. These collaborations help to ensure children receive support in developing the necessary skills and abilities to be ready for school.

The use of a free, online tool known as the Nipissing District Developmental Screen (NDDS) is also promoted. The NDDS is designed to help parents and caregivers track a child’s development from one-month to six-years old. This tool also provides tips and activities to support healthy child development and is available in five languages. The NDDS is a suggested starting point for discussions between parents and caregivers and the primary health care providers during the Enhanced 18-Month Well-Baby Visit.

There is evidence to show that Durham Region parents are taking an active role in monitoring and supporting their child’s growth and development. Between 2010 and 2012, over 48 per cent of all area children received an 18-Month Well-Baby Visit; this number is higher than the provincial percentage of 45 per cent. In addition, provincial data indicates that 21 per cent of all NDDS completed in Ontario were from Durham Region residents.



Health Department offers resources to help children and youth build resiliency

Durham Region Health Department works closely with several local community partners to help build resiliency among children and youth as an important aspect of improving positive mental health. Confidence, self-esteem and positive thinking are all developed by working through life experiences with the support of caring adults. Parental styles, parental attachment and healthy sibling relationships are found to play an important role in shaping the level of resiliency a child will have.

To assist with the development of these critical coping skills, the Health Department has produced Kids Can, a colourful, interactive web-based and print resource for parents and caregivers that includes information and activities to help young children learn resiliency skills.

Since the launch of Kids Can, as many as 10,000 copies of the resource and 3,000 postcards promoting the web-based version have been distributed throughout Durham Region. Several community partners and agencies are also using and sharing this resource to support their work with families. A local school board has also adopted the Kids Can resource as the main feature of their “Welcome to Kindergarten” event in all their schools, while another school board, through the support of the Family and Community Engagement Strategy, provided copies of this resource to 1,000 children who entered kindergarten last September.

In addition to resources such as Kids Can, the Health Department also works directly with schools to promote positive mental health. Research supports the use of positive mental health and resilience strategies in schools to increase student protective factors for mental health.

Statistics show that 15 to 20 per cent of children and youth have a mental health need that can impact their productivity, activities of daily living and functioning. According to a 2013 report on the Public Health Monitoring of Risk Factors in Ontario, 27 per cent of Durham Region secondary school students reported experiencing at least one of the following mental health concerns:

  • elevated psychological distress;
  • antisocial behaviours; and/or
  • problem drug use or hazardous/harmful drinking.

The Health Department has developed several resources to help address these concerns in supporting schools in working on resiliency, including:

  • A school resource designed to assist schools in providing an environment that supports positive mental health and resiliency; 42 schools have requested this resource to date.
  • A pamphlet and presentation to assist educators in building resiliency in students; 18 school communities have requested a presentation with 400 educators attending.
  • A parent resource and presentation providing practical ways of building resilience and the rationale behind these suggestions.


Evaluating family-centred service in Infant and Child Development

In September 2013, Infant and Child Development (ICD) implemented the Measures of Processes of Care for Service Providers - Infant Development (MPOC-ID), a survey to help parents provide feedback on their perceptions of specific behaviours of health care professionals. Surveys were sent to 361 families who have been receiving services from ICD for over one year, which represents approximately 25 per cent of families involved with ICD.

Developed by CanChild Centre for Childhood Disability Research at McMaster University in Hamilton, the survey aims to assess the underlying belief that many aspects of the behaviours and interactions between health care professionals and parents of children with disabilities may contribute, either negatively or positively, to parental health and well-being. Research has shown that a parent’s quality of life can be significantly affected by changes in a child’s abilities or changes in the parent's confidence and competence in meeting a child's needs.

ICD is participating in this pilot project as part of a collaborative effort between the Central West Region and Durham Region Infant and Child Development programs. The aim of this project is to determine if this method can be adopted by all infant and child development programs in Ontario, as a means to measure family-centred service.

A program goal for 2013 was to promote the quality of life for the child and the family. With the implementation of the MPOC-ID, results will be analyzed to help align service targeted at positive family outcomes.

Providing service to enhance the growth and development of young children with developmental disabilities or with risk factors for developmental delay is the mandate of Infant and Child Development. There were 563 referrals to the program in 2013, with a wait list of approximately three to four months.

Best practices in early intervention state that the earlier in a child’s life the intervention begins, the better the outcomes. Although there was a waitlist for services, processes are in place to maximize opportunities for information and support to families within one week of referral.

Referrals were further triaged to prioritize those infants with established risks for developmental delay, followed by those with preterm births of less than 29 weeks. This allows an infant and child development consultant to provide service to children and families with higher needs as quickly as possible, in an effort to maximize child outcomes and minimize parental stress. Further screening is then done with referrals to determine needs and concerns and to offer varying levels of service ranging from monitoring, clinic appointments at an Ontario Early Years Centre or access to a parent information group.

Following this process, ICD adheres to the principles of best practices which advocate for early access to services, providing the right service at the right time.



Healthy Smiles Ontario provides access to dental care for children in need

In October 2010, the Ministry of Health and Long-Term Care introduced a new program to help young families in Ontario access oral health care for children 17 and under. Health Smiles Ontario (HSO) complements the existing Children In Need of Treatment Program (CINOT) which provides urgent care for children whose families can not afford to obtain treatment.

HSO provides routine dental care including, preventive services, restorations and extractions. HSO differs from the CINOT program in that children do not require an urgent need to be eligible. Unlike CINOT however, families must provide proof of financial need. Families must have had an adjusted net family income of $20,000 per year or less to access the program in 2013.

The program has ended its first three year cycle as of December 31, 2013, with the province announcing changes to the program to ensure that even more children will be able to access dental care.

The attached graphs summarize the growth of the HSO program in Durham Region. We now have 1,387 open cases and paid over $232,500 in claims for 757 children in 2013.

Number of New and Open Cases by Year, Healthy Smiles Ontario, 2010-2013

Number and Total Amount of Claims Paid by Year, Healthy Smiles Ontario, 2010-2013


Monitoring infectious diseases in Durham Region

The goal of the Infectious Diseases program is to prevent or reduce the burden of infectious diseases of public health importance as outlined in the Ontario Public Health Standards. Physicians, laboratories and institutions are required under the Health Protection and Promotion Act (HPPA) to report all cases of reportable infectious diseases to the Health Department.

The Health Department's Infectious Diseases staff provide client and contact management of these reportable infectious diseases according to the Ministry of Health and Long-Term Care (MOHTLC) current Infectious Diseases protocols. Electronic reports are sent directly to the MOHLTC through the integrated Public Health Information System (iPHIS) database.

Additionally, public health nurses and public health inspectors are available 24-hours a day, seven days a week to receive reports and respond to identified infectious diseases according to the HPPA, the Mandatory Blood Testing Act, and the Exposure of Emergency Service Workers to Infectious Diseases protocol.

With the assistance of Health Department epidemiologists, reportable disease statistics are monitored and distributed to health care providers on a quarterly basis, including comparative statistics from the previous five years which highlights emerging trends and enhanced surveillance initiatives. Staff also collaborates with health care providers and community stakeholders to provide up to date information and education initiatives related to the prevention and control of infectious diseases in Durham Region.

Below is the number of confirmed cases of selected reportable diseases managed by Health Department staff in 2013.

Confirmed Cases of Selected Reportable Diseases

Public Health Nursing & Nutrition

Environmental Health

Disease

2013

Disease

2013

Group A Strep, invasive

20

Amebiasis

19

Pneumococcal disease

47

Campylobacter

195

Meningococcal disease

1

Crytosporidiosis

7

Measles

0

Cyclosporiasis

3

Mumps

0

Giardiasis

52

Pertussis (Whooping cough)

7

Hepatitis A

3

HIV

7

Legionellosis

21

Aids

9

Listeriosis

2

Chlamydia

1,614

Paratyphoid Fever

1

Gonorrhea

159

Salmonellosis

135

Syphilis

41

Shigellosis

6

Hepatitis B

1

Typhoid fever

2

Hepatitis C

178

VTEC(E.Coli)

13

Neonatal Group B strep

5

Yersiniosis

6

Neonatal Herpes

0

Institutional Outbreaks - Respiratory

60

Tuberculosis

9

Institutional Outbreaks - Enteric

39




Outbreak tabletop exercise

The Health Department’s Environmental Health and Public Health Nursing & Nutrition divisions conducted an in-house outbreak tabletop exercise on November 19, 2013.

Held at the Region of Durham headquarters, the mock exercise was used to educate and train staff, as well as identify any areas for improvement involving the investigation of a hepatitis A positive food handler working at a large grocery store.

The exercise presented the mock implementation of outbreak control measures, including; arrangements for the provision of hepatitis A vaccine for contacts, a media release notifying possible contacts, a FAX about to the local health care community, and the follow-up of the index case and their workplace.

Staff from the infection prevention and control program, immunization program, and the epidemiology and evaluation unit participated in the exercise.



New emergency notification process for Health Department Staff

Since 2009, the Health Department has conducted an annual paper-based exercise of the department's emergency telephone fan-out notification process for all staff in accordance with Ontario Public Health Standards requirements.

In 2013, the Health Department investigated the "Rapid Notify" system, a web-based emergency notification system used by the Durham Emergency Management Office. The Rapid Notify system is enables real-time, two way communications via telephone, email and SMS text messaging to communicate with stakeholders and staff.

The Health Department conducted two pilot tests of the Rapid Notify system in fall 2013. The first test was conducted with a number of Health Department staff involved with Health Emergency Operations Centre, while the second was conducted with the staff from the Health Department’s Environmental Health division.

An evaluation of results from the second test show that the Rapid Notify system is a viable, user friendly method of mass notification for Health Department staff. In addition, over 90 per cent of staff who completed the evaluation preferred the "Rapid Notify" system over the paper-based telephone fan-out process used in the past.

An emergency notification exercise using the Rapid Notify system will be conducted with all Health Department staff in 2014.



Durham Region EMS set to open new paramedic response station; paramedics active in numerous community events

Construction of the new Durham Region Emergency Medical Services (EMS) Oshawa North Paramedic Response Station progressed well in 2013. Scheduled to be fully operational in March 2014, this new facility will result in a larger and more permanent paramedic response station in the Oshawa community, replacing a much smaller leased facility that was not practical for expansion.

This new station will provide improved paramedic coverage and service to the Oshawa community, while also supporting paramedic coverage in Clarington, Scugog, Whitby and surrounding areas.

The 2013 National Paramedic Competition, a challenge allowing paramedics an opportunity to showcase their paramedicine skills, was held at Durham College, Whitby Campus in April 2013. Durham Region EMS paramedic teams placed third in the advanced care paramedic division and second in the primary care paramedic division. All teams demonstrated clinical and academic excellence, as well as great competitive spirit.

Concurrent with the competition, Durham Region EMS welcomed staff from EMS in the Netherlands on a tour of Durham Region EMS headquarters, providing the Netherlands visitors with an orientation on the Durham Region service and an overview of EMS in Ontario. In addition, Durham Region EMS also hosted five members of the Netherlands training staff to oversee Durham Region’s paramedic training and legislative requirements, providing a forum for mutual international learning and development.

In 2013, Durham Region EMS provided dedicated contractual EMS services and response for two large events held in Durham Region. Contracted by Republic Live, Durham Region EMS provided service for the Boots and Hearts music festival, held at Canadian Tire Motorsport Park in summer 2013. Durham Region coordinated all out of hospital medical care and transportation, and worked cooperatively with St. John Ambulance to ensure the provision of first aid services and out of hospital medical care/transportation throughout the event. Durham Region EMS was also contracted to provide out of hospital medical care to race participants and event spectators for the NASCAR Camping World Truck Series, also held at Canadian Tire Motorsport Park in 2013.



Trends in... Tobacco Use and Cessation, Smoke-Free Homes and Vehicles and Support for Smoke-free Outdoor Public Places

The Health Department published four new reports that provide an overview of the changes in tobacco related attitudes and behaviours in Durham Region over the past decade. The data was collected using the Rapid Risk Factor Surveillance System, an ongoing survey of Durham Region adults 18 and over, conducted by the Health Department and the Institute for Social Research at York University in Toronto.

Overall, smoking rates in Durham Region have declined since 2001 and the percentage of smoke-free homes and vehicles has increased. Support for smoke-free outdoor public places such as doorways, playgrounds, sports fields and spectator areas, beaches and patios is high among Durham residents and has increased significantly since 2007.

Key findings in these reports include:

Tobacco Use (PDF)

  • In 2012, 18 per cent of Durham Region adults were current smokers, representing approximately 90,000 adult smokers in the Region. This is a significant decline from 27 per cent in 2001.

Tobacco Cessation (PDF)

  • Two thirds or 64 per cent of current smokers had the intention to quit in 2012, either considering quitting within six months or committed to quitting within 30 days.
  • Between 2001 and 2012 there was no significant change in the percentage of smokers who intended to quit.

Smoke-Free Homes & Vehicles (PDF)

  • The percentage of households in Durham Region that were smoke-free increased steadily and significantly from 58 per cent in 2001 to 89 per cent in 2012.
  • In 2012, the percentage of smoke-free homes was significantly higher among households with children (95 per cent) than those without (85 per cent).
  • In 2012, 85 per cent of adult drivers did not allow smoking in their vehicle, a significant increase over 2001 when the number was 70 per cent.

Support for Smoke-Free Outdoor Public Places (PDF)

  • In 2012, approximately 90 per cent of Durham Region adults supported smoke-free doorways to public places and workplaces and public playgrounds, and 85 per cent supported smoke-free sports fields and spectator areas.
  • Support was somewhat lower for public beaches and patios but was still close to 80 per cent.
  • Since 2007 support for all outdoor venues to be smoke-free has increased significantly.

Learn more about health statistics in Durham Region.


2013 Financial Information

Expenditures

Revenues

Chronic Diseases & Injuries

$ 8,748,500

Region of Durham

$36,501,800

Emergency Medical Services

40,978,400

Province of Ontario

50,731,100

Environmental Health & Emergency Preparedness

5,696,800

User/Program Fees

614,000

Family Health

13,312,400

 

Infectious Diseases

9,077,200

 

Professional & Administration Services

10,033,600

 

 

$87,846,900

 

$87,846,900


2013 Community Health Check-Up