Durham Region Health Department Health Check-Up 2016

An occupational therapist with Durham Region Health Department working with three young clients.
A Region of Durham Paramedic Services paramedic tending to a patient.
A registered dental hygienist and certified dental assistant with Durham Region Health Department working on a young client's oral hygiene.

Message from the Commissioner & Medical Officer of Health

Welcome to Check-Up 2016! We continue to make a difference in the lives of Durham residents of all ages. For more detailed information check out our 2016 Performance Report and 2016 Annual Health Statistics. You can find our 2017 program priorities in our 2017 Health Plan.

As you read on, you’ll find information on the Personal Services Settings Inspection Disclosure Program Know Before you Go implemented in June 2016, the Region of Durham Paramedic Services’ new Sunderland station, and how public health nurses embarked on a qualitative survey on young parenthood as members of the Young Parents Community Coalition.

Our job at the Health Department is to protect and promote the health of Durham Region residents. To assist and support you with healthy living, contact us, browse our website, ‘like’ us on Facebook and ‘follow’ us on Twitter. Here’s to your good health and well-being!

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


In this issue...

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Know Before You Go Durham

Know Before You Go Durham

On June 1, 2016, By-law 17-2016 came into effect, launching Durham Region’s Personal Services Settings Inspection Disclosure Program, Know Before You Go. The program highlights the familiar red, yellow and green inspection summary signs associated with the DineSafe Durham food safety disclosure program, with similar inspection summary signs now posted at area personal services settings including facilities that operate manicuring and pedicuring, tattooing and body piercing and aesthetic services, as well as hair salons and barbers.

Phase one of the program required owners and operators to post the inspection summary sign at entrances to all personal services establishments. The signs include a green “PASS” sign for significant compliance, a yellow “CONDITIONAL PASS” sign for significant non-compliance or a red “CLOSED” sign if an immediate health hazard exists. Premises displaying a red sign can have either the entire operation closed or the closure of a specific service. The by-law also requires all personal services settings operators to notify the Health Department 30 days prior to opening a service. Phase two of the program will include online posting of inspection summaries on www.durham.ca/knowbeforeyougo.

The Know Before You Go Durham program provides the public with quick and easy access to public health inspection results and assists the public in making informed decisions about where to get a personal service. The program also increases the transparency of public health services and compliance by the operators with the current Ontario Ministry of Health and Long-Term Care Personal Services Settings Best Practices Guidelines.


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Region of Durham Paramedic ServicesRegion of Durham Paramedic Services Sunderland Response Station nearing completion

On Nov. 7, 2016 construction officially began on the Sunderland Paramedic Response Station. This station will be staffed with an ambulance 24-hours a day, seven days a week and a rapid response vehicle 12-hours a day, seven days a week. The station was designed for future growth and to support Region of Durham Paramedic Services’ logistics service with a contingency of supplies. Barring no significant delays, completion and occupancy is anticipated for late 2017.

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Region of Durham Paramedic Services on the Road to Mental Readiness

Region of Durham Paramedic Services (RDPS) organized and hosted a provincially recognized program for mental health awareness in the fall of 2016. This program was attended by allied paramedic services, human resources staff, and Canadian Union of Public Employees 1764 members. The program is the first step in developing and preparing a recognition plan for the Ontario Ministry of Labour regarding Post Traumatic Stress Disorder (PTSD). As the recognition of PTSD among first responders has increased, Durham Regional Council has been an active supporter in providing training and resources to support RDPS staff.

Healthy Smiles OntarioImplementation of the new integrated Healthy Smiles Ontario program changes how service is provided for low-income families

In December 2013, the Ontario Ministry of Health and Long-Term Care (MOHLTC) announced that it would be integrating all provincially and municipally funded oral health programs for children under the Healthy Smiles Ontario (HSO) banner. The new program took effect on Jan. 1, 2016.

HSO provides basic dental coverage for children from birth to 17-years old who previously received care through Ontario Works (OW), the Children in Need of Treatment program, the Ontario Disability Support program, HSO, Assistance for Children With Severe Disabilities, and preventive services provided under the Ontario Public Health Standards (OPHS). Children will receive a full range of basic dental care through this new program. Low-income families who have access to some form of dental insurance are no longer automatically ineligible for HSO. Children who do not qualify for the new program may still be eligible for emergency care through the Emergency and Essential Services Stream of the HSO program.

Implementation of the new program has changed how the Oral Health division helps low income families access dental care. Because the new program has a central administrator, Oral Health staff no longer work directly with dental offices or pay dental claims for children. This resulted in the Oral Health division creating a new position to help clients navigate through the system to apply for programs and access treatment. In 2016, 986 families were given access to care through HSO.

The Health Department’s Oral Health clinic continues to screen children and provide preventive care. A clinical dentist has been hired to provide the full range of dental treatment for children on the HSO program. In 2016, the clinic had 4,736 visits, of which, over 1,600 were seen by the new dentist. The Oral Health division continues to provide dental care for vulnerable children both in priority neighbourhoods and at preventive portable clinics in schools.

As part of the OPHS, Oral Health staff provides oral health school screenings and education in all publicly-funded schools, as well as oral health promotion at numerous community events. Oral Health staff will continue to support the Region’s Department of Social Services in the provision of emergency and discretionary dental benefits for adults on OW.

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Healthy Babies Healthy Children: Supporting Durham Region families

Healthy Babies Healthy Children (HBHC) is a home visiting program that provides service to women and their families in the prenatal period, as well as to families with children from birth until their transition to school, that face challenges that may place their child at risk for optimal child development.

Public health nurses (PHNs) and family visitors work collaboratively with families to promote parental and family health, support child growth and development, provide information on improving parenting knowledge and skills, promote positive social support, and connect families with community supports to address their needs.

In 2016, 344 families were referred to the home-visiting program. PHNs conducted 2,148 home visits and family visitors completed 3,748 home visits. Examples of goals that were chosen by families to address through HBHC include optimal growth and development, continued education and employment training, effective management of addiction and dependency, effective settlement and cultural adaptation, financial stability, healthy attachment, healthy nutrition and food security, healthy relationships, housing stability, optimal parental health and positive parenting.

Clients often express appreciation for the support they receive. In a letter to the program, a client wrote, “I wanted to let you know that you made a huge impact on my experience as a new mom and it was a positive one. I hope you know that what you do day-in and day-out impacts lives in the most amazing way possible.” Another client said, “I wanted to take this time to share with you that through these very tough months [the PHN] has been supportive, positive and dedicated to helping both me and my daughter be healthy."

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Infant and Child Development joins the social conversation

On Jan. 8, 2016, Infant and Child Development (ICD) initiated a Facebook page with the goal of encouraging communication with clients and providing general information to the public and clients, while providing a link to families on the waiting list for ICD service. The launch of this Facebook page has been very successful. There have been 117 page “likes”, 92 per cent of which are from women. ICD’s most popular posts were “Avoid the Containers”, posted in April 2016 with 1,875 reaches and 18 shares, and “Building blocks, School Readiness for Children with Autism”, posted in September 2016. The general trend has been a growing of number of reaches, shares and page likes. ICD staff will continue to develop this initiative and will implement plans to improve the reach of the ICD Facebook page to increase engagement of the targeted audience.

Infant and Child Development improves service delivery

Information gathered from Infant and Child Development’s (ICD) 2013 Measures of Process of Care (MPOC) survey determined that improvements could be made to ICD’s service delivery if ICD staff took a more active role in providing general information to families. General information includes material about child development, diagnoses and health conditions, community resources and what the future may look like.

As a result, the MPOC General Information Survey was sent by mail to a total of 443 families who receive active service from ICD, with 97 families completing the survey.

Parents surveyed indicated that although they received most of their “general information” from family members, the preference was to receive this information from ICD staff. In addition to information on general child development and community resources, parents indicated that they also wanted information on their child’s future and how to connect with other parents.

ICD plans to share the results of the MPOC general information survey with families receiving services through the ICD program by sharing the survey results through social media or written communication. Building staff capacity and competency in the area of providing general information to families and planning for the future will be a part of ongoing staff development.

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Reporting lapses in infection prevention and control

In October 2015, the Ontario Ministry of Health and Long-Term Care (MOHLTC) announced that public health units are required to publicly disclose any infection prevention and control (IPAC) lapses in settings such as, but not limited to, facilities operated by regulated health professionals, personal services settings, temporary dwellings established for temporary or seasonal workers, schools at all levels, child care centres and unlicensed child care facilities, recreational facilities including sports clubs, and community centres.

An IPAC lapse is defined as a deviation by an operator from the standard of care required that may result in infectious disease transmission to clients, attendees or staff through exposure to blood, body fluids and/or potentially infectious lesions. The Health Department uses the most current IPAC standards of care documents created by Ontario’s Provincial Infectious Diseases Advisory Committee, Public Health Ontario, MOHLTC, or other relevant organizations as a guide to conduct these investigations. This new reporting requirement formalizes the work that the Health Department was already doing when investigating major IPAC lapses that required public notification in order to locate clients. The major difference now is that all public health units are provincially mandated to report these lapses, even if public notification of clients is not necessary. The Health Department also posts all IPAC reports on the Durham Region website.

In 2016, four IPAC lapse reports were posted. In addition, the Health Department conducted several other IPAC lapse investigations that did not meet the requirements for posting because there was no risk of transmission of infectious disease.

This new posting requirement allows for increased transparency of these investigations that may affect the public, providing more information to help community members make informed decisions on their own health. As well, this new lens on IPAC procedures will help to increase knowledge, practice and accountability for operators of these affected services.

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Snapshot on Harm Reduction Programming

Snapshot on Harm Reduction Programming Report

The Snapshot on Harm Reduction Programming report provides background on why harm reduction is needed and includes trends in drug use, hospitalizations and mortality related to drug use and incidence of relevant infectious disease. The report describes Durham Region’s harm reduction programs, including trends from Project X-Change, and outlines what the Health Department is doing to support harm reduction, along with providing relevant community resources.

Harm reduction consists of policies, programs and practices that aim to reduce the negative health, social and economic consequences that may ensue from the use of legal and illegal psychoactive drugs, without necessarily reducing drug use. The personal medical risks associated with drug use include overdose or acquiring blood-borne infections such as HIV or hepatitis C from sharing contaminated drug paraphernalia. In a recent survey, 12 per cent of Durham Region residents 12 and older reported using an illicit drug in the past 12 months. In addition, among beneficiaries of the Ontario Public Drug Program, opioid prescribing rates have increased in recent years and are higher in Durham Region than other areas of Ontario.

In Durham Region, data shows increases in hospitalizations and emergency department visits due to opioid misuse, as well as deaths due to drug toxicity in the past several years. Between 2003 and 2015, there was an average of 190 hospitalizations and 370 emergency department visits each year among area residents for opioid prescription drug misuse.

Hepatitis C and HIV/AIDS are the infectious diseases most commonly associated with injection drug use. In Durham Region, there was an average of 170 new cases of hepatitis C identified each year between 2011 and 2015, and rates of new cases are higher in Durham Region than other areas of Ontario. Injection drug use was the most common risk factor reported by 41 per cent of hepatitis C cases in Durham Region. During the same time period, there was an average of 13 new cases of HIV/AIDS identified each year locally.

Project X-Change is a harm reduction program offered through the John Howard Society of Durham Region and funded by Durham Region Health Department. Project X-Change has been operating in Durham Region since 1997 to provide sterile needles and other equipment for safer drug use, along with safe disposal of products. The number of needles exchanged increased substantially between 1997 and 2015, with 90 times as many needles distributed and 75 times as many needles received. The number of client contacts at Project X-Change also increased from just over 1,000 in 1997 to close to 10,000 in 2015.

Harm reduction activities in Durham Region include the needle exchange program, opioid patch return program, naloxone distribution and support programs for sex trade workers. Many Durham Region community agencies are involved in harm reduction programming, including the Health Department, the AIDS Committee of Durham Region, the John Howard Society of Durham Region, Pinewood Centre of Lakeridge Health, Carea Community Health Centre, and the Positive Care Clinic of Lakeridge Health.

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Prioritizing comprehensive school health

Public health nurses (PHNs) work with all schools to promote comprehensive school health. Healthy schools initiatives engage school staff, students, parents and community stakeholders to address the health and well-being of the whole school community.

PHNs support schools with establishing health action teams, where representation from all involved stakeholders work together to create, implement and evaluate school health action plans. PHNs play an important role in helping schools to assess their health needs and develop strategies to improve the school’s health and well-being.

Throughout 2016, PHNs used a number of strategies to support comprehensive school health such as:

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My Life My Voice: The Experience of young parents in Durham Region

Adolescence can be a challenging period of growth and development, involving numerous physical, psychological and social changes. Transitioning to parenthood during this sensitive developmental stage can present additional health challenges to both parent and child.

When young parents and their children are supported with the right service at the right time and in the right place, there are many short and long-term benefits. These positive outcomes are reflected in the mental, social and physical well-being of both parent and child.

To gain greater insight into the lived experience of young parents, public health nurses, as members of the Young Parents Community Coalition (YPCC), embarked on a qualitative research project.

Through one-on-one interviews of 44 young parents 14 to 23-years old across Durham Region, researchers asked young parents to share their experiences, along with their hopes and dreams for the future. Information obtained from these interviews was analyzed, themed and summarized in a final report entitled My Life My Voice: The Experience of Young Parents in Durham Region.My Life My Voice Report

Themes identified include:

The report was formally launched on Oct. 19, 2016 and the coalition has presented the report to various community groups. Presentations have included an overview of the project and key findings, along with recommendations to support and enhance programs and services for young parents.

The YPCC was established in 2005 with the goal of ensuring expectant and young parents in Durham Region receive information and services that support and encourage them to be the best parent possible. Membership of the YPCC is currently made up of 12 community agencies from across Durham Region.

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2016 Financial Information

Expenditures

Revenues

Chronic Diseases & Injuries

$ 8,991,031

Region of Durham

$36,575,891

Emergency Medical Services

42,693,304

Province of Ontario

55,355,430

Environmental Health & Emergency Preparedness

6,588,443

User/Program Fees

874,200

Family Health

13,808,978

 

Infectious Diseases

10,133,027

 

Professional & Administration Services

10,590,738

 

 

$92,805,521

 

$92,805,521


2016 Community Health Check-Up