Ministry of Children and Youth Services Update of Best Start February 1, 2007 Council of Ontario Medical Officers of Health Association of Local Public Health Agencies

2 What is Best Start? Goals Children in Ontario will be ready and eager to achieve success in school by the time they start Grade 1. Ontario will be an international leader in helping all children realize their social, intellectual, economic and physical potential. Best Start is a major redesign of services in terms of how families and children are supported from birth through to Grade 1. In the long-term, Best Start will lead to the development of an integrated comprehensive system of services that will: help children be successful in school. help prevent children from requiring services that target high risk children e.g. child welfare, youth justice. invest wisely to help ensure that future generations of Ontarians are prepared to be part of a highly adaptable and competitive economy.

3 Our Comprehensive Approach Human Development and Education SUCCESSFUL ENTRY TO ADULTHOOD AND WORK A prosperous Ontario Healthy, educated, involved citizens LIFE LONG LEARNING TRAINING & POSTSECONDARY ELEMENTARY/SECONDARY BEST START AGE 0 618ADULTHOOD

4 Best Start on the Ground Helps all children – regardless of individual economic or social circumstances. Early and on-going screening of all children to identify potential issues, needs, and risk – which in turn will help focus the planning and services offered by community service providers. An integrated approach – seamless from the child and family’s perspective – that brings together pre-school, JK, SK, quality child care, public health, and parenting programs, with explicit links to children’s mental health, children’s treatment centres and child welfare. Early learning and care hubs that act as the central place in the community where children and parents will go for screening, assessment and access to services. An ideal location for the hub is an elementary school. Flexible at the local level to help meet the needs of different communities: Aboriginal, Francophone, urban, rural, northern, new immigrant, etc.

5 Best Start on the Ground – Community Hubs Child Welfare Developmental Services Children’s Mental Health Children’s Treatment Centres Core Functions: Screening & Assessment: Communication and Social/Emotional Issues HBHC and Public Health Nutrition Programs Parenting Programs Child Care Pre-School JK/SK Preschool Speech and Language Infant Hearing Recreation Services

6 How Are We Going to Get There? Best Start is a comprehensive, long-term strategy to enhance the healthy development and early learning of Ontario’s children, which is being implemented in phases. Phase One of the Best Start Plan is focusing on three key priorities: Enhancing the quality of Ontario’s early learning and care system; Improving the accessibility and affordability of Ontario’s early learning and care system; and Enhancing Ontario’s system of early identification and intervention.

7 How Are We Going to Get There? Key Phase One Best Start components: An expansion of child care for children enrolled in Junior and Senior Kindergarten with moderate expansion of the system for children 0-4 years, as well as wage improvements for child care workers in the regulated sector. Three demonstration projects that will fast-forward the 10+ year vision. Other components included in Phase One: Expert Panel on Early Learning Framework; Expert Panel on Quality and Human Resources; Expert Panel on the 18 month well baby visit; Establishment of the proposed College of Early Childhood Educators; Service restoration/funding enhancements for Healthy Babies Healthy Children, Preschool Speech and Language, and Infant Hearing Programs; Move to a child care income test to determine eligibility for child care fee subsidies; Development of a simplified model for funding child care operators; and Measurement for progress and results using the Early Development Instrument.

8 How Are We Going to Get There? Phase Two will involve the implementation of the full Best Start vision across the province, including: Community hubs that will pull together screening, assessment and treatment, child care and parenting programs, and will have direct links to other children’s services such as mental health and speech and language resources. Preschool early learning program for children ages 2.5 to 4, at no cost to parents for 2.5 hours/day for 10 months every year and increased for the before and after school hours. Other programs and strategies including the implementation of the enhanced 18 month developmental review and evaluation using primary care providers for every child in Ontario, and a post-partum mood disorders strategy.

9 Best Start – Updates Enhanced 18 Month Well-Baby Visit Expert Panel has released their final report “Getting it Right at 18 Months…Making it Right for a Lifetime.” Copies of the report can be downloaded from Mandate of the Expert Panel: development of a report to provide the basis for a provincial strategy to support standardized developmental assessment at 18 months of age for each child in Ontario. Membership to the Expert Panel consisted of representation from pivotal organizations in child health and healthy child development, Ministry of Children and Youth Services and the Ministry of Health and Long-Term Care. Recommendations were reviewed by Ministry of Children and Youth Services (MCYS) in partnership with the Ministry of Health and Long-term Care (MOHLTC) and the Ministry of Health Promotion (MHP) The province is responding to the panel’s recommendations and has created an Implementation Advisory Committee and Working Group.

10 Best Start – Updates Enhanced 18 Month Well-Baby Visit (cont’d) The panel made two overarching recommendations which provide the context for the further recommendations: MCYS and MOHLTC dedicate appropriate resources and work collaboratively to implement an Enhanced 18 Month Well-Baby Visit; MCYS and MOHLTC establish an implementation group comprised of people with expertise in primary care, healthy child development, professional education, and data measurement and evaluation. The Expert Panel’s six specific recommendations are: 1. Provide parents and providers with tools to support an Enhanced 18 Month Well-Baby Visit. 2. Build effective partnerships among parents, primary care providers, and community resources. 3. Provide information, education, and support for primary care providers. 4. Encourage timely access to services and manage wait times. 5. Describe the developmental health status of our children. 6. Evaluate the impact of the Enhanced 18 Month Well-Baby Visit.

11 Best Start – Updates Best Start Demonstration Communities Our Best Start demonstration communities of Timiskaming, the rural areas of Lambton and Chatham-Kent, and Hamilton’s East end have been doing a tremendous job of accelerating the implementation of the full vision of Best Start. Throughout , approximately 24 hubs will become operational across the 3 demo sites, including Francophone- and Aboriginal-specific hubs. Demonstration sites are accelerating the implementation of key components of Best Start: 1. Enhanced 18 Month Well-Baby Visit Pilot an enhanced 18 Month Well-Baby Visit, promoting collaborative models for the delivery of the enhanced 18 Month Well-Baby Visit. 2. Postpartum Mood Disorder (PPMD) Over the next year, they will include activities focused on PPMD as we recognize that supporting parental mental health is a crucial aspect of all strategies aimed at improving child outcomes. 3. HBHC Lambton and Chatham-Kent with be further community integration, providing HBHC services in their hubs. 4. PSL & IH Enhanced Preschool Speech and Language and Infant Hearing Program services to Grade One entry. 5. Early Learning Framework 6. System Integration Learning and best practices from the evaluation of these three demonstration communities will inform broader provincial Best Start strategies responding to needs of public health.

12 Best Start – Moving Forward Preschool Speech & Language, Infant Hearing and HBHC Funding enhancements Announced by Minister Chambers on January 28, 07. Total increased investment for PSL is $4.2M in order to: Reduce existing waitlists, Improve training in the areas of language and literacy, and Expand service to Grade 1 entry for children who do not attend SK. Total increased investment for IHP is $1.1M Extend all services to children with identified permanent hearing impairment to Grade 1 entry. New Blind-Low Vision Early Intervention Program $1.8M The new Blind-Low Vision Early Intervention Program will provide a support program for preschool children who are blind or have low vision, and their families. Family-centred services will be available through this program for children from birth to Grade 1. Total increased investment for HBHC is $2.5M, which began in 2006 To support the universal screening of Ontario's newborns through home visits by public health nurses to new mothers who require or request them. Since 2004, a total of $10.85M additional investments have been made.

13 Best Start Moving Forward Community Planning – Next Steps The next step for community planning is the development of strategies to move the local system forward along the system integration continuum. Best Start networks are a key driver for the next step of Best Start implementation – system integration. The community hub is a venue for delivering an integrated system of services. To move forward with system integration, communities need to consider: How best to align planning process and delivery models so as to maximize the benefits of collaborative planning and avoid service duplication where possible; Shared service priorities and areas of potential collaboration; and, How to streamline delivery in a way that improves access and outcomes for children and their families. Addendum to the Implementation Planning Guidelines developed by the MCYS as a tool to support communities in moving forward with system integration.

14 The success of the HBHC program is our comprehensive strategy and reach, through the various components of the program undertaken by the PHUs: 1. Prenatal Component 2. Universal Component 3. High Risk Home Visiting Component 4. Early Identification Component 5. Service Planning and Coordination Healthy Babies Healthy Children

15 HBHC – Components and Tools Discharge Post Partum Contact Phone Contact Home Visit Assessments Brief In-depth Screening Postpartum Early ID Prenatal Service Delivery Service Planning Home Visiting Referral Service Delivery

16 The Integrated Services for Children Information System (ISCIS) is a case management system that supports the HBHC program and can be used for electronic charting. At present many PHUs are successfully using ISCIS for electronic charting in varying levels of paperless operations. Those PHUs who wish to implement electronic charting, our staff and the ISCIS group are ready and able to assist you in these endeavours. Aside from a case management system, ISCIS tracks large numbers of statistical data elements and service targets permitting the tracking of provincial and PHUs annual achievements. New HBHC-ISCIS Reporting sub system (IRSS 2), a decision support reporting system for the HBHC program, was implemented in April Hands on training was provided in May The initial Data Mart introduced was Post Partum Contact. The Post Partum Home Visiting and Postpartum Screening Data Marts will become available March HBHC - ISCIS

17 ISCIS Statistical Data The Ministry has a number of program standards: 1. Prenatal - 25% of women screened using a Larson 2. PP Contact – 100% of families contacted within 48 hours of discharge. 3. PP Home Visit – 75% of families receive a home visit 4. In-depth Assessment – 12% of families complete an In-depth Assessment HBHC – Program Standards

18 HBHC – Program Standards Prenatal - 25% of women screened using a Larson Provincial average: 20% Women Screened Using a Larson

19 HBHC – Program Standards Prenatal - 25% of women screened using a Larson Provincial average: 20% Women Screened Using a Larson

20 HBHC – Program Standards Live Births Screened with a Parkyn Postpartum – 100% of live births screened with a Parkyn Provincial Average: 93.1%

21 HBHC – Program Standards Postpartum Contact – 100% of families contacted Provincial Average: 96% Families Contacted After Discharge Contacted within 48 hours Contacted after 48 hours

22 HBHC – Program Standards Postpartum Contact – 100% of families contacted within 48 hours of Discharge Provincial Average: 80% Families Contacted within 48 hours of Discharge

23 HBHC – Program Standards Families Receive a Postpartum Home Visit Postpartum Contact Home Visit – 75% of families receive a postpartum home visit Provincial Average: 45%

24 HBHC – Program Standards Postpartum Contact Home Visit – 75% of families receive a postpartum home visit Provincial Average: 45% Families Receive a Postpartum Home Visit

25 HBHC – Program Standards In-depth Assessment – 12% of families complete an In-depth Assessment Provincial Average: 10% Families Complete an In-depth Assessment

26 Postpartum Mood Disorder (PPMD) The outcomes in the three demonstration sites will inform a broader HBHC strategy to respond to needs related to parental mental health. Enhanced 18 Month Well-Baby Visit Collaboration with the Enhanced 18 Month Well-Baby Visit to encourage families to consider participation. Update 2003 HBHC Consolidated Guidelines Update and revise the guidelines, including a review of evidence based practices. ISCIS Enhancements ISCIS Reporting Sub System (IRSS) Data Marts. eParkyn. Remotes assess/entry. Best Start System integration at the Best Start planning tables. Multi Ministry Activities (MOHLTC, MHP and MCYS) Clarification of funding responsibilities. Program expansion/funding enhancements. HBHC – Potential Next Steps

27 Ontario’s Best Start Plan Thank you ……Moving Forward