December 2020 Board Meeting

Meeting held via video.

DATE

December 17, 2020

SUBJECT

Influenza Vaccine Update

BACKGROUND

The Windsor-Essex County Health Unit (WECHU) plays a key role in the implementation of the Ministry of Health’s Universal Influenza Immunization Program (UIIP) which offers influenza vaccine free of charge each year to all individuals six months of age and older who live, work, or attend school in Ontario. The WECHU receives influenza vaccine shipments from the Ontario Government Pharmacy (OGP) and is responsible for the distribution to local health care providers and approved facilities in the community.  Allocation to providers is based on total community allocation, number of clients to be served, past usage by the provider, available fridge space, and the proportion of high-risk clients the provider is responsible for. As of December 1, 2020, there were no laboratory-confirmed cases of influenza in Windsor and Essex County.

SUMMARY OF VACCINE ALLOCATION & DISTRIBUTION

The WECHU received initial shipments of the influenza vaccine on September 28 and October 5.  In total, the WECHU received 127, 150 doses of the vaccine from the Ministry. Of these, 31,800 were the High Dose Trivalent Inactivated Vaccine (HD-TIV) for individuals 65 and over.

As of November 27, the WECHU has distributed 89% (113,960 doses) of our total allocation of the influenza vaccine, and 100% (31,800 doses) of the HD-TIV to the community, including 41 long-term care facilities and retirement homes, 4 hospitals, and approximately 200 healthcare providers. The OGP distributed the influenza vaccine directly to 101 pharmacies in WEC that were approved by the Ministry of Health, and at the time this report was written, pharmacies have administered 43,955 doses to WEC residents.

The initial supply of influenza vaccine is prioritized for the immunization of high-risk individuals, such as residents and staff of long-term care homes and retirement homes. Overall, the WECHU has distributed 5,655 influenza vaccine doses to 19 long-term care homes, and 2,240 doses to 22 retirement homes in WEC. A further breakdown is provided below:

HIGH DOSE -TIV

On November 16th, the Ontario Ministry of Health notified all Health Units that Fluzone High Dose is out of stock, and will not be available for the remainder of the season. However the standard dose of Quadrivalent Influenza Vaccine (QIV) is still available, and there is no preferential recommendation for high dose over QIV.

ADVERSE EVENTS FOLLOWING IMMUNIZATION

Concerns were identified through the Adverse Events Following Immunization reporting system, and the administration of a specific lot of FluLaval Tetra was suspended. Investigation is underway nationally, and the WECHU has contacted all healthcare providers on record who had received the affected vaccine to halt its use until further notice. The WECHU will continue to update healthcare providers as more information is received from the Ministry of Health.

CURRENT INITIATIVES

Although the WECHU is not administering the influenza vaccine to clients this year, we continue to support widespread availability of the influenza vaccine in our community by working collaboratively with many community partners, including those in primary care, to identify service gaps and promote vaccine uptake.

The WECHU continues to raise awareness of the risks of contracting influenza (especially for high-risk groups), and the importance of being vaccinated amongst the COVID-19 pandemic through our social media platforms (i.e., Facebook, Twitter, and Instagram).

PREPARED BY

Lorie Gregg, Director of Corporate Services

DATE

December 17, 2020

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 related programs funded 100% by the Ministry of Children, Community and Social Services (“MCCSS”).  These programs are:

• Healthy Babies Healthy Children Program;
• Prenatal and Postnatal Nurse Practitioner Program.

The budgets for these programs were approved by the Board of Health for the WECHU on May 21, 2020.  On October 30, 2020, the budgets were formally submitted to the MCCSS along with financial information for the period April 1, 2020 to September 30, 2020.  Details of that submission is included in the narrative below.

Of noteworthy mention is the following:

• The MCCSS required that financial information for the aforementioned programs, both budget and year-to-date actuals, be reported on a combined basis.  For consistency with the WECHU’s presentation of the 2020/2021 budgets on May 21, 2020, the WECHU has continued to report these programs separately.
• The prior year’s comparative information for the aforementioned programs has not been presented due to the change the MCCSS change in fiscal years (was January to December; now April to March).

On September 30, 2020, the MCCSS launched the Transfer Payment Ontario (TPON) system.  The TPON will enhanced transfer payment business processes and reduce administrative burden on service providers, enhance efficiency and improve outcomes and the overall client experience.  More specifically, transfer payment recipients such as the WECHU will be able to submit financial and non-financial reporting requirements to the MCCSS on-line.

HEALTHY BABIES HEALTHY CHILDREN PROGRAM INITIATIVE

The Heathy Babies Healthy Children Program Initiative supports 26 FTEs comprised of managers (2), nurses (16), family home visitors (4), social worker (1.0) and support staff (3.0).  The objective of the program is to ensure a healthy future for children and their families.  Total funding envelope for this program initiative is $2,755,841. 

PRENATAL AND POSTNAL NURSE PRACTITIONER PROGRAM INITIATIVE

The Nurse Practitioner Program Initiative supports 1.0 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.  Total funding envelope for this program is $139,000.

DATE

December 17, 2020

SUBJECT

Oral Health Program Update

BACKGROUND

The novel Coronavirus (COVID-19) has affected many public health services, including the WECHU’s oral health program. Those services include the Healthy Smiles Ontario (HSO) and the Ontario Seniors Dental Care Program (OSDCP) dental clinics, as well as in-school dental and vision screening programs.

ORAL HEALTH

Following guidance from the Royal College of Dental Surgeons of Ontario (RCDSO) and the Ministry of Health, the WECHU suspended all non-essential and elective dental services on Monday, March 16, 2020 and redeployed oral health staff to the COVID-19 response.  Dental screenings in schools were suspended and the clinic remained open in Windsor for emergency services only until June 22, providing 79 office visits from March.

Due to the shutdown, 2,377 OSDCP and HSO appointments had to be cancelled. Following the health care sector restart guidance from the Ministry of Health, the Windsor clinic resumed full operations at the end of June, while the reopening of the Leamington clinic was gradual and operational at the end of August. All oral health staff have returned to the department, while continuing to support the COVID-19 call centre as part of their regular duties. As of November 26, 2020, 93% of the 2,377 appointments have been contacted and rescheduled.

All dental screening and vision screening programs have been suspended at this time.

In the 2019/20 school year:

• 73 schools of the 123 schools required for dental screening were completed
• 8,300 children screened, approximately 6,673 children were un-screened under the oral health screening program
• 2,840 (68%) of SK students attending 78 Windsor-Essex elementary schools received vision screening. 35 schools were not completed.

CURRENT INITIATIVES

COVID-19 has affected many public health programs and services, including future program operations. In addition, infection prevention and control measures call for limiting the number of essential visitors in the school. As a result, school dental and vision screening may not resume in 2020-2021.

The WECHU has partnered with the Southwest Ontario Aboriginal Health Access Centre (SOAHAC) to provide free oral health screenings for First Nation, Métis, and Inuit (FNMI) people and their families. A Registered Dental Hygienist (RDH) from the WECHU works at the SOAHAC Windsor location bi-weekly, providing dental screenings and oral hygiene instruction to their clients. This service had been shut down due to COVID-19 but was reinstated on November 23, 2020.

ORAL HEALTH PROGRAMS

Baby Oral Health Program (BOHP)

Parents of babies born at Windsor Regional Hospital usually receive an infant dental education kit. Despite being put on hold due to COVID-19, this service resumed in July. So far this year, 1,802 bags were delivered to the hospital for distribution.

WECHU Healthy Smiles Ontario and Ontario Seniors Dental Care Plan

We have a high patient volume and due to reduced clinical services for four months, we have experienced a slight backlog in treatment. Approximately 40-45 HSO and OSDCP clients are seen daily across the two clinic locations. We are currently booking into March 2021 for certain dental procedures. From January 2020 to November 2020 the WECHU saw 2,386 HSO and OSDCP clients for 4,528 appointments.

The OSDCP began at the WECHU in January 2020, providing free, routine dental services for low-income seniors 65 years of age or older. Since the program’s provincial implementation in November 2019, 1,002 seniors from the Windsor-Essex area enrolled in the program. Each client requires a new patient exam. To date we have completed 405 new patient exams therefore, we can determine that we have seen 40% of the seniors that have enrolled into the OSDCP program in this region. Our contract denturist has completed 88 denture consultations.

Currently, we have one full-time dentist, four contract dentists and a contract denturist. We plan to bring on a second full-time dentist in 2021.

DATE

December 17, 2020

SUBJECT

Healthy Families Department and Healthy Babies, Healthy Children Program Update

BACKGROUND

Healthy Babies, Healthy Children Program (HBHC) is a provincial home visiting program designed to help children get a healthy start in life through nursing and peer support. The program supports the most vulnerable and marginalized families in our community with the goal of improving developmental outcomes. HBHC has three entry stages namely; Prenatal; Postpartum; and Early Identification; and requires screening to identify a family at risk (screen score 2 or >). The HBHC screen identifies a family experiencing a need, issue or risk that may compromise healthy child development; and/or parenting ability; and who may benefit from a more thorough evaluation and receipt of HBHC program services or other community services. HBHC staff utilize standardized assessments and evidence-based interventions to work on family centred goals and develop a Family Service Plan that monitors the progress and achievement of those goals. HBHC is a free voluntary home-visiting program compromised in WECHU of 16 nurses, 4 Family Home Visitors (lay providers) and Social Workers (SW) that support families with:

• healthy pregnancy and prenatal care
• developing a positive relationship with their child
• promoting child’s growth and development
• connecting families to resources and programs within their community
• working together with families to help give their child the best start in life

PROGRAM UPDATE

As a result of COVID-19, pandemic-related redeployment significant adjustments were made to service delivery.  Beginning in March 2020, in-person home visits with families were discontinued due to the COVID-19 pandemic. Two nurses and one social worker continued to support 138 existing HBHC families. All visits with families moved to virtual and phone support and any new qualifying parents who wished to participate in the program were placed on a waitlist until June (48). These forms of communication have inherent limitations (e.g., inability to provide hands-on demonstration or effectively observe the home environment) and many clients did not have access to the technology needed to facilitate meaningful interactions. To maintain engagement and support client progress, staff needed to customize service delivery to meet client needs. The HBHC Social Worker has since worked to improve client access to the internet via financial aide.

The Healthy Family’s department hotline has remained operational, triaging calls on healthy growth & development, community resources and breastfeeding. The Lactation Consultant (LC) was also available to provide breastfeeding support over the phone or virtually to both HBHC clients and community members. Due to the cancellation of services and limited supports available to new mothers during the pandemic, the Healthy Families department prioritized calls to all mothers the HF within 48-72 hours of birth.

Lack of departmental engagement of physicians and midwives during this time likely contributed to the significant reduction in referrals to the HBHC program. Overall, referrals decreased by 14% over the pandemic compared to the same period in 2019. This may also be in part due to the absence of HBHC Hospital Liaison nurse.  Prenatal referrals have been the most significantly affected. Only 22 prenatal referrals were received during this time, compared to 160 in 2019. This change warrants further investigation since prenatal intervention within the HBHC program can improve pregnancy outcomes and better prepare families to navigate the challenging newborn stage of parenting.

Currently, HBHC has six (6) public health nurses supporting 161 clients on caseload. Staff have reported an increase in mental health concerns among their clients and increased severity for those with pre-existing anxiety and depression. This may be attributed, at least in part, to the financial strain, isolation, and general uncertainty caused by the pandemic as reported by some clients. In response, WECHU has hired an additional Social Worker for the HBHC program to focus on mental health-related issues. This Social Worker will consult with HBHC staff regarding mental health challenges, provide brief counselling directly to clients, and help clients access appropriate supports within the community.

Additionally, staff have reported that clients continue to struggle to afford healthy food for their families and access affordable housing. Pandemic-related income loss, along with the simultaneous increase in the price of food and housing have placed excessive strain on the program’s low-income families. This strain has left some families looking for ways to save on groceries, including prematurely discontinuing the use of infant formula. Transitioning from infant formula to fluid cow’s milk before nine months is linked to nutrient deficiency that can hinder a child’s lifelong growth and development potential. To ensure that clients have access to the funds they need to afford infant formula or support a nutritious diet for the breastfeeding mother, the department’s Registered Dietitian and HBHC Social Worker are developing a procedure to ensure clients are able to access the province’s Special Diet Allowance in a timely manner. The Special Diet Allowance provides additional funds to families on social assistance who are pregnant, breastfeeding, or reliant on infant formula.  The Social Worker is also continuing to investigate actions to improve access to affordable housing.  

During these unprecedented times, HBHC staff have remained committed to providing the best possible service to the most vulnerable families within our community. We have continued to work and develop processes with our community partners to ensure wrap around care for our families. Outreach to local midwives and physicians has begun with regard to increasing our Prenatal and Early-ID referrals. Additionally, Policies and Procedures have been prepared to safely reinitiate in-person home visits, on a case-by-case basis, in an on-going effort to improve client engagement and adequately address their needs.

COMPARISON OF WITH RISK SCREENS, 2019 & 2020

Board Members Present:

Gary McNamara, Joe Bachetti, Rino Bortolin, Fabio Costante, Dr. Debbie Kane, Gary Kaschak, Judy Lund, John Scott, Ed Sleiman, Larry Snively 

Board Member Regrets:

Tracey Bailey

Administration

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

QUORUM:  Confirmed

RECORDING SECRETARY:

SUBMITTED BY:

APPROVED BY: