Infant Hearing Program Service Levels and Funding in Toronto

Transcription

1 HL16.4 REPORT FOR ACTION Infant Hearing Program Service Levels and Funding in Toronto Date: November 24, 2016 To: Board of Health From: Acting Medical Officer of Health Wards: All SUMMARY The Ontario Ministry of Children and Youth Services (MCYS) provides 100% funding for the Infant Hearing Program (IHP). Toronto Public Health (TPH) is the lead agency for the Toronto Region and receives $2.3M annually to deliver the program in accordance with the provincially established IHP protocol and service targets. The purpose of the program is to identify infants with permanent hearing loss and provide the intervention they require to maximize their communication potential. Each year, the Toronto IHP screens 36,000 newborns, identifies approximately 150 infants with permanent hearing loss and arranges follow-up audiology and speech language pathology services for them until the age of six. Base provincial funding has been frozen at 2010 levels and has not kept pace with service needs. This has required TPH to rely on one time funding grants from MCYS over the past five fiscal years. These funding grants tend to be approved by the Board of Health and City Council in the provincial fourth quarter (January - March 31) which creates instability in infant hearing services until the grants are realized. It is critical that the IHP base funding be increased by $250,000 annually to meet the needs of Toronto's infants and their families. Without this increase in base funding, it is estimated that the reduction in services will result in a 20% decrease in the identification rate, impacting approximately 30 infants and their access to early intervention each year. This report examines the gap between the base funding and service requirements of the IHP for , and identifies the resources and funding required to bridge this gap going forward. RECOMMENDATIONS The Acting Medical Officer of Health recommends that: 1. The Board of Health request the Ministry of Children and Youth Services to increase the annual base funding for the Infant Hearing program by $250,000, effective Infant Hearing Program Service Levels and Funding in Toronto Page 1

2 in the provincial 2016/17 fiscal year, to enable Toronto Pubic Health to meet the program protocol and service targets. FINANCIAL IMPACT For the provincial fiscal year starting April 1, 2016 the Province approved $2.3 million in base funding for the TPH 100 percent provincially funded Infant Hearing Program. This base during has not changed since 2010 and is included in the TPH 2017 Operating Budget Request. If the Province approves this request, the TPH 2017 Operating Budget expenditures and revenues will be adjusted to reflect the approved increase in the base budget. The Deputy City Manager and Chief Financial Offer has reviewed this report and agrees with the financial impact information. DECISION HISTORY In August 2000, City Council granted authority to the Medical Officer of Health to negotiate and enter into purchase of service contracts for Preschool Speech and Language Services. In accordance with this delegation, the Medical Officer of Health reported annually on the status and amounts of the contracts HL4.7 - Service Agreements Awarded and Executed by the Medical Officer of Health for COMMENTS Description of the Program Research very clearly indicates that the early years are a critical period in a child's development for their health and well-being throughout childhood and well into adulthood. Delays in language development can affect cognitive, emotional and social development. Early detection of hearing loss and early intervention can positively impact a child s language development and success at school. The IHP program has reduced the average age of identification of a permanent hearing loss from four years to three months, enabling earlier intervention and better outcomes for children. The IHP program is an evidence-based early detection and intervention program designed to provide services until the child's sixth birthday. It is a voluntary program that focuses on maximizing children s communication potential and school readiness. In Toronto these services are provided by a blend of multidisciplinary staff which includes infant hearing screeners, audiologists, speech language pathologists, social workers and/or public health nurses from TPH and 10 contract agencies. Annually, the Infant Hearing Program Service Levels and Funding in Toronto Page 2

3 Toronto Board of Health approves the award and execution of service agreements with these contract agencies. The IHP program consists of three components: 1. Screening and Surveillance 2. Assessment and Identification 3. Early Intervention: Family Support and Communication Development Programming. 1. Screening and Surveillance Trained infant hearing screeners, including staff with a child development or nursing background, administer a hearing screen in hospital and the community using MCYSmandated equipment to receive either a pass or refer result. If an infant is missed or receives a "refer" result, they are to receive a subsequent screen at community clinic sites. If a child receives a refer result at this second screen, they are referred for an audiology assessment. The Toronto IHP program screens 36,000 infants a year, (approximately 90% of infants born in Toronto) within four weeks of birth, with an accuracy rate that meets provincial standards. To meet these aggressive targets, TPH has placed significant emphasis on supervision and training of the hearing screeners in the past two years. Infant Hearing Screeners also identify children at birth who exhibit risk factors including family history of hearing loss, infections, (e.g. Toxoplasmosis, Rubella) craniofacial malformations, and syndromes that are known to be linked with progressive permanent hearing losses. Of the 36,000 children screened, approximately 500 are placed on a surveillance pathway, requiring further assessment by an audiologist at four months. Annually, approximately 8 children are identified with a permanent hearing loss through this surveillance pathway. 2. Assessment and Identification Assessments by MCYS-trained audiologists are performed in sound proof booths at five hospitals across the city. Audiologists use MCYS-prescribed equipment and assessment procedures. Toronto audiologists assess approximately1000 babies a year and identify an additional 142 children with a permanent hearing loss for a total of approximately 150 children identified a year. 65% of these hearing losses are identified by 4 months of age. 3. Early Intervention Once identified with a hearing loss by an audiologist, early intervention begins. Family Support Workers (either Public Health Nurses or Social Workers) provide families with the information and support they require to make informed decisions regarding amplification, spoken and signed language development. Most often, infants are fitted with hearing aids and begin communication development programming with a speech language pathologist. 52% of the infants start their early intervention services by six months of age. In 2015/16, Toronto IHP conducted over 440 family support visits and 3375 speech and language pathology visits to the approximately 150 families with children identified with a permanent hearing loss. Infant Hearing Program Service Levels and Funding in Toronto Page 3

4 Funding Gap to Address Service Needs Base provincial funding for IHP has been frozen at 2010 levels and has not kept pace with service needs. This has required TPH to rely on one time funding grants from MCYS over the past five fiscal years: $124,785 (2012/2013), $19,824 (2013/2014), $201,000 (2014/2015), $216,600 (2015/2016), and a request for $237,300 (2016/2017). These funding grants tend to be approved by the Board of Health and City Council in the provincial fourth quarter (January - March 31) which creates instability in infant hearing services until the grants are realized. It is critical that the IHP base funding be increased by $250,000 annually to meet the needs of Toronto's infants and their families. Without this increase in base funding, it is estimated that the reduction in services will result in a 20% decrease in the identification rate, impacting approximately 30 infants and their access to early intervention each year. In 2013, MCYS revised the IHP Protocol that guides the delivery of the program. All of the changes were intended to increase program effectiveness. Toronto Public Health has implemented all components of the revised IHP Protocol. Specifically, TPH has increased the training and supervision to ensure quality assurance of screening, increased audiologist time for the surveillance of preschool children at risk for developing a permanent hearing loss, and purchased the MYCS-prescribed equipment and medical supplies. The Ministry of Children and Youth Services has directed TPH to use a sole source vendor for hearing screening equipment and supplies commencing in 2013, based on an extensive RFP process that was conducted by the province. As a result, TPH has no control over the medical supply and maintenance costs. The cost of supplies increased by 340% (from $1.25 to $5.49 per screen) and the equipment was off-warranty effective June Equipment maintenance costs of approximately $20,000 have been incurred in the past year and are expected to increase over subsequent years as the equipment ages. Thus, adherence to the MCYS protocol is more costly and has impacted TPH's ability to achieve MCYS service targets. In addition, the provincial base funding allocation has not taken into account the increasing need for interpretation and translation costs, given that 45% of Toronto residents speak a language other than English and French (City of Toronto, 2012). It is imperative that hearing screening and assessment results are interpreted for families in order that they may make informed decisions with respect to amplification and treatment to optimize their child s communication. Toronto Public Health has maximized its limited resources to deliver the IHP components at or within 10% of Ministry target levels to date. In the current fiscal year (2016/17), an additional $237,200 is required to maintain these service levels. For the period January to March 2017, all IHP service components will need to be cut by 50% if additional funding is not received. The overall impact to the program for the year will be a 20% reduction in services. The impact on each IHP service component is described below. Screening and Surveillance Approximately 7,200 (or 20% of the total babies (36.000)), will not be screened with a 20% reduction in screening time. Approximately 30 babies will be missed with a permanent hearing loss in the early years. Physicians do not have hearing screening technology in their offices and behavioural indications of milder hearing losses are often Infant Hearing Program Service Levels and Funding in Toronto Page 4

5 not detectable until children start school. Severe hearing losses can often be misinterpreted as developmental delays, resulting in inaccurate early intervention and inappropriate placement at school. Assessment A 20% reduction in audiology appointment times, will result in a 20% increase in wait times for hearing assessments. This impacts the age of identification of the hearing loss and the onset of early intervention. Early Intervention The number of family support and communication development programming visits delivered to individual families should not be impacted, however, there will be a 20% reduction in this service with 20% fewer babies (30) being identified with a permanent hearing loss. Toronto Public Health remains committed to maintaining the highest level of quality IHP services. However, the gap between IHP protocol-required service levels and funded service levels in Toronto is significant. Consequently, it is critical that the base funding for this program be increased by $250,000 annually in order to optimize the communication development and school readiness of at-risk infants and children in Toronto. CONTACT Carol Timmings Sara Koke Director, Child Health & Development Associate Director, Early Abilities Tel: Tel: ctimming@toronto.ca skoke@toronto.ca SIGNATURE Dr. Barbara Yaffe Acting Medical Officer of Health REFERENCES City of Toronto (2012). Backgrounder Census: Language. Retrieved on Nov, 4, administration/file s/pdf/language_2011_backgrounder.pdf Infant Hearing Program Service Levels and Funding in Toronto Page 5