Connecting the Dots:
Connecting the Dots
How Ontario Public Health Units are Addressing
Child and Youth Mental Health
July 10th, 2013, 1:00 - 2:30 PM
Connecting the Dots:
Agenda
• Review report findings
• Panel discussion
• Dr. Heather Manson, Public Health Ontario
• Lynne Hanna, Halton Region Health Department
• Dr. Robin Williams, Associate Chief Medical
Officer of Health for Ontario
• Questions & answers, discussion
2
Connecting the Dots
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Project leads:
Connecting the Dots:
Accessing the Report
4
Public Health Ontario http://www.publichealthontario.ca
Centre for Addiction and Mental Health http://www.camh.ca/en/hospital/about_camh/provincial_systems_support_program
/Documents/Connecting%20the%20Dots%20FINAL.pdf
Connecting the Dots:
Steering Committee
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Connecting the Dots:
Purpose
To capture the range of child and youth mental health activities, initiatives, services and programming occurring across Ontario’s public health system.
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Connecting the Dots:
*Mental Health or other terms of interest • Infant, child or youth mental
health • Psychological health • Emotional health • Mental well-being • Mental wellness • Mental illness • Mental health promotion • Mental illness prevention • Mental health literacy • Body image / self-esteem • Stress • Resiliency • Stigma reduction • Suicide Prevention • Prevention of self-harm • Bullying • Violence • Discrimination • Crisis support / management
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Scope
• Range of activities at public health level
• Children & youth (along the continuum from infants to young adults)
• Mental health focus*
Connecting the Dots:
Methodology
• Ethics review
• Outreach • We contacted all Medical Officers of Health and invited staff
from each of Ontario’s 36 public health units to participate
• Data collection and analysis • Survey (on-line, collect information through key contact at
each PHU) • Two researchers independently cleaned and
reviewed dataset • Data was analysed in SPSS
• Key Informant Interviews
• Transcripts analyzed and coded by two researchers
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Connecting the Dots:
Overview of Findings • All 36 Ontario health units completed the survey.
• 325 activities or initiatives reported
• Ranging from 1 to 32 per PHU
• Many factors shape and influence the role of public
health units, both individually and collectively. Some of these are supportive in nature while others present barriers.
• Health units identified specific supports to improve work in this area.
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Connecting the Dots:
Survey Results
• Activity type
• Target audience
• Partnerships
• Funding
• Mandate/impetus
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Type of Activity
17.2%, n=56
0.6%, n=2
1.2%, n=4
1.5%, n=5
2.2%, n=7
5.2%, n=17
6.5%, n=21
16.3%, n=53
49.2%, n=160
0% 20% 40% 60%
1
2
3
4
5
6
7
8
9 Program delivered by your PHU
Knowledge exchange or capacity building
Communications
Planning
Policy or advocacy-related
Evaluation or research
Program delivered by another agency through a financial transfer from your health unit
Surveillance or population health assessment
Other
Program delivered in partnership with another organization
Committee participation
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Secondary Categorization
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Category Percent Count
School-based programming 32 104
Parenting supports and programs 23 75
Committees, networks and coalitions 10 34
Direct services 8 26
Community-based youth skills-building programming
7 23
Communication and awareness-raising activities
5 18
Strategic planning and policy-related initiatives
5 17
Training and capacity building for PHU staff and/or service providers
5 17
Research and surveillance activities 3 11
Target Audience
62.5%, n=203
52.9%, n=172
44.3%, n=144
44.3%, n=144
26.5%, n=86
20.6%, n=67
18.8%, n=61
11.4%, n=37
8.9%, n=29
5.5%, n=18
0%
20%
40%
60%
80%
Children orYouth
Parents, CareProviders, or
Gaurdians
Education Public HealthStaff
Social ServiceProviders
MentalHealth
Providers
Other HealthProviders
GeneralPublic
Government Other
Other community organization Non-PHU staff Law enforcement Volunteers Faith-based organization Pregnant teens / youth Researchers
13 Guardians
Target Age Groups
47.2%, n=154
57.4%, n=187
64.1%, n=209
25.8%, n=84
16.6%, n=54
0%
20%
40%
60%
80%
0 - 6 7 - 13 14 - 18 19 - 25 25 +
Top 6 discrete age-ranges 1. 0 to 6 16.3% 2. 7 to 18 15.7% 3. 14 to 18 13.2% 4. 0 to 18 12.3% 5. 7 to 13 9.8% 6. “All ages” 7.1%
14 19 - 24
Partnerships
14.5%
0.3%, n=1
2.5%, n=8
6.8%, n=22
11.4%, n=37
17.5%, n=57
11.7%, n=38
5.5%, n=18
1.8%, n=6
1.8%, n=6
24.9%, n=81
50.5%, n=164
23.4%, n=76
2.5%, n=8
6.2%, n=20
4.9%, n=16
17.8%, n=58
33.5%, n=109
27.4%, n=89
23.7%, n=77
10.5%, n=34
8.0%, n=26
35.7%, n=116
21.2%, n=69
0% 20% 40% 60%
Other
Business
College/University
Government
Hospital/CHC
Local Social Service
Mental Health Org.
Other Dept. in PHU
Other Mun. Dept.
Other PHU
School/Board
None
Informal Formal
Committee, coalition or network Community organization Ontario Early Years Centre Health care provider Law enforcement
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Impetus
46.5%, n=151
22.2%, n=72
16.0%, n=52
14.2%, n=46
3.7%, n=12
2.8%, n=9 0.3%,
n=1
30.2%, n=98
2.2%, n=7
0%
20%
40%
60%
Local Need Board ofHealth
School orSchoolBoard
ExternalPartner
City Council OntarioMentalHealth
Strategy
FederalMentalHealth
Strategy
Other Don’t Know
Part of existing program or plan
Mandated program – HBHC
Consultation / report
PHU leadership / initiated
Service gap - youth engagement
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National
Primary Funding Source
63.1%, n=205
8.9%, n=29
2.8%, n=9
1.2%, n=4
17.2%, n=56
6.8%, n=22
0%
20%
40%
60%
80%
OntarioGovernment
LocalMunicipality
NGO User Fees Other Don’t Know 17
63.1%
8.9%
2.8% 1.2%
17.2%
6.8%
0%
20%
40%
60%
80%
OntarioGovernment
LocalMunicipality
NGO User Fees Other Don’t Know
Primary Funding Source (Breakdown of Government of Ontario as Primary Source)
Source Proportion
1. MOHLTC 68.3%
2. MCYS 12.7%
3. Unknown 4.9%
4. MOE 4.4%
5. MOHLTC / MCYS 2.0%
6. MTCS 1.5%
7. MOHLTC / MOE 1.0%
8. MOHLTC / MCYS / MOE 0.5%
9. Ontario Trillium Foundation 0.5%
10. Public Health Ontario 0.5%
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Use of OPHS or Guidance Documents to Guide the Activity
3.7%, n=12
3.7%, n=12
7.1%, n=23
0.3%, n=1
0.9%, n=3
1.8%, n=6
4.9%, n=16
14.5%, n=47
16.3%, n=53
19.7%, n=64
35.4%, n=115
38.2%, n=124
0.9%, n=3
8.0%, n=26
42.5%, n=138
44.3%, n=144
28.9%, n=94
0% 20% 40% 60%
Don't Know
None
Other
Emergency Prepardness Pro. Std.
Nutritious Food Basket GD
Child Health Program Oral Health GD
Comprehensive Tobacco Control GD
Prevention of Injury GD
Prevention of Substance Misuse GD
Healthy Eating, Physical Activity and…
Child Health GD
School Health GD
Environmental Health Pro. Std.
Infectious Diseases Pro. Std.
Family Health Pro. Std.
Chronic Disease and Injuries Pro. Std.
Foundational Std.
HBHC Protocol / GD Sexual Health Pro. Std.
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Connecting the Dots:
20 *Refer to Appendix D for the complete list of activities
Activity Examples*
Connecting the Dots:
Qualitative Results
1. Successes
2. Enablers
3. Barriers
4. Suggested supports
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Connecting the Dots:
1. Successes in promoting mental health/preventing mental illness in children and youth
• Engaging in specific activities & initiatives
• ‘Starting the conversation’
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Connecting the Dots:
2. Enablers for Promoting Mental Health/ Preventing Mental Illness in Children and Youth
• Partnerships
• Indirect Approaches
• Leadership & Commitment
“Public health doesn’t have a mandate within their Standards for mental
health. There are some things that can be linked with mental health and
that we need to address, such
as some of our Standards around nutrition and
addressing eating disorders. Eating
disorders are a mental health issue”
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Connecting the Dots:
3. Barriers to Promoting Mental Health/Preventing Mental Illness in Children and Youth
• Lack of a provincial government mandate
• Limited resources at the health unit level
• Coordination challenges among community partners
“We’ve got standards for everything else, but
mental health is nowhere. People are
talking about it more…it’s almost like the floodgates have opened, and we’re
not – we can’t respond to the
volume…”
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Connecting the Dots:
• Lack of focus on mental health promotion and mental illness prevention
“the backbone stuff around resiliency and youth
asset development and positive mental health promotion…is one area
that we think maybe isn’t being as well addressed because the focus is so
much on treatment, and access to service”
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3. Barriers (cont’d)
Connecting the Dots:
4. Suggested supports for promoting mental health/preventing mental illness in children and youth
• Provincial Guidance and Coordination
• Evidence on Best Practices
• Mental Health Indicators
• Training for Public Health Staff
• Knowledge Exchange
“Specific recommendations for action
would be helpful. Policy or documentation that made it a
Standard that we had to address would mean we would have to
devote time and resources to it”
“The impetus for developing a School Health Team was really the OPHS and I feel our health unit really works that way…it’s very based on the Standards,
like it’s really, really based on the Standards. So I think it would provide
a gateway to staff – permission to staff – to be able to address it. And
the guidance documents provide a lot of direction in terms of what activities we should be looking at. It also helps
define our role as a community partners”
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Connecting the Dots:
Summary and Conclusions • Public health units are undertaking a large number and
wide spectrum of activities to address mental health in children and youth often driven by local need.
• Enablers: partnerships, integration of mental health, alignment with evidence, leadership, and evaluation of efforts.
• Barriers: mandate, need for greater coordination, stigma.
• Future opportunities: exploring identified supports and the role of public health in mental health
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Connecting the Dots:
Questions and Answers
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Connecting the Dots:
Panel discussion: The role of public health in mental health
“I think public health has to look at the mental health of children and youth. It cannot reach its goals without doing
that…We just can’t look at physical health and sexual health and nutrition in isolation from the mental
component of a person’s growth and development.”
“We think our role as public health is to really focus on health promotion, mental health promotion, and on skill-
building in relation to resiliency and managing stress.”
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Connecting the Dots:
Panelists
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Connecting the Dots:
Dr. Robin Williams Associate Chief Medical Officer of Health for Ontario
Lynne Hanna Manager, School Years Health Halton Region Health Department, Region of Halton
Dr. Heather Manson Chief, Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario
Connecting the Dots:
Questions and Answers
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Connecting the Dots:
Thank You!
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For more information about the report, please contact:
CAMH Health Promotion Resource Centre [email protected]
Public Health Ontario
Toronto Public Health [email protected]
Access the report:
http://www.camh.ca/en/hospital/about_camh/provincial_systems_support_program/Documents/Connecting%20the%20Dots%20FINAL.pdf
http://www.publichealthontario.ca