2023 Annual Report

Climate change is causing negative effects on our health in a number of ways. One of which is poor air quality from smoke created from wild fires which was experienced in 2023 in our area.

The Health Unit takes steps to ensure residents are prepared for poor air quality events and they can respond based on their health needs. The Air Quality Health Index is an important tool to help the public prepare and respond when a poor air quality event is imminent or is occurring.

We encourage people to assess their personal risk to reduce the health effects of poor air quality. The promotion of the Air Quality Health Index allows for the public to know when to modify the outdoor activity in which they want to participate or even choose to exclude it. We made the information available on our website as well as through the local media and social media. We provided information to and consulted with school boards, daycares, long-term care homes and with municipalities to help them make decisions about their activities.

Municipalities can monitor Air Quality Health Index and can sign up for air quality advisories.

Health Effects from poor air quality can be reduced by:

• Monitoring the Air Quality Health Index
• Reducing exposure to wild fire smoke
  • Limit outdoor strenuous physical activity
  • Stay indoors and keep windows closed
  • Use air filters in the home
  • Wear a well fitted respirator type mask (N95 or equivalent)
• Reducing others sources of indoor and outdoor air pollutants
• Encouraging citizens to take care of their mental health – poor air quality can increase stress and anxiety
• Encouraging citizens to pay close attention to their health and seek medical attention if necessary

Last year was the first year that our Health Unit experienced a significant poor air quality event because of the large number of wild fires burning across Canada.

“Smoke from wild fires was a new issue for our Health Unit and our partners were looking to us for advice and guidance,” says Manager of Community Health Protection, Kim McCann. “We quickly prepared information for the public including messaging about the health effects of poor air quality.  We were able to get our messages out through press releases, updating our website, using social media and by sharing our information with school boards, long-term care homes and daycares.”

There are many partners involved when dealing with a subject like air quality. We worked together by receiving up-to date information from Environment Canada and Climate Change (ECCC) and the Ministry of Environment, Conservations and Parks (MECP) and disseminating the information out to the public and our partner agencies and empowering them to make informed decisions.

This year we are well-prepared with messaging and the Ministry of Health provided us with a reference document called Wildfire Smoke and Air Quality Reference Document, 2024 which includes additional public precautionary messages.  We created an extreme weather response team that can help disseminate information about vulnerable populations quickly and when needed. During the time of a poor Air Quality Advisory it is important to check on family and friends to ensure that they are coping with their health and wellbeing. We encourage everyone to reference the Air Quality Health Index to help guide participation in outdoor activities.

The Best Practice Spotlight Organization® (BPSO®) designation is a longstanding knowledge translation strategy that helps optimize health outcomes at the individual, organizational and health system levels. This program gives health service and academic organizations the opportunity to formally partner with the Registered Nurses Association of Ontario (RNAO) to achieve “designation” as a BPSO. The BPSO designation can then be renewed every two years after meeting specific deliverables. This internationally-renowned program’s strategic approach has been proven to promote evidence-based cultures, improve patient experience and health outcomes, lower cost of care by preventing complications, and enrich staff satisfaction (RNAO, 2024).

The Health Unit was designated first in 2015 and has maintained designation even through the pandemic. The Health Unit works under an internal steering committee, which is in ongoing contact with RNAO.

To date we have implemented 10 Best Practice Guidelines including:

• Adopting eHealth Solutions,
• Assessment and Interventions for Perinatal Depression,
• Embracing Cultural Diversity in Health Care: Developing Cultural Competence,
• Enhancing Healthy Adolescent Development,
• Integrating Smoking Cessation into Daily Nursing Practice,
• Integrating Tobacco Interventions into Daily Practice,
• Person and Family Centred Care,
• Promoting 2SLGBTQI+ Health Equity, and
• Woman Abuse: Screening, Identification and Initial Response
• Working with Families to Promote Safe Sleep for Infants 0-12 months of age.

2023 was a year of rejuvenation as we reinvested in the work of implementing Best Practice Guidelines. An additional 6 BPGs are being reviewed for potential implementation!

“We are thrilled to be continuing with this important work,” says Lucia Taggart, BPSO Co-ordinator for the Health Unit. “Our participation in this strategy has brought innovation to many of our programs.”

On October 18, 2023, the Leeds, Grenville and Lanark District Health Unit, in partnership with RNAO’s Lanark-Leeds-Grenville Chapter, held two exciting events to connect with nursing and health colleagues during the RNAO Fall Tour. The theme was ‘Building a vibrant nursing profession that benefits all Ontarians’.

On October 25, 2023 we were joined by RNAO CEO Dr. Doris Grinspun who spoke about RNAO’s BPSO and Best Practice Guidelines programs as well as today’s current nursing, health and health care issues. The Health Unit showcased their BPSO journey.

And on October 26, 2023, we hosted a breakfast featuring discussion on recruitment and retention of nurses in Ontario, changes in long-term care legislation, climate change, public health unit amalgamation, and more questions directed to RNAO CEO Dr. Doris Grinspun.

Health Unit staff reviewed a number of online appointment booking systems and selected one that was a good fit for the organization and met the needs of both our staff and our clients. FrontDesk launched in mid-September of 2023 and has been used steadily since with great success. The FrontDesk system is very user-friendly and allows clients the convenience of booking or cancelling appointments for Health Unit clinics online. It is available 24 hours a day and 7 days a week, so clients are able to access it no matter the time of day and they no longer need to call into Health Unit offices to book appointments in the clinics using this system.

“FrontDesk is simply another tool the Health Unit has adopted to better serve our communities,” says Tori Welk, Professional Practice Coordinator for the Health Unit. “This allows clients more flexibility in booking appointments.”

Appointment booking can be accessed by visiting www.healthunit.org, selecting ‘Clinics and Classes’ on the top menu, and subsequently choosing whichever service is required. By choosing “Book Now” you can access times and locations for the services you require.

FrontDesk is currently used for:

• Immunization Clinics,
• Infant Feeding Clinics,
• Prenatal Breastfeeding Information Sessions,
• Sexual Health Clinics, and
• Nicotine Cessation Meetings.

Once an appointment has been scheduled using FrontDesk, a confirmation of booking as well as automatic reminders are sent via email and/or SMS. As always, members of the community and our clients are still able to contact the Health Unit by phone at 1-800-660-5853 during business hours for all services, including appointment bookings.

Getting testing for HIV and Sexually Transmitted Infections can cause some anxiety for people and going to a clinic or seeing a health care provider can sometimes be a barrier to obtaining testing. The Health Unit’s involvement in the GetaKit program was announced in 2023 as a way to provide routine screening services to residents of Leeds, Grenville and Lanark without a referral. We also acknowledge how increased access to testing is important to equity deserving populations.

GetaKit is a study from the University of Ottawa, undertaken in partnership with local public health units in Ontario, to evaluate an online assessment and mail-out system for sexual health services, including testing and prevention from the comfort of home. Available services include HIV self-tests and lab-based testing for HIV, syphilis, hepatitis C, gonorrhea, and chlamydia. The HIV self-test kits, requisitions and swabs are shipped directly to a client’s home for free and no health card is required.

“We are pleased to provide this service to our residents,” said Jennifer Adams, Manager of Clinical Services with the Health Unit. “Our partnership with GetaKit reflects our shared commitment to promoting healthier communities and empowering people to take charge of their health.”

A link to the GetaKit website is available on the LGLDHU Sexual Health Clinic booking page and interested individuals ages 16+ can register themselves without a referral. Upon registration, clients are asked to complete an on-line risk assessment to see what tests, supports and services are recommended for them. After completing testing, individuals will receive results in their account within a few days. They will also receive reminders when it is time to re-test. Anyone receiving positive results of a blood-borne infection will receive follow-up from a public health nurse, including assisting the client with accessing free treatment at any of our local Sexual Health Clinics – 2023 was the first year that this service has been available to individuals in Leeds, Grenville & Lanark.

University of Ottawa runs the online platform, prepares the testing kits and mails out all orders. Our nurses working in the Sexual Health Program review all test results and are responsible for following up on any positive results. Our local Sexual Health Clinics are able to provide clients with free treatment for themselves and their sexual contacts, as well as to provide relevant health teaching and referrals and contact tracing support.

“We are trying to promote this venue for STI testing for those who are asymptomatic and are seeking routine STI screening, says Susan LaBrie, Program Lead for Sexual Health. “It is not appropriate for those who are symptomatic or who have been identified as contacts of cases, as they should be provided with in-person care.”

Sexual Health Clinics are available in seven different locations across Leeds, Grenville and Lanark. Locations and services can be found on our website as well as a link for booking an appointment. Clinics in Brockville, Smiths Falls, Kemptville and Almonte may also be able to offer services to walk-ins, however appointments are highly encouraged.

The World Health Organization, Canadian Pediatric Society, and the Dietitians of Canada, recommend exclusive breastfeeding for the first 6 months, and continued breastfeeding with the addition of iron-rich solid foods for up to 2 years and beyond.

Infant Feeding Clinics (formerly called “Breastfeeding Clinics”), were established in 2015 after the Health Unit identified a gap in breastfeeding support services which contributed to a disjointed transition between the services provided by the hospital and community health services. The goal of these clinics was to increase access to reliable breastfeeding support in the communities where our families live. This was part of implementing Step 10 of the Breastfeeding Committee for Canada’s BFI Integrated 10 Steps Practice Outcome Indicators: Provide a seamless transitions to community supports.

The Healthy Growth and Development team took the opportunity in 2023 to re-brand the clinics to ensure clinics were more inclusive to all feeding methods.

“The Health Unit recognizes that there are many reasons why some babies may be fed with infant formula,” says Jenny Vandermeer, Public Health Nurse and Certified Lactation Consultant, “whether for medical reasons, or for personal reasons. We are committed to providing support to help families feed their babies in a safe and nurturing way.”

For some families, giving formula to their babies may not be their preferred choice. Our infant feeding clinics provide families with an opportunity to discuss their feeding goals, be provided with evidence based information, and be supported in making an informed choice on how to feed their babies. All families are supported to feed their babies in a safe and nurturing way, regardless of method of feeding. For that reason, the Breastfeeding Clinics were re-named, Infant Feeding Clinics.

In addition to the name change, the Health Unit recognized the ongoing barriers to initiation, duration, and exclusivity of breastfeeding in Ontario and within Leeds, Grenville and Lanark Counties. Recognized barriers include; maternal confidence and knowledge; access to services; and inconsistent messages by services providers. In the fall of 2023, we partnered with the Carlington Community Health Centre (CHC) in Ottawa to adopt their Prenatal Breastfeeding Information Sessions, a 1.5 hour in-person or virtual class where expectant parents can learn about the importance of getting off to a good start. This class includes the 4 steps to successful breastfeeding:

1. Identifying community resources before birth,
2. Immediate and uninterrupted skin-to-skin,
3. Prenatal hand expression of colostrum, and
4. Early access to breastfeeding support. 

By utilizing the videos provided by Carlington CHC, developing a package of local resources relevant to Leeds, Grenville and Lanark, and providing access to colostrum collection kits, the Healthy Growth and Development team was prepared to launch their first sessions in January of 2024.

Eighteen in-person Prenatal Breastfeeding Information sessions are being delivered throughout 2024, in Brockville, Kemptville, Smiths Falls, and Carleton Place, as well as 6 virtual sessions for families that may have accessibility concerns or who prefer to learn in the comfort of their homes. An evaluation plan has been developed to assess the success of the program delivery at the end of the first year.

For more information on feeding your baby, visit our website: Infant Feeding – Leeds, Grenville and Lanark District Health Unit

Public health is responsible for inspecting places that provide personal services such as hair and nail salons, tattoo and piercing businesses as well as medical procedure clinics to ensure they are following safe infection control practices. Failure to follow these best practices may result in the transmission of infectious diseases to clients, patients, or staff through exposure to blood or body fluids. Where an Infection Prevention and Control (IPAC) lapse is identified, our IPAC team notifies staff and or patients/clients and ensures corrective actions are implemented to prevent further risk to the public. Lapses can be found when improper cleaning and disinfecting of a setting is identified; it can also be when improper sterilization practices are identified when using reusable equipment.

The complexity required to complete an IPAC complaint/investigation is extensive and time consuming as a number of our staff need to be included in the work around a lapse. The number of IPAC complaints received in 2022 was 3 whereas 11 complaints were received in 2023. One of the complaints in 2023 was the first time the Health Unit issued public notifications to notify clients of a premises from which they were at risk of infection and recommended they go for HIV/Hep B/Hep C serological testing.

“It is important for anyone who provides services to keep detailed records so that their clients/patients can be contacted in the event of a lapse,” says Kim McCann, Manager Community Health Protection with the Health Unit. “Public notifications should be a last resort and we issue them only when necessary.”

We partner with Public Health Ontario, Public Health Ontario Laboratory, and Ontario Ministry of Health for IPAC risk assessments which guide the Health Unit’s decision to issue public notifications. Public Health Ontario Laboratory assists in the organization of laboratory testing.

Residents can prevent infection by knowing more about infection control practices and the inspection of personal service settings in their area. We have information on our website to help learn more: Beauty & Body Art – Leeds, Grenville and Lanark District Health Unit

More information about IPAC lapse complaints can be found on our website: Infection Control Complaints – Leeds, Grenville and Lanark District Health Unit

Annual Nutritious Food Basket (NFB) costing is a tool that collects local level data related to the cost of eating a nutritious diet in Leeds Grenville and Lanark counties (LGL). Results from the NFB costing are used to assess food affordability for a variety of living and income scenarios in Leeds, Grenville and Lanark. The data show that individuals and households living with food insecurity struggle to buy enough nutritious food after paying rent as food budgets are often sacrificed to pay for other expenses. This is due to food being considered a negotiable expense compared to expenses that are considered non-negotiable (e.g., rent, utilities, etc.). In Leeds, Grenville and Lanark, 1 in 7 (14.9%) households experiences food insecurity. Food insecurity is the inadequate or insecure access to food due to financial constraints.

Groups that are planning food insecurity work can benefit from this information as they can use the resources from this tool as a reference in grant writing or to create awareness of food insecurity in Leeds, Grenville and Lanark.

“Conducting annual Nutritious Food Basket costing, as well as developing and disseminating the accompanying report and infographic provides valuable information to community partners,” says Danielle Labonté, Registered Dietitian with the Health Unit. “It also helps those living, working, and/or learning in Leeds, Grenville and Lanark know the affordability of eating a balanced, nutritious diet for various income scenarios and living situations.”

In 2023, the nutrition team revised the list of stores that are used to get the information in the report. The goal was to allow for a more representative sample of stores (i.e., geographically as well as including stores that vary in price/cost of food) that reflect where those in Leeds, Grenville and Lanark do their grocery shopping. As well, 2023 was the first year that we created a full report to accompany our infographic. We did receive informal feedback from community partners that this was helpful and plan to do the same in 2024.

Improvements in health status and longer life expectancy have led to longer life expectance for older adults. Compared to Ontario, Leeds, Grenville and Lanark has an older population structure, identifying the need to carefully plan for our aging population.

In order to gain a better understanding of the older adult experience and support healthy aging in our area, the Health Unit developed the Older Adults of Leeds, Grenville, and Lanark Review.

This review can assist community partners in applying the Age Friendly approach, which leverages the strengths of older adults by creating physical and social environments in which they are active, valued, and supported members of society.

There are numerous benefits of Age Friendly Communities including:

• Reduced isolation/Improved participation,
• Increased volunteerism,
• Improved mental health/feelings of self-worth,
• Increased physical activity,
• Reduced risk of injury (falls),
• Improved accessibility, 
• Awareness of community/health services.

The Older Adults of Leeds, Grenville, and Lanark Review is based on the eight themes from the WHO Global Age-Friendly Cities Framework. The report provides readers with a comprehensive and robust review of literature and best practices, local data, local voice of older adults and service providers, current and future actions that can be taken and additional resources to further enhance knowledge in this area.

The Older Adults of Leeds, Grenville, and Lanark Review has been shared with over 25 community partners including but not limited to primary care, social services, libraries, seniors groups, food banks, service clubs, and faith based organizations. Sharing this resource has supported efforts in program development, work prioritization, grant/proposal writing and applying the Age Friendly Approach.

Sharing this resource with community partners and their local networks has had a number of reactions.  Some communities had delegations at their town councils. Another municipal partner had this comment: “I loved the review and will be using it for grant writing and program planning.” Another partner said: “we can use this review to re-invigorate our age friendly group.”

Municipalities can also use the information when updating municipal plans (e.g., Official Plans, Transportation Plans, Recreation Plans, Economic Development Plans, Housing Plans) to ensure this evidence based approach is integrated in these broader community plans.

Earlier intervention leads to better outcomes. Children’s brains are developing incredibly rapidly in the infant, toddler and preschool years and early intervention has a greater impact on a child’s future well-being and success in school than the same amount of intervention provided when the child is older. At Language Express, registered Speech-Language Pathologists (SLP) and Communicative Disorders Assistants (CDA) provide assessment and therapy for children from birth to school entry.

New Ministry of Children, Community and Social Services (MCCSS) Preschool Speech and Language and Children’s Rehabilitation Services Guidelines were released in 2023, resulting in changes to the program’s mandate and service model. We started phasing out services to children attending JK in September 2023 and started offering more “Tier 1” resources in late 2023. Tier 1 supports include videos, info sheets, and suggestions on our website, and calls to families on our waiting list to offer strategies to try right away and to make connections to other programs and services. These initiatives will be fully implemented in 2024, together with an increased emphasis on reducing wait time. Wait time has been high throughout the year, ranging from 5 to 9 months. Difficulty recruiting for vacant positions is a significant contributing factor.

There are lots of great resources for parents on how to help their children: Language Express – Leeds, Grenville and Lanark District Health Unit. Parents can also complete the online Communication Checkup to check on their children’s development and learn about recommended next steps.

Language Express also works together with partners such as KidsInclusive Centre for Child Development and the Children’s Hospital of Eastern Ontario (CHEO) to provide coordinated services for shared clients, and collaborate on initiatives such as transition to school planning and special needs services. 

In early 2024, we surveyed our clients asking about their experiences and needs.

“I have noticed an incredible difference in my child’s speech,” said a parent from our survey. “There is a high need for speech and language programs like this one. My child is speaking and understanding more words than ever before. My own personal stress and anxiety levels have decreased knowing that he is getting proper support and care through Language Express. I feel more comfortable about his transition to Kindergarten. My child seems happier now that he can communicate more effectively and clearly. I hope my child can continue attending appointments through Language Express in the future.”

Vector-borne diseases (West Nile Virus, Lyme disease, Anaplasmosis, Babesisos, Powassan virus, Avian Influenza, Eastern Equine Encephalitis, Rabies, Avian Chlamidiosis, Echinococcus multilocularis) are present or potentially present in our region. The warming of the climate in our region has allowed various vectors (especially the deer tick) to become established and continue to flourish. With the increase in tick population comes the increased risk of vector-borne diseases, both existing diseases and ones new to our region. Given our proximity to the northeastern United States (where black legged ticks and tick-borne diseases have long been established), our Health Unit and neighbouring health units are particularly affected by the influx of ticks and the diseases they carry. This creates a real challenge for our Health Unit and creates a significant resource demand not experienced by many other health units.

Every year, we raise awareness of the risk factors associated with potentially acquiring a vector-borne disease and the precautions that you can take to prevent bites from the insects, birds and animals that carry the diseases. Getting the word out about these vector-borne diseases is a constant job. We provide on-line resources for the public including fact sheets regarding the various vector-borne diseases of concern. Partners such as municipalities, parks and conservation areas help in spreading the word about prevention. Our local media also help in reaching residents and those visiting our area.

“Vector-borne diseases are preventable,” says Senior Public Health Inspector, Andrew Dunn. “When enjoying the outdoors, don’t forget to cover your skin, wear an insect repellant to protect against ticks and mosquito bites and check yourself, your family and pets for ticks when you get when you come in from outdoors.”

As part of our public awareness program, the Health Unit provides advice as to what to do if you suspect you may have acquired a vector-borne disease or been exposed to a vector of concern like a black-legged tick bite where the tick was attached for more than 24 hours. We recommend that you seek medical attention if you develop symptoms after being bitten by a tick to reduce the impact of a possible infection. It is also recommended to speak with your vet about protecting your pets. For more information, visit our website: Insect Bites and Diseases – Leeds, Grenville and Lanark District Health Unit.

Health Care Providers are provided with information about vector-borne diseases in our area (including the 3 new tick-borne diseases which became reportable in July 2023) with the intention that health care providers consider these diseases when diagnosing/treating patients. A recent presentation to health care providers is available on our website.

Mosquito trapping and tick dragging efforts help provide data on the types and numbers of ticks and mosquitos in our region which helps inform us of the types of diseases which could be present (different vectors transmit different diseases). As of July 1, 2023, Ontario Regulation 135/18 (Designation of Diseases) and Ontario Regulation 569 (Reports), both under the Health Protection and Promotion Act, were amended by the Ministry of Health to include the addition of Anaplasmosis, Babesiosis and Powassan virus as reportable diseases, requiring notification to the local public health unit for investigation. The amendment resulted in a significant increase in the number of disease investigations, particularly for Anaplasmosis and to a lesser extent, Babesiosis. No reports of Powassan virus were received. To date, Lyme disease has been the prominent disease, human cases have been increasing every year since Lyme disease became established in our area in 2006. You can find out more statistics here: Diseases of Public Health Significance (DOPHS) Surveillance Dashboard – Leeds, Grenville and Lanark District Health Unit