History

The idea of establishing a child health network to link hospital and community providers across the Toronto and Greater Toronto Area has a long history. In the 1970s and 1980s, a number of pressures underscored the need to rationalize and regionalize services for mothers, newborns and children to ensure appropriate and timely access to care. Some of these pressures included:

  • Number of maternal/newborn transfers sent out of the region.
  • Demand on tertiary obstetrical beds and concerns regarding the appropriateness of use of these beds.
  • Fragmentation of child and adolescent services.
  • Lack of a systems approach to planning and development of services.
  • Human resource shortages.
  • Inconsistent care standards across the region.

A number of key planning documents produced by current and former planning bodies including the former Toronto District Health Council, the Ontario Health Services Restructuring Commission (HSRC,1996-2000), and the Ontario Ministry of Health and Long-Term Care guided the development of CHN. The impetus, however, for developing and implementing the concept of a 'virutal netowrk' to improve coordination and integration of services emerged from providers themselves.

The chronology of key milestones leading to establishment of the CHN is highlighted below.

PRE-1994
Ministry of Health reports from the Provincial Committee on Reproductive Medical Care results in designation of three levels of care and enhancements to maternal/newborn transport system.

1994
Metro Toronto District Health Council (MTDHC) releases report of the Maternal-Newborn and Child Steering Committee articulating a vision for development of a planned and managed regional system of maternal, newborn, and child health care services.

Strategic plan developed by The Hospital for Sick Children (SickKids) describes a "systems approach" to the provision of child health services. The approach focused on building a regionalized system of care with SickKids concentrating on high-end secondary, tertiary, and quaternary care and devolving primary and low-end secondary care to community hospitals.

1995
MTDHC completes final report on hospital restructuring [Hospital Restructuring Report (1995)] and in it proposes development of a regionalized paediatric network based on designation of Regional Children’s Health Centres (RCHCs).

1997
SickKids, Bloorview Kids, and the five designated RCHCs in Metro Toronto sign the Metro Toronto CHN Letter of Agreement.

HSRC confirms the concept of establishing a CHN in Metro Toronto and directs expansion of the Network’s membership to include all Metro hospitals providing maternal, newborn and child health services [Source: HSRC, Metropolitan Toronto Restructuring Report(s), March 1997, July 1997].

The HSRC recommends that hospitals in the GTA (Durham, Halton, Peel, York) become members of the CHN [Source: HSRC, GTA/905 Restructuring Report(s) (Nov. 1997, April 1998]:

"Currently 15 hospital sites in the GTA/905 provide maternal, newborn and child health services. The programs vary considerably in size and scope of services. The objective of the HSRC’s review was to address the delivery of services within the context of a regional system of care. The HSRC believes that a high-quality, accessible maternal-child system must be built on a strong foundation of primary and secondary care services that meet the needs of the majority of women and children through low-risk birthing services, and ambulatory and community-based services. Building on this foundation are specialized services that are concentrated in fewer sites in order to meet critical mass and quality standards...The HSRC believes that a regional system of care is desirable and recognizes that all hospitals should have a clear role in the regional system." [HSRC (November 1997), GTA/905 Health Services Restructuring Report, p. 56.]

1998
CHN holds planning retreat to confirm the mission, purpose and values of the CHN and the critical success factors for building a regionalized model of care.

1999
CHN submits its final Implementation Plan to the Ministry of Health confirming the vision and framework for establishment of the CHN. The plan included extensive documentation on core processes, enablers, scope of service parameters, transfer plans, redistribution of paediatric cases from HSC to the regions, redistribution of secondary neonatal services from tertiary facilities, priorities and timelines for the CHN’s initiatives, and the financial implications and recommended sources of funding required to support establishment of the Network.

The Ministry of Health appoints an Expert Advisory Panel to provide advice on the guidelines, planning documents and transfer plans submitted to the Ministry by the CHN. Panel completes its report in October 1999.

2000
Ministry of Health responds to recommendations made by the Expert Advisory Panel and releases guiding principles and a policy framework to guide the development of the CHN. The framework expands CHN’s mandate beyond children to include maternal and newborn services, and confirms the fundamental components of a regionalized system of services organized by level of care.

2001
CHN establishes a shared governance model and approves guidelines for membership funding. The CHN secretariat office established and the first operating plan developed to guide activities of the Network. CCACs in the Greater Toronto Area confirmed as official members of the CHN.

2003 - 05
CHN initiates a 16-month internal review of maternal/newborn and paediatric services in member hospitals across the region. The three-phased review (known as the IRC - Internal Review Committee) began with the following mandate from the MOHLTC: "To assess the current status of the regionalized system for maternal/newborn and paediatric services in the GTA, identify issues/barriers prohibiting development of the system in accordance with the original policy plan (i.e., February 2000 MOHLTC policy statement) and recommend opportunities for resolution of the issues."

2007 - Ongoing
CHN initiating partnerships with Local Health Integration Networks (LHINs).

Further information on the Child Health Network is available on this website in the report titled Ideas, Innovation and Integration: The Story of the Child Health Network for the Greater Toronto Area", included in the Publications section of this website.