Can you hear us? My name is We Are we live? Okay, thank you. Good morning. My name is Chris Moyes and I am the chair of the board of health. The clerk has confirmed that we have quorum. So, I'll call meeting 32 of the board of health to order. Today's meeting is being held by video conference and in person at city hall in committee room 1. Because we are meeting in person and remotely, we ask everyone for their patience with any delays and technical issues. If you are registered to speak at today's meeting, please listen for me to call your name. I will call speakers in the order they appear on the list. The list of speakers can be viewed online by visiting the board of health page at toronto.ca/counsel and clicking the speakers box for today's meeting. The clerk has provided all agenda materials on toronto.ca/counsel C /consel and via CMP the clerk's meeting portal. Directors, please ensure that your video is turned on. Please keep your mic muted unless you wish to question staff or to speak. As part of each agenda item, I will ask directors to raise their hand or mute their mic if they wish to question staff or speak. I will then create a speaker list and we'll call on directors when it is their turn to speak. When voting on an item or motion, I ask the directors raise their hand to indicate their vote. Directors, I want to remind you that you must submit your and approve your motions by email. Staff available at bohorronto.ca to help with motions. The board of health acknowledges that land the land we are meeting on is the traditional territories of many nations including the missagos the credit the anabbec the chipoa the hoses and the widnat peoples and is now home to many diverse first nations in matei peoples we also acknowledge that Toronto is covered by treaty 13 the missagas of the credit the city of Toronto acknowledges all treaty peoples including those who came here as settlers as migrants either in this generation or in generations past and those of us who came here involuntarily particularly those who brought who were brought to these lands as a result of the transatlantic slave trade and slavery. We pay tribute to those ancestors of African origin and descent. Are there any declarations of interest under the mutual conflict of interest act? If you have an interest, please raise your hand or unmute your mic and indicate the item number and the nature of the interest. Seeing none, next we need to a motion to confirm the minutes from our last board of health meeting on March 30th, 2026. Director um Gourd, I suppose right? Yeah, Gourd. All those in favor? Post carried. Thank you. Um okay, that is the formalities of the meeting so far. So again, good morning to everybody. Hey, I see Council Thompson's online. Welcome, Council Thompson. >> Thank you, Mr. Chair. I had some challenges uh signing in this morning, but good morning, everyone. >> Happy you're here now. So, welcome to our May 4th meeting and the May May the 4th be with you. I've always wanted to say that. We have a lighter agenda today, but we'll be addressing some very pertinent public health topics. First, I want to acknowledge that Toronto, May 5th, is the National Day of Awareness and Remembrance for the Missing and Murdered Indigenous Women and Girls and the 2 SLGBTI plus people, also known as Red Dress Day. As we take the day to honor the lives and legacies of missing and murdered indigenous women, girls, and 2LGBTQI plus people, we must acknowledge that the way ongoing colonial violence touches all areas of our life and the impacts it can have on health outcomes both at individual and community levels. We stand in solidarity with the families and communities who continue to pursuit of justice, healing, and change, and remain committed to our ongoing work co-led with indigenous communities to address the persisting health inequities that result from the legacy of colonialism. Today, we'll discuss adverse childhood experience, ACEs. In Toronto, over 30% of adults in Toronto have reported at least one ACE with indigenous black lowincome immigrants and to SLGBQ plus communities being disproportionately affected. It is a very heavy topic. It's important to talk about ACEs because they are associated with negative outcomes later in life. But that does not have to be the case. The impacts of ACEs can be offset by positive childhood experiences which can help build resilience. Toronto Public Health plays a role in promoting protective factors from per preconception and thought throughout child development. Shortly we will hear from the Joanne uh Figaniano Scott, chief nursing officer and director of community health and well-being and Dr. Alison Chris, acting deputy medical officer of health about the various interventions we lead to prevent ACEs as well as our co-leership on the Ontario early adversity and resilience framework. The second and final item on the our agenda today is the annual report on service agreements awarded and executed by the medical of health. These agreements allow us to deliver essential public health programs in partnership with community- based organizations, prioritizing equity deserving populations, including seniors with lowincome, youth experiencing homelessness, newcomers, and communities facing barriers to care. I'm very happy to report that DPH has entered into purchase agreement with both the 519 and HQ to continue essential health promotion services previously delivered by the AIDS committee of Toronto. This interimm funding approach will take us to the end of the year while TPH staff will uh examine our existing sexual health program purchase of service agreements to determine a longterm plan. And finally, I would like to acknowledge that Monday, May 12th marks the beginning of National Nursing Week. from our he from our sexual health clinics to the downtown core team and our extensive vaccination program. Our public our Toronto public health nurses take on a merit of roles to ensure that our residents are receiving the care they need. I extend my sincere appreciation to all the nurses of Toronto for their tireless work day in and day out. You truly are the heart of our healthcare system. So thank you once again and with that I'll turn it over to Dr. Mury for some comments. >> Morning and thank you chair Moyes. Welcome and thanks for joining us today both in person and online. Today's report and presentation will touch on some key aspects of public health's work. Before we get into today's agenda, I would also like to take a moment to recognize the recent closure of the AIDS Committee of Toronto, also known as ACT. After years of delivering critical services to the community, ACT's final days of operations was on March 31st. ACT provided important services to people living with and affected by HIV in the city, including through projects supported by the Toronto Urban Health Fund. Toronto Public Health recognizes the importance of this work and has been working to ensure continuity of these services by other providers in the community. We're pleased to announce that to meet those needs, Toronto Public Health has entered into agreements with the 519 Community Center and HQ to provide essential services in 2026, including health promotion, sex, community- based sexual health, education, and outreach, and access to testing and counseling for HIV. Turning back to other reports today, we're looking at the impact of adverse childhood experiences, also known as ACEs, and the work of Toronto Public Health, the city, and our community partners that we're doing to prevent and mitigate the health impacts associated with ACEs. This report highlights the role of positive early experiences in building resilience and lifelong health, including reducing substance risk, and points to the importance of coordinated actions across city divisions and with community partners to achieve this work. This is public health working upstream and demonstrating high return on investment by preventing root causes of health outcomes. Preventing ACEs is grounded in equity, population level interventions, evidenceinformed programming, and trauma-informed practice. Early intervention is the most cost-effective public health strategy with long-term impacts on health, mental health, and substance use prevention. This approach has also been a pillar of our harm reduction strategies and captured in our health our city a mental health substance use harm reduction and treatment strategy for Toronto that was launched in 2023. The prevention of ACEs through enhanced child and family mental health is an explicit goal of the strategy because we know ACEs increase the risk of mental health challenges and substance use later in life. And we know why it is important to prevent the initiation of substance use. In looking at our latest surveillance and monitoring data, we saw a decline in fatal opioid overdoses in 2025. However, we are continuing to see an increase in non-fatal overdoses, both opioid related and through other contaminants such as tranquilizers, benzoazipines, and new more potent synthetic opioid contaminants, reflecting the ongoing toxicity of our unregulated drug supply. Non-fatal overdoses still have significant impact, both short-term and long-term consequences, for the individual experiencing the overdose, as well as their family and friends and for the health care system. In February of this year, we saw the highest number of non-fatal opioid overdoses that we've seen in the past two years. What this tells us is that Toronto's drug supply remains toxic and that we still need as many evidence based interventions as possible to support the prevention, care, and treatment for people who use substances. This includes harm reduction, drug checking, peer supports, and welcoming places where people who use substances can feel comfortable coming to receive immediate and long-term care and supports for their current needs and their recovery goals. We also know why preventing ACEs and increasing resilience is important for preventing family violence. In 2023, city council declared gender-based violence and intimate partner violence as an epidemic. In the years that have followed, Toronto Public Health and the city have strengthened public health programs that support victims and survivors of intimate partner violence, including pregnant individuals and families with young children. With leadership from our city partners with social development's gender equity division, we are developing a city-wide campaign to bring greater awareness of gender-based violence and intimate partner violence through a public health and equity focused lens. The city continues to support programs that connect residents and visitors to city and community- based resources and supports including safetto and IPV data monitoring. Lastly, as councelor Moyes mentioned, tomorrow we recognize Red Dress Day. On this day, May 5th, we observe the National Day of Awareness of Missing, murdered indigenous women, girls, trans, and two spirit plus peoples. In Canada, indigenous women experienced disproportionately high rates of physical and sexual assault in their lifetime. I encourage you all if you are in person to come down and visit in the lobby of city hall a wonderful display for red dress day recognizing the harms against indigenous women and girls who are still missing have not been registered as missing or have not been registered as somebody affected by by violence. Thank you so much for joining today. We'll turn it back to Chair Moyes for continue meeting. >> Thank you Dr. Murdy. And as mentioned we do have two items on today's agenda. So the first item is uh HL 32.1 promoting positive childhood experiences to improve health outcomes across the lifespan. We have a presentation on this item so I will hold it down. And item 2 HL32.2 service agreements awarded uh and executed by the medical office of health 2426. Uh we do have speakers on that item. So I will hold it down as well for that reason. And so we'll go up back to item HL32 one promoting positive childhood experiences to improve health outcomes across the lifespan. Director uh Dr. Mur do you want to introduce the U presenters? Oops. Uh welcoming today's morning we have Joanne Figiano Scott our director of community health and wellbeing as well as our nursing officer as well as Dr. Dr. Allison Chris, our acting deputy medical officer of health, who will be presenting on adverse childhood experiences this morning. Good morning My name is Joanne Figliano Scott and uh here with me today is um Dr. Allison Chris. Today we're presenting the report promoting positive childhood experiences to improve health health outcomes across the lifespan. The report and the attachment provide information about adverse childhood experiences, protective factors, the Ontario early adversity and resilience framework and actions that TPH is taking to mitigate ACEs. Good morning. During the presentation, we are going to share how experiences in childhood impact health across the life course. I will start by briefly describing a few key concepts including adverse childhood experiences, protective factors res and resilience. Joanne will then walk through the Ontario early years adversity and resilience framework and how it applies to public health. We will close by highlighting what the city of Toronto is doing to prevent adversity in early childhood and promote positive experiences in childhood. Research has demonstrated that experiences early in life can have lifelong impacts on health and well-being. The neural connections that make up the architecture of our brains are formed on an ongoing basis, beginning before birth and continuing into adulthood. Brains are not just born. They are built over time based on experiences. In the first few years of life, children experience a period of intense brain development that provides a foundation for the way their brain develops for the rest of their life. When children have positive experiences and interactions with others, their brains grow in a way that prepares them for lifelong physical, mental, and social well-being. It's experiencing some stress and learning how to cope with it are necessary for healthy childhood development. Ideally, supports help to reduce the negative impacts of stress. However, without support, adverse experiences in early life can cause a toxic stress response. The toxic stress response releases cortisol and other chemicals in the brain which can lead to increased reactivity to future stressors. This exposure can have a wear and tear effect on the brain and the body. The term adverse childhood experiences includes stressful or potentially traumatic experiences that occur before the age of 18. These stressful and traumatic experiences can cause extreme or prolonged stress responses that is known as a toxic stress response which can negatively impact brain development, immune function and stress regulation leading to negative uh health outcomes over time. ACEs are linked to a wide range of negative health outcomes and social outcomes, including chronic disease such as cancer and diabetes, poor mental health, substance use, lower levels of physical activity, unsafe sexual health practices, and homelessness. This graphic describes three categories of adverse childhood experiences, which include household, community, and environment. Examples of household include physical, sexual and emot emotional abuse, neglect, parental substance use or mental health concerns, parental incarceration, or witnessing do domestic violence. It is important to recognize that some of these factors are also shaped by broader systemic factors, including structural racism, poverty, and inequities in the justice system, which contribute to higher exposure to adversity in some communities. Systemic inequities create the conditions that increase the risk of aces which reflects the second category in the graphic which is community. There are community and structural forms of trauma such as poverty, racism, housing instability, colonialism and more which contribute to chronic toxic toxic stress. Lastly, the environmental category includes natural disasters and climate crisis. These categories reflect not only individual experiences but broader social and structural conditions that shape the environment where children live. Adverse childhood experiences are highly common in the general population. In Toronto, a study is found that 31% of adults report having experienced at least one type of ACE. This was a survey study done in 2019. The most common type of ACE reported was emotional abuse followed by household violence, physical abuse, sexual abuse, and neglect. The more adversity someone faces early in life, the higher the risk for mental health challenges, chronic disease, and social stress later on. equity denied populations, including black and indigenous communities, low-income families, newcomers, to SLGBTQ plus people, women, people with disabilities, and families impacted by the justice system. Um, I just lost my place. experience higher disabilities, experience higher rates of ACES, thanks Joanne, due to systemic factors such as poverty, racism, housing instability, colonialism, and inequities in the justice system. These differences are not due to individual choices, but rather reflect systemic conditions that shape access to resources and opportunities. This highlights the importance of a public health approach to prevent ACEs that prioritizes upstream interventions that address systemic inequities and promote protective interventions for equity denied groups who are more likely to experience multiple ACEs. Given how common adverse childhood experiences are and how unevenly they affect some communities due to systemic inequities, it's important to understand what can reduce their impact. This visual illustrates resilience as a moving balance. The seessaw shifts as children's experiences change over time. As negative experiences increase, the balance tips and the risk to health rises, including longerterm outcomes like chronic disease. But the balance is not fixed. As positive supports are added, such as caring relationships, stable housing, and supportive communities, connectedness. They add weight to the other side of the seessaw, allowing children to adapt, recover, and even thrive despite adversity. When adversity cannot be fully prevented, strong supports can buffer its effects and protect health. This is the foundation of a public health approach for ACEs. We focus on upstream interventions that address systemic inequities, reduce risk and ne negative experiences where possible while also strengthening positive supports, coping skills, and emotional regulation through responsive relationships. Toronto Public Health partnered with other Ontario public health units to co-lead the development of the Ontario early adversity and resilience framework. The framework guides public health and related sectors in the prevention and of early adversity and promotion of resilience. It identifies four key focus areas that are important to child development and family well-being. Socially connected, equitable and inclusive communities, social and emotional development and resilience. responsive and culturally safe parenting and caregiving and reproductive health and parenting caregiving readiness. The framework identifies five pathways towards implementing effective interventions in the following areas. Shifting social norms, integrating upstream strategies to address the fundamental causes of health disparities, influencing healthy public policy by implementing policies that improve the built environment and encourage child and familyfriendly communities. intervening to lessen harms by increasing resilience learning skills and providing trauma and violence informed environments and collecting and utilizing data. This framework emphasizes that preventing adversity requires coordinated action across sectors, not just individual level services. So now what are we doing about it? One key role public health undertakes is population health surveillance and data analysis related to ASUS. This work increases understanding of how common ACEs are, what drives them, and their impacts supporting datainformed decisions. It's important to note that there are challenges with measuring ACEs locally as it requires analysis of m multiple indicators and data sources, which is why collaboration is essential to addressing some of these data limitations. A few examples of collaborative data efforts include partnering with social development safetto collaborative an analytics and learning environment scale a collaborative lab that allows the city and partners to share data identify effective interventions and communicate lessons to advance prevention focused safety outcomes. Work is also underway with Public Health Ontario and the Association of Public Health Epidemiologists of Ontario on initiatives to analyze local data on adversity and resilience, including a local survey of ASIS prevalence and identification of prioritized ASIS and resilience population health indicators. We also recently hosted a research a research salon with Dalana School of Public Health to explore evidence-based policies and innovative solutions that could support upstream violence prevention. I'll now provide an example to illustrate how monitoring and assessing population health data related to ASUS helps inform program planning to provide interventions through regular population health surveillance. Data showed that the percentage of Toronto women who experienced anxiety during pregnancy pregnancy increased from 4.4% in 2020 2014 to 11.3% in 2023 through the healthy babies healthy children screening of families with newborns. Families who screen in with high levels of postpartum depression and anxiety are referred to the perinatal adjustment program. The data insights shared on TPH's population health status in indicators dashboard prompted the PAP program to start using an anxiety screening tool with all new clients at intake and throughout receipt of PAP services to monitor symptoms and guide interventions. Implementation of the additional screening tool helped to identify those struggling with anxiety for appropriate intervention. In 2025, 54% of clients had a score reduction of four or more, which is considered a significant improvement in symptoms. All clients with either a high anxiety with high anxiety or a high depression score are referred to appropriate mental health services. This example shows how population health data can directly inform program changes and improve outcomes for families and children long term. Early adversity is shaped by systems and environments, not just individual choices. Which means prevention requires collaboration across sectors with city and community partners to increase access to the social and structural conditions that support health. Toronto Public Health collaborates with partners such as social development, Toronto Children's Services, Toronto Employment and Social Services, and Toronto Shelter and Support Services to advance collective action across sectors such as health, housing, employment, and justice. Some examples of the this work include collaborating with the poverty reduction office on food security initiatives including monitoring food affordability in Toronto and the cost of living pressures for low-income households. We are also enhancing understanding of ACES across Safo programs and initiatives. Another key area of collaboration is violence prevention including intimate partner violence and gender-based violence. This work includes policy development, population level reporting on indicators, school health programs that promote healthy relationships and sexual health education, building further awareness of intimate partner violence and gender-based violence. Through a citywide public health awareness campaign led by social development's uh gender equity unit. In our direct client serving work, we establish strong referral pathways to city services and community programs so clients can access the social determinance of health such as housing, food, primary care, and other basic needs. Examples include increasing access to primary care for those that are currently unattached and also include the newborn OHIP access initiative which helps prevent newborns from being incorrectly denied OHIP registration when parents are uninsured and connecting people without a regular healthcare provider to primary care. Together, this cross-divisional and cross- sector work helps reduce risk, strengthen protective factors, and create the conditions that support resilience. In alignment with guidance from the Ontario Early Adversity and Resilience Framework, there are many opportunities to promote protective factors that build resiliency through the life course of a child. Toronto Public Health provides services and programs across the lifespan that help promote safe, stable, and nurturing relationships and ensure a healthy start for children. Toronto Public Health offers programming be beginning in the prenatal period to provide a sense of parenting readiness and address health behaviors that may increase the risk of aces. Toronto Public Health also conducts universal postpartum screening and outreach once the baby is born. Positive maternal, mental health, and responsive infant feeding are important protective factors in the perinatal period. Toronto Public Health operates three home visiting programs which are provided to parents who would benefit from more intensive support in order to provide a safe, stable, nurturing environment for their children. As children grow, ongoing parenting, education, access to ch child care, and school age programs that support healthy relationships and a sense of belonging are other vital protective factors to prevent ACEs or mitigate their impact over the life course. This includes working with school partners to help implement youth leadership programs and build resiliency through school-based peer leadership programs that create opportunities for children and youth to build confidence, strengthen relationships, and develop a sense of belonging. Key protective factors that help buffer the effects of adversity. Our services work across the lifespan and across various sectors such as education and child care to promote protective factors and build resilience. Healthy babies are more likely to develop into healthy children and healthy children are more likely to grow up to be healthy teenagers and healthy adults. I'm going to share more about how Toronto Public Health delivers clinical services to address the downstream impacts of early adversity. Toronto Public Health's provides substance use, sexual health, and dental clinical services. Our programs see clients who have experienced ASETs, which is why clinical services are grounded in harm reduction and embed a trauma-informed approach to foster trust and continuity of care for clients. Trauma-informed and harm reduction approaches improve client experiences through inquiry psychological safety, trust, empowerment, engagement, and effectiveness of services leading to improved outcomes. It is important that services are trauma-informed to prevent further trauma and retraumatization. TPH recently initiated foundational training on ACES, resilience, and trauma-informed supervision and will continue to enhance training for staff and people leaders at Toronto Public Health. Our clinical service programs utilize a holistic approach to service delivery. And we work with clients to connect them to necessary services and programs. This can include referrals related to housing, employment, mental health, and more. Health equity is an integral and foundational component of all of our work. Monitoring health inequities and targeting services is important to advancing health equity and conducting responsible engagement, access, and protection of social demographic data is essential. Each prioritized communities most affected by systemic inequities that increase the risk of of ACEs. Toronto Public Health recently started piloting the collection of sociodemographic data at breastfeeding clinics to monitor outcomes for priority populations and identify opportunities to reduce inequities at the service level. This also involves targeted services to high-risisk communities and delivering programs and supports using culturally safe and trauma-informed approaches to promote equitable access and responsiveness to diverse needs. For example, all of TPH home visiting programs prioritize equityden denied populations at greatest risk for ACEs, including young parents and those facing settlement challenges, homelessness, perinatal mental health concerns, or income instability. Another important component of the health equity work is building relationships and collaborating with indigenousled and blackled community organizations. Key initiatives include establishing the indigenous wellness committee and indigenous harm reduction um table and partnerships with indigenous services providers to deliver culturally grounded health services. TPH is also strengthening the programs and partnerships we have in place to support black families and identifying priority initiatives to enhance our data collection and service delivery to support positive health and well-being outcomes for Toronto's black communities. If we can leave everyone today with two important takeaways, it's it is that early life experiences, both positive and negative, can have lifelong impacts on health and well-being. And more importantly, we can prevent and mitigate against the negative effects of early adversity by strengthening protective factors at all levels of influence, including the family level through responsive caregiving, the community level by building strong supports, and societal levels by developing equitable policies. Toronto Public Health will continue to enhance our work to prevent and mitigate ACEs in alignment with the Ontario early adversity and resilience framework and in collaboration with our partners. I want to thank my colleagues at Toronto Public Health, the city, and in uh community partnerships that work close closely with individuals, families, and communities to build protective factors that shape lifelong health. While it's not easy work, the the passion, commitment that they bring to their work each day is truly admirable and appreciated. Thank you. >> Thank you very much for a wonderful presentation. I've learned a lot uh on this item the last few weeks. Um we do have speakers on this item. Um first up is Nicole Bumont Christianen. Are you here online? Nicole, can you hear me? Hello. >> Can you hear me? >> Yes, we can. >> Hello. >> You have five minutes. Go ahead. >> Hi. Thank you. Good morning, members of the board. Um, Nicole had another event uh and is unable to participate today. I'm Nicole's partner, Staff. >> Sorry. >> I'm here as a parent. >> One moment. One moment. >> Um, >> okay. Well, I'll allow you to speak, but you'll have to give your name information to the clerk. You cannot She cannot trans. >> Absolutely. I'm Stephan Christensen. I'm very happy to be here today. I am here as the parent of two children. I have a 14-year-old who identifies as 2SLgbq plus an 11year-old with autism. I am here since we're talking today about promoting positive childhood experiences through the Ontario Early Adversity and Resilience Framework, which is an extremely important advance. However, the provincial government's education system changes through Bill 101 may exacerbate adverse childhood experiences. So children spend a large part of their life at school. Is it okay if I share a slide? Share. >> Okay, we see. >> Thank you. So Dr. Tyler Black, he's an emergency psychiatrist and Canada's leading suicide researcher. He's done research on suicidality in schools. It shows a difficult reality. Pediatric suicide death rates increase by 30 to 50% during school months and weekdays. The school environment is often a child's greatest stressor. For my children, one navigating a world not built for neurodeiversity and another navigating a social climate that is increasingly hostile to queer youth. School is a high stakes health environment. Bill 101 centralizes power, stripping our local school boards of the ability to respond to the specific needs of Toronto's diverse students. Bill 101 allows the province to override university academic freedom in teacher education and training. This means that the province can mandate a curriculum that deprioritizes diversity or mental health education by dictating curriculum from a central office. The bill also removes protective factors like the school climate surveys that help us identify bullying and safety issues on the ground, issues that the data gathering side of the adversity and resilience framework could complement. In an article in Scientific American, Dr. Black shares some suggestions and areas of focus for how to improve the mental health of students. Uh, universal mental health literacy. We've developed incredible educational goals for math, reading, science, and the arts. There should be a dedicated pathway for equally necessary learning. How to take care of yourself, how to look out for yourself and help others, and how to improve both the detection and prevention of mental health crisis. We should take bullying seriously and not just focus on the bullies. Public health data shows that both the bullied and the bullies share backgrounds of trauma. Our community of services should support both to prevent long-term psychiatric cycles. funding are initiating local community neighborhood groups to restore the social determinance of joy. Then children will be have access to play, music, and art. These aren't extras. These are biological necessities for relaxation and development. Uh we should end a perfect attendance awards which encourage children to ignore their physical and mental limits. We should all from time to time recognize when we are at our limit and we need a break. Children should also be encouraged to report when they can do so and be supported. Dr. Black also recommends reducing or eliminating homework and starting school later. We must respect children's identity and identity formation as a non-political compassionate health requirement. Finally, we must establish mechanisms to address abuse, including teacher-led abuse, ensuring that the adults in the building are never the source of a child's trauma. Should Bill 101 pass, Toronto Public Health will likely see an increase in families, children, and young adults needing city services, community programs, and resources. Communities and guardians will be the ones left to pick up the pieces to provide and distribute the programs and services that we know protect our children and K to2. Thank you very much. >> Thank you very much. Any questions for the deputent? Seeing none, thank you for coming in today. Uh, up next is uh Sammy Richard. Do you hear >> online? Sammy, can you hear me? >> Yes. Good morning. Can you hear me? Okay. >> Yes, we can. Five minutes. Go ahead. >> Wonderful. Thank you. Well, good morning everyone, chair and members of the board. Uh, as noted, my name is Sammy Pritchard and I am the director of advocacy and communications at YWC Toronto, which is the city's largest multi-ervice organization serving women, girls, and gender diverse folks. Our services include supportive and affordable housing, shelters, child care, a girl center, and antiviolence services, including a 12-week parenting program for children and their mothers who have been exposed to abuse. And I want to begin by thanking you for your care and attention to this matter. The report highlights what our organization and the families we serve have long known that childhood adversity does not exist in a bubble or have a single isolated impact but is shaped by social, economic, and structural conditions that often carry into adulthood. Many of the children we support are experiencing multiple intersecting adversities. These experiences are often shaped by gender, race, and broader structural inequities, including barriers to immigration status. For the children and families we support, adverse childhood experiences show up in many ways. They show up as children entering shelter after fleeing a violent household, as families navigating housing procarity and migration, and as caregivers navigating trauma while trying to secure child care, income support, and safety. When caregivers are unsafe, under constant stress, or navigating trauma without adequate support, it directly affects children's ability to feel secure, develop healthily, and flourish. So this tells us that preventing adversity for children means preventing violence and instability in the lives of caregivers as well. So we welcome the report's recognition of a coordinated trauma-informed approach across city services. However, true progress requires more than just training or or minor practice changes. We must fundamentally rethink our systems to ensure that they offer dignity, trust, and flexibility. And this is especially vital for indigenous, black, and racialized families who face systemic surveillance and barriers to care. And the city must ensure its services offer genuine support for survivors of violence, not undue obstacles through system navigation. Gender-based and community violence, are key drivers of these experiences. Children who witness violence, whether at home or in their communities, carry that trauma into their development, into their learning, their relationships, and their health journeys. For caregivers, surviving violence while parenting often means navigating systems that are designed to support safety, healing, and caregiving all at the same time. So again, from our perspective, in order to address these adverse child experiences, we need to focus on preventing them in the first place. In in practice, this means ensuring safe, stable, and affordable housing, accessible child care that supports healthy development, income security, and violence prevention. All of which are foundational to children's health and wellness and that of their caregivers. Having declared gender-based violence and epidemic, the city must now treat safety, housing, and childare as essential public health measures. Multi-service and community organizations like ours play an important role in making this approach tangible. Services such as our housing, child care, violence prevention, and healing support services, as well as youth gathering spaces like our girls center allow us to identify adverse childhood related needs early and strengthen preventative efforts by offering safe, stable environments and access to care. This work and that of our partners must be recognized and supported as the essential public health infrastructure that it is. To truly advance the goals of this framework, that infrastructure must be adequately resourced, stabilized, and meaningfully involved in shaping solutions. This means sustained support to the community organizations leading the work of prevention and healing. Finally, while the report acknowledges colonialism, racism, and discrimination based on identity and sexual orientation as drivers of childhood adversity, we must move beyond recognition. We need clear, accountable implementation of decolonial, anti-racist, anti-opressive practices that are embedded in how services are designed, how they're delivered, and how they're evaluated across the city. And as a sanctuary city, we must ensure non-status residents can access these services without fear or barriers. Public health leadership is essential to aligning city divisions, agencies, and community partners around a shared trauma and violence informed approach. And we really appreciate that this lens is recognized in the report. But again, true progress requires more than training. It demands a systemic overhaul rooted in dignity and trust. And we urge the board of health to adopt these recommendations to begin addressing the root drivers of childhood adversity and advance a vision for public health that identifies safety, housing, and child care as essential protective measures that addresses gender-based violence as a key driver of childhood adversity. ensures access to services free of barriers and fear, including for newcomers, migrants, and families with precarious status, and that sustains the community organizations that are central to prevention and healing. Thank you very much for your time and for the opportunity to speak today. >> Thank you. Good timing. Any questions for the deputent? Seeing none, thank you so much for coming today. Uh, up next is Kelly Mintosh online. Kelly, >> good morning, Kelly. You have five minutes. >> Morning. >> As a member of Clean Indoor Air Toronto, I was encouraged to see Toronto Public Health recognize poor air quality as a contributor to adverse childhood experiences. We already understand that conditions like poverty, instability, and chronic stress can have lasting detrimental effects on lifelong health. As we just heard in this TPH report, the physical environments in which children grow and learn are also predictive of their long-term health. One of the most important parts of that environment is the air they breathe in school every day. Improving indoor air quality in schools benefits students and education workers with fewer illnesses, fewer absences, better concentration, and stronger learning outcomes. In short, clean indoor air helps set children up for healthier, more successful lives. But these benefits are not distributed equally. Students from equityden denied communities are more likely to live in buildings and attend older schools with inadequate HVAC systems due to chronic underfunding. 84% of Tdsb school buildings are in a state of disrepair with many classrooms lacking mechanical ventilation and air conditioning. When air quality is poor, it doesn't affect everyone the same way. It disproportionately harms those who are already facing challenges. That makes clean air not just a health issue, but an equity issue. Without proper ventilation and effective filtration, airborne pollutants and viruses accumulate in the air we share. And without real-time monitoring, we can't assess when this air becomes unsafe. Clean indoor air protects us from pollution, wildfire smoke, allergens, and airborne infectious diseases such as measles, influenza, and COVID. Exposure can have significant health consequences. Fine particulate air pollution from sources including cars, jet planes and industry and climate change related events such as wildfires is viewed by the WHO as a leading risk factor for cardiovascular disease, asthma and cancer. The risk of airborne disease transmission increases with poor indoor air quality which can cause health impacts which are not mild. COVID, for example, increases the risk of heart attack and stroke, can damage the brain and other organs, and according to stats can leads to long COVID in roughly one in nine people. Physical health is also closely tied to mental health. When kids are constantly sick from exposure to air pollution, airborne diseases, and extreme heat, it will almost certainly impact their mental health. Despite these significant risks, public awareness remains very low. Few understand how easily airborne risks can be reduced by cleaning the air. When clean, clear, consistent guidance is not present, misinformation fills the gap. Toronto Public Health's mandate is to support and promote the health of all Toronto residents, including students and education staff. The good news is that we know how to solve this problem with early interventions like ventilation, air filtration, indoor air quality monitoring, and wearing high-quality masks. This will pay off through better overall health, fewer illnesses, increased attendance, stronger academic outcomes, and reduced strain on our healthcare system. I thank the board of health for the motion to direct Toronto Public Health to review indoor air quality guidance and look forward to your report in Q3. For the present report, I ask that TPH review how the conditions within Toronto's public schools may be impacting students physical and mental health, particularly in light of the changes being implemented by the Ministry of Education. I'm asking Toronto Public Health to take three key steps. First, educate. Launch a broad public awareness campaign explaining the risks of poor indoor air quality and how to improve it using these simple, effective tools. Second, advocate. Direct the adoption of indoor air quality standards for all public indoor spaces, particularly schools and childcare centers. Third, publish. Provide clear, accessible IAQ guidelines on what constitutes clean, safe to breathe air, and publicly monitor the carbon dioxide concentrations of classrooms and other public indoor spaces. Educate, advocate, publish. Clean indoor air protects everyone, but it is especially beneficial for those who need it most. By prioritizing clean air, we can create healthier schools, reduce inequities, improve learning, and give every child a stronger, healthier start in life. Thank you. >> Thank you, Kelly. Any questions for the deputent? Seeing none, thank you for coming in today. You >> next up is Debbie King. Morning Debbie. Good morning everyone. I'm Debbie King, as you heard, and I'm the elected trustee representing Parkdale High Park on the Toronto District School Board. I'm here speaking as an individual today in support of the recommendations that are before you and just offering some additional perspective and and context uh based on my experiences. It's very encouraging to see the potential endorsement of Ontario's early adversity and resilience framework and how it can be used to build on public health's initiatives and collaboration with external partners. Since we understand that early experiences have such a powerful influence on lifelong health and the significant amount of time that children spend in school, I really appreciate the report's recognition of the relationship between learning conditions and the mitigation of ACEs and we heard one of the speakers uh speak to that a bit earlier as well as a shared responsibility and the acknowledgment of public health's work requiring very close collaboration with city partners such as school boards on initiatives that advance these goals. So given that it is relevant then to consider the learning and conditions in school environments especially when they are contrary to the goals within the framework and promoting the positive experiences that we're working toward. So, what I'm sharing today are concerns about the learning conditions in Toronto schools that are already arising or have the potential to arise based on recent and proposed regulations from the Ministry of Education. My remarks focus uh attention on some of the equity denied groups who are disproportionately impacted by ACEs as we saw in the slide presentation. So according to the framework, sources of adversity include consistent exposure to structural forms of trauma, including racism and poverty. At the same time, the Ontario Human Rights Commission's Dreams Delayed Report, that's a report on addressing anti-black racism in Ontario schools, it asserts that racial discrimination and harassment continue to cast a shadow over the lives of black children and youth in our schools. And this is relevant because there are changes within Ontario's bill 33, Bill 101, and also decisions that are being made by a ministryapp appointed supervisor at the board that could see even greater sources of adversity uh and also result in reduced access to services and supportive relationships. So, just to give you a few short examples, Bill 33 mandates school resource officer programs in Toronto schools. This is something that Ontario Human Rights, the Ontario Public School Board and Ombbudsman Ontario have all cautioned against because of the historical harm to indigenous and black students in particular. As well, Bill 101, which was referenced earlier, if passed, we could see school climate surveys and research by the Higher Education Quality Council of Ontario cease. And what that would mean is a loss of data collection about student experiences as well as equity centered recommendations from an external body that have proven to be very effective in identifying and responding to systemic discrimination in our schools. And then lastly, under ministry supervision of the board, we've seen uh significant staff support positions cut for the upcoming 202627 school year. And I know that among the community there is quite a bit of concern that based on the financial pressures we might see uh further cuts including the potential loss of the model schools for inner city program. Model schools are programs that are informed by the learning opportunity index and they're designed to enhance equity and well-being in areas that are facing financial challenges and limited access to resources. So the loss of these programs would reduce uh again quality programming and supportive relationships for families as well in some of the highest area needs of the city. So these are just a few examples and you know just considering the the obligation of governments and social services to implement interventions that prevent early adversary uh early adversity. Uh I think that you know all of this can be very helpful as you continue to consider how you support children uh in that school age uh period of the lifespan. And what I would suggest is if you're not already using it as a tool, the TSB learning opportunity index could be very useful as another data source just to help you target uh you know where you apply those upstream interventions and services as well. A review of the impacts that Bill 33 is having on school environments and how it's changing uh the effects of the school and uh and children's experiences in school. So, I think I'm just over the time, but thank you so much uh for the consideration. >> Yes. Go. Thank you, Debbie. Uh you have one question from council bravo. >> Sure. >> Thank you. Uh it's nice to have a trustee here with us. Um and um welcome. I understand I've heard from a few trustees uh with concerns about the uh publication uh whether the public there will be publication of the learning opportunities index and uh how important that is obviously for how the board makes its decisions including on model schools. Is that something you've been hearing yourself? >> Thank you for the question councelor Bravo. absolutely is in the absence of public meetings and with trustees sidelined from the role there's not an opportunity to understand um where this report is how it's being distributed or utilized across the system. Uh and again just with the pattern of types of decisions that we're seeing under ministry supervision um there's concern that we won't see the same attention uh to the kinds of programming and allocations that were informed uh by that data. So the the key um the key challenge here is if we don't we're not able to see how the learning opportunities index is it being collected is it being how is it being used and uh have it be uh publicly available. It's been an important tool not just for decision makers at the board but also for trustees as representatives of the public and for parents. I've been um a parent of uh three children that went to uh model school for inner city. So I understand this very well and I was on the inner city advisory committee at the board for a long time. Um what do you think is lost when the public parents um are and are still elected representatives um and in general other institutions and organizations are not able to understand or see the outcomes of this meas this measurement of inequity. >> There's a level of transparency and accountability that is lost again because the information is not accessible. there's not the opportunity to understand and to advocate for how it might be used. Uh, one of the other changes that we've seen is a community advisory committee uh that specifically addresses uh inner city uh um uh issues uh has also been sidelined. So, you know, for over 10 months now, we haven't had the benefit of external partners, organizations, parents, uh, that have a very particular lens in this area and would normally participate in reviewing that kind of information, making recommendations to the board for consideration. None of that is happening in the current situation. So again, just the loss of that transparency and information is hindering our our ability to to participate uh and to make sure there's accountability for providing the supports that our students need for all of the reasons uh that have been discussed here. >> Thank you. I was a co-chair of that inner city advisory committee which oversaw the um the initiatives and I know that there were Toronto public health staff there. there were um city staff in other divisions, foundations, uh academics including parents and trustees. So really appreciate you coming here today and talk to us about um where we're headed and this tool at least for would be I think of interest. See being able to see that for this board of health and I'll be moving a motion to that effect. Thank you. >> Thank you. Uh go ahead director Zho. Go ahead. Um thank you for the informative um talk today. Um I actually just wanted to learn more about the school climate survey. You mentioned two different uh surveys being ministered. One is the learning opportunities index and then the other one is school climate survey. Can you talk to us a little bit more about what the school climate survey um measures and why it's it's so important? >> Absolutely and thank you for that question as well. So the school climate survey is administered to students. So it's one of the few opportunities that we have to hear directly from students right across the K to2 experience. Uh and it measures everything uh from their sense of belonging um to experiences of bullying and it can capture the kind of information that's not normally captured in in other structured um forms. So again, uh it's just very useful to understand from their perspective what they're actually experiencing. That sense of belonging is foundational, we know, to academic success, uh to a sense of well-being, uh and would definitely have overlaps between some of the the ACEs that we're hearing today as well. Uh so again this the evidencebased information and data collection is really critical to be able to allocate resources, identify programs um and continue that kind of positive work. >> Do you know that with Bill 101, is it going to be replaced with a different form of data collection that addresses the positive experiences, the bullying, or is it just no data being collected at all? >> A great question. when I would have had for the Minister of Education, if there were more time to uh provide feedback and question with him. Um, right now the way the bill is written and if it passes, there's not a requirement for the survey anymore. Um, so it puts into question whether or not it would be utilized and if it's not, uh, whether or not there is, as you said, an alternative measure of collection. There's no mention uh of one in the bill. So that's what raises the concern that we're really losing an opportunity um for some data driven uh kind of information to help inform decisions. >> Got it. Thank you very much. >> Yeah. Thank you. >> Thank you. Um I have a question myself. So, in your deputation, you mentioned the SRO program, and I know that um there's evidence that shows that um black and indigenous uh students are harmed, mainly harmed by the SR program. Um and while I was there, I know that the at Tdsb the program uh was came to an end. Is there any steps for that to continue? Do you know what the supervisor or the school board is now? What the stance is on that? >> So again, because trustees have not been engaged with the board since June 30th of 2025, there have not been any official conversations or information shared um with us as a governance body. My understanding based on information shared through the media is that the Toronto Police are not interested in resuming this program. Uh however, that doesn't mean that there wouldn't be some other type of program under a different name or branding. Uh it doesn't mean that there aren't conversations happening at the staff level. We simply don't have that information. Uh and again the concern would be that this was a program that was cancelled uh by the Tdsb for all of the reasons that we've discussed and that I think you're aware of. Um and with trustees not in a governance role in a ministryapp appointed supervisor in the place um we could see different decisions made under under that leadership. >> Thank you so much. Uh seeing no other questions from uh directors. Thank you Debbie. >> Thank you everyone. Um, next up is Sandra Hugh. H Uh, online. Sandra, can you hear me? Everyone, um, thank you for giving me the opportunity to speak today. My name is Sandra Ha and I'm a parent of a child in the public funded school in Toronto. I'm also director with the Ontario Autism Coalition. I'm here today to speak on the promoting of positive childhood experiences to improve healthy outcomes across the lifespan. I am deeply concerned that for many students with special needs, our school environments are not proving positive experiences and they are actually contributing to adverse ones. children spend the majority of their day at school just like a few of my previous uh delegates have mentioned. Um and for many it's uh you know their primary uh source of of socializing and and dealing with their days. In the special needs community we know that early intervention and supportive environments lead to better lifelong outcomes. Unfortunately that's not what many students are experiencing right now. Students with special needs often face bullying, lack of appropriate academic and behavioral supports, and inequitable expectations around attendance, not because they're unwilling, but because schools are unable to meet their needs. They're also at risk of physical harm due to inadequate supervision. We see students eloping from school buildings or being placed on what we call modified schedules that limit access to to their education. These are not isolated incidents. They are systemic issues that deny students meaningful and equitable access to learning. As Ontario's publicly funded schools continue to be underfunded, these challenges are worsening. Students are being excluded, sometimes informally due to the lack of staff and safe environments. Crowded classrooms and larger classes further compound this issue. Students on the autism spectrum and those with other disabilities are regularly excluded from classroom activities, school trips, and everyday learning experiences. Data from the Ontario Autism Coalition's 202 2025 2026 education survey shows that 26% of autistic students are now on what we call modified schedules. It's a significant 7% increase from last year. Additionally, 74% of families report at least one safety concern during the school year, including bullying or elopment, which means running away from school. These aren't just statistics. They reflect the real harm to children. To address this, I urge the board of health to consider the following. Um you know Debbie mentioned the the collection of data and you know we feel also that the formal and informal exclusions um need to be tracked along with disability and accommodation uh context. Secondly restore funding for play-based learning, arts, music and physical activity. These aren't just extras, they're essential, especially for students with sensory and developmental needs. Thirdly, perfect attendance awards, which unfairly penalize students should no longer be in play. You know, they can't actually go to school without those proper supports. So, it really is something that is difficult for for uh special needs families. um increasing the needs-based education funding so B boards can actually hire more trained support staff and meet their legal obligations under the education act, you know, per and also protecting the democratic oversight and transparency within school boards. As Debbie mentioned, we are not seeing anything from school boards currently due to the you know lack of transparency of supervisor that we have in play right now. Uh we also encourage the use of calming and exclusion rooms with clear enforcable standards um so that they can be safely used by students who need them. We also would hope that the implementation of the Accessibility for Ontarians with Disabilities Act education standards um has some accountability and some timelines attached to that. And finally, as Debbie mentioned previously, removing policing from schools and instead invest in social workers, child and youth workers, and other paraprofessionals who can build supportive relationships with students. I respectfully ask that the board of health direct Toronto Public Health to uh update its report to reflect these recommendations that I've just stated. Um, and I also asked the city council to send a letter to the Ministry of Education, Paul Kandra, and the Minister of Health, Sylvia Jones, uh, recognizing that underfunding in education is contributing to adverse childhood experiences for students in Toronto. Our schools should be places where all children feel safe and supported and be able to thrive. Right now, too many are not. >> Thank you. >> Thank you so much, Sandra. Ha. Any questions for deputent? Seeing none, thank you for coming in today. Um, Mary Sharp. Good morning. No, just swipe and and till it turns green. The base of the mic. Swipe it until it turns green. Now, can you hear me? Okay, good. Thank you so much. Okay. Um, for over five decades, I worked as a health care practitioner with pregnant and lactating women. I have great respect for the complex physiologic processes of pregnancy, birth, lactation, and early infancy, evidence-based practice, bodily autonomy, and informed choice. Today I specifically wish to speak to the issue of sudden unexpected infant deaths and public health consideration around efforts to res to reduce these deaths. On the personal side, I gave birth to six children between 1970 and 82 and breastfed them well into toddlerhood. The children were very healthy and I remember only once using antibiotics for sickness in their pre-teen years. I followed common sense. At night, as young infants, they were nursed and slept soundly in our bed. I didn't pay much attention to how they were positioned when they slept. Certainly in the day, they were placed on their tummies when they slept, usually on a sheepkin. I noticed that by using all four limbs, they were able to lift their heads up and from side to side, and they crawled very early. Thus, as a parent and health professional, I was very surprised and somewhat shocked to learn about the back to sleep, later called safe to sleep campaign launched in 1994 in the United States and 1999 in Canada with the goal of reducing SIDS or sudden infant deaths, sudden sudden unexpected infant deaths. This um this campaign suggested that all infants be placed on their backs to sleep, that they should sleep alone and should avoid sleeping on soft surfaces. Some of this advice seemed sensible and and intuitive, such as infants not sleeping on pillows and soft surfaces and later that cigarette smoke should be avoided and that breastfeeding was protective against SIDS. But sleeping alone and having to sleep on their backs for me was not. A flurry of materials and programs flooded pregnant and new parents with this advice. There have been many studies to suggest that the back to sleep initiative was highly successful and led to a 50% reduction in sudden infant deaths. Critics say that some of this the reduction of the SIDS numbers may have been caused by reclassifications of how infant deaths were being reported as well as by the recent increase in breastfeeding, an area so highly supported by you folks by Toronto Public Health and by our national agencies. However, I think it's very important to consider that the peak age for SIDS, 2 to four months, is the same time infants receive their first round of routine vaccines. A 2011 and a 2020 study analyzing the vaccine adverse event reporting system data from 1990 to 2019 in the US noted that 75% of reported SIDS cases occurred within 7 days of vaccination. However, the CDC and other experts in the state state that the veyors is a self-reporting system and that this clustering is a temporal association rather than a causal one. Often cited to support this lack of connection of SIDS with vaccines are the GE SID study, German study on infant death done by 2007 by venaman at al which showed no link between vaccination and sids. This multi-enter research project was co-unded by Sanafi and Merc. This is with pharmaceutical industry money. This doesn't necessarily invalidate the findings, but industry co-unding and vaccine safety research is certainly a conflict of interest that should be disclosed early when clearly when citing these papers. It's vital to continue to collect and analyze data on every aspect of deaths that do occur from the medical history information of the babies. But to question vaccines is seen as irresponsible, rash, and dangerous. Even though the public health agency of Canada's own documents attest to the many adverse events of vaccines, regardless in their public-f facing messages and in yours, these concerns are not highlighted but seemingly dismissed in favor of a belief in the greater good of vaccines. This direction has undermined transparency. I think it's the role of any health care agency to provide transparent, clear, and evidence-based information about the pros, cons, risks, benefits, and uncertainties of any aspect of care so that informed choices can be made. Let us re-evaluate and be open to the possibility that sudden unexplained infant deaths could be caused by vaccines given in the first few months of a child's life. Thank you very much. >> Thank you. Any questions for the deputent? Seeing none, thank you. Um, Skyler Hail Jackson, >> may I have the overhead, please? >> Just put the item on. >> Go on the overhead. Last time I was here, it didn't go on. >> Just put it on. There we go. Okay, you have five minutes. Toronto Public Health delivers programs and services to enhance the health and well-being of children to improve health outcomes. According to this report, early experiences have a powerful influence on lifelong health and exposure to early adversity is associated with a negative long-term health and social outcomes, including chronic disease and mental health challenges. There is a childhood health crisis. Toronto children are suffering from a variety of lifelong chronic illnesses as well as neurode divergent issues such as autism, ADHD, and dyslexia. Current data shows one in 10 children have ADHD. One in 36 children are on the autism spectrum, mostly boys, and two to five children in every Ontario classroom, has dyslexia. This is pretty shocking. How are Toronto parents and Toronto teachers coping with such a neurodeivergent generation of children? In 2000, in 2024, CAMH revealed a worrying decline in overall mental health among Ontario students. 51% of students indicated a moderate to serious level of psychological distress, a figure that has doubled over the past decade. What is the root cause for our sickest generation? Can all the Toronto public health programs and service services stop the steep decline of children's health and improve childhood health outcomes? It is well known that children are born with immature immune systems. Children must encounter infections one by one to build immunity. If children must encounter infections one by one to build immunity, then why do Ontario children get multiple combined vaccines in one shot? There are 75 doses of 18 vaccines recommended for Ontario children and seven vaccines are recommended for pregnant women. Everything crosses the placenta and the bloodb brain barrier of the unborn baby. Where are the safety studies proving these vaccines are safe for children and pregnant women? Could vaccines cause a toxic stress response in children? Toronto Public Health is focused on providing a healthy start for children by meeting the objective to reduce the burden of chronic and infectious diseases and prioritizing effective interventions for children and youth. Are board members aware that there are hundreds of evidence-based, peer-reviewed studies showing that unvaccinated children are healthier than vaccinated children. Something is causing our children to be the sickest generation. It is time for the Toronto Board of Health to step aside and allow parents to make educated and informed health decisions for their families. Vaccinating is one of the most important decisions a responsible parent is required to make for the long-term health of their child. One mistake early on and the brain and the body of their child may be forever changed. It is heartening to see that Toronto Public Health has expanded their individual and group based in-person and online workshops to support healthy pregnancies, birth outcomes, and preparation for parenthood. and that new mothers have access to a number of breastfeeding clinics. What is most surprising is how board members appear to be thoughtful, logical, cautious, curious, and advocates for truth, transparency, accountability, and informed consent. Except when it comes to vaccination, it is the time. It is time to end vaccine mandates for children to attend school and remove the need for exemption forms. It is time to end vaccine clinics in schools. It is time to empower families to make voluntary and informed health decisions. It is time to support individuals in their right to informed consent and health freedom. Warning, if you don't think for yourself, someone will do it for you. >> Okay. >> Thank you. Councelor Bravo has a question for you. >> I um thank you for all of the deputants that come. I however would like to request that when you refer to people not as neuro divergent that you consider neurodeiversity. Have you thought of the implications of your words and how you're pathizing children when you when you say that we're the most sick gen that they're the most sick generation? Actually, I took that word from you at the last meeting because you used it when you waved your hands around and said there could be autistic people in this room. >> I said neurodeiverse neurode divergent. >> No, I said neurodeiverse and and and uh just for your information, are you aware that Einstein had both dyslexia and ADHD? So, yes, everybody is. It's a Yes. So let's just consider that when advocating for your position perhaps you should think about not venturing into uh into that area because I well it's your right to obviously to come and speak to us as as a as a some of us are parents or have family members or ourselves in that situation. uh the brilliance it can result and it doesn't matter um to to say that this is a throwaway generation I think is very um unfortunate. It's not a throwaway generation. It the problem is that no one is facing the facts of the problems around vaccinations. They're giving vaccinations to two-month-old, four-month-old and six-month old babies based on no safety studies. >> Thank you. Thank you. Seeing no further questions. Um Nicole Curado, are you here online? >> Nicole, can you hear me? >> Yes, I am here. >> Five minutes. >> I would a couple of things I would like to say. Um I do not suffer from autism and my autism was not created by vaccines nor was my ADHD created by vaccines. It was something I was born with. It's something that's genetic. It's something that's been in my family for a while. So, I just want to clear that clear that up and clarify that that uh people do not suffer from autism or ADHD. It's just something they have. It's something they always have. And what I would like to say is that autism is not caused by adversive childhood experiences. However, if an experience that might not be so adversive to a neurotypical person is going to be far more adversive to a person on the autism spectrum because person on the autism spectrum is going to perceive everything very sensitive is going to perceive everything a lot more acutely. I feel everything a lot stronger. I you know everything sounds are a lot louder. I'm still bothered by a lot of things. So you know an adverse of childhood experience would have been they had this big balloon pop. What I I don't know if I was like four or something at a a shopping mall and you know they would drop a bunch of balloons. Everyone would just be popping them to to get to get uh coupons. It was absolutely traumatic. It it was like it was like bombs going off. It was and I'd never been in a war, but it was it was an adverse of childhood experience. Having having someone in a play group because they didn't want to touch paint, grabbing that my hands and shoving them in the paint. Those were adverse of childhood experiences. And they're things that maybe wouldn't traumatize a neurotypical child, but they traumatized me. And those those are the kind of things that, you know, and even then, you know, my my behavior, you know, I would I would have meltdowns and I would bite people and, you know, I heard my mother saying, "Oh, I wonder if she's a psychopath." And and that really hurt. My mother loves me. She wonderful mother, but uh wonderful. I have wonderful parents, but she back then did not know about autism, and I hadn't even been diagnosed yet. She didn't know what I was. I'm actually the opposite of a psychopath. extremely sensitive and but it's those kind of little things where a person you know has meltdowns in public and you know the parent says all this is because they're autistic and then they associate autism with shame or they associate autism with their worst moments. These are the kind of things that we need to to bear in mind and unfortunately a lot of the quote treatments for autism are very fear and shame based. You know, ABA is controversial because it tries to make a person look neurotypical and it's quite quite uh harmful for a lot of people uh you know even even the modern ABA because it it tries to make autism a person feel shamed about the autism and that that those that is adversive. So for a child to to be made to feel shameful for who they are and and in constantly bombarded with with sensory assault is just it's adversive and and you're absolutely right that it's not the it's not caused by the vaccines or or by anything else. But uh it is but it's just that a person on the autism spectrum. Oh and the other thing is in schools a lot of people are also children are also bullied a lot and that that's adversive. I was homeschooled so thankfully I didn't have to go through that but a lot I've heard of a lot of people who who've gone through a whole lot of bullying and and from being in you know in school. So yeah, it's it's a a you need to be working with autistic people and and that was one community, the autistic community. I would suggest working with a fora autistics for autistics and also y youth alliance for intersectional justice um to work more on neurode divergent community. Okay, thank you very much, Nicole. Any questions for Nicole? Seeing none. Um, okay. Uh, we're going to take in-house to directors. Any questions of staff? Council Bravo? Um I just wanted to follow up on the um uh deputation from uh school trustee um about the uh produ the collection production and use and publication of the learning opportunities index and just to quickly ask um how it is used and uh by Toronto public health and um whether it's important to ensure that we have that data to assess uh whether our interventions are where they're needed and how whether they're um delivering and succeeding >> to you Mr. Chair. Thank you very much for the question. Um we do use um learning opportunity index to um assess where the greatest need is in the community. We use it together with a number of other uh data sets and Toronto Public Health takes a proportionate universalism approach to providing services in schools and that helps us uh together all that data helps us determine where we should be providing more intensely uh services to the schools with the highest need. >> Thank you. And uh in terms of uh significant new programs, for example, uh this the school nutrition program, would it be helpful to have that information to be able to for example evaluate later as this is a population level intervention? I'm going to ask my colleague Myan to just respond. Thanks. >> Hi. in terms of for the school-based S&P based programs initially uh if you recall pre-expansion there was limited funding opportunities. So as such when those funding opportunities were there we were basically essentially using that index to say who would be lack of a better term deserving of those funds opportunities. As we moved to universal for phase one and phase two we tackled it from an LOI approach as well as school readiness to maximize the efficiency of the funding opportunities we received. As we move through phase two, phase three, and now as we go to phase four, the LOI is becoming less critical as we're moving to universal. So, every school is going to get that program. Um, when we look at future opportunities, is there a means where we can return to an LOI to look at different opportunities? For sure there is, but for now, uh, it was basically pre-expansion for phase one and two as well. >> So, it's been helpful in terms of identifying, uh, need in the past. Um but and if there is uh opportunities for the future, we would continue to rely on it. Thank you. >> Okay, that's it. Okay, thank you. Uh any other questions? Uh do Dr. Zo? >> Um thank you both for your informative presentation. Um I've actually personally referred some of my patients to the um healthy babies healthy children program and they found that the um uh lactation consultant services to be extremely helpful. Um I guess my question is uh how do you um screen uh people for the um perinatal adjustment program and for the healthy babies healthy children program? Is it done at the hospital level like when a child is born the obstitricians will identify individuals at risk or um is it usually screened by their family physicians? Um and I asked this because not very many family physicians know about the program. I happen to know about it because I'm on the board, but um what is being done to identify more um participants in this very helpful program? >> Thank you, director. Uh to the chair. So, healthy babies, healthy children is a universal program. We do aim to reach every single child um that is born. uh and that is usually at the time of hospital that they would complete an initial screening that looks for a range of um uh issues both uh from the mom from the family situation from baby for risk factors. If there's anything identified on that screen um to indicate either mood or anxiety disorder then they would be referred to the parinatal adjustment program to have a more in-depth assessment and referral. We know unfortunately we don't reach every single baby um through the HBHC program. we we're working with our hospital partners to make sure we're getting a better completion rate that we are reaching um individuals then or sometimes they you know did screen in but then maybe didn't want the program and so need to kind of re-enter and that's certainly you know we we would um HPHC can go up to three years old and beyond. Uh so so providers who maybe they forgot about it and they want to re-refer they can re-refer but we do try at that um initial assessment through that that first screening to identify families who might be eligible for the perinatal adjustment program. Um just a quick follow-up question. So sometimes I have um delivered babies who come from moms who might um use opioids or um babies with like fetal alcohol syndrome. And so in those situations, if they if the physician identifies there is a need um would the physician inform the social worker to uh refer to this program or what is the I was just wondering what is the process of um getting connected to the chair. Uh so the perinatal disput program is is particularly focused on um mood and anxiety disorder. So it doesn't we don't have the complexity we don't have physicians on board to handle substance use. Um, so they could refer, but but we typically would be looking for helping families make other referrals to more specialist programs for substance use care. Uh, we do have a number of hospital partnerships um, who have more perinatal uh, specialist care for more complex mood or substance use disorders because that's certainly outside of the scope of what our our nursing providers would be able to to offer. >> Got it. And just one final question just for my own knowledge. Um, do you work with with CAS? um is that like a source of referrals for you guys >> to the chair? Yeah, we we do work have a partnership and and work closely with um children's aid services um through our children's partners as well. Uh certainly, you know, our goal is really to work with families and that's not um the first place we we uh typically have families enter the the program. Um we we like to be able to identify, you know, all families. We're trying to screen every family to see where they might need it. Um some of the families we work with do um are involved with children's aid services. Unfortunately, you know, many of the families who come through our homeless at risk pregnancy program um uh have involvement with children's aid services as well. And we do help to try to support those families as best as we can through that entire process. But I'll turn it over to our u director if you want to add further. >> Yeah. No, I think you you covered the majority of it, but a lot of the work that the uh teams do across healthy babies healthy program and the parinatal adjustment program is really through uh partnerships and building those strong referral pathways. So, we put a lot of emphasis on uh building those so we can direct um people that need more clinical intervention as quickly as possible uh into the system. And I'll just add that in terms of the um healthy babies healthy children program while we do screen uh everybody and we try and identify the highest risk we also do send uh communications to all families that we do get receive a screen for. That way they are connected should something uh come up uh down the road in terms of requiring additional supports or questions about uh other things as parenting takes a different uh its own journey. Uh they would be able to connect back with Toronto Public Health. >> Great. Thank you. Okay, thank you. We'll now go to Council Jones Lynn and then Council Thompson after that. Go ahead, Councelor Jones. >> Hi, thank you for the presentation. Um, I just had a a slightly I want to go in a slightly different direction. Uh, in the report there is a discussion about monitoring cell phone use. Um, and I wanted to inquire because we're we're starting to see more and more very serious concerns raised around cell phone addiction. Um, not just around young people, specifically around young people, but also in adults as well. Um, and the dangers also associated with social media, but leading to adverse effects in terms of mental health and well-being among young people, uh, depression, anxiety, etc. So, I just wondered if you could speak a little bit more broadly as to how Toronto Public Health is approaching this, whether you're working with the school boards um or the Ministry of Health in and you know, the Ontario Ministry of Health around this and I just wondered uh if you could expand, I guess, a little bit on beyond sort of the monitoring what we're doing. >> Uh to the chair, thanks for that question. Uh we did add um at a previous uh board of health meeting when we presented on our school partnerships and the renewal of our partnerships with um the four Toronto school boards uh looking at some of the foundational work we want to do. We did add specifically looking at um things like digital health, social media use, cell phone use as part of that work. So that is an active conversation we do have with our schoolboard partners as we meet with them quarterly to really look at the the impacts of this. Um other ways we can be supporting um their implementation of things like cell phone bans in schools. Um how we could be also sharing information to school communities about ways that they can prevent um harms at the individual family school and also societal level. We certainly worked with groups like Unplugged Canada um who've been championing uh a number of of ways that we can be really thinking about how to mitigate some of the impacts of social media and um digital technology use for for children for younger children. Uh so we have a number of initiatives underway um that was through a board direction from the fall on this. Uh but I will also just turn it over to um our director if they want to add anything else we're working on. have been covered. >> Yeah, I think there's um other uh interventions that we're doing to also increase aware awareness. So, incorporating key messages and raising uh awareness about some of the um impacts of cell phone use and some of our parenting programs uh directly with uh families as well as we're building out the um our sedentary um uh sorry movement strategy. So encouraging people to get more active uh sharing messages around um the importance of uh monitoring cell phone use and digital use. >> Any further questions, counselors? Um I I guess I would just also add to that one of the other areas that I think we need to be paying attention to and I'm I'm suspect you are um but is uh gambling addiction particularly um as an online harm because we certainly see that as an um a rising addiction issue particularly with boys. Um, and so I guess I'm I'm looking to see more of that in the future here. Uh, just because I am extremely concerned about that and and I think we need to be um monitoring but also going beyond to see how we can partner and and make sure we're making a dent in trying to uh trying to address these really critical issues that are affecting our young people. >> Thank you. Uh, Council Thompson. >> Uh, yes. Thank you and good morning, Mr. uh chair and everyone. Uh Mr. Chair, it's not often that I read a report that just um really makes my heart uh feel amazing and and I'll say the word giddy uh because of the focus here on children and diversity and so on. Um I just wanted to ask a series of questions, but what I'd like to do with your permission, Mr. Chair, is just to ask the questions all together. There's probably about four or five of them. I'll maybe just narrow it down to four. It's a collection of questions and I'll give staff the opportunity to respond as they see fit. But before I do that, I just wanted to thank the staff for um amazing an amazing report and Dr. Murphy for her leadership and so on. This is just really really important stuff quite frankly. So my first question will be you know how will the success in preventing and um mitigation of uh ACS be tracked um and the second question again I'm asking all the questions together and the staff can respond accordingly what ind what indicators uh are we looking for to understand the improvements in uh child um health and outcome across the city and further what researchers what research are we you are basing this information on how will the stats be collected and then um I also wanted to understand uh do we have category categorizing categorize information stats based off on ward breakdown and in order to help us to better understand the needs of children in specific uh areas across the city and then to compare them because I would imagine that there are some unique differences in as much as we're a large city and so on. And then finally, what outcomes have been achieved previously through partnerships that demonstrates the impact and promoting proactive uh childhood experience? It's a collection of questions I've asked. I'll just leave that for the staff to basic basically answer it in in a in a broad way and I'd appreciate that. Thank you, Mr. Chair, and thank you to the staff. >> Thank you for the questions to the chair. Um I'll try to I think I captured them all. So I think the first one is a really important question um because it's not easy because it's not easy to to measure both how are we doing and changing um the number of ACEs that children might be experiencing but also I think more importantly is how are we measuring the impact of this and are we actually showing that children are more resilient moving into the future. We can't prevent all ACES. We know that. But how do we show that the interventions are making children more resilient and and and bending the curve on some of the long-term health outcomes that we have? So, we do have a number of surveys um that we look at uh on a regular basis. So, things like the Ontario student drug use mental health survey um that's connected through CAMH regular basis. We have um school behavior surveys that are uh regularly reported on. We did just hear from the trustee in terms of things like um the school climate survey which uh you know is is a very important survey to us as well. Uh we don't always we don't get the data from that but we certainly are able to discuss the results of that with our our school partners. We would love to be able to get the data from the school climate survey to be able to have that especially if it was to continue or a version to continue into the future to say you know how on a more real-time basis um you know does every child in a school have a trusted adult in the school that they could feel like they could talk to you know do they you know how do we actually sort of measure in that real-time way the kinds of resilient supports that would make a difference and then hopefully start to see a shift in some of the mental health outcomes um that we're seeing. We know that we had you know really negative trajectories through the co pandemic in terms of seeing a declines in youth mental health and I think you know embracing the strategy is not going to change overnight but but how over the next years we can start to see that the the investments we're making in in children and youth now start to improve some of those outcomes that children do feel more supported that they have better access to care that we can start to see those those improved pathways that that people are not um you know waiting for services in the same way that they have So I think that that's an important question and I think certainly an area we we continue to work with a number of partners on. We did have that um uh research salon with a number of academics to help us think through um some of the the ways we can continue to to measure that. Uh in terms of the word breakdowns um we are always trying to get data as local as possible. So we have been working with our colleagues at social development um in their space to look through um the ways we can combine many of the different uh data pieces that we have. You know looking at things like justice um family settings violence uh different factors to have that as hyper local as possible. Not everything can be um local. We did recently invest in a survey to look at the prevalence of ACEs in Toronto and unfortunately we didn't get the the sample size to be able to to to look at some of the results in as narrow way as we'd like to. So we are going to still continue to investigate how we can do that better to try to get um more local information. But but what we do have we're certainly working with as many partners we can to to answer that. And I think a good example of, you know, an outcome of partnership where we've seen real success on this and and where, you know, where we're going forward, um, is the work of what we've been doing. We had a really successful presentation of the ASES framework with our safetto table um, and really being able to share with all the partners there, you know, the importance of understanding the the impact of ACES and a resiliency framework. And we saw, you know, a shift that that that folks and the TCHC, for example, were now really, you know, thinking differently about how they're responding to calls when they have um crisis calls within TCHC and and recognizing, you know, what if there are children in that home, how are they thinking about providing support so that that's not a traumatic experience or if there has been a traumatic experience, how are they connecting those families to to better respond to um to the family needs in those situations. So, I think we're seeing some real shifts in the way that um our city partners are practicing as well. >> Thank you very much. Thank you, Mr. Chair. >> Thank you. Uh councelor Chang, go ahead. >> Thank you, Chair. Uh I have just a few questions. Do we measure ACEs in our vulnerable intake? So when people are getting harm reduction or when they are receiving service in our shelters, is there a time where we have conversations with our clients uh about ACEs and the potential impact on their lives and and therefore potential pathways of healing? >> Thank you very much for the question to the chair. um uh there is not a systematic a way in which um we assess for ACES as part of our harm reduction um and clinical activities currently. Certainly in the course of you know the engagement we have in the client these things may arise and you know as appropriate we you know do have processes in place to ensure referrals to the right you know um place to receive for further support but um you know certainly we could um take that back and take a look at how that might be done in a more structured manner. At what age do you think it would be helpful for people to realize the impacts of adverse childhood experiences they may have had? Because not all people have grown up with this lens, but certainly many people have gone through these type of experiences. >> To the chair, I I would have to take that back and sort of say, you know, is there a specific age? I think what we're, you know, part of what the framework really tries to promote is is a whole of society lends to this that this is not something that, you know, families can do. This is not something school can do. This is not something just a single community do. But we really need all partners to understand and embrace um how how much adverse childhood experiences has an impact on lifelong trajectory and and so I think through that that whole society model there's there's sort of different levels of awareness of this. So, as younger children, you know, sort of understand it and hear about it, um that they, you know, will have more of a readiness as they get older to kind of rethink about um experiences that they've had as real, I think, really leaning into the positive experiences and how we can really support those types of ways of um of of supporting resilience, developing resilience to having um better pathways for for families to have a better outcome. And so, I don't know that there's a specific age. can we can take a look at that but I think really embracing the the whole of society component to it. >> Is there a suggested tool for assessment that people could use uh to understand the impact of ACEs on their lives? >> Uh to the chair. So as as mentioned we recently did conduct a survey in partnership with public health Ontario and other um health units to to try to get a better sense of ASUS and we actually did have a lot of deliberation in developing this tool. There's there's um a real mixed feeling in terms of um the experts in this field as to the best way to ask about ISIS without ret-raumatizing individuals even as adults that um you know asking these kinds of questions can be very um triggering, very uh difficult to answer, feel, you know, that this is a a difficult thing that people don't want to participate in. um and really how do we ask those questions in a way that also balances asking about their positive experiences so that we do get a more wholesome picture of an individual's experience. So we we did have a a long runup to how we ask those questions. Um and I think that there's still probably a lot of ongoing research we need to do to be able to really think about the best ways to to um measure this and monitor it going forward. >> So there's no public facing tool. if somebody who you know was thinking hm I wonder if this impacts me there's no public facing tool where they could do a self assessment so to the chair we do have information um available and and I think the the early introduction um of the uh Ontario adversity framework does do a nice job of explaining what ACEs are so things like physical and emotional abuse things like parental separation things like having a parent who's been incarcerated ated things like parent who has a serious mental health or substance use disorder. So I think talking about what they are is a way of people can recognize in themselves what types of ACEs that they may have experienced um in their life without necessarily having them to to respond in a way that's that you know is triggering or or trying to collect it in a in a too narrowly defined way that that uh you know just boxes their experience as opposed to the more wholesome understanding of their intersectionality of experience. I have just one last question. Uh, in the US, I noticed that there's a few organizations that actually focus on this issue. The American Society of Positive Care of Children, ACES Aware, and the Hope National Research Center. And I'm just wondering if there's any parallel organizations here in Toronto or in our country that are focused on ACES. I'm just checking with my colleagues here. Thank you for the question. Um we are not aware of any parallel organization here. Uh we are excited that the early adversity and resilience framework does bring together a community of practice to um share um the latest research and evidence and and uh share innovations as well and things to try. >> Thank you. Those are my questions. >> Thank you so much. Um >> director Madara, you have five minutes. >> Thank you. Um, I wanted to echo what everyone else has been saying about um, the fabulous work that's gone into the report. I really enjoyed reading it. Um, I had some questions. One of the things that I also really appreciated was the focus on partnerships with indigenous organizations with uh, First Nations in Matate uh, communities within the city. I actually have two questions. My first question that I'm curious about is how this work um reflects or embeds uh indigenous determinance of health. So I'm thinking of things like uh connection to land, culture, language, uh community. I'm wondering um how that those determinants are being um embedded in in Toronto Public Health's understanding of the framework um and is complimentary um and really like embedded uh in the work that you're doing in this area >> to the chair. Thank you for that question. And I I think all of those things you listed are are really wonderful examples of resilience. And you know, if you saw the the graphic of the the negative experiences and the positive experiences and really trying to champion things that are culturally meaningful um to those families to say, you know, being able to connect with land, being able to connect with culture, being able to re-engage with language are all examples of positive experiences that can help uh really, you know, try to trans try to to rebalance those negative experiences that might be experienced from a history of colonialism and a history of social and structural determinance of health. So we I think we do recognize, you know, the importance of that and and similarly for other cultures for for black families, other equity deserving populations, really trying to make those resiliency experiences meaningful to those families. >> Thank you. Um my my second question was around partnerships. Um, in in the appendix there was a great section that talked a lot about um the partnerships that TPH has with uh indigenous organizations and the work um the way in which that work supports addressing ACEs and supporting resiliency in First Nations and Matei communities in the city. Um that's very very important. And I was wondering if you could also speak to how Toronto Public Health is also adapting our own programs um you know supporting our own workforce and the service delivery to really ensure that it's culturally safe. Um that it's providing anti-racist service delivery that's aligned with the framework. Um so thinking about of course the importance of partnerships but also that other piece around ensuring that the services and the work that TPH is delivering is also addressing the needs of communities. to you Mr. Chair and thank you for the question. Um we have a couple of examples of how we are trying to do this in practice that I can share to help um illustrate. Um one of the ways is uh we often partner with an indigenous agency. Um so for example um we have a we're partner currently partnering with an indigenous uh agency and uh working with them to develop and design uh new programming specifically to fathers. And so uh through a fathering circus uh circle it's called and so we're piloting that project but it's in uh collaboration with the indigenous uh organizations that we're designing and developing and evaluating how we uh continue to deliver that service. In terms of an example, in our schools, we've hired two indigenous um nurses who are specifically assigned to schools that have high indigenous uh populations. And for initiatives like our ISPA program where suspension may be a possibility um for students that aren't in compliance, we engage with uh the superintendent at that school responsible for indigenous. We partner with indigenous organizations to really think through how we communicate, approach, engage the families around the uh importance of vaccination and really design a slightly modified intervention for what we may do in other schools. So those are just two examples I'll highlight and sorry I should add the third is that we are doing significant training around trauma-informed training across all of our staff. We've already trained approximately 350 staff. We've also trained our people leaders to make sure that our people leaders are coaching, mentoring, providing advice and guidance along the way. And that program is going to be expanded across Toronto Public Health. Um and uh in partnership with other uh city divisions, uh we're looking to continue that work so that we're um providing the best possible care possible. So those are three examples, but some work happening there. >> Thank you. Um, I will ask questions last. The good thing about being last, most of my questions have been asked and answered. So, so I actually have to look and find other questions. Um, so I do have two questions. The pandemic, how does how does this impact the ACEs in our city? Like again, it's been a life once in a lifetime situation that really has impacted young people. So maybe you can speak to that somewhat. >> Thank you chair. Uh I think the part of the reason that there was such a desire to bring forward the Ontario adversity framework at this time after the pandemic is because we recognize the significant impact that um co has had on family on society on on the the children. We have seen through the pandemic a significant increase in intimate partner violence um which is one of the main uh forms of first child experience that that uh children can be exposed to. We have seen increases and worsening of parental mental health and substance use through this period as well. We've seen through the opioid toxicity crisis a number of families have lost family members um as being all contributors to increasing risk for children experiencing adverse adverse childhood experiences through the pandemic time. At the same time we've seen through the pandemic uh a number of positive factors because you know sometimes families were at home. Uh we saw one of the deputants show um the data on suicide and we know that actually suicides declined during um the pandemic because families were at home more often and be able to support that. So mental health worsened but suicides actually declined. Um so so there had been some positive impacts of that as well and I think some you know new ways to connect with people. We did see an advancement in technology and and certainly there are harms with um cell phones and technology but also new ways of of accessing mental health supports and resources that uh that we are connecting. I think as we are coming out of the you know coming out of the pandemic we have restrengthened a number of our services. So, um, programs like healthy babies, healthy children, which were interrupted during COVID, really being able to restrengthen those, making sure we're taking an equity lens and delivering those services, um, increasing things like our paranatal adjustment program to be able to reach families to to be able to help support some of the impacts we've seen through COVID, um, and the continuing impacts that we're seeing now. >> Wonderful. Um it was mentioned that you work with other divisions uh within the city, but have you looked and I know council Chang mentioned an American state, but um have you looked do you work with other jurisdictions across Ontario and best practices, what they're doing, what works, what doesn't work, because again I know we have these borders around regions, but we're all Canadians here. Um yes, thank you for the question. Um we do work with other jurisdictions. So we know that Vancouver um also has an early adversity and resilience framework. Uh we've uh they uh developed theirs prior to us and we've uh adapted a lot of lessons learned from their experience. Um, and as I mentioned, there's a a community of practice for the early adversity and resilience framework that has representation from uh the 29 health units uh across the uh province and that's where a lot of the evidence research and uh and experiences is brought together um and uh uh recommend sorry application of how the framework is applied is kind of discussed in that forum. So we connect regularly uh through that group as well. >> Okay. Wonderful. Thank you. Those are my questions. Um, okay. Seeing no other questions, let's take it to uh speakers. Who wants to go first? Councilor Bravo. Thank you. I have a motion and thank you very much for uh to staff and for clerks uh with your help. Um while it's displayed, it refers to um the point that um school trustee um uh Debbie King raised in her deputation and I've been hearing from parents and also from other school trustees concerned um about the continuing sharing of the um indices of inequity uh framed as a learning opportunity uh and and the importance for the work of Toronto Public Health in its um design, delivery and implementation of um interventions that promote health among children and youth. I I really want to congratulate staff for this report. I felt as my um my peers did here that it's an excellent piece of work to uh bring together uh this information that sets out for us and for members of the public in Toronto uh the importance of of uh these experiences that happen before the age of 18 that can have a lifelong impact on um mental health. We've been so uh you know concerned and as a board about a children's mental health, children's wellness and all of the different uh factors that harm them. But the the the significant uh ones outlined by the medical officer of health I think need special attention. traumatic events that uh shape um u a life uh but also setting out the their consequences um and then some of the work that can be done to uh mitigate um to prevent and to protect and so I I feel as councelor Thompson said I was excited to read this report grateful for the work um and the importance of this all being done in a data driven way and um as uh as our colleague um uh director Mador said done in partnership um in deep meaningful partnership with organizations that can look at the layers of um exclusion inequity that compound these experiences. So I I really want to thank uh staff and um and all the deputants that came today to speak about the importance um and the need to ensure that we have the best outcomes possible. can't think of a more important intervention that uh pays off in the as for society is focusing on children and I would love to see more and more of our focus to be on children. Um and perhaps we can inflect this into the rest of society and certainly the partnerships with other city divisions are crucial as we refocus on how we u ensure that we have a a better society and better outcomes in the future. Thank you. Thank you, councelor Bravo. Well said. Um, councelor Chain. >> Thank you, Chair. I too have a motion. The motion is focusing on an increasing knowledge and public awareness of ACEs and resilience on strengthening data collection and uh Oh, this is part one of my motion. Sorry. Okay. And then there's another part. We can just put that on the screen as well. >> There's a second motion. >> Yeah. Which also uh reiterates what some of the deputants mentioned about um asking the Minister of Education to preserve the school climate survey and consider expanding it to include issues raised in the Ontario Early Adversity and Resilience Framework. And uh I want to yeah also echo my gratitude for this really important work that puts into I think public knowledge something that um I think more people need to know about. And you know, we saw that uh the Toronto Police Service put out a dashboard on IPV last year and the number of occurrences hovers around 15 to 16,000 for the last 14 years. Um and in 2019, the research shows that 80% of IPV victims don't report to the police. So we know that the 15 to 16,000 reported is just a fraction. And the impact of IPV uh on children and that adverse childhood experience is is proven and profound. And so if we have a an IPV epidemic, we have uh an adverse childhood experience epidemic. And so anything we can do to prevent both, I think will have meaningful long range impacts on people. And I just want to share that this is very very personal for me because I struggled u with several aces in my upbringing and I did not have the language and I didn't know what it was. I only knew that in my 20s I hit a a moment in my life where a lot of things started to unravel. I had mental health challenges. I had an eating disorder. Um and I blamed myself. So I thought hm how come everyone else seems to be doing okay but I am really struggling. Even though to many on the outside I looked very shiny and I was um still achieving publicly but internally I was really really struggling. And one day, you know, someone mentioned the ACEs to me and I took a tool online to assess myself and it just put all the these things into focus. Suddenly the struggles I had made sense and suddenly I didn't have to blame myself anymore. And I I think it's really um important to note that you know we measured maybe 30% of adults um have ACEs in their life but we are not sure it could be far more because of the limits to how we collect that data. And I think the impact of having ACEs is that you are then limping. you're limping for in different ways. Some people it's addiction, some people it's mental health, some people um you know have health challenges, but you don't know you're limping and you don't know why you're limping. And that's why I think bringing this into further public awareness um with you know the delicacy of not retraumatizing people but empowering people to say if you have aces in your life which many people do there is ways there are ways that you can heal that you can be empowered and for me I believe that the struggles that I went through uh in my childhood have really informed formed my leadership, the way I deal with people, the the way I want to see a more connected community where people feel empowered and people feel a sense of belonging. These all have roots in the challenges that I face. So having ACEs is not a sentence, but it does bring clarity and a pathway for people who might be struggling and don't know why they're struggling. So, I look forward to a future report back on the progress that we're making in this area and I I look forward to strengthening collaboration with other organizations. I think it will have a profound impact on the trajectory of many people's lives as more people know about this and as we build a more resilient society. Thank you. >> Thank you, Council Chang. Any other speakers on this item? Uh seeing none as again I'll just say thank you to staff for this comprehensive report. I actually learned a lot about ASUS. I didn't know as much about it before. And some of the things I went the questions I wanted to ask was actually around LOI and student nutrition and uh housing and vision zero all the things the city's been working on especially the food nutrition program which is really important. Um, and of course the SRO program which impacts students uh significantly again again indigenous black students in in the school boards. And I'm happy the TDSB actually took steps to limit that program and I hope other school boards do that as well. Um, and with that being said, I don't want to say more than has been said already, but uh I I and again I support the motions that's been brought forth by councelor Bravo and and councelor Chang. I think it enhances this um this uh the recommendations here. And with that, I will ask staff to put up the um amendments. Councelor Thompson, did you want to speak? >> No. >> No. I was planning to vote, Mr. Chair. It was good to have. All right. Okay. All those in favor of council bravo's motion opposed. Carried. Council Chang's first motion. All those in favor? Those carried. Next and the last motion by Council Chang. All those in favor? Those carried. Wonderful. Thank you so much. Uh item as amended. All those in favor? Those carried. Thank you. Great discussion. Okay. And the last item is item 32.1 promoting positive childhood experiences to improve health outcomes across Nope. That's what we just did. HL 32.2 services agreements awarded and executed by the Met Office of Health for 2026. And we have three speakers on this item. Uh Daniel Fryheight online. Is he here? >> Dad, can you hear me? >> Can hear you loud and clear. >> Okay, go ahead. You have five minutes. >> How's my audio? Okay. >> Yep. Um, by the way, on that school climate survey, I tried to that was there's a copyright threat when the parent looks at that survey, so they can't actually discuss it or share it easily. Anyhow, off topic, but I just thought to threaten parents with copy trademark infringement for publishing that survey. Um, that was pretty weird. Um, my name is Dan Fry, as most of you know. I do some advocacy on Twitter, mostly uh, sorry, under Lion Advocacy. Uh, I've gotten I'm up to 38,300 followers. I get around 78 million views on my posts of um I've I wanted to talk today about the issue of uh vaccine injury support. Um the because I was looking at the budget that the board has approved or is on the verge of approving for other um other items on the budget. Uh specifically the health the sexual health clinic which is getting 2.8 8 million um the the vac so it's just about for my my presentation today is really just about how to manage priorities and how to manage the queue because there are people out there Torononians uh who've been waiting four four to five years for compensation for vaccine injuries and this is these are not um myths these are in some cases ver you know they're often verified um this was had been managed by the federal government uh from the beginning of the pandem or from December 2020 uh up until uh April 1st of this year, 2026, it was being managed by uh a private contractor uh who was processing the injuries or supposed to be processing them, but the the the contractor was really having issues getting through them for some reason. I mean, I think I know the reasons, but um seeking a lot of documentation uh direct control of the documentation. So asking directly from hospitals and physicians to have the documents uh go directly to the assessor and so there are a lot of people's injuries didn't get processed um they just never went through. I actually spoke to people at the vaccine injury support program employees there was a lot of turnover. There was a lot one I think I mentioned this to this board but one of the staff was apparently having mental distress. I think the point is this is a now the the federal government decided to take it over or that's how they pitched it. They said we're going to take it over from this private contractor because they don't seem to be doing a good job. And um what I just learned this a couple week or a week or two ago from uh a young lady who who advocates a lot on Twitter, her name is Caleb Pollock, but that the um this new uh processing by the federal government, they haven't appointed any medical adviserss to actually look at these claims yet. And that was um that's a major flag. So you've got people four or five years out, some with serious catastrophic injuries that have mobility issues now, that are in constant pain, that need physiootherapy, that need medication, and then medication is not cheap. Um they're having they're struggling to to get by. And so when I see these um amounts that are being spent on um you know uh birth control counseling and lowcost birth lowcost birth control, emergency contraceptive pills, interun IUDs, free condoms and lube, uh vaccines for for STI. I mean all that's important, but I just wonder if there's a better way to manage the queue. Um like I say, these people have been reaching out to me for years. I couldn't talk about it on on internet because I was censored. If I mention the word vaccine or injury in the same sentence, for some reason the AI or the sensors took down the video and made it very difficult to discuss um even even you the reason why you're not hearing more from vaccine injured people uh in this board of health is because they had difficulties mobilizing. They formed face group Facebook groups that were taken down. uh our friend uh Zuckerberg at at Meta acknowledged under oath that he was he had been working with uh the US government to uh to restrict the mobilization of people injured by the vaccine. Uh that that's a serious problem that's going to need addressing at some point. But the point is the only reason you're not hearing more from people who've been injured by the vaccine uh a is because some of them are in a in a situation where they're not able to get down to the board of health or to uh have the energy to speak. Um, thankfully I still got a bit of energy left in me and that's what I'm doing. I get uh I was contacted early on by a conservative MP out west about constituents in his writing um how what to do but the how to help people with vaccine injuries. The board of health has a unique opportunity now with uh some of the budget items of just uh respectfully requesting a reconsideration of of priorities and queue management. So in other words, we've got these people in the queue. the board of health can actually work strategically with uh public health agency of Canada to process these claims, streamline them and uh get people the help they need. >> Thank you very much. Any questions of dependent? Seeing none, thank you. >> Uh councelor Chenn and uh can you please turn your camera on for qu? Thank you. Um next up is Council Jon Counc uh Arnold Marqueis online. >> Okay, go ahead. You have five minutes. >> Yeah, good afternoon. Uh thank you for the opportunity again to talk to the uh board of health. Uh yet again today we are hearing um concerns or of the residents about the uh failure to enforce the current indoor air quality by the fun of public health. And uh to that effect, I appreciate the chair and the board on the uh session number 30 uh uh that you uh actually purpose the uh Toronto public health to provide a comprehensive review by the third quarter of this year. I just wanted to suggest that review is not enough. they also need to provide the uh uh suggestions or the the proposals how to actually improve the service not to review only the status quo and in order to do it the logical step is to run the pilot right now on the basis of one of the uh environmental health enforcement units I would suggest a north York unit because it's uh kind of close to north industrial area I'm living at Battle Street and along the corridor at night there are some releases of politans from the industrial um uh companies at night. So uh and uh so uh I also suggest to engage public uh just like MLS was actively engaging public and acorn in their meetings uh discussing the property standards development and uh also uh you know the MLS uh receive Toronto development. Uh I'm one of those residents concerned that you can easily engage me and it would be to your benefit. I'm I'm pretty sure about So what are the components of the pilot that I suggest? First is education. So the inspectors are insufficiently qualified to enforce indoor equality based on my experience. I spoke to University of Toronto and the Metropolitan University professors about the possibility to quickly develop the curriculum for continuing education program. and you can sign actually contracts and they they would be happy to educate uh fasttrack your inspectors to actually enforce the current standards in indoor air quality. So the second thing is to identify suppliers uh and equip uh the uh inspectors with modern portable air quality measurement devices. So current devices insufficient. They measure particulate matter but they don't measure volatile organic compounds which are even more essential for harmful effects on health of bad indoor air quality in schools and resilient buildings. Sometimes uh due to uh you know negligence of the landlords and management of schools and sometimes intentionally to speed up tenants turnaround. So uh in that regard um uh as you know the uh provincial public health unit has an indoor equality equipment loan program and your inspectors should register sign contracts and regularly loan their devices when uh doing the inspections in the building in particular within this pilot project and uh uh that also includes training Right. So they are expected to train you your inspectors how to use the devices. So the first thing is uh the established cooperation from with the provincial environment enforcement units ministry of environment conservation and parks. You know they have Toronto district office enforcing uh uh outdoor air quality. They have a laboratory services branch with a pretty good equipped labs with mastoters uh uh to allow analyzing outdoor quality. You need to establish the contracts with this particular ministry in order to jointly inspect buildings, schools and also overnight samples should be left at facilities and then analyze and minister of environment lab at minimum post to you. So the fifth step is establishing a night shift for the pilot project and at least one inspector should be working at night at the pilot project uh unit and just like uh MLS have let's say noise department they work at night until 2:00 a.m. because it's critical uh otherwise uh you know it's it's not going to work the the contamination often happens at night. So the sixth step is uh uh uh improve your complaints uh pro processing because people will come with this uh with suggestions how to improve the process and uh I'm just asking you to also engage >> yes you're at time sir final thoughts >> okay final thought is engage city manager in order to develop a joint policies how do you are going to work with other enforcement departments jointly to enforce indoor air quality and I'm asking to uh you know to right now to maybe to put a motion to vote or to start this pilot project on on June 1st of this year. Thank you. >> Okay. Thank you. Any questions the deputent? Seeing none um we we are on the final item. I know Chistan that uh councelor Johnston has to leave as well. She's got an emergency call. But um we had beer quorum. Um if councelor Chang stays on, councelor Justin can leave. Okay. Um but no one else can. Nicole Curado. >> Yes. Um I saying I was very very concerned about I was very concerned about uh one of the people who they're raising one of the places that they're contracting with in particular. I'm quite concerned about about um the Planned Parenthood and I know that there's a lot of myths about Planned Parenthood out there, but there are but I am quite concerned because I looked them up and there's a lot of misinformation on the Planned Parenthood site. For one thing, they said that the um Planned Parenthood is used to like like they said that that an that an abortion expels a pregnancy. No, it expels a dead fetus. Uh so there's a lot of the misinformation. There's no they're not really giving women a lot of choices because there aren't lists of of alternatives on their website. They the city of Toronto and when I Google abortion alternatives, it just comes up with abortion clinics. And the other thing is that's very concerning is um well it says you know talks about the abortion pill but it doesn't say that there's actually reversal for the first pill that will stop the abortion from happening. They they won't tell you that. >> Okay. Is that it? Well, no, I was trying to say that there's a lot of concern about that I don't think the city of Toronto should be putting money into into uh Planned Parenthood because they already get enough money as it is Planned Parenthood. They don't need money. They don't need people's t such a controversial organization does not need tax people's tax dollars. >> Yeah. Thank you so I don't I don't think Yeah, I I would suggest giving money to somewhere else. >> They're a less controversial organization. >> Okay. Thank you for your deputation. Any questions for the deputent? Seeing none. Thank you. Uh take it in-house questions of staff. No speakers. No. Okay. Thank you so much. This is a easy breezy one. Uh all those in favor of uh the recommendations oppose carried. Okay. Thank you. And uh the final item here is that um I'm going to bring a motion forward to excuse one second. I'll move a motion to excuse the absence of um Director Charles Oz not in attendance today. Now I'll read it that the board of health excuses the absence of uh Ab's two people here. Abanita Chandalan and Charles Oday from the May 4, 2026 meeting of the board of health. All those in favor carried. Thank you. Thank you every staff. Thank you to my uh colleagues around the table and to all the deputants and those online. Thank you so much. >> Thank you everyone. >> Mr. Shut here. Have a good day everyone. >> Thank you.