The comprehensive assessment done during assessment/course of action works because all the major players in the child’s life are involved, and because of an approach that is an integral part of the way the community social pediatrics team operates, which we call collaborative intervention.

It involves collective know-how and cooperation between the community social pediatrics team and the child’s family, social and institutional networks where the entire focus is placed on coming up with solutions together to best meet the child’s needs.

It is based on the notion of shared leadership, which is the main feature of collaborative intervention, and is defined as a process whereby “each participant, as well as the group as a whole, plays a leadership role and contributes his or her expertise with the aim of reaching a common goal. This goal itself becomes the real group leader” (Luc, 2010). In the community social pediatrics context, the goal is none other than meeting the child’s needs.

Collaborative intervention means true cooperation where all those present, including the child and family, participate on an equal footing. The child’s needs are everybody’s primary concern and the child plays an active role in identifying them. Rather than being the subject of the conversation, he or she becomes an active partner in seeking solutions to his/her problems.

Collaborative intervention is also a way for professionals from different disciplines to support one another so they can better grasp the complexity of real-life situations. That means recognizing everyone’s professional limitations, as well as the need to get another perspective to be able to intervene more effectively. The child and family are equal partners in the search for solutions, thereby moving from a managed-care approach to one of empowerment.

To learn more

Listen to Édith Luc on shared leadership.

References
  • Lapierre et Lormont (2010). La co-intervention : l’apport des « RAR » 2006-2010, Journée de formation de l’Éducation nationale enseignement supérieure et recherche, Bordeaux-France.
  • Luc, E. (2010). Le leadership partagé : modèle d’apprentissage et d’actualisation. Les Presses de l’Université de Montréal (deuxième édition revue et augmentée) : Montréal.
  • Romme, A.G.L. (1996). A Note On the Team-Hierarchy Debate, Strategic Management
    Journal, 17 : 411-417.

 

The Distinctive Features of Community Social Pediatrics

The community social pediatrics model sees health in the same way as the World Health Organization, i.e., “…a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (WHO, 1948). It adopts a holistic approach to health that considers both the basic needs in child development and the environment in which he lives. It aims to reduce the health problems caused by difficult living conditions in order to prevent, detect and limit the effects of toxic stress on children’s development.
grfx_006

References

  • Julien G. (2004). Soigner différemment les enfants, L’approche de la pédiatrie sociale, Les Éditions Logiques : Québec.
  • Julien G. (2004). Soigner différemment les enfants, Méthodes et approches, 2e éd. Les Éditions Logiques : Québec.
  • Préambule à la Constitution de l’Organisation mondiale de la santé, tel qu’adopté par la Conférence internationale sur la Santé, New York, 19-22 juin 1946; signé le 22 juillet 1946 par les représentants de 61 États. 1946; (Actes officiels de l’Organisation mondiale de la santé, n°. 2, p. 100) et entrés en vigueur le 7 avril 1948.

The intervention in community social pediatrics is complex for several reasons:

  • The number of diagnoses and social problems for each child.
  • The number of players involved in each case.
  • The variability of outcomes for each situation.
  • The degree of flexibility that is required to develop tailored interventions.

This type of intervention requires constant innovation, involving professionals from various disciplines.

Adopting a holistic approach to health, medicine gets to integrate other disciplines in the process. Together, they better understand the sources of stress affecting the well-being of the child. This requires breaking down disciplinary barriers and working in close collaboration with the child and his/her family to grasp the complexity of the situation and to bring out solutions within the family system.

Professionals in community social pediatrics must therefore develop collective skills based on shared representations and values (humanism, universalism, benevolence, love of the other, social justice, respect and transparency) cooperation and learning experiences.

References

  • Craig, P. et coll. (2006), Developing and evaluating complex interventions: new guidance, Medical Research Council London, UK. P1-39
  • Campbell N. et coll. (2007), Designing and evaluating complex interventions to improve health care, BMJ, Volume 334, p. 455459
  • Shepperd S. (2010) Cadre d’évaluation des interventions complexes. Des connaissances à la pratique, CIHR Canada.

Empowerment is a process whereby individuals secure the means to better use their resources and to gain greater control over their lives. Empowerment is based on the idea that everyone has the capacity to change and to transform their social milieu to better meet their own needs by relying on their strengths and abilities.

The community social pediatrics model aims to empower and engage the child, the family and the community. It relies on the child’s and family’s participation in all discussions and decisions that concern them. Rather than being the subject of the conversation among social service and health professionals, the child and family become active partners in the discussion. They are always present at assessment/course of action meetings and play an active role in understanding what is at stake and in seeking solutions to the difficulties they face.

Professionals working in community social pediatrics centres are able to secure the child’s and family’s active participation and engagement because of the special relationships they build using the EEDA method. Greeting people in a friendly and informal manner, respect for diverse cultures and values, non-judgemental attitudes, transparency when sharing information, and being open and available are all features of community social pediatrics know-how.

EBy including the child and family in all discussions and decisions, the community social pediatrics model follows recommendations by the Canadian Paediatric Society on decision-making:

  • Joint decision-making involving the patients, their families and health professionals should be fostered.
  • Children who are capable of making their own decisions should be supported.
  • Appropriate, truthful and clear information should be presented with sensitivity to children and their families so they can become effective participants in decision-making.
  • The parents’ wishes and values should be respected.
  • The needs and interests of the child or adolescent should prevail.
  • In situations of conflict, available resources should be sought to help resolve the problem, and to facilitate patients’ and families’ access to assistance.

… and recommendations by the American Academy of Pediatrics on strengthening parents’ capacities and reinforcing the child’s strengths:

  • Families and communities should be strengthened and given the tools they need to be able to provide social support to the child, and to improve their skills so they can nurture the child’s social and emotional development, and help improve his/her language skills.
  • Practitioners should intervene in a way that nurtures the child’s emerging social, emotional and language skills, and promotes positive parenting techniques.
References

  • American Academy of Pediatrics (2012). Early Childhood, adversity, Toxic Stress, and the Role of the Pediatrician: Translating developmental Science Into Lifelong health, Pediatrics, 129 (1) : e224-e231
  • Lemay L. (2007). L’intervention en soutien à l’empowerment : du discours à la réalité. La question occultée du pouvoir entre acteurs au sein des pratiques sociales, Nouvelles pratiques sociales, 20 (1) : 165-180.
  • Société canadienne de pédiatrie (2005). Treatment decisions regarding infants, children and adolescents, Pediatric Children Health, 9 (2) : 99-103.

The community social pediatrics model invites significant adults involved in the child’s life to an assessment/course of action meeting to ensure that the child receives coherent services tailored to his/her needs throughout his/her lifecourse trajectory. Together, they identify a range of resources that need to be mobilized so that services can be created or adapted to meet the child’s specific needs.

These services vary in intensity (number and frequency) depending on the child’s lifecourse trajectory. In this way, the child can receive more services and closer follow-up at more difficult times during his/her lifecourse trajectory and less intervention when things are going better.

This meeting attended by the child, the family, the social pediatrics team and professionals from different sectors (school and daycare teachers, workers from youth protection, health and social service centres, community centre) makes it easier to share information and ensure coherent services. Everyone expresses their point of view openly and transparently, and is listened to respectfully. This leads to a common understanding of the child’s situation, which in turn makes it possible to identify and really deal with the sources of toxic stress. This information sharing process also makes it easier for the group as a whole, including the child and family, to formulate an action plan that all major players in the child’s life agree with and are ready to implement.

Social pediatrics centres create and tailor customized services to meet each child’s needs through the help and involvement of their clinical teams, the many volunteers from the community, and external partners (namely, schools, health and social service centres, community groups). These services vary from one child to the next, but also between different communities. For example, in a neighbourhood with a high immigrant population, a centre may develop services to help children adjust to the host culture, to ease anxiety associated with immigrating and to learn a new language. In another neighbourhood, a centre may decide to work with a community-based institutional partner to promote physical activity and healthy eating habits in response to a visible increase in the number of overweight children using the centre’s services.

The cornerstone of the community social pediatrics model is assessment/course of action. All other services result from this clinical meeting which is a prerequisite to the development of any new services.

By fostering information sharing between the child, the family and other significant adults and practitioners in the child’s development, the model follows recommendations by the American Academy of Pediatrics on interdisciplinary practice and partnerships:

  • A collaborative approach with colleagues in related professions should be used to reduce the barriers to health and well-being faced by children in the community.
References

  • American Academy of Pediatrics (2005). The Pediatrician’s Role in Community Pediatrics, Pediatrics, 115 (4) : 1092-1094.

In the community social pediatrics model, close collaboration with the legal community is also important. The Alliance Droit Médecine Sociale [Law-Social Medicine Alliance] supports actions taken by social pediatrics centres by facilitating access to justice to resolve swiftly and effectively issues that jeopardize respect for children’s basic rights.

The Law-Social Medicine Alliance covers all sectors of the law that relate to the negative impacts of the determinants of health. It ensure that children’s rights are respected in compliance with the Convention on the Rights of the Child and other laws that have an impact on children’s development: landlord/tenant law, family law, youth protection law, immigration law, right to information, right to education, laws related to health and social services, labour and employment laws, human rights, and civil rights.

At the 4th Community Social Pediatrics Symposium of the Fondation du Dr Julien, Nicholas Bala, Professor in the Faculty of Law at Queen’s University, discussed whether adults should make decisions for children or whether children should be involved in the decision-making process, and how to take into account their viewpoints.

By facilitating children’s and families’ access to justice, the model follows recommendations by the Canadian Paediatric Society and the American Academy of Pediatrics on the practitioners’ advocacy role:

  • Medical intervention should be redefined focusing on both children’s development and their rights.
  • The advocacy role of practitioners should be reinforced to ensure that children at risk have access to services and use the services that are available to them.
  • Practitioners should act as vocal advocates on behalf of children and families when resources are scarce and lack of resources is a barrier to accessing health care services.
References

  • American Academy of Pediatrics (2012). Early Childhood, adversity, Toxic Stress, and the Role of the Pediatrician: Translating developmental Science Into Lifelong health, Pediatrics, 129 (1): e224-e231
  • American Academy of Pediatrics (2005). The Pediatrician’s Role in Community Pediatrics, Pediatrics, 115 (4) : 1092-1094.
  • Daneman D., Kellner J., Bernstein M., et coll. (2013). Social paediatrics: From ‘lip service’ to the health and well-being of Canada’s children and youth, The Journal of the Canadian Paediatric Society, 18 (7) : 351-352.
  • Julien G, Trudel H. (2009). Tous responsables de nos enfants : un appel à l’action. Bayard Canada, Montréal.
  • Société canadienne de pédiatrie (2005). Treatment decisions regarding infants, children and adolescents, Pediatric Children Health, 9 (2): 99-103
  • Zuckerman B, (2012). Medicine and Law: New Opportunities to Close the Disparity Gap, Pediatrics, 130 (5) : 943-944.

To be effective, the community social pediatrics model promotes interventions involving ongoing contact with the child’s living environment, namely home, school, and recreational activities. The model is grounded in the community through community social pediatrics centres (CSPC).

Jean-François Lemire/shootstudio.ca

Jean-François Lemire/shootstudio.ca

A CSPC is first and foremost a warm, welcoming, familiar and child-friendly place supported by families and the community. The child and key figures in his/her life are greeted by a team of seasoned professionals and many community volunteers who help ensure the active involvement of an impressive network of partners, including:

  • Families.
  • Community-based organizations.
  • Business and legal communities.
  • Institutions such as daycares, schools, health and social service centres, youth protection services and community police departments.
  • Private enterprises

The CSPC team liaises with the various places in the child’s world by visiting them and speaking directly with the people involved so as to better support the child and his/her development.

The CSPC is able to build trusting relationships with children at risk and their families because it is grounded in a disadvantaged neighbourhood. The close physical location means that children can have easier access to community activities that meet their needs and interests. Being grounded is also a way of giving the community the tools it needs to understand the difficulties these children face and to become involved in the search for solutions. The CSPC becomes a “pediatric medical home” for the child and family, in other words, a safe place where they can seek reassurance to reclaim their strength and build their resilience (American Academy of Pediatrics, 2012).

By ensuring that CSPCs are grounded in the community, the model follows recommendations by the American Academy of Pediatrics:

  • Practices should be put in place to screen for children at risk.
  • Assessments should take into account the adversities children face.
  • Information should be shared.
  • Joint action plans should be formulated in collaboration with parents.
  • Partnerships should be set up with other institutions to better meet children’s needs.
  • An efficient referral process should be set up, in addition to conducting ongoing monitoring and assessment of intervention impacts.
  • Data on the community should be obtained (epidemiological, demographic, social, and economic) so that social and environmental risk factors affecting the child’s health can be better understood.
  • Effective partnerships should be set up with other community resources.

By ensuring that CSPCs are safe and secure places where children and their families can reclaim their strength, the model follows recommendations by the American Academy of Pediatrics on the “pediatric medical home”:

  • Social pediatrics centres should be set up to help children and families develop their resilience and to reduce sources of toxic stress.
  • A wide range of services tailored to children’s needs should be provided in each centre.
  • Funding should be sought and centres should participate in innovative service delivery adapted for children at risk.
  • Centres should identify local resources that work toward reducing and preventing sources of stress and promote the development of these resources.
References

  • American Academy of Pediatrics (2012). Early Childhood, adversity, Toxic Stress, and the Role of the Pediatrician: Translating developmental Science Into Lifelong health, Pediatrics, 129 (1): e224-e231
  • American Academy of Pediatrics (2005). The Pediatrician’s Role in Community Pediatrics, Pediatrics, 115 (4) : 1092-1094.
  • Walker S.P., Chang S.M., Vera-Hernandez M., Grantham-McGregor S. (2011). Early childhood stimulation benefits adult competence and reduces violent behavior. Pediatrics, 127 (5) : 849-857