Assessment/course of action uses a clinical process that incorporates the EEDA method in order to provide children with the tools they need and to support key people around them throughout the children’s lifecourse trajectories. It is an evolving process centred on the child’s needs.

Conclusion

Conclusion The conclusion occurs when solutions or potential solutions have been found in response to the issues that have been raised during the meeting. Before everyone leaves, the doctor checks whether the child’s and the family’s expectations have been met. This conclusion provides continuity between the end of the meeting and the medium-term follow-up. The doctor always ends by positively reinforcing one of the child’s strengths: “You’re so energetic!”, “You’re a big boy!”, “You’re really strong!” The clinical process is now over, but it is just the first step in a continuum of services that will be provided throughout the child’s development and will follow his/her lifecourse trajectory. For this reason, two types of assessment/course of action are set up: the initial meeting and follow-up/ongoing care and support. This second type of assessment/course of action is intended to determine what progress has been made on the plan outlined during the first meeting and to make any necessary adjustments as the child’s needs change. Assessment/course of action is effective because it includes a reassessment of the initial plan at every meeting so that everyone is moving in the right direction.

Action plan

Action plan Once hypotheses and ideas for possible solutions have been suggested, the community social pediatrics team summarizes the various options brought up during the discussion. The doctor establishes a diagnosis or a pre-diagnosis of health-related issues and an action plan is devised based on agreed-upon priorities. The diagnosis may become clearer over time, depending on the child’s lifecourse trajectory. Caution, patience and a more holistic approach to health are needed, given the complexity of most family situations. The action plan includes: A list of the most important needs to be examined. An inventory of major strengths within the child, family and community. The services provided by the community social pediatrics centre (use of local resources). Referrals to external agencies through partnerships or service corridors. Drug therapy, if needed. The action plan is tailored to each child and aims to meet his/her immediate and more complex needs. NOW MOVE ON TO THE CONCLUSION

Advancing hypotheses and looking for possible solutions

Advancing hypotheses and looking for possible solutions Secrets or important information that have surfaced during the parallel discussions may be shared after getting permission from participants. Identifying problem areas in front of all the participants is paramount because this leads to a common, shared understanding of the child’s and family’s experiences in a totally transparent and honest way. It also helps build a trusting relationship among all those involved. Everyone around the table is then in a position to formulate hypotheses and suggest appropriate solutions. The family is an active participant in this hypothesis-development stage, thus setting the stage for them to become aware of their own problems without being judged. NOW MOVE ON TO ACTION PLAN

Parallel discussions

Parallel discussions The next stage in the meeting is key because it introduces a change of pace: the doctor’s clinical examination. The doctor takes the child to the examining table while the clinical assistant stays with the other participants around the table. Parallel discussions then begin with the dual purpose of getting a better sense of the child’s needs and better understanding the family dynamic. Going beyond the conventional clinical examination, the physician uses this opportunity to get close to the child to look for other clues to complete the analysis. Throughout the examination, the physician continues to ask questions to better understand the child’s reality and living situation. The small space means that the doctor and the child are physically close to one other. Their conversation gives the child a chance to confide in the doctor, if needed, and for the doctor to learn more about the child’s opinions and reactions to what has been said previously during the meeting. Even as the examination is being conducted, the doctor keeps an ear out for things being said around the table. During the child’s clinical examination, the clinical assistant continues the informal discussion with the other participants in order to make a more complete assessment and test certain hypotheses that have been put forward in the first part of the meeting. The main objective is to gain a better understanding of what triggered the request, of the family’s social and relational context, and how the child is doing in school. NOW MOVE ON TO ADVANCING HYPOTHESES

Information sharing

Information sharing The clinical team’s aim is to understand the child’s and the family’s situation by exchanging information among all participants. Rather than a data collection, it is a way of exchanging which “provides enough information for the family to better understand the way they do things. At the end of the meeting, this is often expressed through statements such as: ‘We have never been able to talk to each other like this before’ or ‘We said things that we have never said before’” (Ausloos, 2010: 160). Participants bring complementary points, thereby providing a more complete picture of the request from the family, the referral from an organization or the court order. The child explains the situation in his/her own words. The physician tries to make links with what the other participants have said or addresses questions to several participants, which enables information to surface from everyone in the group. The idea is to create a dialogue connecting several people, rather than conducting a one-on-one examination. The point is to let the family further explore its own situation. Sometimes, provocative questions posed in an informal way can shed light on the complex and difficult situations the child and family are dealing with. The doctor takes a complete health history during this discussion, not in the usual linear way however, but by following the flow of the conversation. The goal is to trace the medical, family, social and developmental history of the child to try to make sense of what he/she has lived through. This complete history goes beyond listing the child’s previous illnesses or identifying symptoms. It aims to paint a complete picture of the child’s lifecourse trajectory, and to identify sources of stress in his/her physical and social environment. As the discussion continues, both the child’s needs and rights that are being denied become clearer. In addition, the discussion serves to identify and underscore strengths within the child, the family and the community. This information-sharing process is key to creating a bond between the child, the family, the community social pediatrics team and the other participants. Its real purpose is to get to know each other; diagnosing the problem is secondary at this stage. A diagnosis will become clearer as time goes on, over several follow-up assessment/course of action meetings. Throughout the discussion, the child is free to move around in the clinic, which also includes a play area. He or she can climb on or play with the toys on hand, eat or read. The doctor observes the child the whole time. Letting the child move around freely gives the doctor an opportunity to get a better handle on the child’s verbal and non-verbal language, and to assess certain aspects related to development, such as fine and gross motor skills and reading level. NOW MOVE ON TO PARALLEL DISCUSSIONS

Starting the meeting

Starting the meeting The clinical area looks just like a dining room. Everyone – the community social pediatrics team, the child, family and other participants – takes a seat around a table, just like in someone’s kitchen. This way, a friendly atmosphere conducive to sharing is created even before the meeting begins. The French proverb “The table is the matchmaker of friendship” has proven to be true at the clinic, where the table helps to create a sort of “caring circle”. The mood is set for the start of the meeting, which is just as informal. The physician and the clinical assistant sit next to each other. A member of the team begins the discussion by asking everyone to introduce themselves and explains how the meeting will proceed. NOW MOVE ON TO INFORMATION SHARING

Welcoming children

Welcoming children In community social pediatrics, the welcoming children phase is the first contact between the child, the family, any other significant adults and the community social pediatrics team. Everything is geared toward building a trusting relationship and facilitating the integration of services. The reception area is inviting and friendly, aimed at making the child and those accompanying him/her feel welcome. Fruit, juice, coffee, toys and books are available. The person at the reception desk greets them as if they were coming into his/her home, chats with them, makes sure they are comfortable and answers any questions they may have. The community social pediatrics team, made up of a physician and a clinical assistant (social worker or psychoeducator), comes out to greet them. The doctor first speaks to the child, crouching down to be at the same level, looking him/her straight in the eye and speaking in an informal tone. This is a simple, friendly and forthright way for both of them to establish a first contact. Connections are made using both verbal and non-verbal language, which is the first step toward developing reciprocity and at the same time, providing the doctor with an opportunity to begin subtly assessing the child. In fact, although the atmosphere and approach are informal, the doctor’s observations and questions are already clinical in nature. At the same time, the clinical assistant greets and welcomes the family and other participants to the meeting (significant adults and professionals involved with the child). A discussion ensues involving many voices speaking at the same time, much like when a family has company over. This informal and easy-going atmosphere aims to ensure that the child and family continue to use the community social pediatrics centre’s services. NOW MOVE ON TO STARTING THE MEETING