Community social pediatrics: For the health of all children
Developed by Dr. Gilles Julien, community social pediatrics is a comprehensive approach to health that integrates medicine, law and the social sciences, which makes it possible to:
- Provide integrated, personalized care and services to children in difficult circumstances aged 0 to 18.
- Identify, reduce or eliminate toxic stresses affecting their development, with their fundamental rights in mind.
- Give them and their family hope and the power to regain control of their lives with the support of their communities and institutions.
Why community social pediatrics?
Thousands of children in Quebec lack the care and support they need to grow up healthy and reach their full potential. In difficult living environments, these gaps have serious consequences for their health and overall development. They can result in an increased risk of chronic disease in adulthood. By focusing on the needs, interests and strengths of each child, community social pediatrics provides them and their family with the necessary care, tools and support.
1 in 4
1 in 4 children living in vulnerable circumstances is not ready to enter kindergarten at the age of five; this figure can be as much as one in every two children in some areas.Source: Institut de la statistique du Québec, Enquête québécoise sur le développement des enfants à la maternelle 2017.
A three-year-old child from a privileged background knows 600 more words than a three-year-old from an underprivileged background. *
* Observatoire des tout-petits, November 2019
In 58% of families receiving community social pediatric services, both parents are unemployed. *
*Regard mixte sur certaines particularités et retombées de l’approche de la pédiatrie sociale telle qu’implantée au Québec et sur son intégration dans le système actuel des services sociaux et de santé, 2015.
3 years old
By the age of three, the adverse effects of toxic stress and morbidity can already be observed on the morphology of the developing brain. *
*Altered brain development following global neglect in early childhood, 1997.
First Nations children who live on reserve are four times more likely than non-Indigenous children to experience some of the worst social and economic conditions, causing negative effects on physical, mental and emotional well-being. *
*Natasha Beedie, David Macdonald and Daniel Wilson, in collaboration with the Assembly of First Nations (AFN), the Canadian Centre for Policy Alternatives (CCPA), Towards Justice: Tackling Indigenous Child Poverty in Canada, published by Upstream: Institute for a Healthy Society, 2019; National Report presented pursuant to Paragraph 5 of the Appendix to Resolution 16/21 of the Human Rights Council, Canada. Human Rights Council, Universal Periodic Review Working Group. 30th session, A/HRC/WG.6/30/CAN/1, May 7-18 2018 https://www.ohchr.org/EN/HRBodies/UPR/Pages/CAindex.aspx
How to provide care and empower our children for life
Community social pediatrics is based on an integrated care approach focused on the needs of the child. Children, their family and their social network are at the heart of this comprehensive health model. Care and services are provided by a team of dedicated professionals and volunteers who work in partnership with institutions and the community, for the well-being and development of the child, like a large caring and protective circle.
Child, family and community
The child, their family and the members of the community around them are the primary allies in making meaningful changes in a child’s life. They possess important tools that can be leveraged to help identify needs and sources of stress and actively participate in the development of solutions and a customized action plan.
Community-based medicine enables the physician to diagnose, with the input of other professionals, the development and overall health of the child, including neuromotor function and language as well as physical, psychological, emotional and social health. This human, collaborative approach makes it possible to address the causes of symptoms and propose solutions by leveraging the child’s strengths in conjunction with the resources of the family and the community.
Psychosocial professionals, such as social workers, play a pivotal role in working closely with the physician. By identifying toxic stresses and helping to refine the diagnosis with their observations, psychosocial professionals allow for a more complete medical assessment. They therefore enrich the assessment/orientation and then propose concrete solutions. Psychosocial professionals coordinate access to a range of adapted and integrated care and services in order to implement the action plan based on the clinical assessment.
Incorporating law into social pediatrics facilitates access to justice via the clinic. The lawyer-mediator ensures that the child’s fundamental rights are exercised and respected, through both protective measures and amicable dispute resolution. This also provides children with the means and tools to express themselves and to take ownership of their rights and responsibilities.
Specialized care and services
Psychosocial and psychoeducational services
Mentoring and community services
Medical assessments are conducted by the physician responsible for evaluating the child’s overall health, with the participation of the child and the people around them. The physician puts together the information to establish a collective understanding leading to a comprehensive action plan. With the support of a clinical nurse, the physician is responsible for medical follow-up (follow-up meeting after assessment/course of action meeting, communication with specialist doctors, prescriptions and informal follow-up with the child in their various environments).
These services aim to meet the needs of the child, working with the important people in their life. Specialized professionals are therefore responsible for a variety of services based on the needs of the child identified in the assessment/orientation, such as psychotherapy, remedial teaching, etc. These services are delivered while working with the specialized educator or tutor for stimulation. The resulting personalized follow-up includes stimulation groups, home and school visits and regular calls.
If the clinical team considers that certain rights of the child are being ignored or that the child’s basic needs are being neglected, legal services are provided to the family. A lawyer or mediator specialized in social pediatrics will help ensure access to justice. This person is responsible for the legal follow-up with the child and their family, giving them the tools to participate in the decision-making process affecting them and with a focus on protective measures and amicable dispute resolution.
Art and music therapy meet the needs of children by giving them an opportunity for introspection. Therapists work with children to help them express and understand their emotions and anxieties. Over time, these sessions enable them to connect and de-dramatize these emotions in order to manage them safely and confidently.
Some children with more complex needs require specialized services such as occupational therapy or speech therapy. Theses professional therapists help to make more accurate diagnoses and get the child back on track as quickly as possible.
These services take the form of developmental activities designed to meet clinical objectives. They aim to build up the child’s self-esteem and self-confidence while also enhancing the parent-child attachment relationship. They also seek to help children thrive by experiencing success, become less isolated and connect with caring adults.
Mentoring services, such as the Grands Amis program, are deployed to foster supportive relationships that involve exchange and learning with caring adults in children’s everyday lives. The goal is for the child to learn to develop meaningful and positive relationships of trust with adults.
Many services are offered externally to meet specific needs, through close ties with partner institutions or organizations. Community social pediatrics centres maintain professional partnerships and work closely with the community to ensure the care and well-being of each child in all areas of their life.