Moving the Paediatrician from the Hospital into the Community Dr Gilles Julien Social Paediatrician Best Start Resource Center Annual Conference 2006 January

Moving the Paediatrician from Moving the Paediatrician from the Hospital into the the Hospital into the

CommunityCommunity

Dr Gilles JulienDr Gilles JulienSocial PaediatricianSocial Paediatrician

Best Start Resource CenterBest Start Resource CenterAnnual Conference 2006Annual Conference 2006

January 17, 2006, Toronto January 17, 2006, Toronto

© Gilles Julien, 2004

Practice of Social PaediatricsPractice of Social Paediatrics


Health is not bought with a chemist pill nor saved by the

surgeon’s knife. Health is not only the absence of ills but the fight for the fulness of life.

P. Hein


Social paediatric refers to the importance of child health in the social context, which relates the child to the society, the community and the human neighbourhood which includes the parents.

• The society transmits the values and the rules.• The community assures the necessary links and

references. • The human neighbourhood and

the parents give the attachment, the accompaniment and the supervision.


The mandate of social paediatric is to compose a world :

• That is more aware and involved with children, their needs and their suffering.

• That assures a universal protection for children, for their rights and their security.

• That creates an environment where the child value is the most important for the future of mankind.


Social Social PaediatricPaediatric

Offers global and integrated health

services to suffering children

Participate in teaching and training

Play a role in child advocacy and lobbying

Stimulate and develop

research projects

Assure health promotion programs

Assure access to quality care for children and family

Assure networking with others health ressources in the community

Offers support and empowerment to local networks for child and family care


A base for actions : EquityContinuityAttachmentEmpowermentAdvocacy


Risk and protective factors in children

Risk Factors Protective FactorsFactors specific to the childchild• male sex• Low intellectual abilities• Difficult temperament• Chromosonal abnormalities• History of chronic illness• Communication disorders• Prolonged institutionalization• Severe brain damage• Perinatal complications• Development delays• History of abuse and neglect

• Factors specific to the familyfamily• Severe marital discord and divorce• Maternal psychiatric disorders• Low maternal education• Maternal hostility and conflict with the child• Paternal criminality• Low parental education• Overcrowding or large families• Family violence

• Factors specific to the environmentenvironment• Low SES• Many situational stressors

•Easy temperament•High play involvement and initiative•Receiving positive recognition•Good peer relations•Secure attachment in early life•High intellectual abilities•Good academic performance•Participating in 2 or more activities•Positive self concept•Internal locus of control•Good sibling relationship•Presence of confidant

•Positive mother-child relationship•Positive father-child relationship•Few prolonged separations from primary

caretaker•Close family•Presence of male partner in the home or

marital support

•Support from adults in the community•Community involvement•High SES•Increased family income


• More easily detect children more vulnerable or suffering from different risk factors

• Get in touch with families in a more acceptable and productive way

• Develop a more complete and adapted base of services


Developing prevention Developing prevention and early interventionand early intervention

Attachment, Identity and Children’s NeedsAttachment, Identity and Children’s Needs

The best interest of the child relates to the child right to assure:

• a complete development• a better state of health and well-being• a sufficient autonomy• a future

in a loving and supporting environment with sufficient and fair life conditions.

The best interest of the child relates to a shared responsability within families, communities, societies (including legal issues) in an ethical and respectful perspective considering children’s needs and rights.

Attachment, Identity and Children’s NeedsAttachment, Identity and Children’s Needs

Empowerment from Family, Community Empowerment from Family, Community and System Networksand System Networks

Environ-mental System

LegalSystem

CulturalSystem

FamilySystem

SocialSystem

ChildrenChildrenNeedsNeeds

AttachmentCoherence

Stability

Life Conditions EcologyEquity

Ethics Belonging Knowledge

References Identity Roots

Protection

Care

Values


DEVELOPMENT

Development Pathway

ATTACHMENT IDENTITY

S S SSUCCESS

L L LLOSS

School Drop outExclusionSuicide

SelfesteemConfidentSecureBalance


Increasing protective factors for children• Self-esteem• Autonomy• Social skills• Knowledge• Identity

Supporting integrity, coherence, stability and knowledge of families Implementing a sustaining social model for children, families and communities

Em

po

wer

men

t

The Mission: Accessibility to Preventive CareThe Mission: Accessibility to Preventive Care

Screen, identify and solve children’s health risks and difficulties along their developmental pathway

Required services:• A global approach

considering causes and not just symptoms• A comprehensive approach

centered on children’s needs and their living context• An empowering approach

that sustain and multiply children’s strengths and capacities and that mobilize networks• Actions that:

Exposition Vulnerability

Clinical social paediatric is the application of the principles of social paediatric to:

•a specific community, •a group of children, •a neighbourhood, •a part of a city or a village.

Interventions in social paediatric are focusing mainly on:•suffering children, •those victimized or abused, •those traumatized or excluded, •those neglected or rejected.


Welcoming suffering children, sick, victimized, excluded or abandoned and contributing to bring them back to health and hope and to give them some tools to complete their optimal development with the contribution of their family and of the significant persons around them, with respect and comprehension.

Building sustaining actions for children and their families with thrust and participation.

Providing actions for empowerment and cure.

Creating a community-oriented global health service program.


• To help support global development and well-being of all children, mainly those living in poor conditions.

• To help diminish the suffering of children and their families.

• To help improved their life conditions and

their power to live better .

• To help prevent child abuse and neglect .

• To help prevent and lessen the effects of poverty on children.



YouthProtection

agency

Day care facilities

Humanitarian foundations

Associatedprojects

Children hospital Universities

Medias

Local community groups

Schools

Local community

services Political

HELPHELP


CHILDCHILDEVALUATIONEVALUATION

Strenghts and Strenghts and weaknessesweaknesses

Behaviour and Behaviour and adaptationadaptation

School School performance performance

and adaptationand adaptation

Social Social skillsskills

Family Family involmentinvolment

TraumasTraumas

EmotionsEmotions

SecuritySecurity

EnvironmentEnvironment

Physical Physical healthhealth

Global Global developpementdeveloppement

Method: EEDAMethod: EEDA

EEstablishing a special relationship

EExchanging information

DDecoding knowledge and experience

AActing based on a consensus between family members and professionals, for all children needs.


AED (Montreal, Hochelaga-Maisonneuve)AED (Montreal, Hochelaga-Maisonneuve)

The main goals:• To help support global development and well-being of all

children, mainly those living in poor conditions• To help diminish the suffering of children and their families• To help improved their life conditions and their power to live

better• To help prevent child abuse and neglect• To help prevent and lessen the effects of poverty on children


CSPE (Montreal, Côte-des-Neiges)CSPE (Montreal, Côte-des-Neiges)

The mission:To provide an adapted and integrated system of prevention and early intervention to support child development within the community with the full participation of the families and the surrounding.


The The spectacular spectacular

resultsresults


Child Health: a Question of Justice and EquityChild Health: a Question of Justice and Equity

The corrosive effects of poverty on children

Underserved children

Lack of accessibility for services:Lack of accessibility for services:Institutions not meeting the needs(CLSC, Hospitals, Agencies)

Lack of Lack of global and integrated servicesglobal and integrated services::professionals not meeting the needs

Underserved children

Lack of Lack of hopehope::

Society not meeting the needs Children

falling in the cracks

NET EFFECTNET EFFECT

Charter of the Rights of ChildrenCharter of the Rights of Children

Child Health: a Question of Justice and EquityChild Health: a Question of Justice and Equity

Thank you !Thank you !

Documents

Moving the Paediatrician from the Hospital into the Community Dr Gilles Julien Social Paediatrician Best Start Resource Center Annual Conference 2006 January