Pediatric hub focuses on care for whole child
Family-centric model begun in Quebec addresses root causes of health issues
At the social pediatric hub in Vanier, there’s an examining table and other medical accoutrements. There are also boxes of toys and a kitchen table with a bowl of fruit for nibbling.
The hub is a one-stop shop that recognizes it takes more than medical expertise to keep children healthy — not just physically, but also mentally, emotionally and socially.
“When the child goes into the medical system, the system focuses on the medical. We’re looking at the whole child,” says Dr. Sue Bennett, one of the lead pediatricians in the three-year pilot project.
Here’s how it works: With every new patient, the child’s family gathers around the table with an entire team that has not just a doctor, nurse and social worker, but may also include a teacher, a police officer and a lawyer with expertise in the immigration system or tenancy law. Sometimes, the advocacy of a city councillor, MPP or MP may be enlisted.
“We’re listening to the child’s story. It’s a trust-building exercise,” says Bennett. “There is a lot of bureaucracy. People don’t have the voice to get through the bureaucracy.”
The model was pioneered by Dr. Gilles Julien, known as Canada’s “father of social pediatrics,” and a name that is practically a household word in Quebec. Julien is known for riding his bicycle around some of Montreal’s poorest neighbourhoods, a strategy that got him invited into the homes of his patients and has made him a folk hero in Quebec.
There are now 27 social pediatric hubs with Quebec, with plans for a total of 40 within five years. One hub recently opened in Moncton, with plans for more in New Brunswick in the coming years.
There has been interest from British Columbia and jurisdictions in Europe. The hub in the Vanier Community Service Centre on Marier Avenue is the first of its kind in Ontario.
Health is determined by so much more than genes and germs. For children to be and stay healthy, they must have a safe and warm place to live, nutritious food and a sense of security. A sleepy child who isn’t paying attention at school, for example, might be under-performing because there’s no heat in his family’s family’s apartment and he doesn’t get much sleep.
Julien had worked in remote Inuit communities in northern Quebec in the ’80s, where he noted a 25 per cent rate of deafness in children. The hearing loss was affecting learning. Julien followed the thread backwards. The deafness was caused by chronic ear infections caused by cigarette smoke in crowded housing. Julien managed to reduce the deafness rate by half, in part by pushing for housing improvements.
Bennett was the director of child and youth protection for over 20 years at CHEO and saw many cases of child abuse and neglect that were preventable. “We need to be providing support and care to children and parents much earlier to prevent child maltreatment and within in their own community so as to keep them from long waits in the emergency departments,” says Bennett, who first learned about the community social pediatric model when the first of two centres opened in Gatineau about a decade ago.
The problem isn’t that there are no programs and services. It’s that they exist in isolation, forcing families to slog around town, often with offspring in tow, from one service provider to another. This model creates a customized safety net, says the Vanier hub coordinator Rachelle Lanteigne, a social worker.
“With children, instead of working on specific behaviours, we find out what’s causing it,” she says. “Instead of working in silos, we brought everyone around one table. We get everyone at one sitting. You can make a plan and simplify the process so people don’t feel lost in the system. They don’t have to tell their stories over and over again. It’s the way to go.” Stéphanie Fragman, the Vanier service centre’s director of family services, comes from Montreal and was familiar with the model when she joined the team.
“There’s no one with a white coat. There’s an equal partnership,” she says. “When you think about it, it seems so obvious. We bring all of the services to the family. They don’t have to figure out how to get there, or get babysitters. It just makes it easy.”
Julien, who is the mentor to the Vanier hub, argues that a child living in a difficult environment experiences toxic stress — and this is responsible for all sorts of other problems. When he returned to Montreal from northern Quebec, he offered free home visits to the poorest families and soon realized he needed help to deal with emotional, behavioural, and developmental problems.
“You don’t work alone. You need to work with others. But it wouldn’t happen in regular medicine,” says Julien, who built his model around the UN declaration on the Rights of the Child — and the idea that families should understand their rights.
“Housing is a good example,” says Lanteigne. “Some people are used to problems. But tenants have rights and landlords have responsibilities. When children know that they have rights, and that their voice is important, it’s very empowering.”
The Vanier hub will get $635,000 from the Ontario Poverty reduction Strategy over three years, at which point there will be an evaluation of how it has affected children, families and the community. Julien, who is working to develop courses at McGill University’s medical school that incorporate law and social sciences, says he’s mystified by why it has taken the medical world so long to change.
“When I was in medical school, we came to the idea of the social determinants of health.
But medicine didn’t pursue this knowledge and the physical approach remained,” he says. “It took decades to change.
“It’s still difficult. Most money is invested in medication. But we know we can change the world with prevention.”
With children, instead of working on specific behaviours, we find out what’s causing it.