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La pdiatrie sociale

1) Category:
Approach

2) Issues:
Social and economic disparities are a way of life for many people in the world and are particularly detrimental to children. Lack of proper nutrition, substandard housing and living conditions, social isolation and, often, even loss of human dignity, are common consequences which cause untold deprivation and suffering. This translates into unequal opportunities for a better life. These inequalities often follow individuals from cradle to grave. They hinder children`s development and their chances for success in school and for realizing their dreams.

3) Objectives:
Screen vulnerable children and families early for problems that could affect the children`s health, development and academic success. Determine the child`s and the family`s needs in order to offer them preventive educational services, overall stimulation, and adapted reinforcement. Use a comprehensive holistic approach in tandem with the families and the community. Prevent dropping out, substance abuse, and delinquency. Support and equip parents to improve their skills and foster their commitment to and involvement with their children.

4) Environment:
Vulnerable families living in disadvantaged neighborhoods Community (social pediatrics centers) Childcare services and primary schools

5) Target Group:
Children from 0 to 14 years old Parents

6) Key Words:
Social pediatrics, Dr. Julien, curaction, school-family-community partnership, approach, early screening, prevention, overall stimulation, reinforcement, intervention, respect for rights, social inequalities, network, student success, dropping out, substance abuse, delinquency

This factsheet was taken from the following website: http://rire.ctreq.qc.ca/.

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7) Description:
The purpose of community-based social pediatrics is to support vulnerable children and families so as to ensure the well-being and optimal development of these children in keeping with their rights and interests. This approach hinges on trust, respect and proximity for effective action by all in supporting child development in a spirit of common and shared responsibility. The services offered are in response to the overall needs of children (physical health and all other facets of their development). Social pediatrics consists of establishing a full gamut of services on every level and in relation to the children`s living environments. The services are offered by an interdisciplinary team and volunteers who act together and provide intensive one-on-one support and guidance to each child consistent with the child`s needs and dreams. Social pediatrics centers are at the heart of interventions that help to determine which children are vulnerable, to understand the underlying problems, to forge partnerships with the families, and to rally the community`s resources. Their role is to orchestrate the required mobilization and cooperation of key players from various fields of endeavor. Two social pediatrics centers are directly associated with Dr. Julien`s foundation, the Centre d'assistance d'enfants en difficult (AED), located in the Hochelaga-Maisonneuve district of Montral, and the Centre de services prventifs l'enfance (CSPE), which assists families and children in the Cte-des-Neiges district, also in Montral.

8) Steps:
No specific steps are indicated in the available literature, meaning that steps vary according to the needs of the community and the activities undertaken.

9) Activities/Actions:
Community-based social pediatrics is preventive and curative and uses tools for mobilizing and empowering families and communities in consensus-based actions adapted to children, with a view to: o o o boosting children`s resistance factors (self-esteem, knowledge, self-sufficiency, social ties, identity, etc.); supporting the family unit and family unity; increasing the availability of the social support offered to children and families.

Community-based social pediatrics is a grassroots model of community-specific intervention with a wide ripple effect that makes a real difference. The format varies with the communities concerned, but there are core elements that are compulsory: o o o o o High-quality integrated health services; An accessible service center tailored to the needs of the children in a given community; An interdisciplinary team focused on front-line services for children and on establishing a community network for preventive action; A team of volunteers that supports the children and the team of the social pediatrics center; The ability for respectful intake at the right time and with the right approach;

This factsheet was taken from the following website: http://rire.ctreq.qc.ca/.

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o o

An expanded local network to support the movement to help the children of the community; The ability to intervene to defend children`s rights locally and within society as a whole. Clinical service: The clinical service provides psychosocial monitoring of families at risk who are reluctant to use traditional institutional services. A social pediatrician or family physician and the practitioner`s multidisciplinary team determine followup to an intervention program at a referral and assessment meeting. The clinical assistant oversees follow-up and forms ties with all the other partners working with the child and the family. Ruelle project: Launched in July 2008, the Ruelle project is aimed at giving children in the Hochelaga-Maisonneuve district of Montral a healthy place where they can hang out and have fun. The activities take place outside (in and around the back lane) and within the community. The neighborhood, public services and the district`s community resources were approached in putting together the project. Bb Kangourou project: Bb Kangourou is for infants up to 18 months old and their parents. Interested families are selected at the clinic or if the moderators of stimulation workshops feel that the parent-infant bond of the participant should be intensified. The project has a number of goals, including decreasing the number of Direction de la protection de la jeunesse (DPJ) placements; assisting in the emergence of infants` motor, cognitive, socio-affective and language skills; improving the quality of the parent-child relationship; and providing infants with a safe and stable living environment. Accs l'cole project: Accs l'cole is part of a collaborative venture with neighborhood schools to smooth four-year-olds` initiation to school. The means employed are parent mobilization, screening for difficulties, and early intervention before children enter the school system. Camp de stimulation: The stimulation camp was created in 2004 to give preschoolers the tools they need to succeed in school later on. The camp is for children age 2 to 5 from the Hochelaga-Maisonneuve district who attend Assistance d'enfants en difficult (a community organization for children with difficulties) and who have developmental delays and language impairments.

Here are a few examples of the services offered by social pediatrics centers: o

10) Resources Required:


Human resources: o o o o o Volunteers Parents Practitioners (social pediatrician, speech therapist, remedial teacher, educator, art therapist, psychoeducator, etc.) Administrative staff (coordinator, assistant coordinator, secretary/receptionist) Other collaborators (schools, childcare centers, community organizations, youth centers, DPJ, hospitals, parent association, foundations, etc.) Budget for service provision to children and families, for organizing activities, and for operating the centers (Dr. Julien`s carolling fundraiser takes place every year.)

Financial resources: o

This factsheet was taken from the following website: http://rire.ctreq.qc.ca/.

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11) Roles of the Participants:


Volunteers: o participate in the many activities of the social pediatrics center, such as supervision during outings, childcare, fund-raising, and organizing special events. participate at meetings, activities and training and do everything they can to engage with their children. provide their expertise (screening, prevention, stimulation and intervention); meet with the parents and give them support with their parenting skills; visit the school and the families of the children in question; work with each other and with the parents to foster every child`s optimal development. see to the proper operation of the center; form and strengthen partnerships with other organizations and institutions; do parent intake and refer parents to the appropriate services, when applicable. participate in the intervention by working closely with the social pediatrics centers.

Parents: o

Practitioners: o o o o

Administrative staff: o o o

Other collaborators: o

12) Scientific Basis or Validity:


Dr. Gilles Julien has been a pediatrician for 30 years. He has been in charge of clinical teaching at the Faculty of Medicine`s Department of Pediatrics at Universit de Montral and Associate Professor at McGill University`s Department of Family Medicine since 1991. He has long been recognized as a clinical expert in child abuse and neglect and regularly contributes articles to scientific journals on prevention, child development and parent-child attachment. His numerous publications, including the book entitled Soigner diffremment les enfants, lapproche de la pdiatrie sociale, translated into English as A Different Kind of Care, The Social Pediatrics Approach, set out his philosophy and practice. Dr. Gilles Julien`s social pediatrics approach is widely known due to his speaking engagements at symposiums, seminars and conferences and to his commitment to social causes. As part of their regular activities, Dr. Julien and his two teams are now part of the Rseau de formation universitaire en pdiatrie sociale, aimed at making future physicians aware of the social pediatrics approach. Universit de Montral and McGill University have also made social pediatrics part of the curriculum for future pediatricians. Since 2005, an internship in social pediatrics is compulsory for pediatrics residents at both universities. Every year, under the aegis of the Rseau de formation universitaire en pdiatrie sociale, more than 25 medical students and residents learn community-based social pediatrics practices and approaches at one of the two social pediatrics centers, where physicians work in teams and network with community resources for the well-being of children. Since the year 2000, scientists and researchers have turned public attention not only towards the traditional issue of child protection, but also towards all aspects of child development and the importance of early intervention in preventing health problems in children. More recently, the idea of defending children`s rights and interests has been front and center in discussions on child health.

This factsheet was taken from the following website: http://rire.ctreq.qc.ca/.

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13) Material:
Fondation du Dr Julien, Centre de services prventifs l'enfance (CSPE) and Assistance d'enfants en difficult (AED) websites [in French only]

14) Additional Information:


The success and impact of these two centers located in Montral has made it possible for the Fondation du Dr Julien to work with its many partners to create new centers in the various regions of Qubec. And hence, the opening of five centres in Gatineau, Montral-Nord, Centre-Sud (Montral), Saint-Jean-sur-Richelieu and Trois-Rivires in the coming months. In November 2004, Dr. Julien was awarded the Prix des mdecins de cur et d'action in the Humanitarian Physician category from the Association des mdecins de langue franaise du Canada and Actualit mdicale. The information contained in this factsheet was taken, in whole or in part, from: o o o o o o o o http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2528801/ ; http://www.fondationdrjulien.org/; http://www.aed-hm.org/texte/1.html; http://www.cspe-cdn.org/; http://cnpf.ca/documents/Conference_Dr_Gilles_Julien.pdf ; http://www.alterites.ca/vol6no1/pdf/Carle_2009.pdf ; http://www.innovons.qc.ca/documents/V-2-02_Lebr-Desh.pdf ; http://www.fse.uqam.ca/milieuxdefavorises/collab/DrJulien.html .

15) Contacts:
Fondation du Dr Julien 4765, rue Sainte-Catherine Est Montral (Qubec) H1V 1Z5 Tel.: (514) 527-3777 Email: info@pediatriesociale.org Assistance d'enfants en difficult (AED) 1600, rue Aylwin Montral (Qubec) H1W 3B8 Tel.: (514) 528-8488 Centre de services prventifs l'enfance (CSPE) 6555, chemin de la Cte-des-Neiges, bureau 300 Montral (Qubec) H3S 2A6 Tel.: (514) 341-2220

This factsheet was taken from the following website: http://rire.ctreq.qc.ca/.

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