It takes a village: a realist synthesis of social pediatrics program

Abstract

Objectives To better understand how social pediatric initiatives (SPIs) enact equitable, integrated, embedded approaches with high-needs children and families while facilitating proportionate distribution of health resources. Methods The realist review method incorporated the following steps: (1) identifying the review question, (2) formulating the initial theory, (3) searching for primary studies, (4) selecting and appraising study quality, (5) synthesizing relevant data and (6) refining the theory. Results Our analysis identified four consistent patterns of care that may be effective in social pediatrics: (1) horizontal partnerships based on willingness to share status and power; (2) bridged trust initiated through previously established third party relationships; (3) knowledge support increasing providers’ confidence and skills for engaging community; and (4) increasing vulnerable families’ self-reliance through empowerment strategies. Conclusions This research is unique because it focused on “how” outcomes are achieved and offers insight into the knowledge, skills and philosophical orientation clinicians need to effectively deliver care in SPIs. Research insights offer guidance for organizational leaders with a mandate to address child and youth health inequities and may be applicable to other health initiatives.

First Things First: How to Elicit the Initial Program Theory for a Realist Evaluation of Complex Integrated Care Programs

“…While TARGET's program components are considerably different from a substantive point of view, two types of overarching mechanisms are triggered: confidence and mutual trust. This corresponds with previous realist‐inspired work in the field of integrated care addressing how initiatives work 68,73,74 . For instance, a realist synthesis by Tyler and colleagues identified “four consistent patterns of care that may be effective” in six unique social pediatric initiatives 74 .…”

A Rapid Realist Review of Effective Mental Health Interventions for Individuals with Chronic Physical Health Conditions during the COVID-19 Pandemic Using a Systems-Level Mental Health Promotion Framework

“…Resilience in pre-COVID realist reviews was often associated with power-sharing and co-production, discussed in the following section. One pre-COVID realist review discussed resilience primarily at the neighborhood or meso-level, where community engagement theory was used to describe how community assets are necessary to add resilience or to buffer against stressors, such as lack of access to social determinants of health [ 40 ].…”

“…Pre-COVID realist reviews identified power-sharing as a key mechanism at each systems level [ 30 , 36 , 37 ]. This is discussed in relation to empowerment theory [ 44 ] and community engagement theory [ 40 , 47 ]. For example, a civic engagement realist review [ 36 ] described empowerment as shared decision-making between community providers and service users.…”

Integrated health Services for Children: a qualitative study of family perspectives

“…Trust is important in both effective relationships between patient and provider, and across the health system [ 26 ]. In their realist review, Tyler et al highlight the importance of “bridgers” or “connectors” in enabling trust between families and the health system to foster integrated care [ 27 ]. Similarly, families in this study highly valued the relational aspects of integrated care; relationships with providers, and trust, were central to families’ descriptions of good care.…”