The social paediatrics initiative: a RICHER model of primary health care for at risk children and their families

Abstract

BackgroundThe Responsive Interdisciplinary Child-Community Health Education and Research (RICHER) initiative is an intersectoral and interdisciplinary community outreach primary health care (PHC) model. It is being undertaken in partnership with community based organizations in order to address identified gaps in the continuum of health services delivery for ‘at risk’ children and their families. As part of a larger study, this paper reports on whether the RICHER initiative is associated with increased: 1) access to health care for children and families with multiple forms of disadvantage and 2) patient-reported empowerment. This study provides the first examination of a model of delivering PHC, using a Social Paediatrics approach.MethodsThis was a mixed-methods study, using quantitative and qualitative approaches; it was undertaken in partnership with the community, both organizations and individual providers. Descriptive statistics, including logistic regression of patient survey data (n=86) and thematic analyses of patient interview data (n=7) were analyzed to examine the association between patient experiences with the RICHER initiative and parent-reported empowerment.ResultsRespondents found communication with the provider clear, that the provider explained any test results in a way they could understand, and that the provider was compassionate and respectful. Analysis of the survey and in-depth interview data provide evidence that interpersonal communication, particularly the provider’s interpersonal style (e.g., being treated as an equal), was very important. Even after controlling for parents’ education and ethnicity, the provider’s interpersonal style remained positively associated with parent-reported empowerment (p<0.01).ConclusionsThis model of PHC delivery is unique in its purposeful and required partnerships between health care providers and community members. This study provides beginning evidence that RICHER can better meet the health and health care needs of people, especially those who are vulnerable due to multiple intersecting social determinants of health. Positive interpersonal communication from providers can play a key role in facilitating situations where individuals have an opportunity to experience success in managing their and their family’s health.

Vulnerability in the Child Development: Influence of Public Policies and Health Programs*

“…6,9 The data are in agreement with studies that show that, within the context of child health and child development, to achieve satisfactory results, assistance models are needed that aim to ensure the attendance of the child at the primary level of attention, systematize and integrate clinical care curative actions with preventative measures and health promotion 22 , as well as, the due recognition of their needs and demands. 23 The nurse alludes to equity, within the perspective of active listening to the needs of users in the health units. This process of work is necessary on primary health care, whereas those services should organized in a way unique and appropriate, recombine, rearrange and reorder existing features to meet health needs and demands of the population.…”

How do nurse practitioners work in primary health care settings? A scoping review

“…As this yielded limited responses (Yousey and Carr 2005, DiMarco, Huff et al 2009, Lynam, Loock et al 2010, Wong, Lynam et al 2012) including papers without evaluation data, the search was expanded to investigate care provided by nurse practitioners for all children in communities.…”

“…Examples of this work included case management of home-based palliative care patients (Deitrick, Rockwell et al 2011), addressing the wellbeing of runaway adolescent girls (Edinburgh and Saewyc 2009) and access to health care for vulnerable children (Lynam, Loock et al 2010, Wong, Lynam et al 2012. In these roles nurse practitioners addressed broader social determinants of health for vulnerable populations.…”

“…This included ethnic groups identified as being at risk (Marion, Finnegan et al 2009, Choi and Rush 2012, Barrett , Salem et al 2015, Murphy, Coke et al 2015, individuals and groups from rural areas (Wright, Purdy et al 2007, Jessee and Rutledge 2012, Murfet, Allen et al 2013, Barrett , Salem et al 2015, Kozlowski, Lusk et al 2015, Tokuda, Lorenzo et al 2016, Tyler and Horner 2016, areas of socio-economic disadvantage (Speck, Hines-Martin et al 2007, Marion, Finnegan et al 2009, Lynam, Loock et al 2010, Stines, Perman et al 2011, Wong, Lynam et al 2012, Walker, Marshall et al 2013, Ritten, Waldrop et al 2015, Berry, Williams et al 2016 or frail elderly (Wajnberg, Wang et al 2010, Prasad, Dunn et al 2014, Ritchie, Andersen et al 2016. In this way, nurse practitioners practiced to improve the health of hard to reach populations challenged with access and acceptability of traditional health care services.…”

Definitions and Explication of the "Social Pediatrics" Concept: Results of the Terminological Analysis

“…По ее мнению, социальная педиатрия определяется как вид помощи неимущим, социально изолированным детям и семьям. Другие представители Канады [18] в определе-нии принципов социальной педиатрии основной акцент ставят на практических навыках, таких как установление доверительных взаимоотношений с семьей, обеспечение доступности помощи и расширение возможностей и прав пациентов и их родителей.…”