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Introduction/Objectives: Exposure to adverse social determinants of health (SDoH) in childhood is associated with poorer long-term health outcomes. Within structurally marginalized populations, there are disproportionately high rates of developmentally vulnerable children. The RICHER (Responsive, Intersectoral, Child and Community Health, Education and Research) social pediatric model was designed to increase access to care in marginalized neighborhoods. The purpose of this study was to describe the children and youth engaged with the RICHER model of service and characterize the needs of the population. Methods: A retrospective chart review was conducted on children and youth who accessed primary care services through the program between January 1, 2018 and April 30, 2021. Basic descriptive data analysis was done using Stata v15.1. Results: A total of 210 charts were reviewed. The mean age in years at initial assessment was 6.32. Patients most commonly identified their race/ethnicity as Indigenous (33%) and 15% were recent newcomers to Canada. Evidence of at least 1 adverse SDoH was noted in 41% of charts; the most common included material poverty (34%), food insecurity (11%), and child welfare involvement (20%). The median number of diagnoses per patient was 4. The most frequently documented diagnoses were neurodevelopmental disorders (50%) including developmental delay (39%), ADHD (32%), and learning disability (26%). The program referred 72% of patients to general pediatricians and/or other subspecialists; 34% were referred for tertiary neuropsychological assessments and 35% for mental health services. Conclusions: Our data suggests that this low-barrier, place-based primary care RICHER model was able to reach a medically, developmentally, and socially complex population living in disenfranchised urban neighborhoods. Half of the patients identified in our review had neurodevelopmental concerns and a third had mental health concerns, in contrast to an estimated 17% prevalence for mental health, behavioral, or developmental disorders in North American general pediatric aged populations. This highlights the impact adverse SDoH can have on child health and the importance of working with community partners to identify developmentally vulnerable children and support place-based programs in connecting with children who may be missed, overlooked, or disadvantaged through traditional models of care. [ABSTRACT FROM AUTHOR]

Objective : This study aimed to describe the social determinants of health (SDoH) for patients receiving multidisciplinary team care in a Cleft Palate-Craniofacial program, develop responsive and consistent processes to include trauma-informed psychosocial histories, promote discussions about additional "non-medical" factors influencing health and surgical outcomes, and demonstrate that these activities are feasible in the context of multidisciplinary patient-provider interactions. Design : Single-site, cross-sectional study using a questionnaire. Setting : Participants were recruited from a provincial quaternary care Cleft Palate-Craniofacial program at British Columbia Children's Hospital in Vancouver, BC, Canada. Participants : 290 families completed the questionnaire. Results : 34% of families experience significant barriers to accessing primary health care, 51% struggle financially, and 11% scored four or more on the Adverse Childhood Experiences scale. Furthermore, 47% reported not having adequate social support in their lives, and 5% reported not feeling resilient at the time of the survey. Conclusion : Patients with cleft and craniofacial anomalies have complex needs that extend beyond the surgical and medical care they receive. It is critical that all Cleft and Craniofacial teams incorporate social histories into their clinic workflow and be responsive to these additional needs. Discussions surrounding SDoH and adversity are welcomed by families; being involved in the care and decision-making plans is highly valued. Healthcare providers can and should ask about SDoH and advocate for universal access to responsive, site-based, social work support for their patients. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic is an unprecedented global crisis, affecting millions globally and in Canada. While efforts to limit the spread of the infection and 'flatten the curve' may buffer children and youth from acute illness, these public health measures may worsen existing inequities for those living on the margins of society. In this commentary, we highlight current and potential long-term impacts of COVID-19 on children and youth centring on the UN Convention of the Rights of the Child (UNCRC), with special attention to the accumulated toxic stress for those in difficult social circumstances. By taking responsive action, providers can promote optimal child and youth health and well-being, now and in the future, through adopting social history screening, flexible care models, a child/youth-centred approach to "essential" services, and continual advocacy for the rights of children and youth. [ABSTRACT FROM AUTHOR]

Abstract Background The 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. Methods This 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. Results Respondents 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 Conclusions This 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.

Background: Patients diagnosed with 22q11.2 deletion syndrome, also known as 22q11DS or DiGeorge syndrome, have a diverse array of congenital anomalies and chronic health conditions. Because no study has reported on the coordination of multidisciplinary health services in British Columbia required by individuals with 22q11DS, we set out to determine which health care services these patients access and what barriers in health informatics affect institutional and provincial data sharing. Methods: A retrospective review of patient care at BC Children's Hospital (BCCH) was conducted using the provincial discharge abstract database and databases from hospital specialty services involved in the care of patients with 22q11DS. Data were collected for patients seen at the hospital from April 2001 to March 2018. This 17-year review considered patient age at diagnosis, distribution of patient ages within the study cohort, number and type of specialty services accessed, and length of follow-up. Results: A total of 293 patients with 22q11DS were identified from the hospital discharge abstract databases (DAD) and seven BCCH specialty clinic databases. Data could not be retrieved from some clinic databases due to coding and reporting discrepancies, which prevented the amalgamation of data from all hospital specialty services. Data from the DAD and seven BC Children's Hospital specialty services were then amalgamated, and duplicates were removed to identify 293 unique patients with 22q11DS. On average, patients accessed five services, with 13 new patients being seen each year and followed for an average of 7 years. Most of the pediatric care was provided by the Cleft Palate/ Craniofacial Program, Cardiology, Endocrinology, and Otolaryngology. Using BC Women's Hospital Medical Genetics 22q11DS data (n = 400), we were able to corroborate the size of our study cohort and to estimate the prevalence of 22q11DS in BC for the study period. Conclusions: Barriers to data retrieval and sharing at institutional and provincial levels were found to limit care coordination for patients with 22q11DS, who require ongoing, complex, multidisciplinary management. Incongruent and incomplete data systems in BC are hindering our ability to provide this coordinated care and plan transition, leaving us without the evidence needed by provincial health care providers, local experts, policymakers, and national and international 22q11DS research centres. [ABSTRACT FROM AUTHOR]

The purpose of this study was to describe the upper body exercise capabilities of youth with spina bifida, which would permit comparison of their abilities to norms. Forty-two children with spina bifida age 7 to 18 years were tested for maximal handgrip strength, anaerobic arm-crank power output, and peak arm-crank oxygen uptake. Analysis of variance was used to compare age, gender, and level of disability differences within the total sample. This analysis indicated no significant effect of level of disability on any of the upper body exercise capacity measures. Significant gender and age effects were noted for grip strength and anaerobic and aerobic capabilities. The sample exhibited handgrip strength comparable to that of nondisabled youth but low anaerobic power and peak oxygen uptake values. Some individual subjects, however, had "normal" values for all tests suggesting that a lower level of participation in regular physical activity rather than spina bifida per se may be responsible for the generally lower physical capacity found in the total sample. [ABSTRACT FROM AUTHOR]