University of British Columbia, Vancouver, BC, Canada.
BC Children's Hospital, Vancouver, BC, Canada.
J Prim Care Community Health. 2024 Jan-Dec;15:21501319241273284. doi: 10.1177/21501319241273284.
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.
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.
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.
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.
简介/目的：儿童时期接触不良的社会决定因素（SDoH）与较差的长期健康结果相关。在结构上处于边缘地位的人群中，发育脆弱的儿童比例过高。RICHER（响应性、跨部门、儿童和社区健康、教育和研究）社会儿科模型旨在增加边缘社区的医疗服务机会。本研究的目的是描述参与 RICHER 服务模式的儿童和青少年，并描述该人群的需求。
对 2018 年 1 月 1 日至 2021 年 4 月 30 日期间通过该项目获得初级保健服务的儿童和青少年进行了回顾性图表审查。使用 Stata v15.1 进行了基本描述性数据分析。
共审查了 210 份图表。初次评估时的平均年龄为 6.32 岁。患者最常自认为是原住民（33%），15%是最近新来加拿大的。41%的图表中记录了至少 1 项不良 SDoH 证据；最常见的包括物质贫困（34%）、粮食不安全（11%）和儿童福利介入（20%）。每位患者的平均诊断数为 4 个。记录最频繁的诊断是神经发育障碍（50%），包括发育迟缓（39%）、ADHD（32%）和学习障碍（26%）。该项目将 72%的患者转介给普通儿科医生和/或其他专科医生；34%的患者转介进行三级神经心理评估，35%的患者转介进行心理健康服务。
我们的数据表明，这种低门槛、基于地点的初级保健 RICHER 模式能够接触到居住在贫困城市社区的医疗、发育和社会复杂的人群。我们的审查中，有一半的患者存在神经发育问题，三分之一的患者存在心理健康问题，而北美普通儿科年龄段人群的心理健康、行为或发育障碍估计患病率为 17%。这突显了不良 SDoH 对儿童健康的影响，以及与社区合作伙伴合作识别发育脆弱儿童并支持基于地点的项目与可能通过传统护理模式错过、忽视或处于不利地位的儿童建立联系的重要性。
