Facilitating Access to Care for Children With Complex Health Needs Through Low-Barrier Place-Based Intake Processes: Lessons From the RICHER Social Pediatric Model.

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.

Who is in Your Waiting Room? Social Determinants of Health and Adverse Childhood Experiences in Pediatric Surgery Clinics.

Background: Social determinants of health (SDoH) influence overall health, although little is known about the SDoH for pediatric patients requiring surgical services. This study aims to describe SDoH for pediatric surgical patients attending out-patient, community, and outreach clinics, as well as demonstrate the feasibility of identifying and addressing SDoH and Adverse Childhood Experiences (ACEs) when appropriate.

Methods: A cross-sectional study using surveys evaluating SDoH that were distributed to families attending pediatric surgical clinics over a two-year period.

Telemedicine and Pediatric Care in Rural and Remote Areas of Middle-and-Low-Income Countries: Narrative Review.

Objectives: Caring for children in low- and middle-income countries (LMIC) can be challenging. This review article aims to explore role of telemedicine in supporting pediatric care in LMIC.

Methodology: A narrative review of existing English and Spanish literature was conducted to assess role of telemedicine to support pediatric care in LMIC.

Evaluation of rotavirus vaccine administration among a 22q11.2DS patient population.

Background: 22q11.2 Deletion Syndrome (22q11.2DS) can result in array of congenital abnormalities including immune dysfunction.

Assessing the Social Determinants of Health and Adverse Childhood Experiences in Patients Attending a Children's Hospital Cleft Palate-Craniofacial Program.

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. Single-site, cross-sectional study using a questionnaire. Participants were recruited from a provincial quaternary care Cleft Palate-Craniofacial program at British Columbia Children's Hospital in Vancouver, BC, Canada.

Integrating dermatology services into a social pediatrics network: 8 years of experience in the RICHER (Responsive, Interdisciplinary/Intersectoral, Child/Community, Health, Education and Research) program.

Social pediatric initiatives aim to improve health outcomes for vulnerable children by working in the community to empower families, to enhance protective factors that mitigate adverse childhood experiences (ACEs), and to deliver place-based health care. In 2012, pediatric dermatology was added as a component of the Responsive, Interdisciplinary Intersectoral Child and Community Health Education and Research (RICHER) social pediatric program in Vancouver, BC. We share our experience with inclusion of pediatric dermatology in a well-established social pediatric program as well as lessons we have learned in the first 8 years of our partnership.

Supporting children and youth during the COVID-19 pandemic and beyond: A rights-centred approach.

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.

Treatment algorithm for the use of psychopharmacological agents in individuals prenatally exposed to alcohol and/or with diagnosis of fetal alcohol spectrum disorder (FASD).

Psychotropic medication treatment of individuals who have experienced prenatal alcohol exposure (PAE) has lagged behind psychosocial interventions. Multiple psychotropic medications are often prescribed for those diagnosed with a range of neurodevelopmental disabilities and impairments of PAE (neurodevelopmental disorder associated with prenatal alcohol exposure and/or fetal alcohol spectrum disorder [ND-PAE/FASD]). Despite the diverse comorbid mental disorders, there are no specific guidelines for psychotropic medications for individuals with ND-PAE/FASD.

A Cross-Sectional Analysis of the BC Children's Hospital Cleft Palate Program Waitlist.

Objective: A 2016 review of the BC Children's Hospital Cleft Palate - Craniofacial Program (CPP) revealed that one-third of patients met the program's care recommendations and half met the American Cleft Palate-Craniofacial Association guidelines. This study reviews patients on the CPP waitlist and determines median wait times and missed clinical assessments as well as identifies how wait times are influenced by medical complexity, specialized speech service needs, vulnerability, and distance from clinic.

Design: Cross-sectional.

Myelin Water Fraction Imaging of the Brain in Children with Prenatal Alcohol Exposure.

Background: Prenatal alcohol exposure (PAE) is linked to alterations of cerebral white matter, including volume and nonspecific diffusion magnetic resonance imaging (MRI) indices of microstructure in humans. Some animal models of PAE have demonstrated myelination deficiencies, but myelin levels have not yet been evaluated in individuals with PAE. Multiecho T MRI offers a quantitative method to estimate myelin water fraction (MWF; related to myelin content) noninvasively, which was used here to evaluate brain myelination in children with PAE.

Prevalence of Fetal Alcohol Spectrum Disorder among High-Risk Children and Adolescents in a Correctional Facility.

Background: Fetal alcohol spectrum disorder (FASD) may be under-recognized and under-diagnosed in Israel. Fewer than 10 FASD diagnoses were reported between 1998 and 2007; however, several hundred diagnoses have been made since. Furthermore, less than 10% of surveyed Israeli pediatricians reported adequate knowledge of FASD.

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

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.

Dysregulation of the cortisol diurnal rhythm following prenatal alcohol exposure and early life adversity.

The hypothalamic-pituitary-adrenal (HPA) axis is impacted by a multitude of pre- and postnatal factors. Developmental programming of HPA axis function by prenatal alcohol exposure (PAE) has been demonstrated in animal models and in human infants, but remains understudied in older children and adolescents. Moreover, early life adversity (ELA), which occurs at higher rates in children with PAE than in non-exposed children, may also play a role in programming the stress response system.

Relationships between Head Circumference, Brain Volume and Cognition in Children with Prenatal Alcohol Exposure.

Head circumference is used together with other measures as a proxy for central nervous system damage in the diagnosis of fetal alcohol spectrum disorders, yet the relationship between head circumference and brain volume has not been investigated in this population. The objective of this study is to characterize the relationship between head circumference, brain volume and cognitive performance in a large sample of children with prenatal alcohol exposure (n = 144) and healthy controls (n = 145), aged 5-19 years. All participants underwent magnetic resonance imaging to yield brain volumes and head circumference, normalized to control for age and sex.

Screening and referral to identify children at risk for FASD: Search for new methods 2006-2013.

As part of the Canadian Association of Paediatric Health Centres Taskforce on FASD Screening commitment to further pilot, validate and evaluate the multiple components of the Canadian FASD Screening Tool Kit, it was deemed necessary that recent developments and/or improvements in FASD screening were identified and considered. In 2008 a literature review of methods for screening for FASD was published until 2006 and identified five tools which met pre-set criteria. A review of all new papers was published from the period January 2006 until July 1, 2013.

Evaluation of the neurobehavioral screening tool in children with fetal alcohol spectrum disorders (FASD).

Background: There is a growing need for validated tools to screen children at risk of fetal alcohol spectrum disorders (FASD). The Neurobehavioral Screening Tool (NST) is one of several promising screening measures for FASD, though further evidence is needed to establish the tool's psychometric utility.

Objective: To assess the predictive accuracy of the NST among children with an FASD diagnosis, with prenatal alcohol exposure (PAE) but no FASD diagnosis, and typically developing controls.

Additional post-natal diagnoses following antenatal diagnosis of isolated cleft lip +/− palate.

Introduction: Cleft lip with or without palate (CLP) can be diagnosed antenatally through ultrasound, and may be categorised as apparently isolated versus associated with other malformations. Limited data exist on the long-term outcomes following antenatal diagnosis of apparently isolated CLP.

Aim: This study examined the long-term post-natal outcomes of CLP when found in isolation antenatally, in order to determine the rates of unexpected additional anomalies, developmental delay or genetic syndromes.

"They silently live in terror…" why sleep problems and night-time related quality-of-life are missed in children with a fetal alcohol spectrum disorder.

Children and adolescents with a Fetal Alcohol Spectrum Disorder (FASD) are at high-risk for developing sleep problems (SPs) triggering daytime behavioral co-morbidities such as inattention, hyperactivity, and cognitive and emotional impairments. However, symptoms of sleep deprivation are solely associated with typical daytime diagnosis, such as attention deficit hyperactivity disorder (ADHD) and treated with psychotropic medications. To understand how and why SPs are missed, we conducted qualitative interviews (QIs) with six parents and seven health care professionals (HCPs), and performed comprehensive clinical sleep assessments (CCSAs) in 27 patients together with their caregivers referred to our clinic for unresolved SPs.

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

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.

The RICHER social pediatrics model: fostering access and reducing inequities in children's health.

Considerable evidence shows that children and families who are vulnerable because of their social and material circumstances shoulder a disproportionate burden of disease and are more likely to face both social and structural challenges in accessing healthcare. Addressing these issues in children is particularly important as evidence has demonstrated that inequities in health are cumulative over the life course. In this article, the authors report on the RICHER (Responsive, Intersectoral-Interdisciplinary, Child-Community, Health, Education and Research) social pediatrics initiative, which was designed to foster timely access to healthcare across the spectrum from primary care to specialized services for a community of inner-city children who have disproportionately high rates of developmental vulnerability.

Sleep Health Issues for Children with FASD: Clinical Considerations.

This article describes the combined clinical experience of a multidisciplinary group of professionals on the sleep disturbances of children with fetal alcohol spectrum disorders (FASD) focusing on sleep hygiene interventions. Such practical and comprehensive information is not available in the literature. Severe, persistent sleep difficulties are frequently associated with this condition but few health professionals are familiar with both FASD and sleep disorders.

Preventing fetal alcohol spectrum disorder in Aboriginal communities: a methods development project.

The authors describe their three-year project working collaboratively with Aboriginal communities to prevent fetal alcohol spectrum disorder.