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Facilitating Access to Care for Children With Complex Health Needs Through Low-Barrier Place-Based Intake Processes:
Insights
The RICHER social pediatric model effectively serves complex, vulnerable children in marginalized neighborhoods, identifying significant neurodevelopmental and mental health needs. This highlights the impact of social determinants of health (SDoH) and the value of community-based care.
Area of Science:
- Pediatric Health
- Social Determinants of Health
- Community-Based Interventions
Background:
- Adverse social determinants of health (SDoH) in childhood are linked to long-term health issues.
- Structurally marginalized populations have high rates of developmentally vulnerable children.
- The RICHER social pediatric model aims to improve healthcare access in underserved neighborhoods.
Purpose of the Study:
- To describe children and youth engaged with the RICHER service model.
- To characterize the health and social needs of this population.
Main Methods:
- Retrospective chart review of children and youth accessing RICHER primary care services (Jan 2018 - Apr 2021).
- Descriptive data analysis using Stata v15.1.
Main Results:
- 210 charts reviewed; mean age 6.32 years.
- 33% identified as Indigenous, 15% as recent newcomers.
- 41% experienced adverse SDoH (poverty, food insecurity, child welfare involvement).
- Median 4 diagnoses per patient; 50% had neurodevelopmental disorders (developmental delay, ADHD, learning disability).
- 72% referred to specialists; 34% for neuropsychological assessments, 35% for mental health services.
Conclusions:
- The RICHER model successfully engages a medically, developmentally, and socially complex population.
- High rates of neurodevelopmental (50%) and mental health (33%) concerns were observed, exceeding general population estimates.
- This underscores the impact of SDoH and the importance of place-based programs in identifying and supporting vulnerable children.
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.
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