PAEDIATRIC SCHOOL OUTREACH: DEMOGRAPHICS AND CLINICAL NEEDS OF A UNIQUE INNER-CITY STUDENT POPULATION

Abstract

OBJECTIVES: 1. What are the SDOH impacting CMC and their families? 2. How do families report the impact of their child's medical complexity on their social circumstances? DESIGN/METHODS: A qualitative description approach was used to enable rich data collection through semi-structured interviews until thematic saturation was reached. Nine interviews were conducted with CMC caregivers who were chosen by purposeful sampling. The interview guide was developed by expert consultation and iteratively refined. Ethics approval and written consent were obtained. Interviews were recorded and transcribed verbatim. Three team members independently coded the interviews for recurrent themes to inform qualitative content analysis. RESULTS: Caregiving for a CMC is all-consuming, requiring parents to take on roles including planner, medical professional, medical educator , and advocate. Parents of CMC report three major areas negatively impacted by caregiving: 1) physical and mental health; 2) personal relationships ; and 3) finances. Additionally, three themes emerged describing enablers for resiliency: 1) the CMC's health status when well or stable in hospital; 2) acceptance of one's limitations as a caregiver and of the family's 'new normal'; and 3) broad supports including medical, personal, financial, and educational. CONCLUSION: The wellbeing of CMC families is impacted by medical and social factors. An interdisciplinary model of care may offset some of the caregiver's advocacy and medical educator responsibilities. Paediatricians can support families of CMC by providing comprehensive care for all components of the child's health status, and by including routine assessment of the family's SDOH. Finally, explicit discussion about parental expectations and caregiver burnout helps foster a positive therapeutic relationship with the family. BACKGROUND: Paediatric School Outreach (PSO) clinic is a school-based health centre housed in a Kindergarten-Grade 8 public school. It serves an inner-city community impacted by the social determinants of health, such as language and income, which are barriers to accessing health care. This clinic focuses on developmental/behavioural, mental health and educational concerns. OBJECTIVES: To characterize demographics, social determinants of health and some clinical characteristics of patients accessing services at PSO. By gaining a better understanding of the challenges of patients, services may be tailored to better suit patient/family needs. DESIGN/METHODS: We conducted a retrospective chart review of children enrolled at PSO from November 2015 to March 2017. Data were obtained from demographic questionnaires and the electronic medical record. Analyses were performed in Microsoft Excel and SPSS (ver-sion 23) and are primarily descriptive. This work was funded by a faculty of medicine student research program and approved by research ethics boards at our hospital and school board. RESULTS: 138 children, between the ages of 2 and 15 years (average birth year 2008) enrolled at PSO during the study period. 73% were male. 70% of patients were in Grade 1 or above at enrolment. Children tended to be Canadian born to immigrant mothers; 74% of children were born in Canada but only 34% of mothers were also Canadian-born. After Canada, Hungary was the second common maternal place of birth (12%). English was the most common language spoken by patients (71%), followed by Hungarian, Tibetan, Portuguese and Spanish. 58% of patients' families had a household annual income (HAI) of