Creating & Sustaining Intersectoral Partnerships for Health:

1. Creating & Sustaining Intersectoral Partnerships for Health: RICHER - An Inner City Success Story Judith Lynam, RN, PhD,  UBC Professor & Research Lead

2. What is RICHER? RICHER is an innovative partnership based community outreach PHC model Responsive Intersectoral& Interdisciplinary Child & community Health Education & R esearch

3. Partners for this Initiative • Research Colleagues: Dr. S. Wong, Dr. C. Loock, L. Scott, Dr. K. Khan • Research Funders CIHR, CNA and MSFHR & BCMSF • Community Partners continuing • NEVCO - NICCSS • Ray Cam Community Co-operative • Child Health BC • ALIVE • City of Vancouver • UBC Academic Partners • School of Nursing • Faculty of Medicine • Health Authorities • Provincial Health Services Authority • BC Children’s, Sunny Hill & BC Women’s • Vancouver Coastal Health Authority (VCHA)

4. Why an Integrated RICHER Approach? Marked Inequities in children’s health • Complex health issues & developmental challenges Compounded by social conditions –poverty, marginalization & social exclusion Multiple barriers to health care access along the continuum Prevention Primary care & specialized services Limited access to primary health care Delays in diagnosis Delays in access to treatment & supports Lack of integration with specialized services Use of emergency services for non-emergent but significant health issues ALL conditions associated with poor health in childhood & over the life course

5. An Intersectoral Partnership Initiative.. the RICHER social pediatrics initiative 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 as a consequence of their social and material circumstances

6. Human Early Learning Partnership UBC, 2010

7. Indicators: Developmental vulnerability Limited PHC access Compounded by: Marked social & material poverty Family instabilities Marginalization & exclusion – racialized populations

8. Dismantling structural & social barriers to access – respect & trust. Building clinical relationships that extend and enrich families’ social relationships. Ensuring parents are supported to nurture their child’s development – building community capacity. Tailoring communication, providing direction and support in ways that foster the child’s development. How…..Changing structures & attending to processes of care

9. Partnerships – complementing, enRICHing & extending services • - formal system • intersectoral & interdisciplinary • - informal systems • Community non-profit sector agencies, community centers, schools, daycares, pre-schools and non-health governmental agencies, health agencies, University of BC RICHER clinical program -

10. Regular scheduled weekly primary health care clinics- Nurse Practitioners • Active regular participation with community agencies developing and/or delivering services for children – providing important health perspective • Location of services : daycare, schools, community centers, non-profit family support agencies • Regular weekly integrated Pediatric Specialist/Subspecialist (SPOCK) consultation/intervention in place based venues • Accept referrals from, & consult with, RICHER PHC & other community clinicians • Weekly community table • Community identified issues affecting health & development of the children in the community • Provides for neighbourhood/community introductions & relationships • Weekly clinical rounds • Through dialogue Development of new ways of engaging with the community • BFF (Bright Family Futures) • Off the Grill RICHER clinical program RICHER in Operation

12. In our researchprogramme, we have sought to understand: the influences on access to health services the components of the RICHER approach that foster access for some of our most ‘vulnerable’ children RICHER Research

13. RICHER Results Phase I • Outreach enacted in Partnership • Building relationships and trust and conveying respect fosters access • Partnerships enabled families to ‘link in’ to traditional clinical services, and enabled clinicians to ‘link across’ to specialized services • Partnerships enabled families to access services and resources to address the social determinants of health • Accountability and mechanism for engagement – the role of the Community table

14. Does RICHER foster access…? What impact does RICHER have on patient outcomes? RICHER Research Phase 2 Parents’ ratings of RICHER: Access Continuity Responsiveness Relationship Empowerment, which is associated with: Satisfaction Optimal HS utilization Positive orientation Patient activation

15. RICHER Results Phase II 1) Does RICHER foster access for a population of children and families with multiple forms of social and material disadvantage? The particular profile of the study participants show that YES RICHER does foster access to PHC for children who are vulnerable because of their social and material circumstances.

16. RICHER Results Phase II • 2) What characteristics of the RICHER approach are correlated with (indicators of) positive outcomes? • Social • Characteristics of the providers’ interpersonal style are strongly associated with positive outcomes • Structural • Features of the clinics-schedules, venues etc.

17. Experiences of SPI Clinic

18. The PHC experience of clinician’s interpersonal style is positively associated with patient empowerment (p<0.01). What characteristics of providers’ approaches to service delivery are associated with patient empowerment? (n=76)

20. BC Trends in Developmental Vulnerability http://earlylearning.ubc.ca/media/comsum/w5/sd39.pdf

21. Developmental vulnerability Profile – in a RICHER neighbourhood http://earlylearning.ubc.ca/maps/edi/nh/sd39/

22. Systems can be ‘re-formed’ to be Responsive Purposeful integrationactivities within ‘place’foster individuals’ sense of cohesion, connection & relationship ‘activates communities’ & improves child health outcomes.

23. QUESTIONS?

24. PublicationsLynam, M. J., Loock, C., Scott, L. & Khan, K.B. (2008) Culture, health and inequalities: new paradigms, new practice imperatives.  Journal of Research in Nursing , 13(2): 138-148.Lynam, M.J., Loock, C., Scott, L., Wong, S., Munroe, V. & Palmer, B.(2010) Social Pediatrics: Creating organizational processes and practices to foster health care access for children ‘at risk’.Journal of Research in Nursing.  OnlineFirst February 15: doi:10,1177/17449871093605/  pp: 1-17. Lynam, M.J., Scott, L., Loock, C.L., Wong, S. (2011). The RICHER Social Pediatrics Model: Fostering Access and Reducing Inequities in Children’s Health, Healthcare Quarterly. 14 Special Issue, (3): 41-56.   http://www.longwoods.com/content/22576 Lynam, M.J., Grant, E. & Staden, K. (2012) Engaging With Communities to Foster Health: The Experience of Inner-City Children and Families With Learning Circles. Canadian Journal of Nursing Research,  44(2): June.Wong, S.T., Lynam, M.J., Khan, K., Scott, L. & Loock, C. The social paediatrics initiative: a RICHER model of primary health care for at risk children and their familiesBMC Pediatrics, 12:158 (04 Oct 2012)