KEYWORDS: Knowledge transfer, codification process, values, beliefs, partnership.

ABSTRACT: A codification process is an added value for an innovative model of care. Transmission of explicit and tacit knowledge, along with the organizational mission and values, insures and secures long-term viability of the model. Following such a process, this paper outlines the values and beliefs of Community Social Pediatrics.

An education that one receives without transmitting it
develops minds without dynamism, without self-criticism.
—Bachelard, G. (2002). The Formation of the Scientific Mind, Clinamen Press, 244

Scientific research has led to a better understanding of the brain’s plasticity in response to life experience and how this shapes child development. In short, the biological process of brain development, which begins even before birth, is influenced by genes transmitted from a parent to a child; by the environment in which the child grows up, including that of the mother during pregnancy; and by experiences during the early years of life [1]. Optimal development, therefore, depends on genetic predispositions, a healthy environment, and stimulating experiences that enable social interactions with significant adults [2; 3; 4].

In Quebec, despite the effort and funds invested, there are only a few programs adapted to the reality of disadvantaged children. In response to this situation, Dr. Gilles Julien developed the community social pediatrics (CSP) model and founded centers based on this model in two disadvantaged Montreal neighborhoods: Hochelaga-Maisonneuve and Côte-des-Neiges. Today, twenty-two other communities across Canada offer community social pediatrics’ care and services through a network of 221 professionals that includes pediatricians, family doctors, lawyers, nurses, psycho-educators, and educators.

This has led to a growth in the number of professionals interested in training on the method developed by Dr. Julien and known as EEDA (establishing, exchanging, decoding, and action). This has pushed stakeholders to reflect on a knowledge transfer model. In the past twenty years, the Foundation has generated considerable knowledge on how to help children from vulnerable populations using an evidence-based approach, by mobilizing communities and working in cooperation with other organizations and institutions.

This knowledge can be found scattered throughout the books written by Dr. Julien and in his know-how as well as in the knowledge of experts in community social pediatrics and the care teams at the two centers of expertise. In order to document all of this knowledge of community social pediatrics in one source, it was decided to undertake a knowledge acquisition and transfer project. One might wonder, how the Foundation has been able to capture this large body of knowledge? How has it been able to mobilize all of its professionals around the values intrinsic to community social pediatrics?

The first phase in the knowledge management (KM) cycle is capturing and codifying of knowledge, followed by sharing and disseminating knowledge and, finally, getting to the phase of the acquisition and appropriation of knowledge (based on the Integrated KM Cycle model, Dalkir, 20052). There are two main objectives to this process:

• Reproduce the model in a comparable context and enrich it with the specificities of each practice setting (added-value learning loop). The goal of this step is to answer the following questions: What changes can our model make to a similar setting in order to enhance practices aimed at helping vulnerable children and their families? And how can we bring added value to the model based on the specificities of each setting (scaling-out)?
• Influence institutions. The goal of this step is to answer the following question: What changes can our model suggest to other systems (e.g., governments, academia) in order to enhance practices aimed at helping vulnerable children and their families (scaling-up)?

The codification process aims to uncover explicit and tacit knowledge, as well as the knowledge which is not yet at the disposal of the community social pediatrics team. In other words, we defined this process as not only the capture and coding of explicit and tacit knowledge, but also the creation of new knowledge (“known” and “unknown” matrix). This process was supported throughout by scientific research.

Because the services offered at community social pediatric centers (CSPCs) are neither standardized nor traditional, and because they involve social innovations, the method for identifying knowledge necessitated an immersion in the institutional culture and direct contact based on proximity. The method used was similar to that of an anthropologist or sociologist studying a group: being inside the group while also maintaining a certain distance for analysis. A number of methods were used for knowledge capture: analysis of existing literature, learning through clinical observation, discussions with experts in social pediatrics, participation in co-development workshops with the entire care team, interviews with the team members, learning through sharing information during day-to-day interactions, and value construction workshops with teams.

It was during two-hour value co-construction workshops with community social pediatrics teams that the Foundation managed, on the one hand, to determine the values and principles that guide all interventions and, on the other hand, to mobilize all of its professionals and support workers around these values and principles. This workshop was offered at five CPSCs across Quebec and was attended by a broad range of professionals from a variety of settings. The values underlying intervention are key to the success of a model that encourages shared experience with the child and his/her family in order to help the child better understand any experienced difficulties and facilitate change by empowering the family system.

Values and beliefs

Trust is based on the idea that we can rely on someone or something. But before we can give ourselves permission to do so, we have to build our own self-esteem; that is, the capacity to not depend on anyone but to be autonomous. Self-confidence is another capacity that allows creating bonds and helps developing social relationships. Self-esteem is fundamental, yet fragile: it enables us to make plans for the future but there is the risk that our depository of confidence will not be up to the task [5]. In CSP practice, all actors work to strengthen the self-esteem of children and build a trusting relationship with the child and his/her family. The best way to achieve this solid bond is to maintain close proximity and have frequent gatherings; this experience plays a key role in meeting family’s expectations.

Respect is a word that originates from the Latin respectus, which means, to look back at. This indicates that one must stop and consider the object. Only that which we come to see as being of value can invoke this feeling of esteem and admiration [6]. In CSP practice, helping children and their families requires that professionals and support workers take the time to observe, listen, and understand without judgment or prejudice. All professionals and support workers must respect those with whom they are interacting—those in front of them— as well as their commitments to children and their families. Participatory decision-making is predicated on two fundamental elements: transparency of information and the ability to listen to all points of view.

Empathy, as is well known, relies on understanding the emotions and feelings of the other person. It is the ability to put oneself in the other’s shoes, to perceive what the other is feeling and to conceive of reciprocal altruism [7]. In CSP practice, it involves the construction of responses and otherness between the child, his/her family, and care team members. The intervention must seek balanced harmony and reciprocity in all instances. In the words of the sociologist Michel Maffesoli, one has to work at being with.

Solidarity is a relationship that exists between people who are linked together by a community of interest. It rests on the bonds of social reciprocity between members of this community [7]. In CSP practice, it involves showing that the society has a shared responsibility for future generations. Interventions must be based on mobilizing the community and on its members supporting each other. As the African proverb says, it takes a village to raise a child.

Loyalty is the quality of someone who is honest, loyal [7]. It is devotion to a cause or person, a faithfulness and engagement toward someone or something. In CSP practice, professionals and support workers help children and their families access their strengths and rely on them to surmount their difficulties. This involves building special bonds and engaging with the family. They listen, while being patient and constant in their interventions.

Empowerment is a dynamic, intentional and continuous process that is multidimensional (psychological, cultural, social, economic, organizational, and political) and long-term in its horizon. It evokes positive changes in the lives of children, families, communities, and social structures. It aims to re-balance relationships of power and access to services and resources [8]. In CSP practice, empowerment occurs when the family actively participates in the co-construction of hypotheses and potential solutions, the search for appropriate forms of care, the evaluation of the assistance given, and decision-making. The child and their parents have the right to participate directly in all decisions concerning action plans that affect the child, whether it is in the area of health, social services or legal services. In order to achieve empowerment, professionals and support workers must not take over. Instead, they must allow the child and his/her family to make decisions so that they can be fully involved in their realization. Interventions must leave room for the child’s autonomy and creativity, while professionals and support workers must work with consistency and commitment to meet the expectations of the parties involved and motivate change in their lives. In this sense, they should become catalysts for a collaborative action with the community aimed at supporting children’s health and social cohesion. The intervention must complement the efforts of the State and favor the construction of networks that give space and voice to children and their families. Finally, by demanding the respect of fundamental rights, interventions must reinforce the strengths of the child and his/her family so that they can participate, over the long term, in the life of their community and in the society while also fulfilling their obligations.

Social justice is based on equal rights and the opportunity for all human beings, without discrimination and everywhere in the world, to benefit from economic and social progress [9]. As noted by the philosopher John Rawls, existing inequalities must contribute to improving the situation of the society’s most disadvantaged members. The underlying idea is to preserve an equitable, efficient, and productive system of social cooperation over time, one that is passed down from one generation to the next [10]. In CSP practice, this means relying on the strengths of the child, the family, and the community, and focusing on preventative and curative interventions that enable the children of today to become the leaders of tomorrow— adults in full possession of their power, productive citizens, and individuals engaged in a prosperous and sustainable society. Interventions must always be carried out in respect of the rights set forth in the Convention on the Rights of the Child.

Complementarity in community social pediatrics is represented by collaborative efforts with family, social and institutional networks. All stakeholders are on an equal footing and work toward the objective of ensuring cohesion in the services provided to the child and the family. In CSP practice, this involves active participation of a range of support workers and professionals around the child. This participation is achieved by building partnerships with institutions that enable a better response to the child’s needs, while promoting collaboration between different actors and placing an emphasis on social innovation and social entrepreneurship.

Together, these values, beliefs, and principles of action form the culture of community social pediatrics: a familiar, friendly, and informal setting where children and families feel secure and are able to recognize and develop their strengths. The team and all actors involved with the child recognize the central place of the individual in their practice and see the individual as a full partner. It is through the process of knowledge transfer that the history, deep values, and philosophy of intervention that form the basis of the respectful practice are preserved and ensure the model’s continuity over time.

Each child and each family is a world unto itself, and community social pediatrics teaches us that we must not try accompanying them based on some standardized model of intervention. Rather, we must understand the singularities of each child and each family, while relying on the values and principles of the community social pediatrics approach to establish a trusting relationship. The specificity of each situation allows for co-construction between support workers, the child and the family; this requires learning through spending time together and serves as the base out of which solutions arise. Each meeting, whether formal or informal, is an opportunity to create the bond of trust that is so necessary for co-construction. In other words, and in agreement with thinkers like Heinz von Foerster, Maturana, and Varela, “the observer is always involved in the system they are observing and their attitude influences the functioning of system phenomena” (Ausloos 2010, p. 160, current author’s translation). Or put it another way, “what happens to us is not only the fruit of what acts upon us, but also the result of these influences and of the way in which we enter into the intersection with these influences”(Elkaïm 1991, current author’s translation).

References

[1] National Scientific Council on the Developing Child (2006). Early exposure to toxic substances damages brain architecture. (2006), Working paper, 4, p.1.

http://www.developingchild.net

[2] Weaver, I.C., Cervoni, N., Champagne F.A, D’alessio, A.C., Sharma, S., Seckl, J.R. et al. (2004). Epigenetic programming by maternal behavior. Nature Neuroscience, 7, 847-854.

[3] Wiley, Waever, I.C., Diorio, J., Seckl, J.R., Szyf, M., & Meaney, M.J. (2004). Early environmental regulation of hippocampal glucocorticoid receptor gene expression: Characterization of intercellular mediators and potential genomic target sites. Annals of the New York Academy of Sciences, 1024, 182-212.

[4] Tang, A.C. Akers, K.G., Reeb, B.C., Romeo, R.D., & McEwen, B.S. (2006). Programming social, cognitive, and neuroendocrine development by early exposure to novelty. Proceedings of the National Academy of Sciences, USA, 103, 15716-15721.

[5] Marzano, M. (2010). Qu’est-ce-que la confiance? Revue de culture contemporaine, 412(1).

[7] Larousse (2013). French dictionary online at http://www.larousse.fr

[8] SDC Swiss Development Cooperation (2009). L’empowerment laisse ses traces, orientation pour l’empowerment des acteurs locaux dans la coopération; Division d’Amérique Latine et Mark Smith www.cataliza.ch, Berne.

[9] United Nations (2012). Qu’est-ce que la justice sociale? Journée mondiale de la Justice sociale. Retrieved on October 12, 2017. http://www.un.org/fr/events/socialjusticeday/background.shtml

[10] Rawls, J. (2008). La justice comme équité. Une reformulation de Théorie de la justice. La Découverte, coll. La Découverte/Poche.