The community–based social pediatrics' approach is an innovative model of integrated social medicine dedicated to meeting the global needs of children and ensuring that their fundamental rights are respected. It has originally developed from two key concepts: (1) The desire to make sure that no child "falls through the cracks" in the system – bereft of resources and care, with no one who can really “be there” for the child; (2) The importance of applying the principle that it takes a village to raise a child.  It implies the interconnection of medicine, law, and social services for empowering the child and the family as essential partners for the success of the child overtime. It is clearly a new paradigm of medicine in proximity completely integrative in its actions and outputs.

There is a great deal of confusion when it comes to the issue of child poverty. Who are these children and what are the consequences of this poverty on their health and well-being? Where do they live? How many are there in Quebec and in Canada in general, and, for that matter, around the world? Is poverty real or only the cause of the complex social problems faced by these children, problems that lead to an irreversible loss of human and social capital? Poverty is relative and can endure over time. It has always existed and in many different contexts, its impact varying as a function of various individual, cultural, and environmental factors. In today’s society, poverty continues to exist, even worsen, in many communities to the point that it impacts all facets of children’s lives. Campaign 2000, an initiative of the Canadian Chamber of Commerce, set the goal of “eliminating child poverty in Canada by the year 2000.” However, according to its last report in 2014, 1.3 million children—that is 1 in 5 children—are still living in poverty. In fact, child poverty increased from 15.8% in 1989 to 19.1% in 2014.

Whether it is in health or education, we have a collective obligation to take action to ensure that the issue of children’s rights passes from theory into practice. First and foremost, we must all apply the concept of equality in our daily professional practices so that the rights of all children are protected, and their wellbeing and success are strengthened. In fact, we have a basic tool that can be easily integrated into daily practice to ensure such equality in the global development of our children: the Convention on the Rights of the Child. Signed by most of the world’s countries, this document outlines the fundamental needs of children and the determinants of child health. Its 41 articles are particularly relevant to those seeking to achieve equality and improve the wellbeing of children. Although ratified by Canada many years ago, the Convention has often been left on the shelf to collect dust, despite its great relevance and soundness. In fact, a number of significant societal problems involve violations of the Convention, and the educational system is no exception. For example, article 27 of the Convention recognizes that parents are responsible for their children’s development and that they need appropriate assistance to ensure their children’s wellbeing and success at school. This implies that parents must never be left to struggle on their own and, furthermore, that they have a right to all possible assistance. However, in the educational system parents are far too often excluded from discussions and kept at arm’s length. Parents often find themselves presented with an intervention plan in which they did not participate as key stakeholders. No wonder it can then prove difficult to obtain their approval and implement the plan.

To make the situation more concrete, we’d like to take you for a journey to our pediatric center. Let us look more closely at one particular story. Just as the cases we see daily in our community social pediatric settings, it clearly demonstrates the fact that behind what seems an ordinary problem or a disruptive behavior often lies a violation of children’s fundamental rights. It also highlights how to deal with different views from all actors involved in the child’s life and the importance of acting in the best interest of the child. … An exasperated mother shouted in the clinic of community social pediatrics, “You’ve gotta give him a higher dose! He’s driving me crazy. If you don’t, they sure won’t let him back into school.” In the waiting room, a six-year-old boy stood as the “terror of the neighborhood” – and he knew it all right. He was considered so disruptive that the school had deprived him of his right to education several times. Earlier in his short existence, he’d been sent home from daycare and kindergarten on a regular basis. He was experiencing a form of rejection, not just by his age group and his school, but also by his family. 

The community–based social pediatrics' approach is an innovative model of integrated social medicine dedicated to meeting the global needs of children and ensuring that their fundamental rights are respected. It has originally developed from two key concepts: (1) The desire to make sure that no child "falls through the cracks" in the system – bereft of resources and care, with no one who can really “be there” for the child; (2) The importance of applying the principle that it takes a village to raise a child.  It implies the interconnection of medicine, law, and social services for empowering the child and the family as essential partners for the success of the child overtime. It is clearly a new paradigm of medicine in proximity completely integrative in its actions and outputs.

In the wake of the 1948 Universal Declaration of Human Rights,3 the international community was fostering a sense of hope for children. Hard work has led to the proclamation of the Convention on the Rights of the Child (the “CRC”)4 by the United Nations General Assembly on November 20th, 1989. Since then, some 196 States have signed and ratified this international covenant.5 Canada also embraced the CRC and made major reforms, especially in the delivery of education. It ranks 8th out of 41 rich countries, according to the 2017 UNICEF Innocenti Report Card 14.6 In the province of Quebec, where I work as a lawyer interested in children’s participatory justice, an array of highly developed programs is designed to support children and families, with the goal of seeing that everyone enjoys good physical and mental health: daycare services are widely available at relatively low costs; education and health care are provided mostly free of charge; and children whose development and safety hang in the balance are monitored and protected by powerful watchdog agencies.  Despite all these important efforts, some 26% of Canadian children are still not ready to successfully enter kindergarten, because of either speech and language delays, or lack of social, emotional and cognitive skills. This rate is even higher (34,9%) in communities where living conditions are harsh [1], and based on our practice in community social pediatrics; we estimate that this rate is closer to 50%. 

When countries like Canada ratified the United Nations Convention on the Rights of the Child, children’s rights’ advocates felt a new era was promised to ensure the protection of the children’s inherent dignity as human beings. Countries would strive to meet children’s needs regardless of the neighborhood in which they are born and raised. Education was casted as a fundamental right and advanced as essential for children to grow as healthy adults living a full and satisfying life.2 Schooling is only part of the answer. It cannot, by itself, achieve this noble goal. The responsibility for education must be shared between the State, the family, and the community to provide children with a broad range of experiences. This paper presents the model of the Circle of the Child,3 an amicable alternative dispute resolution mechanism I have developed over three years, with a number of partners (including children), in two disadvantaged communities in Montréal, Canada.4 It is designed to help children and families who come into conflict with the education system. To better understand how this model really works, I will expose Susana’s case (the name is fictional, of course). Through learning, the child develops critical analytical tools that help her understand her rights and become a meaningful participant of the process. The child also gets empowered to act and feel free to find solutions that meet her needs.

To make the situation more concrete, we’d like to take you for a journey to our pediatric center. Let us look more closely at one particular story. Just as the cases we see daily in our community social pediatric settings, it clearly demonstrates the fact that behind what seems an ordinary problem or a disruptive behavior often lies a violation of children’s fundamental rights. It also highlights how to deal with different views from all actors involved in the child’s life and the importance of acting in the best interest of the child. … An exasperated mother shouted in the clinic of community social pediatrics, “You’ve gotta give him a higher dose! He’s driving me crazy. If you don’t, they sure won’t let him back into school.” In the waiting room, a six-year-old boy stood as the “terror of the neighborhood” – and he knew it all right. He was considered so disruptive that the school had deprived him of his right to education several times. Earlier in his short existence, he’d been sent home from daycare and kindergarten on a regular basis. He was experiencing a form of rejection, not just by his age group and his school, but also by his family. 

When countries like Canada ratified the United Nations Convention on the Rights of the Child, children’s rights’ advocates felt a new era was promised to ensure the protection of the children’s inherent dignity as human beings. Countries would strive to meet children’s needs regardless of the neighborhood in which they are born and raised. Education was casted as a fundamental right and advanced as essential for children to grow as healthy adults living a full and satisfying life.2 Schooling is only part of the answer. It cannot, by itself, achieve this noble goal. The responsibility for education must be shared between the State, the family, and the community to provide children with a broad range of experiences. This paper presents the model of the Circle of the Child,3 an amicable alternative dispute resolution mechanism I have developed over three years, with a number of partners (including children), in two disadvantaged communities in Montréal, Canada.4 It is designed to help children and families who come into conflict with the education system. To better understand how this model really works, I will expose Susana’s case (the name is fictional, of course). Through learning, the child develops critical analytical tools that help her understand her rights and become a meaningful participant of the process. The child also gets empowered to act and feel free to find solutions that meet her needs.

Started as a pilot project in 2009, the Music Garage Project for the Young (GAM - Garage a musique pour les jeunes) is the first specialized offering of the Centre de pédiatrie sociale en communauté network of services, set in place by Hélène (Sioui) Trudel, Senior Legal Advisor and General Director at the Foundation Dr. Julien. Based in Hochelaga-Maisonneuve, a Montreal neighborhood holding the highest concentration of children who are not ready for school (over 42.3%; EQDM, 20123) amongst poverty-related problems; this unique blend of integrated preventive interventions proposes a 3-pronged strategy (or three major areas of concern addressed by the program) to accompany vulnerable youth (0-17 years old) to respect the CRC as a whole document by: (1) Offering free music education based on the ideas of collective pedagogy; (2) Providing individualized and adapted educational support at CAS (Centre Accès Scolaire); (3) Insuring evaluation-orientation and follow-up by the interdisciplinary team at a social pediatric clinic.

British Columbia has the highest child poverty rate in Canada with children in Vancouver’s inner city being among the most at–risk. In 2006 we set out to develop a social pediatrics initiative that has evolved into the RICHER research to practice partnership initiative. RICHER is the acronym for the Responsive, Intersectoral-Interdisciplinary, Child-Community, Health, Education, and Research initiative. From its outset RICHER sought to address the marked inequities in children’s health by fostering access to clinical services along the continuum of care from prevention to specialized supports and by forming partnerships and working to develop resources to address the social determinants of health.  At the outset of the initiative the team recognized that the neighborhood had a significant percentage of children who were developmentally vulnerable at school entry, and emerging longitudinal research had demonstrated that the impact of social and material adversities was cumulative over the life course. Moreover, a series of longitudinal studies and emerging neurodevelopmental research has shown that the negative impact of social and material adversity can be mitigated. The importance of engaging to improve children’s health and development was further underscored by analyses that demonstrated that when social and material adversity is left unaddressed there is a negative impact on the child that potentially incurs significant costs for not only health care systems but also for social services, education, and the criminal justice systems.