“… For the children, there could be no reason, no excuse.”
R.J. Ellory

KEYWORDS: Child rights, social pediatrics, global development, education, vulnerability.

ABSTRACT: This paper presents issues related to the respect of children’s rights, questions of collaboration with the school environment, as well as their positive impacts. It can be observed that children’s rights are protected thanks to transparence and everyone’ s collaboration in a concerted action plan. It is through this shared responsibility that we can see the child’s full potential and wellbeing emerge.

Introduction

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.

Yet, such informed approval is a basic premise that ensures parents fully support any plan concerning their child. The school must be an environment that acts in complementarity with families and the community. Children cannot define themselves or succeed without everyone in their environment working together in a model based on the full respect of parents, those first responsible for their children’s wellbeing.

In fact, there does exist an approach that requires the continued presence and mobilization of parents from beginning to end, both for gathering necessary information and for deciding on the best plan of action for their child. Furthermore, this approach also insists on the participation of the child, thereby ensuring that the rights of not only the parents, but also the child, are respected.

1. Community social pediatrics: an approach that prioritizes the rights of children.

Community social pediatrics (CSP) integrates the school into its practice because it believes in rallying the “village” around the child in order to support his/her global development and ensure his/her rights are fully respected. In essence, this paradigm of applied social medicine encourages situating oneself in the community and taking action in the child’s immediate or “proximal” environment. In the past twenty-five years, this approach has helped achieve greater equality with respect to the development of children in vulnerable communities.

More precisely, the CSP approach consists in offering vulnerable children, who often seem to fall through the cracks, a complete range of integrated services in their community. The process begins with a diagnosis made collaboratively by professionals with a range of competencies. Everyone contributes: professionals at the community social pediatrics center, parents and extended family, staff at different health and social services institutions, the school, neighbors, and so on. Together they work at co-constructing an action plan “with” and “for” the child, the goal being to promote the child’s global development.

Article 19 of the Convention addresses prevention and protection in the broader sense. The best way of ensuring the implementation of this article is to build a “village” set up on trusting relationships around the child. The community must get involved and take the wellbeing of its children to heart, care providers from different institutions must talk to each other, and the school must be at the center of this process. In fact, we would argue that the mandate to educate children is a shared responsibility, and the epicenter is the neighborhood school.

2. The rights of the child in terms of education. During the school years, children develop capacities and acquire tools that are essential to their success at school. However, the development of these capacities can be compromised and block a child’s success at school. This can start as early as the preschool years and lead to difficulties that continue throughout the school trajectory.

In Quebec, and no doubt elsewhere in Canada, there is a deep concern over high dropout rates, especially in our most vulnerable communities. It is not surprising to learn that graduation rates are disastrously low in disadvantaged neighborhoods: 30% of Quebec youth celebrate their twentieth birthday without having completed secondary school or professional training, and this percentage is considerably higher for youth from low-income families (Institut de la statistique du Québec, 2014).

There is a clear link between extreme poverty and school failure. The causes and consequences of extreme poverty include lack of resources, social exclusion, toxic environments, exposure to violence, lack of support, loss of motivation and delinquency. These obstacles, which can also lead to school failure, very often correspond to a violation of children’s rights. Furthermore, such factors have a major impact on children’s quality of life and wellbeing, not to mention the global social capital of our society.

The violation of children’s rights and school failure are intimately connected. Therefore, is not the greatest inequality the fact that many children do not have the tools they need to succeed at school, and that these tools are not available to all children right from the time they enter school and through until the end of post-secondary studies?! In reality, this is far from being the case, and there are insufficient community services to ensure action on this basic right.

3. CSP: an approach that links the rights of children and education. For the purposes of consensus building, CSP places the school at the center of its actions. The equation is simple: on the one hand, the school needs a helping hand in the form of the legal and socio-medical expertise provided by social pediatrics; on the other, the social pediatrics team needs teachers and school professionals (speech therapists, psychologists, psycho-educators, and special education teachers) to make a precise diagnosis, implement a joint action plan and ensure proper follow-up. It is part of a winning formula.

Right from its earliest days, CSP has viewed the school as indispensable to its efforts at creating change. A site for comprehensive screening, a completely accessible site for prevention and a place for supporting children on a trajectory of success—these are some of the powerful roles that the school can play, but only if it does not act in isolation.

It is not always easy for external players to build a successful partnership with schools due to a number of potential barriers: a system that is sometimes closed or imprisoned in rigid standards and continually subject to reform, a complex hierarchy that often prevents teachers and professionals from doing more, ongoing limited resources, obscure power struggles, and a failure to integrate parents in school life. The good news is that these barriers can be overcome and that when trust is established, the power of working together is like a light at the end of a tunnel.

When it comes to the rights of children, this partnership is essential because the participation of school staff is needed to implement any collaborative intervention. When a child has difficulties at school, we first have to determine the causes. These could include lack of motivation, attention deficit disorder, learning difficulties or serious emotional issues. Who can better than the teacher or school administration gather all the necessary information and implement corrective measures, all in the spirit of open collaboration with the family and a desire to safeguard the child’s rights?

Schools refer children with a wide range of difficulties to CSP centers (CSPCs). For example, children are frequently referred for behavioral, learning and adjustment problems, concerns about health and development, suspicions of negligence or abuse, and conflict with or between parents. The school accompanies the child to the CSPC in order to participate in the process. Teachers, specialists, special education teachers and even the principal become active partners with the CSPC. We share privileged information and together analyze all concerns, facts, and risks. Together we form a team with exceptional expertise that works with the child and their family as full partners.

The common cause that rallies us is finding the best way to ensure the child’s wellbeing and success. This joint follow-up of the child’s school trajectory enables rapid intervention and the resolution of difficult situations. Based on furthering the best interests of the child and his/her family, an effective partnership is built between professionals from both the school and the CSPC. School personnel regularly visits the CSPC, and vice versa. This creates a network of collaboration and action around the child.

The development of collaborative projects allows us to provide a greater range of preventive and curative services to children, especially those with special difficulties. A good example is the school readiness program initiated by one school principal. It was implemented in two communities to screen for children ill-prepared for school even before the start of school at age four. The screening was done at registration, several months before school entry. A joint assessment was carried out to determine the child’s difficulties and needs, and then an action plan implemented to support the child and the family. Several weeks before the start of school, the child participated in the so-called school readiness summer camp. The child’s teacher was informed and became a partner in the program. Throughout the school year, the child’s progress was evaluated and targets adjusted as needed to ensure the child’s success. This is a good example of how we can positively impact the lives of many children at a minimal cost.

We collaborate with schools in a number of different ways depending on the needs of children throughout their school trajectory. It may be for educational summer camps to preserve skills acquired during the school year, special follow-up for children suffering from an environmental illness (caused, for example, by exposure to mold in school buildings), help with homework at community organizations, or specialized educational support at Garage à musique to complement that offered by specialists at the school.

We also offer comprehensive diagnostic services to support schools with children suffering from a range of difficulties and requiring assistance adapted to their complex needs. Many children in disadvantaged neighborhoods suffer from the consequences of cumulative toxic stresses or have multiple concurrent problems. The risk of school failure and exclusion is high for these children, and so it is imperative that we understand the causes and act quickly. The practice of CSP responds directly to article 3 of the Convention and its call to protect children and provide the care needed to ensure their wellbeing. In short, CSP enables us to identify the causes of difficulties and then take effective action.

For example, the cumulative toxic stresses that often result from poor living conditions is a phenomenon that we can tackle by adopting a collaborative model based on consensus. To this end, we provide support to schools by offering the expertise of our pediatricians, doctors, social workers and lawyers, in addition to onsite assistance from art therapists, neuropsychologists, speech therapists, physical therapists, and child psychiatrists.

This approach also responds to article 2 of the Convention, which states that we must protect children from all forms of discrimination. The lack of resources and underfunding that continues year after year in our schools means that children are not sufficiently protected in this way, despite the efforts of teachers and administrations.

For example, I wonder about a problem that I continue to encounter in my daily practice: bullying. In my experience, at least half of all children report being the victim of hurtful words, threats or physical aggression from one or more other children. Most children say they talked to an adult about the problem but few say that it actually helped. While the problem is certainly not the school itself, the problem is linked to the school because bullying usually takes place at school (often in the school yard) or on the way to or from school. This issue concerns all of us, and we must all act to prevent this type of discrimination and its serious consequences, like demotivation, social withdrawal, and suicide.

Every day at my clinic I see the rights of children being violated because of deficiencies in services and support. Screening and diagnosis for behavioral problems and learning difficulties is often not done early enough, and there are unacceptably long delays in taking action. There is a severe lack of resources and technological tools to ensure the school success of children in difficulty. This is why CSPCs propose working together to change the course of events directly in the community.

Picture by Mathieu Deshayes, photographer

4. Community social pediatrics in action. What, in concrete terms, does an intervention in CSP look like?

Mélina is 10 years old and was referred by her school to the CSPC because of behavioral problems. She came with her parents, her teacher and the psycho-educator who follows her at school. The CLSC social worker involved with the family was also present at the meeting.

In 2013, when she was 9 years old, Mélina was transferred to a class for children with learning difficulties because of her poor performance. Due to problems with attention and motivation, she was performing at Grade 1 level. These problems could be attributed to the trauma associated with the family’s migration to Canada. Mélina also had a history of chronic exposure to violence in her war-torn country of origin and had been unable to regularly attend school prior to 2012. These factors led to her repeatedly falling behind in school.

Now, despite being in a class better suited to her needs, Mélina was developing behavioral problems in the form of passive resistance. She was also frequently absent from school. It was noted that she brought reassuring objects to school, such as a stuffed animal or her personal “planner”. She sought out the presence of adults but was unable to socialize adequately with other children, whom she pushed away, sometimes aggressively, when they became too insistent. Her mother reported new oppositional behavior at home. Starting several days prior to the meeting, Mélina had also experienced sleeping difficulties and gloomy, even suicidal, thoughts. Otherwise, she was helpful, was quickly mastering French, and lovingly took care of her little sister. She was clearly sociable and was not afraid to speak up.

The family immigrated to Canada in 2012 when Mélina was 6 years old. Mélina was enrolled in a special integration class to help her adapt and learn French. The following year, she was integrated into a regular Grade 1 class and it was then that she started having problems. It should be noted that the family was having great difficulty adapting to life in Canada and was threatened with deportation. The father was working under the table, and they were struggling financially. In 2012, shortly after their arrival, Mélina and her family suffered another traumatic event: Mélina was the victim of violence, including a possible sexual assault, by a neighbor. She started seeing a psychologist at this time.

The physical examination was normal. However, Mélina complained of frequent headaches after school. When asked about this, she reported being disappointed about her performance. Her reading was at the grade 1 level and she was having great difficulty following the sequence of words and syllables. People often said that her “head was in the clouds”. I myself observed that she was often not fully present: her gaze was directed elsewhere, and quite often she did not follow the conversation. At the same time Mélina seemed to have good potential; she was, nevertheless, able to follow the discussion and sometimes even spoke up to comment or agree with a suggestion that directly concerned her. She showed considerable interest in our proposals to help her succeed.

We all came to the same conclusion: here was a young girl with a history of trauma, starting with exposure to extreme violence at a very young age, a forced and difficult migration to Canada, and, more recently, exposure to a number of toxic stressors including the family’s precarious status, difficult life conditions, poverty and isolation, and a violent assault on her physical integrity. On top of all this was the unjust and untenable situation of a possible expulsion from the country. Clearly, Mélina was experiencing great anguish and was unable to learn under such circumstances.

The team collaboratively came up with an action plan centered around meeting Mélina’s needs and respecting her rights. Such a plan to address priority issues can only be done by a team and only with the full participation of the child and his/her family.

Action plan

• Support Mélina’s numerous potentials: drawing, an interest in fashion and music (she is a very good singer according to her mother), and her desire to succeed despite all the difficulties she has encountered. She wants to be a fashion designer when she grows up.
• Integrate Mélina into “growth” activities outside of school hours, including personalized support to help her adapt to her new environment. Find a volunteer, “Big Friend”, who can help her better integrate into her community and her city, while also serving as a guide and mentor. Sign her up for a self-esteem workshop for girls given at the CSPC, and for other upcoming activities offered by our partners.
• Find a local family that can pair with and support Mélina’s family, who are newly arrived but not yet fully integrated, and are struggling greatly.
• Check for any physical disorders. Arrange for Mélina to have an eye exam to see whether vision problems could be causing her frequent headaches at school and difficulty reading. Also check for attention deficit disorder without hyperactivity, and for possible learning disorders like dyslexia.
• Strengthen Mélina’s psychological and emotional health through sessions with our music therapist, who will ensure follow-up with the psychologist and psycho-educator.
• Promote Mélina’s motivation and perseverance at school by adapting methods both in and outside the classroom.
• Refer the case to our legal team to ensure that the family receives all possible assistance to improve their living conditions and mitigate the risk of deportation.
• Together ensure Mélina’s success and the follow-up of this integrated action plan through regular communication between all participants in this joint project.

5. Dealing with obstacles along the way

In general, CSP enables us to successfully intervene in order to protect the rights of children and build effective links between medicine and the educational and social spheres. But we live at a time when the role of the school in the community is seriously threatened by budget cuts. Such cuts are even affecting the physical environment of schools, most notably the safety of school buildings.

For example, in Montreal’s Hochelaga neighborhood, children attending the three primary schools close to the CSPC had to be relocated after the discovery of toxic mold in school buildings. The children were forced to take a bus every morning to schools able to temporarily accommodate them but located outside of their neighborhood. This resulted in returning home tired and stressed at the end of the day.

Before the schools closed, we had succeeded in setting up a thriving community of practice around the children and their families. Children passed by the CSPC two or three times a day. Some would stop by to say hello, others to eat or seek refuge. Teachers, the school administration, and specialists regularly got together with the staff at the CSPC and discussed the children’s wellbeing. Parents were comfortable sharing their worries and their successes with us. But after the schools were closed, we rarely saw them.

The parents also lost touch with the teachers, who no longer passed through the neighborhood on a daily basis. Sometimes an educator would go on the bus with the children, but only to deal with a major problem. Even visits at report card time became complicated. School absenteeism increased. For us, it was catastrophic in terms of prevention and protection of the children served by the CSPC.

But this type of barrier or event encountered en route must not deter us from our mission. Children are too precious to be abandoned. We must make do, as they say, even double our efforts and multiply our care and services despite the temporary absence of certain key actors.

6. A proposal to ensure that children’s rights are respected in the educational system.

First and foremost, all actors in the educational system must become familiar with the Convention, which can easily be accessed, integrated, and discussed in class with children. Then, all actors in the educational system must remember themselves and ensure others remember, that rights always come with duties.

Respect, the essential action required for living with others in the society.

Effort, the essential condition for school success.

 Support, the essential factor for ensuring continued effort and perseverance.

We must also remember that despite all the talk about respecting children, there are still many children who have their rights, sometimes several at the same time, violated on a daily basis. Resolving this problem is a complex task; hence, there comes the importance of joining forces. In our practice, we have seen the great burden placed on teachers who fight to make changes but at great personal cost.

It is impossible to tackle this problem alone. All adults involved in the child’s life must position themselves around the child and attentively follow his/her health and educational trajectory. Such banding together of significant adults is needed for an effective action. Information needs to be shared and actions taken collaboratively if we are to succeed in acting in the child’s best interests.

In short, we cannot accept actions taken in isolation or obstacles that hinder actions essential to the wellbeing of children in difficulty.

It is important to remember that the right to quality education implies a number of different steps and many potential obstacles. To succeed, quality stimulation of the proper intensity in early childhood is essential. Adequate preparation for school entry is critical and must be universal. It is absolutely imperative that all schools provide easy access to quality educational resources and effective learning tools for all children.

Every child comes into the world with his/her own unique gift, sometimes even many gifts. Surrounded by a “village”, we need only bring this gift to fruition to ensure the success of every child and a more just society.

References 

Blair, C. & Razza, R.P. (2007). Relating effortful control, executive function and false belief understanding to emerging math and literacy ability in kindergarten. Child Development, 78(2), 647-663.

Center on the Developing Child at Harvard University (2011). Building the Brain’s “Air Traffic Control” System: How Early Experiences Shape the Development of Executive Function. Working Paper 11. http://www.developingchild.net

Diamond, A. (2002). Normal development of prefrontal cortex from birth to young adulthood: Cognitive functions, anatomy, and biochemistry. In D.T. Stuss & R.T. Knight (eds.) Principles of Frontal Lobe Function (pp. 466-503). New York: Oxford University Press.

Espy, K., McDiarmid, M., Kwik, M., Stalets, M., Hamby, A. & Senn, T. (2004). The contribution of executive functions to emergent mathematic skills in preschool children. Developmental Neuropsychology, 26(1), 465-486.

Institut de la statistique du Québec (2014). Faible revenu et inégalité de revenu. Gouvernement du Québec, p. 1-124.

Posmer, M.I. & Rothbart, M.K. (2006). Educating the Human Brain (1st ed.) Washington DC: American Psychological Association.

1 This article has first been published in the Education Review of the Faculty of Education, University of Ottawa, Spring 2016. It is republished here with a written permission from the Education Review.

2 Dr. Gilles Julien,  C.M. (Recipient, Order of Canada, in recognition of his outstanding contributions at the local and regional level);  O.Q. (Officer, National Order of Quebec); Social Pediatrician, Clinical Director, Founder and President of the Foundation Dr. Julien.