Abstract
Background: The Paediatric Inclusion Health (PIH) service in CHI Temple Street aims to directly address social determinants of health such as poverty, homelessness, and forced migration in clinical practice.
Approach: Children’s Health Ireland and other hospitals have seen a rise in children presenting from these groups of children experiencing social exclusion due to the current national and global socio-economic situation (cost of living, housing crisis, increased in forced migration etc.). Each of the cohorts as mentioned below present with different visible and invisible barriers to effective healthcare engagement and an intersectional approach to healthcare delivery must be used to address individual and collective needs.
The outpatient service has been designed along a hub and spoke model and co-designed with key health and other agency stakeholders, including patient advocacy and support groups. A holistic model of care is utilized that involved proactive liaison and support for engagement (Figure A). A variety of medical pathologies are seen and active consideration given to SDH during the clinical review including considering risks to the child and caregiver of abuse, trafficking, torture, sexual and gender-based violence and other health risk behaviours. This service has been designed in tandem with national and international health strategies.
Results: There has been excellent engagement and attendance from children referred to the Lynn Clinic. A clearly designed operational pathway for engagement (Table B) is reflected in excellent attendance rates. Many of these children are without established primary care and have vaccination rates much lower than the general population.
We have recognised specific subgroups unique to our own local and wider geographic area as those at risk of social exclusion and benefitting from an approach that supports equitable care, including children in homelessness, international protection applicants, children from the Roma and Irish Traveller communities and children experiencing the impacts of generational poverty and exclusion. We are incorporating other initiatives into our service delivery model, including on site dental assessment, communicable disease screening and opportunistic MMR and seasonal influenza vaccination. Feedback from community stakeholders has been overwhelmingly positive.
Implications: The Lynn clinic is acting as a template of care for equitable and holistic healthcare nationally as we seek to better support access to services for children on the margins of society. It has demonstrated that with support to overcome visible and invisible obstacles to hospital health care that high quality, comprehensive care can be delivered that supports proactive and preventative health strategies.