Transcript Slide 1

Family Health
Support: Using Social
Determinants of
Health and Ecological
Models to
Plan Holistic
Community Services
Dr. Jason Newberry &
Dr. Andrew Taylor
Centre for Research
and Education
in Human Services
Not to be used without permission © CRHES 2005
The Centre for Research and
Education in Human Services
We are a non-profit and independent
community-based research organization
located in Kitchener, Ontario, Canada.
We engage in diverse streams of work,
including applied research and
evaluation, training & education,
facilitation & planning, and international
consulting.
Our values emphasize community
participation, action, and relevance in the
work we do.
Not to be used without permission © CRHES 2005
The Centre for Research and
Education in Human Services
Our focus areas include:
• Family Support
• Disabilities
• Cultural Diversity
• Community Safety & Violence Prevention
• Women’s Issues
• Health Promotion
Not to be used without permission © CRHES 2005
The Purposes of Today’s Session
To provide the background context and description
of the “Family Health Support Project”.
To present a framework on how to use ecological
models and social determinants of health to aid in
the analysis of diverse health planning
information.
To review our findings and critically examine the
approach we used.
To discuss the strengths and challenges in applying
this and other more holistic approaches to family
and community health planning of supports and
services.
Not to be used without permission © CRHES 2005
Family Health Support Project: The
Background Story
• The Public Health Unit of the Region of
Waterloo (Ontario, Canada) serves 6
counties with a total population of almost
450 000.
• The Region is expected to experience a
substantial population increase, with
estimates of over 700 000 by 2041.
• A “Regional Growth Management
Strategy” is currently under development;
this is a enormous process that is
requiring the involvement all public
service agencies.
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Family Health Support Project: The
Background Story
• The Public Health Unit is a major
participating organization in this process,
and is submitting a wide variety of reports
and briefs to help with a range of sector
planning issues.
• One such report is the “Family Health
Support Plan”, which is to contribute
recommendations for the delivery of
services and supports to families with
young children (0-6 years). This is a
component of an overall “Human Services
Plan”
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And there were other concerns
(and opportunities)…
• The Province of Ontario is in the process of
rolling out “Best Start” –comprehensive early
learning and care hubs (mostly in public
schools) that integrate child care, JK/SK, and
various family health supports. Public Health
is a major stakeholder in this new system.
• With so much regional activity on integrated
planning, this was also a timely opportunity
for Public Health to pursue a family health
agenda that was more holistic and ecological
in character.
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Bureaucracy aside, what is this
all about?
To complete the Family Health Support Plan, Public
Health needed information that was organized
and integrated in one place. In short, they
required a review of:
• Policies, Legislation, and the Role of Public Health
• General best practices for promoting healthy child
development
• Population estimates, projections of key
demographics, and other epidemiological variables
• Family Health and other Public Health Services in
relation to these other information sources
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The purpose of our report was to…
• …identify factors for the Region of
Waterloo to consider, within the Region’s
mandate, in supporting families with
children 0-6 years of age in achieving
healthy child development, now and into
the future.
• ….generate recommendations for how
Region of Waterloo Public Health, within
its Public Health mandate, can best
support families with children 0-6 years of
age in achieving healthy child
development, now and into the future.
Not to be used without permission © CRHES 2005
The purpose of our report was to…
• Provide a basis for Public Health to plan
future community consultations.
• To inform planning as it relates to:
– Local implementation of Ontario’s Best Start
Framework for children 0-6
– Waterloo Region’s Growth Management
Strategy.
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Family Health Supports and Services in
Public Health
Our local Public Health Unit is composed of 6 Divisions.
Within each division there are different components
of family health programming:
• Family Community Resources (where family health
programming is most concentrated)
• Communicable Diseases, Dental and Sexual
Health resources
• Environmental Health & Lifestyle resources
• Emergency and Medical services
• Central Resources (marketing and
communications)
• Health determinants planning and evaluation
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Figure 2 – A Visual Depiction of Public Health Supports and
Services provided by Public Health
Prebirth Screen
& Assessment
Birth Screen in Hospital
Healthy Babies
Healthy Children
programs,
Postpartum contact &
assessment - post-birth clinic
including...
Postpartum home visit &
assessment
Distribution & Promotion of
Child Health Info & Resources
Nutrition Support
Healthy Child Info Packages
(incl. age paced mail outs)
Family Visiting & Service
Coordination
Car Seat Distribution & Education*
Families
with
Children 0-6
Based on need,
Public Health Programs refer
families to various community
supports, services, and
programs. These include:
Other
Parent education
Services in the
Smoking Cessation
Community,
including...
1 This
Child Health Fairs*
Other Family
Breastfeeding Support
Health Program
Breastfeeding Buddies1
Services,
Healthy Children Info Line
including…
“Meet with a Nurse” program
*co-delivered by EHLR
Immunization
Injury Prevention
Prenatal Nutrition Education
Adolescent Prenatal Education
Parenting Education Groups
Inspections of child care facilities
Other
Health promotion & information
Smoking Cessation Referral
Public Health
Service provider &
Services,
peer worker training
including...
Dental Support
Active Living
is a community based group that is sponsored by Family Health. Family
Health does not directly administer it
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Family Health Service planning in
relation to the local service system
Family
Health
Services
Other
Public
Health
Services
Other
Human
Services
Other
municipal
infrastructures/
institutions
Broader
Influences
(private
sector,
government)
Family Health Support planning
Concrete
recommendations &
actions for family
health support
planning
Strategic Partnerships,
opportunities for
influence in the human
service sphere
Advocacy for Holistic
Community Health;
Positioning of Public
Health as a leader
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Archival Documents &
Secondary Data Sources
Best
practices
(locally &
generically; in family
support & beyond
family support)
Public Health
service
mandate &
guidelines
Epidemiological data,
demographic
s
Family
Health
Support
Services
Key informant
interviews and
focus groups
Best Start
Framework;
Growth
Mgmt.
Strategy
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Information overload!!
• This project required a synthesis of multiple
sources of information:
• 5 broad categories of information
• Many different sources of information within each
category
• Focus group and interview data that could speak
to content and issues within all of the categories.
• A focus on concrete planning of family health
services but also a desire to situate the family in
broader community and social health context
• Complex interrelationships existing between all
these things
…and we were afraid.
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Social Determinants of Health &
Ecological Models as tools for
organization
• Public Health as a field subscribes to
holistic and ecological theories of health
(although observing these theories in
practice is elusive)
• Holistic health is predicated on
understanding the interrelationships
between “social determinants of health”
• Thus, it made a lot of sense to attempt to
combine SDOH and ecological models to
organize the information
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Ecological Systems Theory
• Pioneered by Urie Bronfenbrenner,
who envisioned nested and mutually
reinforcing ecological systems that
impact individual development
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Not to be used without permission © CRHES 2005
Examples of ecological models
Huit, 2003
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Examples of ecological models
Dahlgren & Whitehead, 1991
Not to be used without permission © CRHES 2005
Social Determinants of Health
The social determinants of health refer to
both specific features of and pathways by
which societal conditions affect health
and that potentially can be altered by
informed action.
–
–
–
–
–
–
–
–
–
income
education
family structure
service availability
sanitation
exposure to hazards
social support
racial discrimination
access to resources linked to health.
Krieger N. A glossary for social epidemiology. J Epidemiol Community
Health 2001; 55:693-700. Not to be used without permission © CRHES 2005
We developed a simple ecological model
to begin to organize our information –
first to position our social determinants
of health and second to organize and
examine the content of our information
sources.
Child
Health
Parent &
Family
Health
Community
Health
Service
System
GROUP
EXERCISE
Psychosocial
determinants
Behavioural & Lifestyle
Child
Health
Parent &
Family
Health
Community Determinants
Community
Health
Service
System
Early learning & care
determinants
Parent knowledge
& skills
Parenting-focused
knowledge & skills
System level
Social Determinants of
Health at different
ecological levels: Service
System (adapted from Labonte,
Healthy public policy and
organizational practice
Provision of preventative
services
Access to culturally
appropriate services
1998)
Community participation in
health service planning &
delivery
Child
Health
Parent &
Family
Health
Community
Health
Service
System
Social Determinants of
Health at different
ecological levels:
Community Health (adapted
Safe and healthy physical
environments
Supportive economic and social
conditions
Open and stimulating learning
environments
from Labonte, 1998)
PROTECTIVE
FACTORS
Child
Health
Supply of nutritious food and water
Availability of affordable housing
Availability of meaningful, paid
employment; flexible & supportive
work environments
Parent &
Family
Health
Community
Health
Poverty & low social status
Dangerous work
Polluted environment
RISK FACTORS
Natural resource depletion
Discrimination (age, sex, race,
disability)
Steep power hierarchies in
community
Service
System
Social Determinants of
Health at different
ecological levels:
Parent & family health
Risk
version
s
Psychosocial
Participation in civic
activities and social
engagement
Behavioural/Lifestyle
Strong social networks
Feelings of trust
Regular physical
activity
Feeling of power and
control over life decisions
Balanced nutritional
intake
Supportive family structure
Good hygiene
Positive self-esteem
Safe sexual activity
Child
Health
Decreased drug &
tobacco use
Parent &
Family
Health
General
Individual/Family
Determinants
(protective factors).
Adapted from Labonte, 1998;
previous Family Support review.
Community
Health
Service
System
Social Determinants of
Health at different
ecological levels: Child
health
Child
Health
Early childhood education
Parent &
Family
Health
Community
Health
Parenting skills; parenting
style
Service
System
Comprehensive social
programs
Early childhood screening
Universally
available/accessible
Availability of quality child care
Early Childhood
Development &
Health Determinants
(e.g., from Hertzmann, the Best
Start Framework, previous
Family Support review)
Parenting knowledge and skills*
Integration of cross –
sectoral programs &
policies
Community driven
Quality
Accountability
*encompasses a wide variety of knowledge and skills, such as those
surrounding pre/post natal care, nutrition, life skills, parenting techniques, etc.
Social
Determinants
of Health at
different
ecological
levels
Psychosocial determinants
Biophysical
determinants
Supportive family structure
Participation in civic
activities and social
engagement
Strong social networks
Other individual-level
determinants
Decreased drug &
tobacco use
Community Determinants (Protective)
Safe and healthy physical environments
Supportive economic and social conditions
Open and stimulating learning environments
Feelings of trust
Regular physical
activity
Feeling of power and
control over life decisions
Safe sexual activity
Supply of nutritious food and water
Availability of affordable housing
Availability of meaningful, paid employment;
flexible & supportive work environments
Positive self-esteem
Genetic risks
Physical disabilities
Neurological
disabilities
Child
Health
Early learning & child care determinants
Parent &
Family
Health
Community
Health
Service
System
Encouragement of exploration
Mentoring in basic skills
Celebration of developmental advances
Parenting-focused
individual determinants*
Parenting knowledge
Guided rehearsal and extension of new skills
Protection from inappropriate disapproval,
teasing or punishment
Parenting skills
Parenting behaviours
A rich and responsive language environment
*encompasses a wide variety of knowledge, skills, and behaviours such
as those surrounding pre/post natal care, nutrition, life skills, parenting
techniques, etc.
Community Determinants
(Risk)
Poverty & low social status
Dangerous work
Polluted environment
Natural resource depletion
Discrimination (age, sex,
race, disability)
Steep power hierarchies
System level
Comprehensive social
programs
Universally
available/accessible
Integration of cross –
sectoral programs &
policies
Community driven
Quality
Accountability
Policies and Legislation
governing Public Health Practices.
Example questions for the review:
In general, what service content and
modalities are Public Health
mandated to provide?
Which service targets and types are
emphasized?
Example document: Mandatory Health
Programs and Services Guidelines
Under the category of “Reproductive
Health”, policy guidelines require programs
and supports that target youth, expectant
families, and the broader community
through direct education, information and
mass media.
What is the latitude or flexibility of
these mandates?
Child
Health
Programming should contain
the following topics:
Folic acid, nutrition, smoking
cessation, physical activity,
alcohol, supports systems,
stress reduction, access to
prenatal care, early
recognition of/response to
pre-term labour
Parent &
Family
Health
Community
Health
Public education
(in groups to youth,
pregnant women &
partners, people
planning)
Mass media
dissemination
Mass media
dissemination
Telephone
information line
Consultation to
school boards,
teachers,
student
councils re:
curriculum
Support &
resources for
workplaces
Service
System
Service provider
training &
resources,
Service coalition
buidling and
coordination
Policies and Legislation
governing Public Health Practices.
Questions for the review:
In general, what service content and
modalities are Public Health
mandated to provide?
Which service targets and types are
emphasized?
Example document: Mandatory Health
Programs and Services Guidelines
Under “Child Health”, initiatives have
multiple targets, delivery modalities and
content areas.
HBHC programming: Develop & implement screening,
assessment & referral protocols, coordinate home
visiting program (incl. lay home visitors),
What is the latitude or flexibility of
these mandates?
Child
Health
Programming should contain the
following topics:
Milestones re: speech & language,
hearing, vision, growth, motor skills,
social interaction, and behaviour
Immunization, injury prevention,
nutrition, dental health, physical activity,
communication, stimulation & play,
parenting ability, family functioning,
social supports, and coping skills.
A specific focus on breastfeeding as a
priority
Parent &
Family
Health
Promote/provide
information & skills
development to
parents (groups)
Promote & support
development of
peer educators &
peer support
At least 1
community wide
annual education
campaign
Telephone
information lines
Community
Health
Mass media
dissemination
Service
System
Promote/provide
information &
skills development to
providers
Service coalition
buidling and
coordination
Best practices in Family
Support and Early Childhood
development
Questions for the review:
What are the best practices of social
interventions that serve to address
the major social determinants of
health and healthy child
development?
Example document: Review of Literature on
Best Practices, Family Health Plan (internal
review document)
There is a clear correspondence with Public
Health’s mandate and best practices for parent
knowledge and skills in terms of content and
general modality. However, specific best
practices in this regard are often not highlighted,
as in this document.
To what extent are best practices
consistent with the mandate of
mandatory guidelines of PH?
Parent &
Family
Health
Child
Health
Social
Determinant(s):
Parent Knowledge &
Skills
Parent education in :
Smoking cessation
Breastfeeding
Parent skill training
etc….
Community
Health
Service
System
Best practices in Family
Support and Early Childhood
development
Questions for the review:
What are the best practices of social
interventions that serve to address
the major social determinants of
health and healthy child
development?
Example document: Review of Literature on Best Practices,
Family Support Plan
Some best practices for enhancing family and child health
approach intervention more holistically, and focus on higher
ecological levels. For example, “comprehensive community
initiatives” address many determinants across the ecological
spectrum.
Community
safety programs
Community
recreation
To what extent are best practices
consistent with the mandate of
mandatory guidelines of PH?
How does PH observe and link to
these interventions in the
community?
Social
Determinant(s):
Various across all
levels
Social advocacy
Child
Health
Parent &
Family
Health
Community
Health
Peer and leader
based support
as alternative to
traditional
services
Service
System
Enriched
child care
and support
Family peer
support
In some cases, policy guidelines can be unclear or absent in
relation to more comprehensive interventions, because the
mandate is too broad.
Best practices in Family
Support and Early Childhood
development
Example questions for the
review:
What key best practices important
to health fall outside the
legislative mandate of public
health? How does PH contribute,
influence?
Social Determinant(s):
Example document: Implementation Planning
Guidelines for Best Start Networks and The Case
for an Early Childhood Development Strategy
(Hertzman)
We find that there are additional best practices
intimately tied to healthy child development that
appear to fall outside the mandate of public
health (e.g., direct administration of child care).
However, this does not preclude PH involvement
and influence in a variety of ways
Child
Health
Parent &
Family
Health
Community
Health
Service
System
Comprehensive social programs
Universally available/accessible
Integration of cross –sectoral programs &
policies
Community driven
Quality
Accountability
Early childhood education
Availability of quality child care
Child Care and ECE that
Encourages exploration
Mentors basic skills
Celebration of developmental advances
Provides guided rehearsal & extension of
new skills
Protects from inappropriate disapproval,
teasing or punishment
Provides a rich & responsive language
environment
Best Start
Framework:
Hub model typically using
schools as central
service node
Coordinated
network of
stakeholders
Epidemiology, Demographics, and
Population Estimates in the
Region
Questions for the review:
What data is available that speak to
central determinants of health and
healthy child development in the
region?
Child
Health
Parent &
Family
Health
EDI
indicator
data
Family
Composition
Community
Health
Service
System
Poverty levels
Food security
Available
child care
spaces
Employment
rates
Accessibilty
data
What are the main gaps?
Of the available data, what indicators
are used? What indicators are used
in other regions, or nationally?
What major demographic variables
and/or indicators of health are
projected to change and how?
Rate of
low birth
weight
Rates of
tobacco &
alcohol use
These data are population-based indicators of social
determinants. Often the available data is outdated,
incomplete, or overly general.
EDI data = physical health, social competence, emotional
maturity, language and cognitive development, communication
and general knowledge
Current Programming for
Family Health Support
Questions for the review:
What are the central emphases of
family health support programs?
Public Health services intervene at many levels, but
mostly target Parent and Family Health. Services are
generally consistent with legislative mandate but less so
with best practices that target broader environmental
levels and child determinants lying outside family
environment.
How family health interventions
compare to policy guidelines?
Disease and
injury prevention
How consistent are they with best
practices in the promoting the
health of children 0-6?
To what extent are PH family
support programs consistent with
projected demographic variables
and health indicators?
Child
Health
Screening
and
assessment
Immunizations
Parent &
Family
Health
Pre-conception,
pre- & postnatal
supports
Health info lines
and resource
distribution
Parenting
education and
supports
Advocacy for conditions
that support healthy child
development
Community
Health
Service
System
Inspection of
children’s
environments
Child health
education,
training, and
community
campaigns
Current Programming for
Family Health Support
Questions for the review:
What are the central emphases of
family health support programs?
Public Health services intervene at many levels, but
mostly target Parent and Family Health. Services are
generally consistent with legislative mandate but less so
with best practices that target broader environmental
levels and child determinants lying outside family
environment.
How family health interventions
compare to policy guidelines?
Disease and
injury prevention
How consistent are they with best
practices in the promoting the
health of children 0-6?
To what extent are PH family
support programs consistent with
projected demographic variables
and health indicators?
Child
Health
Screening
and
assessment
Immunizations
Parent &
Family
Health
Pre-conception,
pre- & postnatal
supports
Health info lines
and resource
distribution
Parenting
education and
supports
Advocacy for conditions
that support healthy child
development
Community
Health
Poverty & low social
status
Dangerous work
Polluted environment
Service
System
Child health
education,
training, and
community
campaigns
Natural resource
depletion
Discrimination (age, sex,
race, disability)
Steep power hierarchies
in community
Archival analysis has limitations....
• While secondary analysis generated a lot
of information, it was very difficult to get a
sense of what was happening on the
ground
• To supplement our understanding of
service delivery and human service
coordination (or lack thereof) in the sector
we conducted key informant interviews &
focus groups.
Not to be used without permission © CRHES 2005
The central piece to which everything
is compared in this review is “actual
family health support services”…
• Conducted a Service Delivery Model
Interview…we guided a key informant to
sketch the sequence of service delivery of
family support services in diagram form
• Each stage of service delivery was probed
as it was created.
• Reviewed the recorded interview to
complete a more comprehensive model.
• Validated model with several focus groups
with service providers.
Examples of Focus Groups
Departmental Leadership
Team
Family Health Advisory
Committee:
•
•
•
How can Family Health Support
policy and programming best
integrate with other departments,
organizations, and community
services in order to address
broader social determinants of
health?
e.g. “In considering family and child
health holistically and the role of
Public Health, where do you think
there are the biggest gaps or
disconnects in the system?”
•
How do Family Health services
and programming fit with best
practices and future trends, and
how can these services best
integrate with other
departments, divisions,
organizations, and community
services?
e.g. “Can you think of examples
where there is a disconnect
between the design of services
on paper and what actually
happens in practice? What
accounts for this discrepancy?”
Not to be used without permission © CRHES 2005
Brief Overview
Not to be used without permission © CRHES 2005
Individual-Level Determinants of Child Health:
Parenting Knowledge and Skills
Parenting-focused individual
determinants*
Parenting knowledge
Parenting skills
Parenting behaviours
Child
Health
Parent &
Family
Health
*encompass a wide variety of knowledge, skills,
and behaviours such as those surrounding
pre/post natal care, development, nutrition, life
skills, parenting style, techniques, etc.
Not to be used without permission © CRHES 2005
Individual-Level Determinants of Child Health:
Parenting Knowledge and Skills
Public Health has developed a comprehensive system of
parenting education support that addresses many of the
social determinants of parent knowledge, skills, and
behaviour in a wide variety of ways.
Teaching activities almost always take place in the
context of a larger set of services, to enhance
seamlessness, integration, and the opportunity for referral
to Public Health and broader community services.
 Parenting knowledge and skills are imparted via:
 Education campaigns and mass media
 The Healthy Child Info Line
 Peer Education
 Family Visitor Programs
 A variety of other contacts with Public Health nurses
Practice

Individual-Level Determinants of Child Health:
Parenting Knowledge and Skills
Family visitors often find themselves attending
to the basic needs of high risk families, rather
than focusing on health teaching and parenting
support.
 Other community support systems often are
not meeting these basic needs
This is example where determinants at higher
ecological levels are compromising interventions
occuring at lower levels.
Emerging Issues

Individual-Level Determinants of Child Health:
Parenting Knowledge and Skills
Parenting-focused individual
determinants*
Parenting knowledge
Parenting skills
Parenting behaviours
Child
Health
Parent &
Family
Health
Community
Health
Community Risk
Shelter
Food Security
Not to be used without permission © CRHES 2005
Individual-Level Determinants of Child Health:
Other Individual Level Determinants
Other individual-level determinants
Decreased alcohol use
Decreased drug & tobacco use
Regular physical activity
Safe sexual activity
Child
Health
Parent &
Family
Health
Not to be used without permission © CRHES 2005
Individual-Level Determinants of Child Health:
Other Individual Level Determinants
Health determinants associated with general
knowledge areas and behaviours of citizens (e.g.,
smoking, drug and alcohol use) tend to be addressed by
interventions that are spread out across Public Health
programming.
 Some programming is delivered directly by Public Health
(e.g., teen prenatal classes in the Reproductive Health
Program), but much is delivered by other community
organizations.
 Family Health’s role is to introduce these topics and refer
clients to other program areas for more in-depth follow-up
as appropriate.
Practice

Individual-Level Determinants of Child Health:
Emerging Issues
Other Individual Level Determinants
The effectiveness of referral practices in these
health domains is not well understood.
 Given that a good portion of families served may
also engage in these risk activities, effectiveness of
relevant community interventions needs to be
examined

Determinants within Early Learning & Child Care
(ELCC) Environments
Early learning & child care
determinants
Encouragement of exploration
Mentoring in basic skills
Celebration of developmental
advances
Guided rehearsal and extension of
new skills
Child
Health
Protection from inappropriate
disapproval, teasing or punishment
A rich and responsive language
environment
Not to be used without permission © CRHES 2005
Determinants within Early Learning & Child Care
(ELCC) Environments
Public Health does not deliver early learning and care,
but coordinates with another municipal department in a
number of ways:
Practice

planning of program delivery
 provision of information and resources on child
health
 provision of ad hoc training to ELCC providers on
child health
 participation on system level planning committees,
such as Best Start

Determinants within Early Learning & Child Care
Emerging Issues
(ELCC) Environments
Holistic best practices suggest service integration,
wherein day care is integrated with other health care
and support services.
 If Family Health and other Public Health programs
and services have direct links to Best Start Early
Learning and Care hubs, many other family and child
health interventions can be integrated, such as early
screening and assessment, immunization, referrals,
parenting groups, etc.

Psychosocial Determinants of Child Health
Psychosocial determinants
Participation in civic
activities and social
engagement
Strong social networks
Feelings of trust
Feeling of power and
control over life decisions
Supportive family structure
Positive self-esteem
Child
Health
Parent &
Family
Health
Not to be used without permission © CRHES 2005
Psychosocial Determinants of Child Health
Practice:
All Family Health services are designed to be
“supportive”; however, the HBHC Family Visitor Program
and peer support function of the peer workers are
interventions which attempt to directly address the bulk of
the psychosocial factors.

Some Emerging Issues:
The Family Visitor role has supportive qualities but it is
not likely sufficient to meet the longer-term interpersonal
support needs of families. The function of linking families
to broader networks of support is likely more effective and
reasonable.

Implications and ideas for action
How can Public Health best advocate for family
and community-Level health?
“Common place” infrastructure in new neighborhoods and
opportunities for centralized services or service integration.
 Transportation infrastructure that promotes access to
common places, especially within the city, and promotes
walking, cycling, hiking, etc.
 A living wage for all Waterloo residents
 Ongoing creation of affordable and sustainable housing,
especially in urban centres
 Enhanced and affordable healthy food distribution

Implications and ideas for action
How can Public Health best advocate for family
and community-Level health?
Family Health programs should be prepared to respond to:
 a greater need for services for families in new suburban
developments.
 a need to allocate family support resources to particular
locations, and making choices between aligning with
urban renewal or with new suburban development.
 Unique health needs and accessibility of diverse
ethnocultural groups to community life and participation
Implications and ideas for action
How can Public Health best advocate for family
and community-Level health?
Family Health should pursue, support, and collaborate on
research that examines links between the built environment,
health outcomes, and access to services. Examples might
include links between living in suburban versus urban
environments and…
…physical activity, physical health and obesity
 …perceptions of social support and community connectedness
 …service access and service integration
 …healthy eating habits and food access
Closing Questions for Discussion
• In what ways can you envision using
ecological models in your own
work? What aspects of this
approach could you draw on?
Not to be used without permission © CRHES 2005
Lessons Learned: Understanding Your Sphere
of Influence
System
levels
Individual
Programs
Your
Organization
Typical
level of
Control
A lot of control
Values
and
vision
Clarity & consistency
Holistic
influence
Less influence, fewer
SDOH
Our report
recommen
-dations
Concrete
recommendations &
actions for family
health support
planning
Other
Social
(PH)
Services
Other
Human
Services
Other
municipal
infrastructures/
institutions
Broader
Influences
(private
sector,
government)
Some control
Very little control
Unknown, ambiguous,
some overlap with your
own
Inconsistent
Community Values &
Vision
Greatest influence,
most SDOH
Strategic Partnerships,
opportunities for
influence in the human
service sphere
Advocacy for Holistic
Community Health;
Positioning of Public
Health as a leader
Lessons Learned: Understanding Your Sphere
of Influence
System
levels
Integrated & Holistic Human Service System
Typical
level of
Control
Values
and
vision
More control
Shared values, consensus regarding vision
Holistic
influence
Our report
recommen
-dations
More influence, more SDOH
Concrete
recommendations &
actions for family
health support
planning
Strategic Partnerships,
opportunities for
influence in the human
service sphere
Other
municipal
infrastructures/
institutions
Broader
Influences
(private
sector,
government)
Some higher level
system control
Greater dialogue for
community vision
Greatest influence,
most SDOH
Advocacy for Holistic
Community Health;
Positioning of Public
Health as a leader
Acknowledgements
The Centre for Research and Education in Human services would like to
the thank the following committees within the Region of Waterloo Public
Health for their participation:
– Departmental Leadership Team
– Family Health Management Team
– Healthy Babies Healthy Children Advisory Committee & Early Identification
Sub--Committee
– Family Health Advisory Committee
We would also like to thank our steering committee who expertly guided
the project and continually provided support and insight to a complex
set of tasks:
–
–
–
–
–
Andrea Reest
Celina Sousa
Margaret Ann Munoz
Barbara Dyszuk
Elba Martel
The CREHS team members for this project were:
– Jason Newberry, Centre Researcher
– Andrew Taylor, Research Director
– Robert Case, Centre Researcher
Contact Information
Dr. Jason Newberry [email protected]
Dr. Andrew Taylor [email protected]
73 King St. W., Suite 300
Kitchener, Ontario, Canada
N2G 1A7
(p) 519 741 1318
(f) 519 741 8262
www.crehs.on.ca
Not to be used without permission © CRHES 2005
Social Determinants of
Health at different
ecological levels (adapted
from Labonte, 1998; previous
Family Support review, etc.)
Protective
versions
Psychosocial
Behavioural/Lifestyle
Isolation, lack of social
support
Smoking
Poor social networks
Physical inactivity
Low self-esteem/high self
blame
Substance abuse
Low perceived power
Overweight
Loss of meaning, purpose
Unsafe sexual activity
RISK
FACTORS
Poor hygiene
Abuse
Child
Health
Parent &
Family
Health
Community
Health
Service
System
Potential areas for Public Health to conduct
community consultations include:




Community consultations regarding strategies to make
parenting education more integrated across the region.
Investigating ways to expand and support “peer support
groups” in addition to groups that are education/skill
focused.
Understanding the best community education campaign
strategies for newer neighborhoods and new families (e.g.,
ethnocultural).
Examining referral practices, community service use, and
success rates of interventions that target unhealthy
behaviours (e.g., smoking, drug use). This is particularly
important in order to reduce low birth weight rates and Fetal
Alcohol Spectrum Disorder.