Isabelle Laurin

Translating knowledge on poverty to humanize care: benefits and synergies of community engagement with the arts

The knowledge translation movement in health has led to the production of vast amounts of knowledge tools aimed at broadening clinicians’ evidence base and improving the quality and efficacy of their practices. However important, these tools, largely oriented towards biomedical and technological aspects of care, are of limited potential for addressing the complex interactions between patients’ socio-economic contexts and their health. Yet health professionals frequently lack the sensitivity, knowledge and ability to incorporate approaches to poverty within their practices; this is partly due to their limited understanding of the lived experience of poverty and of the complexity of barriers underprivileged people face to achieve and maintain health. In a context of persisting social inequalities in oral health, the Montreal-based Listening to Others multi-stakeholder partnership has been engaged in developing health professional education on poverty since 2006. In this article, we describe and reflect on how service users representing the Québec antipoverty coalition, academics from University of Montreal and McGill University, representatives of Québec dental regulatory bodies and artists collaborated to produce an educational film on poverty. Project partners’ specific contributions to the film script are highlighted, emphasizing their potential to enrich the health professional educator’s practice knowledge base. In doing so, this article provides an explicit and concrete example of how participatory processes can support co-learning and knowledge co-production through engagement with the arts. The overall aim is to demonstrate how participatory research can enhance knowledge translation by producing educational tools that promote critical reflection and address complexity.

Preparing to Start School: Parent and Early Childhood Educator Narratives

This chapter presents a narrative multi-case study that draws on a postocolonial and postmodern narrative theoretical framework and methodology. The narratives recounted by three mothers, four educators, and home-childcare communication documents concerning the childrens upcoming transition to school and educator-parent relationships are presented. For example, Marie-Eve’s narrative is centred around her own sense of comfort at the childcare centre; focuses on the difficulties of transitioning between educators for her son, Mateo; and explains why she believes that he will do well in school. She also identifies home routines to modify once her son starts school. Anne, Mateo’s educator, describes Marie-Eve’s involvement in centre activities, and blames Marie-Eve’s difficulty with Mateo’s transition from group to group on the fact that she is a single mother of an only child. Nicholas has two different educators, Suzanne and Nadia. His mother Audrey is thrilled with her experience at the childcare centre, and relies on additional personnel at the centre, such as the pedagogical advisor, for support and assistance. She claims to not be ready for her son to start school. His two educators have very different understandings of the family, and very different concerns about the child starting school. Finally, Emma’s mom Christine was shocked to find out that her daughter had a language delay when she began childcare at age four, and recounts the routines she instituted at home in order to prepare her two daughters for childcare. Hannah, Emma’s educator, describes the process of building a trusting relationship with Christine. She is worried about Emma starting school, but hopes that she will be fine, because of Christine’s active involvement in the childcare centre. The analysis/interpretation of the narratives focuses on the ways in which mothers and educators draw on and resist metanarratives of deficiency, school readiness, and pedagogicalization of parents when they narrate their transition experiences. For example, three of the educators’ narratives draw on a metanarrative of deficiency to judge divorced or single parent families, implying that these families can be detrimental to children’s well-being, while the other educator was able to craft a counternarrative by focusing on the father’s well-being as a member of the childcare centre community.

Understanding the challenges of intersectoral action in public health through a case study of early childhood programmes and services

Abstract After two decades of intersectoral public health action, the literature reports considerable ongoing difficulty in achieving this aim. This article analyses two of the challenges of intersectoral action: (1) ensuring convergence among the interests and resources of sectoral actors, and (2) coordinating the multiplicity of sectoral programmes. A case study employing Actor–Network Theory is used to provide an in-depth understanding of the persistence of these problems. In 2008, the Montreal Directorate of Public Health in the province of Quebec, Canada, implemented a vast consultation and mobilization process to address problems highlighted by the Survey of the School Readiness of Montreal Children. The process mobilized regional and local multi-sectoral actors in order to propose solutions. At the local community level, the process resulted in increased coordination leading to intersectoral innovation, while at the regional level it brought about the deployment of additional resources, albeit in sectoral programmes. This study analyses how intersectoral issues raised by the survey have been addressed so as to produce these results. It discusses how the balance between sectoral interests and the common good, as well as between sector autonomy and interdependence, is central to dealing with these two critical challenges.

Quelle est l’association entre les caractéristiques résidentielles et du quartier et le développement de l’enfant à la maternelle?

RésuméObjectifsÉvaluer l’association entre les caractéristiques résidentielles et du quartier de la famille de l’enfant et son développement à partir des données de l’Enquête montréalaise sur l’expérience préscolaire des enfants de maternelle (EMEP).MéthodeUn échantillon de 1101 enfants a été extrait de la base de sondage comprenant les enfants montréalais évalués dans le cadre de l’Enquête québécoise sur le développement des enfants de maternelle (EQDEM 2012). Une collecte de données auprès des parents de ces enfants a permis de documenter certaines caractéristiques résidentielles et du voisinage (variables indépendantes) : la défavorisation matérielle du quartier, la salubrité du logement, le surpeuplement du logement, l’instabilité résidentielle, la sécurité du quartier et l’accessibilité des ressources. Un couplage aux données de l’EQDEM donnait accès à la mesure du développement de l’enfant à la maternelle (variable dépendante). La régression logistique a été utilisée afin de prédire la probabilité d’un enfant de maternelle d’être vulnérable dans au moins un domaine de son développement ou dans deux domaines ou plus.RésultatsLes enfants résidant dans un quartier perçu dangereux sont 1,5 fois plus susceptibles d’être vulnérables dans au moins un domaine de leur développement comparativement à leurs pairs résidant dans un quartier perçu sécuritaire (IC à 95% : 1,02–2,14). Un résultat similaire est observé pour la vulnérabilité dans deux domaines de développement ou plus (RC 1,67, IC95% : 1,07–2,61). Les enfants vivant dans une famille ayant un manque d’accès aux ressources sont également plus susceptibles d’être vulnérables dans deux domaines ou plus de leur développement que leurs pairs dont la famille a facilement accès aux ressources (RC 1,56, IC95% : 1,003–2,44).ConclusionLe sentiment d’insécurité des parents et le manque d’accès aux ressources du quartier peuvent restreindre les occasions de socialisation des enfants et leur exposition à des expériences enrichissantes.AbstractObjectivesEvaluate the association between residential and neighbourhood characteristics of families and children and the latter’s development, using data from the Montréal Survey on the Preschool Experiences of Children in Kindergarten (MSPECK).MethodA sample of 1101 children was extracted from a survey frame that included Montréal children assessed in the 2012 Québec Survey of Child Development in Kindergarten (2012 QSCDK). Data collected from the children’s parents were used to document the following residential and neighbourhood characteristics (independent variables): material deprivation in the neighbourhood, housing health, residential crowding, housing instability, neighbourhood safety, and access to resources. Linking QSCDK data provided a measure of development for children in kindergarten (dependent variable). Logistic regression was used to predict the probability of kindergarten children being vulnerable in at least one domain of development, or in two or more domains.ResultsChildren living in neighbourhoods perceived to be dangerous are 1.5 times more likely to be vulnerable in at least one domain of development, compared with their peers living in neighbourhoods perceived to be safe (95% CI: 1.02–2.14). A similar result is observed for vulnerability in two or more domains of development (OR 1.67; 95% CI: 1.07–2.61). Children living in families who lack access to resources are also more likely to be vulnerable in two or more domains of development than their peers in families who have easy access to resources (OR 1.56; 95% CI: 1.003–2.44).ConclusionParents’ feelings of insecurity and lack of access to local resources can limit children’s opportunities for socialization and their exposure to enriching experiences.