Evaluation of a Novel Clinical Prototype for Newcomer Children with Special Health Care Needs

Background: With unprecedented global displacement, Canada has seen more refugees, asylum seekers and immigrants. Children new to Canada are at an increased risk of poor health outcomes, infectious diseases, poor nutrition, and developmental and mental health challenges. We previously conducted an environmental scan and needs assessment that identified six key components of a model of high-quality care for newcomer children and youth with special healthcare needs (NCYSHN), of which none existed in Toronto. To that end, a novel, multidisciplinary clinic for NCYSHN was created in 2019 based on this model. This study explored the experiences of caregivers of patients and healthcare providers (HCPs) with this new clinic.

Methods: In-depth interviews (IDIs) were conducted with caregivers (ie. parents/guardians) of children new to Canada, and HCPs who cared for NCYSHN. NCYSHN were defined as children or youth with chronic medical conditions, physical, developmental or mental health conditions and they or their parents had arrived in Canada < 5 years previously. Prior to data collection, research ethics approval was obtained. Interviews were recorded, transcribed and coded using deductive and inductive coding by two independent coders, with inter-rater reliability confirmed by pooled Cohen’s kappa coefficient. Codes were analyzed within and across stakeholder groups for themes, supported by group discussion, analytic memos and member validation.

Results: 15 IDIs were conducted across both caregivers and HCPs. Both stakeholder groups valued the clinic’s model of a trauma-informed and culturally-safe approach to care, with an emphasis on advocacy. HCPs and caregivers appreciated the clinic’s use of interpreters, longer appointment times, and clinic providers’ knowledge of services specific for newcomers, including health insurance and social services. Caregivers and HCPs reported that they felt the providers were warm, whom they felt safe with and could be trusted. Caregivers stated that this trust helped them feel more comfortable opening up about their needs and challenges caring for their child. Caregivers deeply appreciated the clinic’s help with service navigation beyond the child’s immediate diagnosis, such as supporting immigration and housing applications. Caregivers and HCPs recommended increasing awareness about the clinic to existing community partners to better serve more patients who may benefit.

Conclusion: Our data suggests that this novel clinic has been well-received by patients’ families and HCPs who work with NCYSHN, underscoring the value of the six key components for high quality care for NCYSHN identified in our previous work. Clinical care that is culturally-safe and low-barrier, including access to interpretation, time, and service navigation with knowledge of services related to newcomer families was highly appreciated and facilitated feelings of trust between clinic staff, patients and families. The data suggests that this model of care may be useful when caring for NCYSHN.