Community Outreach with Families of Young Children: Practices and Impacts in Quebec, Canada

Abstract

Community outreach workers support people accessing health and social services. Even though they have been working in the province of Quebec (Canada) for the past 40 years, their practice is poorly documented (especially with families having children aged 0 to 5 years). To document this practice and its impacts for children and families, a content analysis was performed on 55 scientific and gray literature documents, 24 interviews, and 3 focus groups. Three themes were highlighted (i.e. characteristics of the population served, actions performed by community outreach workers, perceived impacts on families and children). Community outreach workers were essential for reaching out families with vulnerable circumstances and children with special needs. They were reported to tailor interventions to respond in different but complementary ways to the healthcare system. Their practice increased access for children and families to services, increased parental abilities, increased social capital of families, and confidence toward the healthcare system. Community outreach workers helped to reduce health inequalities. It is crucial that community outreach proximity approaches be sustained. Future studies should establish which actions are the most efficient and how community outreach workers can connect families with the services they need at the right places in the right moment.

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Journal of Social Service Research
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Community Outreach with Families of Young
Children: Practices and Impacts in Quebec, Canada
Mathieu Roy , Étienne Lavoie-Trudeau , Marie-Andrée Roy , Irma
Clapperton , Yves Couturier , Julie Lane , Linda Bibeau , Myrthô Ouellette &
Chantal Camden
To cite this article: Mathieu Roy , Étienne Lavoie-Trudeau , Marie-Andrée Roy , Irma Clapperton ,
Yves Couturier , Julie Lane , Linda Bibeau , Myrthô Ouellette & Chantal Camden (2021):
Community Outreach with Families of Young Children: Practices and Impacts in Quebec, Canada,
Journal of Social Service Research, DOI: 10.1080/01488376.2021.1877235
To link to this article: https://doi.org/10.1080/01488376.2021.1877235
Published online: 01 Feb 2021.
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Community Outreach with Families of Young Children: Practices and Impacts
in Quebec, Canada
Mathieu Roy
a
,

Etienne Lavoie-Trudeau
b
, Marie-Andr
ee Roy
c
, Irma Clapperton
c,d
, Yves Couturier
e,f
,
Julie Lane
g,h
, Linda Bibeau
i
, Myrth^
o Ouellette
c
and Chantal Camden
b,e
a
Faculty of Medicine and Health Sciences, Department of Family Medicine and Emergency Medicine, Universit
e de Sherbrooke,
Sherbrooke, Canada;
b
Faculty of Medicine and Health Sciences, School of Rehabilitation, Universit
e de Sherbrooke, Sherbrooke,
Canada;
c
Eastern Townships Public Health Department, Eastern Townships Integrated University Health and Social Services Centre,
Sherbrooke, Canada;
d
Faculty of Medicine and Health Sciences, Department of Community Health Sciences, Universit
e de Sherbrooke,
Sherbrooke, Canada;
e
Sherbrooke University Hospital Research Centre, Eastern Townships Integrated University Health and Social
Services Centre, Sherbrooke, Canada;
f
Faculty of Letters and Human Sciences, School of Social Work, Universit
e de Sherbrooke,
Sherbrooke, Canada;
g
RBC Academic Expertise Centre in Mental Health for Children, Teenagers, and Young Adults, Sherbrooke,
Canada;
h
School of Education, Universit
e de Sherbrooke, Sherbrooke, Canada;
i
Avenirs d’enfants, Montreal, Canada
ABSTRACT
Community outreach workers support people accessing health and social services. Even
though they have been working in the province of Quebec (Canada) for the past 40 years,
their practice is poorly documented (especially with families having children aged 0 to
5 years). To document this practice and its impacts for children and families, a content ana-
lysis was performed on 55 scientific and gray literature documents, 24 interviews, and 3
focus groups. Three themes were highlighted (i.e. characteristics of the population served,
actions performed by community outreach workers, perceived impacts on families and chil-
dren). Community outreach workers were essential for reaching out families with vulnerable
circumstances and children with special needs. They were reported to tailor interventions to
respond in different but complementary ways to the healthcare system. Their practice
increased access for children and families to services, increased parental abilities, increased
social capital of families, and confidence toward the healthcare system. Community outreach
workers helped to reduce health inequalities. It is crucial that community outreach proximity
approaches be sustained. Future studies should establish which actions are the most effi-
cient and how community outreach workers can connect families with the services they
need at the right places in the right moment.
KEYWORDS
Community outreach
workers; proximity
approaches; social
intervention; health
promotion; community
Background
Although community outreach work is recog-
nized as an effective practice to provide services
to hard-to-reach individuals (Andersson, 2013),
its implementation with families of children aged
0 to 5 years old is recent . In the province of
Quebec (Canada), many local partners fostering
early childhood health and development have
implemented outreach work with families
through community outreach workers. It is the
most common form of social intervention at the
local level to reach families in vulnerable con-
texts, providing care in their living environment,
and promoting the overall development of their
children . Families considered to be in vulnerable
situations are those who have limited economic
capabilities, who are unable to change their eco-
nomic, psychosocial, and cultural conditions, and
who lack safety and power (Castel, 2000; Spiers,
2005). Families in these vulnerable circumstances
are more at risk of disengaging from existing
structures and, consequently, traditional health
care services may find it harder to reach them
(Castel, 2000). Professionals working as commu-
nity outreach workers act like a relay between the
street (i.e. the community) and the resources (e.g.
healthcare services; Andersson, 2013).
Community outreach work has been recognized
as a successful way to connect and support
CONTACT Mathieu Roy mathieu.roy7@usherbrooke.ca Faculty of Medicine & Health Sciences, Department of Family Medicine & Emergency
Medicine, Universit
e de Sherbrooke, 12e avenue Nord, Sherbrooke, Qu
ebec 3001, Canada.
ß2021 Taylor & Francis Group, LLC
JOURNAL OF SOCIAL SERVICE RESEARCH
https://doi.org/10.1080/01488376.2021.1877235

different groups of individuals in vulnerable con-
texts (Santis et al., 2013). Families supported by
community outreach workers reported higher
self-esteem and less depressive symptoms than
those without support (Navaie-Waliser
et al., 2000).
Community outreach work is complex, with a
focus on quality rather than on the quantity of
provided interventions (Cofie et al., 2014). The
role of the community outreach worker is
dependent on the professional fulfilling the role
but also on the needs and context of the individ-
uals they serve (Cofie et al., 2014; Gunter &
Maccorquodale, 1974). For children and families,
community outreach workers aim to create a
space of trust, and a close relationship with the
individuals they work with. They share informa-
tion according to needs, and often accompany
families to appropriate services to prevent
unwanted situations, and to promote health and
well-being (Kimbrough-Melton & Campbell,
2008). Their role is often all-encompassing and
can include everything from helping to integrate
immigrant families to prevent maltreatment of
children (McLeigh et al., 2017; Vostanis, 2016).
Community outreach workers link with families,
propose activities to foster social support net-
works, and provide direct support or services.
The outreach worker also plays an important role
in supporting collaboration between organiza-
tions and families. The need for collaboration is
crucial and the use of outreach workers as a way
to foster collaboration has been identified
(Primomo et al., 2006). This collaborative work
requires constant adjustments by the community
outreach worker, a good knowledge of the reality
of the families (or individuals served), a flexibility
in their outreach practices and flexibility of the
inter-sectoral partners (Cortis et al., 2009;
Kimbrough-Melton & Campbell, 2008). Although
community outreach work can be offered to
everyone, children of families in vulnerable situa-
tions are overrepresented in their caseload
(Frieden, 2010; Pinto et al., 2012; Walker et al.,
2011; Yoshikawa et al., 2012).
While the core principles of community outreach
work are known, there is much less information on
the actual practices of such professionals, and on
the conditions needed for their interventions to be
successful. To better understand how community
outreach work is operationalized in daily life,
researches must identify concrete actions taken of
such workers, be able to replicate these practices
and linked these practices to expected (or per-
ceived) outcomes by service users. Thus, more
research is needed in a real-world context, in a
collaborative manner to access the right environ-
ment. We were part of a unique local initiative in
the Eastern Townships of Quebec (Canada), where
community outreach work had been implemented
specifically with families in vulnerable situations
for many years. Regional decision-makers were
seeking evidence-based data about perceived prac-
tices and impacts to help inform decisions about
the future of this community approach, particu-
larly in connection with the larger health-
care system.
The aim of this research was to document the
impacts of community outreach work for chil-
dren and families in vulnerable circumstances in
the Eastern Townships, Quebec (Canada). Co-
developed with an advisory committee, specific
aims were to:
1. describe community outreach workers’practices
2. document the perceived impacts of such practice
on the overall development of children aged 0 to 5
years and families from vulnerable circumstances.
Methods
Setting
The Eastern Townships area are located in the
southeastern part of the province of Quebec
(Canada), just beside the New England States in
the US. This administrative region is one out of
18 health areas in Quebec and includes a mix of
urban, semi-urban, and rural areas. The popula-
tion of this region is around 500,000 people
(Statistics Canada, 2016). The city of Sherbrooke
(Quebec’s6
th
largest city) is the central city of this
area with 170,000 people and is predominantly
French-speaking (93.4%; Statistics Canada, 2016).
Study Design
We used an exploratory, multisource, qualitative
design (Trudel et al., 2006), gathering and
2 M. ROY ET AL.

analyzing three sources of qualitative data: 1) sci-
entific articles and gray literature (n¼55 docu-
ments; e.g. community journals, activity reports,
reference frameworks), 2) individual interviews
(n¼24), and 3) focus groups (n¼3). Ethics
approval was received from the Ethics Committee
of the CIUSSS de l’Estrie –CHUS (#2019-3063)
and support by an advisory committee was used
to co-developed the aims, questionnaires, and the
methods for the research. This advisory committee
also provided guidance during the study, and
helped to interpret the results. Committee mem-
bers (n¼8) included three researchers, two public
health representatives, one community outreach
workers, and two parents who already received
services from community outreach workers.
Participant Recruitment Process
Four groups of participants were recruited: a) com-
munity outreach workers, b) parents receiving out-
reach support, c) healthcare employees, and d)
inter-sectoral partners (e.g. community organiza-
tions, early childhood centers, and municipal serv-
ices collaborating with outreach workers; Table 1).
Recruitment was opportunistic and based on a
snowball sampling method. Recruitment efforts
were made to ensure the greatest variability of par-
ticipants, especially families (i.e. family composition,
single parents, parents from immigrant families as
well as English speakers, and families from rural,
semi-rural and urban areas). The advisory commit-
teealsohelpedtorecruitkeystakeholderssuch
experienced community outreach workers, intersec-
toral partners aware of their work, and parents.
Data Collection Process
Documents were collected from December 2018
to April 2019 from partners, and through emails
to community outreach workers. Interviews were
conducted from April to June 2019, with focus
groups occurring in June 2019. Individual inter-
views lasted up to 1.25 hours and focus group
lasted approximately 1.5 hours. The semi-struc-
tured interview covered: a) description of practi-
ces and specificities related to community
outreach workers, b) perceived impacts of the
community outreach work for families and chil-
dren (with a focus on the overall development of
children aged 0 to 5 years old, observable changes
for the kids and the families, empowerment,
social participation, services where families were
referred to answer their needs), and c) any out-
reach work barriers and/or facilitators (any fac-
tors linked to consultation, engagement, context,
resources, stakeholders or the dynamics of inter-
actions between these factors). Questions were
based on available gray literature and experiential
knowledge of the advisory committee.
Data Analysis
A four-step content analysis (Figure 1) was per-
formed on the retained documents, and on the
transcripts of the individual interviews (n ¼24)
and focus groups (n ¼3; Krippendorff, 2003). A
two-step open coding procedure (i.e. axial and
selective coding) was used. In axial coding, raw
qualitative data which were conceptually linked
to other became subcategories of analyzes corre-
sponding to ideas, themes or concepts with
respect to the aims studied (Strauss & Corbin,
1998). These subcategories were then regrouped
into more global dimensions. Selective coding
was then used to order by importance these glo-
bal dimensions for data processing (Strauss &
Corbin, 1998). The next step was about process-
ing the coded qualitative data. During this step,
the qualitative analysis grid was used to re-
analyze the data (Andreani & Conchon, 2005). A
semantic treatment was practiced to bring out a
coherent discourse. Finally, the last step of the
content analysis procedure was to interpret the
Table 1. Number of stakeholders participating in interviews and focus groups.
Data source
Stakeholder participants
Total NumberCommunity outreach workers Parents Healthcare employees
Intersectoral partners
Community Organizations School Municipal
Individual interviews 5 9 5 3 2 –24
Focus groups 3 7 3 4 1 2 20
JOURNAL OF SOCIAL SERVICE RESEARCH 3

coded and processed qualitative data. This step
was carried out in two phases: deconstruction and
reconstruction. The deconstruction phase consisted
of leaving the data to put them back in relation
with the aims under studied (Feldman, 1994). In
the reconstruction phase, the qualitative discourse
was developed with respect to these aims.
Results
Participant Characteristics
Table 1 describes how participants (i.e. commu-
nity outreach workers, parents, healthcare
employees, and inter-sectoral partners) were
involved in the different data collection strategies.
Themes and Subthemes
Three main themes were identified from the con-
tent analysis. These themes were about the: a)
characteristics of the population served, b) actions
of the community outreach workers, and c) per-
ceived impacts of the community outreach work
on families and children. All these main themes
were discussed in the three data sources (Table 2).
Theme #1) Characteristics of the
Population Served
Regarding the characteristics of the individuals
served, three sub-themes were described: a)
family characteristics, needs and dynamics, b)
children’s characteristics and needs, and c) rela-
tionships with services.
Family Characteristics, Needs and Dynamics
Families served by community outreach workers
were described as those living in vulnerable con-
texts with many socio-economic needs. Families
who spoke English at home, who were from
multi-ethnic backgrounds, single parent homes,
families living in rural areas, and those with low
incomes were perceived to live in vulnerable con-
texts and those community outreach workers
hoped to reach. Low family incomes were per-
ceived to be associated with families living with
generational poverty, parents who were students
themselves and/or who received low salaries, or
those living with situational poverty caused by a
trigger (e.g. accident, lost employment). Family
dynamics were reported to be complex, with
parents perceived to be physically present but
sometimes struggling to be emotionally present,
meaning they might not be aware or overlook
their child/children’s needs. Parents felt that com-
munity outreach worker help was important for
getting organized to attend multiple appoint-
ments. Parents reported needing help to under-
stand their kids, and to feel reassured and
protected. Examples of needs discussed by
Figure 1. The steps (and sub-steps) of the four-step content analysis procedure for the qualitative data collected.
4 M. ROY ET AL.

parents included planning school entry or access-
ing kindergarten, being more organized on a day-
to-day basis understanding their child’s physical
and/or psychological diagnosis(es) and respond-
ing properly to their needs. Beyond concrete
help, families reported that having the involve-
ment of outreach workers helped to reduce their
isolation, improve relationships, give them time
to breathe and release emotional stress. Families
described themselves as being resilient in the face
of adversity, being resourceful and creative,
proud of their families, and down to earth.
Another key characteristic of the families was
that they faced persistent, interrelated challenges
at different levels. Many parents faced physical
and psychological health problems, lack of social
and parental abilities, difficulties reading, writing
and communicating. Some families had violent
couple relationships and experienced conflict in
relationships with others in their neighborhood.
Many also suffered from social isolation.
Regarding occupation, some parents worked,
while others didn’t, but most had limited employ-
ment opportunities. Some were reported to be
involved in criminal activities and prostitution.
At the financial and material levels, some of
them were on the welfare program. Issues with
managing money and setting priorities were dis-
cussed, and families were reported to frequently
search for an apartment or furniture, but often
have their electricity services stopped due to lim-
ited resources. These families often did not have
enough resources to cope with stressors, includ-
ing poor family member support, living at long
distances from organizations making it difficult
to reach them. Also, they were not aware of the
resources around them and/or mistrusted
those resources.
There’s a lot of isolation, that is voluntary or not, but
it’s very present. [ …] There’s not a lot of resources
you know, so we stay isolated, in the known. In this
way, nobody [community partners] will come to say
that we do our parental job wrongly. (Parent)
Children’s Characteristics and Needs
Many children were reported to have physical
and psychological health problems (e.g. autism,
attention difficulties, anxiety, language problems).
Community outreach workers and inter-sectoral
partners perceived that their basic needs were
neglected with children lacking food, clothing or
proper hygiene. They also perceived that these
needs could bring more sickness, with the need
for more medication. Many children were iso-
lated, and were reported to have poor interac-
tions with their parents. Frequently, the home
environment lacked rules and structure, which
created challenges when entering preschool/
school. Children often had to assume adult roles,
such as taking care of their parents or supporting
them. Children spent more time playing free
games than organized games, with poor sleep
habits, and some falling asleep in front of the
television late at night. There were additional
developmental challenges such as lack of emo-
tional care and stimulation, the presence of aca-
demic difficulties and challenges at preschool.
Taken together, these difficulties appeared to sug-
gest that children from these families would
Table 2. Themes and subthemes.
Themes Sub-themes Document analysis Interviews Focus groups
1) Characteristics of the
population served
1.1) Family characteristics,
needs and dynamics
XXX
1.2) Children’s
characteristics and needs
XXX
1.3) Relationships
with services
–XX
2) Actions of the
community outreach worker
2.1) Overall approach X X X
2.2) Tasks and strategies to
reach families
XXX
2.3) Specificities of
the practice
–XX
3) Perceived impacts of
community outreach on
parents and children
3.1) Increasing social capital X X –
3.2) Increasing family
empowerment
XX–
3.3) Increasing access
to services
XX–
JOURNAL OF SOCIAL SERVICE RESEARCH 5

begin life with more disadvantages than other
children. Despite these, children had many
strengths and were described as being autono-
mous, and having good motor skill development,
perhaps related to the fact that they often play
outside and protect their siblings.
We [the health care partner and the community
outreach worker] work with children with a lot of
developmental problems, it’s constantly seen. It’s
children that are under stimulated, with a gap. Often,
they have language problems. (Healthcare worker)
Relationships with Services
A lack of awareness about resources and services
was reported among families. Even when families
knew about these resources or lived with close
access to healthcare settings, they might not seek
assistance because of a fear of losing their chil-
dren to the youth protection authorities.
The community outreach worker is less menacing
than us [healthcare workers], because she doesn’t
have the youth protection role as we do. For her,
people see that she works in a ________ [basic office
right in the community], and don’t know how much
she is paid for this job. For us, we are menacing,
because we don’t have choice to report families to
youth protection in certain cases. When there are
more reports to youth protection, less families come
to our services, because it’s a little world, everybody
knows each other. Sometimes, it’s not even us who
reported, but some stay mistrustful after that. In this
context, it’s very less menacing when the community
outreach worker does the approaches with them.
(Healthcare worker)
As a result of this fear, parents may not enroll
children in kindergarten, thereby increasing fur-
ther their family and child’s isolation. Some fami-
lies struggle with rigid processes to access
resources or services, may not understand those
processes, and may have difficulties completing
paperwork due to poor reading and writing abil-
ities and the French language, all of which can
provoke misunderstanding. Families are aware of
long wait lists to access services. When their chil-
dren live with difficulties without knowing the
diagnosis, they report losing faith in the health-
care system knowing that they may wait months
or years to see a specialist. The rigidity of the
healthcare system can be a challenge for them.
When they miss appointments, they may be dis-
charged. They are required to set needs and goals
but may not be able to identify them, often after
a limited number of appointments, provoking
frustration and a feeling of wasted time for both
families and professionals.
Theme #2) Actions of the Community
Outreach Workers
Three subthemes were described for the actions
of the community outreach workers including: a)
overall approach, b) tasks and strategies to reach
families, and c) specificities of practice.
Overall Approach
The overall approach to community outreach fol-
lowed the philosophy underpinning the proximity
approach. This included principles such as being
grounded in families’reality and context, being
flexible, strengths-based, and informal, creating a
strong trust relationship, and fostering engagement
and participation of families. Compared with other
approaches, providing education or information to
a family was perceived to be secondary to being
present in the moment and respecting the rhythm
of the family and their capabilities. This approach
was reported to allow children and parents to cele-
brate successes, experience pleasure and emotion,
and is designed to reduce family fragility. This
approach is designed to help families to identify
their own needs and then to support them and
even accompany them as they access needed serv-
ices. Other characteristics of the proximity
approach reported include helping families to have
a better understanding of their situation, helping
them to trust healthcare and other services and to
stay involved and engaged when they are waiting
for healthcare services.
By using the proximity approach, we try by every
manner to be available and have a familiar presence.
It’s not only about giving information. People don’t
care about information. They want to have a familiar
presence, a welcoming face. They don’t know about
our functions, they don’t care. By deploying
community outreach workers and using the proximity
approach in the community, we create trust links,
and we are anchored in the community. (Community
Organization Partner)
6 M. ROY ET AL.

Community outreach workers’tasks were per-
ceived to address several important aspects. They
were reported to provide direct support to fami-
lies, by accompanying families to the organiza-
tions and helping translate professional language
into lay language, being presence in difficult
moments, and advocating for parents.
They need to be accompanied because they are in a
disorganisation period. They can’t do it alone and it
is complex to analyse the situation. In vulnerable
environment, people don’t have a lot of education.
Also, the system, like welfare, hospital, etc., works
with forms. It’s a barrier that contribute to reduce
their understanding of the situation. Sometimes, they
go to an appointment alone, and they say that it went
well, but they don’t even know why. (Community
outreach worker)
They also helped to reduce barriers, link fami-
lies with other parents and the community and
introduce new families, and provide knowledge
and practice information about fostering child
development. Community outreach workers con-
nect with other partners, work collaboratively,
create confidence in, and promote their role with
other organizations. Also, outreach workers
improve their own practice and their profession
by finding new strategies to connect families, and
by documenting and developing a culture of
regular evaluation, sharing their knowledge of
barriers to access services, and the lack of services
with all partner organizations to help them
adapting the services they offer.
Tasks and Strategies to Reach Families
Different strategies were used by the community
outreach workers to connect with families. Those
strategies could be: a) active or passive (going to
the street to meet people or letting people come to
them), b) traditional or imaginative/roundabout
(introduce themselves directly to offer a ride and
talk during this time), and could c) involve the
outreach worker only, or other people (pivotal
person, other families). Primary strategies included
public strategies, such as appearing on community
television or placing posters in targeted areas
where families typically frequent, including grocery
stores and health partners’offices. Workers pro-
vided families with transportation, as a pretext to
talk with them and create a relationship. They
were active on social networks, including those of
their own profession, those of other partners, local
Facebook pages and Facebook Messenger applica-
tion. The most used and recognized strategy was
visiting places where families were. Community
outreach workers try to connect with families
in this way to show that they are an integral part
of the settings where families gather, and to
increase confidence in their work and reduce fear
toward them.
All the pretexts are good. The idea is to create a first
contact. [ …] The more you are seen, the more you
are part of the picture. The person will come talk to
you like you know each other, even if you don’t
really. (Community outreach worker)
Specificities of Practice
Specificity in community outreach work was
related to the posture, or stance, taken by the
outreach worker. They are closer to families than
conventional workers, providing opportunities to
intervene or discuss with family issues that might
be sensitive or difficult for them. Also, they act
as mediators between families and the healthcare
system or other services, filling in the gap left by
differences in language and/or culture. They can
act as a guide to help service partners recognize
the barriers related to service access, the lack of
services, and how those partners might improve
their services. Outreach workers can be available
to a family almost instantly, and are able to build
relationships slowly with families over months
and years. They are also able to help to obtain
services for a family, and be with the family while
they are waiting to keep them involved and
engaged. They contact families in a number of
ways, including use of texts and social networks,
which is not possible for some organizations.
Also, it was noted that perceived areas of weak-
ness of the healthcare structure for these families
were actually the strengths of outreach practice,
including humanity and availability, and that
families didn’t need to have a specific issue to
consult workers.
I see her like a help, a support, somebody who listen
to me. It’s all that a friend could do, but with more
resources, more directions to give. (Parent)
JOURNAL OF SOCIAL SERVICE RESEARCH 7

Theme #3) Perceived Impacts of Community
Outreach Work on Families and Children
Perceived impacts of the community outreach work
on families and children included: a) increasing
social capital, b) increasing family empowerment,
and c) increasing access to services.
Increasing Social Capital
With the help of the community outreach worker,
parents reported being less isolated and socialized
more with their children and community. The
same observation was made for the children, who
tended to socialize more. Community outreach
workers proposed different types of social activities
to families and were present with parents during
difficult times. Outreach workers helped parents to
help their children, and developed stable, signifi-
cant relationships with them.
It goes a lot with activities. [ …] In every activity, like
collective cooking, coffee meeting, it’s really
interesting to go search the families, to get people to
know you. For example, for moms who stay at home
with their kids, and being anti-kindergarten, if they
are going in collective cooking, and that children play
together, it’s a good debut. It can work the child
socialization, decrease the isolation and see other way
to do things It’s a bit the same for the parents.
(Healthcare worker)
Increasing Family Empowerment
Increasing families’empowerment was related to
increasing parents’feelings of self-efficiency, over-
all self-esteem, and their parenting abilities, but
specifically to helping parents develop positive
parenting practices. Parents became more respon-
sible about their children’s needs, skills, and devel-
opment. They adopted more healthy behaviors,
were more available for their children, and tend to
be more socially active. All of the above contrib-
uted to fostering child development and well-
being, by increasing their autonomy, ability to
express emotions, and communication skills.
There is a big change. She is saying that I learned to
her how to clean her house to protect her kids. How
she is now capable to organize her time. It responds
at her kids needs by her actions. (Parent, with the
help of translator)
Increasing Access to Services
Community outreach workers helped to increase
families’confidence toward accessing community
social and healthcare services which encouraged
them to seek support services. They were able to
create trust between themselves and the families,
something that can be more difficult to establish
with the traditional healthcare system and the
school system. Many participants mentioned how
important it was to put names to faces, to
humanize services, and to understand the func-
tion and the pathways of the health care services.
These actions helped prepare families to access
community health and social services. Many par-
ticipants believed that this helped to improve the
continuum of care and ensure children received
the services they needed.
I want to go, but I don’t know how. I don’t want to
go alone. There’s mistrust. The health care system is
frightful. It’s hospital, not home. The health care
system doesn’t make any sense for them, it’s too big.
But, if I present you [name of a psychosocial
counsellor], if he goes with you, it might make sense
to go there. (Community outreach worker).
Discussion
This study aimed to describe: a) community out-
reach workers’practices, and b) document the
impacts of such practice on the overall develop-
ment of children and needs of families living in
vulnerable contexts. Results were consistent
between all data sources. Our results show that
community outreach workers can effectively
reach families and children with social challenges
and needs, as previously reported in the literature
(Navaie-Waliser et al., 2000; Santis et al., 2013).
Outreach workers establish trusting relationships
with parents, helping families to identify their
needs and providing them with a social safety
net. Their interventions have indirect impacts on
the children, through worker support of the
parents. Results showed that through parental
empowerment, and increased social capital and
access to services, parents become better able to
take care of their children and more confident to
do so. Community outreach workers actions also
have a direct impact on families, by reducing iso-
lation between their children and the community.
8 M. ROY ET AL.

Through these direct and indirect activities
parents are able to enhance their supportive
social circle. By virtue of their role in the com-
munity, outreach workers work in an environ-
ment that has several advantages over the
traditional healthcare system. They are able to
establish a relationship between individuals and
the different organizations providing services in
the community because they work within a con-
text with flexibility, flexibility that is not always
present for workers in healthcare organizations.
Flexibility seems to be a key factor in developing
relationships with families in vulnerable contexts
(Kimbrough-Melton & Campbell, 2008). Where
environments are not as flexible, it can be more
difficult to emphasize trust and relationship-
building. A community outreach worker has the
flexibility and time to work on a relationship for
months even when families have not identified
their own needs, because their primary goal at
the outset is to build trust. This trust and rela-
tionship-building are examples of the community
outreach worker’s role to focus on quality over
quantity (Cofie et al., 2014). Outreach work
allows families to have a close and personalized
access to healthcare services, with a rapid
response, more flexible rules of intervention, as
well as roles and ways to communicate with
parents. Community workers take into account
language, culture, values, habits, rhythm, and
capabilities of families with regard to accessing
services. These aspects of the outreach role
appear to make a difference between acceptance
or rejection of services. In situations where the
healthcare system is not able to adapt enough to
allow individuals who do not meet admission cri-
teria to get access to services, the role of the com-
munity outreach worker is even more important.
By creating a trusting relationship and being
flexible with families, children and their parents
are better supported which in turn supports
healthy child development. This is crucial for
children prior to school age and may make the
transition to preschool/school an easier one.
With a proximity approach guiding the interven-
tions, this may allow workers to more effectively
connect with families in vulnerable contexts. It
may also help to involve and empower families
to work to improve their own quality of life to a
greater extent than through the use of healthcare
services. In addition, their collaborative work
with partners may make it easier to refer families
between organizations and outreach workers in
both directions. In this way, partners can be
informed of families’challenges and needs and
work to find solutions because community out-
reach workers function to increase service access
for families with needs. In the end, community
outreach workers support the healthcare system
in fulfilling its responsibilities of accessibility,
continuity and quality of services for their
respective populations and territories. Outreach
work may have the potential to reduce healthcare
costs when families who are vulnerable and have
serious needs are identified early.
Strengths and Limitations
The fact this study was initiative by organizations
involved in community outreach, and partners
were involved through the research process, is a
clear strength of the study. Moreoever, a multi-
source data collection has been used, allowing for
triangulation of the data. The diversity of meth-
ods and participant groups also allowed for the
exploration of the different perspectives needed
to have a comprehensive portray of the commu-
nity outreach practices. The research design also
allowed to explore simultaneously the practices
and the perceived impact of community outreach
work, which provided some understanding of
how the practices contributed to the perceived
impact. It may however be difficult to generalize
our results to other populations or environments,
given the local context in which our study was
conducted. However, the characteristics of the
population and actions of community outreach
workers were described so other researchers can
assess the applicability of the results to other set-
tings. Social desirability bias might also have
influenced our results, especially for families. In
addition, the community outreach worked needed
to be present for some interviews due to language
barrier and/or mistrust of the interviewer, who
was representing a healthcare organization. It
may have been difficult for parents to be candid,
especially when asked about the community out-
reach worker. During the interviews (not the
JOURNAL OF SOCIAL SERVICE RESEARCH 9

focus groups), half of the parents spoke only a
little and for a shorter period than expected. In
this way, their voices might be underrepresented
compared to other stakeholders. Finally, it was a
challenge at times to determine specific impacts of
the outreach work, given the multi-dimensional
interventions of community outreach workers.
Conclusions
Community outreach workers help to reduce
social inequalities in health for families in vulner-
able situations. Outreach workers can approach
families with challenges, build trust with them,
identify their needs, and strengthen the trad-
itional healthcare system which is often unable to
reach them. Workers do so by using a proximity
approach. Community outreach workers can have
both direct and indirect impacts on families and
children by increasing social capital, family
empowerment and access to services. In collabor-
ation with other health and social service part-
ners, they increase families’access to services, To
meet the needs of vulnerable families, community
outreach practices should be both encouraged
and sustained. Future studies should try establish
which actions of community outreach workers
are the most efficient and such type of social
practice can connect families and children with
the services they need at the right moment in the
good places.
Ethics Approval and Consent to Participate
This study was approved by the Ethics
Committee of the CIUSSS de l’Estrie - CHUS
(#2019-3063). All participants provided a written
informed consent form.
Authors’Contributions
MR and CD conceived the study with the help of
all authors. ELT was responsible for data collec-
tion and analysis under the supervision of MR
and CD. ELT wrote the first draft of this manu-
script. MR and CD correct this draft and share
with all coauthors who read and approved the
article. All authors have read and approved
the manuscript.
Acknowledgements
We are indebted to all community outreach workers,
parents and partners who participated in this study.
Funding
This work was co-funded the CIUSSS de l’Estrie - CHUS
University Institute of Health and Social Services, by local
associations of inter-sectoral partners, by the Collectif
estrien 0-5 years and by Avenir d’enfants. All body funders
have had no role in the design of the study, data collection,
analysis, interpretation and in writing the manuscript.
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