Pediatric Environmental Health Network

The existence of a unit of expertise in pediatric environmental health (PEH) in Catalonia such as the PEHSU located in La Garrotxa should serve not only as a point of reference for professionals and users, but also to deploy PEH throughout the territory. The creation of the figure of the PEH referent at the territorial level, both at the level of hospital centers and especially integrated into the Territorial Pediatric Care Teams (ETAPs), can help weave a network throughout the country (PEHSU.CAT Network) that contributes to implementing PEH programs throughout the territory. This would guarantee basic care in matters of PEH throughout the territory, direct contact of families with a local agent with training in PEH, who can count on direct advice from the reference center and contemplate telematic or in-person referral of the most highly complex cases.

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These territorial PEH referents, previously trained, will be able to develop care, community, or research activities in this field, and will ideally be made up of a pediatrics professional and a pediatric nursing professional, although other maternal and child health professionals (midwives, family physicians, obstetricians, community nursing, etc.) or more pediatric professionals may be integrated if they are available.

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In Primary Care, integrated into the ETAPs, they will focus on prevention and health promotion actions, and emphasize community activity. As preventive health actions during the prenatal stage have the greatest impact and cost-effectiveness, priority will be given to implementing programs such as environmental screening in pregnancy ("Green Page"). It will be necessary to guarantee partial dedication to these tasks within their ETAPs that is integrated into their schedules.

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With the launch of the new Protocol for Preventive Activities and Health Promotion in Pediatric Age ("Growing Up Healthy"), new care and community needs emerge with the incorporation of a specific chapter on PEH. Although it is expected that most activities can be carried out directly by Primary Care professionals, the figure of PEH referents in the ETAPs will be able to channel:

• Community activities: nature prescription, school environmental health, physical activity, prevention of smoking, alcohol, and other drugs, etc.

• Specific schedules: environmental screening or the "Green Page," which is expected to be integrated postnatally with the Childhood with Health program, may be assumed prenatally when possible by the referents; follow-up of infants at high environmental risk (e.g., prenatal exposure to alcohol); follow-up of pediatric cancer survivors, among others.

• Coordination with community agents and PEHSU: local entities, social work, organizations, etc.

• Clinical research in PC: evaluation of programs at the territorial or Catalonia-wide level, clinical and translational research (action-research).

 

In schools, the figure of school nursing can be integrated into the team of PEH referents or at least contribute synergies in the field of PEH, especially in everything related to school environmental health: safe and healthy school environments, school environmental diagnosis, active school mobility, etc.

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The establishment of one or two referents will require the commitment of the center's professionals to carry out PEH activities and the approval of the management that gives sustainability to the project. Just for the establishment of the environmental screening program in pregnancy, it is estimated that the reservation of half a morning or afternoon shift per week will be required for a reference population of approximately 50,000 people.

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In the hospital setting, environmental health units or clinics will be created that can address some of the PEH activities:

• Coordination with PEHSU and local PEH referents, especially when the ETAPs do not have primary-hospital integration.

• Integration with pediatric subspecialties: specific PEH activities for pediatric subspecialties (e.g., Green Page for respiratory pathology, PEH of precocious puberty advancement, environmental and pediatric cancer programs, neurotoxicity, etc.).

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In 2023 we are initiating the process of training referents and piloting the PEHSU-CAT Network with the following work plan:

1. Basic training course in PEH for 1-2 professionals from the collaborating center or ETAP in order to carry out local PEH tasks.

2. Advanced training course in PEH for the Network's referents, with the adaptation of the World Health Organization's training modules.

3. Basic training on PEH for the different maternal and child care professionals in the area by the previously trained professionals ("snowball" strategy).

4. Implementation of an environmental screening program in pregnancy ("Green Page") that provides coverage to couples seeking pregnancy, already pregnant, or breastfeeding mothers in the reference area of that center.

5. Joint follow-up of highly complex cases between the collaborating center and the unit of expertise through ASYNCHRONOUS VISIT.

6. Program evaluation.

7. New activities according to availability.

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Since 2023 and after 6 editions of the basic training course (2.1 credits), more than 120 maternal and child health professionals have been trained in PEH, of whom about twenty have already begun activities in their territory as referents (see map). Two annual editions of basic training are planned. In May 2025, the 1st Meeting of the PEH Referents Network of Catalonia took place in Olot, framed within the III Environmental Health Conference. The asynchronous visit, already in operation since the end of summer 2023, has allowed PC professionals to communicate to resolve consultations on complex PEH topics in the Girona Health Region. It is hoped that referrals can be generalized so that any ETAP or center can make consultations to the PEHSU.

 

Those interested in being part of the PEHSU Network are recommended to get in contact and complete the basic training in PEH.