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Word count of the main text: 3725 Number of pages: 24 Number of tables: 2 Conflict of interest: The authors declare no conflicts of interest Acknowledgements: This work was co-funded by the CIUSSS de l'Estrie-CHUS University Institute of Health and Social Services, local associations of inter-sectoral partners, the Collectif estrien 0-5 years, and by Avenir d'enfants.

In July 2013, the derailment of a train caused the death of 47 people and the destruction of Lac-Mégantic’s downtown area (Canada). Three years after this event, a population survey was conducted among a representative sample of 800 adults, including 282 men. Several significant differences were observed among respondents of a survey based on their level of exposure to this tragedy, including their physical (changes in physical health) and psychological health (post-traumatic stress disorder, mood and anxiety disorders, psychological distress, signs of depression, consultation of social workers and psychologists) as well as their use of prescribed (anxiolytics and antidepressants) and nonprescribed drugs. Such results can be explained by the nature, magnitude, and cause of the event.

Backgound: Community outreach workers support individuals accessing healthcare and other services useful to respond to their needs. Even though community outreach workers have been working in the province of Quebec (Canada) for the past 40 years, their practice is poorly documented (especially for families having children aged 0 to 5 years). Methods: To document community outreach practice and its perceived impacts for children and families, a content analysis was performed on 55 scientific and grey literature documents, 24 individual interviews, and 3 focus groups including parents, community outreach workers, healthcare employees, and inter-sectoral partners. Results: Three main themes were highlighted: 1) characteristics of the population served, 2) concrete actions performed by community outreach workers, and 3) perceived impacts of community outreach on families and children. Community outreach workers were perceived to be essential for reaching out families with vulnerable circumstances and children with special needs. With respect to actions, community outreach workers were reported to tailor their interventions to respond in different but complementary ways to the healthcare system. Perceived impacts included increased access for children and families to services, decreased social isolation, increased parental abilities, increased social capital of families, and confidence towards the healthcare system. Conclusions: Results also showed that community outreach workers helped to reduce social inequalities in health. This social practice helped to augment the capacity of the healthcare system to fulfill its legal mandate to protect citizen and increase health and well-being. It is crucial that community outreach practices and proximity approaches be encouraged and sustained.

Background Community outreach workers support individuals accessing healthcare and other services that could be useful to respond to their needs. Even though community outreach workers have been working in the province of Quebec (Canada) for the past 40 years, their practice is poorly documented and evaluated, especially with respect to young children aged 0 to 5 years. This study aimed to document the practice of community outreach workers and its perceived impacts among children and families. Methods A qualitative methodology with a descriptive research design was used. We performed a content analysis on 55 scientific and grey literature documents, 24 individual interviews, and 3 focus groups with stakeholders including parents, community outreach workers, healthcare employees, and inter-sectoral partners. Results Our analysis reveals three main themes: 1) characteristics of the population served, 2) concrete actions performed by community outreach workers, and 3) perceived impacts of community outreach on families and children. Community outreach workers were perceived as essential to reach families with vulnerable circumstances and children with special needs. With respect to concrete actions, community outreach workers were reported to tailor their interventions to respond in different but complementary ways to the healthcare system. Perceived impacts included increased access for children and families to appropriate services, decreased social isolation, increased empowerment (especially with respect to parental abilities), increased social capital of families, and confidence towards the healthcare system. Results showed that community outreach workers helped to reduce inequalities in health Conclusions Community outreach work help the healthcare system to fulfill its legal mandate to protect citizen and increase health and well-being. It is crucial that such type of proximity approaches be not only encouraged but also sustained. Key messages Community outreach workers adapt their practices to act in a complementary way to the healthcare system. Community outreach workers help to reduce inequalities in health.