Knocking on Every Door (Montreal, QC): How DocTocToc Brings Mobile Pediatric Care to Montreal's Most Vulnerable Children

Introduction

DocTocToc is a Montreal-based nonprofit organization and mobile clinic that offers children aged 0 to 5 free psychosocial care and other healthcare services [1]. Their mission is to improve access to health services for young children and families in underprivileged areas of the Island of Montreal through personalized, proactive outreach, driven by the conviction that early action can transform lives [1]. DocTocToc takes a notably holistic approach, working across the existing healthcare infrastructure, research and evaluation, and knowledge translation rather than through a single point of care [1].

The organization was originally envisioned in 2017 by Dr. Rislaine Benkelfat, a pediatrician at the Montreal Children's Hospital and assistant professor in the Department of Pediatrics at McGill University, while she was completing her Master of Business Administration (MBA) at HEC Montréal [2]. Co-founded alongside Jean-Philippe Couture, a financial analyst specializing in public funding for nonprofit organizations, the initiative was formally incorporated in 2018 under the name Ma MobiClinique and rebranded DocTocToc in 2019 [3].

The name is a play on the French expression toc toc toc ("knock knock knock"), referring to both the tradition of physician house calls and a stance of reaching out to families rather than waiting for them to find the system [4]. In 2020, DocTocToc received charitable registration and began its first community-based activities in Montréal-Nord [3]. The organization's signature mobile pediatric clinic, a 100% energy-efficient bus custom-fitted with a welcome area, an examination room, and an office, was launched on March 19, 2025, in partnership with the Montreal Children's Hospital Foundation and McGill University's Faculty of Medicine [3][4][5].

DocTocToc's clinical team currently consists of a psychosocial worker and a clinical nurse, who work together to identify family needs, guide them through the medical system, and provide children with walk-in consultations and vaccinations as needed [6].

This publication aims to shed light on DocTocToc's work and the broader context in which it operates. By examining the social and health disparities that drove its creation, the vulnerable communities it serves, and the innovative initiatives through which it is reshaping access to early childhood care in Montreal, this publication seeks to illustrate why DocTocToc's model represents a meaningful and necessary step forward in addressing inequity in pediatric healthcare.

Background: Key Local Challenges

DocTocToc's work responds to three intersecting structural challenges that define the landscape of early childhood health and development in northern Montreal: a severe shortage of primary care providers, high rates of developmental vulnerability among young children living in poverty, and compounded barriers to healthcare access facing immigrant and newcomer families.

Challenge 1: Structural Shortage of Primary Care for Children

Quebec faces among the most severe primary care access gaps in Canada. By 2024, only 72% of the provincial population had a regular family physician, down 10 percentage points from 82% in 2019. Furthermore, as of October 2025, 1.5 million Quebecers remained without a family doctor [7]. Children from low-income households are disproportionately affected. In 2021-2022, approximately 10% of babies in Quebec lacked a family doctor or pediatrician, a number that rose to 20% for those living in low-income households [17]. Without access to regular physicians, these children and their families rely on the emergency departments for issues that could and should have been addressed earlier through primary care, a pattern directly observed by Dr. Benkelfat in her hospital practice [4].

This constitutes a reach problem in the clearest sense: the families with the greatest need are the least likely to be enrolled in the services designed to help them. A large majority of Quebec parents (69%) who did not use parenting support services despite a clear need for them reported that they were not aware that such services existed. Parents also mentioned lack of availability and inaccessibility as barriers [19]. In a 2019 report by the Institut national d'excellence en santé et en services sociaux (INESSS), mobile clinics were specifically identified as a local service model capable of effectively reaching vulnerable populations, a reach solution matched to a reach problem [6].

Challenge 2: Rising Developmental Vulnerability Among Young Children

The developmental outcomes of children entering Quebec's school system have worsened over the past decade. The Quebec Survey of Child Development in Kindergarten (QSCDK), conducted by the Institut de la statistique du Québec (ISQ) across more than 78,000 children, found that the percentage of kindergarten children considered vulnerable in at least one developmental domain increased from 25.6% in 2012 to 28.7% in 2022 across Quebec's kindergarten population [8]. It was reported that vulnerability was rising across all five measured domains: physical health and well-being, social competence, emotional maturity, language and cognitive development, and communication skills and general knowledge [8].

Income is a powerful predictor of this vulnerability. As mentioned above, 28.7% of Quebec children entering kindergarten were considered vulnerable in at least one domain, a rate that climbs to 44% for children living in low-income households [18]. Vulnerable children are more likely to experience difficulty with independent schoolwork, emotional regulation, and communication, all challenges that can accumulate over their life course [8].

Challenge 3: Compounded Barriers for Immigrant and Newcomer Families

The northern boroughs of Montreal served by DocTocToc are among the most ethnically and linguistically diverse and economically unstable areas of the island. Montréal-Nord's population includes 39% immigrants (33,350 people), with the Southwest sector reaching 46% [9]. The borough also hosts the largest number of asylum seekers on the island of Montreal, totalling 5,590 people [9]. Visible minority groups constitute 57% of the population overall, rising to 66% in some sectors, compared to 38% across Montreal as a whole [9].

These demographic characteristics intersect with structural barriers in healthcare. Research has consistently identified cultural insensitivity, linguistic obstacles, and unfamiliarity with Canadian healthcare systems as major impediments for immigrant and newcomer families in accessing services for their children [10]. The “healthy immigrant effect”, the observation that immigrants often arrive in better health than the native-born population, tends to erode rapidly in the years following settlement, as families begin to navigate systemic barriers without adequate support [10]. DocTocToc identifies wait times for medical appointments, unfamiliarity with the healthcare system, the costs and travel times associated with fixed service points, and language barriers as the primary obstacles preventing highly vulnerable families from establishing trusting relationships with the healthcare network [6].

These three challenges are mutually reinforcing: families without a family doctor cannot access preventive developmental screening; children presenting with developmental vulnerabilities go unidentified; and immigrant families, often the most in need, face the highest systemic barriers to both. DocTocToc operates precisely at the intersection of these gaps.

The Affected Community and Its Needs

DocTocToc targets children aged 0 to 5 who are not yet reached by the healthcare system, social services, or community organizations, within the territory of the CIUSSS du Nord-de-l'Île-de-Montréal (the regional public health and social services authority for northern Montreal) [2]. This territory encompasses the northern boroughs of the island, including Montréal-Nord, Saint-Laurent, Ahuntsic-Cartierville, neighbourhoods that share characteristics of concentrated socioeconomic deprivation alongside high ethnocultural diversity [4].

Montréal-Nord, the area where DocTocToc conducted its founding activities and where need is most acute, presents a distinctive socioeconomic profile. According to Centraide du Grand Montréal, the borough has 10,255 low-income residents, representing 12% of its population, with the rate rising to 19% in the Northeast sector [9]. Children aged 0 to 5 are the age group most affected by poverty within the neighbourhood, with a poverty rate of 17%, contrasting with the rest of Montreal, where adults are typically most affected [9]. Single-parent families are markedly overrepresented, 40% of Montréal-Nord's families are single-parent, the highest rate of any Montreal neighbourhood, with the Northeast sector reaching 53% [9].

Educational attainment among adults is also significantly lower than the Montreal average, 22% of adults aged 25 to 64 in Montréal-Nord do not hold a high school diploma, more than double the city average of 9%, and reaching 31% in the Northeast sector [9]. In absolute numbers, this constitutes the largest undereducated adult population of any Montreal neighbourhood [9]. Low parental education is a well-established risk factor for child developmental vulnerability, and its concentration in the area speaks directly to the intergenerational nature of the challenges DocTocToc addresses [10].

The families served by DocTocToc navigate multiple, often simultaneous, sources of instability. Many are recent immigrants or asylum seekers who have arrived in Canada without established networks of support, knowledge of how to navigate a complex and siloed healthcare system, or access to services in their primary language. DocTocToc explicitly acknowledges this reality: its mobile clinic services are free for all children aged 0 to 5 [2]. This is a deliberate policy choice reflecting the reality that documentation status is itself a barrier to care for many families in the territory.

For single-parent families, overrepresented at nearly double the city average, the logistical barriers to accessing fixed healthcare services are amplified. Travel time, childcare needs, inflexible appointment scheduling, and the emotional labour of navigating the healthcare system without a partner all compound the structural inadequacy of conventional service models. Research has also documented that immigrant families in Montreal experience unique challenges in mental health service navigation, including cultural and linguistic barriers and a lack of cultural competence among providers [11].

The affected community is best understood through an intersectional lens. Poverty, racialization, recent immigration status, single parenthood, and low educational attainment converge in northern Montreal in ways that create compounded disadvantage. Centraide du Grand Montréal notes that being both an immigrant and a member of a visible minority group significantly increases the risk of poverty [12], and that Montreal's most poverty-affected neighbourhoods, including Montréal-Nord and Parc-Extension, display precisely this combination of characteristics [12]. A global comparison of early childhood development outcomes found that the proportion of Montreal children developmentally vulnerable in at least one domain (26.8%) was substantially higher than in comparable international urban settings, and that boys, immigrants, children not speaking the majority language at home, and those in the most deprived areas were at greatest risk [13].

This community's relationship with the formal healthcare system is marked by historical distrust and repeated exclusion, conditions that conventional clinic-based models are poorly equipped to address. DocTocToc's mobile model is designed to meet families where they are, using the bus's presence in familiar community spaces as a first step toward building the trust that is prerequisite to any sustained engagement with health services [3].

DocTocToc's Programs and Initiatives Addressing Local Challenges

DocTocToc's work is organized around five complementary "gateways" aimed at improving access to healthcare for young children: the mobile clinic, partnerships and cross-sector collaboration, clinical training, research and evaluation, and knowledge translation and advocacy [16]. The following subsections describe each in turn.

Mobile Pediatric Clinic

DocTocToc's flagship initiative is its pediatric mobile clinic, a custom-fitted, fully decorated, 100% energy-efficient bus inaugurated on March 19, 2025 and operational since April 2025 [3][4][5]. The bus features a child-friendly interior designed to make young patients feel welcome, with a reception area, an examination room, and an office. It travels regularly to strategic community locations in northern Montreal, currently the boroughs of Montréal-Nord, Saint-Laurent, Ahuntsic-Cartierville, and Cartierville, parking in spots frequented by the families it seeks to reach [4].

The mobile clinic directly addresses Challenge 1 by bringing care to children who lack a family physician, and Challenge 3 by eliminating the geographic, financial, and logistical barriers that most prevent immigrant and newcomer families from accessing pediatric services. The mobile clinic provides free walk-in nursing consultations for children aged 0 to 5 with no appointment required. On board, a clinical nurse performs health assessments, dispenses frontline care, updates vaccination booklets, administers vaccines, promotes healthy lifestyle habits, and uses the ABCdaire, a reference tool developed at the Centre Hospitalier Universitaire (CHU) Sainte-Justine, to monitor and follow up on each child's health and developmental trajectory, to structure regular health supervision visits [6]. A patient navigator works alongside the nurse, assessing psychosocial family needs, directing families toward appropriate community and healthcare resources, and providing sustained support for up to 24 months to help families gain autonomy within the healthcare system [6]. The clinic also accepts referrals from community organizations that identify children in need of care [2].

The services are available free of charge to all children in the target territory, regardless of their parents' immigration or documentation status, reflecting DocTocToc's commitment to reaching those most likely to be excluded by formal service thresholds [6]. The clinic was initially projected to serve approximately 1,500 children annually [14].

Pop-Up Clinics and Community Health Events (2020-2023)

Before the mobile bus was operational, DocTocToc established its presence through pop-up, appointment-free pediatric clinics in community settings, a direct response to Challenge 1 (the absence of regular physicians for children in northern Montreal) and Challenge 3 (the cultural and systemic barriers facing newcomer families).The first, held in August 2020 in Montréal-Nord in close collaboration with the CIUSSS du Nord-de-l'Île-de-Montréal and the community organization Parole d'excluEs, offered front-line pediatric care to families in a neighbourhood with among the highest poverty rates in Montreal [2][5]. In 2023, DocTocToc co-organized a neurodevelopmental screening event for children aged 0 to 5 at the Foire-Santé, Montréal-Nord's annual community health fair, again in collaboration with the CIUSSS du Nord-de-l'Île-de-Montréal [5]. Both activities drew substantial participation and documented measurable unmet need among the children seen [2]. These pop-up activities proved the demand for such services on foot and built the community trust that the mobile bus now scales into a regular, sustained presence.

Partnerships and Cross-Sector Collaboration

A central operational gateway for DocTocToc is its cultivation of cross-sector partnerships. The organization systematically works to break down the division between the formal healthcare network and community organizations, positioning the mobile clinic as a connector rather than a standalone service [15]. Institutional collaborations include the CIUSSS du Nord-de-l'Île-de-Montréal, the Montreal Children's Hospital Foundation, and McGill University's Faculty of Medicine and Health Sciences [3].

Community-level partnerships are equally central: DocTocToc relies on organizations already embedded in the lives of newcomer and low-income families, such as Parole d'excluEs, to generate referrals and build trust with populations that may be unfamiliar with or alienated from conventional health services [3]. By fostering connection with familiar community spaces, partnering with trusted local organizations, and eliminating logistical barriers like appointments and travel, DocTocToc directly addresses Challenge 3's linguistic, cultural, and systemic obstacles that most prevent immigrant and newcomer families from accessing pediatric care.

Clinical Training

The mobile clinic serves simultaneously as a training site for future healthcare professionals. Medical students, nursing students, psychosocial care workers, and project managers gain practical clinical and community health experience in a real-world, community-based setting [16]. This gateway reflects DocTocToc's commitment to contributing to systemic change beyond direct service delivery [5]. In doing so, DocTocToc directly addresses challenge 1, the structural shortage of primary care for children, by building a pipeline of community-oriented practitioners equipped to expand access to pediatric primary care and help close Quebec's growing primary care gap.

Research, Evaluation, and Knowledge Translation

DocTocToc explicitly frames research and knowledge translation as two of its five strategic gateways [16]. The organization conducts research primarily focused on local health services for vulnerable families, health inequities, and barriers to healthcare access for children aged 0 to 5. Its knowledge translation activities include publications, conference presentations, professional guidance, and public advocacy to inform a broader understanding of the barriers faced by vulnerable families [16].

The project is being developed in three phases, with Phase 1, the delivery of basic nursing care and navigation services, now underway. Phases 2 and 3 are oriented toward knowledge mobilization, systemic advocacy, and potential scale-up, which may include geographical expansion into other Montreal boroughs, such as Côte-des-Neiges-Notre-Dame-de-Grâce, and diversification to serve new populations, such as pregnant women or the elderly [4]. Whether through DocTocToc itself or inspiring replication, the organization's ambition is to reshape the standard for early childhood health equity in Montreal and beyond [4].

AI Use

For this CKP, I used Claude to support initial source discovery and finding demographic data about the affected community. All sources surfaced by AI tools were independently verified by me before being included in this publication. I wrote all CKP text myself.