Integrated care for families in poverty: Barriers and facilitators

Background: Integrated care aims to support families in poverty in all areas of life, such as financial, housing, mental health and social support. Little is known about the factors that help or hinder professionals to provide this care. Understanding these factors is important to strengthen support for families in poverty.

 

Approach: This study was conducted in collaboration with 11 organizations in Rotterdam, the Netherlands, that provide integrated care to families in poverty. Eighteen professionals were interviewed about their experiences providing integrated care to families in poverty, focusing on barriers and facilitators they encounter. Interview transcripts were analysed by combining aspects from grounded theory and framework analysis to identify recurring themes.

 

Study design and materials, including the interview questions, were evaluated and approved by professionals from the participating organizations. People with lived experience of living in poverty were involved in evaluating the study design and materials of the overarching study.

 

Results: Barriers and facilitators were identified at six levels: the professional, the parent, the relationship between the professional and the parent, collaborations between organizations, and the system at large. At the level of the professional, professionals’ competencies, such as connecting with the family and taking action, as well as contextual factors, such as having sufficient time and space, supported effective care when present, but hindered it when absent. At the parent level, important facilitators include being proactive and independent, and barriers include contextual factors such as a challenging home environment. In the professional-parent relationship, factors such as a strong alliance between professional and parent, and parents being motivated, taking responsibility and being involved were mentioned as important facilitators.

 

At both the parent level and the professional level, recurring subthemes involved a distinction between competencies of the professional or parent, and the context people live or operate in. The importance of context is also visible at the systemic level, with bureaucracy frequently being mentioned as a barrier. At the collaborative level, having a shared vision was mentioned as a facilitator when present, and as a barrier when absent. A full overview of barriers and facilitators across the six levels will be presented at ICIC 2026.

 

Implications: The results provide concrete guidance for enhancing integrated care for families in poverty. Key areas for improvement include building strong alliances between professionals and parents; a shared vision with colleagues from other organizations; training professionals’ competencies; and reducing the administrative burden, so professionals have more time to focus on support itself. More broadly, our findings highlight how context shapes the behaviour of both parents and professionals, and how systemic processes seep into professionals’ and parents’ daily lives, as both have to navigate a complicated and bureaucratic system.