Facilitators and Barriers in Integrated Social Care for Families Facing Multiple and Complex Problems: A Scoping Review

– Published during the period 1995–2023

– Focus exclusively on adults or older people rather than families or healthcare solely

– Studies focussed specifically on integrated care, as defined in the introduction, within the context of social care

– Studies outside North America, Europe and Australia

– Studies focused on families with multiple and complex problems, as defined in the introduction

– Editorials and opinion pieces, commentaries, systematic reviews

– Studies including different forms of interventions within integrated social care

– Informal sources, grey literature

– Studies providing outcomes that highlight both facilitators and barriers to integrated care for both families and professionals

– All different kind of studies

– the importance of multidimensional assessments and interventions

– parents often feel blamed and excluded from decision-making

– parents are confused by a system that seems to hold power over them

– multi-professional decision-making

– involvement of the whole family

– families participating in decision-making

– cultural sensitivity

– flexible professionals

– shared decision making

– co-location

– motivation of professionals and services increase collaboration

– no strict referral criteria

– collaboration leads to difficulties in information sharing

– adaptability to intensity of families’ fluctuating support

– trust between family and professional leads to a successful working relationship

– shared decision-making between professional and family members

– favourable inter-personal relations between clients and professionals

– culturally-appropriate, trauma-informed care

– flexibility of accessibility and service navigation

– distrust of welfare services by family members

– favourable inter-personal relations between service providers

– absence of strict referral criteria

– creation of trusting relationships between service-providers

– mutual competition between organizations

– underdeveloped pathways for intra- and interagency collaboration

– fragmented service environment

– professional autonomy can lead to a high degree of responsibility, which can create a risk of burnout

– difficulty maintaining healthy boundaries empathy and professionalism amongst professionals

– persistent silos in healthcare and systemic resistance to collaboration

– professional autonomy

– building trust between professionals/family members

– likeable and approachable: ’a safe person’

– meeting clients on their own terms

– quickly demonstrating staff effectiveness

– client empowerment

– shared learning amongst collaborating professionals

– leveraging other family members

– social and organizational relationships

– mutual respect amongst professionals

– co-location of professionals

– multidisciplinary and/or interagency staff

– flexible service by professionals

– knowledge transfer between staff working together

– advocacy for other professionals or agencies

– difficulties relating to privacy

– care-coordinators combining their interactions with child welfare workers can result in conflicts with families

– flexibility leads to burnout symptoms amongst professionals

– professionals who depend on other services can jeopardize the relationship with families

– holistic, family-centred approach

– shared decision-making

– jointly prioritize needs and focus of support

– an up-to-date care plan

– clarity, tasks, and responsibilities

– co- located professionals

– a care coordinator

– frequent evaluation

– familiarity between professionals through interprofessional collaboration

– accessibility of professionals

– cultural and generational differences in talking about problems (by involving social networks)

– overburdening social networks (by involving them)

– not all parents feel the need to use theirs social networks

– too many treatment goals lead to overburdening of parents

– long waiting lists

– lack of clarity of services

– perceived limited freedom of choice; differences in appropriate support between professionals

– parents feel uncomfortable about sharing personal information

– warm handoffs

– lack of availability of professionals

– involving family narratives in support of practical help

– understanding the family results in greater engagement with services

– understanding the everyday reality of families

– withholding of information by families

– not recognizing the challenges faced by families

– working with family groups instead of individual family members

– opportunity to develop psycho-social skills by establishing treatment expectation

– developing working alliance (therapist and family)

– systemic, family-wide approach

– less goal-directed collaboration

– sufficient self-efficacy in solving problems by family itself

– insufficient time for contemplation amongst professionals

– not being aware of family-related psychosocial problems

– informal support, accepting, non-threatening, non-judgemental, and help for coping with stressors

– multidisciplinary teams appreciated by clients

– families found education and support groups beneficial

– supporting role of the social network

– informal network guide to other support

– networking approach enabling dealing with crisis

– informal network has more weight than formal network

– families less reciprocal in social contacts

– over-involvement of professionals leads to the delegation of responsibility from families to professionals

– humour

– feedback between families and professionals

– home visits

– collaborative position between families

– working with ’multi-stressed’ families is overwhelming for therapists

– qualitative collaboration between professionals and families leads to high treatment outcome expectancy and reduces stress

– supporting family-wide approach

– family members do not maintain or improve collaboration

– hopelessness in clients leads to reduced treatment outcomes

– increased child development risks in families with low socio-economic status (SES)

– whole holistic family approach

– availability of a second key worker (one for the child and one for the parent[s])

– lack of flexibility in approach by professionals

– ambivalent trust in the professional

– crucial aims are not achieved

– access to specialist and statutory support services

– flexibility of intensity and case duration

– high level of supervision and consultation for professionals

– multi-agency partnerships

– range of different approaches

– broad assessment across different areas of life

– early consultation and involvement of informal networks and schools

– professionals see home visits as advantageous

– frequent evaluation support process and collaboration with families and professionals

– a support plan focused on the future

– importance of timely recognition of risks and needs

– multidisciplinary expertise within teams

– agreements about tasks, roles, and responsibilities at the organizational level

– accessibility and availability for families

– autonomy of professionals and tailored support

– professionals work in pairs

– familiarity with other professionals through co-location

– warm handoff professionals

– coordination of care

– jointly discuss focus of support in multidisciplinary teams

– lack of knowledge of dealing with different problems amongst professionals

– difficulties with family privacy re. sharing of information

– difficult to determine when to scale support up or down

– resistance of families to restrictive support in scaling up

– too much involvement with family

– case discussions too crisis-orientated

– prioritizing problems

– barriers to interprofessional collaboration

– risk of too much support regarding the problem(s)

– high work pressure for professionals

– risk of professionals working outside their expertise

– professionals dealing with unclear tasks, roles, and responsibilities

– waiting lists for access to social care; professionals experience difficulties in assessing crisis situations

– partnership between family members and professionals

– fragmenting support formal and informal network

– difficulties families in reciprocal relationships

– regular exchanges to resolve tensions and promote collaboration between teams

– formal mechanisms for communication

– clear referral procedures to increase stability in teams

– possibilities for informal communication between workers

– opportunities for clinical discussion

– shifts of power and a loss of privileges that upset relationships between clinicians and managers

– lack of knowledge of other institutions

– dual key worker approach: one for the parents and one for the children

– prematurely stopping support

– high stress levels in families