An Integrated Specialised Care Approach for Families with Multiple, Severe, and Enduring Problems: A Qualitative Evaluation

Figures & Tables

Main characteristics of families supported by SITs.

CHARACTERISTIC	DESCRIPTION
Problems among multiple family members and in different areas of life	Problems of youth and siblings in the family (e.g. in mental health, intellectual disability, addiction/crime, education/work), and Individual problems of the parents (e.g. in mental health, intellectual disability, addiction), and Socio-economic problems (e.g. finances, work, household, housing, social network).
Severe, enduring, and interrelated problems	Problems within the family are interwoven and mutually reinforcing. Problems fluctuate from periods of relative calmness to relapses and crises.
Frequent unsafety issues	High risk behaviour by the youth or the parent (e.g. aggression, suicidality, and addiction) Neglect, maltreatment or sexual abuse Unstable family situation due to socio-economic problems Youth welfare is regularly involved.
Dysfunctional family dynamics	Parental relational problems, parenting problems or adverse family dynamics Persistent intergenerational dysfunctional patterns
Long and troubled care history	Services fail to match family’s needs, leading to fragmented care. Distrust in care and lack of motivation Instability in coping capacity, with regard to daily life and managing the care process.

Key elements of an integrated specialised care approach.

KEY ELEMENT	DESCRIPTION
Broad view on the family as a whole	Explore problems and strengths on various life domains, map out families’ care history and care network, and focus support on different family members.
Integration of specialist perspectives	Integrate different specialised expertises into an explanatory analysis of problems, together with families. Provide an integrated care plan combining specialised disciplines, aligned and prioritised to families’ needs.
Providing specialised care flexible and timely	Be flexible to families’ needs and preferences in intensity, timing, form, and variety of specialised care. Provide the required care timely.
Working from the preferences and needs of families	Adopt low-threshold approaches, connect to families’ life, strive for shared decision-making with all family members and focus on increasing self-efficacy and self-reliance.
Organising a well-structured care process, including continuous multidisciplinary and family evaluations	Structure the care process into different phases, monitor care in multidisciplinary meetings and family evaluations.