Abstract
Background: Providing integrated care to youth at-risk and their families is a multifaceted challenge. Youth at-risk have multiple severe and enduring problems across various life domains and exhibit behavior in which they pose a risk to themselves or others. All too often, they fall between the cracks of the current care system. Although their problems necessitate coherent and coordinated support, its implementation is hindered by dynamics that occur due to the characteristics of these youngsters and key elements of integrated care. To improve our ability to provide integrated care to youth at-risk, the aim of our systematic literature study was to gain insight into these dynamics based on current studies to integrated care for youth at-risk.
Targeted Population and Stakeholders: This study was collaboratively shaped with input from professionals, policymakers, and youth representatives. Reflective sessions throughout the design and interpretation phases ensured the inclusion of diverse stakeholder perspectives. Additionally, regular learning sessions were conducted to foster improvement in the quality of care for youth at-risk, informed by the study's findings.
Method: To explore the dynamics that unfold within the provision of integrated care for these vulnerable youth, a systematic review was conducted. Out of 5857 publications, 52 studies met the inclusion criteria. A thematic analysis guided by a theoretical framework was used to analyze the included studies.
Results: This review revealed dynamics that occur between youth at-risk, professionals, and organizations. First, between youth and professionals: as youth at-risk show high-risk and avoidant behavior, professionals tend to respond with control, reluctance to act, and stigmatization. The consequences of insufficient information sharing, the number of professionals involved, and staff turnover further disrupt trust, stability, and continuity in the care provided to youth at-risk. Engaging these youth in care proves to be challenging, necessitating assertive outreach and flexibility. Second, between youth and organizations: organizations tend to avoid responsibility when it comes to providing care to youth at-risk, and multiple preconditions are necessary for organizations to facilitate care tailored to the needs, and crisis situations of these youngsters. Third, between professionals from different organizations, dynamics are at play as each organization operates individually, leading to varying perspectives, lack of coordination, and difficulties to exchange information. To navigate these complexities and bridge the gap between different organizations, the findings underscore the critical importance of regular communication, joint interpretation, support, agency, and well-defined roles.
Conclusion: This systematic review sheds light on the dynamics surrounding youth at-risk and the provision of integrated care, revealing a misalignment between the response to the behaviors of these youngsters and their actual needs. This mismatch underscores the importance of integrated care that addresses the underlying complexities these youngsters face. The dynamics at play in providing integrated care to youth at-risk show a sequence of events where the context of youth at-risk, professionals, and organizations mutually impact one another, ultimately leading to a vicious cycle. Overall, providing integrated care necessitates a multi-level approach to support youth at-risk, professionals, and organizations in providing and engaging in care.