Abstract
Introduction/background: Globally, the trend towards integrated care has emerged to meet the mental and social needs of families with multiple and enduring problems across different life domains. Integrated care offers a promising approach, aiming for comprehensive, coordinated, and continuous support. It encompasses a broad view of families’ strengths and challenges and a collaborative attitude. Even as important, it requires partnerships among parents, youth, professionals, organizations and local or national governments. The assumption behind forming these partnerships is that they can strengthen the capacity of people and organizations to achieve long-term improvements in integrated care. However, when operating on the edge of mental healthcare and social care systems, forming and maintaining partnerships is complicated.
Despite the importance of partnerships, there is limited research exploring the complex reality of partnerships within integrated care. Therefore, this study aimed to better understand what partnerships in integrated care entails. We did this by (1) identifying conditions for partnerships when organizing integrated care and (2) deepening our understanding of how these conditions influence the interplay between different stakeholders involved in integrated care. With this, we contribute to a better understanding of the requirements for the integrated workforce (e.g. local/national governments, healthcare organizations, professionals and families) to organize integrated care from partnership.
Method: This study is part of a broader qualitative participatory action research project, in which we followed five integrated care initiatives in The Netherlands (in the form of fully integrated care teams providing specialized care). During a two-year period, we studied partnerships in the organization of these initiatives, by means of (1) observations of clinical case discussions of the integrated care teams (n=40), (2) semi-structured interviews with parents, youth, professionals, managers and local policy makers (n=52), and (3) learning sessions with policymakers, managers, professionals and representatives of families (n=4). All data were transcribed, coded, and analyzed. A unique element of the study was the collaboration with practitioner-researchers: professionals from the integrated care teams who functioned as a researcher throughout the study by collecting data, joining reflexive meetings, and participating in learning sessions.
Results: Our results highlight the complexity of organizing integrated care from partnership, but also its necessity. Based on thematic analysis, we identified four conditions that are important in partnerships: (1) monitoring of integrated initiatives, (2) shared vision and interests, (3) roles and responsibilities and (4) financing. There is an interconnectedness between these conditions. For example, the financing of integrated initiatives strongly influences the way of monitoring integrated initiatives and the amount of trust between stakeholders. Moreover, shared visions and transparency about interests contributes to shaping trust-based and collaborative monitoring between partners. Our study also underlines the importance of continuous evaluation among stakeholders and creating constructive conditions for shared learning and development. In that, the four conditions should be addressed from the perspectives of local governments, organizations, professionals, and families. Fostering this learning-oriented environment asks for a cultural shift in all stakeholders. Further research is needed to explore ways for prioritizing joint learning and development within integrated care to strengthen partnerships.