Key elements of integrated specialized care for families with complex needs

Background: Specialized approaches to integrated care are an emerging topic. Families with multiple, severe, and enduring problems are in need for specialized support, but often fall between the cracks of a fragmented system of siloed care services. To overcome fragmentation in care a global trend is the organization of Specialist Integrated care Teams (SITs), in which professionals from various youth and adult specialized care services collaborate to provide integrated care to families with complex needs. Since little is known about SITs’ working approach in practice, we conducted a qualitative evaluation study to unravel key elements promoting integrated specialized care on the level of professionals. Moreover, we identified the main characteristics of families being supported by SITs.

Approach: As part of our participative action research project ‘The Specialist nearby?! in which we followed five SITs in the Netherlands, we gathered perspectives of families, professionals, managers, and policy makers by conducting 54 semi-structured interviews. Additionally, 40 observations of SITs’ multidisciplinary team case meetings were conducted. To engage the workforce in exploring and developing an integrated specialized care approach in practice, we involved professionals from the SITs as research practitioners. Moreover, practice based knowledge was developed in learning sessions connecting professionals, policymakers, and managers of the SITs as well as parents and youth representatives.  A theory-driven framework method was applied to analyze the transcripts both deductively and inductively.

Results: Families supported by SITs were described as experiencing problems among multiple family members and across life domains. Problems are severe, enduring, and interrelated, leading to frequent unsafety, dysfunctional family dynamics, and a long and troubled care history. Five key elements promoting an integrated specialized care approach included: 1) a broad view on families, 2) an integration of specialized perspectives, 3) providing specialized care flexible and timely, 4) working from families’ preferences and needs, and 5) organizing a well-structured care process and multidisciplinary evaluations.

 

Implications: This study provides valuable knowledge for establishing integrated specialized care for families with complex needs. Although SITs are a promising form of organizing this approach, ensuring an integrated specialized care approach is the responsibility of every professional and specialized care service involved in families’ care. To guide professionals in recognizing which families need this approach, the five identified main characteristics should be considered during assessment. In providing care to these families, professionals and care services are encouraged to adopt the key elements of an integrated specialized care approach. This involves broadening their perspective to the whole family, investing in building trust and collaborative relationships with different family members, and applying flexible and low-threshold approaches in the care process. Moreover, professionals from different care services collaborating in families, would benefit from arranging regular multidisciplinary meetings to integrate their specialized perspectives and working methods in integrated care plans.