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Gheduzzi E, Savarese M, Mangini A, Mitidieri S, Paleologo M, Masella C, Graffigna G. Co-producing and co-assessing a new service solution for enhancing health and social care integration: a participatory research protocol. BMC Health Serv Res 2024; 24:1103. [PMID: 39300510 DOI: 10.1186/s12913-024-11598-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Accepted: 09/17/2024] [Indexed: 09/22/2024] Open
Abstract
BACKGROUND This paper describes a study protocol for co-producing and co-assessing a new sustainable and scalable service solution that enhances health and social integration by involving providers and volunteers delivering services for elderly people in the province of Cremona (Italy), where the elderly population will reach 27% in 2023. METHODS This upcoming study involves mixed-method participatory research and is structured in three study phases and related objectives. First, it will co-produce a new, accessible and sustainable service solution using an iterative design and management method, Plan-Do-Check-Act by involving professionals and volunteers of a heterogeneous group of health, social and third sector organizations located in the city of Cremona (Italy). Second, the study protocol will co-assess the outcomes of the new service solution using a mixed-method approach for measuring the outcomes on: professionals and volunteers (micro level) and their health, social and third sector organizations (meso level). Third, this study will co-investigate the scalability of the new solution promoting health and social integration in other similar urban areas of the Province of Cremona via the Intervention Scalability Assessment Tool (macro level). The data will be collected through the analysis of official documents, websites, policies and participatory workshops. DISCUSSION This protocol proposes an innovative intervention, a novel participatory approach, and an unexplored scalability assessment tool in the context of health and social care integration. This study aims to support professionals from health and social care service providers and volunteers from third-sector organizations to collaborate and integrate each other's resources. In doing so, the participatory approach will facilitate the co-creation of an effective response to the need of health and social integration, and the development of trustful relationships between health and social care service providers. Moreover, the adoption of Plan-Do-Check-Act and Intervention Scalability Assessment Tool will ensure the quality, scalability and sustainability of the new service solution in other settings.
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Affiliation(s)
- Eleonora Gheduzzi
- Department of Management, Economics and Industrial Engineering, Politecnico di Milano, Via Lambruschini 4/B, Milano, 20156, Italia.
| | - Mariarosaria Savarese
- EngageMinds HUB, Università Cattolica del Sacro Cuore, Via Bissolati, 74, Cremona, 26100, Italia
| | - Alberto Mangini
- Department of Management, Economics and Industrial Engineering, Politecnico di Milano, Via Lambruschini 4/B, Milano, 20156, Italia
| | - Silvia Mitidieri
- Department of Management, Economics and Industrial Engineering, Politecnico di Milano, Via Lambruschini 4/B, Milano, 20156, Italia
| | - Michele Paleologo
- EngageMinds HUB, Università Cattolica del Sacro Cuore, Via Bissolati, 74, Cremona, 26100, Italia
| | - Cristina Masella
- Department of Management, Economics and Industrial Engineering, Politecnico di Milano, Via Lambruschini 4/B, Milano, 20156, Italia
| | - Guendalina Graffigna
- EngageMinds HUB, Università Cattolica del Sacro Cuore, Via Bissolati, 74, Cremona, 26100, Italia
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Rungan S, Smith-Merry J, Liu HM, Drinkwater A, Eastwood J. School-Based Integrated Care Within Sydney Local Health District: A Qualitative Study About Partnerships Between the Education and Health Sectors. Int J Integr Care 2024; 24:13. [PMID: 38706539 PMCID: PMC11067993 DOI: 10.5334/ijic.7743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 04/17/2024] [Indexed: 05/07/2024] Open
Abstract
Introduction The unmet physical and mental health needs of school-aged children (5-18 years) in New South Wales (NSW), stemming from poor access and engagement with healthcare, can be addressed by school-based integrated care (SBIC) models.This research aims to understand why and how partnerships between the health and education sector, in SBIC models, are important in providing care for children, and to identify the facilitating factors and barriers for implementation. Methods A qualitative study was conducted using semi-structured interviews and thematic analysis. The principles of the 'Integrated People-Centred Health Service (IPCHS)' framework and Looman et al's (2021) implementation strategies for integrated care were considered. Results Themes within IPCHS framework: Strategy 1: Engaging and empowering people and communities - community-driven models, improved access to healthcare, positive outcomes for children and families, 'connection', and service provision for marginalised populations; Strategy 2: Strengthening governance and accountability - system integration and developing evidence base; Strategy 3: Reorienting the model of care - shifting healthcare to schools reduces inequity and provides culturally safe practice; Strategy 4: Coordinating services within and across sectors - integrating care and stable workforce; Strategy 5: Creating an enabling environment: leadership, stakeholder commitment, and adequate resourcing. Discussion Potential strategies for implementing SBIC models across NSW include community consultation and co-design; building multidisciplinary teams with new competencies and roles e.g. linkers and coordinators; collaborative and shared leadership; and alignment of operational systems while maintaining a balance between structure and flexibility. Conclusion SBIC models require high-level collaboration across sectors and with communities to provide a shift towards child and family centred care that improves engagement, access and outcomes in health delivery.
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Affiliation(s)
- Santuri Rungan
- Croydon Health Centre, 24 Liverpool Road, Croydon, NSW, AU
| | - Jennifer Smith-Merry
- Centre for Disability Research and Policy (CDRP), Susan Wakil Health Building (D18), Camperdown Campus, The University of Sydney, NSW, 2006, AU
| | - Huei Ming Liu
- Menzies Centre for Health Policy, University of Sydney, AU
- The George Institute for Global Health, University of New South Wales, AU
| | - Alison Drinkwater
- Centre for Disability Research and Policy (CDRP), Susan Wakil Health Building (D18), Camperdown Campus, The University of Sydney, NSW, 2006, AU
| | - John Eastwood
- School of Population Health, University of New South Wales, Kensington, NSW 2050, AU
- Sydney Local Health District, Level 11, King George V Building, Missenden Road, Camperdown NSW 2050, AU
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Williams B, Charleston R, Innes S, McIver S. Understanding collaborative and coordinated care in a mental health and well-being context: Essential elements for effective service integration. Int J Ment Health Nurs 2024; 33:397-408. [PMID: 37849028 DOI: 10.1111/inm.13244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 10/03/2023] [Indexed: 10/19/2023]
Abstract
Multiple system reforms in Australia, including the National Disability Insurance Scheme (NDIS), are changing mental health (MH) and disability-related service provision, whilst policy drivers continue to require service integration. This has necessitated service providers discovering new ways of working collaboratively to achieve an integrated model of care. This qualitative study examined what does and does not work to support collaborative and coordinated care (CCC), as essential components of service integration. The study sample (n = 59) included four cohorts: health and community service leaders (n = 16), staff (n = 23); MH service consumers with complex needs (n = 10), and MH carers (n = 10). Thematic analysis from interviews was applied to data from each cohort to identify overarching themes that described the lived experience of current CCC delivery. COREQ and EQUATOR guidelines were applied to reporting the findings. Themes emphasized CCC is enabled by the development and sustainability of positive working relationships, and depth of knowledge across health and community services. Unnavigable service systems, stigmatization, perceived power differentials, multiple and rapid service reforms and Fee-For-Service (FFS) models provide significant barriers to CCC. Recommendations include the need for accessible service navigation, consumer-friendly service environments, a stable workforce, standardization of knowledge across sectors, outcome measures and funding attached to CCC as part of a raft of potential changes.
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Affiliation(s)
- Bronwyn Williams
- Adult Mental Health Program, Eastern Health, Box Hill, Victoria, Australia
| | - Rosemary Charleston
- Centre for Mental Health Learning, Melbourne University, Melbourne, Victoria, Australia
| | - Stanley Innes
- Adult Mental Health Program, Eastern Health, Box Hill, Victoria, Australia
| | - Shane McIver
- The Centre for Research in Assessment and Digital Learning (CRADLE), Deakin Learning Futures (DLF), Deakin University, Melbourne, Victoria, Australia
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Knight L, Neiva Ganga R, Tucker M. Integrated care system leadership: a rapid realist review. Leadersh Health Serv (Bradf Engl) 2024; ahead-of-print. [PMID: 38345072 DOI: 10.1108/lhs-12-2023-0092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
PURPOSE Given the complex nature of integrated care systems (ICSs), the geographical spread and the large number of organisations involved in partnership delivery, the importance of leadership cannot be overstated. This paper aims to present novel findings from a rapid realist review of ICS leadership in England. The overall review question was: how does leadership in ICSs work, for whom and in what circumstances? DESIGN/METHODOLOGY/APPROACH Development of initial programme theories and associated context-mechanism-outcome configurations (CMOCs) were supported by the theory-gleaning activities of a review of ICS strategies and guidance documents, a scoping review of the literature and interviews with key informants. A refined programme theory was then developed by testing these CMOCs against empirical data published in academic literature. Following screening and testing, six CMOCs were extracted from 18 documents. The study design, conduct and reporting were informed by the Realist And Metanarrative Evidence Syntheses: Evolving Standards (RAMESES) training materials (Wong et al., 2013). FINDINGS The review informed four programme theories explaining that leadership in ICSs works when ICS leaders hold themselves and others to account for improving population health, a sense of purpose is fostered through a clear vision, partners across the system are engaged in problem ownership and relationships are built at all levels of the system. RESEARCH LIMITATIONS/IMPLICATIONS Despite being a rigorous and comprehensive investigation, stakeholder input was limited to one ICS, potentially restricting insights from varied geographical contexts. In addition, the recent establishment of ICSs meant limited literature availability, with few empirical studies conducted. Although this emphasises the importance and originality of the research, this scarcity posed challenges in extracting and applying certain programme theory elements, particularly context. ORIGINALITY/VALUE This review will be of relevance to academics and health-care leaders within ICSs in England, offering critical insights into ICS leadership, integrating diverse evidence to develop new evidence-based recommendations, filling a gap in the current literature and informing leadership practice and health-care systems.
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Affiliation(s)
- Lisa Knight
- Liverpool Business School, Liverpool John Moores University, Liverpool, UK
| | | | - Matthew Tucker
- Liverpool Business School, Liverpool John Moores University, Liverpool, UK
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Bosdijk A, Nieboer AP, Cramm JM. The development of an integrated neighborhood approach for health promotion and prevention: a qualitative exploration of stakeholders' views. Health Res Policy Syst 2023; 21:125. [PMID: 38017576 PMCID: PMC10683097 DOI: 10.1186/s12961-023-01077-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 11/20/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Although the promise of integrated neighborhood approaches, including the essential roles of communities and collaboration between the medical and social domains, has been widely acknowledged, the realization of such approaches in practice often remains difficult. To gain insight into the development of integrated neighborhood approaches, this case study describes the experiences of stakeholders involved in such an approach for health promotion and prevention in Rotterdam. METHODS Interviews with 18 stakeholders (including health and social care professionals, health insurance employees, and policymakers) were conducted, and stakeholders' statements were analyzed thematically. RESULTS The results reveal a lack of alignment among the professional, organizational, and system levels. Elements needed for collaboration between health and social care professionals are not supported at the organizational and system levels. The lack of integration at the policy and organizational levels encourages competition and self-interest instead of stimulating collaboration. CONCLUSIONS Intersectoral collaboration and coordination must take place not only between professionals, but also at the organizational and policy levels. As long as integration at the organizational and system levels is lacking, professionals' ability to collaborate and provide coordinated support to neighborhood residents will be compromised.
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Affiliation(s)
- Anniek Bosdijk
- Department of Socio-Medical Sciences, Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands.
| | - Anna Petra Nieboer
- Department of Socio-Medical Sciences, Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands
| | - Jane Murray Cramm
- Department of Socio-Medical Sciences, Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands
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Integrated care systems and equity: prospects and plans. JOURNAL OF INTEGRATED CARE 2023. [DOI: 10.1108/jica-08-2022-0044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
PurposePolicies on integrated care have waxed and waned over time in the English health and care sectors, culminating in the creation of 42 integrated care systems (ICSs) which were confirmed in law in July 2022. One of the four fundamental purposes of ICSs is to tackle health inequalities. This paper reports on the content of the overarching ICS plans in order to explore how they focus on health inequalities and the strategies they intend to employ to make progress. It explores how the integrated approach of ICSs may help to facilitate progress on equity.Design/methodology/approachThe analysis is based on a sample of 23 ICS strategic plans using a framework to extract relevant information on health inequalities.FindingsThe place-based nature of ICSs and the focus on working across traditional health and care boundaries with non-health partners gives the potential for them to tackle not only the inequalities in access to healthcare services, but also to address health behaviours and the wider social determinants of health inequalities. The plans reveal a commitment to addressing all three of these issues, although there is variation in their approach to tackling the wider social determinants of health and inequalities.Originality/valueThis study adds to our knowledge of the strategic importance assigned by the new ICSs to tackling health inequalities and illustrates the ways in which features of integrated care can facilitate progress in an area of prime importance to society.
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Hujala T, Laihonen H. Knowledge management in a regional integrated health and social care system. JOURNAL OF INTEGRATED CARE 2023. [DOI: 10.1108/jica-06-2022-0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PurposeThis article analyses a major healthcare and social welfare reform establishing new regional and integrated wellbeing services counties in Finland. The authors approach the reform and service integration as a knowledge management (KM) issue and analyse how KM appears and contributes in the context of integrated care, specifically in the process of integrating social and health care.Design/methodology/approachThe article analyses the case organisation's KM initiatives in light of the integrated care literature and recognises the tasks and requirements for effective KM when building integrated health and social care system. The empirical research material for this qualitative study consisted of the case organisation's strategy documents, the results of an external maturity assessment, KM workshop materials and publicly available documentation of the Finnish health and social care reform.FindingsThis study identifies the mechanisms by which KM can support health and social services integration. At the macro level, national coordination and regional co-operation require common information structures. At the meso level, a shared regional strategy with shared objectives guides both organisational decision-making and collaboration between professionals. At the micro level, technology supported and data-driven planning of service chains complements the experiences of professionals and may help remove obstacles to integration.Originality/valueThis study contributes to the literature on integrated care by providing a more comprehensive view of the role and tasks of knowledge and KM when reforming health and social services than approaches focussing solely on health informatics and internal efficiency.
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McAiney C, Markle-Reid M, Ganann R, Whitmore C, Valaitis R, Urajnik DJ, Fisher K, Ploeg J, Petrie P, McMillan F, McElhaney JE. Implementation of the Community Assets Supporting Transitions (CAST) transitional care intervention for older adults with multimorbidity and depressive symptoms: A qualitative descriptive study. PLoS One 2022; 17:e0271500. [PMID: 35930542 PMCID: PMC9355229 DOI: 10.1371/journal.pone.0271500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 07/01/2022] [Indexed: 11/24/2022] Open
Abstract
Background Older adults with multimorbidity experience frequent care transitions, particularly from hospital to home, which are often poorly coordinated and fragmented. We conducted a pragmatic randomized controlled trial to test the implementation and effectiveness of Community Assets Supporting Transitions (CAST), an evidence-informed nurse-led intervention to support older adults with multimorbidity and depressive symptoms with the aim of improving health outcomes and enhancing transitions from hospital to home. This trial was conducted in three sites, representing suburban/rural and urban communities, within two health regions in Ontario, Canada. Purpose This paper reports on facilitators and barriers to implementing CAST. Methods Data collection and analysis were guided by the Consolidated Framework for Implementation Research framework. Data were collected through study documents and individual and group interviews conducted with Care Transition Coordinators and members from local Community Advisory Boards. Study documents included minutes of meetings with research team members, study partners, Community Advisory Boards, and Care Transition Coordinators. Data were analyzed using content analysis. Findings Intervention implementation was facilitated by: (a) engaging the community to gain buy-in and adapt CAST to the local community contest; (b) planning, training, and research meetings; (c) facilitating engagement, building relationships, and collaborating with local partners; (d) ensuring availability of support and resources for Care Transition Coordinators; and (e) tailoring of the intervention to individual client (i.e., older adult) needs and preferences. Implementation barriers included: (a) difficulties recruiting and retaining intervention staff; (b) difficulties engaging older adults in the intervention; (c) balancing tailoring the intervention with delivering the core intervention components; and (c) Care Transition Coordinators’ challenges in engaging providers within clients’ circles of care. Conclusion This research enhances our understanding of the importance of considering intervention characteristics, the context within which the intervention is being implemented, and the processes required for implementing transitional care intervention for complex older adults.
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Affiliation(s)
- Carrie McAiney
- School of Public Health Sciences, University of Waterloo and Schlegel-UW Research Institute for Aging, Waterloo, Ontario, Canada
- * E-mail:
| | - Maureen Markle-Reid
- Aging, Community and Health Research Unit, School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Rebecca Ganann
- Aging, Community and Health Research Unit, School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Carly Whitmore
- Aging, Community and Health Research Unit, School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Ruta Valaitis
- Aging, Community and Health Research Unit, School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Diana J. Urajnik
- Centre for Rural and Northern Health Research, Laurentian University, Sudbury, Ontario, Canada
| | - Kathryn Fisher
- Aging, Community and Health Research Unit, School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Jenny Ploeg
- Aging, Community and Health Research Unit, School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Penelope Petrie
- Aging, Community and Health Research Unit, School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Fran McMillan
- Centre for Rural and Northern Health Research, Laurentian University, Sudbury, Ontario, Canada
| | - Janet E. McElhaney
- Northern Ontario School of Medicine and Health Sciences North Research Institute, Sudbury, Ontario, Canada
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González López-Valcárcel B, Ortún V. [Rebuilding the healthcare system: governance, organization and digitalization. SESPAS Report 2022]. GACETA SANITARIA 2022; 36 Suppl 1:S44-S50. [PMID: 35781148 DOI: 10.1016/j.gaceta.2022.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 02/16/2022] [Accepted: 02/17/2022] [Indexed: 01/19/2023]
Abstract
Reflection on three major levers for rebuilding the healthcare system: governance, integration of health and social care and digitalization. Spain has worrying levels of quality of democracy and public confidence in its politicians, and major changes are required in public administration to achieve a better state. Healthcare suffers from a deficient institutional architecture that prevents adequate macrogovernance. There is also a lack of autonomy in the management of public health centers, which hinders competition by comparison, care integration and coordination within and between levels of care. The pandemic has highlighted the value of professionalism and has shown that agile healthcare management is possible, but the challenge is to maintain this flexibility outside state of alarm. Care integration is more necessary as the population ages (albeit healthily), and per capita financing is a powerful tool to achieve it. Digitization concerns practically all areas of healthcare and population health, and will bring with it far-reaching organizational changes, requiring new methods of evaluation that differ according to the degree of intrusiveness in individual health. Telemedicine, sponsored during the pandemic with a view to permanence, induces changes in labor relations, among others. It is necessary to measure the value of digital tools and technologies. Spain has a unique opportunity for its digital transformation, thanks to European funds.
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Affiliation(s)
- Beatriz González López-Valcárcel
- Departamento de Métodos Cuantitativos en Economía y Gestión, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, España.
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Fjellfeldt M. Developing Long-Term Sustainable Collaborations between Welfare Providers That Support and Promote Child and Youth Mental Health in Sweden—A Qualitative Interview Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137730. [PMID: 35805389 PMCID: PMC9265848 DOI: 10.3390/ijerph19137730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 06/02/2022] [Accepted: 06/21/2022] [Indexed: 01/25/2023]
Abstract
When addressing child and youth mental health, policy makers around the world call for collaboration between welfare providers. Research shows, however, that cross-sector collaboration is challenging. This article aims to scrutinize the issue of sustainability in the collaborative work undertaken between welfare providers to jointly support and promote child and youth mental health. In a qualitative interview study, 19 key officials involved in collaborative mental health work in three Swedish municipalities were interviewed, 13 individually and 6 in three small groups. Data were analyzed through content analysis and the application of practice-oriented collaboration theories. The results show that informants feel collaboration is beneficial for child and youth mental health. The results also show that five aspects of this collaborative work can affect its sustainability: (1) how the collaborative work was set up: if it was a special project or part of existing organizational structures; (2) what model of funding was used; (3) how many organizational levels were involved; (4) if goals were common, concurrent or contradictive; and (5) if important stakeholders were seen to be ‘missing’. Collaboration members felt their collaborative work had caused them to drift away from important non-participant stakeholders. This article concludes that to develop long-term sustainable collaborations addressing child and youth mental health, key features of collaborative work need to be taken into consideration.
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Affiliation(s)
- Maria Fjellfeldt
- Department of Health and Welfare, Dalarna University, 791 31 Falun, Sweden
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Sheppard CL, Gould S, Guilcher SJT, Liu B, Linkewich E, Austen A, Hitzig SL. "We could be good partners if we work together": the perspectives of health and social service providers on the barriers to forming collaborative partnerships with social housing providers for older adults. BMC Health Serv Res 2022; 22:313. [PMID: 35255919 PMCID: PMC8900424 DOI: 10.1186/s12913-022-07671-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 02/22/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many older adults are aging-at-home in social housing. However, the lack of integration between housing and health services makes it difficult for older tenants to access needed supports. We examined barriers and facilitators health and social service providers face providing on-site services to older tenants. METHODS We conducted semi-structured qualitative interviews and focus groups with health and social service professionals (n = 58) in Toronto, Canada who provide community programs in support of older tenants who live in non-profit, rent-geared-to-income social housing. Interviews examined the barriers they faced in providing on-site services to older tenants. FINDINGS Service providers strongly believed that collaboration with on-site housing staff led to better health and housing outcomes for older tenants. Despite the recognized benefits of partnering with housing staff, service providers felt that their ability to work effectively in the building was dependent on the staff (particularly the superintendent) assigned to that building. They also identified other barriers that made it difficult to work collaboratively with the housing provider, including staffing challenges such as high staff turnover and confusion about staff roles, a lack of understanding among housing staff about the link between housing and health, challenges sharing confidential information across sectors, and complex and inefficient partnership processes. CONCLUSION Older adult tenants are increasingly vulnerable and in need of supports but the housing provider has a long history of ineffective partnerships with service providers driven by complex and inefficient staffing models, and an organizational culture that questions the role of and need for partnerships. Findings highlight the need for more effective integration of housing and health services. Simplified processes for establishing partnerships with service agencies and more opportunities for communication and collaboration with housing staff would ensure that services are reaching the most vulnerable tenants.
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Affiliation(s)
- Christine L Sheppard
- St. John's Rehab Research Program, Sunnybrook Research Institute, Toronto, Canada
| | - Sarah Gould
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | - Sara J T Guilcher
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | - Barbara Liu
- Regional Geriatric Program of Toronto and University of Toronto, Toronto, Canada
| | - Elizabeth Linkewich
- North & East Greater Toronto Area Stroke Network, Sunnybrook Health Sciences Centre, Toronto, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
| | - Andrea Austen
- Seniors Services and Long-Term Care, City of Toronto, Toronto, Canada
| | - Sander L Hitzig
- St. John's Rehab Research Program, Sunnybrook Research Institute, Toronto, Canada. .,Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada. .,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada.
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Factors Impacting Primary Care Engagement in a New Approach to Integrating Care in Ontario, Canada. Int J Integr Care 2022; 22:20. [PMID: 35340350 PMCID: PMC8896242 DOI: 10.5334/ijic.5704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 02/19/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction: In 2019, Ontario’s Ministry of Health (the Ministry) introduced Ontario Health Teams (OHTs) to provide population-based integrated healthcare. Primary care was foundational to this approach. We sought to identify factors that impacted primary care engagement during OHT formation from different perspectives. Methods: Interviews with 111 participants (administrators n = 80; primary care providers n = 17; patient family advisors = 14) from 11 OHTs were conducted following a semi-structured guide. Interviews were transcribed, coded, and thematically analyzed. Results: Participants felt that primary care engagement was an ongoing, continuous cycle. Four themes were identified: 1) ‘A low rules environment’: limited direction from the Ministry (system-level), 2) ‘They’re at different starting points’: impact of local context (initiative-level); 3) ‘We want primary care to be actively involved’: engagement efforts made by OHTs (initiative-level); 4) ‘Waiting to hear a little bit more’: primary care concerns about the OHT approach (sector-level). Thirteen factors impacting primary care engagement were identified across the four themes. Discussion and Conclusion: The 13 factors influencing primary care engagement were interconnected and operated at health system, integrated care initiative, and sector levels. Future research should focus on integrated care initiatives as they mature, to address potential gaps in the involvement of primary care physicians.
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Challenges and chances for local health and social care integration – Lessons from Greater Manchester, England. JOURNAL OF INTEGRATED CARE 2021. [DOI: 10.1108/jica-07-2021-0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Sustainability and transformation partnerships (STPs) were introduced to England, asking 44 local areas to submit their health and social care plans for the period from October 2016 to March 2021. This study aims to offer a deeper understanding of the complex structure in the local practice, and to discuss the associated challenges and chances.
Design/methodology/approach
Documentary analysis, qualitative interviews and questionnaire survey are used for this study. Findings have been compared and analysed thematically.
Findings
The study participants reported that apart from pooled budgets, past collaborative experience and local leadership are crucial elements for transforming health and social care integration in Greater Manchester (GM). Also, this study provides policy recommendations to promote effective collaborative partnerships in local practices and mitigate local inequity of funding progress.
Research limitations/implications
The findings of this paper cannot be extrapolated to all stakeholders due to the limited samples. Meanwhile, some of the discussions about the case of GM may not be transferrable to other STPs.
Originality/value
This study argues that the success of pooled budgets is the result, rather than the cause, of effective negotiations between various stakeholders; and therefore, there is no evidence suggesting that pooled budgets can resolve the discoordination of health and social care. Moreover, due to the bottom-up approach adopted by STPs, more effective boroughs tend to receive additional funding, resulting in an increasing gap of development between effective and ineffective boroughs.
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Durfey SNM, Gadbois EA, Meyers DJ, Brazier JF, Wetle T, Thomas KS. Health Care and Community-Based Organization Partnerships to Address Social Needs: Medicare Advantage Plan Representatives' Perspectives. Med Care Res Rev 2021; 79:244-254. [PMID: 33880954 DOI: 10.1177/10775587211009723] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Payers and providers are increasingly being held accountable for the overall health of their populations and may choose to partner with community-based organizations (CBOs) to address members' social needs. This study examines the opportunities and challenges that health care entities, using Medicare Advantage (MA) plans as an example, encounter when forming these relationships. We conducted interviews with 38 representatives of 17 MA organizations, representing 65% of MA members nationally. Transcripts were qualitatively analyzed to understand overarching themes. Participants described qualities they look for in community partners, including an alignment of organizational missions and evidence of improved outcomes. Participants also described challenges in working with CBOs, including needing an evidence base for CBOs' services and an absence of organizational infrastructure. Results demonstrate areas where CBOs may target their efforts to appeal to payers and providers and reveal a need for health care entities to assist CBOs in acquiring skills necessary for partnerships.
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Affiliation(s)
| | | | | | | | | | - Kali S Thomas
- U.S. Department of Veterans Affairs Medical Center, Providence, RI, USA
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