Background
Methods
Setting
Participants
Data collection
Analysis
Results
Demographics
Variable | |
---|---|
Gender | |
Male [n (%)] | 2 (8.3%) |
Female [n (%)] | 22 (91.7%) |
Age in years | |
Mean age in years (SD) | 39.25 (11.04) |
Age range in years | 24–61 |
Highest educational level | |
Higher vocational education [n (%)] | 21 (87.5%) |
University [n (%)] | 3 (12.5%) |
Area of expertise | |
Socio-pedagogical assistance [n (%)] | 11 (45.8%) |
Pedagogics [n (%)] | 6 (25.0%) |
Psychology [n (%)] | 1 (4.2%) |
Social work [n (%)] | 5 (20.8%) |
Music therapy [n (%)] | 1 (4.2%) |
Years of work experience | |
Mean years of experience (SD) | 14.23 (9.67) |
Range years of experience | 1.5–35 |
Findings
General aspects of integrated care
“Integrated is of course a very broad concept. That you obtain knowledge on several areas of life: the family level and how they are related to their context, the environment and those involved. In that way, I understand integrated care for families. That you obtain knowledge of their functioning and that you provide support on those aspects if needed.”– Professional HR3.3 -
Theme 1: Early identification and broad assessment to timely recognize potential risk factors
“By adequately identifying signals and from there, I assess what is needed. I also think that [professionals should possess] general knowledge of the possibilities and which intervention suits best. And then I can see if it is something that I can do myself, or if it is something that I have to refer to specialized mental health care services.”- Professional HR1.3 -
Theme 2: Multidisciplinary expertise: specialist professionals in a generalist team
“It is not that I am an expert in all areas of expertise. But I have general knowledge of most areas of expertise as a generalist, and I have specialists in my team who know the rest.”- Professional DH2.1 -
Theme 3: Continuous pathways: flexible support throughout the entire continuum of care
- Familiarity with other professionals and their working approaches, leading to increased trust and improved interprofessional collaboration. Co-location and joint case discussions were reported facilitators to increasing familiarity.
- Frequent evaluation and long-lasting agreements with all professionals involved in care processes throughout the entire continuum of care.
- Sharing up to date information with other professionals, based on mutual agreements on the content and frequency of sharing information.
- Warm handoff, described as the gradual transfer from one professional or organization to another.
- A care coordinator, described as a professional who maintains an overview of the care process. The care coordinator facilitates communication between professionals involved, and coordinates support in line with families’ needs. Whether this care coordinator can also provide ambulatory support to a family remained unclear from the interviews, since professional perspectives varied at this point.
“That families are being monitored, or no, receive continuous support. The moment it improves, professionals can take a little more distance, and if needed, they can return to support the family.”- Professional DH2.2 -
Theme 4: Current approaches in integrated care provision: a mix of stepped and matched care
Matched care
“Sometimes the mother asks for a psychologist. Yes… but mother can ask all she wants, we do not always offer everything a parent wants. Maybe it is more a general request for help, a cry for a psychologist while all mother really wants is being heard. And when you can ask as much as possible beyond this initial request, the faster you can provide adequate support.”- Professional DH3.2 -
Stepped care
“Working by a stepped care approach can also just be that you start with groups, and afterwards start an individual trajectory. In this way, you may also ensure a reduction in waiting lists. Because you see people in groups, you can offer support quicker and eventually, perhaps 40% of the people on a waiting list are sufficiently supported by a group training.”- Professional HR1.3 -
Stepping up and scaling down
“I am very much in favor of preventive services to stimulate parents in solving their problems independently and voluntarily. But sometimes that is simply not possible. And if things remain within voluntary support for too long before referring to more intensive, restrictive support… Then so much has been tried and there is so much resistance, that in the restrictive setting things are difficult to change, because parents simply do not want anymore.”- Professional DH2.1 -
Theme 5: Autonomy of professionals: tailor support and follow guidelines
“It is also a bit overwhelming, because as a professional you need boundaries so you know how to handle certain situations; what works in a specific situation, based on scientific research. It similarly gives much freedom, although such freedom can be a bit overwhelming.”- Professional DH3.4 -
Theme 6: Evaluation of care processes: discuss progress and alter support if needed
Evaluation with families
Multidisciplinary case discussions
“And that you regularly sit down with your colleagues and discuss ‘now I have done this, that has been achieved, and that does not work, and why does it not work? And what is the reason for trying again, if it has already been done?’ In this way, you stay sharp, I think that has added value.”- Professional HR1.4 –