| Theme | Facilitators | Barriers |
---|---|---|---|
1 | Early identification and broad assessment to timely recognize potential risk factors | Early consultation Awareness of (potential) risk factors Accessibility and availability Addressing broad range of topics in broad assessment Outreaching approach Shared care plan | Risk of providing excessive support for minor problems Lack of knowledge of a broad range of problems Time consuming and burdensome for families |
2 | Multidisciplinary expertise: specialist professionals in a generalist team | Awareness of the reach of a professional’s own expertise Multidisciplinary teams: work in pairs Keeping specialist expertise up to date | High working demands, forcing professionals to provide support on areas outside their expertise |
3 | Continuous pathways: flexible support throughout the entire continuum of care | Familiarity with other professionals by co-location and joint case discussion Frequent evaluation and agreements Sharing up to date information Warm handoff between professionals A care coordinator | Complexity and variability of problems Unclear tasks, roles and responsibilities Time consuming Specific organizational demands Privacy issues in sharing information Lack of availability of professionals and high turnover rates Lack of availability of support due to long waiting lists Limited availability of support for specific ethnic groups |
4 | Current approaches in integrated care provision: a mix of stepped and matched care | Providing different options for support Tailor care to families’ needs and preferences Shared decision making Guide families through decision making process Future oriented (shared) care plan Early involvement of the informal network and schools Frequent evaluation of a family’s progress | Least restrictive support inappropriate Time-limit for each step, not matching the pace of families and hence support is not tailored to their needs Difficulties early assessment Lack of availability of support Resistance of families towards less restrictive support of scaling up Limited attention to scaling down Difficulties in objective assessment during crisis-situations Sense of responsibility and personal involvement |
5 | Autonomy of professionals: tailor support and follow guidelines | Autonomy to undertake a variety of tasks to tailor support Focus on professionals’ competencies and personal development Discussing focus of support in multidisciplinary team Structure and extended expertise by following guidelines | Too much autonomy leads to unclear tasks, responsibilities and insecurity Inadmissible differences between professionals in type of support provided Fixed protocols limits the autonomy of professionals Intuitive decision making |
6 | Evaluation of care processes: discuss progress and alter support if needed | Systematic monitoring of the care process Concrete, usable monitoring instruments Weekly clinical case discussions Evaluation of collaboration with other professionals Evaluation of the care process with families | Lack of systematic monitoring Crisis-oriented focus in case discussions Lack of focus scaling down and preventive activities Lack of structure during clinical case discussions |