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Table 3 Overview of facilitators and barriers per theme

From: An integrated approach to meet the needs of high-vulnerable families: a qualitative study on integrated care from a professional perspective

 

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