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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

 ThemeFacilitatorsBarriers
1Early identification and broad assessment to timely recognize potential risk factorsEarly 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
2Multidisciplinary expertise: specialist professionals in a generalist teamAwareness 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
3Continuous pathways: flexible support throughout the entire continuum of careFamiliarity 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
4Current approaches in integrated care provision: a mix of stepped and matched careProviding 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
5Autonomy of professionals: tailor support and follow guidelinesAutonomy 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
6Evaluation of care processes: discuss progress and alter support if neededSystematic 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