Understanding the influences on the design and delivery of an integrated child health and social care service in underserved communities in the UK: A qualitative exploration using the SELFIE framework
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Background
The UK’s National Health Service has provided funds for developing localized services integrating health and social care intended to address the health inequities prevalent in children and young people living in marginalized communities. However, little is understood of the factors that influence their design and delivery, nor which combined health and social care models are most effective.
Objective
To use evidence drawn from staff delivering a collocated integrated health and social support service to inform future integrated care offers.
Methods
A qualitative exploration of staff experience using a directed content analysis to populate and present the results within the Sustainable integrated chronic care model for multi-morbidity: delivery, financing, and performance (SELFIE) framework. The analysis presented here focusses on the domain of Service delivery , predominantly relating to the content and access of care.
Results
A total of 14 staff were interviewed: clinicians from primary and secondary care, social care providers, local voluntary groups, and school-based family mentors. Participants described at the Micro- level how the service increased engagement of families and facilitated referral to social support and preventative care; at a Meso- level the benefits of collocation, collaborative working, and community outreach were described. Finally at the Macro level, improvements to the access and availability of appropriate care were observed.
Conclusions
The pilot appeared to deliver multiple benefits for both patients and staff and the broader health economy particularly through collocating health care and social support. However, sustainable integrated care requires greater institutional commitment and leadership.
Research in Context
What is already known abou t the topic?
In the UK, the National Health Service England has been reorganised to facilitate closer collaboration between health and social care organisations. This includes prioritizing and funding localized services that integrate multiple strands of clinical, preventative and social care. Despite these policy intentions there are few lasting examples that have produced practical learning of which the ‘Sparkbrook Children’s Zone’ is one.
What does this study add to the literature?
Participants described how school outreach, the multidisciplinary team, and extended consultation times increased engagement of underserved families. The collocation of health and social support, both improved referral rates and allowed for more personalised care. Despite the positive experience of staff and patients and the improvement in access and availability of health and social care there was a perceived lack of support at a system level.
What are the policy implications?
Carefully fostered links with local schools meant the service was better able to identify and reach vulnerable families earlier and helped address issues of trust around mainstream healthcare that can exist in underserved populations. The collocation of social support allowed for direct same-visit referrals between services and the chance to address underlying issues.
