Literature Collection

OBJECTIVE: Pediatric care management has the potential to streamline care delivery across fragmented child-serving sectors, but successfully engaging families is challenging. This study aimed to understand barriers and facilitators to family engagement from the perspectives of care managers in a pediatric integrated service delivery model for children with health and social needs. METHODS: Three virtual focus groups were conducted with care managers from North Carolina Integrated Care for Kids (NC InCK), a federal demonstration model to integrate cross-sector care for Medicaid-enrolled children under 21 years. The focus group questions were developed using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Rapid qualitative analysis methods were used for analysis. RESULTS: Eleven care managers were included across 3 focus groups. Four themes emerged as follows: 1) Rapport Building Strategies; 2) Simplifying Program Detail and Providing Information One Step at a Time; 3) Firewalls-Barriers in Technology and Information; and 4) Retention: One and Done. Care managers identified several barriers to engaging families, including effectively communicating the program's benefits, building trust via cold calls, and facilitating long-term retention beyond an initial encounter. They revealed that rapport-building strategies could enhance family engagement by providing tangible resources early in the engagement and offering basic needs assistance to support the whole family, such as rent assistance. CONCLUSION: This study illuminated barriers and facilitators to the family engagement process through the lens of care managers. Our findings support evidence to inform family engagement strategies for children with multisector needs, filling a gap in the pediatric care management literature.

BACKGROUND: As the prevalence of multi-morbidity increases in ageing societies, health and social care systems face the challenge of providing adequate care to persons with complex needs. Approaches that integrate care across sectors and disciplines have been increasingly developed and implemented in European countries in order to tackle this challenge. The aim of the article is to identify success factors and crucial elements in the process of integrated care delivery for persons with complex needs as seen from the practical perspective of the involved stakeholders (patients, professionals, informal caregivers, managers, initiators, payers). METHODS: Seventeen integrated care programmes for persons with complex needs in 8 European countries were investigated using a qualitative approach, namely thick description, based on semi-structured interviews and document analysis. In total, 233 face-to-face interviews were conducted with stakeholders of the programmes between March and September 2016. Meta-analysis of the individual thick description reports was performed with a focus on the process of care delivery. RESULTS: Four categories that emerged from the overarching analysis are discussed in the article: (1) a holistic view of the patient, considering both mental health and the social situation in addition to physical health, (2) continuity of care in the form of single contact points, alignment of services and good relationships between patients and professionals, (3) relationships between professionals built on trust and facilitated by continuous communication, and (4) patient involvement in goal-setting and decision-making, allowing patients to adapt to reorganised service delivery. CONCLUSIONS: We were able to identify several key aspects for a well-functioning integrated care process for complex patients and how these are put into actual practice. The article sets itself apart from the existing literature by specifically focussing on the growing share of the population with complex care needs and by providing an analysis of actual processes and interpersonal relationships that shape integrated care in practice, incorporating evidence from a variety of programmes in several countries.