Understanding the influence of leadership, organisation, and policy on delivering an integrated child health and social care service in community settings: A qualitative exploration using the SELFIE framework.

Abstract

Background: The Sparkbrook Children's Zone is an example of a place-based integrated health and social care service developed to support children and young people living in marginalized populations in the United Kingdom. This model of care is expected to address both clinical need and the social determinants of health but evidence of the practical support needed is lacking.

Objective: To understand the infrastructural challenges of providing a service combining clinical and non-clinical staff from a range of organisations and settings.

Methods: A qualitative exploration of the experiences of staff delivering the service and used a directed content analysis to present the results within the Sustainable integrated chronic care model for multi-morbidity: delivery, financing, and performance (SELFIE) framework.

Results: A total of 14 staff were interviewed including clinicians, social care providers, local voluntary groups, and school-based family mentors. Participants described the gap between system-level integration and the lack of practical support for delivering a unified service on the ground; the training opportunities afforded by collocation; the complexity of securing staff from multiple employers using various funding sources; and the need for lengthier evaluations that extend beyond early instability.

Conclusions: Despite decades of structural reform aimed at integrating the health and social care system in the UK, there was a surprising lack of practicable support for delivering a place-based integrated health and social care service. Their delivery is also hindered by short-term funding cycles limiting the reliability of evidence gathered from complex and evolving services.