Towards integrated care in the Dutch Youth Care system: an action based research

Abstract

Introduction: Since the new Youth Act came into force in January 2015, there has been a decentralization of the Youth Care system in the Netherlands to local municipalities. By decompartmentalization of budgets, municipalities aim to reduce fragmentation of the Youth Care system and facilitate integrated care on a local level. However, despite major organizational and financial changes, there are indications that these changes itself are insufficient to accomplish integrated care in practice. There is a need for practice based knowledge regarding facilitators and barriers on a professional level in providing integrated care in Youth Care practice. Aim: The aim of this study is to identify facilitators and barriers in providing integrated care directly from Youth Care practice and to stimulate professionals to learn and improve the quality of integrated care. Theory of change and short description of practice change implemented: The overall research method of this practice-based study is action research, with Youth Care professionals as fellow researchers and a strong focus on active involvement of important stakeholders, including policy makers and parents. By qualitative research methods, including weekly observations and semi-structured interviews with 24 professionals and 21 parents, facilitators and barriers regarding integrated care are collected directly from practice. Continuous feedback of these results is provided to Youth Care professionals and policy makers, in order to improve the current practice. Targeted population and stakeholders: The primary focus of this study is on the perspective of Youth Care professionals and parents in the renewed Dutch Youth Care system. The study is funded by ZonMw, The Netherlands Organisation for Health Research and Development and is executed by researchers in collaboration with Youth Care professionals, parent representatives, policy makers and educational institutions. Timeline and Highlights: This practice-based action research is performed during a 4 year period (2016-2019). By providing continuous feedback based on the results of the study, professionals and other stakeholders are stimulated to learn and improve the quality of care. Sustainability and Transferability: The relevance, impact and transferability of the current research is augmented by continuously involving representatives of Youth Care professionals and their management, policy makers, parents and youth, and representatives from the educational field during all phases of the project. In order to obtain comprehensive and representative conclusions, results are examined by triangulation and member checks, facilitating the implementation of these results in practice. Conclusion, Discussion and Lessons Learned: Several facilitators and barriers are identified from the qualitative data. Providing direct feedback to professionals stimulates a learning process and encourages professionals to improve quality of care. To maintain stakeholders’ active involvement, it is crucial to involve them as fellow researchers, operate transparent and provide frequent updates about the progress of the project.

Keywords

• integrated care
• action research
• youth care
• professionals