Abstract

Three primary health care organizations are working together to ensure that the barrier is lowered for vulnerable groups to make effective use of all kinds of rights, both financial and social. This partnership “Integrated Social Care” wants to combat non take up and wants to increase the accessibility of social services by working proactively and by outreach.
 To set up such partnership depends on the local context. A careful analysis and knowledge of the field, involvement of all relevant actors and the target group itself, are essential to make it work. Client participation is a crucial aspect.
 Every citizen can turn to a partner of this partnership for all questions related to health, work, care, finances and social problems. Nevertheless, this partnership focuses on the most vulnerable citizens who do not (yet) receive the social rights they are entitled to.
 Colleagues from different ranks of the public social welfare center (OCMW), the social work center (CAW) and the social work department of the health insurance funds (DMW) work together on solutions, along with other local partners and service users.
 The partnership ""Integrated Social Care"" is not an organizational model, but it is a way of offering solutions to vulnerable citizens with complex welfare questions that you cannot find within your own organization alone. This partnership provides neutral information on local social help and service options. They investigate and realize social rights, clarify questions and refer to appropriate local social help and services in a neutral way. A client no longer has to go to different services. Social workers from this different organizations find each other so that the necessary expertise is shared. They work by client centered focus and in a proactive and outreaching way to detect people who were previously under the radar.
 This network is strengthened with local partners, such as poverty associations, community work and family doctors. The local government has the final responsibility.
 The process guidance provided by the Flemish government to realize this partnership in practice is through the principles of Service Design. In fact, Service Design is both an attitude (customer orientation), a methodology (co-creation with users and employees) and a set of tools (a collection of techniques to develop aid and social services). So, it is not only talking about it, but it's about working in practice with and for the target group.
 
 
 Several scientific studies have given us insights to improve the local implementation of this partnership. And we are still learning. The 59 different partnerships ""Integrated Social Care"" are also inspired by each other by using an online platform and by participating guided moments where they exchange good practices.
 The objective is a rollout across Flanders in 2022-2023 and a structural embedding of the working principles of “Integrated Social Care” in 2025.

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