Integrated Care Practice Research Articles

Leaders’ perceptions of integrating health and social services after a structural reform in Finland

Abstract Background Health and social service system was reformed in Finland at the beginning of 2023. The responsibility for organizing health and social services was transferred from c. 300 municipalities to 22 well-being services counties (WBSCs). One aim of the reform was to support integration between and within health and social services. The purpose of this study is to describe strategic leadership approaches to implementing integrated care. The study highlights the issues that should be paid attention to when integrated care practices are implemented. Methods The qualitative study utilized semi-structured interviews collected from the upper-level leaders of the WBSCs (n = 25) responsible for the implementation of the reform. The interviewees represented 11 WBSCs. The data were collected in May-August 2023. Inductive content analysis was used for data analysis. Results Four strategic leadership approaches to implementing integration were identified: 1) service user-based leadership approach, 2) partnership-based leadership approach, 3) service system-based leadership approach, and 4) knowledge-based leadership approach. Most of the interviewees combined several different leadership approaches in their talk. Each approach emphasized different aspects of implementing integration and the contextual factors that have to be addressed at different levels of the health and social service system. Conclusions While the macro level reform toward more integrated health and social service system was implemented, the findings reveal that more efforts are required at the meso and micro levels of the system to fulfill the goal of integrated services. The paper highlights the importance of strategic leadership and its different aspects in implementing integrated care at different levels of the system. Key messages • The paper provides a way of comprehending integration from the perspective of strategic leadership. • The conceptualization through the different leadership approaches may facilitate forming a shared vision for integration among leaders and managers.

Integrated care for children and young people with special health and care needs: a systematic review

ContextThere is a dearth of high-quality evidence on integrated, coordinated and cost-effective care for children with special health and care needs (CSHCN).ObjectiveTo assess the effectiveness of integrated/coordinated care models for...

Infectious Diseases Fellowship Training in Caring for People Who Use Drugs: A National Assessment of an Emerging Training Need.

Infectious complications of substance use are increasingly encountered in infectious diseases (ID) clinical care. In this study, we surveyed ID fellows in the United States to assess training experiences, clinical practices, and perspectives in caring for people who use drugs (PWUD). An 18-item survey was distributed to ID fellows via email and social media platforms. Four focus groups were conducted with a subset of participants to elucidate themes in fellowship experiences and training needs. Among 196 survey respondents (estimated 24% response rate), all reported caring for PWUD in ID fellowship. Forty-nine percent received some formal fellowship-based didactics around care of PWUD, and 64% worked with faculty seen as advocates for PWUD. Integrated care practices for PWUD were infrequently employed: 50% offered risk reduction counseling, and 33% discussed medications for opioid use disorders, naloxone, or HIV preexposure prophylaxis. Risk reduction counseling was felt to be "extremely" within scope of ID practice (69%), although comfort level with this skill was low; fellows' likelihood of offering counseling was significantly associated with their comfort (P ≤ .0001). Common themes in caring for PWUD included an expanded role for ID consultants, a lack of formalized training, and benefits of developing dedicated opportunities in this field. ID fellows frequently care for PWUD but may have gaps in knowledge or comfort that affect care practices. Increased fellowship training in the care of PWUD has potential to improve clinical practices and support growing interest in this field among current and prospective ID fellows.

Optimizing Tuberculosis Care through Family-Based Nursing Care: A Case Study Approach

Tuberculosis (TB) is a global health challenge that significantly impacts individuals and communities. Family-based care is recognized as an effective method to enhance TB management. The aim of this case study is to illustrate the implementation of family-based nursing care in a TB case to provide holistic care. The method used is a case study approach following the Family Nursing Model (FCN) theory by Friedman. A family with TB-diagnosed members was selected as the sample. The nursing care process was conducted over three months with bi-weekly routine visits. The care process included assessment, diagnosis, intervention, implementation, and evaluation stages. The results of this case study formulated the nursing diagnosis “Ineffective Health Maintenance in the Family of Mr. D”. Interventions were based on the five family health tasks, namely understanding health issues through education about TB and the disease process; making informed decisions involving the family; providing care with support for the treatment program undergone by family members; adapting a healthy environment through hygiene behavior education; and utilizing health services through referral to community services. This nursing care illustrates integrated care practices with active family involvement, providing practical guidance to enhance TB treatment outcomes and management at the family level.

Utilizing a family sciences approach to inform integrated care research, practice, and policy.

This interactive workshop describes and makes a case for using a family sciences approach to inform integrated care research, practice, and policy improvements, particularly when integrated care for adult populations is the aim. 
 Adults in need of healthcare are part of unique family systems, and these family systems interact with integrated care systems. For example, when older adults experience declines in health, family members are intricately involved in making care decisions and providing many types of support that interact with care systems. When integrated care is challenged by disconnection or the lack of communication and/or coordination between providers and patients and their families, a family sciences approach to research, practice, and policy improvements can create new knowledge and useful family-based interventions to improve integrated care outcomes for adult populations. This workshop will engage researchers, care providers, and policy makers in understanding the role of family sciences in integrated care research, practice, and policy. 
 This workshop will consist of the following: 
 1)An introduction to family sciences will set the stage by teaching about the principles of family sciences and highlighting the main theories used by family scientists when considering improvements to integrated care for adult populations. 
 2)A family sciences approach will be applied to integrated care research and practice. 
 a)We will consider how, when, and why family sciences could be applied to integrated care research focused on adult populations. We will use examples of family-based methods for research that are appropriate for studying adult populations and intergenerational families (e.g., genograms, ecomaps, dyadic interviewing); the benefits and potential pitfalls of these methods will be discussed. An interactive activity will be used when small groups closely examine a selection of family-based methods. A discussion about the applicability of these research methods in group members’ fields of study will be included. 
 b)We will consider the application of family sciences to integrated care practice and policy. We will examine how, when, and why a family sciences lens could be used to improve integrated care practice and policy. Examples of family focused interventions will be presented, and the benefits and potential pitfalls of these interventions will be discussed. An interactive jigsaw activity will have small groups each examine a unique family-based intervention and discuss the benefits/challenges to implementation, including how the intervention might interact with policy. Groups will summarize the intervention and present their findings to each other so the whole workshop groups is exposed to each family-based intervention. 
 3)We will conclude by considering the future of combining family sciences and integrated care. Participants will list their three main doubts in combining family science approaches and integrated care. They will also list one concrete action they could take in their own research, practice, or policy-setting role that aligns a family sciences approach to integrated care.

From paper to practice: implementing integrated care for youth-at risk

Background: At present, professionals experience difficulties applying known facilitators and barriers of integrated care in practice [1]. This is particularly intricate when working with youth at-risk and their families. These families have a diversity of problems in different life-areas, that often do not seek or accept care, and with a continuing risk of crisis situations occurring. To improve integrated care for youth at-risk, we aimed at deepening insights into how to enable facilitators or overcome barriers when implementing integrated care for youth at risk.
 Targeted population and stakeholders: The overall study design comprises practice-based action research. The primary focus of this study is on the perspective of Youth Care professionals, policymakers and youth at-risk in the Dutch Youth Care system. This study is designed and monitored in co-creation with professionals, policymakers and youth representatives. By organizing learning sessions based on the results of the study, professionals and other stakeholders are stimulated to learn and improve the quality of care for youth at-risk. 
 Method: For the aim of this study, we conducted 31 semi-structured interviews, observations with different stakeholders and one learning session with a youth and parent representative, professionals, and policymakers within a network of an integrated care initiative for youth at-risk. To analyse the transcripts, learning session and observation reports, we conducted a thematic analysis both deductively and inductively.
 Results: The implementation of integrated care for youth at risk seemed to be influenced by three underlying mechanisms: mandate, care coordination, and professional autonomy. Neither mandate, nor care coordination, nor professional autonomy was reported as lying with one person or organization and shifted between them depending on the specific case. When there was a lack of, or insufficient agreement on professional autonomy, mandate, or care coordination, it became extremely difficult for the professionals involved to provide integrated care in practice. Specifically in crisis situations, when clarity on mandate, care coordination, and professional autonomy was urgent but often lacking in practice. This led to indecisiveness and inappropriate support or no care provision at all. At the same time when these mechanisms were present: integrated care for youth at-risk was more easily realized. 
 Conclusions: Providing integrated care for youth at-risk is a joint effort. The different organizations need to specify with every new case who is involved and what their role and responsibility is, in order to offer youth at-risk the care they need. Therefore, professionals and organizations need to realize, understand and act on the underlying mechanisms mandate, care coordination and professional autonomy when providing integrated care for youth at-risk. Future studies are needed to establish whether and if so, what, other underlying mechanisms are crucial when providing integrated care for youth at risk in practice and how these mechanisms are successfully implemented. 
 Reference: 1.Nooteboom LA, Mulder EA, Kuiper CH, Colins OF, Vermeiren RRJM. Towards integrated youth care: A systematic review of facilitators and barriers for professionals. Administration and Policy in Mental Health and Mental Health Services Research. 2020;48(1):88–105.

First Phase of Integrated Care Initiative PAIK in Estonia: Lessons Learned

Background: Patients with chronic conditions often experience fragmented care and suboptimal health outcomes. Therefore, initiatives to improve the care-continuum of high-risk patients have emerged in Estonia. PAIK project was the first which tried to integrate social-services sector, specialist care and primary healthcare to co-ordinate the care for high-risk elderly patients with social health determinants. Although we measured improved perception of quality of care and level of integration, pragmatic analysis with matched controls failed to improve health outcomes and reduce costs.
 Aim: To analyse and describe lessons learned from PAIK initiative and if intervention or implementation failure explains the negative results of the project.
 Method: A qualitative analysis using focused interviews and expert opinion was used.
 Results: Firstly, the PAIK project was more a pragmatic service design and feasibility exercise than a full-fledged study designed to demonstrate better health outcomes. It was started without power analysis and analytical components were added later. No control arm was used and having social health determinants as inclusion criteria prevented retrospectively finding an unbiased propensity matched control group. Analysis showed that majority of the patients included, belonged to a very high-risk stratum (top 1%), where care-management is less effective. Also we found that not all components of the intervention were aligned with reducing hospitalisations and ER-visits.
 Another factor was that the healthcare sector lacked any prior experience with integrated care practice implementation and scaling, so the lack of existing workforce resulted in training activities continuing well into the duration of the project. Mid-study there was a change in clinical leadership, which also resulted in target population adjustment and process redesign.
 Thirdly we failed to identify and recruit champions from the primary care and social services sides, therefore engagement of these sectors was modest and the service was dominantly specialist care focused. The Covid pandemia also coincided causing resource conflicts in the sector both on hospital and primary care side. 
 Despite these above mentioned shortcomings, we consider the study generally a success, as we feel that focusing on social health determinants is important in such services and was very welcomed by both the social service providers and GP nurses. Also due to our project the role of care managers was defined in Estonia and educational programs implemented. Also, a functional care-management software module was developed and tested during the service. Finally our experience has been seen as valuable and has attracted specialist in several other counties to invest in integrated care efforts and there is greater readiness to change.
 Conclusions: Despite the PAIK intervention in Viljandi being well received by the patients and showed better patient reported outcomes, it failed to convincingly reduce health resource utilisation and hospitalisations. Both components of intervention failure and implementation failure are probably responsible. Experience from the project however might improve the success of future initiatives and be part of the foundation for care-delivery model innovation in Estonia.

Review of best practices of integrated care for people living with Motor Neurone Disease

Introduction: Motor neurone disease is a life limiting progressive neurological condition that requires a team-based approach to care. Person-centred care (PCC), integrated care and access to specialised motor neurone disease (MND) multidisciplinary clinics (MDC) are optimal approaches to the delivery of quality service for people living with MND (plwMND) for improved quality of life, health outcomes and care experiences. These MND MDCs models of care vary in design, implementation, and are predominantly specialist hospital based. Therefore, not all MND services are delivered consistently highlighting a need to explore the evidence on current practices that contribute to more effective, efficient person-centred integrated care practices across the continuum.
 Aim: This rapid review explores best practices of integrated care for people living with motor neurone disease, and their families and carers.
 Methods: A search was undertaken of six databases, Medline (Ovid), Embase (Ovid), CINAHL, Cochrane, Joanna Briggs Institute and Google Scholar. The 1469 retrieved abstracts were screened for eligibility against the inclusion criteria, and full text review was conducted on 149 studies. Data were extracted from 58 studies and a quality assessment conducted on final 45 included studies. The following information was gathered from the included studies to inform the review.
 1.What is ‘best practice’ in the management/care of plwMND
 2.What models of (integrated) care have been developed to support plwMND
 3.What are the common elements of integrated care approaches that have been implemented in MND?
 4.What impacts, outcomes, or effects of integrated care approaches have been reported for plwMND?
 
 Results: The initial review analysis indicated specialised MND multidisciplinary clinics (MDC) as ‘best practice’ in the optimal management of MND, but revealed no standardised approaches in design and implementation, the multidisciplinary workforce, and degree of integration and partnerships between hospitals and the community. MND MDC are predominantly hospital based, but the inclusion of either outreach community teams, hub and spoke approaches, and/or a hybrid design, (care delivered in person and /or by telehealth), improved integration, knowledge sharing and coordination across services. The timing of introduction and delivery of palliative care services differs but there is greater focus on integration into MND MDC, or earlier referrals to dedicated palliative care service and/or specific palliative care training of neurologist/multidisciplinary team, to optimise symptom management, decision-making and end of life care. Additional features that enable integration, improve care satisfaction and equity are one or a mix of 1) telehealth, 2) care coordination, 3) case management, 4) partnerships with MND associations, and/or 5) MND helpline.
 Conclusion: This review highlights a range of practices of integrated care that are not universal and predominantly practiced in high income countries. Adapting delivery of model of care to stage and duration of MND, and differing expectations, needs and priorities of plwMND and caregivers, is a common theme throughout. There has been greater uptake in telehealth and technology to support the equitable delivery of integrated approaches to care, with rapid development in this area during COVID 19 pandemic.
 

Healthcare Professionals' Perspectives on the Implementation of the Integrated Care Models for Chronic Patients.

Objective This study aimed toassess the understanding, adoption, and barriers to implementing integrated care for chronic diseases among healthcare professionals in Greece. By gathering insights from healthcare professionals directly involved in the care of patients with chronic conditions, this study sought to identify areas for improvement and inform future policy and strategic initiatives to enhance the quality of care and patient outcomes in Greece. Specific objectives included assessing healthcare professionals' knowledge and understanding of integrated care concepts, principles, and components in chronic disease management and exploring healthcare professionals' experiences in providing or participating in integrated care activities for patients with chronic diseases. Methods This study employed a census-based survey design to assess healthcare professionals' understanding, adoption, and barriers to the implementation of integrated care for chronic diseases in the Greek healthcare system. The sampling technique has been used to ensure the representation of different healthcare professions and regions in Greece. The survey questionnaire was structured based on the internationally recognized Chronic Care Model Elements Survey, specifically tailored to capture insights on integrated care for chronic illnesses in Greece. Healthcare professionals from diverse settings, including primary healthcare centers, public and private hospitals, specialty clinics, rehabilitation centers, home-based care services, and private sector practitioners, were targeted to gather comprehensive perspectives. Both urban and rural areas were included to ensure a representative sample, enabling an understanding of integrated care implementation in Greece. Results A total of 246 responses from healthcare professionals in Greece were collected and analyzed. An applicability index was constructed to evaluate the suitability of the integrated care system in Greece, utilizing variables collected during the survey. The reliability of the index was assessed using Cronbach's Alpha coefficient, which demonstrated a high value of 0.940, indicating strong internal consistency and correlation among the questions related to integrated care. However, the data collected for Greece exhibited a departure from a normal distribution using the Shapiro-Wilk test, suggesting the presence of barriers to the implementation of integrated care within the Greek healthcare system. Conclusions The study revealed several obstacles to integrated care implementation, encompassing organizational and individual factors, such as financial constraints, cultural differences, and regulatory challenges. Tackling these barriers will require a collective approach and close collaboration among multiple stakeholders to create an enabling context for adopting integrated care. Possible strategies involve resource allocation, fostering communication and cooperation among healthcare providers, and revising regulatory frameworks to facilitate integrated care practices. In order to achieve the national objectives of improving public health, the survey increases the focus on evidence-based public health.

Integrated care models in Swiss primary care: An embedded multiple case study.

Healthcare systems are confronted with a rising number of patients with chronic conditions and complex care needs, requiring the development of new models of coordinated, patient-centred care. In this study, we aimed to describe and compare a range of new models of care recently implemented in primary care in Switzerland, as well as to gain insight into the type of coordination or integration implemented, the strengths and weaknesses of each modeland the challenges they face. We used an embedded multiple case study design to describe in-depth a series of current Swiss initiatives that specifically aim to improve care coordination in primary care. For each model, documents were collected, a questionnaire was administeredand semistructured interviews with key actors were conducted. A within-case analysis followed by a cross-case analysis were performed. Based on the Rainbow Model of Integrated Care framework, similarities and differences between the models were highlighted. Eight integrated care initiatives were included in the analysis, representing three types of models: independent multiprofessional GP practices, multiprofessional GP practices/health centres that are part of larger groupsand regional integrated delivery systems. Recognized effective activities and tools to improve care coordination, such as multidisciplinary teams, case manager involvement, use of electronic medical records, patient educationand use of care plans, were implemented by at least six of the eight initiatives studied. The main obstacles to the implementation of integrated care models were the inadequate Swiss reimbursement policies and payment mechanisms and the desire of some healthcare professionals to protect their territory in a context where new roles are emerging. The integrated care models implemented in Switzerland are promising; nevertheless, financial and legal reforms must be introduced to promote integrated care in practice.

Patient Experience of Integrated Care: Findings from a Cross-Sectional Study Involving People with Rheumatic and Musculoskeletal Diseases.

Although the patient experience of integrated care has been documented for several chronic conditions, little is known in the context of rheumatic and musculoskeletal diseases (RMDs). This study provides a first overview of the patient experience of integrated care according to the perspective of people living with RMDs in Italy. A cross-sectional survey was administered to 433 participants who reported their experiences together with the importance assigned to different attributes of integrated care. Explorative factor analysis (EFA) and non-parametric ANOVA and ANCOVA statistical tests were employed to account for the differences in the answers provided by sample subgroups. Two factors (namely, "Person-centred care" and "Health service delivery") were extracted in the EFA. Participants attributed high importance to both of them. Overall positive experiences were reported only for Person-centred care. The delivery of health services instead received a poor evaluation. Significantly worse experiences were observed for women and people that were either older, unemployed, with comorbidities or lower self-reported health, or less engaged in their healthcare management. Italians with RMDs described integrated care as an important approach to care. However, further effort is needed to allow them to perceive an actual benefit from integrated care practices. Specific attention should be paid to disadvantaged and/or frail population groups.

INTEGRATED CARE POLICY AND PRACTICE IN THE US: THE SCENARIO OF AGING IN CHINATOWN

Abstract Background Older Chinese adults, the fastest-growing population among older immigrants, experience multiple barriers to access quality physical and behavioral health care, including low English proficiency, low health literacy, and segregation between health care and social care sectors (Tsoh et al., 2016). While integrated care attempts to address these issues, there is still a lack of culturally sensitive integrated care practices to address the needs of older Chinese immigrants. Methods This article reviews the definition and history of integrated care policies in the U.S., and compares four integrated care models on the service user and community levels, including the Chronic Care Model (CCM), Program of All-Inclusive Care for the Elderly (PACE), Patient Navigation Model, and Delivery System Reform Incentive Payment (DSRIP) Program. Results Taking the community-dwelling older Chinese immigrants as the context, this article discusses factors that are essential to this group of older adults and proposes a framework to integrate social determinants of health in the development of integrated care practice with the infusion of cultural values and norms. Conclusion Integrated care for older immigrants asks for a complicated mass reconstruction of current care systems. We propose an innovative framework that fully takes advantage of CBO’s capacity in providing culturally appropriate services is proactive and preventive in nature by addressing social determinants of health directly, recognizes the role of family and community in older immigrants’ life and aging process, and provide equal attention to the older adults’ needs in health, mental health, and elderly care.

Integrating Health and Social Services in Finland: Regional Approaches and Governance Models.

Introduction:The study explores regional approaches to integrated care, focusing on regions with regular municipality-based and integrated unified health and social care administration. The aim is to describe a governance approach that supports care integration in the regions.Methods:The study draws on analysis of integrated care governance using an extensive collection of administrative documents (n = 176) on regional health and social services within 20 specialised care authorities. The document data were supplemented with interviews of national health and social system evaluation officers. In our analysis, we used deductive content analysis and identified conceptual approaches of social and health care integration according to elements of integrated care governance.Results:Overall, integrated care governance was relatively well advanced. All regional authorities had established at least some preconditions for integrated governance. The stage of integration varied in the different elements of integrated care governance. The regions with unified integrated administrations enabled the more advanced models of integrated care.Conclusions:Various models for cooperation between regional health and social care authorities have emerged in the regions to identify good integrated care practices. The study suggests that the applied theoretical framework and presented elements of integrated care governance can be used to monitor development of care integration.

Evolutionary game model of health care and social care collaborative services for the elderly population in China

IntroductionThe synergy of health care and elderly social care organizations has become the focus of the research on integrated health care and social care. This study aims to propose a collaborative strategy among health care and elderly social care service providers.MethodsAn evolutionary game model is applied for performance analysis and optimization of the cooperation between health care and elderly social care organizations. The behavioural strategies and the impact of key parameters on promoting the cooperation of the players are presented in detail.ResultsSimulation experiments and sensitivity analysis results indicate that (1) the behavioural evolution of health care organizations and elderly social care organizations forms three types of integrated health care and social care services, namely, the bilateral cooperation type, health care organization-led type and elderly social care organization-led type. (2) Increasing the additional benefits for cooperation and reducing the additional costs for cooperation can promote the willingness to synergize to provide integrated health care and elderly social care services. At the early stage of evolution, increasing the costs that elderly social care organizations pay to purchase health care services or pay for negotiation in the bilateral cooperation type can provide incentives for health care organizations to cooperate while reducing the cooperation preferences of elderly social care organizations. However, the long-term impact of the costs on the behavioural strategies for cooperation of the two players cannot be determined.ConclusionThe behavioural decisions on cooperation between health care and elderly social care organizations influence each other; commitment to integration and effective collaboration can be achieved by increasing the additional benefits and reducing the marginal costs. The findings suggest that the political-economic context and government policies have a greater influence on promoting cooperation, thus yielding positive or negative results for integrated care practice.

Screening for Early Emerging Mental Experiences (SEE ME): A Model to Improve Early Detection of Psychosis in Integrated Primary Care.

Early intervention in serious mental health conditions relies on the accurate identification of adolescents and young adults at high risk or with very recent onset of psychosis. Current early detection strategies have had limited success, identifying only a fraction of these individuals within the recommended 3- to 6-month window. Broader public health strategies such as population screening are hampered by low base rates and poor self-report screen specificity. Screening for Early Emerging Mental Experiences (SEE ME) is a three-stage “SCREEN—TRIAGE—ENGAGE” model for the early detection of psychosis in integrated primary care adolescent and young adult patients during the period of peak onset. It builds on the KNOW THE SIGNS—FIND THE WORDS—MAKE THE CONNECTION framework outlined on psychosisscreening.org and developed with input from community collaborators. Systematic screening aims to expand the reach of early detection and reduce reliance on provider knowledge. Triage and engagement by trained mental health clinicians aims to improve the specificity of screen responses, enhance engagement in appropriate care, and reduce provider burden. Leveraging the low stigma of primary care, its reach to non-help-seeking adolescents and young adults, and the mental health training of clinicians within integrated care practices, SEE ME has potential to improve the benefit/risk ratio of early detection of psychosis by improving both the sensitivity and specificity of screening and clinical response. We review the rationale and design of this promising model.

Perspectives of structurally marginalised patients attending contextually tailored and integrated care practices in Canada: a focused ethnography study

ObjectivesTo better understand the experience of patients attending community-based primary healthcare practices (CBPHCPs) aimed at improving equity and access to primary care for underserved patients, which have been implemented locally...

Competencies for the practice of pediatric integrated primary care: A continuum of training.

Competencies for the practice of pediatric integrated primary care: A continuum of training.

Integrated Care in the Era of COVID-19: Turning Vision Into Reality With Digital Health.

The lives of millions of people have been affected during the coronavirus pandemic that spread throughout the world in 2020. Society is changing establishing new norms for healthcare education, social life, and business. Digital health has seen an accelerated implementation throughout the world in response to the pandemic challenges. In this perspective paper, the authors highlight the features that digital platforms are important to have in order to support integrated care during a pandemic. The features of the digital platform Safe in COVID-19 are used as an example. Integrated care can only be supported when healthcare data is available and can be sharable and reusable. Healthcare data is essential to support effective prevention, prediction, and disease management. Data available in personal health apps can be sharable and reusable when apps follow interoperability guidelines for semantics and data management. The authors also highlight that not only technical but also political and social barriers need to be addressed in order to achieve integrated care in practice.

APA Fall Conference to Focus on Determinants of Mental Health

APA Fall Conference to Focus on Determinants of Mental Health

Supporting parents as essential care partners in neonatal units during the SARS-CoV-2 pandemic.

ABSTRACTAimTo review the evidence on safety of maintaining family integrated care practices and the effects of restricting parental participation in neonatal care during the SARS‐CoV‐2 pandemic.MethodsMEDLINE, EMBASE, PsycINFO and CINAHL databases were searched from inception to the 14th of October 2020. Records were included if they reported scientific, empirical research (qualitative, quantitative or mixed methods) on the effects of restricting or promoting family integrated care practices for parents of hospitalised neonates during the SARS‐CoV‐2 pandemic. Two authors independently screened abstracts, appraised study quality and extracted study and outcome data.ResultsWe retrieved 803 publications and assessed 75 full‐text articles. Seven studies were included, reporting data on 854 healthcare professionals, 442 parents, 364 neonates and 26 other family members, within 286 neonatal units globally. The pandemic response resulted in significant changes in neonatal unit policies and restricting parents' access and participation in neonatal care. Breastfeeding, parental bonding, participation in caregiving, parental mental health and staff stress were negatively impacted.ConclusionThis review highlights that SARS‐CoV‐2 pandemic‐related hospital restrictions had adverse effects on care delivery and outcomes for neonates, families and staff. Recommendations for restoring essential family integrated care practices are discussed.