Care Services Research Articles

How do palliative care clinicians use their emotions during end-of-life encounters?

Abstract Background Palliative care clinicians are regularly exposed to emotionally laden end-of-life care situations. Until now, the use of their emotions during palliative care consultations has remained understudied. We aimed to develop a theory to understand how palliative care clinicians use their emotions. Methods Qualitative data were collected via individual interviews held with different types of palliative care clinicians across the world (countries were selected based on their Quality of Death Index ranking). We used a social constructivist grounded theory approach to analyze the data using a constant comparative method. Results We held interviews with 21 palliative care clinicians (5 nurses, 11 physicians, 2 psychologists, and 3 social workers) from 10 different countries. Fourteen were female. Participants’ average age was 46 and they had 14 or more years of palliative care experience. The mean length of the interviews was 52 minutes. The process of using emotions could be characterized as follows: first, a difficult end-of-life encounter (e.g. ethical dilemmas or conflicts) would trigger a strong emotion in clinicians. Second, clinicians become aware of the specific emotion via its physical or psychological cues. Third, an assessment of the appropriateness of the use of the emotion follows, in which facilitators and barriers (e.g. the level of emotion skills, the view on emotions, or the feeling of safety in the team) interplay, influencing the clinician to act upon a specific emotion or not. Finally, with a specific intent (e.g. to build connection, stimulate patients and relatives to express their feelings, or clarify a point of view) the clinician shares, shows, or expresses the emotion. Conclusions We found that the strong emotions clinicians experience can be used as a valuable resource to provide palliative care. We also identified key steps to aid clinicians reflect on the appropriateness of using certain emotions in patient care. Key messages • Palliative care clinicians’ emotions can be considered as tools to support palliative care provision. • The developed theory shows potential to explore its applicability in other professions that are also regularly confronted with emotionally charged situations.

Use and perceptions of involuntary civil commitment among post-overdose outreach staff in Massachusetts, United States: A mixed-methods study.

Involuntary civil commitment (ICC) is a legal process by which people are compulsorily admitted to substance use treatment. This study explored views about and promotion of ICC procedures for substance use disorders among public health-public safety post-overdose outreach programs and their outreach team members in Massachusetts, USA. In this mixed-methods study, survey data were collected from post-overdose outreach programs in 2019, and semi-structured interviews were conducted with outreach team members in 2019 and 2020. Massachusetts, USA. We received 138 survey responses and conducted 38 interviews with post-overdose outreach team members (law enforcement officers, recovery coaches, social workers and harm reductionists) who were majority male (57%) and white (66%). We used the survey instrument to categorize programs as more (discussed ICC at 50% or more of outreach encounters) or less ICC focused (discussed ICC at less than 50% of outreach encounters) and to identify program characteristics that corresponded with each categorization. Semi-structured interviews explored staff perceptions of ICC effectiveness. Among 138 programs, 36% (n = 50) discussed ICC at 50% or more of outreach encounters. Discussing ICC at a majority of visits was positively associated with abstinence-only program philosophies (36% v. 6%, P < 0.001) and collaborating with drug courts (60% v. 30%, P < 0.001), but negatively associated with naloxone distribution (48% v. 75%, P < 0.001) and referring to syringe service programs (26% v. 65%, P < 0.001). Qualitative interviews identified three themes: 1) some programs viewed ICC as a first line tool to engage overdose survivors in treatment; 2) other programs considered ICC a last resort, skeptical of its benefits and concerned about potential harms; 3) families commonly initiated discussions about ICC, reportedly out of desperation. Promotion of involuntary civil commitment (ICC) appears to vary widely across post-overdose outreach programs in Massachusetts, USA, with approaches ranging from seeing it as a first step to treatment to being a tool of last resort. Demand for ICC among family members may relate to inadequate access to voluntary treatment. Family interest in ICC appears to be driven by inadequate availability of treatment and other services. ICC at post-overdose outreach visits should be limited, if used at all.

What challenges exist within the child welfare system in meeting the health needs of children in care?

Abstract From society’s perspective, the goal of societal care is to protect disadvantaged children and provide them with improved opportunities. In the realm of social care, the child welfare system takes the place of parental responsibilities to safeguard children’s well-being and developmental needs, including their health. However, while holding child welfare agencies responsible, national legislation often lacks specific methods for fulfilling this mandate. Over the years, evidence has shown that limited health care access and unmet health needs often endure in care. In Sweden, efforts to address the issue include mandatory health assessments upon entry into care and collaborative agreements between social services and health care sectors. However, recent studies reveal that only one-third of children undergo these assessment, and collaborative agreements remain lacking in many local authorities. This suggests that additional legal requirements do not offer a straightforward solution. Dr Forsman, with a background in social work, will discuss the child welfare system’s responsibilities and the traditional reliance on social workers and foster carers to address health needs and coordinate care. What are the underlying barriers to successful advocacy and comprehensive health care coordination within the child welfare system? How can the system better respond to the health needs of children in care?

Building bridges: mobile mental health care units in four European countries

Abstract Background Individuals living in rural and remote areas may have limited access to mental healthcare due to lack of facilities, socioeconomic reasons, stigma and lack of mental health literacy. To meet the needs and provide needs-based care care mobile mental health care clinics were established in some countries in Europe, including in Belgium, Germany, Greece and in Moldowa. A mobile clinic is a customized motor vehicle that travels to communities to provide mental health care. The mobile clinics are an integral part of the health care system and help ensure access to mental care. Aims To describe mobile care clinics in two countries in Europe using a case study design. Results Mobile clinics deliver a wide variety of mental health services, are heterogeneous and consist of multidisciplinary teams, including physicians, social workers, and other health professionals. The organization and financing of the Mobile mental health clinics is different in the four countries (e.g. part of the mental health care system in Belgium, and Moldova, part of initiatives in Germany and Greece). Due to data protection no detailed data on patients can be provided at the moment. The structures on mental health care mobile clinics in the four countries will be described in detail in the talk. Discussion Mobile clinics often serve as a bridge between communities and the mental health care system. Another important issue in rural areas is the ongoing aging of the population. The number of Elderly patients is expected to rise in the future. The care of those patients is challenging for the mental health and the primary care system. There is a necessity for establishing bridges between mobile clinics and hospital care.

Community mental health care in Croatia: Mobile team for psychosocial support in the community

Abstract The Republic of Croatia has initiated numerous reforms in the mental health care system in the community. Within the framework of EU JA Implement, a mobile team was formed to provide interventions in the community, that is, in the homes of persons discharged from psychiatric hospitals. The mobile team was formed during 2023. The team includes: one psychiatrist, leader and coordinator of the mobile team, three graduate nurses, a case manager, a social worker, three experienced experts who are employed in the team as peer workers, and one social pedagogue and psychologist. The wider composition of the team includes a psychiatrist who provides outpatient psychiatric treatment, who is familiar with the individual recovery plan and, if necessary, participates in the development of the plan. The goal of establishing a mobile team is to implement an individual recovery plan in the community, that is, in the patient’s home, using biopsychosocial interventions, with the aim of better and faster recovery of the user and inclusion in the community, as well as prevention of rehospitalization and disability. Before the patients home visits, the experts in the team were trained. 15 patients were included in the pilot project, with whom 96 home visits or interventions were carried out in the time period from the establishment of the team to April 2024. As a result of the effectiveness of the pilot project, in 2024, in accordance with the Strategic Framework for the Development of Mental Health until 2030, the Republic of Croatia adopted a new network of health institutions, within which 30 mobile psychiatric teams and 24 psychological teams at the primary level of health care are planned. Empowerment of users, engagement of people with experience in the implementation of interventions, increase in mental health literacy of the population and destigmatization are additional results of the implementation of mental health protection in the community through JA impleMENTAL.

Unintended pregnancies in the context of intimate partner violence: Findings from the ELSA-Study

Abstract Intimate partner violence against women (IPV) is a widespread problem with serious consequences for victims and for society. Women affected by IPV have an empirically proven particular risk of unintended pregnancies. ELSA “Experiences and Living Conditions of Unintended Pregnant Women - Counselling and Care Services” is the first study in Germany to analyse the connections between the situations of women and unintended pregnancies. Using an online questionnaire, women from 1) a random representative sample of residents with a child under 6 years of age and 2) a sample of 662 women from abortion facilities or counselling centres were surveyed in 2021. The data (n = 5,101) were analysed in order to compare the life situation and needs of victimized versus non-victimized women. 333 women (6.5% of the total sample; 95% CI [6.2, 7.6]) reported IPV. Victimized women had a 5.6 times higher risk for an unintended pregnancy (95% CI [4.2, 7.5]) and 3.2 times higher risk for an abortion (95% CI [2.0, 5.0]). The pregnancy was sig. more frequently the result of forced sex (CV= .210***). Victims with unintended pregnancies had a sig. poorer mental health before (t(510) = 7.081***), during (t(510) = 5.501***) and after birth (t(456) = 5.234***) as well as before (t(503) = 4.905***), during (t(224) = 3.408) and after (t(503) = 3.352***) abortion. They were sig. more likely to report feelings of guilt and shame (CV = .182***), self-blame (CV = .149***) and anxiety (CV = .190***) after the pregnancy was determined and they received sig. more unsolicited information from the medical staff (CV = .254**). The result shows that victimized women are in an increased risk situation in the context of unintended pregnancies. Health care professionals can play a special role in prevention and intervention. Nationwide awareness-raising training, protocols and commitment are required. Key messages • The study confirms international findings on IPV and unintended pregnancies for Germany. • There is a need for a sensitive approach within the health system to enhance prevention.

Empowering People Experiencing Homelessness for cancer prevention using the Health Navigator Model

Abstract Cancer poses a significant public health concern. Reports highlight that cancer-related mortality rates are double among people experiencing homelessness (PEH). CANCERLESS project delivered an innovative solution based on the Health Navigator Model (HNM). The HNM is an evidence-based patient-centred intervention that develops patient empowerment through health education and social support, promoting timely access to cancer prevention services. A pre-post design study conducted across four pilot sites in Europe (Austria, Greece, Spain, UK) involved 652 PEHs. Pilot interventions based on the HNM were implemented, with effectiveness evaluated at baseline and post-intervention. The study assessed the impact of the HNM on various factors including risk behaviors, lifestyles, quality of life, empowerment, health literacy, psychological distress and utilization of health and care services. Preliminary findings from CANCERLESS HNM intervention showed significant improvements (p= .000) in participants’ quality of life (55.82 (27.65) vs. 66.18 (22.27)) and sense of empowerment (25.58 (19.95) vs. 59.94 (43.10)). However, there were no observable impacts in health literacy (p= .509) or psychological distress (p= .140), which remained within acceptable ranges both pre- and post-intervention. Similarly, there were no significant changes observed in lifestyle or risk behaviours among PEHs. Nonetheless, the evaluation of effectiveness suggested that the HNM increase in the uptake of cancer prevention care, such as cancer screening (p= .000). The CANCERLESS HNM intervention significantly improved the quality of life and empowerment of PEHs. Additionally, it successfully promoted their involvement in cancer prevention efforts, addressing disparities in access to preventive healthcare services. Increased engagement in such initiatives can lead to early detection and treatment, ultimately reducing cancer morbidity and mortality rates, thereby positively impacting public health. Key messages • By promoting health equity and social justice, interventions like CANCERLESS HNM contribute to building healthier and more resilient public health systems. • CANCERLESS boosts cancer prevention awareness, tackles healthcare disparities, enhances cancer early detection, benefiting public health.

Study tours as strategy in building multi-level public health system transformation in Ukraine (UA)

Abstract With 14 million Ukrainians in need of psychological aid (UNDP) and a strained health system, UA urgently requires mental health and psychological support services (MHPSS). As a TA partner on the USAID funded Public Health System Recovery and Resilience project in UA, the Philadelphia (PHL) team supports capacity building for population-based MHPSS at the community level with a study tour strategy. Such approaches apply to other countries interested in remodeling public health systems. The strategy aims to advance community based MHPSS through in person tours in PHL with remote follow up to stimulate vision, exchange ideas and accelerate action among governmental, community, and academic partners. The study tours presented overviews on health policy, system development, program services delivered to children and adults, community interventions, and workforce development of professionals and paraprofessionals. All included the foundational principles of trauma-informed practice. The June 2023 tour hosted 11 decision makers and regional officials who embraced the vision for system development and endorsed further engagement. The December 2023 tour hosted 13 practitioners and coordinators of health and social services to observe community programs. Results include development of PHL NGOs and UA social service hub partnerships to implement train the trainer programs for peers/people with lived experience and for mural arts programs to promote community engagement and empowerment. The September 2024 tour involves university partners from nursing, social work and psychology and PHL counterparts to strengthen curricula to include mental health competencies, support faculty development with potential for collaborative research and student exchange, and design post-graduate continuing education courses for upskilling the incumbent workforce. Study tours and direct exchange are an effective strategy for capacity building for MHPSS in Ukraine to address population health needs. Key messages • The sequenced study tour strategy affects distinct levels of change makers in UA. The results are governmental buy-in, partnerships for programmatic development, and academic advancement. • The study tour model promotes systematic change and offers solutions to MHPSS workforce shortages through information exchange, relationship building, and capacity development.

Perspectives on intersectoral collaboration and citizen participation in community-based prevention

Abstract Background Challenges in healthcare, such as rising healthcare costs, shortages of healthcare staff, and health disparities, have made many countries focus on intersectoral collaboration (IC) and citizen participation (CP) in community-based prevention (CBP) and health promotion (HP). Previous research on IC and CP has addressed the importance of exchanging perspectives to arrive at a shared vision and ambition. Our study is part of a long-term action research project conducted in two neighborhoods in the Netherlands. It aims to provide insight into stakeholders’ perspectives on IC and CP in CBP and HP to facilitate building partnerships. Methods Data collection takes place from March to June 2024. As part of a Q-study, we perform post-sort interviews. The Q-methodology is based on sorting statements concerning various aspects of IC and CP in CBP and HP (e.g., roles and tasks, involvement of citizens, communication, perceived barriers, etc.). We aim to include 40-50 participants from the aforementioned neighborhoods with diverse backgrounds. Participants sort 40 statements (Q-set) into a fixed-scaled framework ranging from -4 (disagree) to + 4 (agree). The interview is about individual sorting and perspectives on their own role within the collaboration. Results So far, the results of 10 participants with backgrounds in health care, social work, sports, local authority, volunteer work, and public health have been analyzed.Preliminary data synthesis shows six themes concerning shared purpose, collaboration partners, social collaboration competencies, personal motivation, conditions, and collaboration organization. Conclusions The preliminary themes overlap with findings from previous research. We will adapt existing models to reflect on our findings and enrich the literature with new themes or insights in the specific context. The interviews will help interpret the Q-sorts and develop follow-up actions in the action research projects in the participating neighborhoods. Key messages • Insights in stakeholders’ perspectives are valuable for building local collaborative partnerships. • Shared purpose, collaboration partners, social collaboration competencies, personal motivation, conditions, and collaboration organization are themes of interest to intersectoral collaboration.

Prevention of sexual exploitation of children in sport clubs and social work in Switzerland

Abstract The Convention on the Rights of the Child, ratified in 1989, provides a clear normative basis for the protection of children from violence, abuse and exploitation. Despite efforts to protect children, many children and young people are victims of sexual violence. In the extracurricular sector, clubs offer great potential for preventing sexual exploitation. However, obstacles such as the taboo nature of the topic and the clubs’ limited resources make it difficult to develop and independently implement specific prevention offers. The aim of the project was to record the activities and competencies of sports clubs, youth associations and other youth organizations in the area of prevention of sexual assault among children and adolescents in the leisure sector and to determine the need for prevention services in the canton of Zurich in Switzerland. In addition, information was obtained on the impact of existing prevention services as well as information on their further development in terms of content and organization. Together, 979 participants from sports clubs, youth associations and youth organizations (e.g. board members, coaches, leaders) as well as the parents of children who are members of these clubs were surveyed. An impact model was developed for systematic modeling, as proposed by “Health Promotion Switzerland”. The prevention of sexualized violence is seen as a very relevant topic by sports clubs, youth associations, open child and youth work and parents. However, the current implementation of prevention measures also shows that there are still barriers to implementation and room for improvement in prevention work. Participants from all areas would particularly like support with advice on how to deal with suspected cases/incidents, the provision of information materials and the creation of a protection concept. Specific ideas for the further development of prevention work were also generated and will be discussed. Key messages • The prevention of sexualized violence is seen as a very relevant topic by sports clubs, youth associations, open child and youth work and parents. • The study reveals that prevention measures are only partially implemented and identifies barriers and facilitators for improvement.

Living with Dementia: exploring the challenges and needs of informal Dementia caregivers in Portugal

Abstract Background Dementia profoundly impacts not only those diagnosed but also their informal caregivers. The Nova Center for Global Health at NOVA-IMS, in collaboration with the Alzheimer Portugal Association, embarked on a comprehensive study to explore the various aspects of daily life that affect informal caregivers of people with dementia in Portugal. Understanding these impacts is important for developing targeted interventions that address the caregivers’ needs effectively, particularly given the current lack of research on informal dementia caregivers. Methods The study utilized a crafted survey developed through initial scripting on key topics identified by informal caregivers and validated by experts on dementia. This phase was followed by a series of in-depth interviews with professionals in neurology, psychology, and social work, as well as with the caregivers themselves. The final survey was distributed among members of the Alzheimer Portugal Association and other volunteers, resulting in 305 valid responses. Results Preliminary findings reveal significant emotional, physical, and financial challenges faced by caregivers, underlining the diverse needs across 14 key areas of their lives. The study highlights specific areas where support is lacking, providing a grounded basis for developing more effective support mechanisms. Conclusions The ‘Living with Dementia’ project underscores the complex reality faced by informal caregivers. It calls for innovative, practical solutions that can alleviate the burden on these caregivers and improve their quality of life. By addressing the specific needs identified through this research, policy-makers and support organizations can better tailor their interventions to help those at the front lines of caregiving in dementia. Key messages • Informal caregivers of people with dementia face challenges that necessitate a comprehensive understanding to tailor effective support systems. • Interventions are needed that address the emotional, physical, and financial hardships caregivers face, improving their overall well-being and capacity to care.

What does international evidence tell us about the health of people with childhood social care (CSC) experiences?

Abstract International research into the health of people with childhood social care (CSC) experiences has found evidence of worse mental health and emotional-behavioural wellbeing, higher rates of substance use, neurodevelopmental conditions, and avoidable mortality. Lower vaccination rates and worse dental health among those in care has also been reported in few countries. However, research results have been more mixed with regard to some physical health conditions, with higher prevalence of asthma and respiratory ill health among foster children reported in the US but no obvious differences found in the UK. Are there countries where these inequalities are less pronounced, and can we draw such conclusions based on available evidence? When making international comparisons or aiming to give policy advice, we also need to consider the quality of our evidence. Has this been based on small sample sizes or without comparison to other children and adjusting for relevant (socioeconomic) confounders? Most of our current knowledge is also cross-sectional and we do not know if some health conditions precede entry to care and may even be risk-factors for entering social care. Recent longitudinal and cross-sectoral data linkage programmes in many nations (Australia, UK, Canada) have a potential to change this and provide a foundation for evidence-based recommendations for policy and practice.

Cost differences between oral anticoagulation therapies in atrial fibrillation patients

Abstract Background Direct oral anticoagulants (DOACs) have largely replaced warfarin as the primary choice of oral anticoagulation (OAC) in atrial fibrillation (AF) patients. This study uses a nationwide registry data set to compare the health and social care costs of AF patients using different OAC therapies. We studied how these costs were distributed among different care services in the year following AF onset and how the costs develop in time before and after AF diagnosis. Methods This study is a part of the Finnish AntiCoagulation in Atrial Fibrillation (FinACAF) research project, which includes data on patients with AF, combining registry data on primary and secondary care services as well as social services, drug purchases and laboratory data. We included all new-onset AF patients from 2011 to 2017 in Finland with an indication for OAC treatment. Patients were divided based on their first OAC purchase. Time in therapeutic range (TTR) values were assessed for warfarin patients, and they were divided into quartiles based on their TTR value. Standardized costs were determined for different health and social care contacts, accounting for hospital care, primary and ambulatory care, and long-term care. Drug costs were acquired from the Reimbursement for Prescription Medicines registry. Results A total of 130,745 patients (66,610 on warfarin, 32,996 on DOACs) were included. First-year total costs after onset of AF were €10,412 for rivaroxaban (n=13,320), €12,631 for apixaban (n=11,886), €10,706 for dabigatran (n=7,514) and €10,689 for edoxaban (n=366). Costs of care clustered near the diagnosis of AF (Figure 1). Costs for warfarin patients increased inversely with TTR, ranging from €10,945 in the highest TTR quartile (TTR over 82%) to €21,387 in the lowest (TTR under 57%). Average first-year costs for warfarin patients were €15,689, higher than DOAC patients by €3,058-€5,277 (Figure 2). Patients without any OAC had the highest first-year costs, €17,898. Patients with high risk of stroke had higher total costs both in patients using DOACS (€7,271 for patients with a CHA2DS2VA score of 1 vs €11,947 for patients with CHA2DS2VA 2+) and warfarin (€9,933 for CHA2DS2VA 1 vs €16,354 for CHA2DS2VA 2+). Drug costs averaged €1,541 for rivaroxaban, €1,659 for apixaban, €1,495 for dabigatran and €1,540 for edoxaban, and €986 warfarin users. Hospital care was the largest cost driver with 64% of total costs across the whole cohort, followed by primary care (19%), drug purchases (7%), social service costs (6%) and reimbursements for travel and private care (4%). Conclusions DOACs were superior to warfarin in a broad range of social and healthcare cost measures despite higher drug expenses. Patients on warfarin with low TTR and patients without any OAC had the highest cost of care.

How to improve informal caregiver’s quality of life and health literacy? – a NGT approach

Abstract Background Previous studies revealed that informal caregivers have a large number of unmet needs, reinforcing the necessity of national policies that ensure an adequate sustainability of the provision of informal care and takes into account the needs of caregiving dyads in the planning process. This study aimed to identify and consensualize initiatives and action strategies to improve the Portuguese Informal Caregiver’s reality and health literacy levels. Methods A Nominal Group Technique (NGT) was conducted with 10 experts. The NGT panel was asked about feasible action strategies to improve informal caregiver’s reality, consensualized and voted them according to perceived relevance in a semantic differential (1 pts to nothing relevant and 6 pts to very relevant), allowing a score calculation. Results Thirty-two initiatives emerged from the NGT. The five most relevant initiatives were identified based on an average score namely: 1) Pressure political decision-makers on the need for an effective implementation of the Informal Caregiver status, which is not being done (score=56); 2) Creation of a specific emergency social line for informal caregivers, as a measure of greater equity (score=52); 3) Raise employers awareness about caregiving demands (score=52); 4) Creation of a proximity social manager, linked to primary care services, that facilitates caregiver connection to health and social care services (score=51); 5) Decentralization of respite care services support, with multidisciplinary teams (score=49). Conclusions The informal caregiver’s role needs to be recognised and understood by healthcare and social care providers. (Re)design political, economic and social policies that address both caregiver and care recipients’ needs is critical to enable the continuity of informal care provision. Key messages • Informal caregivers play a fundamental social role but still have many needs to be addressed, particularly at the level of the official definition of their role. • (Re)design political, economic and social policies targeted to informal carers is imperative to enable the continuity of informal care provision.

Implementing patient navigation for cancer prevention among individuals with mentally ill-health

Abstract Issue In Europe, over 80 million people experience mental ill-health and there are 4 million new cancer diagnoses each year. Individuals experiencing mental ill-health exhibit higher rates of cancer morbidity and mortality, with this excess attributed to risky health behaviors and obstacles encountered when accessing often fragmented healthcare systems. Description of the problem The aim of Co-CAPTAIN is the pilot implementation and evaluation of the Patient Navigation Model (PNM) for the improvement of primary cancer prevention in individuals with mental ill-health, adapted through participatory co-design in the European context. The project will adopt a cohort-based study design, commencing data collection at baseline and succeeded by three follow-ups (6 weeks, 9 months, 18 months). It will utilize a mixed-methods approach, combining quantitative and qualitative methodologies to assess diverse outcomes of PNM, facilitating both exploratory and confirmatory research. Qualitative data will be obtained through semi-structured interviews, while quantitative data will be collected using validated questionnaires and items developed ad hoc. The project will involve four pilot sites in Europe (Austria, Greece, Poland and Spain), where the PNM will be adapted to the specificities of national healthcare and support systems. The implementation phase is expected to begin in June 2024. Results During implementation, gathering both quantitative and qualitative data will offer valuable insights into feasibility and effectiveness, establishing a baseline for reshaping health and social care policies for individuals with mental ill-health across Europe. Lessons Co-CAPTAIN project aims to reduce health disparities for individuals with mental ill-health by improving overall health and reducing cancer burdens, leading to cost reductions in European health and social care systems. Key messages • The project aims to deliver an innovative solution based on the PNM, to address health disparities among individuals with mental ill-health by reducing cancer burden. • Combination of qualitative and quantitative methodologies to assess diverse outcomes.

Learnings from ‘Everyone In’ initiative in England for improving health of people facing homelessness

Abstract Issue The COVID-19 pandemic presented an unprecedented health risk to people experiencing homelessness including risk of infection due to inability to self-isolate, and pandemic restrictions adding barriers to accessing health support. The English Government implemented the ‘Everyone In’ policy at the start of the COVID-19 pandemic, which offered accommodation to those who were (or at risk of) sleeping rough. This led to integration of support for health, care and housing. Description of the problem Between January-October 2023, a qualitative study was undertaken to understand what worked well and less well in implementing the ‘Everyone In’ initiative for improving physical and mental health outcomes for people experiencing homelessness. People who were provided accommodation and those involved in the planning or delivery of the initiative were interviewed. Results Flexibility in provision of funding and support, lack of red tape and joined-up working between partners across sectors were key positives of implementing the policy. ‘Everyone In’ also led to new ways of supporting and overcoming barriers to support, for example, provision for people with no recourse to public funds. Access to health services for people experiencing homelessness was improved by strengthened relationships with service providers, and outreach within the accommodation for wrap-around support. Challenges were faced in support for substance use. Data sharing practices, mental health support, and recognition of trauma were areas that could have worked better. Lessons Availability of flexible and earmarked funding is crucial in implementing strategies for improving outcomes in homelessness. Many short and long-term initiatives have been launched as a result of ‘Everyone In’. This study highlights the importance of partnership working, supported housing and maintaining flexible, responsive approaches to interventions to meet the health and social care needs of people experiencing homelessness. Key messages • Multi-sectoral partnerships and integrating housing with health and care support can improve access to services. • Availability of flexible funding for homelessness strategies supports adaptable and responsive service provision.

Health and Care Horizons Leeds: Attracting, navigating and inspiring the future workforce

Abstract Health and social care (H&amp;SC) partners in Leeds connect and collaborate across seven shared workforce priorities, including ‘growing and developing registrants” and “narrowing inequalities”. A range of programmes across the Leeds H&amp;SC system promote collaborative, person-centred recruitment, and developing diverse &amp; accessible talent pipelines. Through these programmes and the aims of the NHS long-term workforce plan we have identified a need to draw together information, insight and opportunities to attract, navigate, inform and inspire young people into H&amp;SC careers. The Leeds partnership co-designed an interactive career exploration tool with young people to meet these aims. This person-centred digital tool is designed to dispel misinformation and equip young people with personalised actions and pathways to work anywhere in the sector based on their skills, values and lifestyle. The framework of our approach to designing the tool and lessons learned is applicable to other settings and localities. An academically embedded evaluation of the co-design phase demonstrated the importance of reaching out to a diverse audience. We worked with over 400 young people across 12 unique and representative networks and made them feel valued. Our partners were persuaded by the potential for the tool to boost recruitment and retention strategies, aligning with the NHS long-term workforce plan and the vision for a Social Care Workforce Strategy. The platform will be launched in September 2024 so process findings will be combined with results around usage, appraisal from the sector and careers services, and impact on employers and educators. Through co-design we have challenged our assumptions at all stages of the project and created a transformational tool to address the needs of the sector and young people in Leeds. We will continue to work closely with our H&amp;SC sector partners to embed the tool in their organisations and expand the tool’s functionality. Key messages • We have created a system-wide operational career exploration tool to attract young people in Leeds to the right Health and Care career for them. • We will highlight the core values that have underpinned the creation of the tool, its functionality and lessons learned post-launch.

Community Health Worker Service: addressing the needs of Gypsy/Travellers in Scotland

Abstract Background Members of the Gypsy/Traveller community in the United Kingdom face significant health inequalities compared to the general population, including lower life expectancy, higher rates of morbidity and suicide and poorer infant and child outcomes. This study evaluated the implementation of community-based lay workers in Scotland - the Gypsy/Traveller Community Health Worker (CHW) service. Methods This multi-method qualitative study (December 2021 to August 2023) included 16 individual interviews, five focus groups, one workshop, two informal discussions, and one site visit. Participants were stakeholders, CHWs, and members of the Gypsy/Traveller community. Additionally, 116 documents were analysed. The framework method, Proctor’s implementation outcomes and thematic analysis were used for data analysis. Results CHWs reached approximately 1,000 individuals across six National Health Services (NHS) Boards. The implementation outcomes showed that the intervention was accepted and feasible. A third-sector organization (Black and Minority Ethnic Carers of People Project - MECOPP), played a crucial role in successfully delivering the CHW service. This innovative intervention employed members of the Gypsy/Traveller community as lay healthcare workers to break down barriers to accessing healthcare and other services (e.g., uptake of cervical screening, vaccination, housing, and sanitation). The CHWs were trusted, ensured healthcare information was culturally appropriate and successfully addressed discriminatory behaviours in health and social care. Limited resources pose challenges to the sustainability of the service. Conclusions The Gypsy/Traveller CHW service enhanced prevention, acted as a bridge between communities and health systems and addressed the wider determinants of health. The Gypsy/Traveller community still faces discriminatory, racist, and stigmatising behaviours, which further impede the quality, delivery, and accessibility of care. Key messages • The Community Health Worker service was acceptable and feasible in the Gypsy/Traveller community, acting as a bridge between community and health systems and increasing access to services. • Community Health Worker Service is an important strategy for delivering healthcare support through their sector organizations to address historical discrimination against minority ethnic groups.

Integrated care in the Baltic states over a 5-year period: progress, challenges and future directions

Abstract Person-centered, multidisciplinary care is key to addressing evolving complex health needs. In Estonia, Latvia, and Lithuania, this pursuit of integrated care has gained momentum as an innovative approach to allocate resources more efficiently and improve patient outcomes. This study investigates the progress of integrating care in the Baltic countries from 2019 to 2024. It details key learnings, particularly for small European countries with limited resources. The Health Systems and Policy Monitor Network of the European Observatory on Health Systems and Policies undertook a cross-country study to better understand the progress in care integration in the Baltics. The Network’s Baltic country experts completed a 21-item questionnaire on the adoption of integrated care reforms. Responses were analyzed to capture reform characteristics and commonalities, countries’ political environments and their conduciveness to the uptake of integrated care. Country-specific experiences with the implementation of integrated care were further explored via case studies of pilot programs over the five years. The pace of implementing integrating care reforms varied in each country. Existing regulatory barriers, workforce challenges and payment schemes have impeded integration efforts across health and social care. Despite these obstacles, the political commitment to new and innovative service delivery and collaboration for chronic care management underscores an important prerequisite toward achieving more integrated and person-centered healthcare. The three case studies illustrate the hurdles that come with shifting care settings and expanding roles for some workers. Findings stress the role for integrated care to address organisational challenges in the Baltics. This study highlights innovative approaches and long-running efforts to provide multidisciplinary care for complex-needs patients and the implications of their results for broader health system adoption. Key messages • Small countries like the Baltics face structural challenges in integrating care to improve outcomes and efficiency. • Investment and innovative care approaches are key to further advancements.

Understanding and monitoring vulnerability during pregnancy at population-level

Abstract Background Detecting and addressing vulnerability during pregnancy is important to optimize the first thousands days of children’s lives and prevent health inequities. We aimed to gain insight into vulnerability during pregnancy and determine the best data to predict vulnerability. Methods In the Netherlands, two studies were done using nationwide routinely collected data and self-reported Public Health Monitor-data. The first study utilized all data to identify classes of vulnerability among 4172 pregnant women through Latent Class Analysis. The second study predicted multidimensional vulnerability at population-level using solely routinely collected data first, and step-by-step incorporating self-reported data. Random Forest (RF) analysis was employed, and model performance was assessed using Area Under the Curve (AUC) and F1-measure. Results Five vulnerability-classes were found: ‘healthy and socioeconomically stable’, ‘high care utilization’, ‘socioeconomic vulnerability’, ‘psychosocial vulnerability’, and ‘multidimensional vulnerability’. Women in the ‘multidimensional vulnerability’-class shared multiple risk factors across domains and lacked protective factors. They more often had adverse outcomes such as premature birth. In the next study, the initial RF-model achieved an AUC of 0.98 in distinguishing multidimensional vulnerability, with an F1-measure of 0.70. Adding self-reported data improved model performance. Strong predictors were self-reported health, socioeconomic characteristics and healthcare utilization. Conclusions Several vulnerability classes can be distinguished among pregnant women. The co-existence of risk factors and lack of protective factors leads to more adverse outcomes. Effective public health strategies should include both medical and social care and support. Next, it seems possible to predict multidimensional vulnerability using data that is readily available, providing a foundation for longitudinal monitoring and policy formulation. Key messages • Considering the combination of both social risk and protective factors related to vulnerability during pregnancy is necessary. • Routinely collected data could provide insight in the prevalence, geographical distribution and trends in multidimensional vulnerability during pregnancy at population-level.