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A common topic or comment about services for clients is about integration. What do we mean by this? What does integrated services look like? Is it about coordinating services? Is it providing a one stop service? Is it about joining up services? The word can mean different things to different people. Integration at its core involves coordinating and providing a “one experience.” It is different from a one stop service although it could be part of it.
Integration can perhaps be seen as a process of combining two or more things to create a seamless experience. It is a tall order to integrate services. It is even harder when we are talking about joining up services that can be provided by more than one agency. That is why we place a premium on integration. It involves keen observation and thinking that leads to re-design or re-arranging of steps to provide a less jerky or disjointed experience.
The call for integration is more urgent in social care. Because a social care user is usually less mobile and more dependent, she benefits most when services are delivered from her perspective in a coordinated way and seamlessly so that she can experience them as one experience. As such, there’s a ‘no one size fits all’ solution to health and social care integration.
The ideal for a social care user of course is when there is the integration of health, social care and housing. It is tempting sometimes to begin work on integration by looking at structural “solutions.” But this may not be the best place to start as thinking about integration is a complex exercise. A better place to start thinking about integration is to be clear about outcomes. Rather than assuming there's a perfect organisational structure out there to integrate services, we may want to work with different partners in different ways depending on what we want to achieve and for whom. For some issues, a very formally integrated approach between health and social care and/or between different tiers of the health service might be required. In other situations, a broader relationship between social care and a person’s accommodation might be best. For some issues, a single agency such as the Agency for Integrated Care might be best placed to respond.
What does service integration look like for families who often have more than one service provider (whether they are from the same agency or different ones)? The challenge in such situations is when there could be contradictory information arising from a lack of service integration, including contradictory advice and unrealistic expectations from individual professionals.
A therapist, for example, often say that it’s really what you do at home that matters, so there is usually ‘homework’ to do with a child between therapy sessions. This means that sometimes there is speech therapy, physiotherapy and occupational therapy homework to do. Each therapist may not be aware of what the other has said. These homework are usually given without being aware of everything else that an adult is dealing with at home such as medication, bed-wetting, other appointments, let alone the needs of the rest of the family.
The only person who knows it all is the parent or adult who usually has to process it all somehow. Professionals can significantly assist families by sharing information with each other, with the family’s permission. Clearly, efforts to improve communication and coordination can significantly improve service quality and effectiveness.
So what can help in service integration which requires both skills and good processes? Here are some suggestions:
In some cases, coordination moves to the level of significant collaboration that allows for integration of services, especially when specialist disability or early childhood intervention services provide support to mainstream organisations. We see this in the examples of the TeachMe Program of AWWA and the integrated services provided by Pathlight School in classrooms in mainstream settings. The opportunities for collaboration are open doors depending on scheduling, resources and deployment of professionals.
Some professionals are at times asked to collaborate with others who come from a very different perspective or discipline who don’t see family-centred practice as being central to their work. This can be challenging for everyone, yet whatever support family-centred professionals can offer to improve communication, coordination and integration with other services will be beneficial to children, young people, older people and families.
'Integration' is about working together to achieve better outcomes. When integration works well, people using services report satisfaction. This shift towards personalisation, person-centred care and family-centred practice is happening against expectation to deliver better service and support. Effective integration usually results in working in different ways with different people - this in itself can be a challenge because of the need to change relationships, shift perceptions and share responsibilities and information. To achieve integration, it is necessary to establish a common purpose and focus on wanted outcomes. Central to this process is being prepared to change the ways of working as the user perspective is the starting point for designing the service delivery. After all, only if integrated care is a means to an end rather than an end in itself then can we say that we have combined processes, services and resources to provide a better experience for the user.
Director-General of Social Welfare
Ministry of Social and Family Development