Integrated health and social care for pregnant women and young families in a vulnerable situation in the Netherlands: Professionals' views on cross-sectoral collaboration

Purpose: This qualitative study investigated the perspective of professionals from the medical, social, and public health care sectors with regard to: cross-sectoral collaboration in providing integrated health and social care during the first thousand days of life (preconception up to children aged two years) for pregnant women and young families in a vulnerable situation. This knowledge is needed for the enhancement of cross-sectoral collaboration and the implementation of integrated care. Methods: Professionals (n = 35) were recruited from three deprived municipalities in South-Limburg, the Netherlands. Semi-structured interviews gained insight into professionals' views, by using a theoretical framework based on the 'National model for integrated care for childhood overweight and obesity'. Results: Professionals stressed the importance of addressing both medical and social risk factors in pregnant women and young families in a vulnerable situation. However, their interpretation of vulnerability differed, hindering collaborative working. Furthermore, cross-sectoral collaboration was restricted by lack of formal cooperation agreements between sectors, and unclear referral lines from the medical to the social sector. Professionals often did not know the expertise and role of other sectors. Digital information and referral systems are not connected between the sectors which acts as an inhibiting factor. Discussion/Conclusion: This study highlights the need and ways to facilitate collaborative working between the medical, social, and public health care sectors in delivering integrated care. Recommendations include: 1) Enforcing implementation strategies aimed at facilitating collaborative working: formal regulations, structured agreements, and use of consistent definitions and protocols to facilitate integration; 2) Strengthen informal connections between professionals by the Solid Start local coalitions; 3) Align all professionals, also those not directly involved in the Solid Start local coalition, with the goals and vision of the coalition; 4) Implement a joint digital file or IT referral system to improve cross-sectoral collaboration; 5) Enhance collaboration between sectors at case level through multidisciplinary consultation.