Beyond Organizing Structures: Necessary Conditions to Provide Integrated Care for Youth at-Risk in Practice

Youth at-risk face multiple and severe problems across various life domains and poses significant risks to themselves and others. The high-risk and high-pressure circumstances and unique needs of youth at-risk make providing integrated care for these youth challenging yet even more crucial. Integrated care refers to coherent, coordinated, and continuous support across services and sectors. This qualitative study explores the conditions necessary for providing integrated care for youth at-risk according to professionals, organizational representatives, and policymakers. Using a grounded-theory approach, we conducted 31 semi-structured interviews with professionals, organizational representatives, and policymakers across four Dutch youth-care regions. Seven observations of multidisciplinary case discussions were used to support triangulation. The study was co-created with stakeholders, including a youth representative who reflected on the findings. The iterative grounded theory analysis suggests that shared responsibility, shared care coordination, and professional autonomy are key conditions according to stakeholders. Stakeholders perceived that when one of these conditions was lacking, collaboration challenges and stagnation and insufficiency in care were more likely to occur. Stakeholders perceivedthat these conditions mutually influenced one another, such that deficits in one condition can undermine the others. According to stakeholders, providing integrated care in high-risk contexts involves continuous alignment, collective decision-making, and flexibility among professionals and organizations. Attention to these conditions may help support integrated care practices for youth at-risk.