Commonality of 25 Component Themes of integrated care for children: rapid review of 170 models

AbstractIntroduction: The components of integrated care for children, young people and families (CYPF) listed across existing authoritative guidance is generally consistent; the guidance suggests a list of components that should ideally be considered for implementation. Local system managers report specific challenges around integrating system-wide funding, trusted workforce relationships, and CYPF engagement. We aimed to systematically generate a list of components of integrated care from existing systems and models for CYPF, assess their commonality, intended target(s) of impact, and compare these findings with guidance and local system managers’ concerns. Methods: PubMed, CINHAL and Cochrane CENTRAL were systematically searched (01/01/2016 to 31/12/2023) for studies of any design, conducted in high-income countries, describing components of an integrated care system or model for CYPF. Following data extraction, individual components within studies were coded a) using the framework method to generate Component Themes b) for their intended target(s) of impact; system (S), users (U) and/or workforce (W). Simple analytic methods were used to rank and map the commonality of Component Themes and their intended target(s) of impact. Subgroup analysis was conducted for four public health priorities: mental health, learning disabilities and autism, obesity, and early years.Results: From 170 studies, 1057 components nested in one or more 25 Component Themes of integration were identified. None of the studies identified all Component Themes (median 5, range 1-16). Most commonly identified were ‘shared professional responsibility and practices’ (in 58% of studies; intended targets of impact S and W), ‘stronger connections and partnerships’ (52%;SUW), ‘empowerment of service users’ (36%;U), ‘early detection and prevention’ (32%;SUW) and ‘training of parents’ (32%;SUW). Those not commonly identified were ‘finance/budgeting’ (8%;S), ‘family engagement’ (12%;U), 'leadership’ (11%;W), ‘empowering staff’ (8%;SUW), and ‘role of language and culture’ (5%;SW). The commonality of Component Themes for all studies combined and for each of the four subgroups was very similar and is described in visual representations. Alignment with guidance and local system managers’ concerns is discussed.Conclusion: We suggest this list of Component Themes and their intended target(s) of impact be considered when updating guidance on integrated care for CYPF. Existing guidance may benefit from additional implementation support around the integration of finance across the system; leadership, empowerment, language and culture across the workforce; and embedding meaningful CYPF engagement.