Integrated Community Care 4all. New Principles for Care. A strategy paper to move ICC forward.

The strategy paper wants to illuminate both the distinctiveness and diversity of Integrated Community Care (ICC). It aims to reinforce the case for ICC by charting the state of play around this much needed shift in health and social care systems.

The narrative and effectiveness principles presented in the paper are the result of a two-days expert workshop, hosted by TransForm to consolidate the learnings from the three TransForm conferences held in Hamburg (2018), Turin (2019) and Vancouver (2019)

The interactive presentation below offers a glimpse on the strategy to move ICC forward. To read more download the digital version of the paper free of charge.

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Interactive strategy paper

1. Context

Integrated Community Care (ICC) is moving to the forefront of an international policy and practice agenda.

In its most rudimentary form, ICC is recognized as a much-needed and valuable expansion of the more typical notions of integrated care, with explicit recognition of the value, potential and power of communities, citizens and ‘laypeople’.

However, this is a rather shallow vision on ICC.

In this interactive presentation we want to foreground the distinctiveness of the approach beyond a community-flavored version of ‘integrated care’.

Additionally we want to give a feeling for the richness and diversity of the landscape of ICC practices. It is not a standardized practice, but manifests itself in a range of practices that share a common core.

ICC points towards a paradigm shift at the citizen, community and system level. Lived experience, a shared vision on the common goals of a local community, distributed power and collective learning are its cornerstones.

Key is the move beyond ‘delivery’ to genuine ‘co-development’ with the individuals and communities that are traditionally seen as recipients. ICC engages and empowers people in the local communities and values the position of the informal care sector. Furthermore, it assumes accountability towards a territorially defined population. Place-based interventions are often designed to improve population health and strengthen community bonds simultaneously. This requires a dynamic, assets-based approach to community development. ICC is goal-oriented in nature, supporting people’s priorities and life goals and improves both health and social cohesion.

2. Stakeholder perspectives

ICC relies on four key stakeholders to join forces. Here is how they experience the practice of ICC:

THE CITIZEN/USER

  • I am the expert on my own health.
  • I feel my uniqueness and life goals acknowledged.
  • I know where to go for support.
  • I feel I am part of my community.

THE POLICY MAKER

  • I am part of and feel connected to the ecosystem of care.
  • My decisions are informed by a holistic understanding of the notion of health and wellbeing.
  • I recognize the merits of sharing power and decision making.

THE PROFESSIONAL

  • I am part of and feel connected to the ecosystem of care.
  • I recognize the user as the expert of his/her own health.
  • I have access to all the information I need.
  • I feel supported to perform at the highest quality.

THE COMMUNITY

  • We are embedded in the system.
  • We have sustainable resources and funding.
  • We have the opportunity, capacity and power to take part in decision making.
  • We are able to express and address the needs of our community.

3. Practice typology

In order to make sense of the existing and potential variety of ICC practice, we might consider them as underpinned by three key elements:
  • Their main instigators or champions:

individual citizens, professionals, policymakers, and/or grassroots organizations.

  • Their DOMINANT RATIONALE:

focused on care provision, on community building or on spatial-environmental development of a neighbourhood.

  • Their core ingredients or strengths mobilized in the practice:

related to the home, to the wider setting (place), to alliances and partnerships and/or to assets.

So it is the interaction between these three dimensions that give rise to a wide range of practices that can be seen as embodiments of ICC. This typology can be visualized as a set of slider bars, whereby each slider corresponds to one of the key axes. The slider bars illustrate then how the various practices of ICC can be positioned or assessed on these core dimensions or characteristics.

4. Effectiveness principles

How to turn Integrated Community Care from aspiration into reality? Here we propose a limited set of effectiveness principles to guide action in a complex transition.

An effectiveness principle is a clear and actionable statement that provides guidance for thinking and behaving toward some desired result. It informs choices at forks in the road, grounded in values about what matters to those who develop, adopt, and attempt to follow them.

Here are seven effectiveness principles for Integrated Community Care, grouped under three headings:

Co-develop health and wellbeing, enable participation

  • Value and foster the capacities of all actors, including citizens, in the community to become change agents and to coproduce health and wellbeing. This requires the active involvement of all actors, with an extra sensitivity to the most vulnerable ones.
  • Foster the creation of local alliances among all actors which are involved in the production of health and wellbeing in the community. Develop a shared vision and common goals. Actively strive for balanced power relations and mutual trust within these alliances.
  • Strengthen community-oriented primary care that stimulates people’s capabilities to maintain health and/or to live in the community with complex chronic conditions. Take people’s life goals as the starting point to define the desired outcomes of care and support.

Build resilient communities

  • Improve the health of the population and reduce health disparities by addressing the social, economic and environmental determinants of health in the community and investing in prevention and health promotion.
  • Support healthy and inclusive communities by providing opportunities to bring people together and by investing in both social care and social infrastructure.
  • Develop the legal and financial conditions to enable the co-creation of care and support at community level.

Monitor, evaluate and adapt

  • Evaluate continuously the quality of care and support and the status of health and wellbeing in the community by using methods and indicators which are grounded within the foregoing principles and documented by participatory ‘community diagnosis’ involving all stakeholders.Provide opportunities for joint learning.Adapt policies, services and activities in accordance with the evaluation outcomes.

5. Landscape of ICC practices – Community Health Centers

Community Health Centers (CHC) aim to meet a territorially defined group of citizens’ needs by offering high quality, accessible and integrated primary care from a broad, psychological and social perspective.

The patient is considered as someone with a personal history within the context of a family, a community and a professional and socio-economic environment.

CHC usually house several healthcare providers (general practitioners/family physicians, nurses, physiotherapists, social workers, psychologists, etc.) under one roof. These professionals form part of what is commonly known as the “primary care” network and work in a interdisciplinary fashion.

With its activities, a CHC wants to contribute to an open, solidary, just and sustainable society with attention and respect for diversity in all its aspects. In organizing and providing care, the CHC applies the principle of proportionate universalism. The supply is qualitatively and quantitatively attuned to the goals and care needs of patients and local residents. Community health centers have the capability to deliver a broad array of primary and preventive care services, and to offer numerous enabling services such as case management and health education.

6. Landscape of ICC practices – Caring communities

Caring Communities promotes collaboration between different members of the community, capitalizing on the ability of patients and citizens to create social connections and take care of each other.

The mission is to partner with patients, citizens, professionals and decision-makers to bridge informal and professional care.

Patient and citizen partners meet with patients on a regular basis to discuss issues related to their illness, social situation, life project, and find ways to reduce the impact of obstacles on their daily life as citizens, by collaborating with other members of the community (e.g. patient’s family, clinician, community worker).

The idea of a ‘caring community’ can represent an enormous diversity of practices, drivers, target groups and aspirations. However, in many cases, CC originated within a primary care setting, where project co-leaders started caring together for patients in situations perceived as “clinical gridlocks” by professionals.

7. Landscape of ICC practices – Healthy place making

Significant gains in population health can be achieved by working in partnership to improve the built, natural and social environments.

Health-promoting infrastructure, activities and opportunities need to be accessible to all, with a targeted focus on groups with the poorest health outcomes.

Healthy place-making works in part by acting as a connector and catalyst in local systems. The approach places significant value on collaboration and co-design between professionals and local people. The concept of ‘healthy place-making’ builds on this by asserting that an explicit goal of those involved in place-making should be to improve the health and wellbeing of the local population.

Participating sites often start with creating a small team of people with explicit responsibility for bringing partners together and facilitating dialogue across sectors. There needs to be concerted action on health inequalities as part of efforts to create healthy places, informed by data on the specific health needs of local communities.

8. Wrap up

Key in ICC is the move beyond ‘delivery’ of health and social care systems to genuine ‘co-development’ with the individuals and communities that are traditionally seen as recipients.

It gains pertinence against the background of deep trends in society and in health care systems. ICC connects to a positive, empowering conception of health. It also wants to be a positive force for change in the multiple transitions to a new, sustainable equilibrium for our societies.

Therefore:

  • ICC engages and empowers people in local communities.

  • ICC assumes accountability towards a territorially defined population.

  • ICC is inclusive and reaches out to underserved and marginalised groups.

  • ICC’s activates and reinforces the social ties between people.

  • ICC is goal-oriented in nature, supporting people’s priorities and life goals.

  • ICC requires social, economic and environmental determinants to be properly addressed.

  • ICC comes down to a continuous process of whole-system innovation.

  • ICC requires a social movement to make it a reality.

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