Abstract
Summary
Families with multiple and complex problems often interact with numerous professionals, leading to fragmented care. Integrated social care aims to address this, but there is limited knowledge about effective approaches from families’ perspectives. We studied social-neighborhood teams in Amsterdam Nieuw-West.
Findings
From 31 interviews with 19 participants from 11 families, we used inductive analysis to identify five key themes in families’ experiences with integrated social care: “(dis)trust,” “perspective on the future,” “control and overview,” “self-efficacy,” and “participation.” These themes were illustrated by 16 CAIMeR configurations explaining what works, for whom, and why, such as addressing families’ actual needs, ensuring effective coordination, and promoting active professional involvement in multidisciplinary meetings. The CAIMeR approach provided a structured framework examining the interaction of context, actors, interventions, mechanisms, and results across various family situations. For example, in complex scenarios involving diverse youth care professionals (actor), families face risks to children's safe development (context) and often experience frustration and anger due to perceived neglect of their own needs by social workers and specialized youth care workers (intervention), leading to family members feeling unheard and shutting down (mechanism), resulting in anger and frustration (result).
Applications
When social care focuses mainly on the child, parents tend to feel overlooked and unheard, which harms their relationship with care professionals. Trust between professionals and families is crucial, and effective collaboration among professionals, supported by coordination and active participation in multidisciplinary meetings, contributes to improved outcomes.
Keywords
Introduction
Families dealing with multiple and complex problems such as financial debts, problems related to interpersonal relationships, parenting responsibilities, mental and physical well-being, and housing require all-encompassing support (Bodden & Deković, 2016; Knot-Dickscheit & Knorth, 2019; Morris, 2013; Visscher et al., 2020). Addressing these issues comprehensively across all areas of life is essential in supporting these families (Visscher et al., 2018, 2022). In these cases, multiple professionals from various organizations are often engaged with diverse expertise (Brooks et al., 2013; Parr & Hayden, 2019; Tausendfreund et al., 2016). Families need comprehensive service delivery, which requires interprofessional collaboration and coordination of care. These elements are important in supporting families effectively (Eastwood et al., 2020; Sousa & Rodrigues, 2012). However, connected requirements are often not met sufficiently, making integrated social care, which focuses on collaboration between service providers within the social domain or social care system, an important principle in supporting these families (Nooteboom et al., 2021).
Despite the supposed benefits of integrated care in fields such as medical, mental health, social services, and community support, its definition is subject to debate (Armitage et al., 2009; Baxter et al., 2018). A commonly utilized definition of integrated care is as follows: An approach to strengthen people-centered health systems through the promotion of the comprehensive delivery of quality services across the life-course, designed according to the multi-dimensional needs of the population and the individual and delivered by a coordinated multidisciplinary team of providers working across settings and levels of care. (World Health Organization, 2016)
In this study, we rely on this widely used definition of integrated care to emphasize the study of the collaboration and coordination between various social services, distinct from, for example, medical care or social and medical care, aiming to enhance support for families with primary complex social problems.
In the Netherlands, social support is typically provided by social-neighborhood teams (“wijkteams” or “buurtteams” in Dutch). These multidisciplinary teams offer accessible, community-based assistance to individuals and families, often addressing issues related to social care, mental health, youth support, and financial difficulties. Social-neighborhood teams can be organized differently, depending on the municipality's policy. For example, some focus specifically on youth and families (like parent-child teams), while others address issues related to social security. However, as a rule, they offer generalist support in all areas of life and collaborate with various social and healthcare organizations, such as specialized youth care organizations, mental health organizations, and municipal social services (van Arum et al., 2020). Despite the significant role of social-neighborhood teams in providing integrated social care, there remains a gap in understanding how this approach functions for families. As far as we know, there is no research into what works in integrated social care from the perspective of families, why, and under what circumstances. More comprehensive knowledge of the experiences and perspectives of families is necessary to equip social workers so they can collaborate and coordinate the various involved social services and thus create integrated social care to better support families. Additionally, more comprehensive knowledge can help policymakers develop and organize integrated social care to its full potential. Therefore, this study focuses on the lived experiences and perspectives of families receiving integrated social care. We investigate what works for these families, under what circumstances, why, and how.
Study Setting
This study is situated in Amsterdam Nieuw-West, where the non-profit SEZO provides social care funded by the municipality. SEZO operates eight social-neighborhood teams with 173 professionals addressing issues such as poverty, debt, and housing. The area has 163,448 residents, 37% of whom have a low socio-economic status, and 52% of residents have a migration background (Municipality of Amsterdam, 2024).
SEZO's social-neighborhood teams serve as the first point of contact for residents, with a generalist social worker assessing needs and providing support throughout the process. When needed, they collaborate with internal specialists (e.g., debt or social counselors) and external services. A key partner is the parent–child team, a city-wide, municipality-funded service offering specialized support to children and families. While SEZO social-neighborhood teams address general parental and social security issues, parent–child team professionals focus on more specialized youth care needs. Although both are independent, the municipality mandates their collaboration in providing integrated care (Municipality of Amsterdam, 2021; Parent-Child Teams, 2022).
The Amsterdam-Tailoring Method
The municipality of Amsterdam uses the Amsterdam Tailoring Method, which is applied by social-neighborhood teams, parent–child teams, and other municipal organizations. This method offers a generic and effective approach to supporting individuals and families. It consists of five principles: First, “Know the client or family,” where the client's or family's perspective is central, starting with a broad assessment of all areas of life. Second, “Multidisciplinary team,” where professionals work together within a team around the client or family. Third, “Mandate and expertise,” where professionals have the authority and expertise to create tailored solutions in consultation with the municipality. Fourth, “Integrated Approach,” where professionals use an integrated perspective and work together based on a uniform plan. Fifth, “No referrals,” where professionals directly involve the required services, with a care coordinator supervising the support process (Municipality of Amsterdam, 2021).
Methods
We conducted in-depth interviews with family members receiving integrated social care, and the results were subjected to an inductive analysis, followed by the application of the theoretical and conceptual CAIMeR model (Blom & Morén, 2010). The goal of the inductive analysis was to gain in-depth insight into the interview data by identifying overarching themes describing the lived experiences of families receiving integrated social care. The choice of the CAIMeR model stems from its capacity to study whether the elements of integrated social care work as intended, and to provide a deeper understanding of what works, for whom, why, and under what circumstances (Blom & Morén, 2010; Bool et al., 2019; Hermans, 2014).
The CAIMeR model, an acronym for Context, Actor, Intervention, Mechanism, and Result, was developed to assess the process and effects of social work interventions, providing a comprehensive understanding of their complexity and dynamics (Blom & Morén, 2010). The CAIMeR method originates from the meta-theoretical perspective of critical realism as developed by Pawson and Tilley (1997). Critical realism assumes that social interventions do not work universally but depend on specific contexts and mechanisms. Mechanisms refer to the underlying causal processes that generate outcomes, while contexts determine whether and how these mechanisms are activated. The CAIMeR approach, based on this logic, allows for an analysis of how the different CAIMeR components influence each other and lead to outcomes in integrated social care. This approach helps to explain not only what works but also why and under what circumstances. However, the CAIMeR method is specifically designed for evaluating social work practice rather than for evaluating or further developing a program theory, which is the aim of the realist evaluation developed by Pawson and Tilley (Blom & Morén, 2010; Pawson & Tilley, 1997). In-depth interviews are considered essential for gaining insights into stakeholders’ perspectives and enhancing the understanding of the mechanisms at play in social work practices (Pawson & Tilley, 1997).
Data Collection
Between July 2022 and May 2023, a total of 31 semi-structured interviews were conducted with 19 family members from 11 families receiving integrated social care from the SEZO social-neighborhood teams. The interviews were conducted by the first author, a social worker and researcher with extensive experience working with families facing multiple and complex problems. Family members were interviewed individually or together based on their preferences and practical considerations. This approach respected participants’ comfort and allowed flexibility in data collection. While people might feel less free to speak openly when family members are present, in this case, this was based on their own choice, so we expect this to be less of an issue in this context. Content-wise, joint interviews might have influenced responses toward a unified narrative, while individual interviews could provide more personal perspectives. This likely reflects real-life dynamics, where experiences are often shared as well as individual. Of the 31 interviews, 20 were conducted separately with mothers, 4 with fathers, and 4 with both fathers and mothers together. Three interviews also took place with children (aged 12–18). Twenty-eight interviews were held at the respondent's home, and three at another neutral location, reflecting the preferences of the interviewees. The average duration of the interviews was 70 minutes. Of the 31 interviews, 27 were conducted in Dutch and four in English. The quotes presented in the results section were translated from Dutch into English by the first author (MVE). Field notes were taken during the interviews. Although offered the opportunity, none of the respondents chose to read the transcripts afterwards. All interviews were recorded, transcribed verbatim by a transcription office, and checked by MVE and AdJ.
For the interviews, a semi-structured questionnaire with open questions was used to understand the family members’ experiences with integrated social care. The questionnaire included known barriers and facilitators, such as collaboration and communication among professionals, perceived completeness of the support, and (lack of) trust in professionals (Nooteboom et al., 2020). Based on the principles of critical realism, the questionnaire was supplemented with questions targeting the underlying elements, such as where and why the support did (not) work well, and what the contributing factors were (Pawson et al., 2005).
Example questions included in the questionnaire are:
Which care providers are involved? How do you experience the support you receive? What makes the support work well or not? How do you think it works or doesn't work?
Prior to the interviews, two pilot interviews were conducted by MVE, indicating that the questionnaires were satisfactory, and further adjustments were deemed unnecessary.
Recruitment and Selection of Respondents
Social workers from the social-neighborhood teams working with families facing multiple and complex problems in Amsterdam Nieuw-West were asked to select eligible families from their caseload. The criteria for families to be included were: receiving support from the Amsterdam Nieuw-West social-neighborhood teams (SEZO) and facing a combination of (at least) two areas related to socio-economic problems (e.g., poverty, debts, unemployment, and housing problems), psychosocial issues (e.g., psychological problems, chronic illness, domestic violence, and addiction), and/or psychosocial problems in children (e.g., mental health problems, behavioral disorders, and sexual abuse). Families had to consist of at least 1 adult and 1 child aged 0 to 22 who were living at home (NJi, 2020).
Initially, families were contacted by their social workers. Despite some hesitation from social workers concerning burdening families, these concerns were alleviated by MVE through personal contact, trust-building, and promoting awareness, leading to the inclusion of 11 families. After the social worker asked the families if they were willing to be contacted, the researcher (MVE) provided study information directly. Families decided independently, without pressure, and participation did not affect their support. This was explained to them, and they were given ample time to consider. When families were still willing to participate, the interviews were scheduled.
For a thorough understanding, multiple interviews were conducted with all family members except the children. In one family, the father had two separate interviews due to relationship issues. Another family withdrew from the study after the second interview, while two other families, facing a forthcoming move and heightened tensions, did so after two interviews. One family declined to participate after being contacted by the researcher, without providing a specific reason. Table 1 provides an overview of the interviewed family members.
Table Overview of the Interviewed Family Members.
Each family received 25 euros for their participation. In our study, we were mainly interested in the perspectives and experiences of family members; therefore, we did not conduct interviews with children under 11 years of age.
Data Analysis
We performed the analysis in two steps. First, to gain an initial understanding of the data's content, all 31 transcripts were inductively coded by MVE using the data analysis program Atlas.ti (version 23.2.3). This was done following a flexible interpretative approach to qualitative data analysis as outlined by Creswell and Creswell (2017). Codes were assigned to statements about receiving support. Similarities and patterns were then identified from the codes and grouped into categories, such as “distrust in care provision” and “family members experience a high degree of stress.” As a form of inter-rater calibration, 20 transcripts were also coded by AdJ, and differences were discussed.
In the second step, the data were searched for CAIMeR elements, and the resulting CAIMeR configurations were compiled. This involved searching the data for elements related to (C) contexts, referring to the intervention context and the client's lifeworld, (A) actors, e.g., individuals involved, (I) interventions, actions by social workers, clients, or other stakeholders, (M) mechanisms, explaining factors, and (R) results and effects, client experiences and outcomes (Blom & Morén, 2010). The CAIMeR configurations were formed from the relationships between these elements. The analysis underwent a reliability check in consultation with all authors, confirming the accuracy and alignment with their experiences of the approach. A member check was carried out with three family members. After conducting eighteen interviews, data saturation was determined by MVE and AdJ.
Results
Demographics
Descriptive statistics summarize the characteristics of the respondents (Table 2). The interviewed family members had a mean age of 35.5 years, and 52% of residents had a non-Western background. This is consistent with the geographical data of Amsterdam Nieuw-West.
Characteristics of the Respondents.
The 11 families mostly faced parenting, poverty, housing, and employment problems. Additionally, (mental) health issues, domestic violence, and refugee concerns were common. Less frequently, families also faced addiction and legal issues (Table 3).
Problem areas of the families.
The Five Themes and the Subsequent CAIMeR Configurations
Initially, we identified 151 CAIMeR configurations, which we reduced to sixteen configurations in five overarching themes: (dis)trust, perspective on the future, control and overview, self-efficacy, and participation. The 16 CAIMeR configurations are detailed per theme in the following five paragraphs. For each configuration, a (C) appears after a description of the context, an (A) after a description of the actors, an (I) after a description of the intervention, an (M) after a description of the mechanism, and an (R) after a description of the result. In the Results section, all CAIMeR configurations include two quotes from respondents to illustrate trends or salient statements. These quotes are selected based on their representativeness or distinctiveness. Each quote includes the role of the respondent (mother or father) and the family number (e.g., Family 1).
Theme 1: (Dis)trust
As the first theme, ‘(dis)trust’ was identified, and we found six CAIMeR configurations derived from interviews with family members regarding the integrated social care they receive. The first five CAIMeR configurations concern trust-related elements in general, while the sixth specifically focuses on (dis)trust in youth care workers due to their exclusive child focus and fear of out-of-home placement.
1. Several family members who have had negative experiences with social services in the past, who experience a lot of tension, and who expressed a sense of distrust toward them describe (C) that when social workers and youth care workers (A) radiate calmness, demonstrate involvement, work outside established rules and protocols, and strive to create a real connection through genuine interest, attentive listening, and making family members feel welcome by sharing something about their personal lives or experiences (I); they create an environment in which family members feel supported in solving problems or addressing their issues, giving them a sense of recognition, humanity, and involvement (M). This makes them feel comfortable opening up and accepting help, making families more receptive to support (R). A mother said: A small piece of private explanation is appreciated if, for example, a social worker cancels an appointment. For example, in a way such as ‘I'm having a private drama right now and that's why I can't work today,’ that makes it a lot easier. A social worker is also a human being. Then I don't feel so rejected by someone who doesn't have time for me. (Mother, Family 2) Another mother said: The contact with the social worker must be successful and authentic. When I approach you with my problem, I need to feel that click of: ‘You are welcome, you are safe here.’ We want to come to you with our problems. And if you don't open up and we already have the problem, we shut down. And if you don't open up, we shut down even more. And then it won't be successful. (Mother, Family 1) 2. Several family members who have had negative experiences with social services in the past, who experience a lot of tension, and who expressed a sense of distrust toward them describe (C) that some family members highlight the effectiveness of a situation where there is a confidential and positive collaboration with the social worker (C). In such scenarios, a proactive approach by the social worker (A), taking charge in a supportive manner and clearly outlining the plan (I), creates a sense of safety and trust (M). This fosters an environment where family members willingly embrace the support, ensuring the right actions are taken (R). A mother said: In a kind of safe way, my social worker said, in a kind of protective way. No, we are not going to do what you are planning. Listen, we're going to do it this way, it's better for you. You can't see it, but believe me. This is better for you. (Mother, Family 2) Another mother said: I would just like to have a caregiver who knows where I can go with my questions, and not only my questions, but also how my children can be helped. Someone I can turn to, who will actually take action: someone who also has influence, who not only tells me what to do, but also ensures that something happens. If the agency does not keep their agreements, then there should be sanctions or something. (Mother, Family 11) 3. Many family members indicated that dealing with multiple complex problems is complicated and they often feel overwhelmed and at risk of disengagement (C). In cases where the social worker (A) proactively reaches out through calls, messages, or offering advice (I), fostering a sense of trust and involvement (M), this provides a collaborative relationship with the family members, establishing a more trustworthy basis for ongoing support (R). A mother said: When the debt counsellor emails someone, he always puts me in the CC. I always know what he has done. And that was just soothing for me. I knew then, okay, I know he's working on it, I know what was sent and nothing is happening outside of me. (Mother, Family 5) My social worker of the social-neighbourhood genuinely wants to help us as a family. She doesn't just act upon requests; she aims to achieve meaningful outcomes. This fosters a sense of trust in our collaboration and gives me a good feeling. (Father, Family 4) 4. When there are many complex problems and families feel that transparency is important in their dealings with social services and organizations (C), it is crucial that social workers or debt counselors from the social-neighborhood team (A) maintain openness in their interactions. This can be achieved, for example, by involving family members in email communications or by providing updates on contacts made (I). Transparency promotes trust and clarity (M), and provides the basis for better coping mechanisms and reliable collaborative support (R). A mother said: It is important to me that the social worker opens up and involves me if, for example, he has spoken to someone about your situation. Or that he says: I sent an email with you in the CC. It's not much effort, but then you know that and that's nice. (Mother, Family 5) The debt counsellor—I've mentioned this several times. I'm in the process, but creditors keep knocking on my door. All I asked was for him to send an email saying: ‘Please put this on hold, we’re working on debt counselling,’ so the debts don’t increase. To this day, nothing has been done. It feels like stubborn obstruction. (Mother, Family 11) 5. Numerous family members express struggling with high staff turnover (C). When there is a seamless transfer of the current situation from one professional to another, whether it is a social worker or a youth care worker (A), coupled with a thorough reading of the file (I), it instills a profound sense of care, trust, and involvement among family members (M). This dynamic sets the stage for a sustainable foundation of support and fosters enhanced collaboration between social workers and the family (R). A mother said: When a new social worker comes, she needs to look at the file. My file was so large that they didn't read it anyway. I don't feel like explaining over and over again why I need or don't need something, or anything else. I've been in this situation for years. (Mother, Family 1) The first conversation was very awkward because we had to start a conversation, and you don't know what to talk about. She clearly hadn't read my file, not even the second time. She asked me things and even admitted she hadn't read anything. I thought, why come so unprepared? Isn't that your job? (Mother, Family 8) 6. In a complex scenario with various social workers and professionals from diverse youth care organizations, where children's safety is crucial, families face potential risks regarding their children's safe development. This is often coupled with negative experiences with youth care organizations (C). The support, both practical and emotional, offered by both the social worker and the specialized youth care workers (A) tends to hyper-focus on the children (I). Family members feel their own needs receive minimal consideration, leaving them frustrated and unheard (M). This results in family members shutting down, fueled by anger and frustration, as they perceive a lack of genuine listening and serious acknowledgment (R). A mother said: Recently I told the youth care worker, ‘Sorry, but I don't actually need you.’ I say, ‘It may seem harsh, but I really don't need you.’ When have you ever asked me how I am? You are here three times a week. Have you ever asked me: ‘How are you?’ Not a day, not a minute, not a second. When you walk in, you throw your bag down as if you were in an office space. You throw down your bag and immediately ask, ‘How are the children?’ (Mother, Family 1) But they keep hammering on the safety of the children. I see that they are there for the children, you know, but they are not there for our relationship. It's purely about the children. And what's going on in your mind is not important. (Father, Family 1)
Theme 2: Perspective on the Future
The second theme identified is “perspective on the future.” Many family members struggle to envision a positive outlook on the future. Three CAIMeR configurations, numbered 7, 8, and 9, suggest how integrated social care improves this perspective.
7. In the context of housing and financial problems, some family members show a positive change in their outlook (C) when social workers (A) adopt a proactive attitude, such as actively informing family members, providing practical help and suggestions, and demonstrating collaboration between social workers, debt counselors, and legal advisors within the social-neighborhood team (I). This positive and cooperative interaction increases confidence in finding a solution (M), resulting in less stress, a sense of hope, and less worry about the future (R). A mother said: When the school calls her about my partner issue, they can't handle it because they don't know how. But they have someone who can help. That's why they call my social worker to ask about the situation. So, I explain everything to her. She said, ‘We're going to work together as a team to make sure that..’ Yeah. (Mother, Family 9) What the social worker from the social-neighbourhood team does is gauge the situation. Just gauge it. Then she can think for herself, ‘It's not going well, I think we should visit,’ or something like that. And the social worker from the social-neighbourhood team does that very well. She can also assess for herself, ‘We'll see how it goes next year.’ (Mother, Family 2) 8. Some family members mention the long-term uncertainty about their stay in the Netherlands with regard to migration policy. This uncertainty becomes an important source of stress and an obstacle to support, for example in the areas of work and finances, due to the lack of a clear residence status (C). Social workers (A) who convey the message of ‘it will be okay, don't worry’ (I) play a crucial role. When family members internalize this support (M), they are better equipped to handle the situation, increasing confidence in the future (R). A father said: The social worker tries everything to help us. Since last year, we're fighting. She tried. She didn't give up. She was giving me hope. She said don't worry. I know your partner is not working. It's going to be fine. (Father, Family 9) My debt counsellor was very empathetic. He listened. For example, I said: ‘Sorry, I'm so bad today. I should have sent it. I'm sorry. Can I have two more days?’ And then he also said very immediately: ‘No, no. Take it easy. Don't worry.’ (Father, Family 4) 9. Several family members shared how, in situations where waiting lists, bureaucratic delays, or misunderstandings about legislation impact the process of debt assistance (C), fostering positive and collaborative connections between families and all stakeholders involved (e.g., social workers, debt counselors, general practitioner) (A) can be helpful. Actively seeking contact on crucial matters, showing involvement and proactivity (I) cultivates a feeling of commitment and trust (M). This not only enhances the family's ability to cope with the situation but also instills greater confidence in the future (R). A father said: The conversations with the social worker are always good. She didn't give up. She always gives me hope. And she also mentions positive points in the situation. Maybe we can solve it. That gives me hope and that really helps me. (Father, Family 1) The social worker from the social-neighbourhood team will visit again soon. And then we'll just see how things are. It's quite nice, I wouldn't say we're friends, but it gives a bit of a friendly vibe to encourage you to keep doing things, like keeping your administration in order, if there's anything else going on. (Mother, Family 2)
Theme 3: Control and Overview
The third theme, an element in social integrated care that works for families, is “control and overview.” Many respondents stressed the need for a designated point of contact to manage numerous contacts and consultations, supporting them in maintaining control and overview. Four CAIMeR configurations, numbered 10, 11, 12, and 13, relate to this theme.
10. In a setting filled with numerous rules, and in which administrative tasks and standard procedures hinder problem-solving, family members can openly express the difficulties they face (C) when the social worker (A) is available outside of regular office hours and/or takes unconventional approaches that deviate from established protocols, advocating for the interests of the family and offering practical assistance and active support with administrative tasks (I). This promotes a sense of reassurance (M) and involvement among family members (R). A mother said: My social worker regularly calls me to ask how I was doing and such, how I was doing and what was happening to me. She then asks, for example I know two caregivers: those who work outside the book and those who work by the book. I don't want to see the book. If I notice it in the first two conversations, I feel like, go away, I don't have time for this. […] You can sometimes deviate from the guidelines. And, looking at things from a human perspective, that's what I often miss with some caregivers. (Mother, Family 7) 11. Many family members state that in the midst of various challenges, such as administrative burdens, language barriers, and stress (C), they value it when social workers (A) help them in a proactive manner with practical matters (I). This ensures that they develop more control and an overview of their situation (M). This, in turn, enables timely administration management, averting larger issues like debt and poverty (R). A mother said: I just think it's very nice that the social worker helps me with those letters and papers and helps with solving all kinds of practical matters. Things that had been unresolved for years. It helps, I didn't know where to start. (Mother, Family 2) The social worker has arranged my finances for me and has also set up an appointment with someone who will manage everything I pay each month. Regarding money, financially. How much money is spent per month, how much money stays with you, is it good or not good, etc. She helps to get my finances in order. This gives me calmness. (Father, Family 4) 12. Facing multiple and complex challenges, family members often find themselves overwhelmed by the multitude of professionals involved (C). Amid this complexity, clarity emerges as a beacon when it is evident which professional, be it the social worker or a youth care worker (A), takes charge and keeps track of agreements made, especially during meetings (I). This not only instills a reassuring confidence that actions are carried out (M) but also, more profoundly, affords them an overview and control of their lives (R). A mother said: I am very satisfied at the moment. The social worker is the director who puts everyone to work and everyone responds very nicely to that and things are picked up. If I had to do this myself, I wouldn't get that far in five years. (Mother, Family 5) There are so many people involved that they are driving me crazy. There needs to be one person in charge. I have to email hundreds of people with different stories. They contradict each other. It is just a big headache. (Mother, Family 11) I am a mother of four children. I often cannot sleep. I have to take care of my children. I can't handle a lot of appointments because of this. That just doesn't always work. It is important to me that the care providers understand this. (Mother, Family 6) Yes, I really struggle when I've had too many stimuli; that's the main issue in my life, too many stimuli. And if I don't sleep well, for example, after a broken night with the kids, I can't handle all those conversations at 11 in the morning. I just think, people, leave me alone for a while. (Mother, Family 7)
Theme 4: Self-Efficacy
The fourth theme is self-efficacy. Consistent with the definition given by Bandura (1977), family members perceive self-efficacy as the confidence in their own ability to navigate challenges (Bandura, 1977). Stressors like poverty and housing often lead to feelings of insecurity. Multidisciplinary consultations can increase insecurity, whereas proactive support from social workers and assistance with administrative tasks are valued for enhancing confidence and self-efficacy. One CAIMeR configuration, number 14, fits this theme.
14. In a situation where many problems come into play, there is a lot of stress, and family members are uncertain about raising children or handling their problems (C), the social worker (A) offering compliments (I) on how they are handling the situation (M) leads to an increased sense of self-efficacy by family members (R). A mother said: My social worker sees me with a few compliments. She sees me as a person. She sees what I need and she adapts accordingly. That's really cool. She sees that I do have potential, but that I think so little of myself at the moment. That's what you get after seven years of abuse and mistreatment. But, she sees right through that. (Mother, Family 8) I need someone who stands behind me. So, not someone who is negative about it. Someone who will stimulate me, saying, ‘You're doing well,’ giving good compliments, like ‘You're doing well.’ Look, my social worker does give me compliments, but in her own way. (Mother, Family 6)
Theme 5: Participation
The fifth theme is “participation.” Family members emphasize the importance of participating in society in general, but also specifically in the decision-making and support process. They highlight the need for assistance to be tailored to their individual needs and preferences, i.e., their unique pace in receiving support. Most also rely on support from neighbors, friends, family, or volunteers, indicating active participation in seeking assistance from their personal networks, although most prefer to maintain a distinction between professional and personal support.
Two CAIMeR configurations, numbered 15 and 16, fit the theme of participation from the perspective of family members.
15. Several families face multiple and complex problems and lack self-confidence, making it difficult for them to handle challenges. They indicate that when the (C) social worker or a member of their social network (A) helps them navigate the social care system (I), it becomes easier for them to find their way through it (M). This support gives them the opportunity to actively participate in society. A mother said: My social worker, he's a very helpful man. He's a very clever man. Whenever I ask him about anything… Even if he doesn't know what the solution is, he tries and answers me later. Or he guides me to other people or organizations who can help me. Yeah, actually, he helps me a lot and it gives me a feeling that I have more control over my life. (Mother, Family 3) I was encouraged to go to the social-neighbourhood team so that they could help me with my administrative work. My friend said to me, please, go to the social-neighbourhood team. There are social workers there who can help you. That's how I got into it. (Mother, Family 1) 16. Some family members indicate that when consulting with multiple professionals, stress or language barriers significantly influence their involvement during multidisciplinary consultations (C). The social worker of the social-neighborhood team (A) can play an important role by proactively preparing and involving family members in planning consultations. This includes discussing ways to provide support, taking notes during the conversation, and providing support and debriefing with the family afterwards (I). Such preparation allows family members to participate in the conversations with more confidence (M), facilitating their active engagement in conversations with multiple professionals (R). A mother said: I really can't keep up with those conversations. I feel like I'm failing really badly because I'm just not keeping up with the conversation and I'm wondering ‘Why can't I do that? I'm old enough, I'm smart enough, why can't I participate in the conversation?’ It makes me very insecure. (Mother, Family 8) I had to keep my head in the game about who was saying what, sometimes taking notes, like: ‘Okay, these professionals say this and those say that.’ Yeah, with the help of the social-neighbourhood team, I managed. They helped me after I complained about how I could keep up with it. (Father, Family 1)
Discussion
In this study, we outlined the lived experiences of families receiving integrated social care and explored the critical elements of what works for families facing multiple and complex problems, under what circumstances, why, and how.
The results highlight the critical role of trust in supporting families facing multiple and complex problems. Previous research underscores widespread distrust among families toward social support, particularly youth care (Nooteboom et al., 2021; Serbati, 2020). Most participants in our study also expressed negative experiences with youth care, contributing significantly to this distrust. Interestingly, the majority of families, with some exceptions, reported satisfaction with the support provided by social-neighborhood team social workers. They appreciated aspects like genuine listening, proactive engagement, and addressing issues like debt and poverty that directly impact parents. Our research revealed that an overemphasis on child safety, often associated with youth care involvement, can strain parent-professional relationships and diminish trust. In contrast, social-neighborhood social workers prioritized parental issues such as social security, fostering greater confidence among parents compared to youth care professionals.
Although it is a strength of the social-neighborhood team that social workers can connect with parents more easily due to their position, it is important that they pay sufficient attention to the needs of children and youth.
Although we did not interview children directly, the literature indicates that ensuring the safety of children and youth, listening to their voices, and involving them in support processes are crucial (Collins et al., 2021). This prompts questions about whether enough attention is given to children's perspectives within families, as highlighted in related literature (Collins et al., 2021; Davies & Wright, 2008; Falch-Eriksen et al., 2021). While social-neighborhood teams benefit from easier parent connections, they must also prioritize children's needs. Collaborating closely with youth care enhances holistic approaches, ensuring parents, children, and young people are heard across all life aspects, which is key in Dutch reforms (Swagers, 2015). Partnering different professionals, such as social workers focusing on parents and others on children (Thoburn et al., 2013), proves advantageous. Notably, involvement extends beyond social and youth care to include debt counselors, family counselors, psychologists, and addiction specialists.
Our study also showed that in many cases, there was involvement of multiple professionals and organizations. From the perspective of parents, it emerged that in integrated care it is important that they can handle the involvement of all these organizations in their lives. Maintaining an overview of the number of appointments and actions is crucial for many families. In line with other research, this underlines the importance of care coordination. Care coordination involves multidisciplinary consultation with multiple professionals (Eastwood et al., 2020). Within the context of the Amsterdam-tailoring Method, great value is placed on focusing on the family's perspective (Municipality of Amsterdam, 2021). It is therefore important that family members, especially parents, participate in these multidisciplinary meetings. Our research showed that participation is also seen as important by family members themselves, but at the same time, it is experienced as very burdensome. There is often stress among family members and language barriers play a role. It is therefore very important that parents are well supported, both in the preparation and during and after the consultation. This support ensures that parents can participate and that their self-reliance is increased.
The findings highlight the importance of ethical principles in social work, such as self-determination and participation (International Federation of Social Workers, 2018). It is crucial to ensure trust, transparency, and autonomy, allowing families to make informed decisions about their care. The study emphasizes the need to balance the needs of both parents and children, aligning with the principle of respecting autonomy.
Additionally, the study shows that care coordination should be conducted ethically, preventing families from being overwhelmed by the number of professionals involved. Social workers play a key role in managing these ethical considerations, ensuring that families’ rights are respected and addressing power dynamics in interventions.
Social workers who work from different organizations, such as those focused on social security and those focused on youth care, can complement each other. However, collaboration between these organizations is often fragmented (Nooteboom et al., 2021). Further research on how to combat fragmentation and on the conditions for interprofessional collaboration between organizations that focus on social security and organizations that focus on youth and families is therefore necessary. In addition, specific research is needed into organizing integrated care. Finally, further research is needed regarding the participation of family members during multidisciplinary meetings.
Limitations of the Study
A first limitation of this study is that interviews were conducted primarily with adults, and to a limited extent with children aged 11 and over. We acknowledge that children's voices are important in understanding family experiences. However, in this study, the choice to focus on adults was not only due to ethical and practical challenges, particularly with children under 11, but also because parents are often best positioned to reflect on the broader experience of integrated social care. Given the multi-professional and systemic nature of the support involved, their perspective offers essential insight into how care is coordinated and experienced at the family level.
Second, the recruitment method, which involved social-neighborhood team social workers inviting families to participate in this study, may have introduced potential bias in the selection of families. Social workers might have approached families who are more satisfied with the assistance provided by the social-neighborhood team. This might pose a limitation, but it is important to note that the answers to the research question are grounded in the principles of critical realism: what works, how, why, and under what circumstances. These principles provide deep ontological insights that are typically not entirely visible to social workers. As a result, the selection process does not occur at the level of these insights, even though the answers still emerge. Therefore, the study offers valuable insights into the deeper layers of intervention success and failure. Lastly, some family members were interviewed together based on their own preference. Although this may have influenced their responses, it was a conscious choice that likely enhanced their comfort and did not compromise the relevance to the research question.
A first strength of our study was the combination of inductive analysis and the use of the principles of critical realism extended with the CAIMeR model. Through the inductive analysis, we were able to analyze the data comprehensively, providing numerous insights.
A second strength of the study was that the CAIMeR model further enhanced our understanding by contextualizing these empirical findings within a framework that explains not only what works, but also how and why it works, under what circumstances, and for whom it works. However, a limitation arose in the categorization of mechanisms and results, as results could sometimes also serve as mechanisms, and vice versa. Despite efforts to mitigate this issue, some degree of arbitrariness remained unavoidable. This challenge was addressed to some extent through the triangulation of researchers, ensuring a more robust analysis and interpretation.
A third strength of this study was that the CAIMeR model provided valuable insight into the lived experiences of family members by providing the opportunity to capture complex experiences in a flexible yet structured approach to qualitative analysis. Conducting multiple in-depth interviews allowed for a comprehensive exploration of diverse experiences, allowing for an in-depth understanding of different perspectives.
A final strength of this study was the unique strengths of the CAIMeR model that allowed for the results to be grounded in the lived experience of family members. While the authors conducted a number of interviews, this allowed them to explore the various experiences comprehensively and obtain a nuanced understanding of perspectives.
Conclusion
This study focuses on the lived experiences and perspectives of families receiving integrated social care, asking “what works for families with multiple and complex problems,” “under what circumstances,” “why,” and “how.” The results of our research show that building trust, strengthening the future perspective, ensuring control and overview, strengthening self-efficacy, and facilitating participation are important insights.
From the perspective of families receiving integrated social care, trust between professionals and the family emerges as an important and determining factor in the assistance received. When family members observe effective collaboration among professionals, this strengthens confidence in the support system. Additionally, family members express a need for assistance with practical matters, such as administration, and emphasize the importance of addressing these needs in the support provided. Effective care coordination was an important component.
Active participation in multidisciplinary meetings is crucial, necessitating adequate support and preparation from professionals before, during, and after the meetings. Also, when the focus is overly centered on the children, adult family members may feel overlooked or unheard. Therefore, a collaborative approach should be implemented, addressing both parental concerns and focusing on the child and family. Integrated social care is aimed at preventing fragmentation through cooperation. Fragmentation starts as soon as there is no cooperation with the families themselves. Integrated social care starts with trust and cooperation with family members.
Footnotes
Ethical Approval
This study was approved by the Ethics Review Board of Tilburg University [SB_RP245]. All participants were informed about the study, what was expected from them, and their rights, and provided signed informed consent prior to the interviews. Part of the ethical assessment concerns data management, confidentiality, and privacy security, verification of data integrity, data coding, and anonymization.
Funding
The authors received no financial support for the research, authorship, and/or publication of this article.
Declaration of Conflict of Interests
The authors declare that there is no conflict of interest.
Authors’ Contributions
The research design was developed by MVE, RE, MC, CvG, and TVR. MVE and AdJ coded the transcripts and conducted the analysis. MVE wrote the manuscript, with contributions from all authors during the writing process.
Acknowledgments
We thank the SEZO social-neighborhood team for cooperation in this research and the families who participated in this research.
