Challenges when Combining Expertise to Provide Integrated Care for Youth At-Risk and Their Family: A Qualitative Study.

The needs of youth at-risk and their families, facing multiple problems and serious mental health issues, exceed the expertise and possibilities of a single stakeholder (professional, organization, municipality). These youngsters require care in which the expertise of different professionals and organizations is integrated. However, combining various types of expertise to provide integrated care to youth at-risk is challenging. Therefore, this qualitative study aims to describe how stakeholders approach these challenges when combining different types of expertise to provide integrated care for youth at-risk. In total, 28 in-depth interviews were conducted with stakeholders working in various organizations or municipalities for youth at-risk in The Netherlands. Transcripts were analyzed through reflexive thematic analysis. Reflections from a youth representative were also incorporated. Results reveal challenges at four levels: youth and family, professional, organization, and system. At each level, challenges arise in addressing the exceptional needs and problems of youth at-risk, collaborating with multiple stakeholders, reluctance to apply or involve expertise, and finding sufficient resources to combine expertise. Professionals, organizations, and municipalities approach these challenges with a backward or forward approach: either they accept the situation, focus on their own expertise, leave responsibility to others; or they force their expertise on others, or seek collaboration to combine expertise. Overall, combining different types of expertise to provide integrated care to youth at-risk can be seen as an expertise in itself, and necessitates reflection, awareness, and careful consideration from all stakeholders.