Integrating needs and services: A person-centred and place-based approach

‘Social ecology networks’ could help better integrate client needs and services. Image: Unsplash

Having services that meet the needs of their users is vital to have effective social and health services. Ensuring that the intended clients are able to access these services is just as (if not more!) important. In today’s post, Associate Professor Geoff Woolcott, Professor Robyn Keast, Associate Professor Peter Tsasis, Professor Sebastian Lipina, and Dr Daniel Chamberlain, summarise an innovative approach towards integrating the needs and services of the client, based on their ‘social ecology network’. Ultimately, mapping and understanding these networks will ideally lead to better service integration and delivery.

Providing support services has become an increasingly complex task, with current approaches not adequately meeting the needs of individuals or communities, especially those with multiple care needs. The increasing social and economic cost burden of this failure compounds a multi-level system that is already struggling with service integration (The Drum 2019). At least part of the problem relates to the lack of connection between the two levels of person and organisation, two circling systems that are not fully integrated.

A recently published social ecology network model (Woolcott et al 2019) offers a way forward, providing the missing locational connections between person-centred and organisation-centred service provision. The article addresses this key concern; making the links between needs and services apparent so that each person can be provided for in an efficient and effective way, wherever that person is located.

We have all had the experience of being at home, sick with no internet and an empty refrigerator; you can’t go to work, get food or medical help, and sometimes you can’t even get out of bed or take a shower. Some of us may have friends or relatives who will look after our multiple needs until we can once again look after ourselves.

Unfortunately, some of us may have no-one to call upon for help. There may be a number of support services close by and waiting for a contact, but we may not know about them or be able to contact them, much less coordinate their assistance. Imagine now how difficult it is for disadvantaged people, with multiple health and other needs, often isolated from support, to navigate and link up the set of services needed.

Challenges can also snowball, presenting accumulated behavioural, emotional, situational, and cognitive issues in addition to one or more medical conditions (Tsasis et al 2016). A major problem is that needed services may not be integrated, each needing to be contacted and coordinated separately. This lack of integration has given rise to increasingly fragmented services and increased societal cost, even in technologically advanced developed countries.

Such fragmentation is a continuing concern across a number of service sectors, including education (Woolcott et al., 2017) and social welfare (Australian Institute of Health and Welfare 2018; Lipina 2016) as well as health and justice. All service arenas under the strain of increased demand and decreased budgets.

Our article outlines a scenario for a homeless man (Mr X) with multiple health and social problems who was having limited success in securing needed support services. The people helping him were genuine and caring but were overlooking his capacity to make informed decisions based on his experiences. Consequently, not only was it hard to know what services were locally available, it was also difficult to match known services to Mr X’s needs.

In this case, unusually, the service delivery system was a well-documented network of connections, and Mr X was eventually (and unusually) given the skills to navigate this system for himself to obtain available support services at closest locations. This was done by following a three-step process.

·      Giving Mr X a systems’ view of available services, based on social network analysis (Borgatti et al. 2018). This gave him a clearer picture of the service system and how it operated, mapping and unpacking things like location, purpose, eligibility and referral criteria.

·      Helping Mr X engage in personal and mind mapping processes related to his personal and service support network (Keast et al. 2011), including interactions with different groups of people and organisations and the nature or relationship of these interactions (e.g., positive or negative). This enabled him to leverage his own capacity to manage his own care.

·      Showing Mr X how his own network of needs might fit into the wider service network so that he could find the closest services for his current needs.

Despite these interventions, the system itself remained system centric rather than client centric, forcing Mr X to deal with it, rather than the service system being ‘informed enough’ to wrap their services around him. Mr X’s situation, therefore, illustrates the key issue with delivering universal services; connecting across the complex dynamical system to deliver multiple services when and where they are needed.

To resolve this integration issue, we considered each individual as having their own developmental social ecology (Bronfenbrenner & Morris, 2006) re-configured in terms of social network analysis (Neal & Neal, 2013). Considered in combination, these two seemingly disparate approaches frame a powerful new way of thinking about person-centred and place-based integrated care at scale, as well as offering a methodologically rigorous set of analytical tools for optimising service outcomes.

The resulting social ecology network model bridges the apparent disconnect between service levels and patient needs in such a way as to direct optimal effort to interventions at the individual level and to provide a new innovative approach to the delivery of integrated care. This new type of mapping and analysis addresses a broad range of service and support issues, such as in mental health, poverty, social exclusion, and chronic disease, and their combinations, where traditional policies or interventions have proved unreliable (Schoen et al. 2011).

Each social ecology network, as the name implies, describes a person’s connections with elements of their local environment and of other non-local environments or systems further away. As you can see in the diagram, a local environment might include clubs, peers, health services and religious organisations—elements that are directly connected (proximal) to the individual at the centre. These in turn might be connected to non-proximal elements. You might have connections to peers, all connected across the same community, set within a connection to a local industry workplace within a community whose values you share.

Our article shows how a social ecology, re-configured as a network, can be used to map services in the various systems through connections to the individual at the centre. This sophisticated mapping, in conjunction with social network analysis, provides a way of mapping services to needs that is integrated and coordinated. Most importantly, it places person and location as the focus of service and support, providing personal agency in any decision-making processes.

Social network analysis has become an increasingly used tool in examining influence (Jacobson, Gruzd, Kumar, & Mai, 2019) and can be used to calculate your needs based on your internet inquiries. We have applied this tool to social ecologies, but with an aim to help people assess their own needs and make service connections while, at the same time, providing no public record, avoiding the issue of people listening in to your conversations (Zappavigna 2019).

We are already trialling a number of these methods, including use of an online interview process in conjunction with natural language processing (Eichstaedt, J 2016). We also will trial android applications that use multimodal dialogue, such as Simsensei Kiosk, in the near future. Our ultimate aim is to enable people to map your needs with minimal outside help, and to avoid issues with data ownership and control (Nelson, 2017) while enabling appropriate connections to services.

What this means for Mr X is that a decision support tool can be used to automatically connect services to needs. The same tool can be used to connect people in similar circumstances so that organisations have a better idea of how to provide services to people with multiple and complex needs. With this decision support tool Mr X, and other community members, will be back in the driver seat for their own care.

LINKS

The Drum: Health Care Special, May 9, 2019.  https://www.abc.net.au/news/2019-05-09/health-care-special/11099096

Woolcott, G., Keast, R., Tsasis, P., Lipina, S., & Chamberlain, D. (2019). Reconceptualising person-centered service models as social ecology networks in supporting integrated care. International Journal of integrated Care, 19(2), 1-12. DOI: https://doi.org/10.5334/ijic.4222

Woods, M (2017) ‘Why reforming health care is integral for our economy’ The Conversation October 24, 2017 https://theconversation.com/why-reforming-health-care-is-integral-for-our-economy-86209

Tsasis, P, Wu, J, An, A, Wong, HH, An, X, Mei, Z and Hains, T. Conceptualizing type 2 diabetes and its management. Journal of Multidisciplinary Healthcare, 2016; 9: 133-136. https:// doi: 10.2147/JMDH.S88684

Woolcott, G., Chamberlain, D., Keast, R., Farr-Wharton, B. (2017). Modelling success networks to improve the quality of undergraduate education. Quality in Higher Education, 23(2), 120-137. https://doi.org/10.1080/13538322.2017.1356617.

Australian Institute of Health and Welfare (2018) Services and places in aged care https://www.gen-agedcaredata.gov.au/Topics/Services-and-places-in-aged-care

Lipina, SJ. The biological side of social determinants: neural costs of childhood poverty. Prospects, 2017; 46: 265-280. https://doi.org/10.1007/s11125-017-9390-0

North, K, Gunn, J, McCluskey, J, Redman S (2015) ‘Research priority: make Australia’s health system efficient, equitable and integrated’ The Conversation July 8, 2015 http://theconversation.com/research-priority-make-australias-health-system-efficient-equitable-and-integrated-43547

Borgatti, S. P., Everett, M. G., & Johnson, J. C. (2018). Analyzing social networks (2nd Ed). London, UK: Sage.

Keast, R., Waterhouse, J. M., Murphy, G., & Brown, K. (2011). Pulling it all together: Design considerations for an integrated homelessness services system—Place based network analysis. Canberra, Australia: Department of Families, Housing, Community Services and Indigenous Affairs.

Local Government Association (2018) Shifting the centre of gravity: making place-based, person-centred health and care a reality https://www.local.gov.uk/shifting-centre-gravity-making-place-based-person-centred-health-and-care-reality

Bronfenbrenner, U. and Morris, P. A. (2006). The bioecological model of human development. In R. M. Lerner (Ed.), Theoretical models of human development, Volume 1 of Handbook of Child Psychology (6th ed., pp. 793-828). Hoboken, NJ: Wiley.

Neal, J. W., & Neal, Z. P. (2013). Nested or networked? Future directions for ecological systems theory. Social Development, 22(4), 722-737.

Schoen, C, Osborn, R, Squires, D, Doty, M, Pierson, R and Applebaum, S. New 2011 survey of patients with complex care needs in eleven countries finds that care is often poorly coordinated. Health Affairs, 2011; 30: 2437-48. https://doi.org/10.1377/hlthaff.2011.0923

Jacobson, J., Gruzd, A., Kumar, P., & Mai, P. (2019). Networked Influence: An Introduction. Social Media+ Society, 5(3), 2056305119865473. https://doi.org/10.1177/2056305119865473

Zappavigna, A. (2019). Apps and smart devices listening in: how to block them (https://www.news.com.au/technology/home-entertainment/these-apps-and-devices-could-be-listening-to-your-private-chats/news-story/7258fedcbe6103ca41aaf66bb4b28239).

Eichstaedt J (2016) Natural Language Processing. Speaker: Johannes C. Eichstaedt, University of Pennsylvania. https://www.youtube.com/watch?v=qjvGOhuMUKE

Simsensei Kiosk: The Therapy robot is coming (https://www.youtube.com/watch?v=nF8VqXmVW1k)

Nelson, D. The problems of data ownership and data security. Daniel Nelson, October, 3, 2017. https://sciencetrends.com/problems-data-ownership-data-security/