Dynamics that challenge the provision of integrated care for youth at-risk: a systematic review

Background Providing integrated care for youth at-risk and their families is a multifaceted challenge. Youth at-risk are young people experiencing multiple co-occurring challenges across life domains and engaging in behavior that pose risks to themselves or others. Although their needs necessitate integrated care, its implementation is hindered by dynamics between the characteristics of these young people and elements of integrated care. Our aim is to provide an overview of the dynamics shaping integrated care for youth at-risk. Method We conducted a systematic review following PRISMA guidelines. We identified eligible studies using a search strategy in PubMed, Cochrane, Web of Science, PsycINFO, and the Integrated Care Search tool. Two reviewers independently screened and extracted the data. We analyzed the included studies using a thematic analysis. Results Of the 5857 screened studies, 52 studies met the eligibility criteria. The results showed dynamics that occur on different levels. Between youth and professionals: as youth at-risk show high-risk and avoidant behavior, professionals tend to respond with control, reluctance to act, and stigmatization. The consequences of insufficient information sharing, the number of professionals involved, and staff turnover further disrupt their care. Between youth and organizations: organizations tend to avoid responsibility to care for youth at-risk, and several preconditions are required to provide care that meets the diverse and specific needs of youth at-risk. Between professionals from different organizations: organizations tend to operate individually, resulting in varying perspectives, lack of coordination, and difficulties to exchange information, ultimately disrupting care provision. Conclusion This systematic review shows that dynamics between youth at-risk, professionals, and organizations can disrupt the coherence and continuity that integrated care requires. The dynamics at play reflect the interdependence between youth at-risk, professionals, and organizations, as they shape one another’s actions and can ultimately lead to a cycle of avoidance. Strengthening integrated care therefore calls for a multi-level approach: professionals can support engagement through a context- and strengths-based approach, while organizations need to provide the conditions for collaboration and shared decision-making.