An exploration of intersectoral partnerships for people with multiple and complex needs: a realist informed qualitative study
Irvine Fitzpatrick, Linda
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The well-being of people with complex and multiple needs is impacted upon by the interplay of life experiences, social determinants, contextual factors, and health conditions. People with multiple and complex needs are considered to include but not be limited to People with severe and enduring mental health problems People who are in contact with the criminal justice system People with substance misuse problems People whose life opportunities are limited due to income People who have experienced significant trauma Despite policy imperatives, there remains a lack of systematic knowledge and practice relating to what works, for which people, and under which set of circumstances. Evaluating the evidence base for interventions for people with complex and multiple needs is complicated by several factors. Historically (and currently), interventions tend to be focused on a diagnosis, behaviours, or for a particular age range. Too often, professional services look at behaviour and conditions without exploring the wider set of relationships and opportunities and life disruptions that people might have experienced or are experiencing. Within the Lothian area, a number of intersectoral partnerships (ISPs) have been developed, focused on improving health, well-being, and opportunities for people with multiple and complex needs. The partnerships are intersectoral in that they include statutory, private, and voluntary partners working together to provide innovative interventions and services for people with multiple and complex needs. Lothian’s ISPs provide support to individuals, in response to specific needs, and may be defined by geographical locations or in respect to service requirements. However, common features of good practice are obscured by differing models for provision, apparently dissimilar client groups, and a diversity of providers and contributors. Key success features and elements of effective practice require investigation and synthesis. The current research used qualitative and realist methods to propose a “programme theory” of effective intersectoral partnership based on ISPs within Lothian. Qualitative data were gathered from 18 key informants from 6 Lothian-based ISPs. A clearer, more rigorous, and systematic understanding of ISPs for people with complex and multiple needs has been developed, with recommendations for how programmes might be developed in other areas or otherwise expanded. The Incite model is the summary descriptor of the refined programme theory. The model contains the programme theory of context, mechanisms, and outcomes which should be considered in the development of an intersectoral partnership. How the Incite model may be operationalised is discussed in the thesis, as well as implications for policy, practice and research.