136 CHAPTER 5 Clinical integration Primarily clients, experts-by-experience and professionals have reported on the concepts of continuity of care, case management and client-centered care. These concepts, which prioritize the central role of clients’ needs, have gained increasing attention in recent years and have come to influence the provision of care and support. For example, several local coalitions engaged in discussions on how (future) parents navigate care and support provided during the first thousand days to uncover areas for improvement. Despite progress, stakeholders mentioned that care and support were still too much driven by policy and professionals (supply-oriented) and prioritizing clients’ needs was not yet routine practice. Stakeholders expressed the need to better address the multiple challenges faced by (future) parents in vulnerable situations (e.g. related to housing, work, education and parenting). This requires restructuring and improved communication among the professionals involved. In some areas, case managers were appointed or central telephone numbers for referrals have been implemented. One of the clients described her experiences with having one case manager: “I had one person I could share everything with, so that was very nice. [...] [she had] conversations with me about how I feel, but also about finances.” - Client, 2021 Stakeholders also reported that although improvements have been made in the interpersonal interaction between professionals and clients, there remains a need for further development. Clients and experts-by-experience shared both positive and negative experiences. Positive experiences were associated with the keywords empathy, understanding, respect, transparency, safety, trust, and being heard and understood. Negative experiences, however, were marked by incidents of prejudice, judgement and underestimation. To enhance interpersonal interaction, stakeholders have emphasized the need for training in sensitivity and communication. Everyone is different and ‘[…] to me this means that you really look at the person and the situation.’ (Expert-by-experience, 2021). Lastly, stakeholders have noted increased client involvement, both in the organization of care and in daily practice. For example, several organizations established parent or client councils, and the Ministry of Health, Welfare and Sport invited a group of experts-byexperience to reflect on national policy measures since mid-2020. However, stakeholders also mentioned the need to expand and standardize client involvement for quality improvement. They mentioned challenges including how to start and involve the right people, and emphasized that it is important to consider financial reimbursements. Mainly since 2021, client involvement became a more central topic for coalitions and Pharos started to organize learning programs to support this effort. In daily practice, shared decision-making and positive health principles supported client involvement, allowing for putting parents’ needs and preferences first in decisions concerning their own health and well-being.
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