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Care transformation defined by conditions, mechanisms, and outcomes: a systematic literature review

Care transformation defined by conditions, mechanisms, and outcomes: a systematic literature review

A realist synthesis of neighbourhood interventions for families in the community

A realist synthesis of interprofessional collaborative practices in early intervention for children with speech, language and communication needs

BackgroundInterprofessional collaborative practices (IPCP) are considered to be a crucial factor in the optimal support of young children (3–6 years) with speech, language and communication needs (SLCN) in inclusive early childhood education and care (ECEC).AimsTo investigate IPCP in interventions using a collaborative approach for young children with SLCN in ECEC, by identifying mechanisms within IPCP and how these mechanisms relate to specific context factors and professional and child-related outcomes.MethodsA realist review of 22 empirical intervention studies, published between 1994 and 2019, was conducted to synthesise context-mechanism-outcome (CMO) configurations, combining context factors, IPCP mechanisms and outcomes at staff and child level.Main ContributionReciprocal IPCP mechanisms were reported together with interprofessional intervention practices, whereas one-directional IPCP mechanisms were restricted to gains in professional development. Our review further suggests that collective ownership of intervention goals, combined with personal cooperation and communication skills of staff, is vital for inclusive practices and functional communication of children with SLCN.ConclusionOur review has revealed indications for effective IPCP mechanisms, context factors at staff level, and positive outcomes for the professional development of staff working with children with SLCN. In addition, our findings support a link between IPCP and child-related outcomes regarding speech, language and communication development. Future studies should increase our insight into how practitioners, children and families profit from daily collaborative practices.WHAT THIS PAPER ADDSWhat is already known on this subjectInterventions using a collaborative approach for young children (3-6 years) with SLCN in ECEC are considered to be part of the optimal support of these children.What this paper adds to existing knowledgeConducting a realist review of 22 empirical studies on collaborative intervention offered the possibility to identify specific context factors, IPCP mechanisms and professional and child-related outcomes and to synthesise CMO configuations. Findings suggest multiple routes from effective delivery of SLCN services to improvement of speech, language and communication development, supporting the suggested beneficial function of collaboration between multiple professions. Collective ownership of intervention goals, combined with personal cooperation and communication skills of staff, seems to be vital for inclusive practices and functional communication of children with SLCN. Reciprocal IPCP mechanisms were reported together with interprofessional intervention practices, whereas one-directional IPCP mechanisms were restricted to gains in professional development.What are the potential or actual clinical implications of this work?High-quality collaborative intervention for children with SLCN in requires awareness of and critical reflection on IPCP mechanisms in order to improve outcomes for both professionals and children. Both, institutional structural support and individual communicative and cooperative skills are required to increase interprofessional collaboration with the aim to meet the needs of every individual child with SLCN.

What works for whom: A realist synthesis of neighbourhood interventions for families in the community

Neighbourhood interventions are important for creating supportive structures for parents and children and for other community members. Little is known, however, about what works for whom in what situation. The aim of this study was to gain a better understanding of what works for whom in community interventions in the neighbourhood. Realist synthesis was used as a review methodology to examine community interventions. Six databases were searched for studies published between January 1st, 2000 and May 8th, 2020 and 28 community programs reported in 34 publications were included. Multiple rounds of coding and several discussions with experts and the project team were conducted to analyze these studies and programs, and to understand underlying assumptions of neighbourhood interventions. This resulted in the definition of ten important mechanisms of change in specific contexts. These were found on two levels: on an interpersonal level (e.g. social support) and on a community level (e.g. social norms). Positive mechanisms of change varied from supportive professionals to participants in the intervention, to co-production in developing the intervention. Negative mechanisms were only found on the community level and were related to professionals’ and community members’ skills. Mechanisms of change were found to be related to specific contexts, such as implementation strategies and the type of intervention. Professionals and municipalities can use these mechanisms of change to improve their interventions and neighbourhood practices.

A realist synthesis of interprofessional collaboration in the early years; becoming familiar with other professionals

Research into interprofessional collaboration (IPC) has predominantly focused on health care and special-ized care settings, but there is an increasing interest in interprofesssional ‘teams around the child’ in community-based settings. We conducted a realist synthesis of empirical studies into IPC between youth professionals, often in regular community settings, to explore barriers and facilitators of IPC. Included studies were coded with an elaborated scheme to chart the focus of studies and to identify moderators and context-mechanism-outcome configurations of IPC. Professional and normative integration was the main focus of the included studies. Most studies emphasized the challenges of IPC in practice, like unclear roles of self and others, lack of trust and inadequate communication. Other perceived barriers are exclud-ing others in the planning of interventions, taking ownership of plans (vs. sharing) and different modes of communication. Interprofessional education, co-location of staff, acting as a mediator in the team, organising formal and informal meetings, conflict resolutions, self-sacrifice, and conceptualizing practice were perceived as facilitators of IPC. Future IPC research into community-based settings should include all professional stakeholders and the children and their families to evaluate outcomes at both interprofes-sional and clinical level.