1. Training programme of PRISSM Leonardo 1st Workshop “On the integration of social services in Europe” Christina Karaberi, EU Project Management (e-Trikala SA) “PRISSM” 1 ο Workshop, Trikala 04-05 February 2014

2. Integrated services in healthcare Integration in the field of healthcare has been a priority in shaping healthcare policy in the countries of North America and Europe over the last decades The objective is to enhance cohesion, continuity and cooperation between different healthcare institutions with a view to increasing efficiency and quality both of services and the life of users. Patients: easy access, guidance: seamless care Healthcare Professionals: interdisciplinary approach, coordinated effort, Administration: coordination of combined financial resources, coordination of shared objectives, supervision of increased personnel, management of complex organizational structures & relations, creation & maintenance of a common culture Political Authority: design of policies that promote integration, regulation of administrative & financial issues, holistic system evaluation

3. A cause for Integration The lack of coordination or absolute autonomy have not yielded the expected positive results for users of healthcare services and the added cost was much higher. For each country to be able to offer financial & quality healthcare services, it should review the healthcare services structure according to the principles of integration. The parametres that render integration imperative are the following: Ageing population, chronic diseases Unequal access to health services Fragmented services, gaps & meaningless overlapping Access, continuity and coordination problems Ineffective use of resources Suboptimal results and medical errors Failure to contain spending Poor allocation of responsibilities and lack of accountability Decrease of users’ trust in the healthcare system

4. Examples of integration in healthcare: Health Maintenance Organization (HMO) Health Maintenance Organization (HMO) is a typical example of a health system with a manager, an American, market-oriented philosophy, and ingredients that have been adopted in modern integrated care systems: Healthcare services financing system Organizational planning Supplier’s networking Integrated information systems Coordinated healthcare services

5. Examples of integration in healthcare: Integrated Delivery Systems (IDSs) Integrated Delivery Systems (IDSs) – also known as organized delivery systems, integrated delivery systems, integrated services networks and integrated care bodies: Examples of vertical integration, bringing together different healthcare bodies, such as hospitals, medical units and other service provision entities, through common goals in cooperation with insurance schemes. IDSs are a network that extends into different organizations and systems promoting integrated and continuous service provision : 1.Information networks which facilitate the exchange of knowledge and ideas. 2.Coordination networks which bring together service providers allowing them to maintain their autonomy in clinical and financial issues. 3.Procurement Networks, linking suppliers and binding them through common contracts, to guarantee be stability in both quality and fiscal responsibility. 4.Fully Integrated Networks at an administrative level, where the provision and financing of healthcare services are ensured through a single entity or hierarchical structure.

6. Examples of integration in healthcare: case management One of the most well known coordinated healthcare service application and one of the most important tools for integrated care. It is an integrated and systematic procedure of investigation, evaluation, coordination and control of multiple healthcare services for high risk chronic patients with numerous needs. This procedure includes multiple levels (administrative, service provision or/and clinical) and has at least three objectives: (1) improve suitability, coordination and cohesion among services (2) strengthen the choice and flexibility in service provision (3) improve services efficiency and impact on patients.

7. Examples of integration in healthcare: Chronic Care Model (CCM) The Chronic Care Model (CCM) proposes a more global and integrated management of chronic disease compared to a more conventional approach of the disease. Its is a management framework based on indications of 30 specific interventions involved in 6 key areas: healthcare organizations, community resources, self-management, service provision planning, decision support and medical information systems These elements pervade the healthcare system aiming to mobilize patients in a productive interaction with the healthcare professionals Focus is on the need for communication with parties outside the healthcare system, as this is the where primary healthcare takes place Focus is on chronic patients’ self-management

8. The example of VITRY-LE-FRANCOIS Vitry-Le- Francois In the framework of the educational reform which stipulates the increase of the school week from 4 to 4.5 days with additional afternoon extra-curricular activities, the Municipality promoted a 3- year educational programme Offer of extra-curricular activities (theatre, economics, gardening, sports, etc.) providing a larger variety in education and equal access to all inhabitants depending on current resources (personnel, materials and financing sources) This programme required the cooperation between the Municipal Authority, the secondary education service, the different bodies and associations and public transport

9. The example of VITRY-LE-FRANCOIS Obj ecti ves Create extra-curricular activities for all: cooperation with the school service to find the time needed in the curriculum to introduce these activities Decrease of access inequality: free access for all pupils. Classes are held either by municipal employees or by volunteers Active participation in the educational procedure: the choice of specific extra- curricular activities was made under popularity and continuity criteria. Socializing and mutual respect: educational seminars are organized in groups Trigger children curiosity: through pleasant activities showing them a window to the world which opens up their imagination Strengthen children development and empowerment: a tool for further emotional and mental development of children

10. The example of VITRY-LE-FRANCOIS Communication with parents was achieved through letters and information leaflets The overall monitoring (planning, implementation and communication) of the project was undertaken by the Organizing Committee consisting of representatives from the Municipality, the education service, the employees, the professors, etc. Methodology: 1.Meetings were held – coordination in smaller groups 2.Monitoring and integration evaluation was undertaken by a special committee (representatives of the Municipality, the employees, the people in charge of extra-curricular activities, professors and parents)