“The starting point for integrated neighbourhood care is the story of the neighbourhood”

Healthy, thriving neighbourhoods don’t just develop on their own. Health professionals and other care workers need to cooperate both with one another and with neighbourhood residents, according to Maastricht University researchers Arianne Elissen and Anne van den Bulck. As part of the LIME* project ‘Working together for healthy neighbourhoods’, they explored how best to do this. “Find the ‘mayor’ of the street. Someone like that is worth their weight in gold.”

In recent years, many people have found themselves facing multiple problems at once, be they health, financial, psychological or social issues. As a result, neighbourhoods are increasingly dealing with complex care issues. GPs and community nurses can address these problems by working with professionals such as social workers, debt advisers, community support workers and housing association staff. “This is what we call integrated neighbourhood care,” Van den Bulck explains. “It also makes sense to involve residents, because they’re the ones who really know what’s going on in their neighbourhood. The question is: how do you go about it?”

This was the question the LIME project set out to answer. The team brought together researchers from the Research Centre for Community Care at Zuyd University of Applied Sciences and the Academic Collaborative Centre for Sustainable Care at Maastricht University. Elissen and Van den Bulck represented UM, together with PhD candidate Joana Schraft. “We looked at integrated neighbourhood care in the Netherlands and Flanders,” Elissen says. “We limited ourselves to initiatives that had been studied in the context of academic research. Ultimately, we selected six initiatives and analysed them using existing theories on the organisation of integrated care. We also reviewed a wide range of academic publications, documents and websites relating to the initiatives and interviewed people who had been involved in them.” 

Key elements of integrated neighbourhood care

The research showed that there is no single blueprint for improving collaboration within a neighbourhood. “What works in one place won’t necessarily work in another,” says Van den Bulck. “But we can identify a number of key elements of integrated neighbourhood care. It starts with a needs assessment: what does the neighbourhood actually need? It’s also important to identify key locals and involve them in your initiative. One of our interviewees called them ‘the mayor of the street’: that person everyone knows and who knows exactly what’s going on in the neighbourhood. Someone like that is worth their weight in gold.” Elissen adds: “Which also means genuinely valuing their time and experiential knowledge, for example by providing appropriate compensation.”

The various initiatives also show that ‘connectors’ can play an important role. “These are professionals who are right at the heart of the neighbourhood and are constantly working to link the different disciplines with one another and with residents,” Elissen explains. “They might be area coordinators, neighbourhood workers, community support workers or community development workers. Because they speak the language of both professionals and residents, they’re extremely valuable. “Finally, we recommend making initiatives sustainable. By that I mean making sure that what you put in place in the neighbourhood is sustained—or, better still, becomes part of the services available there. Even after the project funding ends.”
 
 

One outcome of the research is the ‘Neighbourhood Experience’ Decision Guide, something Van den Bulck and Elissen are particularly proud of. The guide gives professionals practical tools for working with residents to capture ‘the story of the neighbourhood’: a collection of experiences, values and ideas about what is going well, what could be improved and where the neighbourhood’s strengths lie. This neighbourhood story helps to establish shared priorities, identified in consultation with residents, which can then form the basis for future neighbourhood approaches, actions, interventions or policies.

The Decision Guide includes three methods for capturing the story of the neighbourhood:

1. Photo observation, in which residents document their neighbourhood through photographs and talk about what matters to them
2. Neighbourhood values map, involving conversations with residents about what they consider important
3. Positive health, involving conversations with residents about health and wellbeing.

“All three methods are evidence-based and have previously been used in practice,” Elissen says. “The Decision Guide allows professionals to determine which method is best suited to their neighbourhood. One of its strengths is that the methods are inclusive. Photo observation, for example, is particularly suitable for neighbourhood residents who can’t read or write. The neighbourhood values map, on the other hand, works well for people with limited mobility.”

 

Enthusiastic response

A pilot showed that professionals were very enthusiastic about both the methods and the Decision Guide. “That’s partly down to the variety: there’s a suitable method for every neighbourhood,” Van den Bulck says. “The Decision Guide also gives professionals a solid basis to work from, because they know these methods have already proved themselves in practice.” Elissen nods. “Professionals need support in finding out how residents experience their neighbourhood. The Decision Guide takes them through that process step by step. That’s what I find so rewarding about our research: we haven’t just answered a number of research questions; we’ve also produced something that professionals can really use.”

Text: Martina Langeveld