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In the last 15 years, transdisciplinary research of sustainability transitions has become an increasingly powerful approach. We discuss it as a perspective for social work discipline, and as a theoretical-conceptual frame of a new international doctoral training and research programme in social work taking place in seven European countries. In our qualitative study, we investigate how the participating social work doctoral students reflect upon transdisciplinarity and understand the interconnectivity between environmental, ecological, and social sustainability transitions—which is widely recognised as a highly complex challenge of sustainability. The data used included the students' learning diaries from the first summer school of this programme. As core findings of the analysis five joint themes expressing the interconnectivity emerged from the data: the indispensable role of nature for all life; the economy-based causes of unsustainability; the role of human rights; the researchers' own ways of life; and the practice-relevance for SW. Our results support recent theoretical arguments that transdisciplinarity comprises not only a disciplinary thinking but a way of being, where the holistic lives of researchers merge with the content of their work. Regarding our analysis of the pedagogical and didactic arrangements promoting transdisciplinary thinking, we can encourage direct collaboration and teaching inputs with other disciplines and demonstrable practice applications. [ABSTRACT FROM AUTHOR]

Summary: Professional standards state that social workers in public welfare organisations should act as state and citizen-agents. However, the literature provides little insight into how social workers navigate this dual responsibility in their daily work. To address this gap, we used Maynard-Moody and Musheno's theory on state and citizens-agent narratives to analyse street-level practices of social workers in three local welfare organisations in Germany, the Netherlands and Belgium. This article explores how three specific organisational mechanisms (decision-making authority; the role of the front-line manager and the degree of specialisation) affect the ways social workers navigate both agent narratives in public welfare organisations. The data were gathered by a mixed method design of in-depth interviews and focus groups. Findings: Our study shows that social workers struggle with the tensions that intrude between the state and citizen-agent narrative. We found that the extent to which both narratives are adopted by social workers is affected by a complicated interaction between the beliefs of social workers about social justice and responsiveness and the selected organisational mechanisms. Moreover, we found that critical reflection and a supportive attitude of front-line managers can help social workers to manage their double responsibility in practice. Application: Our cross-national study contributes to a deeper understanding of the relationship between organisational mechanisms and the moral deliberations of social workers regarding their dual responsibility. It provides in-depth insights into the tensions and conflicts social workers in different contexts face daily on account of their dual responsibility. [ABSTRACT FROM AUTHOR]

Background: Professionals play an important role in supporting the social relations of persons with a disability. This study looks at professional practices supporting or strengthening social relations of persons in independent supported living, by integrating the perspectives of adults with a disability, network members and professionals. Method: Fifty-one semi-structured interviews were carried out. Results: Identified practices were: facilitating social situations, connecting with current and new network members, getting to know the person with a disability really well, delivering person-directed work, being a sounding board, being a safety net, working with an empowering attitude, seeing and exploiting opportunities. Influencing factors were related to the person with a disability, the professional, the network members and the broader environment. Conclusion: Identified practices were small actions rather than structured or programmatic interventions. An unique combination and complex interplay of factors was found within each case, where negative factors could be counterbalanced by positive factors. [ABSTRACT FROM AUTHOR]

Available studies on the accountability relation between social work and the government are mainly conducted in Anglo‐Saxion countries. This limits the generalizability of these findings to other countries. Moreover, these studies hardly descent to the street‐level, making the perceptions and actions of social workers barely visible. To address this gap, this article explores how three elements of governance interact with street‐level accountability of social workers in homeless care in three country cases (the Netherlands, Belgium and Germany). The data (N26) was gathered by means of a mixed method design (interviews, focus groups and document analysis). By combining a street‐level bureaucracy research approach with a relational definition of accountability, we opened up the black box of what happens in these organizations and bridged the gap between macro‐level mechanisms and street‐level accountability. Our study adds three important insights to street‐level research of accountability in social work. First, elements of governance cannot be studied in isolation. Mechanisms should always be explained in relation to the context in which they are embedded. Second, the social workers in our cases do not perceive their accountability to the government as a professional obligation. They see it as a strategic mechanism to secure funding. Third, interaction is an important condition for the engagement of the social workers in their accountability relation with the government. More research is needed to develop a multi‐level theory that identifies which mechanisms play a role in the accountability relation between the government and social workers. [ABSTRACT FROM AUTHOR]

Although diverse European welfare states have institutionalized an extensive infrastructure of public welfare services to redistribute resources, governments have been confronted with barriers in realizing the social rights of certain groups of citizens. Decentralization and increasingly local welfare provision has been promoted as a strategy to substantially realize social rights. In that sense, the vital role of frontline social work has been stressed in local welfare systems, being considered as dynamic arrangements in which local policymakers and professional social work actors are involved in the substantial realization of social rights. These trends have been frequently studied from a social policy perspective, but the role of professional social work on the frontline level has received much less attention. In this study, we accordingly rely on neo‐institutional theory to explore how frontline social workers employ their professional discretion during processes of local social policy implementation, related to the broader circumstances in which they operate. Our qualitative study aims to tease out whether their strategic actions might transform and/or change the rules of the local institutional game. The qualitative analysis is based on policy documents and qualitative interviews with key actors in two municipalities in Belgium. Our research findings reveal three central fields of tension: (1) Rescaling of responsibilities to the local welfare system and community level versus in‐built spatial concentrations of social problems and inequalities, (2) Efficient local welfare system organization versus wicked social problems, and (3) Fast local welfare system logics versus slow realities. [ABSTRACT FROM AUTHOR]

Homeless individuals often find that welfare services are inaccessible, despite being designed to meet their needs. This frictions with access which is a fundamental principle in western welfare states. Adaptations in social policy and service delivery are therefore made to deal with the problem of inaccessibility to services and welfare rights. One such adaptation is outreach work and is often developed to engage with homeless people and link them up with available services. This raises questions on the transformative potential of outreach work to deal with those mechanisms which result in inaccessibility. We argue that in a context in which accessibility is increasingly guaranteed by rights-based frameworks, exclusion management is also increasing. This is due to hybrid developments in social policy and welfare ideology. Nonetheless, the initial transformational potential of outreach work never really vanished. [ABSTRACT FROM AUTHOR]

AbstractThe poverty literature often overlooks the relationship between housing insecurity and income-generating activities. The often informal sources of income among the homeless strongly connect to other aspects of their lives. Nonetheless, these groups of severely deprived people are often missing from large-scale studies and official statistics. Using an original and comprehensive survey, we document the complex interaction between living conditions and begging, a most visible form of extreme poverty and a central concern for urban planning and social assistance. We interviewed 358 people who were begging between 2021 and 2022 in Brussels. We estimate that approximately 80% of them are Romanian Roma. Our findings suggest that around half of the people who beg sleep rough, while some occupy relatively insecure and low-quality dwellings. Further differences relate to gender and ethnicity, with women and those with children more often seen in emergency accommodations and non-conventional dwellings and Romanian Roma occupying, on average, more problematic housing. [ABSTRACT FROM AUTHOR]

This literature review analyses the adoption and development of a street‐level perspective in public management, social policy and social work. The last years have seen a prominent revival of a perspective based on Michael Lipsky's street‐level bureaucracy approach in the debates conducted within all three disciplinary fields. Based on 71 key publications in public management, social policy and social work, the review analyses the adoption of the street‐level bureaucracy approach during the period 2005–2015, pointing out the main themes of the debate within, as well as overlaps and differences between, the three disciplines. The findings show the potential of better integrating the different perspectives and taking stock of the articulated debate. Lastly, the review discerns a common viewpoint for further street‐level research, emphasising its importance for the critical analysis and understanding of street‐level work as a vital dimension of responsive and accountable institutions and as a decisive moment to shape positive policy outcomes on the ground. Key Practitioner Message: • The use of discretion by frontline practitioners and their role as policy actors on the ground has become an important focus of research; • This literature review shows that the debate has gone far beyond discussing discretion as an all‐or‐nothing issue, pointing out both positive and negative aspects of discretion and developing comprehensive frameworks to explain the use of discretion at the street‐level; • However, street‐level research has traditionally rather neglected the notion of professionalism. The social work literature brings in the perspective of professionalism; more research efforts are needed to better explore and explain how professionalism matters in relation to challenges and dilemmas of different policy and practice fields. [ABSTRACT FROM AUTHOR]

Abstract: In the margin of the ongoing experimental and quasi‐experimental research projects on family preservation, some research projects focus on the process through which families accomplish change and acknowledge the importance of the working alliance. There is, however, little information about barriers and facilitators in building this working alliance. To fill this gap, we performed a multiple case study with a triangulation of ethnographical methods such as observation, in‐depth interviews, case file analysis, and multistakeholder focus groups. We illustrate how, in a context of managerialism and transactional leadership, social workers find themselves in a continuous tension between complying with the expectations of their social organization and “tuning in” with the service users. This jeopardizes the working alliance between a social worker and a family. Consequences for research, practice, and policy regarding family preservation interventions are discussed. [ABSTRACT FROM AUTHOR]

Both in Flanders and in the Netherlands, there is a growing attention to family preservation programs. Research on family preservation is, however, mainly conducted within a positivist framework. Because of that, we have gathered some insights into overall trends, but we have very little detailed information about the day-to-day practice of family preservation. What happens when a social worker and a family are face-to-face? What are the underlying mechanisms that influence the impact of a family preservation program? In this study, we use a multiple case-study with a triangulation of different ethnographical methods to build knowledge about the complex and dynamic tension in which family preservation programs take shape. We illustrate the discrepancy between how an intervention is displayed ‘front stage’ (in case-files, reports, registrations) and what happens ‘back stage’ (during the face-to-face contacts). We describe how, at the beginning and at the end of a treatment process, the focus on the ‘front stage’ influences the attunement between a social worker and a family. In between, however, the social worker undertakes small but significant actions at the ‘back stage’ of the intervention process, which are regarded as extremely helpful by the families. By shedding light on what happens beyond case-files, reports and registrations, it becomes possible to open the black box of social interventions and enrich the conceptual framework of ‘what works' in family preservation. In addition, by working collaboratively between researchers, social workers and families, a collaborative research community is formed and local improvement processes are enhanced. [ABSTRACT FROM AUTHOR]

Population registries have become essential instruments in the expansion of welfare states to determine a person's eligibility for social rights and benefits. To (temporarily) register people without a residential address, Belgium introduced an alternative registration system: the 'reference address'. By using data from interviews with 80 experts from two research projects, we focus on the reference address and the implications of registration and de-registration for administratively disadvantaged people. More specifically, we shed light on the importance of civil registration and the link with citizenship for people experiencing homelessness. Building on the concepts of domicile-based and local citizenship, we argue it disproportionately hampers the access to rights for people experiencing homelessness and creates an 'invisible crisis' in Belgium. [ABSTRACT FROM AUTHOR]

Summary: In contemporary welfare states, the non-take-up of rights is a pervasive and considerable problem. Yet, our empirical and theoretical understanding of this phenomenon is still rather limited. In this context, the historical role of social work practice in bridging between citizens and the welfare state cannot be overlooked. To adequately tackle non-take-up, there is an urgency for usable knowledge that is oriented towards practice. In this article, we address this issue by studying Integrated Rights-Practices that focus on overcoming non-take-up through proactive, outreaching, generalist and relation-based interventions. We conducted a qualitative realist evaluation (n = 18) with the intention to explain how and why these interventions provide an answer to the determinants of non-take-up. Findings: We argue that the aforementioned guidelines – referring to the 'who', 'where', 'what' and 'how' of social interventions – are not to be considered separate strategies, but should rather be understood as synergistic, jointly activating 10 generative mechanisms that overcome the information, process and social costs associated to non-take-up. Applications: This article makes both a methodological and theoretical contribution. First, the potential of realist evaluation has convincingly been advocated for by different authors in social work academia, but empirical examples have been lacking hitherto. Second, the identified mechanisms and interventions can provide inspiration to develop similar practices to tackle non-take-up in other welfare regimes and contexts. [ABSTRACT FROM AUTHOR]

Introduction: In the ongoing scientific debate concerning the future of health care models, two trends can be discerned. On the one hand, integrated care is considered as the solution to current issues, such as the fragmentation of care, the lack of coordination and the evolution from acute to chronic care. On the other hand, participation of patients and family carers in health care decisions on various levels (micro, meso, macro) is considered as an important value. In other words, integration and participation seem to be two guiding principles when organising care. But it is unclear which connections are made between both evolving conceptual and empirical research strands. Purpose and objectives: The aim of this contribution is to examine whether the participation of patients and family carers is studied in the literature on integrated care, on which level this involvement is realised and what kind of methods and strategies are described. Method: We conducted a systematic review of empirical studies focusing on the relationship between integrated care and participation of patients with chronic care needs. For describing the different ways in which patients and family carers can be involved a conceptual framework of participation will be applied. Results and conclusions: Integrated care models aim to realise demand-driven care. Our findings give an overview of the current evidence on the methods and the effects of patients' and family carers' involvement in integrated care. Lessons Learned: - Integrated care places patients at the centre of the care process. - More attention must be paid in research and practice to the question how and on what levels patients and family carers can play an active role in integrated care initiatives. This research is part of the multidisciplinary research project CORTEXS that studies integrated care initiatives (1). [ABSTRACT FROM AUTHOR]

Abstract: Despite the growing interest of users in online services, social workers are still reluctant to offer their services in an online environment. Moreover, little is known about online working methods and their contribution to an effective online session. This paper reports on the findings of a Dutch case study of the online intervention “Clickforhelp”. The first aim of this paper is to explore whether social workers believe that they are able to stimulate the problem‐solving abilities of the users in an online working environment. The analysis pertaining to this question was based on the results of a qualitative online survey completed by 26 online social workers. The second aim is to examine how social workers implement the five essential components of a solution‐focused approach in a chat and email environment. A qualitative content analysis of 50 online cases was carried out based on analytical questions derived from the problem‐solving method. The findings illustrate that the social workers of “Clickforhelp” believe that they are able to stimulate the problem‐solving abilities of users in an online environment, but prefer a face‐to‐face setting. They rarely implement all five components of a solution‐focused approach. They predominantly stimulate the self‐esteem and the power position of the user, while relatively little attention is given to the strengths of the user and the social support system. Neither do they translate the problem‐solving process into concrete and achievable steps or evaluate the progress and the user’s experience. It is necessary to further develop knowledge relating to online working skills and methods. [ABSTRACT FROM AUTHOR]

This study explores the palliative care capacity of social workers in Flanders. First, it examines the frequency with which social workers in Flanders are currently performing palliative care tasks. Second, this study assesses their attitudes and competencies regarding the performance of these tasks. Third, as contextual factors also influence this performance, this study explores the level of appreciation experienced by social workers in Flanders. To achieve these objectives, a mixed-methods explanatory sequential design was used. Quantitative data were collected by distributing electronic survey questionnaires on QUALTRICS© to a theoretical sample of social workers in Flemish hospitals, community health clinics, nursing homes, home care, and health insurance services. A total of 499 social workers completed the survey in April and May 2021, of whom 352 met the eligibility criteria and were retained for analysis. Qualitative data were collected based on online focus groups between June and September 2021, in which a total of 24 social workers discussed the main survey results. Transcripts from the focus groups were analysed by using the framework method. The results indicate that the current palliative care capacity of responding social workers in Flanders is limited to tasks related to client assessment and referral, while their potential role extends beyond these tasks. With an expanded role, social workers would be better able to address the social dimensions of care, engage in politicising work, and, in turn, contribute to a holistic and multidimensional approach to palliative care. However, this study illustrates the need to increase the competencies and actual involvement of social workers in tasks associated with this expanded role. [ABSTRACT FROM AUTHOR]

Palliative care is a holistic practice using a multidisciplinary approach in addressing multidimensional needs. Although the social aspects surrounding the end-of-life phase suggest a place for social work in it, the profession is often inadequately involved in daily practice. This contrasts strongly with the potential meaningful contributions of social workers in this field. To date, no comprehensive list of prerequisites for meaningful social work involvement in palliative care exists. This review aims to gain more insight on the prerequisites for meaningful social work involvement in palliative care and how to realise them in practice. It could therefore provide pathways for future intervention development in enhancing the involvement of social workers and maximising their contributions in palliative care. A scoping review methodology was used. A systematic selection of peer-reviewed articles ranged from 2000 to April 2021 – out of the electronic databases Web of Science, Scopus and Pubmed – was conducted. The 170 articles that met the eligibility criteria were analysed for relevant content using open and axial coding processes. The findings are reported according to the PRISMA-ScR checklist. The nine prerequisites listed in this review concern the level of individual social work capacities and the level of contextual factors structuring social work practices. A majority of articles have, however, focused on the level of individual social work capacities in a rather specialist view on palliative care. Future research should further address the contextual level of social work involvement in the broader practice of death, dying and bereavement. [ABSTRACT FROM AUTHOR]

Palliative care is a holistic practice using a multidisciplinary approach in addressing multidimensional needs. Although the social aspects surrounding the end-of-life phase suggest a place for social work in it, the profession is often inadequately involved in daily practice. This contrasts strongly with the potential meaningful contributions of social workers in this field. To date, no comprehensive list of prerequisites for meaningful social work involvement in palliative care exists. This review aims to gain more insight on the prerequisites for meaningful social work involvement in palliative care and how to realise them in practice. It could therefore provide pathways for future intervention development in enhancing the involvement of social workers and maximising their contributions in palliative care. A scoping review methodology was used. A systematic selection of peer-reviewed articles ranged from 2000 to April 2021 – out of the electronic databases Web of Science, Scopus and Pubmed – was conducted. The 170 articles that met the eligibility criteria were analysed for relevant content using open and axial coding processes. The findings are reported according to the PRISMA-ScR checklist. The nine prerequisites listed in this review concern the level of individual social work capacities and the level of contextual factors structuring social work practices. A majority of articles have, however, focused on the level of individual social work capacities in a rather specialist view on palliative care. Future research should further address the contextual level of social work involvement in the broader practice of death, dying and bereavement. [ABSTRACT FROM AUTHOR]

Introduction: Integrated care is a valuable approach in creating a health care system that addresses the complex needs of people with chronic diseases. For integrated care to be successful, patient participation, i.e. the involvement of patients in decision making and active participation in care activities in partnership with professionals, is crucial. Patient participation can occur at the micro (i.e., individual), meso (i.e., organizational) and macro (i.e., policy) level of care. At all levels, participation can range from purely one-sided information exchange provided by professionals, to consultation of patients, to collaboration (also labelled as co-creation) where professionals and patients share power and responsibility in making decisions. While integration and patient participation appear to be two guiding principles in reorganizing health care systems, so far little is known on the actual contribution of patients with chronic diseases to the organization of integrated care. Hence, the objective of this study is to systematically review studies on patient participation in the development and evaluation of integrated care. Method: PubMed (Medline) and Web of Science databases were consulted to conduct a systematic literature review. We searched for papers on patient participation, integrated care and chronic diseases that were published between January 2003 and December 2016. After categorizing the general focus of the articles, the levels and degrees of patient participation that were described in the studies were reviewed. Results: As for the focus of the articles, most papers address patient participation in the creation and/or evaluation of integrated care initiatives or ICT facilitators to achieve integrated care. A small group of articles explores the perspectives of patients on integrated services and policies. Regarding the level of care in which patients are involved, most studies refer to patient participation at the meso level. Also, in some studies participation at the macro level is described. Concerning the degree of participation, in the majority of articles patients are consulted to express their views, yet this infrequently leads to the actual cocreation of integrated care initiatives. Discussion: Despite the importance of patient co-creation that has been articulated by the WHO, actual participation activities and practices in integrated care often comprise a limited degree of patient collaboration in decision making. Conclusion: In the field of research into integrated care, current practices of integrated care provide little opportunity for impact of patients with chronic diseases to collaborate in decision making on (re)designing and changing health care systems. [ABSTRACT FROM AUTHOR]

This study reviews the literature available on contents, form, and effectiveness of group‐based programs for combined financial education and counseling aimed specifically at populations at risk for financial difficulties. Despite the widespread application of these programs, relatively little is known about their effectiveness. In general, evidence points to positive effects of several programs on knowledge, confidence, and (intended) behavior, but the exact mechanisms through which this is achieved remain unclear. The topics covered differ among studies, but common themes can be identified. It appears of importance to combine education with practical exercises allowing participants to apply the skills they learn. Motivating clients is another important recurring theme. Working in groups provides an added benefit through recognition and peer support. It is important that future research focuses on the mechanisms of change and on long‐term effects, since these remain largely unknown in the current body of literature. [ABSTRACT FROM AUTHOR]

One of the main goals of primary care is providing equitable health-care, meaning equal access, equal treatment and equal outcomes of healthcare for all in equal need. Some studies show that patients from lower socioeconomic groups visit a GP more often, while other studies show that they are more likely to postpone a visit to a GP. In this study, we want to explore within the social group of low-income patients living in Flanders, Belgium, which patients have a higher risk of postponing a visit to a GP. A face-to-face questionnaire was administered among 606 low-income users of Public Social Services. The questionnaire consisted of questions on socioeconomic and demographic characteristics, social networks, health and healthcare use. A multivariate logistic regression model was built to study the relationship between postponing or cancelling a GP visit which respondents thought they needed and variables on health, socio-demographic background. The multivariate regression indicates that depression, self-rated health and trust in the GP independently predict postponing a visit to a GP. Low-income people with a low trust in the GP, people with a poor self-rated health and people suffering from a severe depression are more likely to postpone or cancel a GP visit they thought they needed compared to other people on low incomes. This might indicate that the access to health-care for low-income people might be hindered by barriers which are not directly linked to the cost of the consultation. [ABSTRACT FROM AUTHOR]

In spite of a progressive institutionalisation of community–based learning into higher education, relatively little is known about the actual dynamics and correlates of volunteering by students. The study presented seeks a more in–depth understanding of the spontaneous, extracurricular involvement within a university student population. Data are drawn from a postal survey of a representative sample of third–year university students enrolled at a Flemish university ( n = 744). In a first step, an exploration of the course and nature of students’ volunteer involvement is provided. In a second step, an explanatory model is constructed to predict the likelihood of belonging to the categories of volunteers, former volunteers or non–volunteers. Firstly, it appears that a large group of students drop out of volunteering in transition to university, and that volunteering is rarely given priority in students’ agenda. Furthermore, a bifurcated pattern of involvement with a different pace inside and outside university is identified. Finally, extensive embedding in a volunteer environment as well as the discipline of study are major predictors of volunteering by students. Gender, church practice, being encouraged to volunteer and subjective study pressure produce subsidiary effects. [ABSTRACT FROM AUTHOR]

In 2013, a 4-year research project on integrated care in Flanders (Belgium) was launched: "Care Organisation: a Re-Thinking EXpedition in search for Sustainability" (CORTEXS). The multidisciplinary research team focuses on the challenge of how to organize care integration. Numerous studies convincingly demonstrate the need for care integration, and several conceptual models and evaluation frameworks have been published. However, far less is known about systematic approaches to organizing care integration. CORTEXS developed a social systems based approach for redesigning care systems. A system consists of components that relate to each other, and has a certain openness to its environment. A care system is a social system, of which the elements are activities. Grouping and linking those activities forms the central focus of redesigning care systems. Splitting up care processes in specialized activities, grouped in specialized sectors, organizations, organizational units and occupations, leads to highly fragmented care systems. The number of interactions and dependencies between the many care processes and activities then becomes so high that delivering integrated care becomes virtually impossible. The mere introduction of additional coordination mechanisms leaves the underlying fragmentation untouched, and risks to increase complexity even more. From a social systems perspective, the far-driven fragmentation of processes and activities itself must be tackled. The 'law of requisite variety' (Ashby 1957) posits that variety can only be managed with variety. In other words: the variety a care system offers must be equal to or greater than the variety of care demands. The enormous variety of individual care demands can be reduced to a manageable range of groups of people with comparable care needs. Then, the variety of the care system can be increased by clustering activities in parallel streams for each target group. In order to further reduce the complexity of care systems, it is important to avoid ending up interlinking everything again at the end. The objective is to vest the decision-making power at the level where it is most needed, facilitating that any problems can be resolved as soon as they arise. We can assume that a care system for people with chronic care needs will often consist of multiple care organizations and professionals. In line with the reasoning developed above, such an organizational network should always be focused on achieving concrete added value for the identified target group, by being built around the care processes and activities that are needed for that target group. It should also be noted that people with a chronic care need are not regarded as passive users of the care system. Not only is it appropriate for them to be involved in the redesign exercise, but also to become an active part of the care processes, as comanagers and potential carriers of activities. Evidently, the opportunities for redesigning care systems are limited by the environment in which they operate. We discuss contextual preconditions in terms of legislation, financial incentives, information technology and competence development. The main priority of the redesign is to ensure that care systems can address the chronic care needs of their target groups, and contribute to the well-known Triple Aim. In addition, it is advisable that the redesign also contributes to improving the quality of working life of the care professionals. We will demonstrate how the proposed redesign approach could contribute to this Quadruple Aim. This social systems based approach already offers a theoretical and empirically substantiated framework for the redesign of care systems for people with chronic care needs. Further steps include the application of this generic approach to specific challenges in the field of policy and practice. [ABSTRACT FROM AUTHOR]

Background: In line with international developments, the Flemish government is concerned about the quality of care in Flemish nursing homes. In 2003, new legislation shifted the attention from structural quality aspects to introducing quality processes. From from 2010 on, this evolved further with growing interest in the outcomes of quality management. This presentation will describe the subsequent steps taken towards the development and implementation of an integral framework of quality for the Flemish nursing homes using quality indicators. Objective: The aim was to develop an integral framework which supports nursing homes in quality management and improvement. This framework also needs to be informative for policy makers and be useful for inspection services and public communication. Process description: As a research partner, we started with formulating six process agreements, for instance, defining the objectives of the project, the roles of partners or clarifying the distinction between monitoring and evaluation. In 2011 and inspired by the Progress-study (Hoffman e.a. 2010), an integral framework of quality was developed through focus group discussions with all relevant stakeholders, including representatives of residents and family, nursing home workers, representative organisations, representatives of policy and inspection. This framework involved three themes: (1) quality of care and safety, (2) quality of life and (3) quality of caregivers and care organisations. The second year, a pilot study was conducted in eight nursing homes to develop feasible, scientific and essential quality indicators that can be self-administred for the themes (1) and (3). Based on this pilot study, a manual and a stepwise implementation plan were formulated. In 2013 the first self-registrations were initiated and further efforts were made to develop the monitoring of quality of life of residents. Here too, a pilot study informed the further steps to be taken. Conclusion: A comprehensive framework was developed capturing both quality of care aspects ('objective') and quality of life ('subjective'). The success of the project can be attributed to several factors: building on scientific evidence, intensive collaboration with all relevant stakeholders, participation of practice workers in pilot study and facilitating leadership of policy makers. Discussion: The six process agreements guided the whole process. Continuing efforts are needed to build trust between all collaborating parties. However, this project demonstrates that policy can really initiate innovations while recognizing partnerships with research and practice. Hoffman, F., Maas, F., Rodrigues, R. e.a., (2010). Measuring progress: indicators for care homes. PROGRESS, European Centre for Social Welfare Policy and Research:Vienna. [ABSTRACT FROM AUTHOR]

Integrated care is seen as an important new method towards more demand-driven and costconscious health systems. In November 2013, a 4-year, multidisciplinary and multi-method research project on integrated care in Flanders (Belgium) was launched: CORTEXS - Integrating Care. The €3 million project focuses on long term care. CORTEXS strives to combine high quality innovative basic research with a strategic utilization of the research results. The research agenda covers three domains: To develop concepts of integrated care that meet the requirements of availability, quality, feasibility, patient empowerment and job quality; To optimize the work processes and design of care organizations in terms of care quality, job quality, and productivity; To identify the conditions that foster (or impede) effective organizational coordination, normative integration and implementation of high quality care concepts. Especially the innovative combination of expertise on organization sciences, social innovation and (integrated) care is expected to lead to substantial knowledge development. The project encompasses 7 workpackages: - WP1 Conceptualization and operationalization of integrated care - WP2 CORTEXSLAB: Performance of integrated care under controlled circumstances - WP3 New processes in Integrated Care - WP4 Governance in networked settings - WP5 Normative and systemic integration - WP6 Evaluation of the performance of Integrated Care - WP7 Policy advice The various tasks in the different workpackages are part of an overall empirical research design, which consists of six iterative steps: 1. In WP1, the development of the taxonomy identifies the concepts and the types of chronic care. 2. WP 3, 4, 5 and 6 each start with a literature review on theories, previous research results and implementation reviews. 3. WP 3, 4, 5 and 6 involve comparative case studies on patients pathways in networks of organisations. 4. WP 2 involves the creation and management of the CORTEXSLAB, which is used to integrate the findings from WP 3, 4, 5 and 6 in case study and literature review based models for integrated care. In CORTEXSLAB, these models will be discussed and virtually tested. 5. After testing models and simulating possible solutions in the CORTEXSLAB, specific measures will be tested in real life situations (WP3, 4, 5 and 6). By developing pilots or intervention studies, new integrated care processes will be tested in various settings. 6. WP7 connects the separate results from the various work packages into several practical and accessible tools and instruments. The CORTEXS project aspires to apply the described approach to tackle the complexity of contributing in a scientific sound way to the societal need for innovations in chronic care. [ABSTRACT FROM AUTHOR]