A systematic review of the impact of integrating health and social care services on child health and wellbeing

Context or Objective: The UK is implementing integrated and place-based health and social care, with a greater emphasis on preventive healthcare delivered in community settings. The aim is to reduce longstanding inequalities with 29% of children and young people (CYP) in the UK living in poverty. This review collates existing evidence for early years interventions from developed health economies across the globe that combine health and social support to improve child health and wellbeing.

Study Design and Analysis: Systematic mixed methods review with the quality of manuscripts assessed by Critical Appraisal Skills Programme tool (qualitative), Effective Public Health Practice Project tool quantitative) and Mixed Methods Appraisal Tool (mixed methods). The review uses a narrative synthesis to describe common themes arising from the implementation of the interventions identified, including their strengths and weaknesses, and the quality of the evidence evaluating their impact. PROSPERO registration: CRD42023399907.

Setting or Dataset Major databases were searched including Embase, Social Policy and Practice, CINAHL, Cochrane (DSR), and APA Psychinfo (since ever).

Population Studied: All CYP ≤ 18.

Intervention-Instrument: All study designs were included that described an intervention that integrates delivery of healthcare with early years intervention for CYP and reports the impact on child health/wellbeing.

Outcome Measures: Impacts on a wide range of outcomes on child health (preventive, acute, chronic health issues) and social support/wellbeing (e.g., school attendance, domestic violence).

Results: There were 11 studies included in the review, five of them single centre. Of the ten studies that demonstrated impact only three were considered as having strong evidence. The interventions included: system navigation (5 studies), professional working, partnerships (2 studies), holistic perinatal support (2 studies), food prescription (1 study) and a legal practice (1 study) embedded in paediatric clinics.

Conclusions: Results show interventions tended to improve care navigation and an overall trend toward improved outcomes. Future evaluations should endeavour to include well- designed RCTs at adequate scale to encourage more comprehensive funding for integrated care.