Health and social care staff's experiences working with adults with complex needs - a focus group study

Multimorbidity is increasing globally, affecting over one-third of the population. Adults with complex needs often experience physical, mental, and cognitive disorders, leading to increased healthcare utilization, reduced quality of life, and social challenges. The frequent co-occurrence of psychiatric conditions, substance abuse, addiction, and homelessness highlights the complexity of these needs. Collaboration between healthcare and social services is essential for delivering integrated care but is often hindered by legislative constraints and difficulties in coordinating care. Although integrated care has been shown to improve outcomes, persistent challenges affect staff in their daily work with adults with complex needs. Therefore, the aim was to describe health and social care staff's experiences working with adults with complex needs, with a focus on what promotes or hinders collaboration and the individual's participation.

This study employed a descriptive qualitative design. Data were collected through four focus group interviews with 17 health and social care staff members and analyzed using qualitative content analysis.

Data analysis resulted in three generic categories: (i) collaboration between authorities is complex, (ii) challenges working according to the person's needs, and (iii) participation under difficult conditions.

This study highlights both challenges and facilitators in working with adults with complex needs. Collaboration was hindered by legislative, financial, and organizational disparities but facilitated by interprofessional forums and collaborative meetings. Establishing trusting relationships free from bureaucratic constraints was important for providing person-centered care. However, fostering meaningful participation remains challenging because of the individual's limited capacity to engage and the complexities that staff face in balancing respect for autonomy with acting in the person's best interest. Further research incorporating perspectives from adults with complex needs, their relatives, and management could enhance the understanding of how collaboration, participation, and organizational barriers impact the provision of integrated healthcare and social services.