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Introduction: This paper analyses and discusses the models and tools in the Finnish health and social care system to identify the individuals who might benefit from integrated multidisciplinary care. Description: The analysis and discussion of the paper is based on a study which mapped and studied the models and tools in practice or under development for identification in the Finnish health and social care organizations. The study used electric survey and structured interviews as research methods. Discussion: There are several different established models of identification in Finland and the experiences of using them are mainly positive. However, only every third of health and social care organizations in Finland have defined a common model or tool. The identification practices and criteria vary by region, municipality and/or organization. The identification is in general unsystematic and insufficient in practice that may inhibit the individuals to access the integrated care they might benefit from. Conclusions: Models and tools are needed for founding and identifying individuals who are outside the service system, those whose client-ship has just begun, and those who already access services. The identification of individuals for integrated multidisciplinary care and the assimilation and understanding of different identification models and tools requires the development of basic and further competence in the different fields of health and social care. Multidisciplinary collaboration requires shared concepts and positive attitudes on the development of integrated professional environments, identification models and services. It is therefore also a question of shared working culture.

Introduction: This research in progress studies the enactment of integrated care in the system-wide social and health care reform suggested by the government of Finland. In the new model the responsibility for organising social and health care will be transferred from the municipalities to the eighteen new counties, while the service delivery will be the responsibility of public, private and third sector organisations. The counties will have the responsibility for defining the service packages and chains on the basis of the needs of different client groups. The challenge for integrated care is that there will be multiple service providers from whose services a client’s service package or chain can be composed of. The preparation of the implementation of the model has started in the preliminary county organisations, while the new counties are planned to start their activity in January 2021. Theory and Methods: This research studies the social and health care system as systemic practices that constitute and mold each other. A model is studied as a script that defines the elements of a practice and their relations. A model is locally translated and adapted into practice. This research is based on a multi-case study setting which studies the implementation process in five counties. This first part of the research analysed during 2018 the strategies and means for defining the service packages and chains within five county organizations..Official public documents were analysed and thematic dialogues with the temporary county organisations were carried out. Results and discussion: There was uncertainty among the counties concerning what the government means by the service packages and chains. Every county had chosen the life span model as a ground for defining the service packages and chains: children and families, adults of working age, and elderly. Within this model definition of different sub-segments was under consideration. The challenge concerned especially how to identify the clients who need several different services. The present public service providers were extensively involved in the definition practices in every county, while there were differences between the counties who, organiser or provider, was leading the definition practice. The different client groups were heard in different occasions and forums in the counties, but they were not participating in the actual definition practices. Conclusions and lessons learnt: The counties were preparing the service packages and chains in extreme uncertainty because the suggested laws were not accepted in the parliament yet. So far they were in the beginning of the definition work. Segmentation, defining the service packages and chains on the basis of the needs of client groups, multifaceted utilization of knowledge, and above all the role of the counties as an organizer of services were new things which required time and learning. Limitations and suggestions for future research: This research defines generic socio-technical elements to be taken into account when implementing new models of integrated care. Later it will analyse how the way the service packages and chains have been defined constitutes preconditions, possibilities and challenges for enacting person-centered integrated care by the service providers.

Introduction: Since the early 2000s, Government policies in Finland have supported administrative and operative integration of health and social care to create larger authorities for organising services and to strengthen coordination of primary and specialised care, and social services. Nationally, the policies have led to attempts to reform the service system to support integration. At the local level, municipal collaboration has been launched to create regional joint health and social care authorities to boost administrative integration and to facilitate the implementation of innovative forms of integrated care. Of these local initiatives, we address two county level joint authorities which have established comprehensive integrated care organisations merging primary and specialised health care and social services under one management. Our aim is to evaluate the success and transferability of these initiatives. Methods: We focus on two vanguard counties, South and North Karelia, which have established joint health and social care authorities in Finland. In South Karelia the authority has operated since 2010 and in North Karelia since 2017. For the multimethod study, we collected intensively data on the operation of the joint authorities and health and social services provided particularly for client groups benefiting from integration. We compiled county policy and evaluation documents on health and social care, run an online survey among employees, and carried out individual and group interviews of management and employees. Results: The two counties have several common features including the population of 130,000-169,000 inhabitants, regions of a larger town with a specialised hospital and several rural municipalities. While both counties have intensively supported to care integration, they display differences in their approaches. South Karelia has gradually developed integrated services for focused client groups, such as homebased rehabilitation services for the elderly, integrated services for children and young people, and integrated psychosocial services for adults. In North Karelia, reorganised recently, integration has focused on integrated health and welfare centres bringing earlier separate primary and mental health care, and social and substance abuse services on the same premises. In both counties, preliminary experiences on adopting integrated care models are positive. Efficiency has improved and waiting time and costs decreased without deteriorating patient satisfaction. The early experiences also underline the importance of strengthened shared management to address smooth work processes between different professional groups. Discussion and conclusions: The establishment of the joint health and social care authorities with a strong emphasis on integrated care seems to be successful. The early experiences suggest a positive impact in terms of efficiency. Transferability particularly to larger urban municipalities is challenging to assess. The national health and social system reform currently prepared in Finland may include features, such as increasing privatisation and market-based services, which request changes in the integrated care models. Limitations: The study was based only on two county-based health and social care authorities with relatively similar integrated care models. Suggestions for future research: Due to limitations in case-studies, long-term broader follow-up studies are needed for assessing and comparing the impact and outcomes of different integrated care models.