Combatting social exclusion by strengthening primary care The Rotterdam experience

1. Combatting social exclusion by strengthening primary careThe Rotterdam experience

2. Structure 1. Dutch primary care developments; two ways of intervening 2.The Rotterdam experience 3. Conclusions 4. Group discussion

3. 1. Dutch Primary Care Developments and anticipation emphasis on organisation Horizontal program planning ROS Vertical program planning multidisciplinary care programs

4. Horizontal program planning Strengthening primary care on organisational level ROS-structure Characteristics - continuity of care and cooperation - quality & staff training - innovation Zorgimpuls; ROS Rotterdam

5. Vertical program planning

6. The Rotterdam experience Three examples 1 Diabetes, depression and overweight 2 Domestic violence 3 Chronic medically unexplainable pain But, first zooming in on Rotterdam

9. Rotterdam Largest harbour in Europe International Film Festival Rotterdam Marathon Cultural Capital 2001 European Capital of Sport 2005 City of Architecture 2007 Rotterdam European Youth Capital 2009 600.000 inhabitants 46% of non-Dutch origin 170 nationalities Relatively young population (55% under age of 40vs. 50% NL) unemployment rate 11% (vs. 6,5% NL)

10. Diabetes, depression and exercise Context Increase of diabetes and depression

11. ‘From illness to strength’ Intervention program ‘getting people in motion’ Three phases: - I can move! - I’m exercising! - I keep on exercising! Objectives - Take own responsibilty for enough and healty exercise Outcome and results Motivation and enthusiasm New exercise groups Weight loss

12. ‘From Illness to Strength’ Source: www.vankasteel.nl/informatie/infoafb/fitkids/nieuws1.jpg

13. Domestic Violence Context From private to social problem to health problem Intervention for primary care workers Local meetings and a intensification course - raising awareness and recognize signals - learning consultation skills - dealing with conflict of interest - cooperation with other parties involved Objectives Outcome and results

14. Domestic Violence 2 Partners Connection with social work

15. Chronic medically unexplainable pain

16. Chronic pain in primary care

17. Chronic pain Outcome and results Professionals know each other and know their professional skills - integrated treatment Connection with social work

18. Conclusions Health problems often have a social component Social problems appear as health problemes or cause health problems Interaction between professionals is necessary for effective results Especially in neighbourhoods whith low SES an integrated approach is needed because the presented problems are integrated also Primary care (i.c. healthcare centres) serves as a save and non-stigmatising environment to work along with other partners on social inclusion and wellbeing

19. 4. Group discussion Questions/ themes for group discussion What do the different professionals have in common in relation to patients/clients problems, what are their joined objectives? What would you need to improve your cooperate with other professionals in the care process and on what issues would you like to cooperate? Is social work part of primary care or vice versa? Would it be useful to merge or mix the services? If yes, what is the added value. If not, what are the arguments?