Multisectoral integrated care for children and young people with life-limiting conditions: A realist review.

Abstract

Children and young people with life-limiting conditions require input from health, education and social care. Despite consensus among stakeholders that service-integration is necessary, it is not clear how models of integrated care delivery can benefit children and their families. To determine <i>how, why, and under what circumstances integrated multisectoral assessment and care is achieved for children with life-limiting conditions?</i>Design:We conducted a realist review according to RAMESES guidelines (PROSPERO: CRD420250653996). Iterative searches of peer-reviewed and grey literature were conducted between February and March 2025. We included documents that explain contexts and mechanisms by which multisectoral care might lead to optimal outcomes for children. From 49 documents, we developed nine CMOCs representing two themes: (1) needs of children and families, and (2) agencies and systems of care. Key contexts including the co-creation of care plans, interagency working and collaborative funding systems. Mechanisms include children and families feeling reassured that care will be responsive to their evolving needs. Positive and negative outcomes were also evident: increased referrals to appropriate services, improved care experiences and a distrust of school services to meet the needs of children and families. This is the first realist review of multisector integrated care that considers the perspectives of health, education and social care. Policymakers should prioritise child-centred policies and cross-sector funding systems to support shared goals, information-sharing and planning care that incorporates families' views and needs. The development and rigorous evaluation of multisector programmes for children with life-limiting conditions requires further research.