Health isn't determined by healthcare alone. Housing, food, income, social connection, safety—these social determinants affect health as much or more than clinical services. Integrated and wraparound service models recognize this by bringing together health and social services, addressing the full range of factors that affect wellbeing rather than treating medical conditions in isolation from the circumstances that cause or worsen them.
The Integration Imperative
>People with complex needs interact with multiple systems—healthcare, social services, housing, mental health, addictions, income support—that often operate independently. Navigating these separate systems taxes those who are already struggling. Gaps between systems leave needs unmet. Contradictory requirements create impossible situations.
>Traditional service organization reflects professional and administrative divisions, not client realities. Healthcare providers treat health conditions; social workers address social circumstances; housing workers handle housing. But the person experiencing health problems because of housing instability and social isolation needs response that crosses these boundaries.
>Integration brings services together in ways that serve people holistically. This can mean co-location—different services in the same place. It can mean care teams that span disciplines. It can mean shared information systems and coordinated planning. The specific form matters less than the outcome: people receive coherent support that addresses their full situation.
Models of Integration
>Community health centres often integrate primary care with social services. Health services address clinical needs while social workers help with income, housing, and other circumstances. This integration recognizes that clinical care alone won't help someone whose health problems stem from poverty or homelessness.
>Hospital-based social workers provide integration at the acute care level. When patients' medical needs intersect with social circumstances—no home to discharge to, no one to provide post-discharge care, no income for medications—social workers bridge clinical and social domains.
>Assertive Community Treatment (ACT) teams for people with serious mental illness integrate mental health treatment with housing support, employment assistance, and daily living help. The team wraps multiple services around each client rather than requiring clients to navigate separate systems.
>Hub models bring multiple services to single locations. One-stop service centres where people can access healthcare, social services, housing help, and other supports reduce the navigation burden that separate locations create.
Wraparound Approach
>Wraparound is a specific philosophy and process for creating individualized service plans that integrate multiple supports around a person or family. Originating in children's mental health, wraparound has been applied across populations with complex needs.
>Key wraparound principles include: family voice and choice in planning; team-based service delivery including natural supports as well as professionals; individualized planning based on each person's situation; strength-based approaches that build on what's working; and persistence through setbacks rather than discharge for non-compliance.
>Wraparound requires coordination capacity—someone to bring providers together, facilitate planning, and monitor implementation. This coordination role is essential but often underfunded. Integration without coordinators often fails.
>Funding for wraparound is complicated when services come from different budgets with different rules. Braided or blended funding approaches combine resources from multiple sources, but administrative complexity makes this difficult. Funding silos remain barriers to service integration.
Social Prescribing
>Social prescribing connects people to community resources through healthcare encounters. A physician might "prescribe" exercise programs, arts activities, social groups, or volunteer opportunities—addressing social determinants through non-clinical interventions.
>Link workers or community connectors receive referrals from healthcare providers and help people access community resources. This role bridges clinical care and community supports, translating health needs into social interventions.
>The social prescribing model has grown internationally and is developing in Canada. Evidence suggests benefits for mental health, loneliness, and quality of life. But implementation requires community resources to prescribe—in areas without adequate services, social prescribing has less to offer.
Housing and Health Integration
>Housing affects health directly—cold, damp, or unsafe housing causes health problems—and indirectly—homelessness makes managing health conditions nearly impossible. Integrating housing with healthcare responds to this reality.
>Housing First models provide housing to homeless people without preconditions, then layer services around them. Research consistently shows better outcomes than treatment-first approaches that require sobriety or treatment compliance before housing. Stable housing enables other interventions to work.
>Supportive housing combines accommodation with services for those who need ongoing support. Healthcare, mental health, life skills support, and other services come to where people live rather than requiring them to access separate locations.
Indigenous Approaches
>Indigenous concepts of health—like the Medicine Wheel's physical, mental, emotional, and spiritual dimensions—have always been holistic. Integrating services reflects Indigenous worldviews that Western medicine historically ignored.
>Indigenous health centres often provide integrated services that include traditional healing alongside clinical care, and community services alongside health services. This integration reflects Indigenous understanding of interconnected wellbeing.
>Self-determination means Indigenous communities designing integration that fits their values and needs, not adopting mainstream models that may not fit. Indigenous-led integration looks different than mainstream integration imposed on Indigenous contexts.
Challenges of Integration
>Despite benefits, integration faces significant challenges. Professional boundaries create resistance to working outside one's discipline. Liability concerns arise when non-specialists address issues outside their training. Confidentiality rules may limit information sharing across services. Administrative systems designed for separate services don't accommodate integration.
>Turf and funding competition create barriers. Services may see integration as threat to their autonomy or budget. Collaborative approaches that serve clients well may not serve organizational interests.
>Integration takes time and resources that aren't always available. Building relationships across services, creating shared processes, and coordinating care all require capacity that acute service demands may not leave.
>Scale creates challenges. Integration may work in small programs but face implementation barriers at larger scales. What's possible in a pilot may not translate to system-wide transformation.
Questions for Reflection
>Should funding flow to integrated services or remain in separate silos with requirements to collaborate? What funding models best support integration?
>How do we preserve specialized expertise while enabling the generalist approaches that integration requires? What professional training changes would support integrated practice?
>How can integration serve people's needs without creating surveillance systems that track their lives across domains? How do we balance coordination with privacy?