The partnership between Ontario Shores Centre for Mental Health Sciences and the Catholic Family Services of Durham (CFSD) exemplifies an innovative approach to integrated care through the development of a stepped care model for trauma services. This initiative aligns with Pillar 2 of the Nine Pillars of Integrated Care, focusing on creating partnerships and alliances to enhance health service delivery. Furthermore, it emphasizes leveraging partnerships for health and development.

The stepped care model addresses significant barriers to accessing trauma-focused services by employing a tiered approach that matches intervention intensity to client needs utilizing a measurement-based care approach. The initiative introduced key innovations, including virtual therapy options that transcend geographic limitations and expand service accessibility. This model ensures the equitable distribution of resources by optimizing care pathways, from low-intensity interventions for early-stage trauma to high-intensity treatments for complex cases. A pivotal aspect of this collaboration is the integration of child trauma services, which broadens the scope of care to address intergenerational impacts of trauma.

Outcomes from the first two years of implementation demonstrate statistically significant improvements across multiple clinical measures, including the PCL-5 (Posttraumatic Stress Disorder Checklist), PHQ-9 (Patient Health Questionnaire), and WSAS (Work and Social Adjustment Scale). On average, clients reported a 52% reduction in trauma symptoms, with 77% expressing high satisfaction with the services. Furthermore, attrition rates were maintained below the targeted threshold of 10%, reflecting strong engagement and adherence. Notably, the virtual therapy component eliminated access disparities, achieving a 100% satisfaction rate for accessibility metrics among underserved populations.

The project exemplifies the power of collaboration in overcoming systemic barriers. A co-designed evaluation framework engaged patients, caregivers, and stakeholders at every stage, ensuring that the services remained person-centered and adaptable. The project also demonstrates fiscal prudence by optimizing human resources, with an additional 1.6 full-time equivalent positions allocated for supervision and service delivery, ensuring sustainability.

Future directions include scaling the model to other regions, guided by lessons learned in virtual delivery and partnership dynamics. An evaluation plan set for completion in 2025 aims to refine the model further and explore opportunities for long-term funding. The integration of patient feedback through client satisfaction surveys and focus groups will continue to shape service evolution.

This initiative underscores the critical role of partnerships in fostering innovation, equity, and sustainability in integrated care. By leveraging shared expertise and resources, Ontario Shores and CFSD have developed a replicable model that advances the global agenda for trauma-informed care and sustainable development. The outcomes highlight the importance of aligning clinical goals with collaborative frameworks to achieve impactful and scalable solutions in mental health care.

This work not only contributes to the knowledge base for integrated care but also provides a practical roadmap for addressing complex health needs through multi-stakeholder engagement and evidence-based practices. It serves as a compelling case study for the transformative potential of collaborative care models in achieving universal health coverage and reducing health disparities.

Background:
Portugal has a high burden of mental health disorders and a relatively low bed density compared to most EU countries (1), highlighting the need for comprehensive, integrated, and community-based mental health services. Evidence suggests that innovative strategies can reduce coercive treatment, address trauma, broaden treatment options, enhance professional expertise, and foster collaborative care. Research also indicates that intensive home treatment, acute day units, and community crisis services can help prevent hospitalisation for some individuals (2). The increasing prevalence of mental illness (3), calls for innovative care models like Psychiatric Home Hospitalisation (PHH), which offers intensive, home-based care as an alternative to traditional psychiatric hospitalisation (4). Although PHH models have been adopted in various countries (4,5), substantial differences in components and implementation practices have emerged. This variability underscores the need for more clearly defined guidelines and reliable tools to measure model fidelity, ultimately aiming to improve their effectiveness (4).
Approach:
This study protocol aims to co-design a sustainable psychiatric home hospitalisation model by actively involving stakeholders to ensure equitable and person-centred care. The project focuses on developing a PHH model tailored to the Portuguese context, serving as a strategic pillar for community-based mental health care. Stakeholders—including users, caregivers, health professionals, policymakers, and community leaders—participate in three key phases. First, a systematic literature review maps existing PHH models to identify their core components and outcomes. Second, user profiling is conducted using validated tools to characterise eligible users and caregivers within a specific care setting. Finally, the PHH model is developed through stakeholder workshops, incorporating focus groups with users and caregivers, and an e-Delphi method involving professionals and community representatives. This participatory approach ensures that the resulting model reflects the needs, values, and priorities of all stakeholders.
Results:
The HOME-ENGAGE project delivers a comprehensive psychiatric home hospitalisation (PHH) model tailored to Portugal, detailing key components such as eligibility criteria, team structure, therapeutic interventions, safety protocols, and mechanisms for inter-professional communication. It also provides operational guidelines covering admission, assessment, care planning, monitoring, crisis management, discharge, and follow-up, alongside implementation strategies that address integration within the Portuguese health system, resource allocation, infrastructure, professional training, and coordination with other mental health services.

By decentralising mental health care, PHH promotes autonomy, social reintegration, and continuity of therapeutic follow-up while potentially reducing hospitalisations, optimising resources, and lowering costs. The model is designed to enhance service accessibility, ensuring a person-centred approach by actively involving users and caregivers in its development. Furthermore, HOME-ENGAGE aligns with the 9 Pillars of Integrated Care by fostering user engagement and interdisciplinary collaboration and supports the Sustainable Development Goals (SDGs) by promoting accessible and equitable mental health care (SDG 3 and SDG 10), strengthening community-based care (SDG 11), and reinforcing multi-stakeholder partnerships for sustainability (SDG 17).

By involving care providers, service users, and policymakers in the co-design process, this project ensures that the PHH model reflects their needs, priorities, and values, addressing service gaps and fostering more holistic, responsive, and person-centred mental health care. This study protocol forms part of a doctoral research project.

The growing aging trend associated with a higher prevalence of chronic illnesses and increased vulnerability of older adults during hospitalization highlights the need for a person-centered approach in healthcare. This approach emphasizes patient involvement in the healthcare process, fosters shared decision-making and mutual understanding, and honors individual values, preferences, and beliefs. Despite broad consensus on the importance of adopting this clinical practice paradigm, its implementation remains challenging. Person-centeredness understanding of those involved in the therapeutic relationship may significantly impact the development of person-centered practice (PCP) in specific care settings. This study aims to compare and analyze the perceptions of the PCP among a multidisciplinary team and older adults with chronic illnesses hospitalized in a Portuguese internal medicine unit using the Person-Centered Practice Inventory (PCPI). PCPI is an instrument aligned with the theoretical elements of the Person-Centered Practice Framework (PCPF), offering an understanding of its practice, identifying areas of potential improvement, and designing specific interventions to elevate the PCP operationalization.
A quantitative, descriptive, cross-sectional approach was followed. A sociodemographic and professional questionnaire and the PCPI-Staff were used for health professionals. For older adults, a sociodemographic and health history questionnaire and the PCPI-Care were applied. Both versions of the PCPI evaluate the person-centered processes domain derived from the PCPF. A descriptive analysis of the effect of different variables on each construct of the person-centered process was performed using an analysis of variance (ANOVA). The independent sample t-test was applied to compare health professionals' and hospitalized older adults' perceptions of care.
The results showed that the person-centered process dimension was positively perceived by health professionals (M= 4.08; SD= 0.62) and older adults (M= 3.92; SD= 0.47). For health professionals, the highest-scored construct was working holistically (M= 4.22; SD= 0.62), and the lowest was sharing decision-making (M= 3.91; SD= 0.72). Concerning older adults, the highest-scored construct was working with the person's beliefs and values (M= 4.12; SD= 0.51), and the lowest was working holistically (M= 3.68; SD= 0.70) and sharing decision-making (M= 3.78; SD= 0.60). A significant difference occurs in the perception of working holistically (t(273)= 6.12, p-value= <0.001) and engaging authentically (t(273)= 3.05, p-value= 0.03), showing differences in how care is delivered and experienced through the integration of physiological, psychological, sociocultural, developmental, and spiritual dimensions in a therapeutic relationship that should be dynamic and genuine.
No significant effect of the independent variables was found to influence the perceptions of any constructs in the person-centered processes domain in health professionals and hospitalized older adults. These results suggest that each person uniquely experiences person-centered processes through individualized therapeutic relationships rather than as a pattern of care shared by hospitalized older adults.
Differences in how working holistically and engaging authentically are perceived should propel health professionals to reassess their understanding of person-centered practice, seek guidance, and actively work to refine their approaches in these areas. This process can help align the perceptions of their work with patients' care experiences, promoting greater consistency between professional intentions and patient outcomes.