Integrated on paper, or in practice?
Most National Action Plans commit to integrated community services. The term is the same across plans. What families experience can be very different. This activity shows how to tell functional integration from symbolic integration, and where in the system integration has to be built.
"What distinguishes substantive integration from nominal alignment is whether a family encounters a coherent, coordinated response, in other words, whether a single team knows their whole situation or if the family continues to navigate multiple disconnected services that happen to be nearby."
One family, two systems
Meet the family: a mother of three in a small town. The youngest child has a developmental delay, the eldest has stopped attending school regularly, and the family is behind on rent. Next, the same family meets two systems. Both are described in their National Action Plan as integrated. You will open four layers of each, in turn, and follow what happens to the family.
Follow the family through each system
Open each layer. It opens in both systems at once, so you can compare directly.
Same label, different experience
Both systems describe their services as integrated. Only one can answer the four questions that distinguish functional integration from nominal alignment. In System A the family carries the coordination; in System B the system carries it. A system that cannot answer these questions is integrated in name only, whatever its plan says.
The four questions
- Who is the case manager?
- How do education, health and social services share information lawfully and systematically?
- What formal mechanisms link national plans to local delivery?
- How does the system measure whether integration improves access and outcomes?
Integration is built on three axes
The four questions point to three places where integration has to be built: across sectors, from national mandate to local delivery, and around the family. Open each axis.
A shift from sectoral to cross-cutting policymaking: ministries with separate budgets, statutory frameworks and reporting lines align around common outcomes.
It requires
- a designated lead institution with cross-sectoral convening authority
- a formal interministerial agreement or legal instrument
- a shared monitoring framework that holds all ministries accountable to common outcomes
National mandates are synchronised with regional and municipal execution. Municipalities provide the infrastructure (schools, clinics and social housing) through which the National Action Plan reaches children.
It requires
- fiscal mechanisms: transfers calibrated to local need
- governance instruments: shared standards, joint planning forums
- capacity support for municipalities with limited administrative capability
Families deal with a single multidisciplinary team rather than several separate agencies.
It requires
- one team, one assessment and one plan
- a case manager who coordinates assessment, planning, delivery, monitoring and review across sectors
Where does each feature build integration?
Each card describes one feature of a practice documented in the ECG synthesis. The label shows how the practice delivers services. Tap the card, then tap the axis where the feature mainly builds integration. Many practices work on more than one axis; tap a placed card to move it.
Tap the card to pick it up.
Horizontal
Vertical
Operational
No single practice, no single axis
Seen together, the practices show two things. First, integration is strongest where it is built on more than one axis: Romania's Minimum Package of Services appears on all three, a legal basis for alignment across ministries, a national framework rolled out through municipalities, and a community team around each family. Second, the delivery typology shows how services reach families, not where integration is built. A co-located hub, a home-visiting programme or a neighbourhood team at the frontline still depends on the other two axes to last.
Where does it break?
Each situation is illustrative and draws on patterns described in the ECG synthesis. Which axis is missing? Choose, read the feedback, and try the other options if you want to see why they point elsewhere.
Scenario 1 · The agreement without a budget
Three ministries have signed a joint agreement on integrated services for children, with a shared monitoring framework. Two years later, municipalities report that they have received no funding line, no standards and no guidance on how to organise integrated teams.
The national level is aligned, but the mandate does not reach local delivery. Vertical integration requires transfers calibrated to local need, shared standards and capacity support for municipalities with weaker administrative capability.
Scenario 2 · The law without a team
A national law establishes integrated services as an entitlement, and municipalities receive a dedicated budget. Families still visit the school, the health centre and social assistance separately, and each service keeps its own file.
The architecture exists, but families still have to navigate among service providers. Operational integration requires one team, one assessment and one plan, coordinated by a case manager.
Scenario 3 · The team without the ministries
A municipality has built a community team that knows every family in its area. The team cannot access health or education records, and each ministry asks for separate reports with different indicators.
On the ground the family is approached in an integrated way, but the local team experiences the fragmentation above it. Horizontal integration requires a lead institution, a formal agreement between sectors and a shared monitoring framework that holds all ministries to common outcomes.
Three things the evidence shows
Integration is defined by what the family experiences.
A shared label does not make services integrated; one team, one assessment and one plan do.
Four questions separate function from label.
Who is the case manager, how information is shared lawfully, what links the national plan to local delivery, and how results are measured.
Integration is built on three axes at once.
Across sectors at national level, from national mandate to local delivery, and around the family on the ground. A gap on one axis weakens the other two.
Apply this to your context
If you work at national level
- Which institution has the mandate to convene health, education and social protection around child poverty?
- Does your National Action Plan set out how municipalities will be funded, supported and held to common standards for integrated services?
- Could your system answer the four questions today, for one family?
If you work at municipal or service level
- For a family with several needs in your area, who is the case manager?
- Can your team share information lawfully with the other services?
- On which axis would you need national support first?
Take this to your team: integrated on paper, or in practice?
National Action Plans across the EU commit to integrated community services. The term is shared; what families experience is not. The difference is whether integration has been built across sectors, from national mandate to local delivery, and around the family, or only declared.
Three things the evidence shows
- Integration is defined by what the family experiences. A shared label does not make services integrated; one team, one assessment and one plan do.
- Four questions separate function from label: who is the case manager, how information is shared lawfully, what links the national plan to local delivery, and how results are measured.
- Integration is built on three axes at once: horizontal, vertical and operational. A gap on one axis weakens the other two.
Questions to use with your team
- For one family with several needs in our system today, can we name the case manager?
- How do education, health and social services share information about that family, and on what legal basis?
- What formal mechanism links our national plan to municipal delivery: funding, standards, joint planning?
- How would we know whether integration has improved access and outcomes for children?
- On which of the three axes is our system weakest, and who would need to act first?
The point of this card is to open a cross-sectoral conversation, at national or municipal level. Bring it to a working group or a team meeting and start with the first question.