Continuum of Integrated Care Strategies

Kodner and Spreeuwenberg discuss integration in the context of health care, which, although related, presents different needs and concerns than homelessness. However, much of what they discuss, as a philosophy or framework, can be applied to the homeless sector. 

They suggest that, “A continuum of strategies—from the macro to the micro—are available to foster integrated care. The application of these strategies is not only crucial to achieving more humanistic patient outcomes, but also better results in both efficiency and cost-effectiveness terms. The list of methods and tools found in [the list below] though not exhaustive, are most useful in addressing the barriers and bottlenecks which often occur at various levels in five important, interlocking domains” (Kodner and Spreeuwenberg, 2002).


  • Pooling of funds (at various levels)
  • Prepaid capitation (at various levels)


  • Consolidation/decentralization of responsibilities/functions
  • Inter-sectoral planning
  • Needs assessment/allocation chain
  • Joint purchasing or commissioning


  • Co-location of services
  • Discharge and transfer agreements
  • Inter-agency planning and/or budgeting
  • Service affiliation or contracting
  • Jointly managed programs or services
  • Strategic alliances
  • Consolidation, common ownership or merger

Service Delivery

  • Joint training
  • Centralized information, referral and intake
  • Case/care management
  • Multidisciplinary/interdisciplinary teamwork
  • Around-the-clock (on-call) coverage
  • Integrated information systems


  • Standard diagnostic criteria (e.g. DSM-IV)
  • Uniform, comprehensive assessment procedures
  • Joint care planning
  • Shared clinical record(s)
  • Continuous patient monitoring
  • Common decision support tools (i.e. practice guidelines and protocols)
  • Regular patient/family contact and ongoing support


Adapted from the Kodner and Spreeuwenberg report.