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Implementing an integrated care pathway for unaccompanied children and young people seeking asylum: a qualitative evaluation of implementation barriers, enablers and acceptability

Year: 2026

Type: article

Abstract: Unaccompanied children and young people seeking asylum are a highly vulnerable patient group with complex social, physical and mental health needs. Integrated care pathways hold promise for improving care access, coordination and outcomes across fragmented health and social care systems; however, evidence on their implementation in this population is limited. This multistakeholder evaluation aimed to explore the acceptability of a trauma-informed integrated pathway for unaccompanied children seeking asylum in North East London, UK, and to identify barriers and enablers influencing implementation. We conducted semi-structured qualitative interviews with healthcare workers, social workers and carers between June and October 2025. We used the Theoretical Framework of Acceptability and the Theoretical Domains Framework to inform the design of interview schedules and guide data analysis and interpretation. Thematic analysis was undertaken in NVivo 14 using a combined deductive and inductive approach. We interviewed 31 participants across the three stakeholder groups. The integrated pathway was broadly acceptable across stakeholders, who valued the multidisciplinary team approach, particularly the inclusion of a mental health clinician and health improvement practitioner. Acceptability was enhanced by perceived improvements in patient outcomes but moderated by the additional time commitment required for integrated trauma-informed assessments and concomitant impacts on workload and patient wait-lists. Implementation enablers included structured follow-up processes, alignment with stakeholders’ goal of preventing future harm through early identification of needs, belief in the benefits of trauma-informed care, and motivation to deliver the pathway. Barriers included knowledge and skills gaps, professional role tensions, and multi-agency coordination challenges. Healthcare workers, social workers and carers were supportive of an integrated care pathway for unaccompanied asylum seeking children. Multidisciplinary team working, in particular, the inclusion of mental health and health improvement practitioners, was perceived as central to delivering whole person trauma-informed care. Addressing training needs and workforce capacity, and strengthening partnership working across health and social care will be critical to optimising sustainability and scalability.

Source: BMC Health Services Research

DOI: 10.1186/s12913-026-15646-0

Authors: Lauren Rayner, Emma Wilson, Laura Salvo, Michelle Heys, Sveta Alladi

Institutions: East London NHS Foundation Trust, University College London

Language: English

Topic: Health Policy Implementation Science

Subfield: General Health Professions

Field: Health Professions

Domain: Health Sciences

SDGs: Good health and well-being, Reduced inequalities

Open Access status: gold

Estimated APC paid: $3,290