Introduction: Community paramedic programs are being implemented to leverage existing resources and contribute to a sustainable patient-centered healthcare system. Expanding the role of paramedics into home care requires new collaborative relationships with healthcare providers such as nurses and physicians. Developing effective and productive collaborative relationships will enhance and support the integration of community paramedic programs. Our objective was to describe the barriers and facilitators to effective collaboration between nurses, physicians, and paramedics within home-based community paramedicine. Methods: We conducted semi-structured interviews with nurses, physicians, paramedics, and faculty who teach in paramedic programs. We explored the attitudes, perceptions, barriers, and enablers to collaboration in home-based community paramedic programs. Participants were recruited utilizing the professional networks of the researchers as well as snowball sampling. Recruitment in each group stopped when saturation was achieved. We conducted a thematic analysis of the interviews to generate findings related to our objectives. Results: We interviewed 33 participants with a typical cross-section of age, years of experience, and education. Overall, participants felt that collaboration was important for effective integration of community paramedics into home care and for ensuring a patient-centered approach to care. Currently, collaboration mostly occurs between physicians and paramedics and community paramedicine appears to be a siloed rather than integrated service. Few collaborative relationships exist between paramedics and nurses, despite the fact that nurses are highly involved in home care. We identified several barriers to effective collaboration including lack of understanding of the contributions of the different health providers, and regulatory and funding constraints. Inter-professional education that supports collaboration and facilitates dismantling of professional and service silos can support the effective integration of paramedics into home care. Conclusion: Strengthening networks of collaboration between nurses, physicians, and paramedics can help dismantle silos and enhance inter-professional collaboration to support appropriate integration of paramedics into home care. The willingness and positive attitudes for collaboration are assets that provide an excellent foundation upon which to move forward. Continuing education to support inter-professional collaboration is needed.

This article describes developments in residential childcare services in Scotland and the influence of various policy trends; in particular, it draws on the work of the National Residential Child Care Initiative, a major government-led review that reported in 2009. The development of small-scale residential units, the emergence of a ‘mixed economy’ of provision and a focus on staff training are key features of residential care for children in Scotland. The sector has received strong central government affirmation for two decades, notwithstanding a gradual reduction in its overall size. The article focuses on developments over the past 10 years and identifies a number of ‘drivers’ that aim to promote improvement, including staff training and the promotion of interprofessional collaboration. The emergence of specialist education and health services for ‘looked after children’ is noted. The relative underemphasis, until recently, on specific theories of care or particular therapeutic approaches is considered. Constraints on improvement are also considered; these include the fragmentation of provision and the operation of markets, the pressure on places and a high level of placement breakdown.