Interagency collaboration in children and young people's mental health: a systematic review of outcomes, facilitating factors and inhibiting factors

Operational and organizational variation in determinants of policy implementation success: the case of policies that earmark taxes for behavioral health services

BACKGROUND

Research on determinants of health policy implementation is limited, and conceptualizations of evidence and implementation success are evolving in the field. This study aimed to identify determinants of perceived policy implementation success and assess whether these determinants vary according to: (1) how policy implementation success is operationally defined [i.e., broadly vs. narrowly related to evidence-based practice (EBP) reach] and (2) the role of a person's organization in policy implementation. The study focuses on policies that earmark taxes for behavioral health services.

METHODS

Web-based surveys of professionals involved with earmarked tax policy implementation were conducted between 2022 and 2023 (N = 272). The primary dependent variable was a 9-item score that broadly assessed perceptions of the tax policy positively impacting multiple dimensions of outcomes. The secondary dependent variable was a single item that narrowly assessed perceptions of the tax policy increasing EBP reach. Independent variables were scores mapped to determinants in the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework. Multiple linear regression estimated associations between measures of determinants and policy implementation success.

RESULTS

Perceptions of tax attributes (innovation determinant), tax EBP implementation climate (inner-context determinant), and inter-agency collaboration in tax policy implementation (outer-context and bridging factor determinant) were significantly associated with perceptions of policy implementation success. However, the magnitude of associations varied according to how success was operationalized and by respondent organization type. For example, the magnitude of the association between tax attributes and implementation success was 42% smaller among respondents at direct service organizations than non-direct service organizations when implementation success was operationalized broadly in terms of generating positive impacts (β = 0.37 vs. β = 0.64), and 61% smaller when success was operationalized narrowly in terms of EBP reach (β = 0.23 vs. β = 0.59). Conversely, when success was operationalized narrowly as EBP reach, the magnitude of the association between EBP implementation climate and implementation success was large and significant among respondents at direct service organizations while it was not significant among respondents from non-direct service organizations (β = 0.48 vs. β=-0.06).

CONCLUSION

Determinants of perceived policy implementation success may vary according to how policy implementation success is defined and the role of a person's organization in policy implementation. This has implications for implementation science and selecting policy implementation strategies.

Addressing Child and Adolescent Mental Health Problems in the Community. Evaluation of a Consultation and Advise Team for Assessment, Support and Referral

Introduction

Youths with mental health problems are often not identified in primary healthcare, which may prevent or delay appropriate support. In the Netherlands, a Consultation and Advise expert team (CandA team) was implemented to support general practitioners (GPs), youth professionals and youths with mental health problems. This study investigates the team's scope, activities, stakeholders' and users' experiences.

Method

Interviews and focus groups with policymakers, healthcare professionals, parents and youths were analysed using ATLAS.ti. Demographics and mental health problems of 706 youths (0-18 years) consulting the CandA team, type of healthcare providers consulting the team, and type of care provided by the team (2015-2017) were analysed, using descriptive statistics and Chi-square tests.

Results

Youths consulted the CandA team for 'other behavioural/psychological complaints' (41%); irritable/angry behaviour (14%); anxious/nervous behaviour (10%); overactivity (8%); feeling down/depressed (6%). CandA team services were used by GPs, youth counsellors, and youth physicians/nurses. Most stakeholders were positive about the team's services.

Conclusion

The CandA team seems an adequate form of integrated assessment and support for youth mental health problems in the community. The team's composition, expertise and positioning are success factors. Cooperation with schools could be improved. Quantitative evaluation is needed to investigate effects of the team and adequacy of referrals.

Implementing an integrated family approach in mental health care for families experiencing complex and multiple problems: a case example in Amsterdam

For youth care professionals who work with families with complex needs, we implemented an interagency, family-focused approach involving child and adult mental health care services and child protection services. The primary objective of the collaboration was to minimize fragmentation in service delivery and to improve practitioners' self-efficacy in supporting families. A total of 50 families were enrolled between 2020 and 2023. Quantitative descriptive analysis was conducted to map the sample characteristics and the correlations between the practitioners' consultation requests and the recommendations they received. We evaluated the applicability of the model using semi-structured interviews. Results revealed the frequent socioeconomic and psychosocial challenges and co-current mental health issues faced by the families. As expected, practitioners who work with families experiencing complex and multiple problems encountered a range of difficulties in their service delivery. These related to barriers such as poor role demarcation between organizations, practitioners' unrealistic expectations of other services, the impact of multiple problems on family well-being, and complicated family dynamics. The interprofessional collaboration improved the practitioners' self-efficacy in supporting families. They also perceived improvements in child safety. The study emphasizes the need for clear pathways for youth care practitioners to obtain assistance from adult mental health services and to liaise with community support and services. It proposes including adults and young people with lived experiences in the interprofessional collaboration. The study data provides initial evidence that the interagency model has added value for youth care professionals who struggle with issues in family-focused care.

Interagency Coordination to Manage Co-Occurring Intellectual and Developmental Disabilities and Mental Health Conditions

OBJECTIVE

The authors aimed to identify barriers to and strategies for supporting coordination between state agencies for intellectual and developmental disability (IDD) or mental health to meet the mental health needs of people with co-occurring IDD and mental health conditions.

METHODS

Forty-nine employees of state agencies as well as advocacy and service delivery organizations across 11 U.S. states with separate IDD and mental health agencies were interviewed between April 2022 and April 2023. Data were analyzed with a thematic analysis approach.

RESULTS

Interviewees reported that relationships between the IDD and mental health agencies have elements of both competition and coordination and that coordination primarily takes place in response to crisis events. Barriers to interagency coordination included a narrow focus on the populations targeted by each agency, within-state variation in agency structures, and a lack of knowledge about co-occurring IDD and mental health conditions. Interviewees also described both administrative (e.g., memorandums of understanding) and agency culture (e.g., focusing on whole-person care) strategies that are or could be used to improve coordination to provide mental health services for people with both IDD and a mental health condition.

CONCLUSIONS

Strategies that support state agencies in moving away from crisis response toward a focus on whole-person care should be prioritized to support coordination of mental health services for individuals with co-occurring IDD and mental health conditions.

Providers' experiences collaborating with child welfare workers: The good, the bad, and the impacts

BACKGROUND

Successful interprofessional collaborations have been identified as a potential solution to mitigate problems associated with negative outcomes for clients involved with the child welfare system. The barriers to collaborative relationships need to be better understood and effectively addressed.

OBJECTIVE

To understand the characteristics, barriers, and facilitators of collaborations between different types of providers and child welfare workers, as well as their impacts.

PARTICIPANTS AND SETTING

Mental health professionals, foster and kinship parents, legal professionals, and other providers responded to an online survey distributed in a Northeastern State of the United States of America.

METHOD

Participants (n = 208) completed the Quality of Collaboration with Child Welfare survey. Qualitative responses were analyzed by three coders using three levels of axial coding with constant comparison.

RESULTS

Participants identified different aspects of communication, relationships, and follow-through as key elements of successful collaborations, as well as the items most likely to interfere with their formation. Providers differed somewhat in how concerned they were with various aspects of collaborations in accordance with their professional roles. Barriers to successful collaborations included both individual and systemic factors which often resulted in negative outcomes. Overall, more negative experiences were offered than positive ones.

CONCLUSIONS

Strategies are needed to improve communication, promote positive relationships, and address systemic barriers to enhance collaboration and, in turn, improve outcomes for child welfare-involved clients.

Evaluating Success and Challenges of a Primary Care Youth Mental Health Programme Using Complexity, Implementation Science, and Appreciative Inquiry

Background Using an innovative framework of complexity and implementation science, with underpinning core values of appreciative inquiry (CIS-A), this paper describes the evaluation of a pilot service in New Zealand aiming to deliver integrated psychological therapy services within primary care, to young people (aged 18-24) experiencing mild to moderate mental distress. Method Using mixed quantitative and qualitative methods and multiple data sources, there was a strong focus on local innovation and co-design with service users, young people and multiple care providers. Data is drawn from service users, stakeholders and providers of the service in three areas of the lower North Island of New Zealand.  Results The Piki pilot provided a significant and innovative enhancement of mental health care to this population. The service supported 5307 individuals with a range of therapy options, with the majority having between one and three therapy sessions. From 730 service users who completed a survey, 591 (81%) were 'very satisfied' with the service provided. The CIS-A framework was used successfully to provide rapid feedback and encourage adaptation to evolving issues. These included unexpected workload pressures, changes to therapy delivery, the integration of co-design and prioritising the needs of vulnerable groups. There was a successful incorporation of youth/service user input to co-design the programme, introduction of a peer-to-peer support service, and integration of a digital resource platform. The framework was also used to address challenges encountered and to support necessary adaptations in response to the COVID-19 pandemic.  Conclusions We describe the use of an embedded evaluation to support and inform the implementation of a novel and innovative youth mental health programme. Complexity and implementation science, underpinned by the core values of appreciative inquiry (CIS-A), were successfully utilised providing potential learning that can be applied locally, nationally and internationally. This study has a focus on youth mental health but the principles and utility of applying a complexity and implementation science approach have application in many different health care settings. The use of a framework such as CIS-A can support complex innovation and implementation and can be used to enable rapid course correction and turn 'hindsight to foresight'.

An analysis of interagency collaboration: Lessons learned from Colorado's early intervention program

INTRODUCTION

The purpose of this study was to describe interagency collaboration in Part C Early Intervention (EI) programs.

METHODS

Between 18 April and 9 May 2022, 48 EI service coordinators (SCs) from 14 programs in one state completed adapted versions of the Interagency Collaboration Activities Scale (IACAS) and Relational Coordination Survey (RCS). Assessing perceptions of shared structures (IACAS) and coordination quality (RCS), these combined measures summarized interagency collaboration with 11 organizations. Mean (SD) survey responses were estimated and ranked.

RESULTS

Sample SCs represent a breadth of professional disciples and vary substantially in their current and desired collaborations. The quantity of SCs collaborating with organizations ranged from 0% to 98%. Nearly all (98%) reported collaborating with the school districts, few (15%) reported collaborating with insurance, and none reported collaborating with Supplemental Nutrition Assistance Program or Special Supplemental Nutrition Program for Women, Infants, and Children. The majority of SCs expressed desire to increase their collaborations with most of the listed organizations. The perceived quality of collaborations varied substantially at both individual and organizational levels. When comparing SC perceptions of shared structures and coordination quality, SCs reported more favourable collaborations with school districts (IACAS rank: first and RCS rank: first) and less favourable collaborations with insurance (IACAS rank: ninth and RCS rank: seventh). Some organizations rankings varied across both scales, including pediatric primary care (IACAS rank: third and RCS rank: eighth) and hospitals (IACAS rank: sixth and RCS rank: second). Overall, SCs reported low perceived existence of shared structures while coordination quality varied by organization. Opportunities for collaborative growth were identified.

DISCUSSION

Despite its importance and required implementation in EI, perceptions of interagency collaboration varied substantially within and between EI programs. There is a suggested need to increase the quantity of SCs that collaborate and identified opportunities to increase the quality of collaborations that already exist.

Exploring interprofessional collaboration during the implementation of a parent-infant mental health service: A qualitative study

We examined interprofessional working in a newly implemented parent-infant mental health service team supporting families experiencing bonding and attachment difficulties. The aim was to identify forms of interprofessional work undertaken, barriers and facilitators of this work, and families' and healthcare professionals' perceptions of it. Semi-structured interviews were carried out with 21 stakeholders (5 parents, 4 team clinicians, 9 service referrers, 3 service commissioners) and were analyzed thematically. Interprofessional activities identified included building the service team's cohesion and shared practice, building partner networks, interagency communication, coordination of roles, and raising awareness of infant mental health and parent-infant relationship needs. Enablers and barriers to interprofessional working were broadly consistent with findings from previous studies of related services, but with additional emphasis on consultative work as an enabler. Healthcare professionals reported benefiting from the case consultations and training on infant mental health provided by the service team. Parents reported that good interprofessional working enhanced satisfaction and engagement with the service. Findings indicate the centrality of interprofessional working for parent-infant mental health teams, with implications for future service implementation, service development, and understanding of mechanisms by which such services may influence family outcomes.

Examining preconditions for integrated care: a comparative social network analysis of the structure and dynamics of strong relations in child service networks

BACKGROUND

To help ensure that children and families get the right support and services at the right time, strong and stable relationships between various child service organizations are vital. Moreover, strong and stable relationships and a key network position for gatekeepers are important preconditions for interprofessional collaboration, the timely and appropriate referral of clients, and improved health outcomes. Gatekeepers are organizations that have specific legal authorizations regarding client referral. However, it is largely unclear how strong relations in child service networks are structured, whether the gatekeepers have strong and stable relationships, and what the critical relations in the overall structure are. The aim of this study is to explore these preconditions for integrated care by examining the internal structure and dynamics of strong relations.

METHODS

A comparative case study approach and social network analysis of three inter-organizational networks consisting of 65 to 135 organizations within the Dutch child service system. Multiple network measures (number of active organizations, isolates, relations, average degree centrality, Lambda sets) were used to examine the strong relation structure and dynamics of the networks. Ucinet was used to analyze the data, with use of the statistical test: Quadratic Assignment Procedure. Visone was used to visualize the graphs of the networks.

RESULTS

This study shows that more than 80% of the organizations in the networks have strong relations. A striking finding is the extremely high number of strong relations that gatekeepers need to maintain. Moreover, the results show that the most important gatekeepers have key positions, and their strong relations are relatively stable. By contrast, considering the whole network, we also found a considerable measure of instability in strong relationships, which means that child service networks must cope with major internal dynamics.

CONCLUSIONS

Our study addressed crucial preconditions for integrated care. The extremely high number of strong relations that particularly gatekeepers need to build and maintain, in combination with the considerable instability of strong relations considering the whole network, is a serious point of concern that need to be managed, in order to enable child service networks to improve internal coordination and integration of service delivery.

Preparing students for interprofessional collaboration in services for children with special needs in Finland: A document analysis

Introduction

Multiple types of support and expertise are needed for the benefit of children with special needs, with the collaboration between psychologists, social workers and special education teachers playing a key role. Here, we studied the extent of their academic training in interprofessional collaboration.

Methods

A document analysis of 24 curricula with 1699 courses from eight Finnish universities was applied. The courses focused on interprofessional collaboration were selected for the analysis. The course information was analysed with descriptive statistical methods, content analysis and qualitative quantification.

Results

A total of 38 courses focused on interprofessional collaboration. The courses were often mandatory; however, in psychology, they were often optional. The content of the courses included the basis of interprofessional collaboration, collaboration skills, and service systems and network familiarity. Two courses were common for the social work, psychology and special education programmes. Various learning methods were used, with five courses being based on independent online self-study.

Discussion

Considering the need for studies focusing on interprofessional collaboration, it was contradictory that these were largely maintained within one discipline and some were realised as independent self-studies. The variability of the curricula may reflect on students’ professional skills. For the collaboration of professionals working with children with special needs, it is also needed to deepen familiarity with cross-sectional services and the school system.

Actors' awareness of network governance in Child Welfare and Healthcare service networks

To ensure that families with social and behavioral health problems get the support they need, organizations collaborate in child service networks. These networks are generally lead-organization governed. It is assumed that network members have relatively accurate information about the governance mode. However, discrepancies between the formally administered and perceived governance mode could raise legitimacy questions and lead to conflicts, and ultimately affect network effectiveness. Therefore, we investigated to what extent such discrepancies exist and how they might be explained. Hereby, the focus was on the concepts level of trust, interaction, and strength of relationship with the lead organization in the network. A comparative case study was conducted of three inter-organizational networks of child services in different-sized municipalities in the Netherlands in 2018 and 2019. A multiple generalized linear mixed model analysis was used. We found that only a minority of the network members had an accurate perception of the governance mode. This awareness did improve over time. The level of interaction and relationship strength with the lead organization were independently associated with an accurate perception of the governance mode. Trust of a network member in the network, however, had no significant association. These insights underline the necessity to consider network information accuracy as an important variable for understanding network behavior and as crucial for the effective delivery of child services.

Improving Interprofessional Collaboration Between Behavioral Mental Health and Pediatric Primary Care Providers Through Standardized Communication

INTRODUCTION

Pediatric mental health crisis increases demand for integrated behavioral health and pediatric primary care providers (PPCP). Communication is key to successful integrated pediatric behavioral-mental health, but studies demonstrate gaps between existing and desired communication practices. Project aims to improve PPCP factors and patient outcomes by implementing standardized communication tool in the Electronic Health Record (EHR).

METHOD

Pre-post 20-week intervention.

SETTING AND SAMPLE

Pediatric primary care and affiliated pediatric behavioral-mental health clinic of academic health system. PBMH patients and referring PPCPs.

MEASURES

PPCP satisfaction with communication, comfort and confidence continuing mental health care pre-post PBMH consult, and patient appointment attendance.

RESULTS

PPCP confidence and comfort treating mental health in primary care increased. No significant change in PPCP satisfaction after implementing standardized communication.  Identified factors associated with patient appointment continuity.

DISCUSSION

Standardized EHR communication tools and enhancing PPCP confidence in managing common pediatric mental health conditions are effective collaboration strategies.

To What Extent Can Digitally-Mediated Team Communication in Children's Physical Health and Mental Health Services Bring about Improved Outcomes? A Systematic Review

Digital communication technologies can be used for team consultation, case management, and information sharing in health and mental health services for children and young people (CYP). The objective of the systematic review was to investigate the evidence as to whether digitally-mediated team communication for CYP improves outcomes. We searched PsycINFO, PubMed, Web of Science, and Cochrane Library for relevant studies. Results were synthesised narratively. Seven studies were identified from 439 initial records. Analysis highlighted that digitally-mediated team communication is generally valued by professionals for supporting practice and that there is overall satisfaction with the process. There was preliminary evidence (from one study) that clinical outcomes from digitally-mediated team communication are comparable to those achieved by a collaborative service model with direct specialist care to service users via digital communication technology. There is a need for further high-quality research into clinical outcomes and service user experience, as well as financial implications.

Inter-agency collaboration is associated with increased frequency of research use in children's mental health policy making

OBJECTIVE

To determine whether the self-report frequency of inter-agency collaboration about children's mental health issues is associated with the self-report frequency of using research evidence in children's mental health policy and program decision making in mental health agencies (MHAs).

DATA SOURCES

Primary data were collected through web-based surveys of state (N = 221) and county (N = 117) MHA officials.

DESIGN

The primary independent variable was a composite score quantifying the frequency of collaboration about children's mental health issues between officials in MHAs and six other state agencies. The dependent variables were composite scores quantifying the frequency of research use in children's mental health policy and program decision making in general and for specific purposes (i.e., conceptual, instrumental, tactical, imposed). Covariates were composite scores quantifying well-established determinants of research use (e.g., agency leadership, research use skills) in agency policy and program decision making.

DATA METHODS

Separate multiple linear regression models estimated associations between frequency of inter-agency collaboration and research use scores, adjusting for other determinants of research use, respondent state, and other covariates. Data from state and county officials were analyzed separately.

PRINCIPAL FINDINGS

The frequency of inter-agency collaboration was positively and independently associated with the frequency of research use in children's mental health policy making among state (β = 0.22, p = 0.004) and county (β = 0.39, p < 0.0001) MHA officials. Inter-agency collaboration was also the only variable significantly associated with the frequency of research use for all four specific purposes among state MHA officials, and similar findings we observed among county MHA officials. The magnitudes of associations between inter-agency collaboration and frequency of research use were generally stronger than for more well-established determinants of research use in policy making.

CONCLUSIONS

Strategies that promote collaboration between MHA officials and external agencies could increase the use of research evidence in children's mental health policy and program decision making in MHAs.

Factor Analysis of Interteam Collaboration Process for Family Planning Program (Longitudinal Prospective Time Series Design)

Background. The success of Family Planning (FP) program is strongly determined by a collaboration process of two organizations responsible in managing the program. There has not any collaboration concept discussing the program within team level but belonging to different organizations. Objective. To conduct factor analysis of interteam collaboration process in cross-organization for family planning. Methods. This was a quantitative study with a longitudinal prospective time series design conducted at the public health center and the family planning extension worker team in Lamongan. Interteam collaboration data were obtained by questionnaires for three months and analyzed by factor analysis utilizing SPSS program. Results. Factor analysis in interteam collaboration resulted in KMO value and Bartlett’s test > 0.5 with 0.000 significance and MSA value in Anti Image Metrics > 0.5.  The result of variable extraction process and factor rotation, with eigen value was 1.661. The cumulative total variety value was 83.057%.  Shared value (shared structural dimensions and shared team autonomy) and mutual benefit indicators could explain interteam collaboration variables. Conclusion. This study demonstrated that interteam collaboration process was an three factor, effort for shared structural dimensions and shared team autonomy process by considering mutual benefit of interteam belonging to different organizations.   Keyword:  interteam, collaboration,  time series, program

School Reintegration Following Psychiatric Hospitalization: A Review of Available Transition Programs

OBJECTIVES

This study aimed to 1) identify transition programs for school reintegration after youth psychiatric hospitalization, and 2) assess these programs using criteria established by Blueprints for Healthy Youth Development.

METHOD

Principles outlined by the Evidence for Policy and Practice Information and Coordinating Centre were used to systematically search 15 electronic databases up to October 2021 for both published and unpublished reports of transition programs. Reports meeting inclusion criteria were examined through three steps: 1) coding of available information, 2) synthesis of programs and 3) assessment of intervention specificity.

RESULTS

Thirteen reports met the inclusion criteria and identified eight transition programs. Program theories were rarely explicit about the causal mechanisms and outcomes of their interventions. Nevertheless, areas of consensus emerge as to core components of these programs including: 1) the involvement of a multidisciplinary team, 2) the implementation of a multicomponent intervention, 3) the development of a reintegration plan, 4) the need for gradual transitions, and 5) extended support through frequent contact.

CONCLUSION

School reintegration programs following psychiatric hospitalization are still rare. They can be hard to implement due to the challenges they impose for inter-professional and intersectoral collaborations. Despite this, four of the eight programs are in a good position for an evaluation of their promising standing. Nevertheless, well-designed controlled trials and cohort studies are needed.

Intersectoral collaboration at a decentralized level: information flows in child welfare and healthcare networks

Background

As needs of families with social and behavioral health problems often exceed the expertise and possibilities of a single professional, service or organization, cross-service collaboration is indispensable to adequately meeting those needs. Despite the progressive focus on organizing integrated care, service fragmentation and service duplication remain persistent problems in child welfare and healthcare service delivery systems. A crucial factor to overcome these problems is information exchange between organizations. This study explores and compares the development over time of structures of information exchange in networks, concerning both material and knowledge-based information.

Methods

A comparative case study and social network analysis of three inter-organizational networks of child welfare and healthcare services in different-sized municipalities in the Netherlands. The research population consisted of organizations from various sectors participating in the networks. Data were collected at two moments in time with a mixed method: semi-structured interviews with network managers and an online questionnaire for all network members. Density and degree centralization were used to examine the information exchange structures. Ucinet was used to analyze the data, with use of the statistical tests: Compare Density Procedure and Quadratic Assignment Procedure.

Results

This study shows that different structures of information exchange can be distinguished, concerning both material and knowledge-based information. The overall connectedness of the studied structures of the networks are quite similar, but the way in which the involvement is structured turns out to be different between the networks. Over time, the overall connectedness of those structures appears to be stable, but the internal dynamics reveals a major change in relationships between organizations in the networks.

Conclusions

Our study yields empirical evidence for the existence of and the differences between structures and dynamics of both material and knowledge-based information exchange relationships. With a loss of more than a half of the relations in a year, the relationships between the organizations in the network are not very stable over time. The contrast between major internal dynamics and the stable overall connectedness is an important point of concern for network managers and public officials, since this impermanence of relations means that long-term integrated care cannot be guaranteed.

Community paediatricians' experience of joint working with child and adolescent mental health services: findings from a British national survey

OBJECTIVES

Children and young people (CYP) presenting to paediatric or child and adolescent mental health services (CAMHS) often have needs spanning medical and psychiatric diagnoses. However, joint working between paediatrics and CAMHS remains limited. We surveyed community paediatricians in the UK to inform better strategies to improve joint working with CAMHS.

METHODS

We conducted an online survey of community paediatricians through the British Association for Community Child Health (BACCH) on how much joint working they experienced with CAMHS, any hindrances to more collaborative working, and the impact on service users and service provision. This paper is based on thematic analysis of 327 free-text comments by paediatricians.

RESULTS

A total of 245 community paediatricians responded to the survey (22% of BACCH members). However, some responses were made on behalf of teams rather than for individual paediatricians. The following were the key themes identified: a strong support for joint working between community paediatrics and CAMHS; an acknowledgement that current levels of joint working were limited; the main barriers to joint working were splintered commissioning and service structures (eg, where integrated care systems fund different providers to meet overlapping children's health needs); and the most commonly reported negative impact of non-joint working was severely limited access to CAMHS for CYP judged by paediatricians to require mental health support, particularly those with autism spectrum disorder.

CONCLUSION

There is very limited joint working between community paediatrics and CAMHS in the UK, which is associated with many adverse impacts on service users and providers. A prointegration strategy that includes joint commissioning of adequately funded paediatric and CAMHS services that are colocated and within the same health management organisations is crucial to improving joint working between paediatrics and CAMHS.

Cross-sectoral collaboration: comparing complex child service delivery systems

Purpose

To help ensure that children with social and behavioral health problems get the support services they need, organizations collaborate in cross-sectoral networks. In this article, the authors explore and compare the structure of these complex child service delivery networks in terms of differentiation (composition) and integration (interconnection). In particular, the authors investigate the structure of client referral and identify which organizations are most prominent within that network structure and could therefore fulfill a coordinating role.

Design/methodology/approach

The authors used a comparative case study approach and social network analysis on three interorganizational networks consisting of 65 to 135 organizations within the Dutch child service delivery system. Semi-structured interviews with the network managers were conducted, and an online questionnaire was sent out to the representatives of all network members.

Findings

The networks are similarly differentiated into 11 sectors with various tasks. Remarkably, network members have contact with an average of 20–26 organizations, which is a fairly high number to be handled successfully. In terms of integration, the authors found a striking diversity in the structures of client referral and not all organizations with a gatekeeper task hold central positions.

Originality/value

Due to the scarcity of comparative whole network research in the field, the strength of this study is a deeper understanding of the differentiation and integration of complex child service delivery systems. These insights are crucial in order to deliver needed services and to minimize service silos and fragmentation.

Changes in youth care use after the implementation of community-based support teams: repeated measurement study using registry data and data on team characteristics

OBJECTIVES

New legislation on youth care in the Netherlands led to the implementation of community-based support teams, providing integrated primary youth care. Important aims of the new Youth Act were more integrated, timely care and less use of intensive forms of care. Our aim was to study changes in youth care use in time and the role of newly introduced community-based support teams herein.

SETTING

Register data (2015-2018) on youth of a large city were linked and combined with administrative and aggregated data on team characteristics.

PARTICIPANTS

Data on 126 095 youth (0-18 years) were available for analyses.

PRIMARY AND SECONDARY OUTCOME MEASURES

Primary, specialised and residential youth care use were the primary outcomes.

RESULTS

Generalised estimating equations analyses adjusted for individual characteristics demonstrated that over 4 years, use of primary youth care increased from 2.2% to 8.5% (OR 1.70; 99% CI 1.67 to 1.73), specialised youth care decreased from 7.2% to 6.4% (OR 0.98; 99% CI 0.97 to 1.00) and residential youth care increased slightly (OR 1.04; 99% CI 1.01 to 1.06). Gender, age, family status, migrant background and educational level were all associated with the types of youth care use and also with some trends in time. Likelihood to receive care increased in time for preschool and younger children but did not improve for migrant children.Case load, team size, team turnover, team performance and transformational leadership showed significant associations with different types of youth care use but hardly with trends in time.

CONCLUSION

Patterns of youth care use changed towards more locally provided primary youth care, slightly less specialised and slightly more residential youth care. Furthermore, youth care use among younger children increased in time. These trends are partly in line with the trends intended by the Youth Act. Little evidence was found for the role of specific team characteristics on changes in youth care use in time.

Clinician stakeholder experiences of a new youth mental health model in Australia: A qualitative study

AIM

Late teens and early adulthood is the peak age of onset for mental disorders. Currently, there is a gap between primary mental health care and more intensive mental health services for young people in New South Wales (NSW), Australia. Two headspace Early Intervention Teams (hEITs) were developed to bridge this gap in Sydney Local Health District (SLHD), in Sydney, Australia. This study aims to explore clinician experiences of hEIT after the first 2 years of implementation.

METHODS

Semistructured interviews were conducted with key clinicians working within hEIT or closely associated with hEIT. Nine interviews were conducted, transcribed and analysed using qualitative thematic analysis.

RESULTS

Four themes were identified: (1) building a bridge between services, (2) filling a clinical gap, (3) service collaborations and their challenges and (4) difficulties of small team size.

CONCLUSIONS

There is evidence that clinicians value the service provided by hEIT. There are difficulties such as referral confusion, staff turnover and suggestions to increase staffing to improve the stability, skill diversity and viability of the service. Findings have implications for other collaborative youth mental health models.

How can mental health practitioners collaborate with child welfare practitioners to improve mental health for young people in out of home care?

BACKGROUND

Young people who grow up in out of home care have higher risk of poor mental health outcomes than peers who grow up with their family-of-origin. Interagency collaboration is an important service-level intervention to improve access to mental healthcare. However, few descriptions of collaboration provide guidance about collaboration between individual practitioners.

AIM

This substudy aimed to contribute to a larger study-the Ripple project-through exploring the experiences of practitioners working across child welfare and mental health services regarding collaboration in the care of young people; and to identify practices that might enhance collaborative work and improve mental health outcomes.

METHODS

Practitioners from across child welfare and mental health services were purposively sampled and participated in focus groups. Recordings and transcriptions of focus groups were analysed to identify themes within and between groups. A cross-sector expert advisory group was involved in this work.

RESULTS

Focus groups were convened with 43 practitioners. We identified four themes during analysis, these were: shared understanding of the history and context of problems; specific skills and practices; self-awareness of workers and carers; and involving and supporting carers.

CONCLUSIONS

A number of practices were identified that might lead to enhanced collaboration between agencies and across interdisciplinary care teams. Supporting mental health practitioners to adopt these might assist interagency and interdisciplinary working.

Psychometric Properties of the German Version of the Perception of Interprofessional Collaboration Model-Questionnaire (PINCOM-Q)

OBJECTIVE

The Perception of Interprofessional Collaboration-Model Questionnaire (PINCOM-Q) measures professionals' perceptions of interprofessional collaboration in the field of child and youth mental health. The aim of this study was to validate the PINCOM-Q in a sample of German child welfare and child and youth mental health professionals.

METHODS

The PINCOM-Q was translated into German and its underlying factor structure was examined using exploratory and confirmatory factor analysis.

RESULTS AND DISCUSSION

Findings from this study suggest four factors (Interprofessional Climate, Conflict, Role Expectancy and Shared Goals, and Motivation) capture the concept of perceptions of interprofessional collaboration between child welfare and child and adolescent psychiatry.

CONCLUSION

The use of PINCOM-Q (German) can be recommended as a research tool, investigating professional groups working with children and young people with multiple and complex needs.

Recommendations for improving adolescent addiction recovery support in six northwest tribal communities

American Indian and Alaska Native (AI/AN) communities offer tangible and intangible resources, including centuries of indigenous wisdom and resiliency, to support their young people in recovery from substance use disorders. At the same time, tribal youth returning home from residential or inpatient treatment are vulnerable to relapse, especially if they encounter the same environmental triggers in which their substance misuse developed. This study endeavored to learn about community stakeholder perceptions of existing strengths and needs for supporting recovering adolescents among six tribal communities of the Inland Northwest. Using a Tribal Participatory Research approach, we conducted Group Level Assessments with key stakeholders representing educators/coaches, medical and behavioral health providers, social service providers, cultural leaders/elders, and legal professionals among each participating tribe (N = 166). We used content analysis to identify emergent themes among participants' recommendations for improving recovery support. The five emergent themes were (1) Communication, Collaboration, and Accountability among Tribal Departments and Agencies; (2) Community-wide Education; (3) The Importance of Providing Wraparound/Supportive Services; (4) Youth-focused Education, Services, and Events; and (5) Recovery Coaching Model. AI/AN culture was infused within nearly all recommendations for improving recovery support that composed these themes. We discuss specific ways to implement these recommendations, including the forthcoming development of a culturally-grounded community-wide mental health training program developed specifically for, and with, these tribes.

How can services be improved to effectively address the mental health of vulnerable children and young people?

This discussion article describes a Child and Adolescent Mental Health Service (CAMHS) in the United Kingdom developed to meet the mental health needs of children and young people particularly those vulnerable children and young people at risk of actual or potential harm through child abuse and neglect, but may not be therapy ready. The aim was to improve the level of access to CAMHS for vulnerable groups and the quality and effectiveness of services for children, young people and their families.The model of service delivery is underpinned by the THRIVE Framework for System Change (THRIVE) which builds on the resilience of families and the skills of the workers who have the closest relationships with them. The article describes how a redesign was accomplished in the London Borough of Camden between 2016- 2018 to do this. Qualitative evidence of the positive impact of the changes for service users and key workers and quantitative evidence of the increased service capacity are presented. Challenges and opportunities provided by the new service model are discussed.

Good Lives Model: Importance of Interagency Collaboration in Preventing Violent Recidivism

Violence is a complex and multifaceted problem requiring a holistic and individualized response. The Good Lives Model (GLM) suggests violence occurs when an individual experiences internal and external obstacles in the pursuit of universal human needs (termed primary goods). With a twin focus, GLM-consistent interventions aim to promote attainment of primary goods, whilst simultaneously reducing risk of reoffending. This is achieved by improving an individuals’ internal (i.e., skills and abilities) and external capacities (i.e., opportunities, environments, and resources). This paper proposes that collaborations between different agencies (e.g., psychological services, criminal justice systems, social services, education, community organizations, and healthcare) can support the attainment of primary goods through the provision of specialized skills and resources. Recommendations for ensuring interagency collaborations are effective are outlined, including embedding a project lead, regular interagency meetings and training, establishing information sharing procedures, and defining the role each agency plays in client care.

The impact of a needs-based model of care on accessibility and quality of care within children's mental health services: A qualitative investigation of the UK i-THRIVE Programme

BACKGROUND

The i-THRIVE Programme is a needs-based model of care, based on the THRIVE Framework, that is being implemented across the United Kingdom with the aim of improving outcomes for children and young people's mental health and wellbeing. This study aimed to investigate the impact that this programme has on accessibility and quality of care, as viewed by key stakeholders.

METHODS

Interviews with professionals and service users were conducted during the implementation of the THRIVE Framework in four sites of one mental health and community service provider.

RESULTS

Three themes are identified: 'impact of needs-based groupings on referral', 'impact of collaborative and interagency approach' and 'impact of i-THRIVE on clinical practice'. Findings suggest that accessibility was seen to be promoted through the integration of a needs-based approach, flexible re-referral, signposting and information sharing, the use of goal-orientated interventions and collaboration over risk and treatment endings. Shared decision making was perceived to improve the experience of care for young people, as was interagency working. Goal-focused interventions and upfront discussion of treatment endings were seen to help clinicians manage expectations and discharge but could also compromise effectiveness and engagement. Obstacles to impact were resistance to interagency working and a shortage of resources across the system.

CONCLUSIONS

i-THRIVE is a promising approach with the potential to facilitate the accessibility and quality of mental health care. However, a tension exists between enhancing accessibility and quality of care, which points towards the importance of outcome and satisfaction monitoring. Obstacles to impact point to the importance of a whole-system approach supported by sufficient resources across the locality.

Interagency Collaboration for Pediatric Autism Spectrum Disorder: Perspectives of Community-Based Providers

Background

Interagency collaboration between community and school settings is one mechanism to serve the complex needs of pediatric patients with autism spectrum disorder (ASD).

Purpose

We surveyed a national sample of community-based providers to examine their perspectives on interagency collaboration with school-based providers when serving pediatric patients with ASD.

Method

Medical and behavioral/mental health professionals practicing in community settings were recruited. Participants (N = 116) completed an online survey about their interagency collaboration experiences with schools.

Results

The majority of the sample reported engaging in interagency collaboration with school-based providers; however, the frequency was limited and was associated with the number of years working in the field. Community-based providers wanted more didactic and hands-on experiences in collaboration. Barriers and facilitators were related to schools' administration, school personnels' training in ASD, information exchange, and delineating between identification systems.

Discussion and Conclusion

Our findings highlight the importance of leadership support and the need for innovative training experiences to support school-community interagency collaboration.

The impacts of collaboration between local health care and non-health care organizations and factors shaping how they work: a systematic review of reviews

BACKGROUND

Policymakers in many countries promote collaboration between health care organizations and other sectors as a route to improving population health. Local collaborations have been developed for decades. Yet little is known about the impact of cross-sector collaboration on health and health equity.

METHODS

We carried out a systematic review of reviews to synthesize evidence on the health impacts of collaboration between local health care and non-health care organizations, and to understand the factors affecting how these partnerships functioned. We searched four databases and included 36 studies (reviews) in our review. We extracted data from these studies and used Nvivo 12 to help categorize the data. We assessed risk of bias in the studies using standardized tools. We used a narrative approach to synthesizing and reporting the data.

RESULTS

The 36 studies we reviewed included evidence on varying forms of collaboration in diverse contexts. Some studies included data on collaborations with broad population health goals, such as preventing disease and reducing health inequalities. Others focused on collaborations with a narrower focus, such as better integration between health care and social services. Overall, there is little convincing evidence to suggest that collaboration between local health care and non-health care organizations improves health outcomes. Evidence of impact on health services is mixed. And evidence of impact on resource use and spending are limited and mixed. Despite this, many studies report on factors associated with better or worse collaboration. We grouped these into five domains: motivation and purpose, relationships and cultures, resources and capabilities, governance and leadership, and external factors. But data linking factors in these domains to collaboration outcomes is sparse.

CONCLUSIONS

In theory, collaboration between local health care and non-health care organizations might contribute to better population health. But we know little about which kinds of collaborations work, for whom, and in what contexts. The benefits of collaboration may be hard to deliver, hard to measure, and overestimated by policymakers. Ultimately, local collaborations should be understood within their macro-level political and economic context, and as one component within a wider system of factors and interventions interacting to shape population health.

A 36-Hour Unplugged Full-Scale Exercise: Closing the Gaps in Interagency Collaboration between the Disaster Medical Assistance Team and Urban Search and Rescue Team in Disaster Preparedness in Taiwan

Introduction

Disaster medical assistance team (DMAT) and urban search and rescue team (USAR) need to cooperate seamlessly to save lives in disasters, but related research is limited.

Objectives

To estimate the disaster preparedness of the DMAT and the barriers affecting interagency cooperation between the DMAT and the USAR team.

Methods

This was an observational study of a full-scale exercise conducted in Taiwan from November 16 to 18, 2018. The exercise scenario simulated a magnitude 7 earthquake in Tainan City. DMATs from other counties were deployed and cooperated with local USAR teams to carry out disaster relief. Our study invited 7 experts to evaluate DMATs on disaster preparedness capabilities and the interagency collaboration between DMATs and USAR.

Results

A total of eight DMATs, consisting of 30 physicians, 65 nurses, 74 logisticians, 5 health bureau personnel, and 85 USAR teams, participated in this exercise. During the mission, 176 patients were treated. The capabilities of each team were generally consistent with the basic technical standards for type I emergency medical teams, but the compliance rates for basic local anesthesia, cold chain equipment for medication, rapid blood test tools, and sterilization devices were only 50%, 12.5%, 12.5%, and 9%, respectively. In addition, 53% of participants reported abnormal vital signs, indicating that it was a high-stress situation. Moreover, the main barriers to interagency collaboration were differing perspectives and poor mutual understanding.

Conclusion

A full-scale exercise carried out jointly with DMATs and USAR teams was valuable for disaster preparedness, particularly in terms of understanding the weaknesses of those teams and the barriers to interagency collaboration.

Parent-perceived barriers to accessing services for their child's mental health problems

BACKGROUND

Many children and adolescents with impairing mental health disorders are not in contact with specialized child and adolescent mental health services (CAMHS). In order to close the service gap, it is important to increase our knowledge of barriers to access. The aim of this study was to investigate parent perceived barriers to accessing services for their child's mental health problems to identify potential areas for improvement of access to CAMHS.

METHOD

In this cross-sectional observational study 244 parents of children and adolescents referred to outpatient psychiatric assessment were interviewed using the Children's services interview regarding barriers to accessing child mental health services across healthcare, educational services and social services. Parent reported barriers were analyzed in relation to the child's age, referral reason, symptom duration and impairment of the child.

RESULTS

The most commonly reported barriers were lack of information about were to seek help (60.3%), the perception that professionals did not listen (59.8%) and professionals refusing to initiate interventions or provide referral to services (53.7%). Lack of knowledge, stigmatization and unavailability of services were common themes across barriers to help-seeking. Long symptom duration and parent rated impairment was associated with increased risk of reporting several barriers to help-seeking.

CONCLUSION

Parents seeking help for their child's mental health encounter numerous barriers that could explain part of the treatment gap and long duration of mental health problems in children prior to referral to CAMHS.

Inter-professional practice in the prevention and management of child and adolescent self-harm: foster carers' and residential carers' negotiation of expertise and professional identity

Inter-professional collaboration remains a significant concern within healthcare and social care. However, there has been scant attention paid to practices at the interface of clinicians and carers, namely foster carers and residential carers. The present study considers child and adolescent self-harm management and prevention practices as a site of empirical interest due to reports that multi-agency teams are not effectively operating. Drawing upon a grounded theory approach, data were generated via semi-structured interviews and focus groups with residential carers (n = 15) and foster carers (n = 15) in Wales. Themes were developed through axial coding. The results present two central themes to explain the nature and perceived causes of inter-professional discord. First, there are clear contestations in expertise, with carers challenging clinicians' propositional knowledge in favour of their own experiential expertise. However, participants simultaneously endorse medical dominance, which contributes to their sense of disempowerment and marginalisation. Second, is the preclusion of carers' professional identity, primarily due to inadequate professionalisation procedures. Meanwhile, the privileging of their parenting role is perceived to support the perpetuation of courtesy stigma. Carers are then compelled to undertake the effortful labour of legitimisation. Together these thematic insights provide direction on mechanisms to improve inter-professional interactions, notably around training and accreditation.

Collaborative care in 'Youth One Stop Shops' in New Zealand: Hidden, time-consuming, essential

Young people in New Zealand have high morbidity but low service utilization rates. Dedicated youth services 'Youth One Stop Shops' provide 'wraparound' health and social care. However, little is understood about how staff within these services interact with each other or with external agencies to provide this specialist care. This article reports on volume and type of internal and inter-agency health and social service staff-staff interactions, to better understand elements of potential collaboration in day-to-day practice. An observational, case-study approach was utilized. Four dedicated youth services recorded data over three-month periods about a selected number of high-use clients. Youth service staff recorded all interactions with colleagues within their organization and staff from external services. A large volume of non-patient contact work was revealed, with a high proportion of 'complex/involved' interactions recorded. The range and diversity of external agencies with which youth service staff interacted with to meet the needs of young people was extensive and complex. The focus on 'information sharing' and 'complex/involved' interactions demonstrates a well-coordinated, wraparound service delivery model. Current funding formulae take inadequate account of the volume of non-patient contact work that youth services provide for high-needs young people.

Towards Integrated Youth Care: A Systematic Review of Facilitators and Barriers for Professionals

To overcome fragmentation in support for children and their families with multiple and enduring problems across life domains, professionals increasingly try to organize integrated care. However, it is unclear what facilitators and barriers professionals experience when providing this integrated care. Our systematic review, including 55 studies from a broad variety of settings in Youth Care, showed that integrated care on a professional level is a multi-component entity consisting of several facilitators and barriers. Findings were clustered in seven general themes: ‘Child’s environment’, ‘Preconditions’, ‘Care process’, ‘Expertise’, ‘Interprofessional collaboration’, ‘Information exchange’, and ‘Professional identity’. The identified facilitators and barriers were generally consistent across studies, indicating broad applicability across settings and professional disciplines. This review clearly shows that when Youth Care professionals address a broad spectrum of problems, a variety of facilitators and barriers should be considered.

Registration PROSPERO, registration number CRD42018084527.

An integrated approach to meet the needs of high-vulnerable families: a qualitative study on integrated care from a professional perspective

BACKGROUND

To meet the needs of high-vulnerable families with severe and enduring problems across several life domains, professionals must improve their ability to provide integrated care timely and adequately. The aim of this study was to identify facilitators and barriers professionals encounter when providing integrated care.

METHODS

Experiences and perspectives of 24 professionals from integrated care teams in the Netherlands were gathered by conducting semi-structured interviews. A theory-driven framework method was applied to systematically code the transcripts both deductively and inductively.

RESULTS

There was a consensus among professionals regarding facilitators and barriers influencing their daily practice, leading to an in depth, thematic report of what facilitates and hinders integrated care. Themes covering the facilitators and barriers were related to early identification and broad assessment, multidisciplinary expertise, continuous pathways, care provision, autonomy of professionals, and evaluation of care processes.

CONCLUSIONS

Professionals emphasized the need for flexible support across several life domains to meet the needs of high-vulnerable families. Also, there should be a balance between the use of guidelines and a professional's autonomy to tailor support to families' needs. Other recommendations include the need to improve professionals' ability in timely stepping up to more intensive care and scaling down to less restrictive support, and to further our insight in risk factors and needs of these families.

Improving interprofessional collaboration in Norwegian primary schools: A cluster-randomized study evaluating effects of the LOG model on teachers' perceptions of interprofessional collaboration

Increased demand for interprofessional collaboration within the educational field also increases the need for the development and evaluation of interventions to improve collaboration. In Norway, the LOG model was developed and implemented in compulsory schools to facilitate interprofessional collaboration by increasing arenas for more efficient use of existing interprofessional resources. We evaluate the effects of the model on teachers' perceptions of interprofessional collaboration in a cluster-randomized trial, with 19 schools randomized to the experimental group and 16 schools to the control group. We use data from 5th-7th grade teachers in the 35 participating schools (N = 157) prior to randomization and one-year into the implementation. Response rates were 70% and 74%, respectively. The PINCOM-Q scale was used to analyze effects of the model on various dimensions of interprofessional collaboration. At the one-year follow-up, the LOG model demonstrates no significant effects on teachers' perceptions of interprofessional collaboration. However, there is an indication of effect on the organizational aim dimension (ES = -0.39, CI = -0.82-0.03), but the evidence is not conclusive.

Intersectoral collaboration for people-centred mental health care in Timor-Leste: a mixed-methods study using qualitative and social network analysis

BACKGROUND

Intersectoral collaboration is fundamental to the provision of people-centred mental health care, yet there is a dearth of research about how this strategy operates within mental health systems in low- and middle-income countries. This is problematic given the known attitudinal, structural and resource barriers to intersectoral collaboration in high-income country mental health systems. This study was conducted to investigate intersectoral collaboration for people-centred mental health care in Timor-Leste, a South-East Asian country in the process of strengthening its mental health system.

METHODS

This study employed a mixed-methods convergent design. Qualitative data elicited from in-depth interviews with 85 key stakeholders and document review were complemented with quantitative social network analysis to assess understandings of, the strength and structure of intersectoral collaboration in the Timorese mental health system.

RESULTS

There was consensus among stakeholder groups that intersectoral collaboration for mental health is important in Timor-Leste. Despite resource restrictions discussed by participants, interview data and social network analysis revealed evidence of information and resource sharing among organisations working within the health and social (disability and violence support) sectors in Timor-Leste (network density = 0.55 and 0.30 for information and resource sharing, respectively). Contrary to the assumption that mental health services and system strengthening are led by the Ministry of Health, the mixed-methods data sources identified a split in stewardship for mental health between subnetworks in the health and social sectors (network degree centralisation = 0.28 and 0.47 for information and resource sharing, respectively).

CONCLUSIONS

Overall, the findings suggest that there may be opportunities for intersectoral collaborations in mental health systems in LMICs which do not exist in settings with more formalised mental health systems such as HICs. Holistic understandings of health and wellbeing, and a commitment to working together in the face of resource restrictions suggest that intersectoral collaboration can be employed to achieve people-centred mental health care in Timor-Leste.

Interagency collaborative care for young people with complex needs: Front-line staff perspectives

Worldwide, a growing burden of health and social issues now affect young people. Interagency collaboration and the "integration" of health and social care services are advocated to address the increasingly complex needs of at-risk youth and to reduce barriers to accessing care. In New Zealand, Youth-One-Stop-Shops (YOSSs) provide integrated health and social care to young people with complex needs. Little is known about how YOSSs facilitate collaborative care. This study explored the collaboration between YOSSs and external agencies between 2015 and 2017 using a multiple case study method. This paper reports qualitative focus group and individual interview data from two of four case sites including six YOSS staff and 14 external agency staff. Results showed participants regarded collaboration as critical to the successful care of high needs young people and were positive about working together. They believed YOSSs provided effective wraparound collaborative care and actively facilitated communication between diverse agencies on behalf of young people. The main challenges participants faced when working together related to the different "world views" and cultures of agencies which can run contrary to collaborative practice. Despite this, some highly collaborative relationships were apparent and staff in the different agencies perceived YOSSs had a lead role in co-ordinating collaborative care and were genuinely valued and trusted. However without the YOSS involvement, collaboration between agencies in relation to young people was less frequent and rarely went beyond limited information exchange. Establishing and maintaining trusting interpersonal relationships with individual staff was key to successfully negotiating agency differences. The study confirms that collaboration when caring for young people with high needs is complex and challenging, yet agencies from diverse sectors value collaboration and see the YOSS integrated wraparound approach as an important model of care.

Interagency collaboration in primary mental health care: lessons from the Partners in Recovery program

Background

Collaborative care is a means of improving outcomes particularly for people with complex needs. The Partners in Recovery (PIR) program, established in Australia in 2012, provides care coordination to facilitate access to health and social support services for people with severe and persistent mental illness. Of the 48 PIR programs across Australia, 35 were led by Medicare Locals, the previous Australian regional primary health care organisation and nine involved Medicare Locals as partner organisations.

Aims

To identify features which enabled and hindered collaboration in PIR programs involving Medicare Locals and determine what can be learnt about delivering care to this population.

Methods

Data were collected from 50 interviews with senior staff at Medicare Locals and from eight focus groups with 51 mental health stakeholders in different Australian jurisdictions.

Results

Successful PIR programs were based upon effective collaboration. Collaboration was facilitated by dedicated funding, a shared understanding of PIR aims, joint planning, effective network management, mutual respect and effective communication. Collaboration was also enhanced by the local knowledge and population health planning functions of Medicare Locals. Jurisdictional boundaries and funding discontinuity were the primary barriers to collaboration.

Towards a definition of multiple and complex needs in children and youth: Delphi study in Flanders and international survey

Background

Multiple and complex needs (MCN) in children and youth jeopardize their development and pose significant challenges to the different professionals they meet. However, there is no agreed-upon definition of this vulnerable population.

Objectives

To develop a definition of 'MCN in children and youth' that is meaningful for all professionals involved in care delivery for this population.

Method

A cross-sector, multidisciplinary, and geographically spread panel of 47 experts representing mental health, youth care, juvenile justice, and education in Flanders participated in an online Delphi study. Qualitative analysis of answers in the first round yielded four definition possibilities that participants then ranked in the second round. In the last round, participants rated their agreement with the highest ranked definition. An additional survey asked 25 international experts to rate and comment their agreement with the final definition.

Results

The final definition was: Children and adolescents with profound and interacting needs in the context of issues on several life domains (family context, functioning and integration in society) as well as psychiatric problems. The extent of their needs exceeds the capacity (expertise and resources) of existing services and sequential interventions lead to discontinuous care delivery. As such, existing services do not adequately meet the needs of these youths and their families. Cross-sector, integrated and assertive care delivery is necessary for safeguarding the wellbeing, development and societal integration of these young people. Response rates to the three Delphi rounds were 76.6, 89.1, and 91.3%. The definition was widely endorsed among Flemish (93.2% agreement) and international experts (88% agreement).

Conclusion

A definition of MCN in children and youth was constructed using the Delphi method and further evaluated for international relevance in an additional survey. Such an agreed-upon definition can be valuable for optimizing care delivery and conducting research.

"What is the efficacy of specialised early intervention in mental health targeting simultaneously adolescents and young adults?'' An HTA

OBJECTIVES

Current service organization is not adapted for youth with or at risk of mental illness. Access, engagement and continuity of care are notorious challenges, particularly during transition from adolescence to adulthood, when youths are transferred to adult services. An HTA was initiated to evaluate the efficacy of programs for which admission is not a function of the legal age of majority.

METHODS

A systematic review of systematic reviews identified literature published between 2000 and 2017 in 4 databases. To be selected, studies had to focus on specialised mental healthcare early intervention (EI) programs targeting both adolescents and young adults. Contextual and experiential data were collected through interviews with local leading experts. Article selection and quality assessment using ROBIS were conducted with inter rater agreement. The analytical framework developed includes 4 domains: access, engagement and continuity, recovery as well as meaningfulness and acceptability.

RESULTS

1841 references were identified. Following inclusion/exclusion criteria, 5 studies were selected, 3 of which focused on EI for psyschosis. EI programs alone do not seem to decrease duration of untreated psychosis. EI including a multi focus campaign were more successful. EI does, however, seem to decrease hospitalisation for psychosis. The experience of service users and professionals with inter agency collaboration and person-centred care models were analysed to identify facilitating and inhibiting implementation factors.

CONCLUSIONS

Healthcare policies need to support further research and development of EI where admission is not a function of the legal age of majority and diagnostic, particularly for youths at risk.

Supporting emotional well-being in schools in the context of austerity: An ecologically informed humanistic perspective

Background

Schools are commonly asked to take on roles that support the emotional well‐being of students. These practices are in line with humanistic education theory and can be difficult to fulfil by schools. Broader ecological pressures, such as periods of austerity, are likely to add to the difficulty in meeting students’ needs.

Aims

To explore whether professionals in schools believe that their work supporting pupils’ emotional well‐being has changed as a consequence of the current period of austerity.

Sample

This project reports the views of staff from three secondary schools in the North West of England. A purposive sample of 29 individuals, including members of the senior leadership team and newly qualified teachers, were involved.

Methods

All participants were interviewed about their perceptions of the impact of a sustained period of austerity upon their work. The transcripts of these interviews were analysed using thematic analysis.

Findings

Educational professionals associated wider socio‐political factors with a perceived increase in the need for emotional support of pupils. They reported taking on new roles and responsibilities to accommodate this and noted they are doing so with fewer resources and limited governmental support.

Conclusions

This paper concludes that considering humanistic education theory alongside ecological theory helps to conceptualize how socio‐political factors can impact upon the emotional well‐being in schools. An ecologically informed humanistic framework is depicted based upon the findings of this project as a means of understanding how these two theories complement one another and interact.