Nordic 0 – 24 collaboration on improved services to vulnerable children and young people. Second interim report
Engelsk sammendrag av Fafo-report 2019:23
The Nordic 0–24 project was initiated by the Nordic Council of Ministers in 2017. The main agenda is to prevent the social exclusion of vulnerable children and young people, and to prevent dropout from school and future marginalisation in the labour market. The project’s aim is to improve services in the Nordic countries that are aimed at vulnerable children and young people aged 0–24 years by improving cross-sectoral collaboration. The project compromises cases from each of the Nordic countries (Denmark, Finland, Iceland, Norway and Sweden) and from the autonomous islands (Greenland, Aaland and the Faroe Islands). Aaland participate in the project, but without a specific national case.
A process evaluation follows the work of the Nordic 0–24 collaboration. The first interim report from this process evaluation, which was published in June 2018, presented the project and the national policy context of the cases involved (Hansen et. al. 2018). The first report also included a detailed presentation of the design of the process evaluation (ibid.:12-24). This report is the second interim report, and a final report from the evaluation will be published in 2020.
The main subject and the starting point of this second interim report is the national cases and the experiences from these cases. We discuss how the cases involved are dealing with the aim of providing a more coherent follow-up of vulnerable children and young people. The two main questions of this report are:
- How do the national cases understand the user perspective and how is this embedded in the cases?
- What can be learned from the national cases about cross-sectoral coordination and collaboration of services? What factors may promote better coordination and collaboration?
The report is based on two main sources: participation and observation at two joint meetings in the Nordic 0–24 project, and one mapping with input from the national cases.
The presentation of the national cases shows that they are rather heterogeneous . They are at different levels of governance, even though most of the projects entail developing municipal practices and systems. This heterogeneity is also found in terms of the age groups targeted by the cases. Even though the national cases in question vary, they are all concerned with developing more efficient follow-up of vulnerable children and young people. The report identifies three factors that are addressed in all the projects, or three factors that all the projects stress as important for achieving a more efficient follow-up. These factors are: 1) a more individual-centred approach, 2) a more coherent follow-up, achieved by cooperation and collaboration, and 3) early intervention.
The report shows that the national projects encompassed in the Nordic 0–24 collaboration are in continuous development. Participation in the Nordic project has so far had a significance primarily in relation to mutual learning. Participation has provided insight into projects in other countries, access to research on relevant issues and the sharing of experiences and learnings. As such, the cases included in the Nordic 0–24 collaboration are in a continuous process of development and the joint meetings have become dynamic arenas of mutual learning related to ongoing activities.
The user perspective is embedded in the national cases in different ways. Many of the partners involved have been engaged in user participation and user involvement at an individual level. At the same time, several of the national cases are concerned with how to organise and provide services that are better adapted to the needs of users (vulnerable children, young people and their families), meaning more user orientation of the services.
The term ‘user orientation’ refers to different ways of putting the user at the centre and developing services from this perspective. Many of the cases address specific methods or ways of working to achieve better user involvement in service provision. Many of them are at an individual level, developing methods that empower the user and bring their perspective and needs to the forefront in the relationship between users and service providers. These methods and initiatives often have three main factors: getting the perspective of the user, applying a whole child (holistic) approach, and empowerment (different strategies to empower the user in the relation with the service provider). The efforts in user orientation tend to be at the system level, developing systems, structures and routines that promote access to services and follow-up based on the needs of the users and not restricted by defined service mandates, criteria of a specific diagnosis or other specifications. In all of the cases, this user orientation has made the mismatch between 1) the implications of an individual and whole child approach, and 2) a complex system of fragmented and specialised services, more apparent. A more prominent user orientation makes the complexity and holistic picture of the users’ situation more distinct, hence the need for a more coherent and coordinated follow-up. User orientation and user involvement have clear implications both for the role of the professionals and the organisation of services, not only the users. This is often the starting point for many of the initiatives in the Nordic 0–24 project’s work on promoting better cross-sectoral coordination and collaboration between services, professions and users.
Coordination and collaboration
Variations exist between the cases involved and the local projects of the Nordic 0–24 collaboration depending on whether they are cross-sectoral or cross-professional within a defined sector. Even so, many of the experiences in the work on better coordination and collaboration are the same. The previously introduced factors (Hansen et al. 2018:108); geographical proximity or location; professional knowledge, culture and trust; leadership; incentive systems and economy; resources and time; and systems and regulations, are all relevant for the further work on identifying good practice and how to achieve a more collaborative practice. We see how these factors interrelate and have implications at different levels in the work on better coordination and collaboration. Geographical proximity is emphasised in all cases but with different solutions for how to facilitate the bringing together of actors who are going to collaborate. In some cases, co-location is necessary, in others it is more a question of integrating services, and in many of the cases they are concerned with devising a structure for cross-sectoral and cross- professional meetings for more coherent follow-up. In all of these cases, the factors of anchoring the approaches, leadership and working on the relations between the professionals and services involved are essential, and are connected to proximity. Framework factors encompass the importance of having resources and time for working on new practices, relating to the context of incentive systems and economy based on single sector management, and efforts to ensure collaboration within defined systems and regulations in the national context. All the national cases in some way constitute an initiative that at some level is in the process of developing new collaborative practices and embedding this in new structures, systems, models, methods and routines. How far they have come varies, but at this point they are all working on relevant new practices or on implementing practices.
In the closing chapter, a coordination staircase is used to illustrate the different phases in the process towards better collaboration. The empirical data show that this collaboration process is not a continuous process in one direction of climbing up the stairs. Even though some national cases have reached a high level of collaboration, they still have to continue to work on what is defined at an earlier stage of the process (stage two); how to make professionals adopt a new, more collaborative way of working. This stage two in the coordination staircase is addressed in all of the cases; i.e. how to make the services and professionals involved develop shared problem-understanding as a platform for a more coherent follow-up. This work on how to encourage and maintain relational competence as part of a new collaborative practice should be more explicitly addressed in the further process of the evaluation.
In the remaining process of the Nordic 0–24 collaboration, it should be an explicit aim that all the national cases work systematically on identifying learning points from their cases related to developed systems, models, methods of working and routines that they believe are relevant to bringing into the collaboration. These learning points can be a starting point for further discussions in the joint meetings for identifying the main elements that are important to achieving a high quality in more collaborative services aimed at the target group. What are good examples and recommendations for developing better collaboration and more coherent services across the heterogeneous national cases? What models, methods and systems are considered to work?
In the report, some areas are highlighted in which it could be constructive to get more systemised information on practices as a platform for joint work on recommendations from the project. One example is different systems for sharing information and obtaining consent from users, and different national regulation of this. Another is how to facilitate more collaboration between services and sectors. Are there examples of how regulations could in some way contribute to encourage more collaboration between different services and organisations? Other areas where there are several experiences are how to empower users in their meeting with the welfare services, and how to conduct effective cross-professional meetings. Another question is how to integrate other services in school and facilitate more collaboration between teachers and other professionals.
The report also raises the question of good practices for funding cross-sectoral collaboration and solutions, and models of financial management that encourage cross-sectoral collaboration.
In the next phase, there is a need for all the national cases to put more thought into what to share from their participation in the joint project. What have they learned from their national and local projects that is of relevance to the problems of the Nordic project? What do they consider to be sufficiently important or successful in their project that they want to share it with the rest of the network? And, finally, what experiences and assessments of their local work can contribute to the joint work on making recommendations from the Nordic project on how to develop improved services to vulnerable children, young people and their families by enhancing cross-sectoral collaboration?