Exploring cross-boundary collaboration for youth mental health in Sweden - a qualitative study using the integrative framework for collaborative governance.
Collaboratio
Governance
Mental health system
Youth mental health
Youth mental health services
Journal
BMC health services research
ISSN: 1472-6963
Titre abrégé: BMC Health Serv Res
Pays: England
ID NLM: 101088677
Informations de publication
Date de publication:
11 Mar 2024
11 Mar 2024
Historique:
received:
09
10
2023
accepted:
20
02
2024
medline:
12
3
2024
pubmed:
12
3
2024
entrez:
12
3
2024
Statut:
epublish
Résumé
Youth mental health is a major health concern in almost every country. Mental health accounts for about 13% of the global burden of disease in the 10-to-19-year age group. Still there are significant gaps between the mental health needs of young people and the quality and accessibility of available services. Collaboration between health and social service actors is a recognized way of reducing gaps in quality and access. Yet there is little scientific evidence on how these collaborations are applied, or on the challenges of cross-boundary collaboration in the youth mental health space. This study aims to explore how collaboration is understood and practiced by professionals working in the Swedish youth mental health system. We conducted 42 interviews (November 2020 to March 2022) with health and social care professionals and managers in the youth mental health system in Sweden. Interviews explored participants' experience and understanding of the purpose, realization, and challenges of collaboration. Data were analysed under an emergent study design using reflexive thematic analysis. The analysis produced three themes. The first shows that collaboration is considered as essential and important, and that it serves diverse purposes and holds multiple meanings in relation to professionals' roles and responsibilities. The second addresses the different layers of collaboration, in relation to activities, relationships, and target levels, and the third captures the challenges and criticisms in collaborating across the youth mental health landscape, but also in growing possibilities for future development. We conclude that collaboration serves multiple purposes and takes many shapes in the Swedish youth mental health system. Despite the many challenges, participants saw potential in further building collaboration. Interestingly our participants also raised concerns about too much collaboration. There was scepticism about collaboration directing attention away from young people to the professionals, thereby risking the trust and confidentiality of their young clients. Collaboration is not a panacea and will not compensate for an under-resourced youth mental health system.
Sections du résumé
BACKGROUND
BACKGROUND
Youth mental health is a major health concern in almost every country. Mental health accounts for about 13% of the global burden of disease in the 10-to-19-year age group. Still there are significant gaps between the mental health needs of young people and the quality and accessibility of available services. Collaboration between health and social service actors is a recognized way of reducing gaps in quality and access. Yet there is little scientific evidence on how these collaborations are applied, or on the challenges of cross-boundary collaboration in the youth mental health space. This study aims to explore how collaboration is understood and practiced by professionals working in the Swedish youth mental health system.
METHODS
METHODS
We conducted 42 interviews (November 2020 to March 2022) with health and social care professionals and managers in the youth mental health system in Sweden. Interviews explored participants' experience and understanding of the purpose, realization, and challenges of collaboration. Data were analysed under an emergent study design using reflexive thematic analysis.
RESULTS
RESULTS
The analysis produced three themes. The first shows that collaboration is considered as essential and important, and that it serves diverse purposes and holds multiple meanings in relation to professionals' roles and responsibilities. The second addresses the different layers of collaboration, in relation to activities, relationships, and target levels, and the third captures the challenges and criticisms in collaborating across the youth mental health landscape, but also in growing possibilities for future development.
CONCLUSION
CONCLUSIONS
We conclude that collaboration serves multiple purposes and takes many shapes in the Swedish youth mental health system. Despite the many challenges, participants saw potential in further building collaboration. Interestingly our participants also raised concerns about too much collaboration. There was scepticism about collaboration directing attention away from young people to the professionals, thereby risking the trust and confidentiality of their young clients. Collaboration is not a panacea and will not compensate for an under-resourced youth mental health system.
Identifiants
pubmed: 38468279
doi: 10.1186/s12913-024-10757-y
pii: 10.1186/s12913-024-10757-y
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
322Informations de copyright
© 2024. The Author(s).
Références
Patel V, Flisher AJ, Hetrick S, McGorry P. Mental health of young people: a global public-health challenge. Lancet (British Edition). 2007;369(9569):1302–13.
Patel V, Saxena S, Lund C, Thornicroft G, Baingana F, Bolton P, et al. The Lancet Commission on global mental health and sustainable development. Lancet (British Edition). 2018;392(10157):1553–98.
Samji H, Wu J, Ladak A, Vossen C, Stewart E, Dove N, et al. Review: Mental health impacts of the COVID-19 pandemic on children and youth– a systematic review. Child Adolesc Mental Health. 2022;27(2):173–89.
doi: 10.1111/camh.12501
O’Connor RC, Wetherall K, Cleare S, McClelland H, Melson AJ, Niedzwiedz CL, et al. Mental health and well-being during the COVID-19 pandemic: longitudinal analyses of adults in the UK COVID-19 Mental Health & Wellbeing study. Br J Psychiatry. 2021;218(6):326–33.
pubmed: 33081860
doi: 10.1192/bjp.2020.212
Kohn R, Ali AA, Puac-Polanco V, Figueroa C, López-Soto V, Morgan K, et al. Mental health in the Americas: an overview of the treatment gap. Revista Panam De Salud pública. 2018;42:e165.
Schleider JL, Dobias ML, Sung JY, Mullarkey MC. Future directions in single-Session Youth Mental Health interventions. J Clin Child Adolesc Psychol. 2020;49(2):264–78.
pubmed: 31799863
doi: 10.1080/15374416.2019.1683852
Radez J, Reardon T, Creswell C, Lawrence PJ, Evdoka-Burton G, Waite P. Why do children and adolescents (not) seek and access professional help for their mental health problems? A systematic review of quantitative and qualitative studies. Eur Child Adolesc Psychiatry. 2021;30(2):183–211.
pubmed: 31965309
doi: 10.1007/s00787-019-01469-4
Planey AM, Smith SM, Moore S, Walker TD. Barriers and facilitators to mental health help-seeking among African American youth and their families: a systematic review study. Child Youth Serv Rev. 2019;101:190–200.
doi: 10.1016/j.childyouth.2019.04.001
Gulliver A, Griffiths KM, Christensen H. Perceived barriers and facilitators to mental health help-seeking in young people: a systematic review. BMC Psychiatry. 2010;10(1):113.
pubmed: 21192795
pmcid: 3022639
doi: 10.1186/1471-244X-10-113
Halsall T, Manion I, Iyer SN, Mathias S, Purcell R, Henderson J. Trends in mental health system transformation: integrating youth services within the Canadian context. Healthc Manage Forum. 2019;32(2):51–5.
pubmed: 30799661
doi: 10.1177/0840470418808815
García-Carrión R, Villarejo-Carballido B, Villardón-Gallego L. Children and Adolescents Mental Health: a systematic review of Interaction-based interventions in Schools and communities. Front Psychol. 2019;10:918–8.
pubmed: 31068881
pmcid: 6491840
doi: 10.3389/fpsyg.2019.00918
God och nära. vård: vård i samverkan. (SOU 2019:29). Stockholm: Fritze.
Börja med barnen!. Följa Upp hälsa och dela information för en god och nära vård - utredningen om en sammanhållen god och nära vård för barn och unga (SOU 2021:78). Stockholm: Fritze.
Morley L, Cashell A. Collaboration in Health Care. J Med Imaging Radiation Sci. 2017;48(2):207–16.
doi: 10.1016/j.jmir.2017.02.071
WHO. Multisectoral action for mental health. [Internet] Copenhagen.; 2019. [Cited 230913] Available from: https://apps.who.int/iris/bitstream/handle/10665/346538/WHO-EURO-2019-3579-43338-60799-eng .pdf?sequence=1&isAllowed=y.
Patel H, Pettitt M, Wilson JR. Factors of collaborative working: a framework for a collaboration model. Appl Ergon. 2012;43(1):1–26.
pubmed: 21616476
doi: 10.1016/j.apergo.2011.04.009
Mahler C, Gutmann T, Karstens S, Joos S. Terminology for interprofessional collaboration: definition and current practice. GMS Z für Medizinische Ausbildung. 2014;31(4):40.
Hodges S, Ferreira K, Mowery D, Novicki E. Who’s in Charge Here? Structures for collaborative governance in children’s Mental Health. Adm Social work. 2013;37(4):418–32.
doi: 10.1080/03643107.2012.758062
Karlsson M, Garvare R, Zingmark K, Nordström B. Organizing for sustainable inter-organizational collaboration in health care processes. J Interprof Care. 2020;34(2):241–50.
pubmed: 31329471
doi: 10.1080/13561820.2019.1638760
Hodges S, Hernandez M, Nesman T. A Developmental Framework for collaboration in child-serving agencies. J Child Fam stud. 2003;12(3):291–305.
doi: 10.1023/A:1023987710611
Hernandez M, Hodges S. Applying a theory of Change Approach to Interagency Planning in Child Mental Health. Am J Community Psychol. 2006;38(3–4):183–90.
doi: 10.1007/s10464-006-9079-7
Hazen AL, Hough RL, Landsverk JA, Wood PA. Use of mental health services by youths in public sectors of care. Ment Health Serv Res. 2004;6(4):213–26.
pubmed: 15588032
doi: 10.1023/B:MHSR.0000044747.54525.36
Sullivan TJ. Collaboration: a health care imperative. New York: McGrew-Hill; 1998.
Morgan S, Pullon S, McKinlay E. Observation of interprofessional collaborative practice in primary care teams: an integrative literature review. Int J Nurs Stud. 2015;52(7):1217–30.
pubmed: 25862411
doi: 10.1016/j.ijnurstu.2015.03.008
Miller PM. Examining the work of boundary spanning leaders in community contexts. Int J Leadersh Educ. 2008;11(4):353–77.
doi: 10.1080/13603120802317875
Goicolea I, Wiklund M, Linander I, Sundberg LR. Protecting, managing and bending boundaries: a biomedicalization perspective on Swedish youth clinics’ responses to mental (ill) health. BMC Health Serv Res. 2022;22(1):1.
doi: 10.1186/s12913-022-08259-w
Wallace C, Farmer J, McCosker A. Community boundary spanners as an addition to the health workforce to reach marginalised people: a scoping review of the literature. Hum Resour Health. 2018;16(1):46.
pubmed: 30200968
pmcid: 6131945
doi: 10.1186/s12960-018-0310-z
Pedersen PV, Hjelmar U, Høybye MT, Rod MH. Can inequality be tamed through boundary work? A qualitative study of health promotion aimed at reducing health inequalities. Soc Sci Med. 2017;185:1–8.
Brownlie EB, Chaim G, Heffernan O, Herzog T, Henderson J. Youth Services System Review: moving from knowledge gathering to implementation through collaboration, Youth Engagement, and exploring Local Community needs. Can J Community Mental Health. 2017;36(2):133–49.
doi: 10.7870/cjcmh-2017-018
Iversen T, Anell A, Häkkinen U, Kronborg C, Ólafsdóttir T. Coordination of health care in the nordic countries. Nordic J Health Econ. 2016;4(1):41–55.
doi: 10.5617/njhe.2846
Settipani CA, Hawke LD, Cleverley K, Chaim G, Cheung A, Mehra K, et al. Key attributes of integrated community-based youth service hubs for mental health: a scoping review. Int J Mental Health Syst. 2019;13(1):52.
doi: 10.1186/s13033-019-0306-7
Shahzad M, Upshur R, Donnelly P, Bharmal A, Wei X, Feng P, et al. A population-based approach to integrated healthcare delivery: a scoping review of clinical care and public health collaboration. BMC Public Health. 2019;19(1):708.
pubmed: 31174501
pmcid: 6556001
doi: 10.1186/s12889-019-7002-z
Castillo EG, Ijadi-Maghsoodi R, Shadravan S, Moore E, Mensah MO, Docherty M, et al. Community Interventions To Promote Mental Health and Social Equity. Curr Psychiatry Rep. 2019;21(5):35–5.
pubmed: 30927093
pmcid: 6440941
doi: 10.1007/s11920-019-1017-0
Gobis B, Yu A, Reardon J, Nystrom M, Grindrod K, McCarthy L. Prioritizing intraprofessional collaboration for optimal patient care: a call to action. Can Pharmacists J. 2018;151(3):170–5.
doi: 10.1177/1715163518765879
Rees DJ, Bates V, Thomas RA, Brooks SB, Laing H, Davies GH et al. (2021). Collaborating to deliver value in health care: exploring conditions required for successful healthcare and life science sector collaboration. Transforming Government, 2021;15:1, 169–90.
Ostrom E. Governing the commons: the evolution of institutions for collective action. Canto classics edition. Cambridge: Cambridge University Press; 2015.
doi: 10.1017/CBO9781316423936
Emerson K, Nabatchi T, Balogh S. An integrative Framework for Collaborative Governance. J Public Adm Res Theor. 2012;22(1):1–29.
doi: 10.1093/jopart/mur011
Braun V, Clarke V. Thematic analysis: a practical guide. Los Angeles: SAGE; 2022.
doi: 10.1007/978-3-319-69909-7_3470-2
Trainor LR, Bundon A. Developing the craft: reflexive accounts of doing reflexive thematic analysis. Qualitative Res Sport Exerc Health. 2021;13(5):705–26.
doi: 10.1080/2159676X.2020.1840423
Sveriges Kommuner och Regioner. Första linjen. 2020. Nulägesbeskrivning av hälso- och sjukvårdens första linje för barn och ungas psykiska hälsa. [Internet] Stockholm: SKR; 2021. [Cited 230804). Available from: https://www.uppdragpsykiskhalsa.se/wp-content/uploads/2021/03/F%C3%B6rsta-linjen-2020-nul%C3%A4gesbeskrivning-av-h%C3%A4lso-och-sjukv%C3%A5rdens-f%C3%B6rsta-linje-f%C3%B6r-barn-och-ungas-psykiska-h%C3%A4lsa.pdf .
Folkhälsomyndigheten. Skolbaserad samverkan för barns och ungas psykiska hälsa– lärdomar från praktiken. [Internet] Solna: Folkhälsomyndigheten; 2021. Dnr 05030– 2018. [Cited 230804) Available from: https://www.folkhalsomyndigheten.se/contentassets/53b9b0c2c54d4619b71d4ab8bc8db6f9/skolbaserad-samverkan-barns-ungas-psykiska-halsa.pdf .
Richter Sundberg L, Christianson M, Wiklund M, Hurtig AK, Goicolea I. How can we strengthen mental health services in Swedish youth clinics? A health policy and systems study protocol. BMJ open. 2021;11(10):e048922.
pubmed: 34686550
pmcid: 8543652
doi: 10.1136/bmjopen-2021-048922
Long JC, Cunningham FC, Braithwaite J. Bridges, brokers and boundary spanners in collaborative networks: a systematic review. BMC Health Serv Res. 2013;13(1):158.
pubmed: 23631517
pmcid: 3648408
doi: 10.1186/1472-6963-13-158
Hunt CM, Spence M, McBride A. The role of boundary spanners in delivering collaborative care: a process evaluation. BMC Fam Pract. 2016;17(1):96.
pubmed: 27473529
pmcid: 4966858
doi: 10.1186/s12875-016-0501-4
Friedman RA, Podolny J. Differentiation of Boundary spanning roles: labor negotiations and implications for Role Conflict. Adm Sci Q. 1992;37(1):28–47.
doi: 10.2307/2393532
Blank MJ, Berg AC, Melaville A. Growing community schools: the role of Cross-boundary Leadership. Coalition for Community Schools. Coalition for Community Schools; 2006.
Sanders M, Galindo C, DeTablan D. Leadership for collaboration: exploring how Community School coordinators Advance the goals of full-service community schools. Child Schools. 2019;41(2):89–100.
doi: 10.1093/cs/cdz006
Cunliffe AL, Eriksen M. Relational leadership. Hum Relations (New York). 2011;64(11):1425–49.
doi: 10.1177/0018726711418388
Kaas MJ, Lee S, Peitzman C. Barriers to Collaboration between Mental Health Professionals and families in the care of persons with Serious Mental illness. Issues Ment Health Nurs. 2003;24(8):741–56.
pubmed: 13129751
doi: 10.1080/mhn.24.8.741.756
Darlington Y, Feeney JA, Rixon K. Interagency collaboration between child protection and mental health services: practices, attitudes and barriers. Child Abuse Negl. 2005;29(10):1085–98.
pubmed: 16315352
doi: 10.1016/j.chiabu.2005.04.005
Haddara W, Lingard L. Are we all on the same page? A discourse analysis of interprofessional collaboration. Acad Med. 2013;88(10):1509–15.
pubmed: 23969354
doi: 10.1097/ACM.0b013e3182a31893
Hedberg B, Nordström E, Kjellström S, Josephson I. We found a solution, sort of - A qualitative interview study with children and parents on their experiences of the coordinated individual plan (CIP) in Sweden. Cogent Med. 2018;5(1):1428033.
doi: 10.1080/2331205X.2018.1428033
Almqvist AL, Lassinantti K. Young people with complex needs meet complex organizations: an interview study with Swedish professionals about sustainable work practices. Community work Family. 2018;21(5):620–35.
doi: 10.1080/13668803.2018.1527758
Jonsson F, Gotfredsen AC, Goicolea I. How can community-based (re)engagement initiatives meet the needs of NEET young people? Findings from the theory gleaning phase of a realist evaluation in Sweden. BMC Res Notes. 2022;15(1):1–232.
doi: 10.1186/s13104-022-06115-y
O’Reilly M, Adams S, Whiteman N, Hughes J, Reilly P, Dogra N. Whose responsibility is adolescent’s Mental Health in the UK? Perspectives of key stakeholders. School Mental Health. 2018;10(4):450–61.
pubmed: 30464778
pmcid: 6223973
doi: 10.1007/s12310-018-9263-6
Gratzer D, Goldbloom D. New Government, New Opportunity, and an Old Problem with Access to Mental Health Care. Can J Psychiatry. 2017;62(1):8–10.
pubmed: 28055258
pmcid: 5302111
doi: 10.1177/0706743716669084
Malla A, Shah J, Iyer S, Boksa P, Joober R, Andersson N, et al. Youth Mental Health Should Be a Top Priority for Health Care in Canada. Can J Psychiatry. 2018;63(4):216–22.
pubmed: 29528719
pmcid: 5894919
doi: 10.1177/0706743718758968