Evaluering av prosjektet: Sammen for barn og unge bedre samordning av tjenester til utsatte barn og unge

This report presents the final evaluation of a project called: “Sammen for barn og unge – bedre samordning av tjenester til utsatte barn og unge.» Norwegian Social research (NOVA) was commissioned by The Norwegian Association of Local and Regional Authorities (KS) and The Ministry of Children, Equality and Social Inclusion (BLD) who stood behind the project. The basic idea has been that the various local authorities involved in assisting children and youth at risk, have to have well coordinated and functional ways of collaborating, if they are to offer the aid the youngsters need. The main goal of the project has been to develop functional models for interdisciplinary collaboration at the local level. These models can serve as inspiration and guides for other municipalities and be developed further. The three year project, started in the end of 2008, has supported fifteen selected municipalities in their efforts to develop good interdisciplinary models for such collaboration. In addition to financial support the participating municipalities received assistance in their efforts to raise the level of competence, internal control, secure support from administration and amongst the employees, clarify placement of responsibility and improve the quality of meetings etc. Each municipality tried out their own version of an interdisciplinary collaborative model. Some models had a narrow scope, while others included virtually all the local authorities that are involved with children and youth. The present evaluation includes six of the fifteen municipalities. These are: Haram, Harstad, Moss, Risør, Bærum and Fet. They were chosen to illustrate the variation in size and geographical location amongst the participating municipalities. Elaborate descriptions of the models are available online at: http://www.ks.no/Sammen-for-barn-og-unge The municipality of Harstad had a model that included a wide scope of participants; the public health centers, school health services, child welfare services, mental health care services, psychiatric services for children and youth, police, nursery schools, schools and The Norwegian Labor and Welfare Administration. They established an interdisciplinary “preventive” forum that played a central role in their local project. The forum worked with improving cooperation between the involved stakeholders and the implementation of a handbook in collaboration, was important. Haram had a program that included several developmental projects. They targeted the organization, management and structural aspects in the municipality. A key partner in their developmental efforts was the office “Tiltakstjenester for barn og unge”, which included local health centers, child welfare services and the educational – psychological services. They also worked with other agencies, local and governmental. The municipality of Risør based their project on a previous one that had targeted youth at risk of becoming addicted to drugs. In their project they intended to coordinate the services for children and young adults, and developed a model for coordinating local measures to prevent crime, called the SLT- model - to strengthen primary preventive action. The development of a guidebook was central in their work. All services connected with children and young people are potential partners in their model. Moss had a model that aimed at implementing an overall childhood plan. The project was organized through the establishment of interdisciplinary teams in three city districts. The teams work with cases at the system level. Fet participated with a model where the interdisciplinary groups were organized around each school and childcare center. There are three main elements in their model. One is a resource team, in which an educational- psychological professional is added to the unit’s own group. The second are interdisciplinary groups, consisting of the unit leader, an educational- psychological resource, Child Welfare Services, school nurse and the resource team. The interdisciplinary group visits the schools and child care centers every 4-6 weeks. The third is a coordinating working committee. The members of the committee are the leaders of each of the units that work with children and youth. Participating in the project are the health services, the educational- psychological services, Child Welfare Services and the coordinator for interdisciplinary collaboration for children and youth. During the project period this municipality also collaborated with Oslo University College on teaching 80 employees about interdisciplinary interaction. Bærum participated with a model that consisted of collaboration between the Child Welfare Services and Child and Adolescent Psychiatry. They have focused on developing their joint expertise and intensifying the collaboration between ten employees in each of the two services. They intend to transfer their good experiences to other collaborative constellations. While they were developing their competences, they also worked together on cases that involved other agencies. Network meetings and kickoffs were essential to getting the interaction started. The aim of the evaluation has been to evaluate and describe changes in the interdisciplinary and interdepartmental collaboration during the project period. Only 14-18 months passed between the first and second collection of data, which limits the likelihood of there having been any major changes in the municipalities. Organizations take time to change, and a year and a half is a short time in this respect. Municipalities usually also have several projects going on at the same time, which makes it difficult to know what is caused by which process. In our evaluation we have looked at criteria that characterize good types of cooperation. Amongst these are; regular meetings, clear allocation of responsibility, formalized routines, management follow-up and the correct skills and knowledge. Other characteristics of collaborative competence are knowledge about each others routines, work practices, duty of confidentiality and informing. The intent has been to understand which processes the employees have participated in and their experiences. We collected data for the evaluation twice. The first round was in the fall of 2009 in four of the municipalities and in January 2010 in the last two municipalities. The first round consisted of individual interviews and focus groups with the employees, and also gathering information from statistics and documents. The second round was the winter / spring of 2011. In February/ March we sent an electronic questionnaire with questions about how the employees in the involved services, in all six municipalities, experienced the interdisciplinary and interdepartmental collaboration. In the spring of 2011 we did a new round of individual and group interviews. After the first round of data collection NOVA wrote a status report about how the collaboration was perceived in the municipalities. Some of the municipalities used that Paper as a basis for the continuation of their efforts and development of their models. The first stage of the study showed that there was a lot of variation between the municipalities regarding how far they had developed their models for cooperation. There were some common experiences that can be summed up as follows: The participating services overall had high level of expertise. It was challenging to get the professionals working in “the field” committed to collaboration. All the municipalities experienced that there wasn’t enough time for extensive collaboration. Collaboration wasn’t always useful. Many had established routines for regular meetings, but the challenge was to make them meaningful, constructive to improving the services to the clients. Several were discontent with the results of the meetings. In general improvement of cooperational skills was required. There was discontentment with how the duty of confidentiality was handled. There was a lack of knowledge about and understanding of the partner’s services, responsibilities and roles. There was a need for more knowledge about one’s own organization and possible offers in the municipality. There were few who knew about the project “Sammen for barn og unge” at the time of the first round of data collection. The municipalities had made some changes between the first and second round of data collection. Some of the common experiences at the end of the project can be summarized as follows: Many employees were involved in interdisciplinary cooperation. Most were aware of the importance of collaboration in creating better services for the users. Several formal routines for collaboration have been established. Within the municipalities there were differing experiences of the changes in routines. Some experienced many changes in routines, while others didn’t notice that any changes. Collaborative skills had improved through courses and the practice of collaboration itself. The respondents were generally more favorable to collaboration. Several focused on collaboration, and had a better understanding of its importance. The answers show that management can improve their facilitation of collaboration. Not everybody interpreted the changes that happened as results of the project, often they focused on the changes themselves. In the second data set there were fewer differences between the municipalities with regard to how collaboration was experienced. There were large variations in the degree interdisciplinary collaboration had contributed to an increase in perceived efficiency. A main challenge has been to incorporate collaborative routines amongst all employees. Staying focused increases the chances of success, without focus a model can deteriorate easily. With time and patience many eventually succeed at having constructive meetings, even if they felt meaningless in the beginning. There was less dissatisfaction with the routines for giving feedback. (During the project a new law about the Child Services duty to give feedback to someone who made a report was passed.) Most reply that collaboration has been on the agenda for years. Those who say they do experience a difference say it’s mainly due to the common platform that has been established. Obstacles to interdisciplinary collaboration can amongst other things be due to differences in professional cultures, unrealistic expectations, lack of knowledge about the others, complex routines, lack of skills needed for collaboration, limited feedback, management’s insufficient prioritization etc. To overcome such obstacles it is important to grasp the attitudes, knowledge and various types of cooperation that exist. The following factors were considered important in our study: Openness: Cooperation regarding clients and the development of good relations are dependent upon inclusion of the involved parties and that sufficient and meaningful feedback is given. Meeting places: The employees appreciate joint courses and places to meet. Herein joint conferences and other get-togethers are also included. Personal relations: To make interdisciplinary cooperation work, people need to spend time getting to know each other. There is an evident need to get to know the people in the other fields and authorities, and do things together. Formal structures: are necessary to anchor the collaborative efforts. Formal structures such as meetings, contribute to enhance competence in teamwork. Thereby it becomes easier to clarify roles and premises, in addition to giving an opportunity to discuss disagreements. Management’s responsibility: It is very important that the attention to cooperation and enabling of it is a management priority. Management must lay the foundation for, motivate and follow up collaborative possibilities. Collocation: Those who are located together say it contributes to strengthening cooperation and establishing collaboration. Client participation: Involving parents contributes to good results. It is especially beneficial when children, youth and parents / guardians participate throughout the whole process. Tools: Manuals and guides can be very useful tools when used. A common intranet could be used more actively for communication