Divergent conceptions : obstacles to collaboration in addressing the needs of children and adolescents

Abstract

Children and adolescents with complex psychosocial needs calls for collaboration between professionals, due to their own problems and due to problems related to the adults and peers in their environment. Since cares about children and youth in the welfare sector are largely organized through specialization the complex needs can only be met through efforts from several welfare organizations, and thus simultaneously. This makes collaboration inevitable and requires that the professionals can work together in a flexible and straightforward manner for the benefit of those seeking help. The aim of the thesis was to gain a deeper understanding of what affects collaboration between professionals from different organizations and what is required to facilitate the process between them.

Professionals from schools, municipality and health care were interviewed in focus groups about various aspects of collaboration. Parents were interviewed through in-depth interviews. Study 1 was conducted in an administrative district of Stockholm, and examined the perceptions professionals had about barriers to collaboration. Unclear division of responsibilities between the organizations, lack of trust between the professionals and ambiguities in the professional meeting acted as obstacles. Study 2 examined parents' perceptions of collaboration between professionals from different organizations. The results showed parents needs for confidence in individual professionals and structure in collaboration between them. Study 3 was undertaken in the administrative district of Stockholm and in a municipality close to Stockholm and examined professionals' conceptions (social representations) of each other in collaboration. These were marked by restrictions and the professionals perceived each other as setting boundaries, inaccessible and closed and they had beliefs about negative attitudes from the other parties. Study 4 was performed in the municipality close to Stockholm and examined the extent to which organizational affiliation influenced the professionals' views (professional representations) on children's and adolescents need for psycho-social support. The results showed different approaches in the perception of children ́s and adolescent's needs, of which CAMHS (BUP) represented an individual approach focused on psychological understanding, social services represented a contextual approach focused on social environment and schools, which represented a pedagogical approach focused on learning.

The results of the thesis indicate that professionals' knowledge of each other and trust between them are of importance for smooth functioning of collaboration. The thesis contributes with new knowledge about collaboration by highlighting the need for such knowledge, providing professionals both insights and deeper understanding of each other's views on children's and adolescents needs and how the organizational conditions affect them in collaboration. A practical implication of this is that professionals are given the opportunity to meet and share knowledge with each other to jointly and more deeply reflect on what is perceived as problematic in collaboration. In this respect, dialogue groups or backstage groups are appropriate methods.

The thesis also shows the need for coordination between professionals in order to ease the burden for those who seek their help. By nominating a coordinator for families they jointly are involved in, will joint meetings between professionals and between them and the family be planned. A higher preparedness to handle the contact with families with complex needs in the form of joint meetings (network meetings) would create a holding environment around children and their families. In 2010 mandatory rules were instituted for social services and health care to implement the so-called "coordinated individual plan” (SIP) for children and adolescents with complex needs. A prerequisite for such meetings to be effective and successful, however, is that the professionals have knowledge and understanding of each other's work and approach.