Background
Research methods
Identification of mental health ICMs for children and youth
Identification of facilitators and barriers to successful implementation or scale up
Results
Sampling results
Counties | Sex | Age | Work experience within the mental health field | Roles |
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• Oslo (n = 4) • Innlandet (n = 1) • Vestfold og Telemark (n = 1) • Agder (n = 2) • Viken (n = 1) | • Female (n = 8) • Male (n = 1) | • Average 45 years • Range 28–60 years | • Average 17 years • Range 3–30 years | • Administrator • Counsellor/advisor within mental health • General practitioner • Health nurse • Psychiatrist • Psychologist • User representative |
Integrated care model | Start year | Objective | Description | Target group | Degree of integration* | Dimensions of integration** | Implementation status | Source |
---|---|---|---|---|---|---|---|---|
0–26 Lier [27] | 2019 | To find good solutions together with the child/youth and family, and to provide quick and the right support | • Includes family, school, health, social, economy and housing services • Offers health promotion, prevention, professional care, and self-care by an intersectoral team | Children and youth, 0–26 years and their family | Full integration | Vertical, horizontal, longitudinal and population | 2019: Expansion to include children ages 0 to 12 years as well as families | Literature review |
Children and youth’s health service – Helse Fonna Health Authority [28] | 2016 | To ensure children and young people receive the right help from the right service and to connect the different services to provide an integrated and comprehensive offer | • Develops seven new care pathways, ranging from concerned behaviour to specific diagnoses • Describes and maps roles and responsibility of the services offered | Children and youth with mental health challenges | Coordination in networks | Vertical | 2019–2021: Implementation | Literature review |
Better mental health care for children in child welfare [29] | 2016 | To develop different initiatives and models for better integrated care services for children and youth utilizing child welfare services | • Considers two models: (1) responsibility allocation, i.e., one professional being responsible for the child’s welfare and health care services, and (2) new care pathways | Children and youth in child welfare services | Cooperation (responsibility allocation) Coordination in networks (pathway) | Horizontal and vertical | (1) 2018: Started implementation of responsibility allocation and (2) 2019: Started implementation of new care pathways | Experts’ suggestion |
BTI – Better multidisciplinary efforts [30] adapted from Denmark | 2012 | To create a comprehensive and coherent system between different services | • Provides a travelling log file following the child/youth • Assignes a personal coordinator | Pregnant women, children and/or youth with connected raised concern | Mix of cooperation and coordination in networks | Horizontal and vertical | Ongoing: Further developments and implementations | Literature review |
One who listens – Mental Health Youth [31] | 2016 | To promote mental health and provide a place where youth can talk about their problems | • Offers free counselling by a psychologist, social worker or nurse student in cooperation with municipal services • Focuses on early intervention | Youth, 15–25 years | Coordination in networks | Vertical | Ongoing: Further developments and implementations | Experts’ suggestion |
2020 | To ensure that young people who often “falls between two stools” receive assessment, treatment and rehabilitation services to prevent the onset of symptoms and improve quality of life, in a youth-friendly environment | • Provides multidisciplinary and flexible outreach treatment | Children and youth, 12–24 years, with complex challenges | Mix of cooperation and coordination in networks | Horizontal and vertical | 2020–2023: Piloting | Literature review | |
The family’s house Færder [33] | 2016 | To ensure that children and youth have a good upbringing that leads to a good adult life with participation in society and work | • Includes child welfare, preventive health and school and kindergarten services | Children, youth and families | Full integration | Vertical, horizontal, longitudinal and population | Ongoing: Further developments and implementations | Literature review |
The health fellowship [34] | 2019 | To ensure that hospitals and municipalities collaborate better | • Establishes arrangements between health authorities, municipalities, hospitals, GPs and patients to develop and locally adapt service models | Vulnerable patient groups, children and youth | Coordination in networks | Vertical | 2020–2023: Planning and establishing | Experts’ suggestion |
Care pathway, mental health disorders – children and youth [35] | 2016 | To increase user participation and satisfaction, to promote coherent and coordinated patient processes, to avoid unnecessary waiting time for assessment, treatment and follow-up, and to improve somatic health care and healthy living habits | • Coordinates GP, specialist sector, the municipality and the user or guardians • Describes contact points and follow-up care in municipalities, somatic health care and healthy living habits | Children and youth with one or more sign(s) of serious mental illness | Coordination in networks | Vertical | 2018–2019: Started implementation | Literature review |
Coordination of local drugs and crime preventative measures (SLT) Bærum [36] | 2013 | To prevent drug use and crime among children and youth | • Consists of a team-based collaborative model between municipality, police, community services and professionals working closely with children and youth | People at risk of committing crime and possible victims of crime – main emphasis on children, youth and their parents | Mix of coordination in networks and cooperation | Vertical and horizontal | Ongoing: Further developments and implementations | Literature review |
The Scaffolding Builders [37] | 2015 | To close gaps between children and services, and arrange a comprehensive follow-up care centered around children’s needs | • Identifies gaps in the system to ultimately strengthened it | Child or youth living in foster care or residential childcare institution, 0–23 years | Coordination in network | Vertical and longitudinal | 2020: Included in Akershus University Hospital’s operating framework | Experts’ suggestion |
Multi-disciplinary low-threshold team Tromsø [38] | 2015 | To ensure children and young people use services that are professional, coordinated and characterized by continuity between the municipality and specialist sector | • Consists of a multidisciplinary, intersectoral outreach team • Allows initial referrals to be made by professionals as well as family members | Children, youth and families | Coordination in network | Vertical | Ongoing: Further developments and implementations | Literature review |
Youth Arena Oslo [39] adapted from Australia | 2016 | To reach children and young people who are not reached by other measures, and to offer youth-friendly help and conversations | • Offers low-threshold counselling in a youth-friendly drop-in environment • Carries out multidisciplinary collaboration | Children and youth, 12–25 years | Mix of cooperation and full integration | Longitudinal, vertical and horizontal | Ongoing: Further developments and implementations | Literature review |
GP supervision groups, DPS Vestfold - | 2017 | To improve collaboration in order to provide a more coherent health service, and to promote competence development so that all parties achieve the highest possible competence in patient care | • Includes services provided by the GPs, municipal psychiatry services, district psychiatric centres and the Norwegian Labour and Welfare Administration | Originally adults but suggested to be expended to children and youth | Cooperation | Vertical | 2020: Report suggested the expansion of the model [40] Ongoing: Further developments and implementations | Literature review |
Barriers and facilitators related to the Norwegian healthcare system
Facilitators related to mental health care delivery for children and youth
Facilitators specific to children and youth
Integrated care model | Facilitators and barriers to successful implementation or scale up | Examples of quotes |
---|---|---|
0–26 Lier [27] | Facilitators • Provides easy access (by phone, short waiting time, limited need of assessment forms to fill out)* • Provides care through intersectoral teams, creating a holistic and smooth pathway • Reaches beyond the critical age of 18** • Includes housing – especially important for children and youth not living with their parents** | *“The idea is to intervene early, with a low threshold and eliminate many assessment forms that imply that if you tick certain boxes, you will receive help.” Administrator at the municipal level **“And then, housing comes into play, which is a crucial factor and is not included in many other models because they only extend until the age of 18 and assume that children always live at home.” Senior advisor at the national level |
Children and youth’s health service – Helse Fonna Health Authority [28] | Facilitators • Allocates responsibilities across different levels of care, and hence avoids unequal access to services as the service is less dependent on individuals for their success (less “person dependent”) Barriers • Professionals may select the wrong pathway as there are overlapping approaches • Depends on high expertise in the front line to select right pathway • Requires a certain flexibility to change pathway • May focus on a specific condition too early* • Information about the model is not directed to the users | *“How do you know which pathway to start on? Because it’s really important to jump on the right track, and for that, you need a lot of specialized knowledge and high professional competence far in advance. Otherwise, you may do injustice to children.” Administrator at the municipal level |
Better mental health care for children in child welfare [29] | Facilitators • Narrows the gap between child welfare and need for mental health services • May promote cooperation between child welfare services and child and adolescent psychiatric outpatient clinic* | *“There is a significant need for it because a report stated that 9 out of 10 individuals in the child welfare system have some form of mental disorder or mental challenge, which is not surprising considering the experiences they have been through. The child welfare system says it is difficult to collaborate with the Child and Adolescent Psychiatric Outpatient Clinic (BUP), and BUP says it is challenging to collaborate with the child welfare system. There is often high pressure in the child welfare services, and there is little room for maneuver if something urgent happens.” Counsellor within mental health at the municipal level |
BTI – Better multidisciplinary efforts [30] | Facilitators • Establishes basic structures for cooperation across interdisciplinary teams on a local level* • Provides systematic care delivery, avoiding unequal access to services as the service provision are to be less dependent on individuals for their success (less “person dependent”) • Is a devoted model on a national level (a central push) Barriers • Consider the travelling log-document a barrier for some providers to put into use • Travelling log-document may not work for complex cases • Depends on good leadership and available resources in order to be successful • Lacks innovation as the principles of this ICM is already in place locally | *“It is more of a system tool for working interdisciplinary on concerns related to children. It’s beneficial to have a common language, in a way, within the services and to have a system in place for identifying, assessing, and approaching concerns.” Health nurse at the municipal level |
One who listens – Mental Health Youth [31] | Facilitator • Allows students to practise and learn while increasing accessibility to mental health services (win-win situation) • Integrates mental health services with general services in the community* Barriers • Students may have limited experience and expertise • Depends on the availability of students | *“I think that is a very effective way to integrate a service that may be considered taboo, such as mental health, by incorporating it into regular operations.” Senior advisor at the national level |
FACT Young [32] | Facilitators • Tailors services to children and youth who need it the most, i.e. those with complex needs or those who lack a support system* • Provides flexible**, comprehensive and low threshold services (no referral needed, specialist contacting patient) • Approaches youth in their environment, providing better understanding about their context • Reaches beyond the critical age of 18 • Reconsiders competences of professionals across care levels • Supports creating a better understanding of responsibilities and collaboration across care levels • Is a devoted model on a national level (a central push) Barrier • Unclear funding streams in or across the different sectors involved | *“ (…) If we manage to reach more of those children and adolescents, I believe it is the most vulnerable ones who lack other support systems, whether it be family or stability.” Senior advisor at the national level **“Being able to go directly to the user instead of requiring the user to come to the services is something I strongly believe in. We need more of that.” User representative |
The family’s house Færder [33] | Facilitators • Provides a good understanding of roles and responsibilities • Promotes fast collaboration as services are offered in one place* Barriers • Depends on anchoring and good leadership within and between different services • Requires a good understanding of the different services offered and their mandates** • Needs to implement a clear framework for collaboration | *“We can see that, especially for families, it is perceived as easier to deal with. And it is true that if you are forced to be in the same building and have offices next to each other, it becomes easier to communicate with another service, which allows for better creation of comprehensive and cohesive support for those children or families.” Senior advisor at the national level **“(…) I think such a family house requires quite clear management and understanding of the whole house so that you not only co-locate, but get the different services in the house to flourish with their mandate and make things fit together.” Administrator at the municipal level |
The health fellowship [34] | Facilitators • Is implemented by large independent organizations, such as the Regional Health Authorities* • Increases competence and specialization in providing care for vulnerable patient groups • Supports merging primary with specialist care • Is a devoted model on a national level (a central push) Barriers • May be stigmatizing and less effective to focus on the vulnerable instead of using a broader and positive public health approach • Implemented measures may be too generic and “one size fits all” does not work • May not be innovative since this type of cooperation is considered to be already be in place** | *“What is innovative about it is that they actually require such large independent enterprises, sush at the Regional Health Authorities, to actually implement it.” Senior advisor at the national level **“It simply gives new names to things we already do. I think it may indicate that those who came up with it have a lack of knowledge about what actually happens. This includes the practice consultant scheme and the collaboration committees working between municipalities and hospitals.” GP |
Care pathway, mental health disorders – children and youth [35] | Facilitators • Creates a system of the different roles and responsibilities of the providers in the care pathways • Provides clear feedback to patients and families and supports user involvement. • Increases cooperation, coordination and workflow across care levels • Elevates competencies and consciousness regarding differences between mental health difficulties and mental health disorders • Clarifies what services should be delivered by primary or specialty care • Enhances early intervention in municipalities and supports prioritisation of care for the specialist sector* • Has been well adopted by the specialist sector • Is a devoted model on a national level (a central push) Barriers • Provides standardized pathways that does not work for every patient • Care provision is dependent on the GP’s decisions, resulting in unequal access to services • Requires knowledge by the providers to use the right pathways** • Requires time to fill out the assessment forms by patients and families • Needs to be better anchored in the communities to avoid ad hoc solutions | *“So the care pathways reaffirm the importance of the prioritization guidelines and identifying early signs and symptoms that need to be detected for people to receive help for their optimal development. It somehow pushes us in the right direction.” Administrator at the municipal level **“While it may state in the care pathway that it should be individually tailored and comprehensive, it turns out that it doesn’t quite work that way in practice. There is a lot of coding involved, and it requires a significant number of administrative positions for registration and data entry (…).” Counsellor within mental health at the municipal level |
Coordination of local drugs and crime preventative measures (SLT) Bærum [36] | Facilitators • May have a good spill over effect onto child welfare services • Supports cooperation with the police in relation to local crime preventative measures connected to mental health conditions Barriers • Is dependent on individuals for their success (“person dependent”) • Does not provide a clear mandate or organizational framework regarding who should have the coordinating role and carries responsibilities in the municipality* • Requires a national mandate to be further broadened out | *“It varies greatly among municipalities as well. In some, the public health coordinator also serves as the SLT (Coordination of Local Substance Abuse and Crime Prevention Measures) coordinator and does the best they can. So, apart from Bærum, we don’t have many others who are clear about how they work on this.” Administrator at the municipal level |
The Scaffolding Builders [37] | Facilitators • Identifies challenges and gaps and strengthens the system* • Tailors the measures to the individual user Barriers • Scale up may fail due to financial strains in child welfare services. | *“It is very health-promoting and focuses on strengthening what can be strengthened. I think it is wise for someone to take responsibility for identifying where the issues lie.” Administrator at the municipal level |
Multidisciplinary low-threshold team Tromsø [38] | Facilitator • Facilitates cooperation and coordination through increased understanding and shared competences between different sectors Barriers • May provide “too easy” access to specialized services* • Includes a small number of professionals compared to the task at hand | *“I believe it is somewhat typical for specialized healthcare services to want to work in municipalities, but are not allowed to do so. It becomes too easy to receive challenging treatment, which not everyone should have access to.” Administrator at the municipal level |
Youth Arena Oslo [39] | Facilitators • Provides high accessibility (locally adapted youth-friendly environment, volunteers as part of staff) • Is a health promoting organisation bridging the gap of services between no services and specialty care* • Focuses on user participation Barriers • Municipalities may lack expertise and placements, and find decisional process of the organisational structure challenging • Needs to be adapted locally according to resources and expertise available | *I believe that Youth Arena is an excellent offer. It tries to fill the gap between no help and specialized healthcare services. Providing localized help where people are. I am positive to the user involvement principles and recovery thinking.” User representative |
Original ICM: GP supervision groups, DPS Vestfold | Facilitator • Improves cooperation with the GPs and increases the effectiveness of the referral process • Includes the Norwegian Labour and Welfare Administration Barriers • Limited GPs’ capacity to incorporate model* | *“I believe that many who work in District Psychiatric Centers (DPS), the Norwegian Labour and Welfare Administration (NAV), Child and Adolescent Psychiatric Outpatient Clinics (BUP), and the Child Welfare Services all desire better collaboration with general practitioners (GPs). However, poor GPs have taken on so many roles that it becomes yet another role for them.” Counsellor within mental health |