Abstract
Neurodevelopmental disorders, particularly ADHD and autism, present significant challenges in child and adolescent mental health. The overarching rationale for developing integrated care models emphasizes the early and appropriate inclusion of relevant stakeholders in the assessments, care, and treatment of children and adolescents with ADHD or Autism spectrum disorders. It is our end-goal to develop a feasible and a sustainable chain-of-care model to address the significant need for coordination from the perspective of both the affected youth, their families and professionals responsible for the best line of care.
This study addresses the crucial need for coordinated and cross-sectoral care, highlighting the profound impact of these disorders on social skills, academic performance, family dynamics, and overall well-being. Recognizing the limited evidence in cross-sectoral interventions, our initiative, led by the Child and Adolescent Psychiatry research Unit in Southern Denmark, introduces an innovative collaboration model.
The intervention has evolved through a meticulous developmental process, initiated by clinicians and the research department in partnership with municipalities, progressing through distinct phases including needs assessment, stakeholder analysis, development, pilot testing, iterative adjustments, implementation and a repeating circle. Shaped by continuous feedback and co-creation with professionals in intervention municipalities, clinicians, families, and affected youth, the model integrates key components; these components include streamlined data exchange, patient and family-involved goal setting, and the pivotal role of a designated municipal 'key' person for coordinated progress. Network meetings, involving relevant stakeholders ensures comprehensive care and assessment, extending even to those with subthreshold diagnoses. Emphasizing a dynamic interplay between clinical implementation in both sectors and research, we underscore the importance of ongoing monitoring and adjustments throughout the model's implementation phases to ensure continual refinement and quality assurance.
The initiative has been implemented in three intervention municipalities and compared against five control municipalities. Data collection involves semi-structured interviews with professionals, supplemented by psychometric assessments from patients and their parents at baseline, 6-month, and 12-month intervals. Preliminary results underscore the acceptability and feasibility of the intervention components, as deemed indispensable for fostering ""care through communication"" according to patient feedback. Qualitative results from interviews with professionals and families have prompted revisions to model components found unfeasible between sectors. Considerations for more suitable psychometric tools are in scope for the next phase, enhancing the model's appropriateness and measurability.
Having revised the first version of the proposed model, we are now ready to implement a new version based on ongoing feasibility study data. Continuous data analysis and implementation monitoring will inform evidence-based refinements to the model. The next step involves implementation of the revised model in already established intervention municipalities before conducting a large-scale randomized controlled trial (RCT) with a cost-benefit analysis in several municipalities in our region of Southern Denmark, assessing an evolved iteration of our collaboration model. This research significantly contributes to the implementation science in cross-sectoral mental health interventions, offering nuanced insights into an underexplored domain within current literature.