Abstract
Background: Cross-sectoral collaboration in child and adolescent mental health services is essential for addressing the increasing burden of neurodevelopmental disorders like ADHD and autism. These conditions not only affect children’s functioning but also create significant societal and economic challenges. As the prevalence of ADHD and autism rises globally, the need for integrated care models that span healthcare, educational, and social services becomes ever more pressing. In Denmark, an integrated care model was introduced to improve coordination between psychiatric services and municipalities. This study explores the varying definitions of success across municipalities and the secondary sector, emphasizing how outcomes differ based on factors such as leadership engagement, resource distribution, and system size.
Approach: This process evaluation focuses on a level of co-creation aimed at evaluating and refining the care model based on stakeholder dynamics and feedback. In this context, professionals from both primary (municipal) and secondary (psychiatric) sectors provide input, particularly in relation to how success is defined and measured within their systems. Using Complex Adaptive Systems (CAS) theory, the evaluation explores how the model is implemented and integrated at different system levels. Semi-structured interviews with professionals from different-sized municipalities and the secondary sector assess feasibility, workflow integration, and leadership involvement, guided by Proctor et al.'s implementation framework.
Results: The preliminary analysis reveals significant variations in outcomes based on the size of municipalities and the level of leadership engagement. Larger municipalities tend to face high staff turnover, which affects continuity and the ability to embed new collaborative workflows, while smaller municipalities struggle with low patient flow, making it difficult to justify dedicating resources to collaboration initiatives. Leadership engagement is a critical factor in determining success; in municipalities where leaders are actively involved, there is stronger commitment to implementing changes and better integration of services. In contrast, secondary sector professionals (psychiatry) often view success in terms of clinical outcomes and more streamlined referrals, yet they face challenges when the support from municipal partners is inconsistent. These discrepancies highlight the complexity of defining success across systems, with each sector valuing different aspects of the care model. As the full analysis continues, further insights are expected, particularly in how systemic factors influence the sustainability and scalability of the model.
Implications: The findings suggest that a one-size-fits-all approach to integrated care is ineffective due to the diversity in system structures and priorities. For municipalities, success is often measured by the degree to which new workflows are integrated and how well resources are allocated to match patient needs, while for the secondary sector; success is more closely tied to clinical efficiency and coordination with municipal services. Leadership engagement plays a pivotal role in driving success, with higher engagement correlating with better integration and system adaptation. These insights underscore the importance of considering system-level factors when evaluating the success of integrated care models. By focusing on outcomes that are meaningful for different sectors and understanding how system dynamics influence these outcomes, this evaluation offers pathways for more sustainable and effective cross-sector collaboration.