Intersectoral collaboration at a decentralized level: information flows in child welfare and healthcare networks

Exploring the Impact of COVID-19 on a Child Maltreatment Prevention Network

OBJECTIVE

Child maltreatment is a complex and preventable public health problem that cannot be effectively addressed by a single organization or sector. We examined a network of organizations working to prevent childhood maltreatment before and during COVID-19, including members of the Parents and Children Together-St. Louis Collaborative. The Collaborative is an initiative with the purpose of strengthening ties among service agencies and was new when the COVID-19 shutdowns began.

DESIGN AND PARTICIPANTS

In September 2020, we surveyed 62 agencies working on childhood maltreatment prevention in the public health, health, or social service sectors. We asked about frequency of contact between organizations before (pre-COVID) and during COVID (in-COVID). We used descriptive and inferential network methods to examine network properties and changes.

RESULTS

There were 360 ties among organizations in the pre-COVID network (density = 0.19) and 321 ties among organizations (density = 0.17) during COVID. The median number of ties per organization decreased from pre- to in-COVID for most organizations and most notably for smaller and newer organizations and mental health care organizations. The only organization type that increased connections was substance abuse organizations. Pre- and in-COVID odds of connection were significantly higher for mental health care, substance abuse, health care, child welfare, and legal-advocacy organizations compared to multisector organizations. Odds of a connection between 2 organizations were significantly higher pre-COVID and in-COVID if one or both organizations were Collaborative members.

CONCLUSIONS

Disruptions during COVID-19 coincided with fewer connections among organizations. Collaborative members had higher odds of connection before and during COVID-19, suggesting a potential strategy for building and maintaining a cross-sector service network. Understanding network structure and change in the early stages of COVID-19 provides an opportunity to work on building and sustaining inter-organizational connections essential in violence prevention and child well-being and other areas of public health.

Multisectoral interventions and health system performance: a systematic review

Objective

To conduct a systematic review on the effects of multisectoral interventions for health on health system performance.

Methods

We conducted a systematic review according to the preferred reporting items for systematic review and meta-analysis protocols. We searched for peer-reviewed journal articles in PubMed®, Scopus, Web of Science, Cumulated Index to Nursing and Allied Health Literature, and the Cochrane Database of Systematic Reviews on 31 August 2023 (updating on 28 February 2024). We removed duplicates, screened titles and abstracts, and then conducted a full-text eligibility and quality assessment.

Findings

We identified an initial 1118 non-duplicate publications, 62 of which met our inclusion and exclusion criteria. The largest proportions of reviewed studies focused on multisectoral interventions directly related to specific health outcomes (66.1%; 41 studies) and/or social determinants of health (48.4%; 30 studies), but without explicit reference to overall health system performance. Most reviewed publications did not address process indicators (83.9%; 52/62) or discuss sustainability for multisectoral interventions in health (72.6%; 45/62). However, we observed that the greatest proportion (66.1%; 41/62) considered health system goals: health equity (68.3%; 28/41) and health outcomes (63.4%; 26/41). Although the greatest proportion (64.5%; 40/62) proposed mechanisms explaining how multisectoral interventions for health could lead to the intended outcomes, none used realistic evaluations to assess these.

Conclusion

Our review has established that multisectoral interventions influence health system performance through immediate improvements in service delivery efficiency, readiness, acceptability and affordability. The interconnectedness of these effects demonstrates their role in addressing the complexities of modern health care.

Examining preconditions for integrated care: a comparative social network analysis of the structure and dynamics of strong relations in child service networks

BACKGROUND

To help ensure that children and families get the right support and services at the right time, strong and stable relationships between various child service organizations are vital. Moreover, strong and stable relationships and a key network position for gatekeepers are important preconditions for interprofessional collaboration, the timely and appropriate referral of clients, and improved health outcomes. Gatekeepers are organizations that have specific legal authorizations regarding client referral. However, it is largely unclear how strong relations in child service networks are structured, whether the gatekeepers have strong and stable relationships, and what the critical relations in the overall structure are. The aim of this study is to explore these preconditions for integrated care by examining the internal structure and dynamics of strong relations.

METHODS

A comparative case study approach and social network analysis of three inter-organizational networks consisting of 65 to 135 organizations within the Dutch child service system. Multiple network measures (number of active organizations, isolates, relations, average degree centrality, Lambda sets) were used to examine the strong relation structure and dynamics of the networks. Ucinet was used to analyze the data, with use of the statistical test: Quadratic Assignment Procedure. Visone was used to visualize the graphs of the networks.

RESULTS

This study shows that more than 80% of the organizations in the networks have strong relations. A striking finding is the extremely high number of strong relations that gatekeepers need to maintain. Moreover, the results show that the most important gatekeepers have key positions, and their strong relations are relatively stable. By contrast, considering the whole network, we also found a considerable measure of instability in strong relationships, which means that child service networks must cope with major internal dynamics.

CONCLUSIONS

Our study addressed crucial preconditions for integrated care. The extremely high number of strong relations that particularly gatekeepers need to build and maintain, in combination with the considerable instability of strong relations considering the whole network, is a serious point of concern that need to be managed, in order to enable child service networks to improve internal coordination and integration of service delivery.

Intersectoral Collaboration to Promote Child Development: The Contributions of the Actor-Network Theory

An integrated intersectoral care model promises to meet complex needs to promote early child development and address health determinants and inequities. Nevertheless, there is a lack of understanding of actors' interactions in producing intersectoral collaboration networks. The present study aimed to analyze the intersectoral collaboration in the social protection network involved in promoting early child growth and development in Brazilian municipalities. Underpinned by the tenets of actor-network theory, a case study was conducted with data produced from an educational intervention, entitled "Projeto Nascente." Through document analysis (ecomaps), participant observation (in Projeto Nascente seminars), and interviews (with municipal management representatives), our study explored and captured links among actors; controversies and resolution mechanisms; the presence of mediators and intermediaries; and an alignment of actors, resources, and support. The qualitative analysis of these materials identified three main themes: (1) agency fragility for intersectoral collaboration, (2) attempt to form networks, and (3) incorporation of fields of possibilities. Our findings revealed that intersectoral collaboration for promoting child growth and development is virtually non-existent or fragile, and local potential is missed or underused. These results emphasized the scarcity of action by mediators and intermediaries to promote enrollment processes to intersectoral collaboration. Likewise, existing controversies were not used as a mechanism for triggering changes. Our research supports the need to mobilize actors, resources, management, and communication tools that promote processes of interessement and enrollment in favor of intersectoral collaboration policies and practices for child development.

Actors' awareness of network governance in Child Welfare and Healthcare service networks

To ensure that families with social and behavioral health problems get the support they need, organizations collaborate in child service networks. These networks are generally lead-organization governed. It is assumed that network members have relatively accurate information about the governance mode. However, discrepancies between the formally administered and perceived governance mode could raise legitimacy questions and lead to conflicts, and ultimately affect network effectiveness. Therefore, we investigated to what extent such discrepancies exist and how they might be explained. Hereby, the focus was on the concepts level of trust, interaction, and strength of relationship with the lead organization in the network. A comparative case study was conducted of three inter-organizational networks of child services in different-sized municipalities in the Netherlands in 2018 and 2019. A multiple generalized linear mixed model analysis was used. We found that only a minority of the network members had an accurate perception of the governance mode. This awareness did improve over time. The level of interaction and relationship strength with the lead organization were independently associated with an accurate perception of the governance mode. Trust of a network member in the network, however, had no significant association. These insights underline the necessity to consider network information accuracy as an important variable for understanding network behavior and as crucial for the effective delivery of child services.