When opinions differ:The development of a reflection tool for youth professionals to support shared decision-making with parents

The importance of shared decision-making (SDM) in youth care is increasingly emphasised. Professional reflection on the decision-making process is an important means to improve the use of SDM in practice. In this study, we report on the development of a reflection tool for youth professionals primarily to use when they hold a different opinion then parents about referral to specialised youth care services. In co-creation with local youth professionals and parent representatives from the South of the Netherlands, the tool was developed and tested in practice. This process was guided by a three-stage cyclical research project. First, reflective group discussions provided an initial understanding of professionals’ needs, interests and experiences. This input then was analysed and documented into a draft tool with reflective questions. Next, this tool was tested on fictive and real life cases and adjusted with input from youth professionals and parents. This process resulted in an online reflection tool covering 16 overarching reflective questions to support youth professionals’ reflection on their shared decision-making in practice. The tool can be used and adapted by others in the field of youth care to improve the process of making shared decisions with parents in complex cases

Family Functioning and Child Problem Behavior: a longitudinal study among referred children and adolescents

From several theoretical perspectives as well as in psychotherapeutic practice it is assumed that family characteristics have a causal influence on the course of emotional and / or behavioral problems of children and adolescents (e.g., Boszonneny-Nagy & Sparke, 1973; Dadds, 1995; Hetherington & Mat1in, 1986; Jacob & Tennenbaum, 1988; Minuchin, 1974; Patterson, 1982). However, although there is an enollatous amount of evidence for the presence of an association between family functioning and children's problem behavior (e.g., Adams, Overholser, & Lehnert, 1994; Davies & Cunnnings, 1994; Emery, 1982; Grych & Fincham, 1990; Hollis, 1996; Patterson, 1982; Reid & Crisafulli, 1989; Rollins & Thomas, 1979; Rothbaum & Weisz, 1994; Simons, Robertson & Downs, 1989), it has hardly been shown whether family functioning and family relations, and changes therein are causative of changes in children's intematizing and / or extemalizing problem behavior, or vice versa. In other words, empirical support for the above stated assumption is rather lacking. Therefore, the primary aim of the research project which is reported in this thesis was to examine the causal relation between the course of family characteristics and the course of problem behavior in children and adolescents referred to outpatient mental health services. In order to improve our understanding of the nature and direction of the relation between family characteristics and child problem behavior longitudinal studies are indispensable

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

BACKGROUND: As needs of families with social and behavioral health problems often exceed the expertise and possibilities of a single professional, service or organization, cross-service collaboration is indispensable to adequately meeting those needs. Despite the progressive focus on organizing integrated care, service fragmentation and service duplication remain persistent problems in child welfare and healthcare service delivery systems. A crucial factor to overcome these problems is information exchange between organizations. This study explores and compares the development over time of structures of information exchange in networks, concerning both material and knowledge-based information. METHODS: A comparative case study and social network analysis of three inter-organizational networks of child welfare and healthcare services in different-sized municipalities in the Netherlands. The research population consisted of organizations from various sectors participating in the networks. Data were collected at two moments in time with a mixed method: semi-structured interviews with network managers and an online questionnaire for all network members. Density and degree centralization were used to examine the information exchange structures. Ucinet was used to analyze the data, with use of the statistical tests: Compare Density Procedure and Quadratic Assignment Procedure. RESULTS: This study shows that different structures of information exchange can be distinguished, concerning both material and knowledge-based information. The overall connectedness of the studied structures of the networks are quite similar, but the way in which the involvement is structured turns out to be different between the networks. Over time, the overall connectedness of those structures appears to be stable, but the internal dynamics reveals a major change in relationships between organizations in the networks. CONCLUSIONS: Our study yields empirical evidence for the existence of and the differences between structures and dynamics of both material and knowledge-based information exchange relationships. With a loss of more than a half of the relations in a year, the relationships between the organizations in the network are not very stable over time. The contrast between major internal dynamics and the stable overall connectedness is an important point of concern for network managers and public officials, since this impermanence of relations means that long-term integrated care cannot be guaranteed

Cross-sectoral collaboration:Comparing complex child service delivery systems

Purpose To help ensure that children with social and behavioral health problems get the support services they need, organizations collaborate in cross-sectoral networks. In this article, the authors explore and compare the structure of these complex child service delivery networks in terms of differentiation (composition) and integration (interconnection). In particular, the authors investigate the structure of client referral and identify which organizations are most prominent within that network structure and could therefore fulfill a coordinating role. Design/methodology/approach The authors used a comparative case study approach and social network analysis on three interorganizational networks consisting of 65 to 135 organizations within the Dutch child service delivery system. Semi-structured interviews with the network managers were conducted, and an online questionnaire was sent out to the representatives of all network members. Findings The networks are similarly differentiated into 11 sectors with various tasks. Remarkably, network members have contact with an average of 20–26 organizations, which is a fairly high number to be handled successfully. In terms of integration, the authors found a striking diversity in the structures of client referral and not all organizations with a gatekeeper task hold central positions. Originality/value Due to the scarcity of comparative whole network research in the field, the strength of this study is a deeper understanding of the differentiation and integration of complex child service delivery systems. These insights are crucial in order to deliver needed services and to minimize service silos and fragmentation

Beliefs of public health nurses about solution-focused parenting support:A questionnaire study

Background Parenting support guidelines for public health nurses have shifted from a problem-focused to a solution-focused approach. Given the fundamental differences between these two approaches, implementation of solution-focused parenting support is assumed to be difficult. Since the way public health nurses provide parenting support is largely guided by their beliefs, knowledge about their beliefs concerning solution-focused parenting support is important for its actual implementation. This study aims to explore the behavioral, normative, and control beliefs of public health nurses about solution-focused parenting support for future design of implementation interventions and related research activities. Methods A theory of planned behavior questionnaire was systematically developed and tested using focus groups. Thematic analysis and nominal group technique were used to analyze the data and to reach consensus. Next, this questionnaire was conducted among 449 public health nurses in the Netherlands. Factor analysis and descriptive statistical analysis were performed. Results Factor analysis resulted in three distinguishing subscales: behavioral beliefs (α = 0.79), normative beliefs (α = 0.80), and control beliefs (α = 0.64). Beliefs of public health nurses about solution-focused parenting support were moderately positive to positive (means varying from 4.24 to 5.54, on a 1–7 scale), and differences were statistically significant for various background variables. Control beliefs were less positive than behavioral and normative beliefs. Public health nurses trained in solution-focused parenting support reported more positive control beliefs (M = 4.34, SD = 0.83) as compared to untrained public health nurses (M = 4.00, SD = 0.82). Conclusion This study is the first to provide insight into public health nurses’ beliefs about solution-focused parenting support. The overall moderately positive to positive beliefs of PHNs about solution-focused parenting support suggests that PHNs tend to accept solution-focused parenting support as a viable approach. Compared to behavioral and normative beliefs, PHNs score the lowest on control beliefs

Survey of intention among public health nurses in providing solution‐focused parenting support

OBJECTIVE: Parenting support has shifted from a problem‐focused to a strengths‐based solution‐focused approach. This study surveyed public health nurses to explain their intention to provide solution‐focused parenting support in their practice. DESIGN: The design of this study was cross‐sectional. SAMPLE: The initial sample included 781 public health nurses who were employed with various youth healthcare organizations in the Netherlands. MEASUREMENTS: Based on the Theory of Planned Behavior, a questionnaire was developed and administered to measure (a) behavioral, normative, and control beliefs, (b) attitudes, subjective norm, and perceived behavioral control, and (c) intention. The data were subjected to structural equation modeling. RESULTS: A total of 449 (57.5%) public health nurses completed questionnaires. Associations as indicated by the Theory of Planned Behavior were confirmed with the exception of that between perceived behavioral control and intention. Statistically significant paths and correlations were added. The final model accounted for 53% of the variance in the intention to perform solution‐focused parenting support. CONCLUSIONS: In this study, public health nurses strongly intended to provide solution‐focused parenting support, thus indicating their acceptance of the approach. Their intention was predominantly associated with subjective norm

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