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.

Background:
In Switzerland, children with complex care needs (CCN), of whom one-fifth suffer from chronic health risks or disabilities, struggle to access the necessary support due to a fragmented health and social care system, leading to high readmission rates, increased costs, and family burden; accordingly, the SPARKLe project aims to develop, implement, and evaluate an transitional integrated care model to optimize the transition from hospital to home using a systematic methodological approach.

Approach:
SPARKLe is a multiphase project following the Medical Research Council (MRC) framework and adopting implementation science principles. Phase A (between 2022 and 2023) involved an evaluation of the evidence, a contextual analysis using qualitative design guided by different implementation frameworks and models (individual interviews were conducted with 4 families, 12 healthcare professionals, and 8 leaders), and active stakeholder involvement. As a result, the SPARKLe care model was co-developed. In Phase B, the feasibility and initial implementation of the SPARKLe care model were tested in a real-world setting using mixed methods design: 3 general pediatric units at the Children’s University Hospital in Zurich, Switzerland were recruited to implement the SPARKLe integrated care model. Qualitative data was collected through focus groups and interviews of 6 families and 10 healthcare professionals respectively, while quantitative data was gathered from surveys and health records of 6 patients and 9 community healthcare providers post-discharge.

Results: Findings from the evaluation of the feasibility study (Phase B) demonstrated good acceptability of the SPARKLe integrated transitional care model among families of CCN children compared to the hospital care providers (nurses, MDs, therapy team and social workers). The study also demonstrated the need to improve the model’s reach, fidelity, and feasibility, particularly in components such as information transfer (fidelity 50%) and follow up post discharge (fidelity 0%) by a) implementing it in a supportive environment at the forefront of children with complex care needs; and b) providing continuous support to nursing staff to enhance clarity over their roles. The community health care providers reported 64% acceptance of the model and 63% feasibility of the collaboration with the hospital professionals with regards to the CCN care. Full evaluation of the effectiveness outcomes will follow in the effectiveness study (Phase C).

Implications: While adaptation of the peripheral components of the model is needed, the SPARKLe integrated transitional care model was highly accepted by families of CCN children. This implication indicates that SPARKLe can serve as a blueprint to scale it up to other Children’s Hospitals in Switzerland and beyond after the effectiveness study. To increase its reach, stronger leadership and efforts to involve community care providers in the referral process are essential.

Background
Specialized approaches to integrated care are an emerging topic. Families with multiple, severe, and enduring problems are in need for specialized support, but often fall between the cracks of a fragmented system of siloed care services. To overcome fragmentation in care a global trend is the organization of Specialist Integrated care Teams (SITs), in which professionals from various youth and adult specialized care services collaborate to provide integrated care to families with complex needs. Since little is known about SITs’ working approach in practice, we conducted a qualitative evaluation study to unravel key elements promoting integrated specialized care on the level of professionals. Moreover, we identified the main characteristics of families being supported by SITs.

Approach: As part of our participative action research project ‘The Specialist nearby?! in which we followed five SITs in the Netherlands, we gathered perspectives of families, professionals, managers, and policy makers by conducting 54 semi-structured interviews. Additionally, 40 observations of SITs’ multidisciplinary team case meetings were conducted. To engage the workforce in exploring and developing an integrated specialized care approach in practice, we involved professionals from the SITs as research practitioners. Moreover, practice based knowledge was developed in learning sessions connecting professionals, policymakers, and managers of the SITs as well as parents and youth representatives. A theory-driven framework method was applied to analyze the transcripts both deductively and inductively.

Results: Families supported by SITs were described as experiencing problems among multiple family members and across life domains. Problems are severe, enduring, and interrelated, leading to frequent unsafety, dysfunctional family dynamics, and a long and troubled care history. Five key elements promoting an integrated specialized care approach included: 1) a broad view on families, 2) an integration of specialized perspectives, 3) providing specialized care flexible and timely, 4) working from families’ preferences and needs, and 5) organizing a well-structured care process and multidisciplinary evaluations.

Implications: This study provides valuable knowledge for establishing integrated specialized care for families with complex needs. Although SITs are a promising form of organizing this approach, ensuring an integrated specialized care approach is the responsibility of every professional and specialized care service involved in families’ care. To guide professionals in recognizing which families need this approach, the five identified main characteristics should be considered during assessment. In providing care to these families, professionals and care services are encouraged to adopt the key elements of an integrated specialized care approach. This involves broadening their perspective to the whole family, investing in building trust and collaborative relationships with different family members, and applying flexible and low-threshold approaches in the care process. Moreover, professionals from different care services collaborating in families, would benefit from arranging regular multidisciplinary meetings to integrate their specialized perspectives and working methods in integrated care plans.

Background: In integrated youth care shared decision-making (SDM) is deemed the approach to tailor care to families’ needs. However, families experiencing complex problems often feel insufficiently heard and involved in decision-making on their care. In practice, SDM is hampered by the multitude and changeability of families’ problems as well as differing opinions and roles of the multiple professionals and care services involved. Therefore, in this qualitative study we explored challenges of SDM in the setting of integrated youth care, and the facilitating strategies professionals and families adopt to overcome these challenges.

Approach: As part of our participative research project ‘The Specialist nearby?!’, in which we followed five Specialist Integrated care Teams (SITs), we gathered experiences and perspectives of 18 parents, 3 youth and 22 care professionals by semi structured interviews. Moreover, engaging three professionals from the SITs as research practitioners, observations of SITs’ multidisciplinary team case meetings were conducted. Combining thematic, context, and strategy coding, provided an in-depth understanding of SDM in the specific context of families with multiple and enduring problems.

Results: It is precisely the interplay between barriers in the context of families and in the context of professionals and care services leading to complex, adverse processes in SDM regarding families' autonomy, mutual trust and multiple partnerships in decision-making. The challenges as well as facilitating strategies are described in three themes: (1) Balancing roles of families and professionals, (2) Trust and collaboration in shared decision-making, and (3) Multiple stakeholders in decision-making.

Implications: When making shared decisions on care with families experiencing complex problems, it is essential to approach SDM as a continuous cycle throughout the care process. Moreover, professionals should foster continuity in relationships with families and the involved care network and engage in a human-to-human partnership with families. In this way, families and professionals can walk the path of care together until families continue their own path.