The agreement is struck between on the one hand the national government and the other the regional and local governments.
What´s the purpose of the program?
The program focus on creating coordinated effective service systems for promotion, prevention and treatment of mental health and other related challenges for the entire age range for children, youth and their families (pre-birth to 25).
Why invest in Children and Youth’s mental health?
Research on mental health shows that the problem is a major contributor to the burden of disease in Europe. It is also highly interconnected with other important aspects of a successful life trajectory in terms of educational, employment and family outcomes. The problem is growing in Europe and it seem to be growing fast. Since an estimated 75% of mental ill-health starts already before 25. effective interventions to promote, prevent and treat these problems is crucial. These issues should make this area a priority strategic investment in EU and its member states.
The new national improvement model – cross-level coordination
The two parties of the agreement are The Swedish Association for Local Authorities and Regions and the national government through the Ministry of Health and Social Affairs. The agreement contains a dual set of strategic drivers for change:
A new national improvement and innovation support function. The agreement states that the Swedish Association for Local Authorities and Regions shall develop an intermediary tasked with supporting policy implementation through identifying, testing and disseminating innovations and “best practice” models. Tools, training and technical assistance is provided both to these pilot localities and to others who have been trying to improve their services using these examples.
Performance-based reimbursement schemes. The majority of funding runs to Regional and Local Authorities in a scheme where these are reimbursed when they meet certain targets. For children and youth these targets include:
• Agreements about collaboration and division of responsibilties between regional authorities (healthcare) and local authorities (education and social care and welfare)
• Access to information to the public over the web about existing services and about mental health
• Access to coordinated care planning when someone gets simultaneous services
How have the improvement work been run?
The national improvement support function at SALAR has organized the work built upon lessons learned from the previous program “Model Areas”. Two fundamental principles provide the fundamental basis for the program: synchronization and prevention and early intervention pays.
Synchronization. The principle of synchronization refers to the idea that the appropriate way to coordinate activities and processes, from all relevant actors across sectors, depends upon the outcomes in focus. The best configuration of a synchronised system is the one that can best reach outcomes in focus and local context. However, getting there always require a systematic process where different levels of decision-making need to know their role and act systematically to get there.
Prevention and early intervention pays. Research show that many of the problems that may need specialist treatment or other interventions in older adolescence and adulthood could have been prevented from developing at all or at least become less severe if appropriate actions for prevention were taken at an earlier stage. A better understanding the trajectories of development of mental health have shown that “skills begets skills” (Heckman) and that cognitive and non-cognitive skills support interacts in positive and negative spirals. The economics of child and youth development substantiates these findings with a clear economic case for early intervention, promotion and prevention.
The first strategic work stream: Governance of inter-sectoral service systems
This strategic work stream focuses on effective models for strategic collaboration between the levels of management from education, social care and healthcare. The six local areas in this stream work to design and refine effective cross-system governance models for strategic issues of importance to children and youth at the three levels of management below. An important focus is on how management can drive improvement more efficiently based on data on needs, processes and outcomes
The second strategic work stream: Governance of inter-sectoral service systems
The four areas in the social investment stream focus on the development of so called social investment strategies. The five steps below illustrates a process that is applied in many such initiatives. One financial innovation, used by several local authorities, is the construction of social investment funds. Through such funds the local authorities can find new ways to finance and test innovative approaches that are promising preventative approaches upon which, given successful evaluation, the local authority can draw for strategies to re-allocatemoney from treatment to prevention.
The topical work streams: Mental health and educational performance, early intervention services, children and youth with complex needs
Mental health and educational performance engages innovative areas across the country to further design and refine innovative practice within the educational system through pre-school through to the end of high-school. The work stream draws heavily on the understanding of the strong interconnectedness between educational outcomes and mental health throughout the trajectory of development for children and youth. Early intervention services is a new form of service in Sweden that focus on fast access, short interventions for mild to moderate mental health and psychosocial problems. They can be seen as the “first line” i.e. the first place to go to when a child or youth experiences a need for some support but where the problems are not yet severe. Many service solutions at this level are based in primary care but engage staff from social services, mental health and special needs education services. Children and youth with complex needs focus on models for effective coordination when needs are high and complex. The implementation of the Swedish legislation of coordinated care plans for children is one focus for this work stream.
What have we learned?
Because the program has not yet ended only some preliminary lessons can be drawn at this stage. A fuller understanding of these will be reached through the final phase of synthesis and evaluation during the first months of 2015.
Some lessons for the strategic level
Investing in national support resources that can help design, refine and disseminate innovative practice seems highly important to effectively drive comprehensive systems change. These central resources need to be highly connected with local authorities and regions so as to function as a bridge between the levels of government in Sweden.
Helping local and regional politicians and top management levels outside and inside the traditional mental health sector to understand the importance of the interconnectedness between mental health and other central outcomes such as education, employment is critical.
Prevention and early intervention can pay, but it requires the development of a systematic approach to identifying needs, formulating strategies based on the best available knowledge and to conduct impact evaluation. Organizational capacity for improvement, such as systems and skills to do this, need to be strengthened since it is often lacking in local authorities and regions.
Some lessons for services
The education system, the social care and the mental health sector need to bed aligned towards common goals. They also need to engage in active development of innovative collaborative practice to promote, intervene early and provide high quality education during treatment.
Services need to be outcomes-driven and be able to swiftly identify and effectively address gaps in quality within and between services. This require investments in new skills and systems for improvement capacity at the service level.
How can we build systems for colletive inpact through action in all sectors (PDF)