This is the final report from a process evaluation of the Nordic 0–24 project. The project has involved a collaboration between initiatives to provide improved follow-up of vulnerable children and young persons between the ages of 0 and 24 years from all the Nordic countries and autonomous islands. The project’s starting point is that improved cross-sectoral collaboration is necessary to provide more coherent and higher quality services. In this final report we discuss the lessons learned from the Nordic 0–24 project in relation to how to provide more effective and coherent follow-up of vulnerable children and young persons.
In all the Nordic countries the need for improved follow-up of vulnerable children and young persons is on the political agenda. There is a growing awareness that many of those facing a higher risk of social exclusion at school and other areas might experience multiple difficulties and, hence, require multiple types of support. These multidimensional difficulties might be related to personal issues, to their family situation, as well as to more structural conditions. The difficulties are often interdependent and in order to manage them, new integrated approaches to the service provision are required. This need for innovation forms the backdrop to the Nordic 0–24 project on improved services to vulnerable children and young people initiated by the Nordic Council of Ministers in 2017.
The Nordic 0–24 collaboration and the process evaluation
Representatives from the national initiatives have met twice a year to exchange experiences and discuss how to provide more effective services to vulnerable children and young persons. The national initiatives are identified by the Ministries of Education in each of the involved countries, and there is a national contact person for the project in each country. The Nordic 0–24 project has been administered by the Norwegian Directorate of Education and Training.
The main object of the evaluation has been to analyse how the Nordic 0–24 collaboration, with the involved efforts directed at vulnerable children and young persons below 24 years of age, improves the coordination of services aimed at this target group. The Nordic collaboration and the network for participating cases has been the main subject of the evaluation. The participants’ exchange of experiences and reports from the cases in the network constitute the main empirical data. The process evaluation is based on the following data sources and methods: The main part of empirical data originates from participation at the joint meeting of the network. At these meetings the research team has facilitated the exchange of experiences on the main issues of the evaluation, observed the activities and discussions of the network, conducted interviews and presented findings from the evaluation, and engaged in a dialogue with the participants on these findings. In addition, mapping forms to the national cases, document studies and phone interviews with key informants are conducted to supplement the empirical material.
The involved national cases
The cases involved vary according to whether they entail 1) broad municipal development processes on structures and systems for improved coherent follow-up of children and young persons, 2) specific approaches and methods for more effective follow-up, 3) integrated services in a specific field arranged as one-stop shops, interdisciplinary teams, or other forms of flexible structures. These are the cases:
- Denmark: Inclusion of vulnerable children and families. Specific local initiatives from five municipalities on more inclusive practices in schools and follow-up of children and families, gathered in a network administered by The National Agency of Education and Quality.
- Finland: Services for children and families based on the life-cycle model. Local initiatives from three municipalities.
- Iceland: Expanding a one-stop-shop model for preventing school dropout. The model consists of a local service centre with school follow-up services working in close collaboration with schools, students and families in the area.
- Norway: Improvement of the quality of interdisciplinary collaboration. A network with representatives from different sectors in seven municipalities administered by the Association of Local and Regional Authorities (KS).
- Sweden: Preventing youth from early school leaving. Specific initiatives in four municipalities and one region gathered in a network administered by the Association of Local Authorities and Regions (SKL). While the municipal initiatives are all related to the follow-up of young people, the regional project is targeted towards coherent follow-up of children and young people with multiple support needs.
- Greenland: Local competence-building in a remote area. An initiative for screening non-formal qualifications among employees working with children and youth and developing the possibility for decentralised education and competence-building.
- The Faroe Islands: A coherent programme for pupils at risk of not completing their basic education. A programme called The Springboard in the municipality of Torshavn.
In some of the cases, local authorities at management or administrative level are involved in the cases and participated at the Nordic meetings. For most cases, those who participated in the joint Nordic meetings were professionals working in frontline services, local set-ups and initiatives involved in the case. As such, the Nordic 0–24 collaboration has in principle been a bottom-up project – generating experiences from a broad range of local activities and innovation work to provide more effective follow-up of vulnerable children and young persons.
Two interim reports
During the project period, two interim reports from the evaluation have been published. This final evaluation report builds on findings and elaborations presented in two previous interim reports. The first report (Hansen, Jensen, Strand, Brodtkorb & Sverdrup 2018) presented an overall framework for the project and the involved cases. This included an overview of relevant services in the Nordic countries. This overview illustrated the comprehensive Nordic welfare states with extensive family and childhood policy. Based on the analysis of data from the two first joint meetings, as well as a mapping of the national cases, this first report stated six factors as being relevant to consider in the work of promoting improved cross-sectoral collaboration: 1) geographical proximity; 2) professions with different knowledge and culture; 3) leadership; 4) incentive systems and economy; 5) resources and time; 6) systems and regulations. These factors have been used to structure further discussions in the joint meetings related to how to succeed in improved cross-sectoral collaboration.
The second interim report (Hansen, Jensen & Hansen 2019) thoroughly presented the involved cases and discussed the experiences from these cases. In this report three factors were identified as important for more effective follow-up:
- A more individual-centred approach (the child / young person / family’s total life situation in the centre – holistic approach).
- A more coherent follow-up achieved through enhanced cooperation and collaboration.
- Increased success through early intervention.
Results and lessons learned
One of the purposes of the evaluation has been to discuss lessons learned from the experiences in the involved cases, related to how to improve services and a more coherent follow-up of vulnerable children and young people through enhanced cross-sectoral collaboration This final report concentrates mainly on identified lessons learned from the project on these matters.
A joint mindset on more effective follow-up
The Nordic 0–24 collaboration has resulted in a joint mindset among the participants on how to provide a more effective and coherent follow-up of vulnerable children and young persons. The most prominent denominator is the need to take the perspective of children, young persons and families and to develop services and follow-up more on the basis of their needs. The adoption of an individual and holistic approach has implications both for the development of services and for the role of professionals and children/young persons/parents in the individual relations. Success in implementing a new practice demands systems that support this practice as well as professionals reflecting on their own way of relating to children and parents.
The following lessons learned are identified related to more effective follow-up:
- The three identified factors of effective follow-up are all connected. The individual-centred and holistic approach often demonstrates the need for more coherent follow-up and is an important element in succeeding with identifying follow-up needs and early intervention.
- An individual and holistic perspective implies approaching the individual as a whole person in context and not in predefined and generalised categories. The relational dimension and a resource-oriented approach is an essential part of this approach.
- Putting the child and young persons at the centre is a way of overcoming the institutional logics of specific services and revealing the total situation of the individual and, further, providing a joint platform for more coherent follow-up.
- A user-oriented approach at the system level implies developing systems, structures and routines that promote easy (low-threshold) access to services and follow-up based on the needs of the child / young person / family, unrestricted by specific service mandates, criteria of a specific diagnosis, or other specifications.
- A user-oriented approach at an individual level implies involving the person (the child, youth, parent) in the process of defining relevant follow-up, and striving to acknowledge the persons in need of follow-up as equal partners in possession of competence and resources that could make the services more effective.
- One way to improve follow-up is to implement methods for empowering the child, young person and parent in meetings with professionals, in order to bring their perspectives and needs to the forefront in the relationship or meetings.
- An individual and holistic approach increases the possibility of identifying risks at an early stage and intervening early to avoid challenges escalating. Investments in broad universal arrangements pay off as it could both prevent the need for further follow-up and increase the possibility of identifying follow-up needs at an early stage and as such reduce the need for specialised services.
- Monitoring systems for early identification of risk is essential to succeeding with early interventions.
- Schools are core arenas of inclusion: One implication of a whole-child approach at school will be to go from approaching learning difficulties and challenges at school as something related to a problem with the child, to approaching these kind of challenges as being rooted in the continuous interplay pupils engage in with the other pupils, the teachers and other professionals in school, the educational practice and the physical environment.
- An inclusive school applying a whole-child approach involves greater attention being paid to the learning environment and a mindset that places a greater responsibility for students’ development in the hands of the schools’ teachers and management.
- A whole-child approach at school implies addressing not only academic development, but also social and emotional development. Emotional and social skills are essential to building resilience and strategies to cope in life.
- To promote a more inclusive school the following four dimensions of collaboration are essential: developing a collaborative culture; striving for involvement of pupils and parents as partners in the total learning situation; providing access to relevant follow-up services; and implementing systems for collaboration between the school system and other services when necessary.
A more collaborative practice is a continuous process
Succeeding with cross-sectoral collaboration is both a question of developing new systems and structures for a more collaborative practice, and of developing relational competence and a collaborative culture in services and among involved professionals. A new collaborative practice must be embedded in systems and structures and supported by relevant toolboxes of methods, measures, routines and guidelines. The ways in which cross-sectoral collaboration is organised will vary between contexts, and initiatives must be amended to the local situation and problems to be faced. Succeeding in developing a new collaborative practice is a continuous process involving the building of both relational capacity and competence in the systems.
The following lessons learned have been identified on how to succeed with enhanced cross-sectoral collaboration:
- Cross-sectoral coordination implies that different sectors, agencies, institutions, services, disciplines or professions are involved in a process of collaboration to achieve better coordination of their efforts with the aim of solving a joint problem or reaching a joint goal.
- The coordination staircase illustrates that there are different phases in a continuous process towards developing improved collaboration. The first step is restricted to sharing of information; the second step to developing a shared problem understanding; in the third step, involved actors change their own practice, either because they realise that their own practice may negatively affect the goal achievement in other sectors or services, or because the change of practice could lead to positive synergy effects in relation to other interventions; the fourth step involves actual collaboration in a joint intervention. The analysis has demonstrated the need for a fifth step, focussing on the work of implementing and upholding new collaborative practices.
- Reaching a shared problem understanding is crucial for collaboration and is a continuous task for maintaining collaborative practices. Although a collaboration has been established, continuous efforts are necessary to ensure a common understanding of the problem and that involved actors and professionals acknowledge various competencies involved.
- Six interrelated factors should be reflected on in order to succeed with improved cross-sectoral coordination; 1) geographical proximity; 2) services constituted by professions with different knowledge and culture; 3) the role of leadership; 4) incentive systems and economy; 5) resources and time; 6) systems and regulations.
- Geographical proximity can be essential for improved collaboration, but there are different relevant solutions to how to bring together actors who are to collaborate. In some cases, co-location is relevant and necessary; in others it is more a question of integrating services and developing cross-sectoral teams, but in many cases a question of developing systems and routines for cross-sectoral and interdisciplinary meetings when necessary.
- In the process of developing improved collaboration, it is necessary to take into consideration professional differences and that different sectors’ and services’ responsibility, regulations, professional knowledge and culture influence how professionals see a situation (their institutional logic) and which intervention and solutions they find relevant.
- New approaches presuppose anchoring in the involved services at both management and frontline level; dedicated leadership and working on the relations between services and professionals involved in a collaboration are both essential.
- The development of new cross-sectoral collaborative systems demands resources and time to work on new practices; this relates to the context of incentive systems and economy based on single-sector management, and efforts to ensure collaboration within defined systems and regulations in the national context.
- The development of greater relational capacity in the systems for follow-up of vulnerable children and young people is a question of both developing systems and structures with relevant toolboxes, as well as relational competence among those to be involved in new integrated and more collaborative practices.
- There are three main dimensions of relational competence: knowledge about other relevant services and professions and what they might contribute to; acknowledging the added value of other professionals and services contributions; relational skills on how to work together with other professionals and involved citizens to achieve something one could not do alone.
Joint Nordic learning from a local perspective
The issues raised in the Nordic 0–24 project are high on the agenda in all the Nordic countries, with initiatives at both state and local level. The Nordic 0–24 project has evolved to be a bottom-up project, one with high value related to bringing knowledge and experiences forward from local innovation work on improved services and more coherent follow-up of vulnerable children and young persons. However, the relatively weak links to ongoing cross-sectoral initiatives at national level have hampered the possibility of generating learning from this and from vertical collaboration between local and national levels.
It took time for the participants in the Nordic 0–24 project to get into the project and for the discussion to move forward. The fact that the cases were not selected on the basis of clear criteria was reflected in them being rather heterogeneous. The project could have gained from a clearer framework and from establishing a joint problem understanding of what to achieve at an earlier stage.
As the project has evolved the participants have developed a common problem understanding through participation in the joint meeting and engagements in discussions. Through this, the project has generated important learning on how to improve services from a local perspective.