背景:2018年,荷兰政府启动了SolidStart计划,为每个孩子提供人生的最佳开端。该计划的重点是生命中至关重要的前一千天,从先入为主到孩子两岁生日,并特别关注(未来)处于脆弱状况的父母和幼儿。计划的关键要素是通过创建SolidStart联盟来改善医疗和社会部门之间的合作。本研究旨在描述荷兰SolidStart计划的实施,以便为未来的实践和政策学习。具体来说,本文描述了在市政当局中实施SolidStart的程度,并概述了利益相关者在实施SolidStart和相关的跨部门合作方面的经验。
方法:从2019年到2021年收集定量和定性数据。问卷被发送到所有352个荷兰城市,并使用描述性统计数据进行分析。通过焦点小组讨论(n=6)和与护理和支持组织代表的半结构化访谈(n=19)获得了定性数据,知识机构和专业协会,SolidStart项目负责人,顾问,市政官员,研究人员,客户和专家的经验。使用综合护理的彩虹模型分析定性数据。
结果:结果表明,SolidStart联盟的发展取得了进展(2019年n=40,2021年n=140),增加跨部门合作。根据利益相关者的说法,启动SolidStart增加了对前一千天重要性的紧迫感,并刺激了来自不同背景的专业人士相互了解,导致在跨部门护理提供方面达成更多合作协议。联盟内部有效合作的重要因素是积极的协调员作为驱动力,和共同的社会目标。然而,利益相关者经历了坚实的开始尚未完全纳入所有专业人员的日常实践。最常见的合作障碍与宏观层面的系统整合有关,包括有限的资源和抑制协作的法规。利益相关者强调了确保坚实起步的重要性,并提到了各种需求,包括可持续的资金,支持性法规,响应利益相关者的需求,正在进行的知识开发,和客户参与。
结论:坚实的开始,作为一项以地方为重点的国家计划,导致了各种渐进的变化,这些变化支持跨部门合作,以改善前一千天的护理,没有系统结构的重大转变。然而,为了确保项目的可持续性,应解决可持续资金等需求。
BACKGROUND: In 2018, the Dutch government initiated the Solid Start program to provide each child the best start in life. The program focuses on the crucial first thousand days of life, which span from preconception to a child\'s second birthday, and has a specific focus towards (future) parents and young children in vulnerable situations. A key program element is improving collaboration between the medical and social sector by creating Solid Start coalitions. This study aimed to describe the implementation of the Dutch Solid Start program, in order to learn for future practice and policy. Specifically, this paper describes to what extent Solid Start is implemented within municipalities and outlines stakeholders\' experiences with the implementation of Solid Start and the associated cross-sectoral collaboration.
METHODS: Quantitative and qualitative data were collected from 2019 until 2021. Questionnaires were sent to all 352 Dutch municipalities and analyzed using descriptive statistics. Qualitative data were obtained through focus group discussions(n = 6) and semi-structured interviews(n = 19) with representatives of care and support organizations, knowledge institutes and professional associations, Solid Start project leaders, advisors, municipal officials, researchers, clients and experts-by-experience. Qualitative data were analyzed using the Rainbow Model of Integrated Care.
RESULTS: Findings indicated progress in the development of Solid Start coalitions(n = 40 in 2019, n = 140 in 2021), and an increase in cross-sectoral collaboration. According to the stakeholders, initiating Solid Start increased the sense of urgency concerning the importance of the first thousand days and stimulated professionals from various backgrounds to get to know each other, resulting in more collaborative agreements on cross-sectoral care provision. Important elements mentioned for effective collaboration within coalitions were an active coordinator as driving force, and a shared societal goal. However, stakeholders experienced that Solid Start is not yet fully incorporated into all professionals\' everyday practice. Most common barriers for collaboration related to systemic integration at macro-level, including limited resources and collaboration-inhibiting regulations. Stakeholders emphasized the importance of ensuring Solid Start and mentioned various needs, including sustainable funding, supportive regulations, responsiveness to stakeholders\' needs, ongoing knowledge development, and client involvement.
CONCLUSIONS: Solid Start, as a national program with strong local focus, has led to various incremental changes that supported cross-sectoral collaboration to improve care during the first thousand days, without major transformations of systemic structures. However, to ensure the program\'s sustainability, needs such as sustainable funding should be addressed.