133 Implementation and experiences of the Solid Start program Table 4. Continued. Dimensions Positive experiences and recent developments Challenges ahead and needs for improvement System integration • Solid Start funds facilitated implementation on local level • Increased involvement stakeholders from social and medical sector • The Solid Start program’s structure was appreciated for its governmental stewardship and strong local focus • Solid Start creates social value at system level • Previous local cross-sectoral projects targeted at health and disparities (during pregnancy) were used as starting point • Ensuring structural and sustainable funds for long-term planning • Involving more GPs, health insurers, clients-by-experience • Adapting the scope of laws and regulations to stimulate Solid Start, with regard to cross-sectoral collaboration and task-division • Aligning integration with coalitions’ and professionals’ needs for support • Facilitating knowledge development and dissemination • Acknowledging Solid Start as ultimate form of prevention • More insight into impact, costeffectiveness and success factors to maintain its prioritization and political support at local level • Solid Start is regarded as a transition rather than an innovation; transitions are complex and time-consuming • Balancing workload, limited time and capacity (workforce shortage) with adequate care and support is challenging • COVID-19 pandemic decreased funds, manpower and priorities for Solid Start Normative integration The experiences of stakeholders seemed to reveal that normative integration was the starting point for more collaboration and integration in relation to Solid Start. During almost all conversations, stakeholders stressed how Solid Start created more sense of urgency regarding the importance of the first thousand days and prevention, and feelings of collective responsibility to coordinate care and support for parents and children. This increased sense of urgency had implications at different levels (micro, meso and macro) and was a starting point to initiate or intensify activities. However, especially in 2019, stakeholders also described difficulties in deciding where and how to begin with the local implementation of Solid Start. Most municipalities started building their coalition by organizing a kick-off meeting with relevant parties to discuss current workflows, challenges and strengths. These and other meetings contributed to mutual acquaintanceship between individuals from different organizations, as they got to know each other and gained insight in each other’s expertise. This led to quick gains such as the exchange of contact details and casuistry, and long-term benefits such as increased trust, understanding, learning and contact for future clients. This quote of a participant in a FGD illustrates how getting to know each other can improve the collaboration: 5
RkJQdWJsaXNoZXIy MTk4NDMw