134 CHAPTER 5 “And I think, the moment we know about each other, what each other’s expertise is, what you’re good at, how you can support the other, that’s already very helpful to be able to start forming a local coalition and to start organizing care together around vulnerable pregnant women.” - FGD, 2020 Stakeholders described how the historical separation and fragmentation between the medical and social sector was persistent and challenging to overcome. Involved organizations often had different cultures, languages, ways of working, legislations, structures, focus areas, networks and missions, which were frequently mentioned as barriers to collaboration. Practical examples included differences in working hours that impeded finding a time to meet. Other examples included a difference between working supply-oriented or demand-oriented, curative versus preventive, focused on children versus parents, and no common understanding of vulnerability. Stakeholders expressed a need for providers to move beyond their own professional perspectives, to further transcend domain perceptions, and overcome cultural differences and fragmented structures. Besides getting to know each other, elements such as developing a shared vision and objectives, and joint multidisciplinary education were considered as helpful. Professional integration At the professional level, stakeholders reported more agreements on interdisciplinary collaboration. Over the past years, there has been an increase in multidisciplinary guidelines, protocols, interventions and policies for the first thousand days. For example, multiple stakeholders reported the initiation or expansion of multidisciplinary meetings and joint intakes. Moreover, there has been an increase in the use of structured risk screening tools that focused on both medical and social factors. Additionally, tailored multidisciplinary care pathways for vulnerable pregnancies have been developed or refined to ensure timely and appropriate referral. However, the agreements made did not ensure successful implementation in practice, due to several reasons. For example, the high number of professionals made it difficult to get everyone together, and sometimes there was sufficient funding to develop guidelines but not enough to implement them, despite a stakeholder’s view that “implementation remains most important, regardless of all the documents” (FGD, 2021). Implementation in practice was considered an ongoing challenge and stakeholders wished for greater alignment in processes in the coming years. Additionally, notwithstanding numerous developments at the professional level, the Solid Start program and the need for collaboration are not yet fully incorporated into all professionals’ everyday practice. Stakeholders have emphasized the need for everyone to acknowledge its importance and take responsibility. As one stakeholder stated: “There is a need for change, there is potential for change, if we do it together.” (FGD, 2021) Several stakeholders agreed that this can be stimulated by including Solid Start in curricula and professional profiles. Moreover, professionals must receive practical tools, adequate support, and training to enhance their competences. These competences include, but are not limited to, effective communication and interacting with clients in a cultural and stress sensitive way.
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