135 Implementation and experiences of the Solid Start program Organizational integration The Solid Start program enabled organizational integration by centering the needs and preferences of the target population as a binding agent at the core of all activities. One of the stakeholders explained this by noting: “What the added value is, is the focus on the child. And not just on disciplines or sectors, domains and acquired practices.” (FGD, 2020). Moreover, a dedicated local initiator, project leader or coordinator as driving force was considered essential for coalitions’ progress. Someone who brings parties together, facilitates and takes an ambassadorial role. Despite differences, this position was often filled by someone from Public Health Services, a regional support structure, the municipality, or another neutral party. Stakeholders provided examples where the development halted when that person left. Therefore, they suggested that these driving forces should be institutionalized and supported financially and practically in the future. Several challenges that arose at the organizational level were related to different organizational features. For example, municipalities and care and support organizations had different structures and their physical working areas often did not completely overlap. The social sector was described as fragmented, in contrast to birth care in which organizations often united in obstetric partnerships. Additionally, several organizations, including youth healthcare (preventive public health services to promote health and development for children from birth till the age of eighteen), work in multiple municipalities. The differences and fragmentation made it harder to reach agreements between organizations. Stakeholders also mentioned how the perceived difficulties arising from developments within one organization or sector (e.g. integrated birth care and transitions in youth care) could complicate cross-sectoral collaboration for Solid Start as well. Learning and sharing knowledge were frequently mentioned as essential to improve integration. Stakeholders highlighted how the existence and design of Solid Start fostered learning opportunities. Municipalities sought to learn from best practices in other municipalities in order to avoid unnecessary duplication of efforts. They did so for topics ranging from ‘developing a local approach with a comprehensive set of interventions’ in 2019 to ‘monitoring and ensuring/embedding the approach’ in later years. One of the stakeholders mentioned: “[…] we also keep a close watch on what other regions are doing, what can we learn from them?” (FGD, 2020). As such, stakeholders emphasized the importance of learning and knowledge sharing in the future, both between and within coalitions. The qualitative data showed that municipalities started with monitoring and evaluation. Examples were provided about discussing data and indicators on processes and outcomes during the first thousand days with professionals at municipal or neighbourhood-level, in order to understand local developments and prioritize future actions. However, many municipalities had questions regarding monitoring, such as: which indicators to include, how to start monitoring, where to find data and how to interpret the data? Support from RIVM’s learning community to aid the setup of local monitoring was appreciated. 5
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