Integrating children's services in England: national evaluation of children's trusts
Integrating children's services in England: national evaluation of children's trusts
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DOI：
10.1111/j.1365-2214.2008.00928.x
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发表时间：
2009-03-01
影响因子：
1.9
通讯作者：
Mugford, M.
中科院分区：
文献类型：
--
作者：
Bachmann, M. O.;O'Brien, M.;Mugford, M.
服务协调不力会对有复杂需求的弱势儿童造成严重后果。自2003年以来，英格兰的国家和地方政府开始了全面改革，旨在改善和整合当地的儿童保健、教育和社会服务。这些都是由当地的儿童信托组织和35名儿童信托探路者进行试点。这项研究描述和比较了所有35名儿童信托探路者，涵盖20%的儿童在英格兰的儿童服务整合的经验。它有一个前瞻性的混合方法设计。在过去的三年里，我们采访了147名儿童信托基金的管理人员和专业人员，其中包括172名半结构化访谈，对35个儿童信托基金进行了两次问卷调查，并分析了官方文件。在大多数地区，不同的机构联合委托儿童服务，特别是精神健康、残疾和多功能儿童中心，并越来越多地汇集资金。多机构和多专业服务的提供正在增加。专业人士普遍支持这些变化，但发现他们的压力。所有儿童信托基金都任命了儿童服务机构的主任，并设立了代表多个机构的董事会。分享儿童个人信息的系统大多已经建立，但仍未得到充分利用。与地方当局的教育和社会保健服务相比，保健服务一般较少参与联合工作，但有明显的例外。在地方当局和卫生当局地理边界相近的地区取得的进展最大。有些儿童信托基金会在其法定义务之外很少作出改变，但在地方行为者和组织受到激励和授权的领域，儿童信托基金会使服务发生重大变化。在其他领域，儿童信托基金的职权范围往往过于宽泛和模糊，无法克服根深蒂固的组织和专业分歧和利益。决策者需要在促进具有活跃变革推动者的领域的变革与确保不被遗忘的领域和机构的方法之间取得平衡。
Poor co-ordination of services can have severe consequences for disadvantaged children with complex needs. Since 2003 national and local governments in England embarked on sweeping reforms aimed at improving and integrating local health, education and social services for children. These were to be organized locally by children's trusts and piloted by 35 children's trust pathfinders.This study described and compared the experience of integrating children's services in all 35 children's trust pathfinders, covering 20% of children in England. It had a prospective mixed-methods design. Over 3 years we interviewed 147 managers and professionals working in the children's trusts, including 172 semi-structured interviews, carried out two questionnaire surveys of the 35 children's trusts and analysed official documents.In most areas different agencies jointly commissioned children's services, especially for mental health, disabilities and multi-purpose children's centres, and increasingly pooled finances. Provision of multi-agency and multi-professional services was increasing. Professionals generally supported these changes but found them stressful. All children's trusts appointed directors of children's services and established boards representing multiple agencies. Systems for sharing information about individual children were mostly in place but were still underused. Health services were generally less involved in joint work than were local authorities' education and social care services, with notable exceptions. Areas where local authorities and health authorities shared geographical boundaries made most progress. Some children's trusts made few changes beyond their statutory obligations.Children's trusts enabled major changes to services in areas where local actors and organizations were motivated and empowered. In other areas the remit of children's trusts was often too broad and vague to overcome entrenched organizational and professional divisions and interests. Policymakers need to balance facilitation of change in areas with dynamic change agents with methods for ensuring that dormant areas and agencies are not left behind.