Interorganisational collaboration in child care services

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Interorganisational collaboration in

child care services

Date of submission: January 31, 2016 Karen Schoenmaker Student ID 5999669 Master thesis Executive Programme in Management Studies University of Amsterdam Supervisor: Mark van der Veen

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Foreword ... 1 Abstract ... 2 1. Introduction ... 3 2. Literature review ... 5 2.1. Wraparound care ... 5 2.2. Collaboration ... 9 2.3. Problem statement ... 15 3. Research design ... 17 3.1. Data collection and method ... 17 3.2. Sample and procedure ... 18 3.3. Measures ... 21 4. Results ... 27 5. Conclusions ... 38 6. Discussion ... 41 6.1. Future research ... 41 6.2. Recommendations ... 42 6.3. Finally ... 43 References... 45 Appendix A ... 47

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Foreword

Finally, my master thesis. With great pleasure I have been able to do my research in the field of child care services in The Netherlands. With all the changes in the law and governance concerning child care services organisations are very much in transition. There are many interesting developments taking place making it difficult to choose which to investigate. I would like to thank my thesis supervisor, Mark van der Veen, for his help and advice while writing this master thesis. A paper such as this will not be made without the help of others. First of all, I want to thank all respondents for participating and generously giving their time to do so. Also, I would like to thank Anneke Menger and Renske Schamhart for introducing me to the organisations which have participated. Finally, I thank my family and friends for their continuing support throughout my studies. Plenty of times I had to cancel social events because of my studies and they always were very understanding. Hopefully you will enjoy reading this paper. Karen Schoenmaker Statement of Originality This document is written by Student Karen Schoenmaker who declares to take full responsibility for the contents of this document. I declare that the text and the work presented in this document is original and that no sources other than those mentioned in the text and its references have been used in creating it. The Faculty of Economics and Business is responsible solely for the supervision of completion of the work, not for the contents.

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Abstract

Interorganisational collaboration is necessary in child care services catered to multiproblem families where several professionals are involved. Over the last years several well‐publicized cases have shown this does not always go well. In answer to this a number of child care organisations have introduced a new work method called wraparound care. This paper investigates whether the management level of these organisations are facilitating the collaborative process as well as expected attitudes of professionals towards wraparound care. For this purpose a survey was conducted among seven cases. The results show that while professionals are fairly content with the resources devoted to collaboration, management has opportunities to improve facilitation of the collaborative process. In particular, questions on power of authority need to be addressed which would help professionals in their collaborative efforts. Although there are some hesitations, the general attitude of professionals towards the foundations of wraparound care are on the positive side. The idea that families need to be empowered to take matters in their own hands seems to be widely supported. Ideological consensus on wraparound care is positive and therefore should aid collaborative activities.

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1. Introduction

During the last few years there have been a number of notorious cases where children met with tragedies (e.g. Savanna, 2007 or Ruben and Julian, 2013). This in spite of the fact that child welfare work was aware of the problems within the families. Still, social workers were unable to intervene in time. Subsequent research revealed this is in part related to the sheer amount of social workers assisting these so‐called ‘multiproblem families’. Ten or more workers being involved with one family is no exception. These workers belong to different organisations, which in turn have different missions and goals. Insufficient collaboration (i.e. mutual consultation) between these organisations results in a loss of continuity of care. The effect of which means certain matters are dealt with more than once whilst other matters are overlooked (Beek et al., 1999). It is clear that this is not an effective method of working and worse, entails the risk that families drop out of care. To overcome this, child welfare work is searching for a different way of collaborating. For this purpose several child‐serving agencies are introducing a work method called ‘wraparound care’. Wraparound care is a method by which a care program is developed on an individual level according to the needs of the client. In the province of Utrecht, among other locations, several child‐serving agencies have started pilots to examine if and how the method is effective and functional within their organisations’ context. Although much of the program is concerned with the effects on the clients, organisational preconditions are also of interest. Among these, the preconditions for interorganisational collaboration which is an important foundation of the working method. The Dutch system of child welfare work encompass a large number of associated organisations. The system involves organisations such as the Centre for Youth and Family,

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Department of Children Protective Services, Institutions for mental health care and other health care departments, Office of Juvenile Justices, municipals, provinces, Educational organisations, etc. The large amount of different organisation that may be involved with one family poses challenges interorganisational collaboration. Professionals working for these organisations can have different goals they want to achieve. Sometimes these goals may even be conflicting. Also, the different regulations and guidelines for treatments may interfere with each other. This paper examines the facilitation of interorganisational collaboration by organisations involved in Dutch child care services. In particular, within the context of introducing wraparound care as a new working method. The paper is organised as follows. The next section present a literature review and theoretical framework for interorganisational collaboration. The second section describes the method and procedures used to collect the data. The third section presents the empirical results. Following that, the results are presented. In the final section the research and findings are discussed.

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2. Literature review

In this section the concepts of wraparound care en interorganisational collaboration will be discussed. The first paragraph describes the background of the development of wraparound care and some of its main characteristics. Following this, an overview is given of the concept of collaboration. In particular collaboration among non‐private organisations because child care services for a large part consists of non‐private organisations. Based on the theoretical overview the last paragraph outlines the research questions used during the empirical research.

2.1. Wraparound care

For quite a while now government services are increasingly modelled such that the delivery of their services is organised from a client perspective rather than the organisations perspective (Kernaghan, 2005). One result is that services which were separated throughout specialized organisations are organised into a more integral service delivery. The so‐called ‘one‐stop shop’ idea where clients approaches only one organisation which then provides a range of services. This does not necessarily mean that this organisation carries out all the services. It may very well be it coordinates the services from several different organisations. The difference is that clients do not have to approach all these organisations separately. Wraparound care was developed in the United States as an solution for social care which was too fragmented and did not coordinate services with each other.

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It is important to note that wraparound care is not a form of treatment. It is a method by which a care program is developed on an individual level according to the needs of the client, rather than the opposite (Walker et al., 2003). In this sense wraparound care is market oriented as it focuses on the needs of the client first and foremost. This care program is coordinated and managed by one central facilitator. That way care is more relevant to the client whilst coordination by one person enables more efficiency. There are more advantages to this method. For a more extensive list see Bruns et al. (2006). SOCIAL WORKER FROM SCHOOL CLIENT / FAMILY DEBT MANAGEMENT LOCAL COUNCIL MENTAL HEALTH ORGANISATION PROBATION OFFICER CHILD PROTECTIVE SERVICES SOCIAL WORKER FROM SCHOOL CLIENT / FAMILY DEBT MANAGEMENT LOCAL COUNCIL MENTAL HEALTH ORGANISATION PROBATION OFFICER CHILD PROTECTIVE SERVICES

Child care services traditionally Child care services in the _{wraparound care model}

FIGURE 1TRADITIONAL SOCIAL CARE SERVICES DELIVERY COMPARED TO WRAP AROUND CARE SERVICE DELIVERY (AN EXAMPLE) Figure 1 depicts an example of a potential child care case which shows the difference in the relationship between clients or families and organisations which supply child care services are organised. In the traditional model the client communicated with each professional separately. This also gives clients a lot of leeway in deciding which information to share with separate

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professionals. In the past there have been cases where clients use this leeway in order to play off the different professionals against each other. Within the model of wraparound care communications are comprehensive. Professionals from all organisations communicate with clients but also with all other organisations. Apart from how services are organised there is also a big difference is how clients are approached by the professionals. Most professionals are inclined to resolve problems for their clients. The question professionals ask is ‘What needs to be solved?’ and subsequently go about solving the clients’ problems themselves. The philosophy of wraparound care is that professionals should not be addressing the problems themselves but rather should support clients in their efforts to resolving their problems. The question then becomes ‘What do clients need to do?’. The professionals take a more supportive approach by assisting clients in resolving a clients’ issues. The added benefit of this approach is that professionals are less likely be prescriptive on what clients should be changing in their lives. Rather than impose their view on what the problems of clients are, wraparound care allow clients themselves to decide what issues need to be resolved. Clients make the decisions rather than the professionals. The added benefit is that this allow clients to regain control over their own lives thereby at the same time boosting confidence in themselves. By allowing clients to make the decisions on their care plan clients become more involved in the care plan which increases the chance of interventions being effective. Within wraparound care there is a risk that professionals rely too heavily on the wishes and decisions of their clients. Wraparound care is not the same as granting wishes to clients. The difficulty is that professionals should at the same time direct clients to making

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decisions that will improve their situation. This requires careful balancing on the part of the professionals. One of the traditionally most undervalued way clients may take control over their own situation is by accessing existing resources. One of the most important available resource to clients is their natural support or informal network. These are family, friends, neighbors with the ability to help clients. Professionals working with wraparound care considering developing this informal network as a priority. A clients’ informal network generally has better means to follow clients and intervene at an early stage if problems arise. The informal network may have better access to assess a clients’ situation because they are not strangers like professionals are. In this way an informal network is a valuable addition to professionals. Also, the informal network stays in place after finishing the care plan. This means the informal network may signal a relapse into old problems. By also training the informal network how to approach clients in case of such a relapse, subsequent professional care may be prevented. As becomes clear from the description above one of the most important issues when introducing the wraparound care method, is collaboration between the different organisations involved with the families. Considering the nature of social services these might be compared to government services. Although not every organisation involved is a government organisation these days. The structure and regulations are similar. When these organisation are required to collaborate more closely differences in organisational culture may be an obstacle (Kernaghan, 2005). Introducing a new work method with a strong ideological component, such as wraparound care, may exacerbate those cultural differences. This is due to renewed examination of the current method and consequent discussion of its underlying principles as part of the introduction of a new work method.

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2.2. Collaboration

Organizational networks are described in business literature by many terms. Terminology such as strategic alliances, partnerships, strategic alliances and interorganisational relationships are all used to describe collaboration between organizations. The individual terms do not represent the same type of collaboration. Each has their specific characteristics. In general though the common theme of collaboration can be discerned. The term collaboration and the way it is used in the literature, denotes an assortment of social interactions. Several definitions are used to describe collaboration. One definition commonly used is formulated by Gray (1989). It states that collaboration is a process ‘through which stakeholders who see different aspects of a problem can constructively explore their differences and search for solutions that go beyond their own limited vision of what is possible’. Himmelman (2002) defines collaboration as a process ‘in which organizations exchange information, alter activities, share resources, and enhance each other’s capacity for mutual benefit and a common purpose by sharing risks, responsibilities, and rewards’. Although the definitions are formulate differently they all refer to a common goal or purpose and should be beneficial to participating organizations. Huxham (1996), amongst others, stressed that collaboration should only occur out of necessity, when an organization is unable to achieve those goals by itself. Buono (1997) considers strategic fit as well as a mutual agenda as a factor for success of partnerships.

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Like definitions, many forms of collaboration exist. For instance, Todeva and Knoke(2005) distinguishes thirteen forms in the literature by ordering according to degree of integration and formalization. These degrees could be seen as different stages in the collaborative process. In time organisations which work together would naturally become more familiar and integrated with each other work processes. On the other hand, Ring and Van de Ven (1994) view the collaborative process as iterative and cyclical. Hereby organisations will reassess the collaboration on a continual basis and commit to and/or renegotiate it. Research into reasons why organisations develop interorganisational relationships has resulted in a number of theories. In their review though, Oliver and Ebers (1988) conclude that most of these are grounded on the resource dependency view. The resource dependency theory states that organisations are in some degree dependent on resources in control of other organisations. Dependency implies the possibility of power exertion by one of the parties and therefore a power relationship. An underlying assumption of this theory is that interorganisational relationships are entered primarily to gain access to resources. In this sense resource dependency theory may be linked to the exchange perspective. The exchange perspective argues that organisations collaborate with others because it needs to in order to achieve its organisational goals. It focuses on either the benefits from the exchange (or collaboration) with other organisations or on the exchange with the environment of an organisation. The latter is primarily concerned with reducing the uncertainty of this environment. The excessive use of available power by one organisation would negatively affect the collaboration with other organisation within the network. The ability of an organisation to use power may be related to the position within the network structure. Brass and Burkhardt

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(1993) found that centrality is associated with power. This (lack of) power may derive from both a formal position as well as the informal position within a network. Centrality may be viewed as the number of network ties of an organisation (Provan et al., 2007). Depending on the type of centrality one applies, these ties are direct or indirect. It can also be measured by factoring in the length of connections to other network organisations, the amount of links of different types or whether an organisation is part of a smaller network within the network (‘clique’). Some structures contain properties within itself that would favour some participants power. For instance, if a network is highly centralized one or a limited amount of organisations have significantly more network ties than others. Thereby given them a position that enables them to exert more influence. Vangen and Huxham (2003) stresses that however the distribution of power, all partners need to have an advantage by working in a collaboration with other organisations. Some may think that issues such as power and control, concerned with competitive advantages, may be of less importance in this papers because the organisations concerned are from the not‐for‐ profit or public sector and are therefore not required to financially profit of a collaboration. However, matters of control and power in these sectors tend to be of great importance because funding of these organisations, and consequently their survival, generally depends on it (Vangen and Huxham, 2003). When organisations in this paper cannot sufficiently demonstrate their ability to resolve child welfare issues, funding these organisations loses its legitimacy. It is not unusual for collaborating organisations in the child welfare system to be competing for funds (Hardy et al., 2003).

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The reasons and characteristics of the manner in which organisations collaborate with, as mentioned above, are then the necessary conditions at the organisational level to collaborate. These characteristics are then translated at the managerial level into guidelines and policies to accommodate collaboration at the operational or team level. Conditions at the organizational level will dictate how collaboration opportunities are given to the operational level. To show this difference in levels, Benson (1975) compares an interorganisational network to a political economy. Such a network consists of two structures which mutually influence each other. One level consists of four factors relating to the performance of a network. This level Benson (1975) calls the micro‐political level or operational factors (Hudson (2004) uses the term superstructure). The other level, the macro‐political level or policy factors (substructure in Hudson’s (2004) terminology), consists of four parts concerned with the processes of resource acquisition and pursuing the authority to decide over resources. Benson’s main argument is that those more fundamental factors in this level ultimately shape the interactions at the operational level. The macro‐political level relates to an organisation’s own purpose, sufficient funding, legitimacy of the network and the level of commitment to a certain method of working. These contextual factors at the level of an organisation influence the operational or team level by means of the behaviour of the organisation in the partnership. This may lead to a change of the equilibrium within the operational level. The operational factors are domain consensus, ideological consensus, positive evaluation of the network partners and work coordination. These factors are described as measures which would reach an equilibrium among partners. That way a consistent notion across participating

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organisations on the different tasks, roles and the manner in which activities are executed and planned, is constructed.

Figure 2 shows the model and its eight factors as adapted by Hudson (2004).

OPERATIONAL RELATIONSHIPS Degree of domain consensus Degree of ideological consensus Degree of positive evaluation Degree of work coordination

CONTEXTUAL INFLUENCES

Fulfilment of programme requirements

Maintenance of a clear domain of high social importance Maintenance of resources flow

Application of defence of the organizational paradigma

FIGURE 2MODEL OF PARTNERSHIP FROM BENSON (1975) AND HUDSON (2004)

Managerial support for collaboration is critical. Without this support professionals cannot collaborate effectively with other professionals from different organisations. Managers allow professionals to do their work by providing the appropriate regulations, procedures and tools. Vangen and Huxham (2003) mentions working processes as one of the themes in research on collaboration. Kernaghan (2005) states operational and managerial barriers as an barrier for integrating services. For instance clarity of roles and responsibility with in a collaborative team

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is important (Ring and Van de Ven, 1994). Members of the team also need to be aware of the shared goals to be achieved (Ring and Van de Ven, 1994 and Thomson and Perry, 2006). An actual collaboration will only be successful at team level because there the operations are carried out. Besides organisational support successful collaboration also requires conditions to fulfilled by team members (Walker et al., 2003). Professionals should actively seek out to collaborate as it does require additional efforts. For example, professionals in child care services would need to attend meetings, share information and make commitments to the collaborative team. At this team level the individual relationships between team members play a larger role and these relationships need to be build. This requires opportunities to do so which management may help with by providing resources to do so. At the same time, professionals have to be motivated to build these relationships. Also, professionals need to have the ability to collaborate. When the latter constitutes a problem, training would be helpful in solving this issue.

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2.3. Problem statement

As discussed, a degree of ideological consensus is important for collaboration to be successful. In addition, in the starting phase of a new work method values and meaning play an important part in developing a common purpose of the network. Currently, projects have been started to test the introduction of wraparound care in child welfare work. Collaborative action is one of the main themes of this work method. The focus of this study is on the perspective of the professional. The goal is to approach collaboration from themes in the framework by Benson (1975) as discussed above. Therefore the research questions of this paper are: a) Ideological consensus: do professionals support the ideological opinions on the principles of wraparound care, in particular related to collaborative activities? b) Availability of resources: are the organisations encouraging collaborative efforts on the operational level of the professionals? The first research question on ideological consensus is concerned with the operational or team level of the professional within a collaboration. This question examines whether the core principles of wraparound care are likely to be executed in practice. This questions concerns a form of ideological consensus (Hudson, 2004). Research has shown execution of wrap around care principles to have the potential to improve the outcomes for child and family (Bruns et al, 2006). Based on the theory of planned behaviour (Ajzen, 1991) a positive attitude towards the principles behind wraparound care would lead to behavioural intentions to apply the method of wraparound care. This in turn would ultimately lead to behaviour applying wraparound care. Collaboration being an important component of wraparound, this would include

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behaviour favourable towards collaboration with professionals from other organisations involved with the clients. This question, therefore, is an indicator of propensity of the professional for collaboration with professionals from other organisations. The second research question about availability of resources concerns the organisational conditions provided at the organisational level that enable collaboration by professionals (Benson, 1975). These contextual factors for professionals would create the necessary, hospitable environment for professionals to actively engage in collaboration and give professional the required resources to collaborate. For professionals in these organisations this mostly revolves around the ability to coordinate work within the collaborative teams without this conflicting with the demands of their own organisation. Although collaboration in a wraparound environment has been researched already, this has not been done in a Dutch setting. Partly because until recently, integration of services was not a common approach to child care work. Because of the uniqueness of any national social system the result of this study would give an opportunity to verify whether known issues in the scientific literature apply in this country as well. If wraparound care proves to be a successful way to manage integrated child care services for multiproblem families more agencies will adapt this process. The results of this study would provide them with information on the impact of the organisational factors on the operational level. For the organisations involved in the current study it offers information on the current state of the implementation of wraparound care. They can use this study to follow progress over time by repeating the study in the future.

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3. Research design

This sections of the paper describes the design of the empirical research done in this study. The design of the study is the outcome from the literature review and the subsequent research questions as described in the former section of this paper. From the literature review it follows that empirical research on the subject of interorganisational collaboration in child care services in the Netherlands was not found. Literature available on wraparound care are based on child care services in the United States. This literature is published in journals with subjects such as psychology, child abuse, or social services. It follows then that literature from a managerial perspective was not found. In the articles on wraparound care collaborative efforts are discussed but not empirically studied extensively. Therefore not much information on collaboration in the context of The Netherlands in conjunction with wraparound care is known beforehand. As a consequence this study has an exploratory disposition.

3.1. Data collection and method

Fitting in with this exploratory feature the research method of the case study was chosen. Thereby allowing for actual realistic collaborations to be examined. In order to gain preliminary information on existing practices with interorganisational collaboration in child care services in The Netherlands two interviews were conducted. The two respondents have

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both research and practical experiences with child care services. Following this preparatory research, the research questions are then investigated by conducting a survey.

3.2. Sample and procedure

The first step in the data collection process was done by conducting two interviews. One of the interviews was with a professor of Education at a Dutch university. The respondent has numerous years of experience of conducting scientific research on child social services in The Netherlands. The other interview was conducted with a project manager who for the last two years has been responsible for a project concerning the introduction of wraparound care method. The main purpose of these interviews was collecting preliminary information on child social services and issues concerning wraparound care. In particularly, information on issues with collaboration the respondents are familiar with. Both were semi‐structures interviews (Saunders et al., 2007). This allowed for flexibility during the interviews, necessary because the subject matter was not determined beforehand. Minutes were taken during the during the interviews which were then processed in a report directly following the interviews. Thus ensuring an accurate account because the interviews is still in the memory of the interviewer. The information gathered from these interviews were used as background information for this paper and as input for the consecutive survey. Based on the research questions a research strategy of a survey is chosen. The collection of data by survey will allow for comparing the responses (Saunders et al., 2007). Rather than randomly collecting data from different professionals with no relationship, data was collected

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from actual client cases. This allows for examination of a group of professionals from different organisation who could or should be collaborating. For this purpose five child social services organisations were approached with a request to make one or two cases available for participation in the research. Specifically cases were more than three professionals were involved, thus guaranteeing the potential for collaboration. Per case contact information was provided of all known professionals involved with the client and their family. By asking the organisations to provide the cases rather than choosing them randomly, there is a risk of subject error (Saunders et al., 2007). An organisation might for instance choose cases were collaboration is going very well or the opposite collaborations that are having problems. Unfortunately, due to privacy reasons of their clients random choosing was not an option. The results show no reason to suspect cases were specifically chosen for reasons other than the required number of professionals involved. The professionals were then contacted by email by the researcher with a request to fill out the survey. To avoid response bias (Saunders et al., 2007) by the respondents were respondents might give desired answers rather than actual ones, they were assured that there participation and their answers would remain anonymous. Filled out questionnaires could also be returned anonymously through a post office box. The purpose of this is to enhance reliability of the data (Saunders et al., 2007). As a result seven cases were made available which provided contact information for a total of 37 professionals. Of these 20 surveys were filled out and returned. This gives a response rate of 54%. Of these 20 surveys one questionnaire was excluded from analysis due to insufficient answers. The number of respondents per case ranged from one through four. This

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averages out to 2,7 per case. Respondents report 53 unique relations. That is including the non‐respondents. So not every relations is reported from both sides. As may be expected most respondents (37%) work for organisations for child care services. Other respondents work in education, (mental) health services or the municipality. A detailed summary is shown in the table below. From this it becomes clear that respondents are limited to directly involved with the child rather than the whole of the family. Otherwise one would have expected other organisations to be included. These are not present here. After reviewing the results this was checked by phoning the contact of one of the organisations. It was confirmed that organisations indeed limit their collaborative effort to organisations directly involved with children. Part of the reason is practical as coordinating becomes more complex when more organisations are involved. TABLE 1: ORGANISATION WHERE RESPONDENTS WORK PER CASE

Type of

organisation Case 1 Case 2 Case 3 Case 4 Case 5 Case 6 Case 7 Totaal

Social work 2 1 1 4 Child services 1 1 2 1 1 1 7 Education 1 1 2 (Mental) health services 1 1 1 3 Municipality 1 1 1 3 Total 4 1 4 3 2 4 1 19

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3.3. Measures

The questionnaire is composed of four sections. It contains twenty‐two questions. For two questions additional details were asked to elaborate on the answers. Of the questions eleven pertain to the actual case and the active collaboration process. Another six questions focus on the supporting activities of organisations and their management for the collaborative processes. Three questions relate to the attitude towards the wraparound care method. Finally, the questionnaire ends with two open questions on collaboration. A copy of the questionnaire (in Dutch) is enclosed in Appendix A. As a guideline for the questions on collaboration, in particular within the context of wraparound care, part of the wraparound fidelity index (Walker et al., 2003) was used. This instrument was developed to monitor how the implementation of wraparound care is established. For this paper only items concerning collaboration were used. The first section applies to the collaborative activities in the actual case. The questions are designed to gather general information on the case and collaboration within this case. Questions concern actual characteristics of the collaboration. Such as  What organisation do you work for?  What organisations are involved with the family? And do you find certain organisations lacking?  How do you rate the satisfaction with collaboration per organisation? To gather more in‐depth insights respondents are asked to elaborate on the most positive and least positive rating.  How often do you consult with the other organisations?

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Also in this section are questions to establish to what degree principles of the wraparound care method are observed in reality. To this end respondents are asked whether a collective care plan is in place; whether families are present at meetings and if there is a coordinating professional. These are three characteristics of wraparound care within the theme of collaboration. The aim of a collective care plan is twofold. On the one hand it is about sharing goals and making sure that everybody involved has the same vision of where they want to go with the treatment. This is related to domain consensus. At the same time it allows for work coordination. Making sure there is no overlap in goals, achievements and activities nor any gaps between the organisations. Also, determining who is responsible for what part of the treatment. Because a care plan is made at the start of a treatment it should avoid problems with conflicting goals and responsibilities later on during the treatment. In practice, it is also the moment when professionals and clients get introduced to each other. Involving clients during this part of the process enables them to influence and determine what to include in the care plan. Involving the client should not be limited to the start of the process. That is why clients ought to attend meetings as well. Or if this is not possible, be informed of what is discussed at these meeting. The availability of a coordinating professional is important when conflicts arise. It is the professional to whom the client can turn when they are experiencing issues with professionals from the other organisations. The coordinating professional would also be the one who makes the ultimate decision on further actions in case of conflicts. The second section connects to the research question on facilitating collaboration by management. In order for professionals to be able to actually engaged in collaborative activities organisations needs to enable them to do so. Management needs to provide professionals with resources to enable them to actually engage in collaborative activities.

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When professionals do not receive the necessary resource to collaborate their evaluation will be negative and they will not be motivated to participate in collaborative activities. Not only will this influence the immediate collaboration of the case at hand, it will also diminish their willingness to collaborate in future cases. These resources are not necessarily physical resources. For social professionals resources are mostly the policies as set out by the organisation. These should subsequently be imposed by the manager. The most important resource is the availability of time needed for extra activities to be undertaken in order to collaborate with other organisations. For organisations in the social sector this is a particular issue because this time is generally not financed by government. Also, when professionals have to repeat (administrative) tasks to comply with two different contexts (the collaboration and the organisation), this will severely limit enthusiasm to collaborate. The same is true when professionals do not have the ability to make decisions independently. When professionals need to check whether changes to care plans are allowed, they will become frustrated quickly. Frustration also happens when conflict between collaborating partners occurs. Although conflicts cannot be prevented they may be mitigated by assigning one of the professionals involved a decisive vote. In this way conflicts may be resolved in a swiftly manner rather than drag on for a long time. This will negatively impact their evaluation of the collaborative process. This section exists of six measures: 1. Does management encourage collaboration with other organisations? 2. Do guidelines and procedures support consulting with other organisations? 3. Does collaboration lead to work having to be done twice? This may be the case for accountability towards the collaborative team as well as towards one’s own organisation.

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4. Do professionals have the authority to make decisions regarding treatment directly or do they have to match this with management level first? 5. Does one professional have the decisive vote in case of problems within the collaborative team that need to be resolved? 6. Are there sufficient opportunities to collaborate effectively with other organisations? In the third section of the survey focus lies on ideological consensus. Ideological consensus may have many different aspects. For collaboration in the social sector one of the most important ideological consensus is agreement on how clients’ needs are best met. Within the context of wraparound this is captured by how professionals approach their clients. For this study therefore, ideological consensus is measured by using endorsement of the principles of wraparound care as a proxy. When using a work method such as wraparound care it is important that professionals from different organisations can agree that working along the lines of these principles is the best way to achieve the desired results. It is important for clients that the professionals involved in their care exhibit consistent behaviour towards them. That way they know what to expect and what not to expect from professionals as well as what is expected of themselves. Consistent behaviour by the professionals also prevents clients from playing off the different professionals against one another. For instance, clients may otherwise ‘shop around’ professionals for getting things done by them rather than by the client itself. In order to prevent a lengthy questionnaire a selection was made based on the most distinctive foundations of this working method. The interviews conducted as part of the preparatory research revealed these to be the most distinguishable compared to existing work methods. The first foundation is concerned with families actively participating in resolving their issues

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rather than professionals taking charge of the problems. The underlying idea is that clients need to resolve problems themselves rather than relying on professionals to resolving them, as is often the case. For instance when a phone call needs to be made to social services in order to receive aid. In plenty of cases professionals might then make the call themselves. Within wraparound care professionals prepare the phone call with clients. They might discuss the questions clients need to ask or might have to answer. Also, rehearsal of the conversation might be part of the treatment. Professionals help and coach clients so that clients obtain the capability to resolve problems. The second foundation relates to the involvement of the informal social network of the families. Like the first foundation this further prevents professionals from taking charge of the problems and allowing clients to resolve them. The argument here is that care should be temporary while the clients issues should be solved permanently. That means clients need to learn how to solve issues. One way to do that is by getting help from their social network. The major benefit is that even after professional services are ceased, the informal network is still in place for enduring assistance for the family. The third foundation addresses the empowerment of the family by following their preferences for treatment. Again, this foundation is based on the premise that families need to take control of their problems and resolving them. By following families’ preferences for treatment two objectives are met. Treatment is more likely to be successful when families are involved in the decisions and are aware that they have a problem. The second objective is that by giving them this control they build self‐confidence. The difficulty here is that what families think should be resolved does not always match with what professionals think should be resolved. The challenge for professionals is to ensure proper treatment but in a manner that families do not feel that professionals are taking over their lives.

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Finally, the last section is made up of two open question. One asks for a necessary condition for improving or further advancing interorganisational collaboration. The other questions asks what specifically not to change when improving interorganisational collaboration. These open questions allow respondents to add items related to collaboration which have not been included in the remainder of the questionnaire or to highlight an item which they find more important than others. Open questions also allow respondents to give more than one item per answer. For most of the items the answers are ranked on a five point Likert scale and coded as ‘often’, ‘regularly’, ‘sometimes’, ‘rarely’ and ‘never’. For polar questions the answers are coded as ‘yes’, ‘no’ and ‘sometimes’. Satisfaction with the collaboration was scaled from 1 to 10. To reduce the risk of response set, questions were phrased so that scales were mixed towards a positive and negative endpoint.

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4. Results

In the following section of the paper outcomes of the study are described. This section follows the arrangement of the survey. It starts with the characteristics of the collaboration and satisfaction about this collaboration. Followed up with the outcomes concerning the availability of resources or facilitation of collaborative activities by organisations. Next the results concerning ideological consensus by means of the principles of wraparound care are described. The following part results by case study are compared. The final part of this section describes the suggestions of respondents on how to further enhance collaboration with other organisations. The frequency of interactions is one of the characteristics of collaboration which indicates if and to what extent the group may be called a network (Koppenjan and Klijn, 2004). Our study found that respondents reported an average of 16 meetings a year. This translates into an interaction once every three weeks, approximately. The standard deviation of 17,5 is very high though, suggesting large differences. This is a result of a some respondents having little interactions. The total range of meetings reported runs from once a year to once a week. The expectation would be that all professionals within the same case to be giving the same answer to the question of frequency of meetings because the question asks for an actual measurement as opposed to an opinion or personal experience. Findings show considerable divergence in this answer though. Additional examination was done by contacting child care professionals and confronting them with these findings. The divergence was explained by the fact that respondents only take part in some meetings, not all of them. This is a common

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occurrence in child care services where meetings take place in different configurations (see also Walker et al., 2003) The average is comprised of 24 reported connections by respondents. An additional three connections reported regular meetings but did not provide a number, so could not be measured. Another nine connections reported interactions ‘when needed’. The advantage of the latter is the lack of unnecessary meetings. The disadvantage is that professionals have to assess the need for work coordination and whether or not information needs to be shared with other professionals. Regular meetings would lessen this need for individual assessment by providing a set interaction moment. Also, another eight connections reported only one meeting, usually at the start of counselling. These professionals have no further meetings during the course of a client’s treatment but may interact on individual levels. All in all only 34% of the connections have reported regular (more than four times a year) meetings. Of the seven cases two reported that a joint treatment plan where shared goals and work coordination are proved did not exist. Four of the cases had a partly joint treatment plan where some organisations did not participate in the treatment plan. Only one of the cases had a completely joint treatment plan. Not participating in the joint treatment plan did not necessarily mean that organisations were not included in joint meetings. It is common for organisations to sit in on meetings even when not included in the treatment plan. In fact, one of the cases without a joint treatment plan reported having joint meetings nonetheless. The average rating of satisfaction with the collaboration with other organisations is rated at 7,4 based on 67 ratings. The ratings range from the minimum of 3 to the maximum of 10. Standard deviation is 1,43. Interpreting the standard deviation suggest 84% of the collaborations are graded as sufficient (i.e. graded 6) or higher.

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Also in the survey was an open‐end question as to why certain collaborations were deemed to be successful. As it was open‐ended respondents could supply more than one answer. The success factor given the most, nine times, are short lines of communication. This indicates that professionals working with the same client do not always know each other or know how to contact each other. Closely followed by the next most important factor which is clarity of roles and responsibilities professionals have towards a client. This factor is mentioned by eight respondents. Actually taking responsibility is specifically mentioned twice. It is possible that taking responsibility is implied within the answer of clarity on responsibilities. Another seven respondents stated commitment as an important factor. The common goal or plan of action is mentioned six times. Five respondents answered the contact with the family as a success factor on their collaboration. Other answers given were good communication, a central coordinating organisation, and not too many meetings. On the opposite side another open‐ended questions was included as to why certain collaborations were not successful. Of the respondents twelve gave an answer to this question compared to the twenty who answered when asked about success factors. Here the lack of accessibility of professionals was an important impediment to successful collaboration. This is given three times as an issue. In addition two respondents mentioned there was no collaboration at all or the collaboration was at a distance. These might be also be construed as lack of accessibility. Also disagreement about roles and responsibility played an important and negative role. Three respondents gave this as an answer. Twice the answer given was about the solutions for clients which were disputed. Other factors mentioned were not enough sharing of information, and lack of structural meetings.

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The next section examines if resources are made available to allow collaboration with other organisation. In other words if management is facilitating interorganisational collaboration. In In Table 2 the frequency table of the six items is presented. Not all frequencies add up to 19 respondents because of missing data. The reason is that respondents neglected to answer the question. Because this was a rare occurrence the filled out questionnaires of these respondents were not eliminated from further analysis. Two of the questions were reverse coded. This means that one would expect answers to be inclined opposite of those of the other questions.

TABLE 2:FREQUENCY TABLE MANAGERIAL FACILITATION INTERORGANISATIONAL COLLABORATION

Encouraging collaboration by management in 16 of the 19 answers is done regularly or often. Only one respondent noted that management was not supportive of collaboration with other organisations. In correspondence with this 15 of the 19 respondents reported few guidelines hindering collaboration. The survey further shows that collaboration does on occasion lead to

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redundant work. This is mostly due to reporting issues with regard to treatment plans and timekeeping duties. Also mentioned was extra time needed to communicate with organisations who did not attend jointly meetings. As far as management having to approve decision regarding treatment 53% of respondents report having to do that sometimes. 26% of respondents have to ask for approval more often than sometimes. The existence of decision power within the collaborative team is evenly dispersed with an equal amount of answers on the negative side of the scale and the positive side. The necessity of professionals having to ask for approval for decisions in advance already indicates that the collaborative team has limited power as management seems to control a considerable share of this. Having a decisive power within the team then would also be lacking. When asked if opportunities for collaboration are sufficiently available answers are located on the middle and positive side of the scale. The next section of the survey concerns a degree of ideological consensus. This is measured by the attitude of professionals towards de support for the foundations of wraparound care. When attitude towards the working method is more positive professionals should also be considered to have a more positive attitude towards interorganisational collaboration since this is such a large part of wraparound care. In Table 3 the frequency table for the three items is presented.

TABLE 3:FREQUENCY TABLE CONCERNING SUPPORT FOR FOUNDATIONS WRAPAROUND CARE

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In general, most of the answers are in the middle of the scales with the majority of the other answers inclined to the positive side. This suggest that there are considerable hesitations about the foundations of wraparound care. 53% of respondent agree that families can actively participate in resolving their problems. That means 47% thinks this is rarely or only sometimes the case. A possible issue with these differences, if they occur within one of the collaborative teams, that professionals will have quite different approaches towards the same family. Hereby one of the team members will be more actively solving problems whilst others will have a more passive attitude. This may lead to families experiencing this as a stricter attitude and complaining about this. This in turn will lead to discussions or irritations within the collaborative team thereby decreasing satisfaction with the collaboration. When it comes to involving the informal social network of a family 37% of the respondents think this is regularly or often overlooked. This may suggest that the resolving capacity of informal networks is perceived as limited or that it is already customary to involve them as much as possible. Although 65% of respondents feel that a family should take the lead in decisions regarding the treatment plan that still means 35% of them find this is generally not advisable. Considering that this questions pertains to the empowerment of families in order to make results long lasting, this is quite substantial. A possible outcome of this may be the continuing reliance of families on child care services which is not desirable. Results were also examined by case. In Figure 3 the results of availability of resources compared to satisfaction with collaboration are depicted. Each point represents a case. Satisfaction with collaboration was calculated by taken the average of each reported score per case. Availability of resources was calculated by the averages scores on all six measures of this

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Sa ti s fa cti o n w ith c o ll ab or a ti o n Availability of resources

Very low Mod

FIGURE 3MEAN SATISFACTION WITH COLLABORATION FOR MEAN FACILITATING COLLABORATION BY CASE

( DENOTES A CASE WITH ONE RESPONDENT)

item. All points in the diagram are in the upper right quadrant in close proximity suggesting on average a substantial level of similarity. Placement of all points in the right side of the diagram indicates the availability of resources is deemed adequate or better by respondents. The amount of open space to the right of the points means there is room for improvement. The trajectory of the trend line exhibits a positive slope. This is in line with the theory which says that by making resources available for collaborative activities satisfaction with collaboration will increase. The graph shows this by the fact that the case which reported the highest satisfaction with the existing collaboration also ranks high (second) on the availability of resources. Likewise the least satisfied case with existing collaboration scored the lowest on availability of resources.

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Further examination on the individual measures of the score between the two extremes on the graph concerning availability of resources shows that the lowest score is lower on every individual measure. The largest difference between these two extreme scores is on the measures of procedures within the organisation of the professional. Overall the most variation in answers was given to the question on repeating tasks for both the organization and the collaboration. The lowest score about availability of resources overall concerned the need for feedback from professionals’ own organization before making decisions in the collaborative team. This seems to be a consistent point perceived by professionals as lacking in resources because most respondents give a low score. Ideological consensus is compared to satisfaction with collaboration as well, also by case. The results are shown in Figure 4. Ideological consensus was calculated by the average scores on the three measures of this item. All points in the diagram are in proximity to each other meaning that differences between individual cases are small. All points being positioned in the upper right quadrant indicates that ideological consensus on wraparound care is on the positive side. The relationship between ideological consensus and satisfaction is less straight forward than with the availability of resources. This is indicated by the more horizontal scattering of the points, i.e. more ideological consensus is less likely to results in an increase of satisfaction with the collaboration. Nonetheless, the trend line for ideological consensus exhibits a positive slope. Albeit, less positive than for the availability of resources.

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FIGURE 4MEAN SATISFACTION WITH COLLABORATION FOR MEAN IDEOLOGICAL CONSENSUS BY CASE (

DENOTES A CASE WITH ONE RESPONDENT)

The case where professionals agree the most positive with the ideology of wraparound care as measured is the same case which reported the highest score on availability of resources. At the same time these are not the respondents who are most satisfied with the actual collaboration. This might be due to higher expectations. Comparing the individual measures of the case with the highest ideological consensus with the case with the lowest ideological consensus finds that the principle of working with the informal network of a client is the most contentious. Conspicuous is the position in the graph of the case with the highest satisfaction about the collaboration. Respondents show only moderate agreement on the principles of wraparound care. Investigation of the detailed answers per respondent shows one of the respondents is in

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high agreement with the principles of wraparound care compared to the other (three) respondents who are only moderately in agreement with these principles. The final section of the survey consisted of two open questions. The first questions was what not to change when introducing more interorganisational collaboration. Sixteen respondents answered this question. Six of these answers related to actively involving families in the decision process and the solution of issues. Four respondents referred to structural agreements with associated organisations and the desire to keep it this way. Continued experiences in working together with the same organisations settle issues about working methods and power of decision. Finally, three respondents mentioned short lines of communication. This matches the results found earlier about resources which provide satisfaction with collaborations. The first theme relates to an ideological item of wraparound care. Both the second and third answer refers to the degree of work coordination. On the other hand, the last question inquired on how further to facilitate interorganisational collaboration. Fifteen answers were given to this inquiry. A third of the answers referred to a joint treatment plan. Three added the desire for combining this with a joint client registration system. Three respondents have a need for improving knowledge on what organisations are present in the region and how they may be contacted. Related to this answer was the enablement of a specific organisation to collaborate. These (types of) organisations are currently absent in the process. Also three respondents mentioned power of decision. Two of these mentioned arranging who has power of decision. One respondent specifically feels a need for more power of decision for the collaborative team. Two respondents, finally, stated that some of the experiences achieved through pilot projects

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should be implemented into the regular procedures of organisations. Most suggestions therefore refer to the availability of resources, in particular to coordinate work.

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5. Conclusions

This paper examined the facilitation of interorganisational collaboration by making resources available at the management level of organisations involved with child care services. At the team level the attitude of professionals towards the foundations of wraparound care were examined to establish whether the lack of ideological consensus might hinder collaborative efforts. The results show that all investigated cases engage in interorganisational collaboration. From the large variance in the number of meetings it follows there is a difference in the level of involvement with the collaboration. In some cases professionals meet more regularly than others. This would have a strong influence on the degree of work coordination. In general professionals are positive about the collaboration they participate in. Factors mentioned by respondents positively contributing to existing interorganisational collaboration are the presence of shared objectives, short lines of communications and determining mutual responsibilities and authority. Accessibility of professionals and disagreement on authority were the main hindering factors for collaboration. A number of positive factors are represented on both the positive and negative side. A positive factor negatively influences collaboration in situations where the positive factor is lacking. Factors being specifically mentioned as important, both positively or negatively by lacking, indicate that they are important for interorganisational collaboration as they are missed when not available. Although different factors are mentioned by professionals, many of them are or would be improved or resolved by a joint treatment plan. Factors such as roles, responsibilities, contact information of other professionals are all items which should be a part of the joint treatment

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plan. Furthermore, the development of such a joint plan would actively engage all professionals involved with the family at an early stage. This could vastly improve accessibility of professionals from other organisations during the rest of the collaborative process. A joint treatment plan would enhance work coordination as well as domain consensus in advance. Positive scores indicate that professional experience that organisations are making resources available to allow for collaboration. Organisations are generally considered by professionals as facilitating interorganisational collaboration. Some professionals find resources made available by their organisation as lacking. In that situation organisations need to ensure that employees are aware of their resources. Or, in case professionals are indeed lacking resources, organisations could improve the level of support for collaborative efforts. In particular, matters of authority of power are considered a source of disagreement in collaborative teams. This applies to authority issues within collaborative team itself as well as a professionals’ authority to make decisions in that team on behalf of their organisations. One way such disputes about authority might be prevented is if organisations develop collaboration agreements. That way responsibilities and authority is established before professionals actually get together to collaborate. Some respondents found collaboration agreements to be good guidelines in such matters. Attitude towards the basic foundations of wraparound care are, although inclined towards the positive, also quite hesitant. This might be because professionals are uncertain about the ability of families to actively decide about how to resolve their problems. Professionals tend to have a propensity to act and resolve issues themselves. They might find it difficult to hold back on those impulses. This will especially be the case if families start complaining about ‘lazy’ professionals because professionals adapt a more passive position. Attitudes towards the

Interorganisational collaboration in child care services