User involvement and external collaboration in child and school health services

Leaders report higher collaboration and user involvement than staff. Service affiliation predicts collaboration, with the strongest ties to school – insights that may enhance cooperation with others.

Background: Child health clinics, school health services, and youth health clinics are responsible for ensuring that citizens have influence when interacting with these services, both at the individual and system levels. These services are mandated to collaborate with other public services, such as schools and kindergartens – a collaboration referred to as external collaboration throughout this study. This study examines whether staff and leaders share perceptions of user involvement and collaboration and identifies factors predicting the likelihood of employees rating collaboration with other services as high (4 or 5 on a 5-point scale).
Methods: The Department of Child and Adolescent Health Promotion Services (NASKO) distributed a survey via Nettskjema to staff (n=918) and leaders (n=159) in Norwegian child health clinics and school health services in the spring of 2024. Responses were received from service providers across all counties in Norway. The questionnaire included a dedicated section with questions on user involvement and external collaboration. Chi-square tests analyzed differences between staff and leaders, and Generalized Estimating Equations (GEE) identified factors predicting high collaboration scores with kindergartens, schools, pedagogical-psychological services (PPT), child welfare (barnevernstjenesten), and specialist health services, while controlling for age, years of experience in the services, and municipality size.
Results:
User involvement and overall collaboration: Leaders were more likely than staff to report that municipal residents were involved in user participation (64.8% vs. 41.3%, p<0.05), while staff more often reported uncertainty (24.3% vs. 6.3%, p<0.05). Leaders also rated external collaboration higher than staff members (p<0.001). Overall, collaboration with schools was rated significantly higher than with other services (p<0.001).
Predictions of high collaboration scores: Employees in child health clinics (0–5 years) and school health services were more likely to report strong collaboration with kindergartens (B=0.777, p<0.001) and schools (B=1.579, p<0.001), respectively. No significant differences were found between leaders and staff in either case. Leaders, however, were more likely than staff to report strong collaboration with PPT (B=0.566, p=0.009) and child welfare services (B=0.574, p=0.015). Collaboration with specialist health services was not significantly associated with service affiliation or job position (both p>0.05).
Conclusion: Service affiliation influences collaboration patterns, and leaders report higher user involvement and external collaboration than staff. Collaboration with schools stands out as the strongest, potentially due to established structures and shared responsibilities.