Decades of research have shown that there are significant advantages to maintaining close communicative and collaborative relationships between primary care and behavioral health providers. Fiscal, structural, and systemic barriers, however, often restrict the degree to which such interprofessional collaboration can occur. In the present study the authors examined relationships between primary care clinics in the Appalachian region’s characteristics (i.e., clinic type, rurality, and clinic size), barriers (i.e., fiscal, structural, and systemic) reported to using increased collaboration, and the level of collaboration used at a particular clinic. For the present study 136 surveys were completed by providers working in primary care practices across the Appalachian region of Tennessee. The results showed that only about one fifth of the primary care clinics in Appalachian Tennessee reported engaging in moderate to high levels of primary care behavioral health (PCBH) collaboration (e.g., colocated or integrated models of care). Among community health clinics, however, nearly half reported moderate or high levels of collaboration. The findings of this study underscore the importance policy change (e.g., changes in reimbursement patterns, increases in incentives, introduction of PCBH models in training programs) in facilitating the uptake of high levels of PCBH collaboration in Appalachian Tennessee (especially in regards to nonpublicly funded clinics). Further, the methodology used in this study could provide policymakers and researchers in other regions of the U.S. with a means for obtaining baseline data regarding local trends in PCBH collaboration and could serve as first step in developing a standardized methodology for comparing the overall uptake of PCBH collaboration models across regions.

Socialtjänsten är en kommunal verksamhet som har ansvar att tillhandhålla sociala tjänster för barn och unga. Barn- och ungdomspsykiatrin är en del av hälso- och sjukvården som är organiserad på regional nivå. Syftet med denna uppsats har varit att undersöka hur samverkan fungerar mellan BUP heldygnsvård och socialtjänsten när en ungdom är inskriven inom heldygnsvården. Studien baseras på åtta kvalitativa intervjuer med professionella inom både BUP:s heldygnsvård och socialtjänsten. Vi använde oss av en semistrukturerad intervjuguide där materialet analyserades utifrån tematisk analys. Med utgångspunkt från samverkansteori och gräsrotsbyråkrati kunde vi sedan fördjupa vår analys utifrån resultaten. Studien visar på att samverkan generellt sett är relativt god, där båda professionerna fokuserade på barnets bästa. Framgångsfaktorer inkluderar vilja till samarbete, kontinuerlig kommunikation och gemensamma möten. Hinder för samverkan inkluderar tidsbrist och brist på effektiva system för informationsöverföring. För att förbättra samverkan i framtiden efterlyser respondenterna bättre system för informationsöverföring och mer kontinuerliga möten. Tydligare riktlinjer och ökade resurser kan också underlätta samarbetet. Genom att BUP:s kuratorer ökar sin förståelse för socialtjänstens arbete och kommunicerar mer effektivt, kan en mer integrerad och effektiv vårdmodell utvecklas, vilket skulle gynna både ungdomar och deras familjer. / The social services are a municipal organization responsible for providing social services for children and young people. Child and Adolescent Psychiatry (BUP) is part of the healthcare system, organized at the regional level. The purpose of this thesis has been to investigate how collaboration functions between BUP inpatient care and social services when a young person is admitted to inpatient care. The study is based on eight qualitative interviews with professionals from both BUP inpatient care and social services. We used a semi-structured interview guide, and the material was analyzed using thematic analysis. Based on collaboration theory and street-level bureaucracy, we were able to deepen our analysis of the results. The study shows that collaboration is generally relatively good, with both professions focusing on the best interests of the child. Success factors include the willingness to cooperate, continuous communication, and joint meetings. Barriers to collaboration include time constraints and a lack of effective systems for information transfer. To improve collaboration in the future, respondents call for better systems for information transfer and more continuous meetings. Clearer guidelines and increased resources can also facilitate cooperation. By BUP counselors increasing their understanding of social services' work and communicating more effectively, a more integrated and efficient care model can be developed, which would benefit both young people and their families.