Implementation study of a system design for the organization of diagnostics for children and adolescents in Flanders

This research plan in support of the policy fits within the projects "diagnostics" and "1 child 1 diagnosis", of the Agency Growing Up. Diagnostics must be given a more prominent place within developmental trajectories and the fragmentation of diagnostic activities must be overcome in order to arrive at a transparent, equally accessible and nearby supply for everyone.
In the field of social work, one is increasingly confronted with a group of young people whose requests for help cannot be adequately answered by social work. It concerns young people with extreme behavioral problems, aggression, internalizing problems, ... often in combination with intellectual disability, psychiatric problems and an inadequate family context. The continuity of the assistance trajectories is often hindered by inadequate access to appropriate diagnostics and care. One of the conclusions of the improvement note 'managing blocked developmental trajectories in young people, preventing intervention' (2018, Decoene et al.), commissioned by Minister Vandeurzen, was that the absence of quality diagnostics is a major pain point. Research on the accessibility of multidisciplinary diagnostics of developmental disorders in Flanders (Cloet, Kimpe, Van Ransbeeck, Leys, 2020) confirms that the accessibility of diagnostics is insufficient. There is a lack of capacity, there is a need for more even regional distribution of knowledge, expertise and capacity and it is recommended to strive for better organized collaboration to use the available capacity more efficiently. After all, the landscape of facilities offering diagnostics is heterogeneous. Organizations engage in and work with diagnostics from a variety of organizational goals and habits, with varying composition of teams and from different work practices. Access to diagnostic services, the nature of diagnostics and the target group (age and pathology) differs between organizations and is not aligned, neither between organizations of the same type nor of different types. Organizations and professionals lack an unambiguous vision of the concept of diagnostics and how it should be concretely implemented. There is an equal lack of a shared inter-organizational vision of quality diagnostics and how the integration of activities can be shaped. Policy orientations and regulations for the different types of organizations have historically been developed in a fragmented way, which has an impact on the way of working (together). There is a need for a more shared policy framework, set up from a cooperation logic. The biggest known barrier to working together inter-organizational is the lack of mutual trust in the quality of the diagnostics delivered, which is reinforced by insufficient mutual detailed knowledge about the way of working and the lack of a shared frame of reference from the authorities involved.
The COVID 19 pandemic has reinforced the accessibility problem with even longer waiting times for diagnostics, which has a direct impact on the child's care and support trajectory. Bridge care (or bridging care) is needed to avoid major social and cultural inequalities where children and youth are not receiving appropriate care due to accessibility issues, while waiting for quality and refined diagnostics.