Negotiating collaborative agreements: Interprofessional collaboration in a Norwegian welfare context

ABSTRACT

Interprofessional collaboration among welfare services is a policy objective promoted to ensure successful service provision to people with complex needs. In the Nordic region, people who are not in education, employment, or training often have challenging life situations requiring help from a multitude of services. In Norway, significant political and institutional efforts focus on implementing policies that support collaboration. However, we know little about how service workers formalize joint efforts. In this study, I used institutional ethnography to explore how interprofessional collaboration was constructed through negotiations of collaborative agreements among leaders of welfare services and how such negotiations are consequential for collaborative practices. I explored two cases of negotiations initiated by the leader of the Norwegian Labor and Welfare Administration. The negotiations were with the local child welfare and protection services and Refugee services, focusing on the transition of care regarding youth and refugees. The data includes two collaborative agreements between the services, an observation of the negotiation of one agreement, and 10 interviews with leaders and staff. Results show that collaboration is constructed based on holistic service provision. The negotiations, however, do not result in such collaborative practices, but are characterized by the demarcation of responsibilities and work.

KEYWORDS:

• Child welfare and protection
• collaboration
• Norway
• refugee
• social welfare
• welfare services

Introduction

Interprofessional collaboration among welfare services has often been perceived as necessary to achieving successful service provision to people with complex needs (Anvik et al., 2019). Understood as interaction aimed at establishing and maximizing knowledge and competence across services and professions, interprofessional collaboration is a strategy of service providers and their leaders to reach common goals (Anvik & Waldahl, 2017; D’Amour et al., 2005). Collaboration is understood as the integration of different service providers’ efforts and perspectives when following up with service recipients. Coordination, however, implies service providers of different welfare services seeking to align their tasks conjointly. Leaders at different levels of the respective services typically encouraged such alignment to handle specific societal problems (Anvik & Waldahl, 2017). The transaction costs, however, are commonly underestimated when considering whether to engage in interprofessional collaboration (Huxham & Vangen, 2005). Establishing new routines and forms of interaction is resource-consuming and demanding on an interpersonal level (Huxham & Vangen, 2005). Still, interprofessional collaboration is often a recommended strategy in policy documents (Anvik et al., 2019), requiring service providers to plan and agree on routines to transcend professional boundaries (D’Amour et al., 2005). Thus, planning serves to avoid ad hoc approaches to collaboration, whether workers in the welfare services initiate it or policies sponsor it and governments mandate it. In this article, I draw attention to the organization of interprofessional collaboration by asking: How is interprofessional collaboration constructed through the negotiation of collaborative agreements among leaders of welfare services? Furthermore, how are such negotiations consequential for collaborative practices?

Background

In general, the Norwegian welfare system is extensive because everyone receives services through schooling, health service provision, and social benefits at different phases during their lifespan (Sandvin et al., 2020). People caught up in social disadvantage, however, are at times in need of intensive service provision, and embark on the institutionalized processes of service engagement. Regardless of the causes of the disadvantage, people need economic support from the Norwegian Labor and Welfare Administration (NAV). Service providers in NAV are therefore engaged in interprofessional collaboration. Thus, the starting point of this study is the experiences NAV staff have with interprofessional collaboration with the municipal child welfare and protection Services (CWP) and Refugee services.

NAV is a partnership managed partly by the central government and the municipal government. CWP is a municipal service whose workers’ mandate includes services for children, such as parental guidance, and protection services when children need foster care. CWP also has the responsibility for young people’s transition from children to adult services, such as NAV. This transitional phase is called post-adolescent care. The municipal refugee services are responsible for the Introductory Program for refugees in Norway consisting of language training and classes about Norwegian society. It usually lasts two years, with a maximum duration of three years. Every refugee is supposed to have an individual plan, specifying the goals for the program. At the finalizing stage of the Introductory Program, the interprofessional collaboration between NAV and the Refugee Services is necessary in cases where the refugees do not proceed to further education, employment, or training.

In Norway, the organization of the welfare system is influenced by the ideology of New Public Management, hereafter NPM (Christensen & Lægreid, 2007). More precisely, NPM brought forth the idea of direct control over work processes by supervision, thereby introducing objectives to measure performances in detail (Griffith & Smith, 2014) to increase the efficiency of public institutions (Christensen & Lægreid, 2007). Consequently, an intensified demarcation between agencies developed. The demarcation of the agencies lead to professionals within the agencies specializing further in knowledge within their fields, in order to achieve service specific objectives (Christensen & Lægreid, 2007). Such specialization, in combination with leaders’ supervision over work processes, meant that service providers’ roles and work were delimited to the spheres of their respective welfare services (Anvik & Waldahl, 2017). Thus, interprofessional collaboration has gained momentum as a strategy aimed to compensate for the demarcation of service providers’ specialized knowledge to comply with objectives transcending the respective services’ mandates.

The political focus on collaboration, coordination, and establishment of collaborative agreements between welfare services and different levels of the bureaucracy has prevailed for decades (Lægreid et al., 2015). Internationally, Firbank et al. (2016) found that collaborative efforts initiated at the grassroots level by service providers more often lead to positive outcomes than collaboration mandated from the top. In contrast, they found that in the case of Norway, when leaders mandated collaborative initiations, collaboration was prioritized among service providers. In their studies about leadership in CWP and health care, Willumsen (2006) and Folkman et al. (2019) respectively found that leaders of collaborative efforts organized collaboration through co-governance rather than through hierarchical ruling. However, emphasizing routines and division of responsibilities to formal frameworks such as laws and regulations were central to collaboration (Willumsen, 2006), thus enhancing the potential of formalized collaboration despite nonhierarchical organization.

Considering CWP, Breimo et al. (2019) found that workers and leaders of CWP participated extensively in formalized collaboration with service providers of other welfare services. CWP service providers’ motivation to collaborate, however, was limited to the responsibility and mandate of CWP as defined by the legal framework. This limitation enhanced the instrumental understanding of collaboration – as something frontline workers do to obtain CWP service-specific goals (Breimo et al., 2019). Other goals thus become secondary. To enhance collaboration, the Norwegian Directorate of Children, Youth, and Families and the Directorate of Labor and Welfare developed guidelines for collaboration between NAV and CWP (Nav.no, n.d..). The leaders and service providers on the municipal level alike are obliged to follow these guidelines and adjust them to the local setting of NAV and CWP.

In contrast, Vannebo and Breimo (2020) found that regarding the Refugee services, collaboration among service providers is characterized as “boundaryless,” referring to the feeling of exclusion that service providers experienced in interactions they had with other welfare service providers. The organization of responsibility between the Refugee service and other services is less visible, and collaboration has been characterized as ad-hoc (Vannebo & Breimo, 2020). In 2017, the Ministry of Justice and Public Security published Circular G-27/2017 (og beredskapsdepartementet, 2017), insisting on the formalization of collaboration between leaders and service providers of NAV and the Refugee services, stating that the leaders of the respective services were obliged to formalize collaborative efforts through agreements. Thus, an increased emphasis on formalizing collaboration through agreements is evident, but knowledge about how leaders and frontline workers alike experience the implementation of such agreements is still needed.

Method

Research design

In this study, I applied institutional ethnography (Smith, 2005) as a theoretical framework and methodology to explore welfare service staff’s experiences of negotiating collaboration and how this negotiation is consequential for collaborative practices. Institutional ethnography is a critical approach that directs the researcher’s attention to the lived experiences of people to explicate discourse through social practices. The concept of work in institutional ethnography reflects the range of activities that people do – whether paid or not – that take up their time and require physical or mental effort (Smith, 2005, pp. 151–152). As an institutional ethnographer, one seeks to explore how people’s work is shaped by and is shaping institutional and political discourse.

To uncover how people’s work is tied to discourse, one has to explore which texts coordinate people’s work with the work that other people do in other places and at other times (Smith, 2005, p. 166). By incorporating texts, which are replicable, one can understand the work people do at particular sites beyond the particularity of those sites. In institutional ethnography, the text is understood as existing in material form, as writing on paper, music, pictures, and signs. The replicability of text entails that the text has the same writing, sound, or shape – depending on the material form of the text – when located at different sites. The replicability of text makes it possible to distribute the text. Furthermore, through distribution, the shaping of social practices occurs. The shaping of social practices happens when readers of a text activate it by applying the text’s message in a local setting, thereby anchoring the text in that specific setting (Smith, 2005).

Specific to this study, collaborative agreements between NAV and CWP, and NAV and the Refugee services were established by the leaders of the three services and distributed to all staff. These texts generate circuits of accountability (Griffith & Smith, 2014, p. 12), aligning the work of the staff with the objectives given importance to in NAV, CWP, and the Refugee services.

Data collection

Semi-structured interviews

I conducted semi-structured interviews with NAV leaders (n = 4) in 2018 and 2019. In the interviews I focused on five topics, a) the organization of the welfare service, b) needs to collaborate, c) collaborative partners, d) challenges, and e) lack of collaboration. Although I focused particularly on work practices and routines around young service recipients, the four NAV leaders described the experiences of both young people’s and refugees’ transition from one service to another as challenging. To establish routines for such transitions, one of the NAV leaders that I had previously interviewed had organized meetings with the leaders of CWP and the Refugee services to negotiate collaborative agreements.

Observation and text

The NAV leader granted me access to observe the meeting between the NAV (n = 1) and the CWP (n = 1) with their respective subordinate leaders (n = 2). Beforehand, the NAV leaders sent me a draft of the agreement. The observation lasted for an hour and a half, where the NAV leader led the meeting, reading through the drafted agreement, while directing the discussion on each point in the text. Due to the COVID-19 pandemic, the meeting was held online, over Teams, making it challenging to observe the participants’ body language. The format, however, enabled me to write down field notes discretely. Observing the discussion on how the agreement ought to be formulated provided insight into collaborative practices and the discursive argumentation behind specific formulations. I did not have access to observe the negotiation of the agreement between the leaders of NAV and the Refugee services due to calendar scheduling issues. Instead, the NAV leader sent me the final version of the agreement after the meeting.

Focused interviews

After investigating the two collaborative agreements, I conducted focused interviews with the NAV leader (n = 1), and the leader (n = 1) and frontline workers (n = 2) of the team members in NAV that worked with youth. I also conducted focused interviews with the leader (n = 1) and a frontline worker (n = 1) of the Refugee services. The focused interviews lasted 30 minutes, where I asked the question “What role has the collaborative agreements played for you in your work?” I followed up with questions during the interviews, encouraging the participants to illustrate through anonymized examples. The focused interviews were conducted online, through Teams.

Fieldwork context

The three welfare services were situated in a small town of less than 7,000 inhabitants, resulting in small staff groups. The benefit of observing and interviewing small staff groups is that the experiences shared by the participants reflect the collaborative work among the welfare services holistically. As an example, by interviewing everyone in the youth team in NAV – although the total number of involved staff was limited to four participants – I was provided with the opportunity to observe what consequences the negotiation of the agreement had on the youth team as a whole. Also, accessing data in different forms online e.g., collaborative agreements, interviews and observation of group interactions helped mitigating the consequences that the COVID-19 pandemic had on data collection.

Participant information and consent procedures

I provided the participants with information about the study, consent, and data storage in a document beforehand. I also informed the participants verbally before initiating interviews and the observation. The participants gave their verbal and written consent to participate in audio-recorded interviews and observations. Regarding the collaborative agreements included in this study, the leaders of NAV, CWP, and Refugee services consented to the inclusion of these documents. There was no need for further organizational consent for the inclusion of the agreements.

Data collection tools

I conducted the semi-structured interviews in-person at the NAV-leaders’ offices. The meeting I observed, and the focused interviews were held over Teams. I used an audio-recorder to record the interviews and observation. I transcribed the interviews in Norwegian and translated the transcripts into English.

Ethical considerations

I anonymized participants’ identities, and all names referred to in this article are pseudonyms. I anonymized information in the collaborative agreements that could identify the municipality and participants. This study was registered at and approved by NSD – Norwegian Center for Research Data under project number 831,918.

Data analysis

Semi-structured interviews

I started the analysis by reading through the interview data of the four NAV leaders. As part of the analytical work, McCoy (2006) suggests asking questions about the data. To understand the work NAV leaders did or did not do to formalize collaboration, I asked about the data: Why do they do this work in that specific way? Their experiences in formalizing collaboration differed, and this made me curious to explore these processes further.

Text

When reading the agreements, I actively looked for what Smith calls facts: “A fact is something that is already categorized, already worked up to conform to the model of what that fact should be like” (Smith, 1990, p. 27). To explore how interprofessional collaboration was constructed, I asked a) How is interprofessional collaboration categorized in the texts? and b) How is the categorization of interprofessional collaboration enabled/authorized in the texts? A discernible characteristic when searching for facts in the texts was the persistent insistence on the division of responsibilities and work.

Focused interviews

Interested in understanding how consequential these details on the division of responsibilities and work were for the leaders’ and service providers’ collaborative practices, I asked c) How do people know what to do when collaborating? Moving back and forth between the text, observation, and interview data, there was one common theme regarding the division of responsibilities and work; namely, participants identified the transition of care as a key challenge.

Results

The results in this study show that leaders construct collaboration based on holistic service provision. The negotiations, however, do not result in such collaborative practices, but are characterized by the demarcation of responsibilities and work, to reduce the need to collaborate.

NAV leaders’ experiences with collaborative agreements

The four NAV leaders explained how they perceived the role collaborative agreements played in the organization of collaboration with other welfare service providers. One of the NAV leaders explained that such an agreement would lead to more cohesive service provision for service recipients through establishing set routines of interaction and formalizing outputs of collaborative efforts: “Such an agreement will first and foremost establish what the collaboration is based on, both in regard to the Refugee services and CWP” (Carina, NAV leader). For Carina, an agreement needed to be based on the tasks and mandates of the welfare services involved. Carina had previously indicated that roles needed to be explained and routines established between the different services. Establishing agreements with CWP and the Refugee services was of particular importance for Carina. Carina explained that people receiving services often had complex life situations that required interprofessional collaboration. Thus, the motivation for making agreements was to provide service recipients with holistic help, as well as be a tool for workers in NAV to fulfill their tasks.

NAV leader Tom, however, did not have the same view on establishing agreements: “I think if there is a need to make collaborative agreements in order to initiate collaboration, it is a sign that there is something problematic [between the services].” Tom considered establishing collaborative agreements unnecessary when frontline workers provided joint services to user recipients adequately. Formal agreements were an indication of challenging interactions between collaborative partners. Tom explained that establishing agreements could lead to the opposite result:

The Refugee services used to be organized as part of NAV. Now they have been separated from us […] we used to perceive them [the Refugee services] as part of NAV. But then the ministry released a circular called G-27 where they sort of … say how the collaboration should be organized—as if we [NAV and the Refugee services] were divided (Tom, NAV leader).

Tom indicated that the agreement obliged by Circular G-27 demarked the two welfare services in question, creating a gap between them that had not been there before and implementing it through new institutionalized routines of interaction.

The NAV leaders’ experiences of establishing agreements differed. Tom indicated that the agreement between NAV and the Refugee service changed and partly eradicated the feelings of being colleagues across NAV and the Refugee service. Contrastingly, in Carina’s experience, the agreements served as a tool to define responsibilities, leading to more cohesive service provision and recognition of each service’s respective tasks. Carina reported working actively to establish collaborative agreements. Carina’s work made me curious about the negotiation processes she was involved in, which led me to explore this process in her community.

Negotiating a collaborative agreement: NAV and CWP

NAV-leader Carina’s work on negotiating the collaborative agreement with the CWP leader included drafting the agreement before sending it to the CWP leader ahead of the scheduled meeting. The agreement consisted of five pages, and most of the text – except for a few alterations – was extracted from the national guidelines for collaboration between NAV and CWP (Nav.no, n.d..). The text contained an introduction claiming the need for collaboration, followed by the legally stipulated obligations to collaborate. The text addressed the services’ respective responsibilities and mandates before tackling collaboration regarding service provision for families in socially and economically challenging situations and service provision for youth receiving post-adolescent care.

The agreement was based on two facts: a) NAV and CWP’s “ … purpose and tasks border each other” and b) “ … they often relate to the same families and youth” (Collaborative agreement, NAV and CWP). The aim of the text was explicitly stated, namely that the services “ … through this collaborative agreement wish to strengthen collaboration” (Collaborative agreement, NAV and CWP). When reading the agreement, I read the two facts as implicit reasons for the need to strengthen collaboration, reflected in the division of responsibilities and work regarding the issues of service provision for families in socially and economically challenging situations and for youth receiving post-adolescent care. In the meeting where the two leaders and two subordinate leaders of these services negotiated the agreement, they paid considerable attention to the specific points clarifying who should do what in specific situations.

One of the discussions in the meeting was regarding post-adolescent care of young people aged between 18 and 23 receiving services from CWP¹. In the meeting, Carina introduced post-adolescent care as an issue. As a reaction, all four participants took deep breaths and sighed, laughing slightly, voicing their concern about post-adolescent care being a difficult issue. CWP leader Frida took charge of the topic, explaining that CWP as a welfare service holds the main responsibility for these young people. Following Frida’s comment, Carina added an additional comment to the draft: “CWP has the main responsibility/is the coordinating service as long as the person is registered as recipient of post-adolescent care services” (Collaborative agreement, NAV and CWP). Frida explained that this responsibility included calling involved parties to meetings, coordinating service provision from different welfare services, and ensuring that young people receive the services they are entitled to.

When I asked why the participants of the meeting were sighing, Frida explained that post-adolescent care was a difficult area for the welfare services:

We do not really know quite which measures to initiate … who is responsible for what. It goes a bit back and forth, time passes, and the young people sort of disappear between our hands. And, we spend a lot of time discussing “is it our responsibility, is it someone else’s responsibility?” (Frida)

The uncertainty of who is responsible for what often boils down to a question of resources, Frida explained. Other welfare services might not necessarily know that although other services other than CWP provide services for this group of young people, the leader of the sector to which CWP belongs refunds resources spent on these young people at the end of the year. Although this reflection was not specifically aimed at their interactions with NAV, Frida stated that establishing an agreement is an asset as “it will be very good to know who will do what” (Frida). On all points concerning responsibility, the participants from CWP, Frida and Caroline, stated that it was the CWP’s responsibility to follow up with youth receiving post-adolescent care services.

The participants specifically negotiated when frontline workers of NAV should be involved in the follow-up. After Carina had read the following question from the draft “Should all youth that are in contact with CWP become service recipients of NAV?” (Collaborative agreement, NAV and CWP), Caroline – second in charge of CWP – replied abruptly, “Oh no! No, no!” Caroline and Frida laughed, slightly perplexed:

Frida:

No! They shouldn’t [become service recipients of NAV]!

Caroline:

Oh my God!

Frida:

There could be room for it, but I do not think that everyone should automatically go [to NAV]. We should not teach them to become NAV-service recipients!

Carina’s response to Frida and Caroline’s exchange is acknowledgment in the sense that she attempted to find a formulation accepted by them, thus, adding, “It will only be relevant for those in need of follow-up from NAV” (Collaborative agreement, NAV and CWP). Carina and her subordinate leader Irene discussed for a moment how they could change practices in NAV’s youth team to accommodate Frida and Caroline’s consideration and decided to create a new routine for the frontline workers in the youth team. When young people register as service recipients, the frontline workers have to ask directly whether they receive any services from CWP and, if they do, whether they consent to collaboration between NAV and CWP frontline workers since the coordinating responsibility lies with the frontline workers of CWP. Figure 1 illustrates the placement of responsibility as a circuit of accountability, showing how frontline workers place the responsibility for following up with youth in post-adolescent care with the CWP staff.

Figure 1. Circuit of accountability: Follow-up of youth in post-adolescent care.

The leaders of NAV participating in the meeting decided to change practices of frontline workers in NAV’s youth team because of the negotiation of the agreement. By acknowledging the responsibility of who should follow up with these youth, Carina and Irene aligned the youth team’s work regarding youth receiving post-adolescent care with the institutional responsibility and objectives of the CWP workers. Such a demarcation of the potential joint effort of NAV and CWP workers can be regarded as counterproductive to interprofessional collaboration when understanding such collaboration as joint work to reach the objectives of CWP. However, the demarking of responsibilities in the collaborative agreement shows that the agreement is meant as a tool to align – rather than integrate – service provision between workers of NAV and CWP.

Negotiating a collaborative agreement: NAV and the refugee services

The collaborative agreement between NAV and the Refugee services was seven pages, and most of the text was extracted from circular G-27/2017. The circular is an instruction on responsibilities and obligations regarding collaboration between NAV and the Refugee services. The agreement contained an introduction stating that the services need to collaborate in providing services for refugees, followed by an explanation of the services’ responsibilities toward the refugees. The text addressed the need to negotiate a collaborative agreement between the two services, followed by a list of responsibilities and obligations. The next section explained the organization of the collaboration on two levels (e.g., between leaders and between frontline workers). This section specified the names of specific people and their roles. The last point in the agreement encouraged collaboration in interprofessional teams when necessary to include other professions. The last section in the agreement was the coordination of benefits between NAV and the Refugee services, before closing with the leaders’ signatures.

When reading the text, I found one main fact regarding collaboration, namely, “ … the Introductory Program should result in a swifter transition to ordinary work for newly arrived immigrants, [and that] NAV should have a central role in the shaping and implementation of the Introductory Program” (Collaborative agreement, NAV and Refugee services). The aim of this agreement is “ … to provide clear guidelines for collaboration … in regard to dividing responsibilities, information flow, and collaborative routines” (Collaborative agreement, NAV and Refugee services). Moreover, “ … well-functioning collaboration is important to ensure an efficient and targeted Introductory Program for every participant” (Collaborative agreement, NAV and Refugee services). The aim of the agreement was authorized in the introduction of the agreement by a reference to the Introductory law (Introduksjonsloven, 2003) regarding newly arrived immigrants. The reference to the Introductory law was followed by “The work of the follow-up of participants in the Introductory Program has to be aligned with […] the activities and prioritizations of both NAV at the county level and the municipal level” (Collaborative agreement, NAV and Refugee services). I read the fact and the aim of the agreement as an attempt to align the work done by frontline workers in the Refugee services with the activities and priorities that workers of NAV adhere to. In the interviews with the leaders and frontline workers of NAV and the Refugee services, the participants shared their experiences with collaborative routines and information flow and reflections on what activities and priorities they attached importance to regarding the refugees.

Linda, a frontline worker in the Refugee services, explained how the agreement ideally should inform people working in the Refugee services about NAV’s work tasks and vice versa, but that “it did not work as planned” (Linda). Linda explained that she often assisted refugees in filling out applications for them to receive social benefits from NAV:

We [in the Refugee services] have to print out everything they [the refugees] need [for the application]. We have to provide the printouts from their bank accounts, and the annual tax reports when these are published, instead of them [the refugees] going to the NAV office as we originally agreed upon: that they go there … and have a dialog with their councilor there [in NAV] (Linda, frontline worker Refugee services).

According to Linda, the work of helping to fill out applications to NAV was work that the workers in NAV should do. Linda explained that since she did not work in NAV and therefore did not have the necessary knowledge about NAV, she felt that she only had her experiences as a Norwegian to guide the refugees through the application process. Regarding the application for social benefits, Linda pointed out this mismatch in the work that NAV workers ought to do and the work that people in the Refugee services do by referring to the agreement.

When I asked Julie, a frontline worker in NAV, about this issue, she responded that it was challenging to assist refugees in filling out the application for social benefits: “The problem is that we do not have any close contact with these service recipients [refugees] … it is a bit difficult for us to know what they [the refugees] are lacking, what they need” (Julie). Julie explained that it made more sense that the workers in the Refugee services assisted in applying for social benefits because they knew the refugees and their needs better. When I probed this issue further, Dina – the leader of the youth team in NAV – explained that the question of who should assist refugees in applying for benefits was neither specified in the collaborative agreement nor agreed upon informally by the frontline workers of NAV and the Refugee services. According to Dina, the question was less about the work task itself and more about the reasons behind the refugees’ need for help:

We have previously agreed upon that the frontline workers of the Refugee services should do those pieces [of work tasks] about training and such. So, is [applying for social benefits] training and integration, or is it a support function [in NAV]? (Dina).

Here, Dina explained that behind each work task, there is a reasoning for who should do what. If filling out applications for social benefits was considered part of the refugees’ training, then Dina considered it as part of integration work and therefore not a task that workers in NAV were responsible for: “We [in NAV] think that when you have learned how to apply to NAV digitally, then you have also learned when you should [apply]. It is sort of the purpose of the training” (Dina). The support function that NAV staff can assist the refugees with the application process is to inform them when to apply for social benefits, meaning that they have knowledge about the criteria for receiving social benefits. Dina explained that by learning to apply digitally – which she considered training and therefore a work task that frontline workers in the Refugee services should do – the refugees will gain knowledge about when they should apply as well. Accordingly, the support function in NAV that Dina explained become superfluous as the refugees will learn when to apply through the integration work done by workers in the Refugee services.

Frontline workers in the Refugee services activated the agreement, holding the frontline workers in NAV accountable for the work they do concerning applying for social benefits. Concurrently, the leader of the NAV youth team considered this work part of the integration and training work that workers in the Refugee services ought to do, while workers in the Refugee services considered this particular work task to be a support function in NAV. Figure 2 illustrates this work task as a circuit of accountability, showing how frontline workers mutually oppose their collaborative partners’ understanding of how responsibility should be divided.

Figure 2. Circuit of accountability: Applying for social benefits.

In Figure 2, the workers in the Refugee services activated what Dina in NAV called the “service function.” Dina, however, did not explain this work as service function, but rather as “integration work” through digital training because the application is filled out online. If the refugees needed assistance to apply for social benefits digitally, NAV staff considered that the refugees had not received adequate training by workers of the Refugee services, and the work task of assisting refugees in the application process was therefore considered training – not service work. Thus, NAV staff considered the work of assisting refugees in applying for social benefits as work of the Refugee service staff. In this example, the circuit of accountability illustrates how the staff of NAV and the Refugee services demark responsibility and work related to the application process for social benefits. The collaborative agreement is a text in which they formalize this demarcation.

Discussion

In this study, I show that by dividing responsibilities and tasks for service providers to fulfill their respective service objectives, the collaborative agreements become a tool for the leaders and frontline workers alike to reduce the need to collaborate. As Anvik and Waldahl (2017) argued, collaboration requires mutual integration of service providers’ efforts and perspectives. Emphasizing the demarcation of service providers’ respective responsibilities makes it challenging to integrate different perspectives in the follow-up with youth, refugees, and other service recipients.

The asymmetrical relationship between the services in this study can help explain the challenges to service integration. D’Amour et al. (2005) stress that successful collaboration requires the participants to establish a true partnership where every participant is empowered and recognized. In cases where asymmetry results in constraints in communication and availability among collaborative partners, the consequences may lead to delays or halts in service recipients’ progress (Pedersen, 2020). Through negotiations of the agreements, the leaders of the respective services communicated the division of responsibilities and negotiated intersecting discourses. The legal responsibility that service providers in CWP hold in following up with youth in post-adolescent care intersects with how workers in the NAV youth team interact with youth, constructing an asymmetrical relationship between frontline workers in NAV and CWP favoring the institutional objectives of CWP. Such an asymmetry in favor of CWP is in contrast with the findings of Firbank et al. (2016). The potential consequences are that the involved participants may find it challenging to collaborate successfully, leading to further division of responsibilities. An agreement in which responsibilities and roles of participants engaged in interprofessional collaboration are articulated and differentiated may be beneficial to enhancing clarity regarding scope, intent, and purpose (Massi et al., 2021). However, when the scope of collaborative efforts does not reach beyond a participant’s service objective, the instrumental understanding of interactions may limit the potential outcome that lies within differentiating responsibilities. Thus, the necessary interprofessional perspectives are made invisible in the mediated text with the insistence on differentiating responsibilities between service providers.

Likewise, the focus on integration work aimed at refugees is sharpened when intersecting with the service work of frontline workers in NAV, consequently delimiting the potential for an integrated perspective of integration, digitalization, and system learning. I show how discourses on integration were anchored in the local practices of applying for social benefits – and activated by the NAV staff – resulting in the obscuring of responsibilities.

The collaborative agreements as texts in Smith’s (2005) understanding, shape and anchor the discourses on integration, post-adolescent care, and social labor practices in the interactions between frontline workers of the three services in this study. By illustrating the work of leaders and frontline workers as circuits of accountability, I highlight what objectives are given priority and how collaborative efforts of leaders and frontline workers alike are aligned with these objectives. In the joint efforts of NAV and CWP staff, the legal responsibility of follow-up of youth under post-adolescent care mandates the interaction between service staff. Likewise, the priorities of workers in the Refugee services must align with the labor market activities and priorities of the NAV staff, affirming the asymmetrical relationship between participants. Challenges in aligning activities and priorities in collaboration are relevant internationally, where the struggle of closing gaps between collaborative objectives and practice is recognized (Huxham & Vangen, 2005).

A limitation of this study is that the context of the issue is Norway; thus, the findings may not be directly applicable to other countries. However, the political focus on formalizing coordination and collaboration between and within organizations is similar to that in Nordic and other European countries, as well as internationally (Lægreid et al., 2015). Thus, there may be both practical and policy implications even though local contexts may differ.

The results may help practitioners merge different professional perspectives when engaging in interprofessional collaboration. Leaders of welfare services may use the results when considering potential outcomes of negotiating collaborative agreements to achieve service provision that meets the needs of recipients, regardless of the complexity of their life situations. The results are relevant for frontline workers engaged in interprofessional collaboration, shedding light on potential challenges related to collaborative partners and service recipients. Successful collaboration between partners has the potential to improve access to services and provide appropriate help and measures for youth in post-adolescent care and refugees alike. On a policy level, insights from this study can be used to inform further development on interprofessional collaboration in a social welfare context, emphasizing the needs of service recipients, where the objectives of welfare services contribute to unique professional perspectives, rather than benchmarks for how to distribute and divide work tasks and responsibilities.

Conclusion

An overall conclusion of this study is that the demarcation of service providers’ respective responsibilities in collaborative agreements can be useful in achieving each service’s objectives, but counterproductive in promoting integrated professional perspectives in the follow-up of service recipients with complex service needs. Based on the results of this study, I suggest that frontline workers be included as stakeholders in the further development of agreements. In addition, I recommend further studies on how service recipients with complex service needs experience the implementation of collaborative agreements regarding their needs being met.

Acknowledgments

The author would like to acknowledge the contributions of Sophie Hickey and Jonathan Quetzal Tritter for their feedback in various stages of the writing process.

Disclosure statement

No potential conflict of interest was reported by the author.

Data availability statement

The data that support the findings of this study are available from the corresponding author, [L.-M.L.P.], upon reasonable request.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.

Notes on contributors

Linn-Marie Lillehaug Pedersen

Linn-Marie Lillehaug Pedersen, PhD Candidate in Sociology, has a special interest in topics about public welfare in the Nordic countries. Her work and research has focused on interprofessional collaboration and youth.

Notes

1. From January 1^st of 2021, the age limit for post-adolescent care was raised from 23 to 25 (see the Norwegian Government’s webpage: https://www.regjeringen.no/no/tema/familie-og-barn/barnevern/tiltak-i-barnevernet-for-ungdom-over-18-/id670234/).