Peer-reviewed article

Intermediary Relational Coordination in Fragmented Child Developmental Support Systems: An Early Implementation Evaluation of a Multi-Agency Network in Japan.

Akihiro Sato · 23 Oct 2026

Abstract

BACKGROUND: Fragmentation across healthcare, education, welfare and community-based services creates persistent challenges for coordinating support for children with developmental difficulties. Formal integration across these sectors may be difficult to achieve. This study explored how participating professionals perceived cross-sectoral collaboration during the early implementation of a paediatrician-initiated multi-agency network operating within existing institutional structures. METHODS: An exploratory early implementation evaluation was conducted using a retrospective pre-post survey design. An anonymous questionnaire was distributed to 116 network members, of whom 32 responded. Participants retrospectively rated their pre-network experiences and their current experiences across four study-specific domains of collaboration: ease of consultation, understanding of roles across sectors, adoption of a needs-based perspective and confidence in cross-sectoral referral and collaboration. Quantitative data were analysed descriptively, and free-text responses were analysed thematically by two reviewers. RESULTS: Participants reported higher current than retrospective pre-network ratings across all four collaboration domains, with the largest perceived changes in understanding of roles and confidence in cross-sectoral referral and collaboration. Thematic analysis identified four themes: accessible consultation pathways, shared language and mutual understanding, confidence through relational trust and persistent structural constraints. Participants described the value of identifiable consultation contacts and repeated cross-sectoral interaction, while also noting limitations in network reach and continuing institutional barriers. CONCLUSIONS: This exploratory evaluation provides preliminary insight into how professionals participating in a voluntary multi-agency network perceived cross-sectoral collaboration during early implementation. Building on these findings, we propose the M-MEW (Mesh-in-Dome) model as a practice-derived conceptualisation of a bidirectional and multidirectional relational mesh developing across existing institutional structures. The model envisages an initial facilitating hub supporting network formation, with the potential for coordination to become increasingly distributed as reciprocal relationships develop. Prospective evaluation is required to determine whether this model improves collaboration or outcomes for children and families.