Multi-agency Approach Research Articles

Changing Gears and Buying Time: A Study Exploring AMHP Practice Following Referral for a Mental Health Act Assessment in England and Wales

Abstract The role of the Approved Mental Health Professional (AMHP) under the Mental Health Act (MHA) 1983 in England and Wales is to respond to referrals for psychiatric detention and make an application for detention where they consider this necessary. This article reports the findings of my doctoral study into AMHP decision-making at the point of referral for an MHA assessment. The strengths-based methodology of Appreciative Inquiry was adopted, positioned in a social constructionist paradigm. Nine AMHPs working for one Local Authority participated in the study, including myself as an insider researcher. During four one-day workshops over five months participants defined their best practice, analysing emerging data together within the workshops using nominal group technique. Service developments included the creation of a triage role and a bespoke report to prioritise this decision within the service, opening avenues to change gears and buy time for a more thorough assessment at this point, and promoting greater collaboration with those referred. A multi-agency approach to searching for less restrictive options was advocated within an assessment pathway. The results of this study offer a research insight into this important area of practice, offering an evidence base to inform practice and policy developments.

Integrated health reporting within the UN architecture: learning from maternal, newborn and child health

Despite a proliferation of the United Nations General Assembly high-level meetings on a range of health issues and developmental challenges, global funding continues to flow disproportionately to HIV and maternal, newborn and child health (MNCH). Using the experience of MNCH, this short article argues that successful human rights framing and the development of robust and regular reporting mechanisms in the international development architecture has contributed to these areas receiving attention. Taking non-communicable diseases (NCDs) as an example of a relatively neglected health area, we propose mechanisms that would improve integrated reporting of health issues in a way that aligns with the move toward cross-cutting themes and matching political and financial commitments with impact. As new frameworks are being developed to support multi-agency approaches to achieving SDG 3—including reporting and accountability—there are opportunities to ensure MNCH and NCDs jointly seek data collection measures that can support specific targets and indicators that link NCDs with early childhood development.

Policy Networks and Relationship between Multiple Streams Approach and Implementation of Road Safety Policy Measures in Kenyan Counties

Policymakers and policy practitioners have pointed out the use of policy networks in the development and execution of road safety policy measures as a suitable strategy for addressing road safety. Governments at all levels—national, state, and local—have moved from single- to multi-agency approaches to handle the execution of road safety policy measures. Previous research on policy networks in road safety has concentrated on the role that organizational networks play in this policy domain. This study aimed to investigate the moderating influence on the relationship between the multiple streams approach and the implementation of key road safety policy initiatives in Kisii and Kisumu counties. The study adopted descriptive survey and explanatory designs. The study adopted pragmatism and phenomenology research philosophies. The Multiple Streams Framework and Punctuated Equilibrium Model served as the study’s foundation. The sample size of the study was 347 of the target population. Quantitative data was examined using multi-linear regression approaches and Pearson correlation analysis. Stepwise regression was used to analyze the moderating variable. Thematic analysis was used to assess qualitative data. The results of the study demonstrated that policy networks influenced the relationship between the MSF and the enforcement of road safety policy measures, which explains 6.5% of the variances in implementation. The study concludes that the execution of road safety rules is a collaborative effort that ought to include policy networks and other pertinent players in the transport industry.

School Administrators’ Support for Teachers’ Training and Maintenance of Digital Literacy Devices, in the Implementation of Digital Literacy Programme in Public Primary Schools in Kitui County-Kenya

Purpose: This study sought to assess the school administrators’ support to implementation of digital literacy program in public primary schools in Kitui County. The study sought to find out whether school administrators had facilitated teachers for digital literacy trainings and to examine whether school administrators had provided for maintenance of the digital literacy devices.
 Methodology: Descriptive survey research design was used. The target population comprised of 3280 school administrators, who comprised of both head teachers and deputy head teachers and 328 classroom teachers making a total of 3608 respondents. A sample of 10% of the total population was taken making a sample size of 361 respondents, comprising of 328 school administrators and 33 classroom teachers. Self-administered questionnaires were used for data collection. A test- retest was carried out in four public primary schools to establish the reliability of the research instrument. Data collected were analyzed descriptively with help of Statistical Packages of Social Sciences (SPSS) version 28.
 Findings: The findings revealed that a large number of teachers were supported by their school administrators to attend digital literacy training sessions. It was further noted that very few administrators always facilitated for repair of the broken parts of the computers 16(9.8%).
 Unique Contribution to Theory, Policy and Practice: The findings of the study will guide the leadership in effective delivery of flagship programs like the digital literacy program through multi-agency approaches.

School Administrators’ Possession of Digital Skills and Digital Literacy Content for Implementation of Digital Literacy Program in Public Primary Schools in Kitui County-Kenya

Purpose: The purpose of this study was to find out school administrators’ possession of digital skills and digital literacy content impact on the implementation of digital literacy program in public primary schools in Kitui county-Kenya.
 Methodology: Descriptive survey research design was used to describe the characteristics of the respondents. Review of related literature was done in line with the objectives of the study. The target population comprised of 3280 school administrators, who comprised of both head teachers and deputy head teachers and 328 classroom teachers making a total of 3608 respondents. A sample of 10% of the total population was taken making a sample size of 361 respondents, comprising of 328 school administrators and 33 classroom teachers. Self-administered questionnaires were used for data collection. A test- retest was carried out in four public primary schools to establish the reliability of the research instrument. Data collected were analyzed descriptively with help of Statistical Packages of Social Sciences (SPSS) version 28.
 Findings: The study established that school administrators’ skills and competencies in digital technology were a good predictor of a smooth digital literacy implementation. On the overall the study found out that schools’ administrators’ possession and use of digital literacy skills was below average. The study further established that 145(88.48%) respondents could access digital literacy content in their school while 19(11.52%) could not access the content in school.
 Unique Contribution to Theory, Policy and Practice: The findings of the study will guide the leadership in effective delivery of flagship programs like the digital literacy program through multi-agency approaches

Parent perspectives of engaging with a community paediatric clinic with linked child development supports in a disadvantaged area of Ireland.

Parent experiences of child health services can be used to understand their value and optimise the support provision to families during critical developmental periods. A gap in the literature exists regarding parental perspectives of linked child development supports, particularly in disadvantaged areas. This study examined parent experiences of the impact and value of a community paediatric clinic (Kidscope) with linked, multi-agency supports in a disadvantaged area of Ireland. Using a qualitative analysis design, 10 parents participated in one-to-one interviews. A Community Advisory Group consulted on interview schedules. Data was thematically analysed in line with Braun & Clarke's Framework. Five themes and twenty-two sub-themes emerged. Kidscope's linked, multi-agency approach was valuable for engaging families, addressing developmental delay, supporting readiness for education, and developing parent-child relationships. Relational working and a child and family centred model of care empowered parents to become active agents in children's health. Coronavirus disease 2019, national deficits in healthcare, and staff turnover impeded service delivery. Kidscope and linked supports work in partnership to disrupt the impact exclusion from healthcare has on vulnerable children and families. This study provides evidence of an effective integrated paediatric service delivery model designed around vulnerable children and families and highlights areas for improvement.

Empowering Older Adults in Underserved Communities—An Innovative Approach to Increase Public Health Capacity for Fall Prevention

Although evidence-based programs have been effective for fall prevention in many communities, older adults living in underserved areas cannot access these services due to the shortage of providers and trainers. In this cross-sectional study, a multi-agency approach was adopted for integrating an evidence-based program, A Matter of Balance (AMOB), into the public health curriculum at a rurally placed university. We assessed student learning as well as the community benefits of fall prevention among those who participated in the AMOB program. Eighty-four percent of the students reported intentions of using AMOB training in their future careers. The average of the items for the effectiveness of “Classroom Training” and “Community Training” provided by the students (n = 25) ranged from 3.52 to 4.32 and 3.48 to 4.36, on a Likert scale (1 = Strongly Disagree to 5 = Strongly Agree), respectively. Older adults who participated in the fall prevention community workshops showed increased confidence in reducing falls, protecting themselves from falling, and becoming steadier on their feet after the training (p < 0.05). Our study demonstrates the value of integrating evidence-based programs such as AMOB in a university curriculum to address rural health disparities related to falls.

‘He hits me and that’s just how it is here’: responding to domestic abuse in rural communities

Few criminological studies have specifically set out to research responses to domestic abuse in rural communities. A small number of recent studies have arrived at the problem from a health and/or social geography perspective lending weight to the increasingly apparent significance of space and culture in rural domestic abuse. This article contributes to this research agenda, focusing on the ways in which police and other agencies respond to domestic abuse within the spatial context of rural England and victim-survivors’ experiences of such responses. The article outlines empirical work with a police partner based in the North of England. The study involved a case file analysis of police data and interviews with police officers, partner agency representatives and victim-survivors. We discuss the ways in which apparent heightened gendered conservatism and the ‘cloak of silence’ leads to difficulties in the identification of domestic abuse in rural communities and argue the importance of engaging in holistic and multi-agency approaches when responding to domestic abuse in remote and inaccessible rural communities.

Justice System Involvement, Employment, and Homelessness in Rural Areas

Individuals who have been involved with the criminal justice system face many re-entry obstacles in their communities, including homelessness and unemployment, which increase their likelihood of recidivism. These challenges are often multiplied for justice-involved individuals in rural communities where access to employment opportunities and suitable housing are limited. This article provides an overview of specific challenges to obtaining and maintaining suitable housing and employment for those with previous involvement in the criminal justice system in the United States. Recommendations for using an evidence-based multi-agency collaborative approach to service provision to reduce recidivism and improve housing stability among this population are discussed and encouraged.

Community Health Workers' Perceptions of Depression and of Barriers and Facilitators in Mental Health Care in Sierra Leone: A Qualitative Study

AimsSierra Leone has a 98% mental health treatment gap. This has been attributed to lack of resources and attitudinal/cultural barriers. Community health workers (CHWs) are the backbone of healthcare delivery in the country, constituting 1,500 of the general health workforce. The government has trained CHWs to improve mental health care. However, evidence have shown that this training is inadequate, leading to poor mental health literacy among CHWs. Sierra Leonean CHWs' perceptions of mental health and experiences of mental healthcare delivery have not been investigated. Therefore, this study aims to assess CHWs' knowledge regarding depression and suicidality, as well as their perceptions of barriers to, and facilitators of, mental health care in Sierra Leone.MethodsPurposive sampling and snowballing were used in this qualitative descriptive study (N = 10) to recruit CHWs in Kono and Freetown, Sierra Leone. Participants were interviewed remotely using Zoom. A short vignette on depression and suicidality was employed, together with remote semi-structured interviews exploring mental health literacy, perceptions of mental health care, and experiences in providing care during COVID-19. Thematic analysis was utilized.ResultsFive themes and 10 subthemes were derived from the thematic analysis. More than two-thirds of the participants viewed the problem as 'depression', while none mentioned suicidal ideation. Life events were the most commonly identified causes of depression, with no mention of spiritual, supernatural or biological attribution as possible causes. The inductively coded themes include the need for change; barriers to mental health care; accessing care; and COVID-19-related mental health care challenges. All participants agree that seeking counselling or speaking with a mental health expert is preferred. Stigma, prejudice, misconceptions, religious and traditional beliefs and insufficient government support were perceived as key impediments to care. Community health workers' experiences during COVID-19 were mixed. Awareness campaigns, training, establishing mental health policies, and integrating mental health into communities were identified as facilitators of mental health care.ConclusionThe findings have shown that developing and implementing a comprehensive multi-agency approach is fundamental in dealing with mental health problems in Sierra Leone. In addition, future larger-scale research should be conducted on the underlying cultural principles and traditions regarding mental illness and the status of mental health care provision in Sierra Leone.

Challenges of Chemsex in Health, Justice, and Social Care Settings: Developing a Coordinated Response

AimsChemsex refers to the use of specific drugs before or during sex to sustain, enhance, disinhibit, or facilitate the sexual experience, primarily amongst gay, bisexual and other men who have sex with men. The main drugs associated with Chemsex are crystal methamphetamine, gamma-hydroxybutyrate/gamma-butyrolactone, mephedrone and ketamine. There are complex biological, psychological, and social factors that influence why someone may choose to engage in Chemsex that are yet to be fully elucidated. However, there are global concerns that such harm is increasing both in prevalence and complexity, including interfaces between the health, social care and criminal justice systems. Chemsex has been identified as a priority for the UK Home Office Drug Strategy since 2017; however, the response to date has lacked a coordinated approach between the multiple services and agencies where Chemsex can present.MethodsWest London NHS Trust hosted a day-long meeting of the Chemsex Expert Reference Group (ERG) on 27th July 2022 at the London School of Hygiene and Tropical Medicine. This comprised of a group of clinicians and academics across the NHS, criminal justice system and third sector, with the meeting focused on three main clinical questions: what do we need to know about working with this complex and vulnerable group of people?; What is the research needed to improve this?; What are the aspiration clinical pathways that should be developed?ResultsThe ERG identified several gaps in our knowledge including a paucity of epidemiological data, the importance of cultural competency around the health needs of LGBTQ+ people, inconsistencies in the knowledge of healthcare professionals on how to manage emergency presentations such as methamphetamine-induced psychosis, GHB withdrawal and GHB overdose and risk assessment and risk management for those who may also be a victim and/or a perpetrator of a criminal offence in the Chemsex context. The group's core values for service and pathway development were identified as to be authentic, competent, non-judgemental and that lived experience should be at the centre of service development, as well as being evidence-based and supported by national clinical guidelines.ConclusionWhat was apparent was the ambition and interest from across so many clinical specialities, and some incredibly positive work that is already ongoing. It is hoped that the outcomes of this ERG can help progress this to a more cohesive set of responses, and the development of an evidence-based, multi-agency approach to assessment and treatment for this complex group.

Understanding “Honour”-Based Abuse and Safeguarding Victim-Survivors

Over the course of the year ending March 2022, England and Wales recorded a total of 2,887 cases of so called “honour”-based abuse (HBA). This was a 6% increase over the previous year’s figures, indicating that this unfortunate phenomenon is on the rise. HBA predominately affects women and girls and with a concerted multiagency approach and prioritisation of survivors’ safety, it can be prevented. This article explores some of the most prominent cases of HBA in the last two decades and provides guidance on how midwives and students can best support victim-survivors.

#6672 THE DEVELOPMENT OF A COMMUNITY-NEPHROLOGY, MULTI-DISCIPLINARY SERVICE

Abstract Background and Aims The Walsall Together clinical and operational leads constructed a collaborative initiative between nephrology and community services. Driven to provide multi-agency, patient-focused care. The aim of the community nephrology MDT service is to identify and optimally manage individuals with acute nephrological presentations and optimally manage individuals with secondary complications of chronic kidney disease (CKD) at home, while maximally utilising outpatient community services to prevent hospital admissions. Method Nephrology and community teams, including rapid-response, complex-case management, enhanced-care and frailty teams devised a MDT service for individuals with either community-acquired acute kidney injury (AKI) or complications of CKD. The MDT can consist of; a nephrologist, community-CKD nurse, a member from each of the above teams, a community pharmacist and an MDT coordinator. Patients are identified from the MDT attendee's caseload, from the community heart failure and the community geriatrician patient cohort. A weekly MDT meeting is held on Microsoft Teams, this allows for efficient working across a large geographical area. The MDT coordinator is essential for the efficient performance of the community nephrology MDT. They are responsible for: organising meetings, producing minutes, requesting laboratory investigations (including urine album in creatinine ratio), chasing results from clinical investigations and finally ensuring that the actions generated from the MDT are completed. The community pharmacist is an independent prescriber and immediately actions any medication changes. The community teams consist of advanced clinical practitioners or band 7/above nurse prescribers. All clinical staff perform home visits and fully utilise outpatient services including ambulatory-care-unit services for medical assessment, urgent imaging and intravenous electrolyte replacement. The medical-day-case unit services for the administration of blood transfusions. The community outpatient access team services for intravenous iron therapy and antibiotic therapy. Results Currently, the community nephrology MDT is actively managing over 60 patients. This excludes patients who have been successfully managed and discharged from the community MDT service. The multimorbid, patient cohort with recurrent hospital admissions appear to have benefited the most. A reduction and/or cessation is noted, in hospital admissions after the introduction of interventions from the community nephrology MDT. The service allows the nephrology team to easily monitor and manage housebound, individuals with CKD. This reduces the number of admissions related to secondary complications of CKD. Furthermore, by managing acute illness in the community, the service reduces the number of individuals admitted to hospital with community acquired AKI. Finally, in the unfortunate event of terminal, irreversible pathology, the MDT service allows for advanced care planning and referral to community palliative care services. Conclusion The Walsall Together collaboration has demonstrated that utilising a multi-agency approach to managing acute and chronic renal disease, can result in a reduction in hospital admissions. Furthermore, the cooperative multi-speciality approach, has led to improved monitoring and management of housebound individuals with CKD.

Victims of Violence, How a Trauma Center and Family Justice Center Can Provide Continued Care After Initial Hospitalization.

Intentional injuries are the second leading cause of death in the U.S. between the ages of 1 and 44. Each traumatic event is approached best with a multiagency and multidisciplinary approach. Family Justice Centers (FJCs) are structured as one-stop centers for victims of all forms of violence to provide services. The purpose of this study is to describe trauma patients evaluated in an FJC and determine the effect of the referrals on injury-related hospital recidivism. This is a cross-sectional descriptive study of traumatically injured patients that were evaluated in an adult level II trauma center for 3years and were referred to Ventura County's FJC. There were 415 trauma admissions for intentional injuries, which accounted for 10.4% of the total trauma-related hospital admissions. Of these patients, 203 (49%) were evaluated in Ventura County's FJC. The remaining 212 (51%) had an open judicial case, thus, were not processed through the FJC due to conflict of interest. The mechanisms of injuries of patients that were evaluated at the FJC (N = 203) were mostly assaults (83%). Majority of the patients were of the Hispanic race (70%), males (69%), English speaking (77%), and aged 18-59 (84%). 573 individual services were provided to these patients. The patients evaluated through the FJC (N = 203) had zero recidivism, while those with open cases had a 1% recidivism rate (P = NS). By collaborating with FJCs, trauma center outcomes contribute to a pathway for healing and may prevent future acts of intentional injuries.

A follow-up evaluation of a coordinated police-social services response to recidivist family violence

Coordinated multi-agency approaches are a key strategy for responding to recidivist family violence. This paper presents a follow-up quantitative evaluation of Alexis: a coordinated police-social services approach to recidivist and high-risk family violence piloted in Victoria, Australia. State-wide police data was collected for 75 perpetrators 20 to 36 months since case closure following Alexis intervention. Results indicated that 38 perpetrators (51%) had no further recorded incidents of family violence. The remaining non-mutually exclusive categories indicated that 17 (22%) had perpetrated family violence against the original Alexis victim in another location (outside the pilot catchment zones); 28 (37%) had perpetrated family violence against a different victim; and 8 of the prior two groups (11%) had perpetrated violence against both Alexis and non-Alexis victims. Those classified as low recidivists before intervention were less likely to have a further recorded incident of family violence during the follow-up period compared to high recidivists. Implications for police and policy-makers are discussed with reference to intimate partner violence and parent abuse by adult children.

Global Norm-Maker as China’s New Brand? An Analysis of the Responsible Cobalt Initiative

Abstract China’s influence in extractive industry sectors worldwide has expanded in tandem with the rising global demand for the natural resources integral to producing such low carbon products as electric vehicles. Many Chinese-operated mining projects overseas have hence generated broad concern on the ground about their negative environmental and social impacts. Chinese actors, meanwhile, have begun to engage with transnational extractive governance initiatives entailing a transparency norm that requires disclosure of environmental and social risks. China, however, appears to be reshaping this transparency norm through its establishment of the Responsible Cobalt Initiative (RCI)—a China-led “transnational” governance initiative facilitating a Chinese version of that norm, known as “thin” transparency. Based on process-tracing and semi-structured interviews, in applying Acharya’s (2018) norm-circulation model, this paper examines what type of Chinese domestic actors act as norm-makers and under what conditions. The study thus refines certain core analytical concepts of the model. The RCI case stands alone in highlighting China’s growingly normative role in contesting the transparency norm through transnational interactions among Chinese and international actors in global extractives governance. The result shows China’s norm-making as a strategic choice of a local idea-shifter to cope with China’s internal and external legitimacy crises and to strengthen its emerging identity as a responsible great power. This study rejects the notion of China as a monolithic actor, rather suggesting a multi-agency and multilevel approach to understanding the complex realities of China’s normative leadership in global governance.

The hard and complex work of implementing new multi-agency risk assessment approaches to policing domestic abuse

In the period since multi-agency working became the dominant approach to tackling domestic abuse, there has been ongoing development and innovation. However, little is known about what tends to enhance or inhibit the roll-out of such initiatives. This article examines the process of building an enhanced flagship multi-agency model for policing domestic abuse. We report on results from semi-structured interviews, observations of meetings and an online survey with stakeholders who were involved in the development of the principles underlying a new multi-agency risk assessment conference (MARAC) process. The participants representatives from policing, third sector, health, and probation organisation-described positive benefits of the process, whilst challenges coalesced around the focus on and engagement of perpetrators, and the problem of assessing the dynamics of risk.

Identification and treatment of individuals with attention-deficit/hyperactivity disorder and substance use disorder: An expert consensus statement.

Attention-deficit/hyperactivity disorder (ADHD) often co-occurs with substance use (SU) and/or substance use disorder (SUD). Individuals with concurrent ADHD and SU/SUD can have complex presentations that may complicate diagnosis and treatment. This can be further complicated by the context in which services are delivered. Also, when working with young people and adults with co-existing ADHD and SU/SUD, there is uncertainty among healthcare practitioners on how best to meet their needs. In February 2022, the United Kingdom ADHD Partnership hosted a meeting attended by multidisciplinary experts to address these issues. Following presentations providing attendees with an overview of the literature, group discussions were held synthesizing research evidence and clinical experience. Topics included: (1) A review of substances and reasons for use/misuse; (2) identification, assessment and treatment of illicit SU/SUD in young people and adults with ADHD presenting in community services; and (3) identification, assessment and treatment of ADHD in adults presenting in SU/SUD community and inpatient services. Dis-cussions highlighted inter-service barriers and fragmentation of care. It was concluded that a multimodal and multi-agency approach is needed. The consensus group generated a table of practice recommendations providing guidance on: identification and assessment; pharmacological and psychological treatment; and multi-agency interventions.

"In an ideal world that would be a multiagency service because you need everybody's expertise." Managing hoarding disorder: A qualitative investigation of existing procedures and practices.

Hoarding disorder is characterised by the acquisition of, and failure to discard large numbers of items regardless of their actual value, a perceived need to save the items and distress associated with discarding them, significant clutter in living spaces that render the activities associated with those spaces very difficult causing significant distress or impairment in functioning. To aid development of an intervention for hoarding disorder we aimed to identify current practice by investigating key stakeholders existing practice regarding identification, assessment and intervention associated with people with hoarding disorder. Two focus groups with a purposive sample of 17 (eight male, nine female) stakeholders representing a range of services from housing, health, and social care were audio recorded, transcribed verbatim and analysed thematically. There was a lack of consensus regarding how hoarding disorder was understood and of the number of cases of hoarding disorder however all stakeholders agreed hoarding disorder appeared to be increasing. The clutter image rating scale was most used to identify people who needed help for hoarding disorder, in addition to other assessments relevant to the stakeholder. People with hoarding disorder were commonly identified in social housing where regular access to property was required. Stakeholders reported that symptoms of hoarding disorder were often tackled by enforced cleaning, eviction, or other legal action however these approaches were extremely traumatic for the person with hoarding disorder and failed to address the root cause of the disorder. While stakeholders reported there was no established services or treatment pathways specifically for people with hoarding disorder, stakeholders were unanimous in their support for a multi-agency approach. The absence of an established multiagency service that would offer an appropriate and effective pathway when working with a hoarding disorder presentation led stakeholders to work together to suggest a psychology led multiagency model for people who present with hoarding disorder. There is currently a need to examine the acceptability of such a model.

Policy transition: public sector sport for development in Northern Ireland

ABSTRACT Globally, governments are implementing public sector reform to address declining budgets and public trust to improve programme efficiency and effectiveness. Sport has become ever more relevant with regards local, national and international social policy as part of an enhanced role for the third sector in tackling a plethora of societal issues. This article attempts to explore, the success (or otherwise) of sport for development (SfD) programmes transitioning positive outcomes from a micro and meso level to the macro level in Northern Ireland. Three management models (Outcomes-based accountability, Organisational capacity and Resource dependency theory) are used to establish the level of efficiency and effectiveness of SfD programmes in Northern Ireland, based on semi-structured interviews with a range of policy and delivery stakeholders. This article identifies potential areas of conflict at the intersection between policy and practice which limit the translation of successful project outcomes. The ambiguity of purpose combined with the absence of a population level evaluation model and financial reliance perpetuates task-based projects at the expense of sectoral outcomes. In turn, individuals are faced with a ridged multi-agency offering without a multi-agency approach. This article recommends a government-wide indicator for sport and physical activity linked to an overarching sport-related strategy, which clearly defines language, purpose and responsibilities across the public sector. One which builds on existing structures to support transition (individual and organisational) across the three identified interlinking phases of sport.