A Service Held Together in Practice: A Qualitative Study of Interorganizational Collaboration in a Swedish Youth Mental Health and Substance Use Service.

Adolescent substance use frequently co-occurs with mental-health difficulties and social adversity. Existing research highlights heterogeneous risk profiles and a paucity of integrated service models that bridge health- and social-care sectors. A qualitative case study was undertaken at the newly established MiniMaria treatment centre in Sweden. Data were gathered through participant observation of 18 steering-, project- and operative-group meetings, four workplace meetings, and semi-structured interviews with five staff members. Reflexive thematic analysis was applied iteratively, guided by a conceptual framework of collaborative advantage (power, trust, organizational culture, leadership, goal management). This study adheres to the Standards for Reporting Qualitative Research (SRQR) checklist. Four overarching themes emerged: (1) divergent organizational cultures and power; (2) fragmented goal management; (3) fluctuating trust and leadership; and (4) operational-level impact on staff. Middle-management pragmatism compensated for strategic indecision, sustaining service delivery despite resource constraints (for instance absence of a dedicated physician). The MiniMaria project demonstrates that clear, enforceable governance structures are vital for integrated youth services. When senior-level alignment falters, empowered front-line managers can preserve continuity of care, but the sustainability of such models hinges on explicit memoranda, shared information systems and ongoing cultural monitoring.