Child Behavior Problem, Interprofessional Relations, Multidisciplinary Communication
Conditions
Keywords
school-based mental health, TeamSTEPPS
Brief summary
Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) is an evidence-based approach for teams that can be adapted for school mental health. TeamSTEPPS has been widely disseminated in health care settings with promising outcomes. TeamSTEPPS is designed to build competencies in the areas of leadership, situation monitoring, mutual support, and communication and has been associated with improvements in teamwork and communication as well as patient outcomes, such as decreased seclusion in psychiatric hospitals. This approach has yet to be extended as an implementation strategy in school or community mental health teams. If an evidence-based team approach like TeamSTEPPS can be successfully applied to school mental health teams, it could provide a cost-effective strategy for improving student mental health services and bolstering existing EBP implementation efforts, which to date generally have been insufficient in producing long-term clinician behavior change. In Aim 1 the investigators will capture key stakeholder perspectives about challenges in collocated school mental health services through formative work to inform collaborative planning and capacity building activities in Aim 2. Then, in Aim 2 the investigators will identify inter-organizational challenges and required components of TeamSTEPPS to adapt. The investigators will establish an advisory board and adapt TeamSTEPPS. The product of Aim 2 will be an adapted TeamSTEPPS, directed toward both school mental health and school-employed personnel, and specific, tailored implementation strategies to improve services in schools in conjunction with TeamSTEPPS. Finally, In Aim 3 the investigators will explore the feasibility, acceptability, and utility of TeamSTEPPS and the strategies generated in Aim 2 on inter-professional collaboration, teamwork, and student outcomes in eight schools.
Interventions
BEHAVIORALTeamSTEPPS
TeamSTEPPS is an evidence-based approach for teams that can be adapted for school mental health. Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS), has been widely disseminated in health care settings with promising outcomes. TeamSTEPPS is designed to build competencies in the areas of leadership, situation monitoring, mutual support, and communication and has been associated with improvements in teamwork and communication as well as patient outcomes, such as decreased seclusion in psychiatric hospitals.
Sponsors
University of Pennsylvania
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 100 Years
Healthy volunteers
No
Inclusion criteria
* Must be one of the following: mental health providers, teachers, leaders from schools (e.g., principals), leaders from community mental health agencies (i.e., executive directors, clinical supervisors), and leadership personnel from the payer or partner school district.
Exclusion criteria
* There are no
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Feasibility of Intervention Measure (FIM) | assessed immediately post-training in TeamSTEPPS (on average, 4 hours after completion of baseline measures) | Reliable and validated 4-item tool to assess perceptions of the feasibility of an intervention (in this case, TeamSTEPPS training). Each item may be scored 1 = completely disagree, 2 = disagree, 3 = neither agree nor disagree, 4 = agree, or 5 = completely agree. An overall mean score (possible score range from 1 to 5) across the 4 items is computed, where higher scores indicate more positive perceptions of intervention feasibility. |
| Acceptability of Intervention Measure (AIM) | assessed immediately post-training in TeamSTEPPS (on average, 4 hours after completion of baseline measures) | Reliable and validated 4-item observational tool to assess perceptions of the acceptability of an intervention (in this case, TeamSTEPPS training). Each item may be scored 1 = completely disagree, 2 = disagree, 3 = neither agree nor disagree, 4 = agree, or 5 = completely agree. An overall mean score (possible score range from 1 to 5) across the 4 items is computed, where higher scores indicate greater perceptions of intervention acceptability. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Oxford Non-Technical Skills (NOTECHS) Scale | Assessed at baseline (i.e., on average, 1 week prior to training in TeamSTEPPS), immediately post-training in TeamSTEPPS (on average, 1 week after completion of baseline observation), and at 6- and 12-month follow-ups. | Validated 4-item observational tool to assess teamwork and cognitive skills in teams. Items reflect team skills in leadership and management; teamwork and cooperation; problem-solving and decision making; and situational awareness. An observer codes team behavior in each domain using 3-5 items rated from 1 (Below Standard) to 4 (Excellent). An overall mean score, ranging from 1 to 4, is computed across items, where higher scores indicate stronger teamwork skills. |
Other
| Measure | Time frame | Description |
|---|---|---|
| Expanded School Mental Health Collaboration Instrument (ESMHCI) | Assessed at baseline (i.e., pre-training in TeamSTEPPS) and and at 6- and 12-month follow-ups. Six- and 12-month follow-up scores were averaged to create a single follow-up score. | 59-item tool to assess perceptions of aspects of collaboration between school professionals and mental health professionals from collaborating agencies on a continuous scale. An average score is calculated, with higher scores indicating strengths and lower scores indicating areas to consider improving or targeting. Responses for all items on the scale are measured on one of two, four-point Likert-type scales (1 = never to 4 = often for items related to Types of Collaboration; and 1 = strongly disagree to 4 = strongly agree for items related to Influences on Collaboration and Perceived Benefits of Collaboration). A mean total score is computed, with possible scores ranging from 1 to 4, with higher scores indicating stronger collaboration. |
| TeamSTEPPS Teamwork Perceptions Questionnaire (T-TPQ) | Assessed at baseline (i.e., pre-training in TeamSTEPPS) and at 6- and 12-month follow-ups. Six- and 12-month follow-up scores were averaged to create a single follow-up score. | Self-report measure of individual perceptions of group-level team skills and behavior. It is based upon the five core components of teamwork that comprise TeamSTEPPS, totaling 35 items. Items are rated continuously on a five-point scale from strongly disagree = 1 to strongly agree = 5. A mean total score is computed by averaging all items (possible score range = 1 to 5). Higher scores indicate more favorable perceptions of teamwork. |
| TeamSTEPPS Teamwork Attitudes Questionnaire (T-TAQ) | Assessed at baseline (i.e., pre-training in TeamSTEPPS) and at 6- and 12-month follow-ups. Six- and 12-month follow-up scores were averaged to create a single follow-up score. | Self-report measure of individual attitudes related to the core components of teamwork captured within TeamSTEPPS. Six items measure each of the core teamwork constructs, for a total of 30 items. Items are rated continuously on a five-point scale from strongly disagree = 1 to strongly agree = 5. A mean total score is calculated across items with a possible score range of 1 to 5. Higher scores indicated more positive attitudes toward teamwork. |
Countries
United States
Participant flow
Recruitment details
Participants were school staff recruited from school mental health teams working across three school districts.
Pre-assignment details
Participants were existing employees working across three partner school districts. There was no randomization or assignment to study arms/conditions, though because participants naturally existed within the three districts, we report some analyses by district unit. All participants across all districts received the same intervention (i.e., TeamSTEPPS training).
Participants by arm
| Arm | Count |
|---|---|
| Schools Implementing TeamSTEPPS We conducted a quasi-experimental, single-arm pilot study of an adapted TeamSTEPPS curriculum for school mental health team members. Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) is designed to build competencies in the areas of leadership, situation monitoring, mutual support, and communication and has been associated with improvements in teamwork and communication as well as patient outcomes, such as decreased seclusion in psychiatric hospitals. All participants across all school districts received training in TeamSTEPPS which is the primary intervention in this trial. | 90 |
| Total | 90 |
Baseline characteristics
| Characteristic | Schools Implementing TeamSTEPPS |
|---|---|
| Age, Continuous | 38.73 years STANDARD_DEVIATION 9.41 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 4 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 84 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 2 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants |
| Race (NIH/OMB) Asian | 0 Participants |
| Race (NIH/OMB) Black or African American | 15 Participants |
| Race (NIH/OMB) More than one race | 1 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 4 Participants |
| Race (NIH/OMB) White | 70 Participants |
| Sex: Female, Male Female | 70 Participants |
| Sex: Female, Male Male | 18 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | 0 / 90 |
| other Total, other adverse events | 0 / 90 |
| serious Total, serious adverse events | 0 / 90 |
Outcome results
Primary
Acceptability of Intervention Measure (AIM)
Reliable and validated 4-item observational tool to assess perceptions of the acceptability of an intervention (in this case, TeamSTEPPS training). Each item may be scored 1 = completely disagree, 2 = disagree, 3 = neither agree nor disagree, 4 = agree, or 5 = completely agree. An overall mean score (possible score range from 1 to 5) across the 4 items is computed, where higher scores indicate greater perceptions of intervention acceptability.
Time frame: assessed immediately post-training in TeamSTEPPS (on average, 4 hours after completion of baseline measures)
Population: Staff that completed TeamSTEPPS training
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Schools Implementing TeamSTEPPS | Acceptability of Intervention Measure (AIM) | 4.28 score on a scale | Standard Deviation 0.68 |
Primary
Feasibility of Intervention Measure (FIM)
Reliable and validated 4-item tool to assess perceptions of the feasibility of an intervention (in this case, TeamSTEPPS training). Each item may be scored 1 = completely disagree, 2 = disagree, 3 = neither agree nor disagree, 4 = agree, or 5 = completely agree. An overall mean score (possible score range from 1 to 5) across the 4 items is computed, where higher scores indicate more positive perceptions of intervention feasibility.
Time frame: assessed immediately post-training in TeamSTEPPS (on average, 4 hours after completion of baseline measures)
Population: Staff that completed TeamSTEPPS training
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Schools Implementing TeamSTEPPS | Feasibility of Intervention Measure (FIM) | 4.25 score on a scale | Standard Deviation 0.57 |
Secondary
Oxford Non-Technical Skills (NOTECHS) Scale
Validated 4-item observational tool to assess teamwork and cognitive skills in teams. Items reflect team skills in leadership and management; teamwork and cooperation; problem-solving and decision making; and situational awareness. An observer codes team behavior in each domain using 3-5 items rated from 1 (Below Standard) to 4 (Excellent). An overall mean score, ranging from 1 to 4, is computed across items, where higher scores indicate stronger teamwork skills.
Time frame: Assessed at baseline (i.e., on average, 1 week prior to training in TeamSTEPPS), immediately post-training in TeamSTEPPS (on average, 1 week after completion of baseline observation), and at 6- and 12-month follow-ups.
Population: Staff trained in TeamSTEPPS, observed in district teams. When multiple observations occurred by multiple raters at a time point, we computed mean (SD) ratings across raters.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Schools Implementing TeamSTEPPS | Oxford Non-Technical Skills (NOTECHS) Scale | Baseline | 2.40 units on a scale | Standard Deviation 0.33 |
| Schools Implementing TeamSTEPPS | Oxford Non-Technical Skills (NOTECHS) Scale | Post-training | 3.33 units on a scale | Standard Deviation 0.13 |
| Schools Implementing TeamSTEPPS | Oxford Non-Technical Skills (NOTECHS) Scale | 6 month follow-up | 3.38 units on a scale | Standard Deviation 0.52 |
| Schools Implementing TeamSTEPPS | Oxford Non-Technical Skills (NOTECHS) Scale | 12 month follow-up | 2.88 units on a scale | Standard Deviation 1.11 |
Comparison: Repeated measures ANOVA examining change over time across the three partner school districts.p-value: 0.088ANOVA
Other Pre-specified
Expanded School Mental Health Collaboration Instrument (ESMHCI)
59-item tool to assess perceptions of aspects of collaboration between school professionals and mental health professionals from collaborating agencies on a continuous scale. An average score is calculated, with higher scores indicating strengths and lower scores indicating areas to consider improving or targeting. Responses for all items on the scale are measured on one of two, four-point Likert-type scales (1 = never to 4 = often for items related to Types of Collaboration; and 1 = strongly disagree to 4 = strongly agree for items related to Influences on Collaboration and Perceived Benefits of Collaboration). A mean total score is computed, with possible scores ranging from 1 to 4, with higher scores indicating stronger collaboration.
Time frame: Assessed at baseline (i.e., pre-training in TeamSTEPPS) and and at 6- and 12-month follow-ups. Six- and 12-month follow-up scores were averaged to create a single follow-up score.
Population: Staff that completed TeamSTEPPS training
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Schools Implementing TeamSTEPPS | Expanded School Mental Health Collaboration Instrument (ESMHCI) | Baseline | 2.83 score on a scale | Standard Deviation 0.54 |
| Schools Implementing TeamSTEPPS | Expanded School Mental Health Collaboration Instrument (ESMHCI) | Follow-up | 3.01 score on a scale | Standard Deviation 0.57 |
Comparison: We conducted paired t-tests to evaluate simple pre-to-post changes in the primary outcome measures. We fitted linear mixed-effects regression models for each outcome variable, specifying random intercepts for participant ID to account for repeated measures and within-individual clustering. The core model included a binary post-training indicator as the primary predictor, along with the baseline value of the corresponding outcome as a covariate.p-value: <0.0595% CI: [0.036, 0.373]Regression, Linear
Other Pre-specified
TeamSTEPPS Teamwork Attitudes Questionnaire (T-TAQ)
Self-report measure of individual attitudes related to the core components of teamwork captured within TeamSTEPPS. Six items measure each of the core teamwork constructs, for a total of 30 items. Items are rated continuously on a five-point scale from strongly disagree = 1 to strongly agree = 5. A mean total score is calculated across items with a possible score range of 1 to 5. Higher scores indicated more positive attitudes toward teamwork.
Time frame: Assessed at baseline (i.e., pre-training in TeamSTEPPS) and at 6- and 12-month follow-ups. Six- and 12-month follow-up scores were averaged to create a single follow-up score.
Population: Staff that completed TeamSTEPPS training
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Schools Implementing TeamSTEPPS | TeamSTEPPS Teamwork Attitudes Questionnaire (T-TAQ) | Baseline | 4.43 score on a scale | Standard Deviation 0.31 |
| Schools Implementing TeamSTEPPS | TeamSTEPPS Teamwork Attitudes Questionnaire (T-TAQ) | Follow-up | 4.42 score on a scale | Standard Deviation 0.29 |
Comparison: We conducted paired t-tests to evaluate simple pre-to-post changes in the primary outcome measures. We fitted linear mixed-effects regression models for each outcome variable, specifying random intercepts for participant ID to account for repeated measures and within-individual clustering. The core model included a binary post-training indicator as the primary predictor, along with the baseline value of the corresponding outcome as a covariate.p-value: 0.99695% CI: [-0.082, 0.083]Regression, Linear
Other Pre-specified
TeamSTEPPS Teamwork Perceptions Questionnaire (T-TPQ)
Self-report measure of individual perceptions of group-level team skills and behavior. It is based upon the five core components of teamwork that comprise TeamSTEPPS, totaling 35 items. Items are rated continuously on a five-point scale from strongly disagree = 1 to strongly agree = 5. A mean total score is computed by averaging all items (possible score range = 1 to 5). Higher scores indicate more favorable perceptions of teamwork.
Time frame: Assessed at baseline (i.e., pre-training in TeamSTEPPS) and at 6- and 12-month follow-ups. Six- and 12-month follow-up scores were averaged to create a single follow-up score.
Population: Staff that completed TeamSTEPPS training
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Schools Implementing TeamSTEPPS | TeamSTEPPS Teamwork Perceptions Questionnaire (T-TPQ) | Baseline | 3.77 score on a scale | Standard Deviation 0.51 |
| Schools Implementing TeamSTEPPS | TeamSTEPPS Teamwork Perceptions Questionnaire (T-TPQ) | Follow-Up | 3.76 score on a scale | Standard Deviation 0.55 |
Comparison: We conducted paired t-tests to evaluate simple pre-to-post changes in the primary outcome measures. We fitted linear mixed-effects regression models for each outcome variable, specifying random intercepts for participant ID to account for repeated measures and within-individual clustering. The core model included a binary post-training indicator as the primary predictor, along with the baseline value of the corresponding outcome as a covariate.p-value: 0.27795% CI: [-0.064, 0.219]Regression, Linear