Implementation, Teamwork
Conditions
Keywords
multidisciplinary teamwork, implementation
Brief summary
In a previous research study, the investigators adapted an evidence-based team training intervention for healthcare settings (TeamSTEPPS) to fit the needs and context of Child Advocacy Center multidisciplinary teams. This study is a cluster-randomized controlled trial of the adapted training, TeamTRACS (Team Training in Roles, Awareness, Communication, and Support). This hybrid type 2 effectiveness-implementation study will test the effectiveness of TeamTRACS and pilot a self-guided approach to implementing TeamTRACS in low-resource settings.
Detailed description
This study is designed to test the effects of TeamTRACS on knowledge, skill use, and team functioning. It will also evaluate the acceptability, appropriateness, and feasibility of a self-guided implementation approach that requires few resources and builds local capacity for change. Six rural Child Advocacy Centers (CACs) will be randomized to TeamTRACS (4 CACs) or a waitlist comparison (2 CACs). The long-term goal of this research is to create an effective team training that can be rapidly scaled up and disseminated to rural CACs nationwide. Supporting rural teams can improve team performance, strengthen the workforce, and ultimately improve service quality and outcomes for rural children who experience child abuse.
Interventions
BEHAVIORALTeamTRACS
TeamTRACS is a team training intervention adapted from TeamSTEPPS (Team Strategies and Tools to Enhance Performance and Patient Safety), a widely used evidence-based team training developed by the Agency for Healthcare Research and Quality. TeamTRACS targets knowledge, skills, and attitudes related to team member roles, shared awareness, communication, mutual support, and goal-setting. TeamTRACS is structured, easy to use, flexible in length and intensity, and requires few resources. It incorporates didactic instruction, discussion, and interactive activities and can be delivered virtually or in-person.
Sponsors
National Institutes of Health (NIH)
University of Pittsburgh
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Individuals at least 18 years of age who are members of the multidisciplinary team at the participating CACs.
Exclusion criteria
* Under 18 years old
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Feasibility of Self-guided Implementation | Beginning, midpoint, and end of self-guided implementation process (Months 0, 5, & 7) | Perceived feasibility of the self-guided implementation process will be assessed with items from the Feasibility of Intervention Measure. Each item is rated on a 1-5 Likert scale. Scores will be averaged; higher scores indicate more positive perceptions. |
| Change in Teamwork Skill Use From Baseline to 3-month Follow-up | Baseline, 3-month follow-up (Month 7, 3 months after training workshop) | Frequency of teamwork skill use will be assessed with survey items rated on a 5-point Likert scale (range 1-5). Scores will be averaged; higher scores indicate more frequent skill use. |
| Acceptability of Self-guided Implementation | Beginning, midpoint, and end of self-guided implementation process (Months 0, 5, & 7) | Perceived acceptability of the self-guided implementation process will be assessed with items from the Acceptability of Intervention Measure. Each item is rated on a 1-5 Likert scale. Scores will be averaged; higher scores indicate more positive perceptions. |
| Appropriateness of Self-guided Implementation | Beginning, midpoint, and end of self-guided implementation process (Months 0, 5, & 7) | Perceived appropriateness of the self-guided implementation process will be assessed with items from the Intervention Appropriateness Measure. Each item is rated on a 1-5 Likert scale. Scores will be averaged; higher scores indicate more positive perceptions. |
| Change in Teamwork Knowledge From Baseline to 3-month Follow-up | Baseline, 3-month follow-up (Month 7, 3 months after training workshop) | Survey questions assessing knowledge taught in TeamTRACS will be assessed with multiple choice questions. The percent of correct answers (range 0-100%) will be calculated. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in Team Functioning From Baseline to 3-month Follow-up: Learning Behavior | Baseline, 3-month follow-up (Month 7, 3 months after training workshop) | Learning behavior (behavioral process) was assessed with Edmondson's (1999) Learning Behavior scale of 7 items rated on a 7-point Likert scale (1-7). Scores were averaged; higher scores indicate more learning behavior. |
| Change in Team Performance From Baseline to 3-month Follow-up | Baseline, 3-month follow-up (Month 7, 3 months after training workshop) | The overall quality of work done by the team will be assessed with Edmondson's (1999) Team Performance scale of 5 items rated on a 7-point Likert scale. Scores will be averaged; higher scores indicate better performance. |
| Change in Team Functioning From Baseline to 3-month Follow-up: Psychological Safety | Baseline, 3-month follow-up (Month 7, 3 months after training workshop) | Psychological safety (affective state) was assessed with Edmondson's (1999) Psychological Safety scale of 7 items rated on a 7-point Likert scale (1-7). Scores were averaged; higher scores indicate more psychological safety. |
Countries
United States
Participant flow
Recruitment details
Only current team members were eligible to participate at each timepoint. Participants who completed baseline data collection but left the team before follow-up were not invited to participate in follow-up data collection. Participants who joined the team after baseline were invited to participate in follow-up data collection.
Participants by arm
| Arm | Count |
|---|---|
| TeamTRACS (Team Training in Roles, Awareness, Communication, and Support) CACs randomized to the intervention condition (n = 4) will participate in TeamTRACS. CACs will receive an implementation guide to assist in preparing for and maximizing the impact of training.
TeamTRACS: TeamTRACS is a team training intervention adapted from TeamSTEPPS (Team Strategies and Tools to Enhance Performance and Patient Safety), a widely used evidence-based team training developed by the Agency for Healthcare Research and Quality. TeamTRACS targets knowledge, skills, and attitudes related to team member roles, shared awareness, communication, mutual support, and goal-setting. TeamTRACS is structured, easy to use, flexible in length and intensity, and requires few resources. It incorporates didactic instruction, discussion, and interactive activities and can be delivered virtually or in-person. | 117 |
| Waitlist Comparison CACs randomized to the waitlist comparison (n = 2) will participate in TeamTRACS approximately 4 months after CACs in the intervention condition. | 55 |
| Total | 172 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Participants Entering at Baseline | Lost to Follow-up | 11 | 11 |
| Participants Entering at Baseline | Not eligible for followup - no longer member of team | 17 | 4 |
Baseline characteristics
| Characteristic | TeamTRACS (Team Training in Roles, Awareness, Communication, and Support) | Waitlist Comparison | Total |
|---|---|---|---|
| Age, Categorical <=18 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical >=65 years | 1 Participants | 2 Participants | 3 Participants |
| Age, Categorical Between 18 and 65 years | 106 Participants | 50 Participants | 156 Participants |
| Age, Continuous | 39.46 years STANDARD_DEVIATION 11.41 | 45.33 years STANDARD_DEVIATION 11.46 | 41.40 years STANDARD_DEVIATION 11.72 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 12 Participants | 0 Participants | 12 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 94 Participants | 51 Participants | 145 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 11 Participants | 4 Participants | 15 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 12 Participants | 0 Participants | 12 Participants |
| Race (NIH/OMB) Asian | 1 Participants | 0 Participants | 1 Participants |
| Race (NIH/OMB) Black or African American | 1 Participants | 8 Participants | 9 Participants |
| Race (NIH/OMB) More than one race | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 11 Participants | 4 Participants | 15 Participants |
| Race (NIH/OMB) White | 92 Participants | 43 Participants | 135 Participants |
| Region of Enrollment United States | 117 participants | 55 participants | 172 participants |
| Sex: Female, Male Female | 74 Participants | 39 Participants | 113 Participants |
| Sex: Female, Male Male | 33 Participants | 13 Participants | 46 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 0 | 0 / 0 |
| other Total, other adverse events | 0 / 117 | 0 / 55 |
| serious Total, serious adverse events | 0 / 117 | 0 / 55 |
Outcome results
Primary
Acceptability of Self-guided Implementation
Perceived acceptability of the self-guided implementation process will be assessed with items from the Acceptability of Intervention Measure. Each item is rated on a 1-5 Likert scale. Scores will be averaged; higher scores indicate more positive perceptions.
Time frame: Beginning, midpoint, and end of self-guided implementation process (Months 0, 5, & 7)
Population: Only rated by key informants in CACs randomized to TeamTRACS
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| TeamTRACS (Team Training in Roles, Awareness, Communication, and Support) | Acceptability of Self-guided Implementation | Baseline (Beginning of self-guided implementation process) | 4.38 score on a scale | Standard Deviation 0.48 |
| TeamTRACS (Team Training in Roles, Awareness, Communication, and Support) | Acceptability of Self-guided Implementation | Month 5 (midpoint of self-guided implementation process) | 4.25 score on a scale | Standard Deviation 0.96 |
| TeamTRACS (Team Training in Roles, Awareness, Communication, and Support) | Acceptability of Self-guided Implementation | Month 7 (End of study) | 4.25 score on a scale | Standard Deviation 0.5 |
Primary
Appropriateness of Self-guided Implementation
Perceived appropriateness of the self-guided implementation process will be assessed with items from the Intervention Appropriateness Measure. Each item is rated on a 1-5 Likert scale. Scores will be averaged; higher scores indicate more positive perceptions.
Time frame: Beginning, midpoint, and end of self-guided implementation process (Months 0, 5, & 7)
Population: Only rated by key informants in CACs randomized to TeamTRACS
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| TeamTRACS (Team Training in Roles, Awareness, Communication, and Support) | Appropriateness of Self-guided Implementation | Baseline (Beginning of self-guided implementation process) | 3.63 score on a scale | Standard Deviation 0.75 |
| TeamTRACS (Team Training in Roles, Awareness, Communication, and Support) | Appropriateness of Self-guided Implementation | Month 5 (midpoint of self-guided implementation process) | 4.25 score on a scale | Standard Deviation 1.5 |
| TeamTRACS (Team Training in Roles, Awareness, Communication, and Support) | Appropriateness of Self-guided Implementation | Month 7 (End of study) | 4.25 score on a scale | Standard Deviation 0.96 |
Primary
Change in Teamwork Knowledge From Baseline to 3-month Follow-up
Survey questions assessing knowledge taught in TeamTRACS will be assessed with multiple choice questions. The percent of correct answers (range 0-100%) will be calculated.
Time frame: Baseline, 3-month follow-up (Month 7, 3 months after training workshop)
Population: Descriptive data: Team members with data for that timepoint. Intent-to-treat analysis: All team members with data at 1 or more timepoints
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| TeamTRACS (Team Training in Roles, Awareness, Communication, and Support) | Change in Teamwork Knowledge From Baseline to 3-month Follow-up | Baseline | 75.60 percentage correct answers | Standard Deviation 10.87 |
| TeamTRACS (Team Training in Roles, Awareness, Communication, and Support) | Change in Teamwork Knowledge From Baseline to 3-month Follow-up | Follow-up | 80.00 percentage correct answers | Standard Deviation 11.16 |
| Waitlist Comparison | Change in Teamwork Knowledge From Baseline to 3-month Follow-up | Baseline | 74.72 percentage correct answers | Standard Deviation 10.82 |
| Waitlist Comparison | Change in Teamwork Knowledge From Baseline to 3-month Follow-up | Follow-up | 75.00 percentage correct answers | Standard Deviation 7.88 |
Comparison: Intent-to-treat analyses tested changes in knowledge from baseline to follow-up using linear mixed models. Mixed models analyses were conducted in R using the lme4 package and restricted maximum likelihood estimation (REML). Models included fixed effects of time (baseline vs. follow-up), intervention condition, and their interaction as well as random effects for person and team. We used the clubSandwich package to calculate cluster robust standard errors.p-value: 0.0395% CI: [0.76, 7.74]Regression, Linear
Primary
Change in Teamwork Skill Use From Baseline to 3-month Follow-up
Frequency of teamwork skill use will be assessed with survey items rated on a 5-point Likert scale (range 1-5). Scores will be averaged; higher scores indicate more frequent skill use.
Time frame: Baseline, 3-month follow-up (Month 7, 3 months after training workshop)
Population: Descriptive data: Team members with data for that timepoint. Intent-to-treat analysis: All team members with data at 1 or more timepoints
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| TeamTRACS (Team Training in Roles, Awareness, Communication, and Support) | Change in Teamwork Skill Use From Baseline to 3-month Follow-up | Baseline | 4.22 score on a scale | Standard Deviation 0.49 |
| TeamTRACS (Team Training in Roles, Awareness, Communication, and Support) | Change in Teamwork Skill Use From Baseline to 3-month Follow-up | Follow-up | 4.19 score on a scale | Standard Deviation 0.54 |
| Waitlist Comparison | Change in Teamwork Skill Use From Baseline to 3-month Follow-up | Baseline | 4.08 score on a scale | Standard Deviation 0.59 |
| Waitlist Comparison | Change in Teamwork Skill Use From Baseline to 3-month Follow-up | Follow-up | 4.20 score on a scale | Standard Deviation 0.55 |
Comparison: Intent-to-treat analyses tested changes in skill use from baseline to follow-up using linear mixed models. Mixed models analyses were conducted in R using the lme4 package and restricted maximum likelihood estimation (REML). Models included fixed effects of time (baseline vs. follow-up), intervention condition, and their interaction as well as random effects for person and team. We used the clubSandwich package to calculate cluster robust standard errors.p-value: 0.395% CI: [-0.4, 0.2]Regression, Linear
Primary
Feasibility of Self-guided Implementation
Perceived feasibility of the self-guided implementation process will be assessed with items from the Feasibility of Intervention Measure. Each item is rated on a 1-5 Likert scale. Scores will be averaged; higher scores indicate more positive perceptions.
Time frame: Beginning, midpoint, and end of self-guided implementation process (Months 0, 5, & 7)
Population: Only rated by key informants in CACs randomized to TeamTRACS
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| TeamTRACS (Team Training in Roles, Awareness, Communication, and Support) | Feasibility of Self-guided Implementation | Baseline (Beginning of self-guided implementation process) | 4.50 score on a scale | Standard Deviation 0.58 |
| TeamTRACS (Team Training in Roles, Awareness, Communication, and Support) | Feasibility of Self-guided Implementation | Month 5 (midpoint of self-guided implementation process) | 4.00 score on a scale | Standard Deviation 0.82 |
| TeamTRACS (Team Training in Roles, Awareness, Communication, and Support) | Feasibility of Self-guided Implementation | Month 7 (End of study) | 4.38 score on a scale | Standard Deviation 0.75 |
Secondary
Change in Team Functioning From Baseline to 3-month Follow-up: Learning Behavior
Learning behavior (behavioral process) was assessed with Edmondson's (1999) Learning Behavior scale of 7 items rated on a 7-point Likert scale (1-7). Scores were averaged; higher scores indicate more learning behavior.
Time frame: Baseline, 3-month follow-up (Month 7, 3 months after training workshop)
Population: Descriptive data: Team members with data for that timepoint. Intent-to-treat analysis: All team members with data at 1 or more timepoints
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| TeamTRACS (Team Training in Roles, Awareness, Communication, and Support) | Change in Team Functioning From Baseline to 3-month Follow-up: Learning Behavior | Baseline | 4.77 score on a scale | Standard Deviation 1.02 |
| TeamTRACS (Team Training in Roles, Awareness, Communication, and Support) | Change in Team Functioning From Baseline to 3-month Follow-up: Learning Behavior | Follow-up | 4.86 score on a scale | Standard Deviation 0.99 |
| Waitlist Comparison | Change in Team Functioning From Baseline to 3-month Follow-up: Learning Behavior | Baseline | 4.96 score on a scale | Standard Deviation 1.02 |
| Waitlist Comparison | Change in Team Functioning From Baseline to 3-month Follow-up: Learning Behavior | Follow-up | 5.08 score on a scale | Standard Deviation 0.96 |
Comparison: Intent-to-treat analyses tested changes in learning behavior from baseline to follow-up using linear mixed models. Mixed models analyses were conducted in R using the lme4 package and restricted maximum likelihood estimation (REML). Models included fixed effects of time (baseline vs. follow-up), intervention condition, and their interaction as well as random effects for person and team. We used the clubSandwich package to calculate cluster robust standard errors.p-value: 0.8995% CI: [-0.44, 0.4]Regression, Linear
Secondary
Change in Team Functioning From Baseline to 3-month Follow-up: Psychological Safety
Psychological safety (affective state) was assessed with Edmondson's (1999) Psychological Safety scale of 7 items rated on a 7-point Likert scale (1-7). Scores were averaged; higher scores indicate more psychological safety.
Time frame: Baseline, 3-month follow-up (Month 7, 3 months after training workshop)
Population: Descriptive data: Team members with data for that timepoint. Intent-to-treat analysis: All team members with data at 1 or more timepoints
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| TeamTRACS (Team Training in Roles, Awareness, Communication, and Support) | Change in Team Functioning From Baseline to 3-month Follow-up: Psychological Safety | Baseline | 5.46 score on a scale | Standard Deviation 1.12 |
| TeamTRACS (Team Training in Roles, Awareness, Communication, and Support) | Change in Team Functioning From Baseline to 3-month Follow-up: Psychological Safety | Follow-up | 5.51 score on a scale | Standard Deviation 1.13 |
| Waitlist Comparison | Change in Team Functioning From Baseline to 3-month Follow-up: Psychological Safety | Baseline | 5.59 score on a scale | Standard Deviation 1.04 |
| Waitlist Comparison | Change in Team Functioning From Baseline to 3-month Follow-up: Psychological Safety | Follow-up | 5.94 score on a scale | Standard Deviation 0.98 |
Comparison: Intent-to-treat analyses tested changes in psychological safety from baseline to follow-up using linear mixed models. Mixed models analyses were conducted in R using the lme4 package and restricted maximum likelihood estimation (REML). Models included fixed effects of time (baseline vs. follow-up), intervention condition, and their interaction as well as random effects for person and team. We used the clubSandwich package to calculate cluster robust standard errors.p-value: 0.4595% CI: [-1.25, 0.79]Regression, Linear
Secondary
Change in Team Performance From Baseline to 3-month Follow-up
The overall quality of work done by the team will be assessed with Edmondson's (1999) Team Performance scale of 5 items rated on a 7-point Likert scale. Scores will be averaged; higher scores indicate better performance.
Time frame: Baseline, 3-month follow-up (Month 7, 3 months after training workshop)
Population: Descriptive data: Team members with data for that timepoint. Intent-to-treat analysis: All team members with data at 1 or more timepoints
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| TeamTRACS (Team Training in Roles, Awareness, Communication, and Support) | Change in Team Performance From Baseline to 3-month Follow-up | Baseline | 5.47 score on a scale | Standard Deviation 1.28 |
| TeamTRACS (Team Training in Roles, Awareness, Communication, and Support) | Change in Team Performance From Baseline to 3-month Follow-up | Follow-up | 5.63 score on a scale | Standard Deviation 1.14 |
| Waitlist Comparison | Change in Team Performance From Baseline to 3-month Follow-up | Baseline | 5.75 score on a scale | Standard Deviation 1.08 |
| Waitlist Comparison | Change in Team Performance From Baseline to 3-month Follow-up | Follow-up | 6.07 score on a scale | Standard Deviation 0.97 |
Comparison: Intent-to-treat analyses tested changes in team performance from baseline to follow-up using linear mixed models. Mixed models analyses were conducted in R using the lme4 package and restricted maximum likelihood estimation (REML). Models included fixed effects of time (baseline vs. follow-up), intervention condition, and their interaction as well as random effects for person and team. We used the clubSandwich package to calculate cluster robust standard errors.p-value: 0.8595% CI: [-1.51, 1.36]Regression, Linear