1
|
Jia J, Sun T, Tang J, Sun K, Meng Z, Zhu H, Huang X. Participation in Multidisciplinary Teams Among Healthcare Professionals: A Discrete Choice Experiment in Tertiary Public Hospitals in China. J Multidiscip Healthc 2024; 17:4397-4409. [PMID: 39267892 PMCID: PMC11390835 DOI: 10.2147/jmdh.s473675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 09/04/2024] [Indexed: 09/15/2024] Open
Abstract
Purpose Healthcare professionals' participation is crucial for the efficient implementation of multidisciplinary team (MDT) collaboration models. We identified the key factors influencing healthcare professionals' preference to participate in MDTs in tertiary hospitals. Methods To clarify the attributes and levels of the discrete choice experiment (DCE), we conducted a targeted literature review and conducted in-depth interviews with MDT service providers. Following this, a DCE was designed to evaluate healthcare professionals' preferences for MDT participation, and the influence of factors such as salary subsidies, leadership attention, patient participation, quality assessment, working intensity, and case complexity. A conditional logit model estimated the utility of each attribute. Willingness-to-pay estimates were derived by taking the negative ratio of the coefficients of non-economic and economic attributes. A series of policy simulation analyses were conducted. Results Two hundred healthcare professionals completed the questionnaire, with 180 valid responses used for analysis. All attributes were statistically significant. Leadership attention and working intensity were the primary factors influencing staff willingness to participate in MDTs, followed by quality assessment and salary subsidies. Significant preference differences were observed between respondents; compared with mid-level staff, senior-level healthcare professionals believed patient engagement would be more helpful in boosting participation. The policy simulation showed that changing leadership attention from "neglect" to "emphasis" would increase the probability of staff choosing to participate in MDTs from 24.4% to 66.98%. Conclusion Leadership attention was the primary concern for healthcare professionals in MDTs. To effectively motivate staff participation in MDTs, policymakers should adopt a holistic approach that considers work motivation and individual backgrounds, including competitive salary packages and a positive work environment. They should concurrently introduce MDT case complexity measurement tools to optimize resource allocation. Addressing staff members' unique needs and career aspirations by creating targeted training programs, pathways for advancement, and personalized career development plans are also crucial.
Collapse
Affiliation(s)
- Jie Jia
- Department of Health Policy and Management, School of Public Health, Hangzhou Normal University, Hangzhou, 311121, People's Republic of China
| | - Tao Sun
- Department of Health Policy and Management, School of Public Health, Hangzhou Normal University, Hangzhou, 311121, People's Republic of China
| | - Jiamin Tang
- Department of Health Policy and Management, School of Public Health, Hangzhou Normal University, Hangzhou, 311121, People's Republic of China
| | - Kaidi Sun
- Department of Health Policy and Management, School of Public Health, Hangzhou Normal University, Hangzhou, 311121, People's Republic of China
| | - Zhengnan Meng
- Department of Health Policy and Management, School of Public Health, Hangzhou Normal University, Hangzhou, 311121, People's Republic of China
| | - Hailong Zhu
- Department of Sociology, School of Public Administration, Hangzhou Normal University, Hangzhou, 311121, People's Republic of China
| | - Xianhong Huang
- Department of Health Policy and Management, School of Public Health, Hangzhou Normal University, Hangzhou, 311121, People's Republic of China
| |
Collapse
|
2
|
Kuriyan AB, Albright J, Rushworth S, Duresso B, Testa S, Eiraldi RB, Marshaleck EW, Wolk CB. Partnering with Schools to Adapt a Team Science Intervention: Processes and Challenges. SCHOOL MENTAL HEALTH 2024; 16:695-709. [PMID: 39372095 PMCID: PMC11452467 DOI: 10.1007/s12310-024-09665-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2024] [Indexed: 10/08/2024]
Abstract
Public schools are a major provider of mental health services for children in the US. Mental and behavioral health services range from universal programming to individualized clinical supports to address student needs. These services in schools are delivered by various professionals including non-teaching and teaching school personnel, school-employed clinicians, and/or contracted community mental health partners. Provision of mental health services requires complex coordination of providers across disciplines, although few professionals have training in multidisciplinary collaboration strategies. Attention to team processes, such as delineating team members' roles, improving communication, and identifying collaboration strategies, may impact the effectiveness of evidence-based mental health service provision in real world settings. One intervention, Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS), has been used in healthcare with positive outcomes and has been adapted to educational settings. The current paper describes the community-partnered subsequent adaptation of TeamSTEPPS for schools. Needs assessment interviews identified challenges, successes, and goals for student mental health. Overarching themes extracted from interviews include limited resources at multiple levels (e.g., financial support, time, and personnel), communication challenges, and poor role clarity. A community advisory board provided guidance during the adaptation and implementation planning process. Adaptations to the intervention included tailoring the intervention to the school context and the development of flexible training plans. In addition, individualized implementation plans were developed with each school partner to mitigate foreseeable barriers to rolling-out TeamSTEPPS. Our team is currently piloting the adapted TeamSTEPPS intervention and implementation strategies in partnership with three school districts. Supplementary Information The online version contains supplementary material available at 10.1007/s12310-024-09665-7.
Collapse
Affiliation(s)
- Aparajita Biswas Kuriyan
- Center for Mental Health, University of Pennsylvania Perelman School of Medicine, 3535 Market St. 3rd Fl., Philadelphia, PA 19104 USA
| | | | - Samantha Rushworth
- Center for Mental Health, University of Pennsylvania Perelman School of Medicine, 3535 Market St. 3rd Fl., Philadelphia, PA 19104 USA
| | - Biiftu Duresso
- Center for Mental Health, University of Pennsylvania Perelman School of Medicine, 3535 Market St. 3rd Fl., Philadelphia, PA 19104 USA
| | - Shannon Testa
- Center for Mental Health, University of Pennsylvania Perelman School of Medicine, 3535 Market St. 3rd Fl., Philadelphia, PA 19104 USA
| | - Ricardo B. Eiraldi
- Pediatrics and Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA USA
- Children’s Hospital of Philadelphia, Philadelphia, PA USA
| | | | - Courtney Benjamin Wolk
- Center for Mental Health, University of Pennsylvania Perelman School of Medicine, 3535 Market St. 3rd Fl., Philadelphia, PA 19104 USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA USA
| |
Collapse
|
3
|
Kang-Yi CD, Kuriyan A, Kinkler G, Pisciella AE, Williams T, Wolk CB. Generating Actionable Evidence for School-Based Mental Health Service Delivery: Public-Academic Partnership Based Evaluations. Community Ment Health J 2023; 59:1588-1600. [PMID: 37289384 DOI: 10.1007/s10597-023-01147-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 05/19/2023] [Indexed: 06/09/2023]
Abstract
Public-academic partnership-based program evaluations can generate actionable evidence for policymaking, program design and implementation in improving school-based mental health service delivery. The University of Pennsylvania Center for Mental Health and public behavioral health care agencies in Philadelphia in the United States have evaluated Philadelphia's school mental health programs reimbursable through Medicaid billing since 2008. The variety of evaluations include (1) examining acute mental health service use of children receiving school-based mental health care and Medicaid expenditure, (2) examining children's externalizing and internalizing behaviors to measure school mental health providers' performance, and (3) examining effects of different types of school mental health programs on children's behavioral health functioning, school outcomes, and other out-of-school service use. This paper reports key findings of these evaluations, discusses how programs have been refined based on evaluation results, and shares lessons learned for successful public-academic partnership-based evaluations to promote use of actionable evidence.
Collapse
Affiliation(s)
- Christina D Kang-Yi
- Department of Psychiatric Rehabilitation and Counseling Professions, School of Health Professions, Rutgers Biomedical and Health Sciences, NJ, USA.
| | - Aparajita Kuriyan
- Center for Mental Health, University of Pennsylvania Perelman School of Medicine, PA, USA
| | - Grace Kinkler
- Center for Mental Health, University of Pennsylvania Perelman School of Medicine, PA, USA
| | | | - Tamra Williams
- Department of Health and Human Services, Pennsylvania Montgomery County, PA, USA
| | - Courtney Benjamin Wolk
- Center for Mental Health, University of Pennsylvania Perelman School of Medicine, PA, USA
- The Leonard Davis Institute of Health Economics, University of Pennsylvania, PA, USA
| |
Collapse
|
4
|
McGuier EA, Feldman J, Bay M, Ascione S, Tatum M, Salas E, Kolko DJ. Improving teamwork in multidisciplinary cross-sector teams: Adaption and pilot testing of a team training for Child Advocacy Center teams. CHILDREN AND YOUTH SERVICES REVIEW 2023; 153:107096. [PMID: 37601235 PMCID: PMC10437145 DOI: 10.1016/j.childyouth.2023.107096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
Background Effective teamwork is critical to the mission of Child Advocacy Center (CAC) multidisciplinary teams. Team interventions designed to fit the unique cross-organizational context of CAC teams may improve teamwork in CACs. Methods A collaborative, community-engaged approach was used to adapt TeamSTEPPS, an evidence-based team training for healthcare, for CAC multidisciplinary teams. The adapted training was piloted with one team and evaluated using mixed methods. Team members completed pre-training (n = 26) and follow-up surveys (n = 22) and participated in qualitative interviews (n = 9). Results The adaptation process resulted in the creation of TeamTRACS (Team Training in Roles, Awareness, Communication, and Support). Participants rated TeamTRACS as highly acceptable, appropriate, feasible, relevant, and useful for CAC teams. They identified positive and negative aspects of the training, ideas for improvement, and future uses for TeamTRACS. Conclusions TeamTRACS is a feasible approach to team training in CACs, and team members find the content and skills relevant and useful. Additional research is needed to test the effectiveness of TeamTRACS and identify appropriate implementation strategies to support its use.
Collapse
Affiliation(s)
| | - Jamie Feldman
- Western Psychiatric Hospital, University of Pittsburgh Medical Center
| | - Mikele Bay
- Children’s Advocacy Center of McKean County
| | - Sue Ascione
- Northeast Regional Children’s Advocacy Center
| | - Mary Tatum
- Child Advocacy Center of Clearfield County
| | | | - David J. Kolko
- Department of Psychiatry, University of Pittsburgh School of Medicine
| |
Collapse
|
5
|
Lawson GM, Comly R, Beidas RS, Khanna MS, Goldstein J, Brizzolara-Dove S, Wilson T, Rabenau-McDonnell Q, Eiraldi R. Therapist and supervisor perspectives about two train-the-trainer implementation strategies in schools: A qualitative study. IMPLEMENTATION RESEARCH AND PRACTICE 2023; 4:26334895231190854. [PMID: 37790186 PMCID: PMC10403977 DOI: 10.1177/26334895231190854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023] Open
Abstract
Background Train-the-trainer (TT) implementation strategies (in which designated clinicians are trained to then train others in an intervention) are promising approaches to support mental health clinician use of evidence-based interventions in school contexts. However, there is little evidence to date examining clinicians' perceptions of the acceptability and feasibility of TT strategies, or comparing clinicians' perceptions of different types of TT strategies. Methods The current study was conducted as part of a larger hybrid effectiveness-implementation trial, in which school-based therapists and supervisors received one of two different types of implementation support to implement cognitive behavioral therapy (CBT) groups for anxiety: TT (i.e., initial training for therapists and supervisors) or enhanced TT (TT+; i.e., initial training for therapists and supervisors, and ongoing external consultation for supervisors). We used applied thematic analysis to compare qualitative interview transcripts from 28 therapist interviews and 33 supervisor interviews from therapists and supervisors who received TT or TT+ support and report themes that were similar and different across the two groups. Results Most themes were similar across the TT and TT+ conditions: therapists and supervisors in both conditions perceived the group anxiety intervention as acceptable and viewed supervision as acceptable, helpful, and feasible. Therapists and supervisors in both conditions had mixed impressions of the contextual appropriateness of the group anxiety intervention, and some reported logistical challenges with weekly supervision. Some unique themes were identified among the TT+ condition, including supervisors experiencing professional growth, and therapists and supervisors perceiving supervision as critically important and enjoyable. Conclusions These results suggest that TT implementation support, using a model in which an internal supervisor receives initial training and then provides ongoing supervision, is acceptable and feasible to support a group CBT intervention in schools. The results also highlight additional benefits that therapists and supervisors perceived when supervisors received ongoing consultation. Clinical Trial Registration Information The clinical trial from which these data were derived was registered at ClinicalTrials.gov (https://clinicaltrials.gov/) prior to the time of first patient enrollment. The registration number is: NCT02651402.
Collapse
Affiliation(s)
- Gwendolyn M. Lawson
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Rachel Comly
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Rinad S. Beidas
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | | | - Tara Wilson
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Ricardo Eiraldi
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| |
Collapse
|
6
|
Willgerodt MA, Blakeney EAR. Can relational coordination theory be used to understand and improve interprofessional care coordination in schools? A pilot study. J Interprof Care 2022; 36:761-764. [PMID: 35129028 PMCID: PMC9356112 DOI: 10.1080/13561820.2021.1997951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 05/02/2021] [Accepted: 10/15/2021] [Indexed: 10/19/2022]
Abstract
Attending to the health needs of students with chronic conditions requires a fluid exchange of information and coordination between parents, educators, administrators, and school healthcare professionals. Previous research often omits school nurses in this exchange, although their role is key to successful outcomes. Relational Coordination (RC) theory posits that cohesive relationships help support communication, enabling stakeholders to coordinate their work. This article preliminarily explores whether RC domains might be relevant in school health settings, utilizing existing qualitative data. Responses from focus group sessions were analyzed using a deductive and inductive analytic approach. Data were coded using the 7 RC domains as a priori codes. Frequent, timely, and accurate communication emerged as major themes in the communication domain. Shared knowledge was a major theme within the relationship domain. Problem-solving communication, shared goals, and mutual respect were minor themes. The results suggest that improving interprofessional collaboration (IPC) and health outcomes in children with chronic conditions using RC theory-informed interventions will be important to deepen the understanding of how these different domains interact and influence student health outcomes.
Collapse
|
7
|
McClain MB, Shahidullah JD, Harris B, McIntyre LL, Azad G. Reconceptualizing Educational Contexts: The Imperative for Interprofessional and Interagency Collaboration in School Psychology. SCHOOL PSYCHOLOGY REVIEW 2021. [DOI: 10.1080/2372966x.2021.1949247] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
8
|
Kuriyan A, Kinkler G, Cidav Z, Kang-Yi C, Eiraldi R, Salas E, Wolk CB. Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) to Improve Collaboration in School Mental Health: Protocol for a Mixed Methods Hybrid Effectiveness-Implementation Study. JMIR Res Protoc 2021; 10:e26567. [PMID: 33555258 PMCID: PMC7899798 DOI: 10.2196/26567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 01/04/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Public schools in the United States are the main providers of mental health services to children but are often ill equipped to provide quality mental health care, especially in low-income urban communities. Schools often rely on partnerships with community organizations to provide mental health services to students. However, collaboration and communication challenges often hinder implementation of evidence-based mental health strategies. Interventions informed by team science, such as Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS), have the potential to improve treatment implementation and collaboration within schools. OBJECTIVE The objective of this study is to improve communication and collaboration strategies among mental health and school staff by adapting an evidence-based team science intervention for school settings. We present a protocol for a hybrid effectiveness-implementation study to adapt TeamSTEPPS using stakeholder feedback, develop a tailored implementation plan, and pilot the adapted content in eight schools. METHODS Study participants will be recruited from public and charter schools and agencies overseeing school mental health services in the local metro area. We will characterize current services by conducting a needs assessment including stakeholder interviews, observations, and review of administrative data. Thereafter, we will establish an advisory board to understand challenges and develop possible solutions to guide additional TeamSTEPPS adaptations along with a complementary implementation plan. In aim 3, we will implement the adapted TeamSTEPPS plus tailored implementation strategies in eight schools using a pre-post design. The primary outcome measures include the feasibility and acceptability of the adapted TeamSTEPPS. In addition, self-report measures of interprofessional collaboration and teamwork will be collected from 80 participating mental health and school personnel. School observations will be conducted prior to and at three time points following the intervention along with stakeholder interviews. The analysis plan includes qualitative, quantitative, and mixed methods analysis of feasibility and acceptability, school observations, stakeholder interviews, and administrative data of behavioral health and school outcomes for students receiving mental health services. RESULTS Recruitment for the study has begun. Goals for aim 1 are expected to be completed in Spring 2021. CONCLUSIONS This study utilizes team science to improve interprofessional collaboration among school and mental health staff and contributes broadly to the team science literature by developing and specifying implementation strategies to promote sustainability. Results from this study will provide knowledge about whether interventions to improve school culture and climate can ready both mental health and school systems for implementation of evidence-based mental health practices. TRIAL REGISTRATION ClinicalTrials.gov NCT04440228; https://clinicaltrials.gov/ct2/show/NCT04440228. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/26567.
Collapse
Affiliation(s)
- Aparajita Kuriyan
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Grace Kinkler
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Zuleyha Cidav
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA, United States
| | - Christina Kang-Yi
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA, United States
| | - Ricardo Eiraldi
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Eduardo Salas
- Department of Psychological Sciences, Rice University, Houston, TX, United States
| | - Courtney Benjamin Wolk
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA, United States
| |
Collapse
|
9
|
Qu J, Zhu Y, Cui L, Yang L, Lai Y, Ye X, Qu B. Psychometric properties of the Chinese version of the TeamSTEPPS teamwork perceptions questionnaire to measure teamwork perceptions of Chinese residents: a cross-sectional study. BMJ Open 2020; 10:e039566. [PMID: 33191259 PMCID: PMC7668380 DOI: 10.1136/bmjopen-2020-039566] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES The purpose of this research was to evaluate the psychometric properties of the TeamSTEPPS Teamwork Perception Questionnaire (T-TPQ) among the Chinese residents. DESIGN Cross-sectional study. SETTING A clinical hospital of the China Medical University in Liaoning Province, China. PARTICIPANTS A total of 664 residents were enrolled in this research. The valid response rate was 83.0% (664 of 800 residents). MAIN OUTCOME MEASURES Internal consistency and test-retest reliability were used to assess the reliability of the questionnaire. The construct validity of the Chinese T-TPQ was evaluated by confirmatory factor analysis. Furthermore, the concurrent, convergent and discriminant validity were analysed. RESULTS Cronbach's α coefficient of the T-TPQ in Chinese language was 0.923. Except for the communication dimension (0.649), the Cronbach's α coefficient of all dimensions were satisfactory. The T-TPQ and its five dimensions reported a good test-retest reliability (0.740-0.881, p<0.01). Moreover, the results of the confirmatory factor analysis demonstrated that the construct validity of the Chinese T-TPQ was satisfactory. All dimensions significantly correlated with the Hospital Survey on Patient Safety Culture (HSOPSC) teamwork within units dimension and the Safety Attitudes Questionnaire (SAQ) teamwork climate dimension (p<0.01), and the questionnaire showed satisfactory convergent and discriminant validity. CONCLUSIONS The T-TPQ in Chinese language demonstrated good psychometric characteristics and was a reliable and valid questionnaire to measure the Chinese health professionals' perception of teamwork. Thus, the Chinese version of the T-TPQ could be applied in teamwork training programmes and medical education research.
Collapse
Affiliation(s)
- Jinglou Qu
- Institute for International Health Professions Education and Research, China Medical University, Shenyang, China
- Department of Postgraduate Administration, The First Hospital of China Medical University, Shenyang, China
| | - Yaxin Zhu
- Institute for International Health Professions Education and Research, China Medical University, Shenyang, China
| | - Liyuan Cui
- Institute for International Health Professions Education and Research, China Medical University, Shenyang, China
- China Medical University Library, China Medical University, Shenyang, China
| | - Libin Yang
- Center for Higher Education Research and Teaching Quality Evaluation, Harbin Medical University, Harbin, China
| | - Yanni Lai
- Medical Education Office, Fudan University, Shanghai, China
| | - Xuechen Ye
- Institute for International Health Professions Education and Research, China Medical University, Shenyang, China
| | - Bo Qu
- Institute for International Health Professions Education and Research, China Medical University, Shenyang, China
| |
Collapse
|
10
|
Bearman SK, Bailin A, Rodriguez E, Bellevue A. Partnering with School Providers to Co-Design Mental Health Interventions: An Open Trial of Act & Adapt in Urban Public Middle Schools. PSYCHOLOGY IN THE SCHOOLS 2020; 57:1689-1709. [PMID: 36590313 PMCID: PMC9799065 DOI: 10.1002/pits.22410] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Schools are well positioned to provide access to youth mental health services, but implementing effective programs that promote emotional and behavioral functioning in school settings is complicated by the poor fit of interventions developed in research settings to complex school contexts. The current study formed a research-practice partnership with two urban public schools and mental health providers employed by those schools (N = 6, 100% female, 50% Black/African American, 50% White/Caucasian) in the adaptation of a depression prevention intervention, Act & Adapt. The intervention was modified by decreasing meeting time and streamlining session content, increasing flexibility, making intervention materials more similar to academic curriculum, and increasing the focus on managing disruptive behavior within group sessions. In an open trial, 6th grade students (N = 22; 59% boys, 31% Hispanic, 22% Black/African American, 4% Asian, 30% White/Caucasian) at both schools who were identified as clinically "at risk" reported improvements from baseline to post-intervention and at one-year follow-up on measures of emotional and behavioral difficulties and coping strategies, with parallel results by caregiver report. The providers reported satisfaction with the intervention, and qualitative analyses of provider focus groups suggested both barriers and facilitators to research-practice collaborations to implement mental health interventions in schools.
Collapse
Affiliation(s)
| | - Abby Bailin
- Department of Educational Psychology, The University of Texas at Austin
| | - Erin Rodriguez
- Department of Educational Psychology, The University of Texas at Austin
| | - Alison Bellevue
- Ferkauf Graduate School of Professional Psychology, Yeshiva University
| |
Collapse
|
11
|
Implementation of KEIGAAF in Primary Schools: A Mutual Adaptation Physical Activity and Nutrition Intervention. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17030751. [PMID: 31991622 PMCID: PMC7037055 DOI: 10.3390/ijerph17030751] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 01/20/2020] [Accepted: 01/22/2020] [Indexed: 01/19/2023]
Abstract
School health promotion is advocated. Implementation studies on school health promotion are less often conducted as effectiveness studies and are mainly conducted conventionally by assessing fidelity of "one size fits all" interventions. However, interventions that allow for local adaptation are more appropriate and require a different evaluation approach. We evaluated a mutual adaptation physical activity and nutrition intervention implemented in eight primary schools located in low socioeconomic neighborhoods in the Netherlands, namely the KEIGAAF intervention. A qualitative, multiple-case study design was used to evaluate implementation and contextual factors affecting implementation. We used several qualitative data collection tools and applied inductive content analysis for coding the transcribed data. Codes were linked to the domains of the Consolidated Framework for Implementation Research. NVivo was used to support data analysis. The implementation process varied greatly across schools. This was due to the high level of bottom-up design of the intervention and differing contextual factors influencing implementation, such as differing starting situations. The mutual adaptation between top-down and bottom-up influences was a key element of the intervention. Feedback loops and the health promotion advisors played a crucial role by navigating between top-down and bottom-up. Implementing a mutual adaptation intervention is time-consuming but feasible.
Collapse
|
12
|
Wolk CB, Stewart RE, Cronholm P, Eiraldi R, Salas E, Mandell DS. Adapting TeamSTEPPS for school mental health teams: a pilot study. Pilot Feasibility Stud 2019; 5:148. [PMID: 31890260 PMCID: PMC6918659 DOI: 10.1186/s40814-019-0529-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 11/12/2019] [Indexed: 10/29/2022] Open
Abstract
BACKGROUND School mental health care often is provided by teams contracted from community mental health agencies. The team members that provide this care, however, do not typically receive training in how to work effectively in a team-based context. Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) provides a promising, evidence-based strategy for improving communication and climate in school-based teams. METHODS In collaboration with stakeholders, we adapted and piloted TeamSTEPPS for use with school mental health teams. Teams in six schools were randomized to receive the adapted TeamSTEPPS approach or usual supports. The main outcomes of interest were feasibility and acceptability of the adapted TeamSTEPPS strategy. RESULTS Results indicated that team member burnout was significantly higher at follow-up than pretreatment for both control and intervention teams. TeamSTEPPS was feasible and acceptable to implement, and leadership emerged as an important facilitator. Barriers to implementation success included staff turnover, lack of resources, and challenges in the school mental health team relationship. Additional supports to implement TeamSTEPPS were suggested, including ongoing consultation and booster training to address high staff turnover. CONCLUSIONS Results suggest that TeamSTEPPS is promising for school mental health teams but additional modifications are likely needed.
Collapse
Affiliation(s)
- Courtney Benjamin Wolk
- Center for Mental Health Policy and Services Research, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Floor 3, Philadelphia, PA 19104 USA
| | - Rebecca E. Stewart
- Center for Mental Health Policy and Services Research, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Floor 3, Philadelphia, PA 19104 USA
| | - Peter Cronholm
- Department of Family Medicine and Community Health and Center for Public Health Initiatives, University of Pennsylvania, 51 North 39th Street, 6th Floor Mutch Bld, Philadelphia, PA 19104 USA
| | - Ricardo Eiraldi
- Division of Developmental and Behavioral Pediatrics and Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 2716 South Street, 8th floor, Philadelphia, PA 19146 USA
| | - Eduardo Salas
- Department of Psychological Sciences, Rice University, P.O. Box 1892, Houston, TX 77251 USA
| | - David S. Mandell
- Center for Mental Health Policy and Services Research, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Floor 3, Philadelphia, PA 19104 USA
| |
Collapse
|