Measuring interprofessional team collaboration in expanded school mental health: Model refinement and scale development

Enhancing interprofessional teamwork between youth care professionals using an electronic health record; a mixed methods intervention study

We aimed to investigate whether using a shared electronic patient record (EPR-Youth) strengthened interprofessional teamwork among professionals in youth care and child healthcare. Using a mixed-methods design, we compared two partly overlapping samples of professionals, who completed questionnaires before the introduction of EPR-Youth (n = 117) and 24 months thereafter (n = 127). Five components of interprofessional teamwork (interdependence, newly created professional activities, flexibility, collective ownership of goals, and reflection on processes) were assessed for this study. Midway through the study period, focus groups were held with 12 professionals to examine how EPR-Youth contributed to interprofessional teamwork. Professionals reported significantly more flexibility after the introduction of EPR-Youth than before. Professionals scored slightly -but not significantly- more positively on the other components of teamwork. Focus group participants reported that using EPR-Youth strengthened their sense of interdependence and collective ownership of goals, and contributed to newly created professional activities. At baseline, levels of interprofessional teamwork differed between organizations. Focus group participants confirmed these differences and attributed them to differences in facilitation of interprofessional teamwork. Our findings suggest that using EPR-Youth can foster interprofessional teamwork. Organizational differences underline that implementing an EPR alone is inadequate: shared definitions of teamwork and organizational facilities are needed to strengthen interprofessional teamwork.

The Ethical Obligations, Barriers, and Solutions for Interprofessional Collaboration in the Treatment of Autistic Individuals

With an estimated 1 in 44 children having been diagnosed with autism and given the variety of types of service providers that treat autism, collaboration among these professionals is a necessary part of the overall treatment package for an autistic individual. However, like with any professional skill, competence in collaborating effectively must be developed, especially because behavior analysts have been criticized for being resistant to collaboration. Competence with collaboration may be developed through coursework, professional development opportunities, and supervision by someone who has demonstrated competence with collaboration. With the 2020 update to the Ethics Code for Behavior Analysts, the behavior analyst's role in collaborating with other professionals has been clarified by several expectations. Current literature also provides additional guidance on the potential barriers to collaboration as well as recommendations for how to support a collaborative team. In order to facilitate successful collaboration, it is also important to evaluate the effectiveness of the collaborative team and to take advantage of opportunities to learn about the methodologies and perspectives of the other professionals to ensure that the client's best interests are met.

Implementation of a School Mental Health Learning Collaborative Model to Support Cross-Sector Collaboration

Facilitating success for students with behavioral health challenges requires effective collaboration among professionals from traditionally disparate systems (e.g., education, health, and mental health). The current investigation describes a case-study implementation of a school-based learning collaborative model and explores its effectiveness in promoting knowledge, skill, efficacy, and systems-related improvements in cross-sector collaboration. The learning collaborative (LC) was offered to school teams over the course of a year and consisted of a combination of didactic and experiential learning opportunities, guest speakers, district-specific improvement goals, peer learning and support, and individualized consultation support. Evaluation efforts included evidence demonstrating the efficacy of the LC, improvement in person-centered knowledge skills and competencies, and generation of concrete changes in school systems. Respondents consistently shared that the quality of the LC was high that the topics were highly useful for their day-to-day practice, and that they would recommend the LC to their colleagues and peers. In turn, this process fostered improvement in educators' knowledge, skills, and confidence, and generated systemic improvement in districts to support children with behavioral health needs and their families. Specific components of this model that best account for changes are discussed, along with implications for application and next steps.

Improving interprofessional collaboration in schools: A cluster-randomized study evaluating the effectiveness of the LOG model on collaboration practices

Although interprofessional collaboration is emphasized as important in schools, little is known about how it should be organized. We analyzed the effects of an organizational model of interprofessional collaboration, the LOG model. The model aims to improve interprofessional collaboration by identifying and improving various meeting places for collaboration, involving municipal school leaders, principals, staff, and interprofessional collaborators, and by increasing feedback from meeting places in and around schools. In a cluster-randomized design including 35 Norwegian primary schools, 19 schools were randomized to the experimental group and implemented the LOG model, and 16 were randomized to a control group. A total of 142 interprofessional collaborators (e.g., school nurses, social workers, and principals) received a questionnaire prior to randomization, with one- and two-year follow-up. Using a validated scale to measure interprofessional team collaboration, we evaluated the effects of the model on collaborators' perceptions in four dimensions: (a) Reflection on process, (b) Professional flexibility, (c) Newly created professional activities, and (d) Role interdependence. During the first, but not the second year of follow-up, the results demonstrated positive and statistically significant effects of the LOG model on the dimensions Reflection on process (p< .001) and Newly created professional activities (p= .016). Our findings demonstrate the potential of interventions addressing interprofessional collaboration at the organizational level.

Can relational coordination theory be used to understand and improve interprofessional care coordination in schools? A pilot study

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.

Interprofessional collaboration in hospital-based services for victims of sexual violence in South Korea: participating professionals' different attitudes and their impacts on collaboration

Human service professionals (HSPs) play important roles in supporting victims of sexual violence. When these professionals work together in various forms of collaboration, attitudes of professionals in different fields can sometimes facilitate or sometimes hinder collaboration. The effect of attitude can be further highlighted when HSPs collaborate with experts with different fields of sexual violence, such as police officers. This study examined the difference in the attitudes toward interprofessional collaboration and victims of sexual violence between HSPs and police officers in South Korea. Then, the effect of such attitudes on the degree of interprofessional collaboration was analyzed. Survey data were collected from 174 HSPs and 65 police officers at 34 hospital-based Sunflower Centers across South Korea. Results showed that HSPs had a more positive attitude toward the benefits of interprofessional collaboration, and had a less negative attitude toward victims of sexual violence, than police officers. The results further confirmed that collaboration can be strengthened by actively fostering interprofessional work and reducing prejudice against the victims. Based on these results, practical implications to promote the degree of interprofessional collaboration are suggested.

A mixed-method longitudinal study of an interprofessional education course

The purpose of this mixed-method longitudinal study was to understand how health professional students' perceptions of their professional flexibility, role interdependence, and reflection on their process of working together change over time as a result of participating in an interprofessional education course. Data were collected from students enrolled in an interprofessional service-learning course each year from Fall 2014 to 2018 via online surveys at four assessment points and through qualitative reflection papers that served as course assignments. The 14-week course consisted of both didactic instruction and an experiential component whereby students conducted a service-learning activity in interprofessional teams. Quantitative findings demonstrate that students experienced a significant quadratic growth trajectory in reflection on process and a significant linear growth trajectory in professional flexibility. Students reported experiencing non-significant changes in role interdependence. Qualitative data, however, suggest student learning across all three domains. This study has implications for interprofessional educational initiatives aimed at promoting students' interprofessional competencies.

An examination of the factor structure of TeamSTEPPS measures in school mental health teams

Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS™) is a tested strategy for improving communication and climate in hospitals. It is a promising but untested tool among school-based mental health teams. We examined the psychometric properties of the TeamSTEPPS Teamwork Perceptions Questionnaire (T-TPQ) and Teamwork Attitudes Questionnaire (T-TAQ) among 167 school mental health team members. Team members worked for one of five agencies in 33 K-8 urban public schools. Exploratory factor analyses and descriptive data are presented. For both the T-TPQ and T-TAQ, a unitary factor structure best fit the data for this sample. The T-TPQ and T-TAQ were not significantly correlated with one another and total scores did not significantly differ by staff role. Agencies differed in T-TAQ results, and one agency had lower T-TAQ total scores relative to other agencies. Results suggest that the factor structures are different among school mental health teams than among other healthcare providers.

A Systematic Review of Community Engagement Outcomes Research in School-Based Health Interventions

BACKGROUND

Involving communities in school health has been purported as a practice integral to supporting a Whole School, Whole Community, Whole Child (WSCC) approach. Although community collaboration is often included in school-based health initiatives, there is little research considering methods for increasing community engagement. The purpose of this study was to identify effective school-based health interventions documenting changes in community engagement.

METHODS

Academic experts and school stakeholders guided procedures for a systematic review of studies published from 1987-2017 and gray literature (ie, best practice documents; policy documents, etc.) on comprehensive school health interventions including community engagement as a targeted outcome.

RESULTS

The search identified 9 studies addressing community as an outcome of school-based health interventions; types of partnership mechanisms and partners' roles were classified.

CONCLUSIONS

Although involving communities is a WSCC component and commonly recommended as a strategy fundamental to school health, there is little empirical research examining effective strategies for engaging communities and engagement is often not measured as part of intervention studies. Further measurement and research in engaging communities in school health is warranted.

Supporting the end of prostitution permanently (SEPP) prostitution court: examining inter-professional collaboration within alternative criminal justice settings

Problem-solving courts such as prostitution courts are becoming an important feature of the American court landscape. Internationally, while there is a great deal of skepticism regarding problem solving courts, at least five countries (e.g., England, Scotland, Ireland, Australia, and Canada) are deliberating whether this "revolutionary panacea" which has swept America's criminal justice system is the right approach for them. Few studies have explored the benefits and challenges of problem solving courts (i.e. prostitution court) using an interprofessional collaborative framework. The purpose of this case study is to examine contemporary issues related to prostitution courts using Bronstein's model of interprofessional collaborative framework which identifies five components that facilitate optimum IPC: 1) interdependence, 2)newly created professional activities, 3)flexibility, 4)collective ownership of goals, and 5) reflection on the process. Some benefits of IPC include working collaboratively, adaptability, adjusting expectations, investment in the process and making changes as needed. Some of the challenges of IPC were coercive power, dual roles, bait and switch, hierarchy, and push for outcomes at the expense of clients. As criminal justice systems nationally and internationally contemplate widespread implementation of different kinds of problem-solving courts, these benefits and challenges need to be considered before states and countries adopt these courts.

Quality of collaboration within health promotion partnerships: Impact on sense of community, empowerment, and perceived projects' outcomes

Community coalitions or intersectoral partnerships have long been advocated for the promotion of population health. In the present study, we assessed the quality of the functioning of health promotion partnerships created within a large community health promotion program implemented by the Emilia-Romagna region located in the north-east of Italy (2014-2016). In particular, we aimed to test the effectiveness of partnership working in strengthening participants' empowerment, sense of community and ultimately, the outcomes of a well-functioning partnership, conceptualized as including perceived effectiveness of health promotion interventions developed by the partnership, trust in their implementation and personal commitment in health promotion in the future. Participants were 238 stakeholders (e.g., health professionals, representatives of local administrations, teachers, representative of community and volunteer organizations, and citizens) formally included in six partnerships lead by six major local health services. Using Bayesian structural equation modeling, we found that a higher perceived quality of collaboration within the partnership enhances the outcomes of a well-functioning partnership, by strengthening their sense of a health-promoting community and empowerment. Sense of community responsibility did not predict future commitment in health promotion. The study findings suggest that community members' ownership and feeling of responsibility, as well as empowerment constitute positive partnership processes.

Developing a Scale to Measure Interprofessional Collaboration in HIV Prevention and Care: Implications for Research on Patient Access and Retention in the HIV Continuum of Care

To adapt and validate a scale for measuring interprofessional collaboration in HIV prevention and care (IPC-HIV), primary survey data were collected (2012-2017) from 577 HIV service providers in 60 organizations in New York, New Jersey, and Michigan. Cross-sectional training data were used to develop the IPC-HIV scale. The model was validated by fitting the five-factor confirmatory factor-analysis model to a 30-item set. The scale measures five domains with reliable alpha coefficients: Interdependence, Professional Activities, Flexibility, Collective Ownership, and Reflection on Process. Correlations between subscales were significant (p < .05). The strongest correlation was between Reflection on Process and Collective Ownership subscale scores. Mean scores ranged lfrom 4.070 to 4.880, with the highest score for Flexibility across all locations. IPC-HIV is valid and reliable among HIV-prevention and care workers, and is recommended for examining the effect of IPC on patient access to HIV testing and primary care.

Development of a Quantitative Instrument to Measure Mobile Collaborative Learning (MCL) Using WhatsApp: The Conceptual Steps

It has been reported that WhatsApp, a social media application, had approximately 1.6 billion active users globally as of July 2019, almost one-fifth of the total world’s population. Thus, research about WhatsApp’s influence in general and especially its influence in education was relevant and significant. While there was much research involving WhatsApp and learning, it was not conclusive about the effects of WhatsApp on student learning. Specifically, research focusing on collaborative learning using WhatsApp was lacking, including research instruments for measuring collaboration on WhatsApp. Consequently, the paper’s research problem was the lack of research instruments for measuring collaboration on WhatsApp in relation to academic achievement. To address the research problem, the study followed the important initial and conceptual steps of the instrument development process to develop a research instrument to measure collaboration on WhatsApp in relation to academic achievement. The result of the paper was a developed instrument that provides researchers with a basis to measure the explanatory constructs involved in mobile collaborative learning (MCL) processes on WhatsApp and potentially other social media platforms. Therefore, the paper made an appropriately theoretical contribution, which was grounded in the scientific literature. The study facilitated positivistic research and epistemology for acquiring objective and precise scientific knowledge. Such deductive research promotes theory testing and development and presents educators and students with scientific evidence about learning with MCL applications such as WhatsApp from which both curriculum and learning design can be informed and benefited. In the age of connected mobility this is a necessity.

Coach Support of High School Student-Athletes Struggling With Anxiety or Depression

This study sought to identify factors that influence whether coaches support athletes struggling with depression and anxiety. Participants were U.S. public high school coaches who completed a written survey assessing their experiences, attitudes, and behaviors related to student-athlete mental health (n = 190 coaches, 92% response rate). Around two-thirds of coaches were concerned about mental health issues among the students they coached. They were more likely to extend help to a struggling athlete if they were aware of their school’s mental health plan and had greater confidence related to helping, including feeling confident in their ability to identify symptoms of mental health disorders. Mental health professionals, including sport psychologists who work with or consult with coaches, are well positioned to help provide coaches with the education necessary to be able to support and encourage care seeking by athletes who are struggling with anxiety or depression.

Individual-level determinants of interprofessional team collaboration in healthcare

Interprofessional team collaboration (ITC) is pivotal for the safety and the quality of healthcare settings, being associated with higher staff and patient satisfaction. However, individual-level determinants (i.e. socio-demographic and working satisfaction) remain currently largely unexplored. This study aimed to describe the overall ITC (i.e. partnership, cooperation, coordination), identifying the individual-level determinants of each ITC domain. This study had a multicentre approach, using cross-sectional data collection. ITC was assessed using the Interprofessional Team Collaboration Scale II, Italian version (I-AITCS II). The determinants of ITC were investigated through multivariable linear regression models. The study results showed significant associations between the same ITC domains, as well as the important role of work satisfaction in determining cooperation and coordination. Physicians reported more inadequate partnership levels than other healthcare professionals. This study provides insights for future research and gives a useful description of the determinants of ITC for multi-stakeholder healthcare organizations.

Experiences of interprofessional collaboration in a special school programme for adolescents who struggle with school life: an explorative study

A growing proportion of adolescents struggle with school life and could benefit from special school programmes. School could be an arena for supporting such adolescents and, to meet these challenges, interprofessional collaboration (IPC) has been recommended for better health. The aim of the present study was to explore the experience of IPC in a special school programme offered to adolescents who struggle with school life - from the perspective of the professionals involved. Focus group interviews were carried out with four groups and fourteen participants, and the focus groups included two to five participants each. The focus group interviews were analysed using qualitative content analysis. The analyses from this study resulted in a main theme: IPC in the special school programme is unpredictable. Five categories emerged from the data, including: variations in initiative, significance of individual characteristics, informal and formal contact, lack of criteria and goals, and different obligations. The participants described IPC as differing from case to case, with a lack of criteria and goals for adolescents in the special school programme. They experienced the random nature of whoever took the initiative to collaborate, and that confidentiality and the different documentation requirements could affect IPC.

Unpacking Partnership, Engagement, and Collaboration Research to Inform Implementation Strategies Development: Theoretical Frameworks and Emerging Methodologies

Background: Partnership, engagement, and collaboration (PEC) are critical factors in dissemination and implementation (D&I) research. Despite a growing recognition that incorporating PEC strategies in D&I research is likely to increase the relevance, feasibility, impacts, and of evidence-based interventions or practices (EBIs, EBPs), conceptual frameworks and methodologies to guide the development and testing of PEC strategies in D&I research are lacking. To address this methodological gap, a review was conducted to summarize what we know, what we think we know, and what we need to know about PEC to inform D&I research.

Methods: A cross-field scoping review, drawing upon a broad range of PEC related literature in health, was conducted. Publications reviewed focused on factors influencing PEC, and processes, mechanisms and strategies for promoting effective PEC. The review was conducted separately for three forms of partnerships that are commonly used in D&I research: (1) consumer-provider or patient-implementer partnership; (2) delivery system or implementation team partnership; and (3) sustainment/support or interagency/community partnership. A total of 39 studies, of which 21 were review articles, were selected for an in-depth review.

Results: Across three forms of partnerships, four domains (cognitive, interpersonal/affective, behavioral, and contextual domains) were consistently identified as factors and strategies for promoting PEC. Depending on the stage (preparation or execution) and purpose of the partnership (regulating performance or managing maintenance), certain PEC strategies are more or less relevant. Recent developments of PEC frameworks, such as Partnership Stage of Change and multiple dynamic processes, provide more comprehensive conceptual explanations for PEC mechanisms, which can better guide PEC strategies selection and integration in D&I research.

Conclusions: This review contributes to D&I knowledge by identifying critical domain factors, processes, or mechanisms, and key strategies for PEC, and offers a multi-level PEC framework for future research to build the evidence base. However, more research is needed to test PEC mechanisms.

The measurement of collaboration within healthcare settings: a systematic review of measurement properties of instruments

BACKGROUND

There is a growing call by consumers and governments for healthcare to adopt systems and approaches to care to improve patient safety. Collaboration within healthcare settings is an important factor for improving systems of care. By using validated measurement instruments a standardized approach to assessing collaboration is possible, otherwise it is only an assumption that collaboration is occurring in any healthcare setting.

OBJECTIVES

The objective of this review was to evaluate and compare measurement properties of instruments that measure collaboration within healthcare settings, specifically those which have been psychometrically tested and validated.

INCLUSION CRITERIA, TYPES OF PARTICIPANTS

Participants could be healthcare professionals, the patient or any non-professional who contributes to a patient's care, for example, family members, chaplains or orderlies. The term participant type means the designation of any one participant; for example 'nurse', 'social worker' or 'administrator'. More than two participant types was mandatory.

TYPES OF INTERVENTION(S)/PHENOMENA OF INTEREST

The focus of this review was the validity of tools used to measure collaboration within healthcare settings.

TYPES OF STUDIES

The types of studies considered for inclusion were validation studies, but quantitative study designs such as randomized controlled trials, controlled trials and case studies were also eligible for inclusion. Studies that focused on Interprofessional Education, were published as an abstract only, contained patient self-reporting only or were not about care delivery were excluded.

OUTCOMES

The outcome of interest was validation and interpretability of the instrument being assessed and included content validity, construct validity and reliability. Interpretability is characterized by statistics such as mean and standard deviation which can be translated to a qualitative meaning.

SEARCH STRATEGY

The search strategy aimed to find both published and unpublished studies. A three-step search strategy was utilized in this review. The databases searched included PubMed, CINAHL, Embase, Cochrane Central Register of Controlled Trials, Emerald Fulltext, MD Consult Australia, PsycARTICLES, Psychology and Behavioural Sciences Collection, PsycINFO, Informit Health Databases, Scopus, UpToDate and Web of Science. The search for unpublished studies included EThOS (Electronic Thesis Online Service), Index to Theses and ProQuest- Dissertations and Theses.

METHODOLOGICAL QUALITY

The assessment of methodological quality of the included studies was undertaken using the COSMIN checklist which is a validated tool that assesses the process of design and validation of healthcare measurement instruments.

DATA COLLECTION

An Excel spreadsheet version of COSMIN was developed for data collection which included a worksheet for extracting participant characteristics and interpretability data.

DATA SYNTHESIS

Statistical pooling of data was not possible for this review. Therefore, the findings are presented in a narrative form including tables and figures to aid in data presentation. To make a synthesis of the assessments of methodological quality of the different studies, each instrument was rated by accounting for the number of studies performed with an instrument, the appraisal of methodological quality and the consistency of results between studies.

RESULTS

Twenty-one studies of 12 instruments were included in the review. The studies were diverse in their theoretical underpinnings, target population/setting and measurement objectives. Measurement objectives included: investigating beliefs, behaviors, attitudes, perceptions and relationships associated with collaboration; measuring collaboration between different levels of care or within a multi-rater/target group; assessing collaboration across teams; or assessing internal participation of both teams and patients.Studies produced validity or interpretability data but none of the studies assessed all validity and reliability properties. However, most of the included studies produced a factor structure or referred to prior factor analysis. A narrative synthesis of the individual study factor structures was generated consisting of nine headings: organizational settings, support structures, purpose and goals; communication; reflection on process; cooperation; coordination; role interdependence and partnership; relationships; newly created professional activities; and professional flexibility.

CONCLUSIONS

Among the many instruments that measure collaboration within healthcare settings, the quality of each instrument varies; instruments are designed for specific populations and purposes, and are validated in various settings. Selecting an instrument requires careful consideration of the qualities of each. Therefore, referring to systematic reviews of measurement properties of instruments may be helpful to clinicians or researchers in instrument selection.

IMPLICATIONS FOR PRACTICE

Systematic reviews of measurement properties of instruments are valuable in aiding in instrument selection. This systematic review may be useful in instrument selection for the measurement of collaboration within healthcare settings with a complex mix of participant types. Evaluating collaboration provides important information on the strengths and limitations of different healthcare settings and the opportunities for continuous improvement via any remedial actions initiated.

IMPLICATIONS FOR RESEARCH

Development of a tool that can be used to measure collaboration within teams of healthcare professionals and non-professionals is important for practice. The use of different statistical modelling techniques, such as Item Response Theory modelling and the translation of models into Computer Adaptive Tests, may prove useful. Measurement equivalence is an important consideration for future instrument development and validation. Further development of the COSMIN tool should include appraisal for measurement equivalence. Researchers developing and validating measurement tools should consider multi-method research designs.

Intergroup contact and team functioning among nursing students: the mediation role of intergroup anxiety

BACKGROUND AND AIM

BACKGROUND AND AIM OF THE WORK

The improvement of team effectivity is one of the main concerns for healthcare organizations. Moreover, healthcare organizations must cope with increasing multicultural composition of both workforce and patients. The intergroup contact theory suggests that frequent and positive face-to-face contact among professionals or students with different cultural heritage can help to reach both increasing team effectiveness and adequate care in a multicultural setting. The aim was then to verify whether intergroup contact during practical training would decrease intergroup anxiety and then increase team functioning.

METHODS

A cross-sectional design was used in which a questionnaire was delivered to 83 nursing students.

RESULTS

According to the intergroup contact theory, frequent and positive contact with non-native professionals decreased the intergroup anxiety which, in turn, increased prejudice and, more importantly, decreased team functioning. Moreover, intergroup anxiety showed a complete mediation effect on the relations between intergroup contact during practical training and both negative attitude toward immigrants and team functioning.

CONCLUSIONS

Intergroup contact with non-native professionals or students during practical training is able to indirectly decrease prejudice and improve team functioning by lowering the anxiety that is aroused by encounter with non-native individuals.

Does contact at work extend its influence beyond prejudice? Evidence from healthcare settings

This article reports on two studies investigating the role of intergroup contact on the reduction of prejudice against migrants and on organizational and health outcomes. Study 1 enrolled 624 native healthcare professionals and showed that frequent and positive contact with non-native co-workers was associated with a decrease in the professionals' prejudice and an increase in the professionals' perception of team functioning. These effects were mediated by reduced in-group threat perception. Study 2 enrolled 201 native patients and showed that frequent and positive contact with non-native healthcare providers was associated with a decrease in patients' prejudice and an increase in patients' satisfaction for the care received. These effects were mediated by reduced in-group threat perception. These novel findings showed that frequent and positive contact with non-native individuals can improve health and organizational outcomes along with facilitating positive intergroup relations.

Psychometric properties of implementation measures for public health and community settings and mapping of constructs against the Consolidated Framework for Implementation Research: a systematic review

BACKGROUND

Recent reviews have synthesised the psychometric properties of measures developed to examine implementation science constructs in healthcare and mental health settings. However, no reviews have focussed primarily on the properties of measures developed to assess innovations in public health and community settings. This review identified quantitative measures developed in public health and community settings, examined their psychometric properties, and described how the domains of each measure align with the five domains and 37 constructs of the Consolidated Framework for Implementation Research (CFIR).

METHODS

MEDLINE, PsycINFO, EMBASE, and CINAHL were searched to identify publications describing the development of measures to assess implementation science constructs in public health and community settings. The psychometric properties of each measure were assessed against recommended criteria for validity (face/content, construct, criterion), reliability (internal consistency, test-retest), responsiveness, acceptability, feasibility, and revalidation and cross-cultural adaptation. Relevant domains were mapped against implementation constructs defined by the CFIR.

RESULTS

Fifty-one measures met the inclusion criteria. The majority of these were developed in schools, universities, or colleges and other workplaces or organisations. Overall, most measures did not adequately assess or report psychometric properties. Forty-six percent of measures using exploratory factor analysis reported >50 % of variance was explained by the final model; none of the measures assessed using confirmatory factor analysis reported root mean square error of approximation (<0.06) or comparative fit index (>0.95). Fifty percent of measures reported Cronbach's alpha of <0.70 for at least one domain; 6 % adequately assessed test-retest reliability; 16 % of measures adequately assessed criterion validity (i.e. known-groups); 2 % adequately assessed convergent validity (r > 0.40). Twenty-five percent of measures reported revalidation or cross-cultural validation. The CFIR constructs most frequently assessed by the included measures were relative advantage, available resources, knowledge and beliefs, complexity, implementation climate, and other personal resources (assessed by more than ten measures). Five CFIR constructs were not addressed by any measure.

CONCLUSIONS

This review highlights gaps in the range of implementation constructs that are assessed by existing measures developed for use in public health and community settings. Moreover, measures with robust psychometric properties are lacking. Without rigorous tools, the factors associated with the successful implementation of innovations in these settings will remain unknown.

A hybrid effectiveness-implementation cluster randomized trial of group CBT for anxiety in urban schools: rationale, design, and methods

Background

Schools present a context with great potential for the implementation of psychosocial evidence-based practices. Cognitive behavioral therapy (CBT) is an evidence-based practice that has been found to be very effective in treating anxiety in various community settings, including schools. Friends for Life (FRIENDS) is an efficacious group CBT protocol for anxiety. Unfortunately, evidence-based practices for anxiety are seldom employed in under-resourced urban schools, because many treatment protocols are not a good fit for the urban school context or the population, existing behavioral health staff do not receive adequate training or support to allow them to implement the treatment with fidelity, or school districts do not have the resources to contract with external consultants. In our prior work, we adapted FRIENDS to create a more culturally sensitive, focused, and feasible CBT protocol for anxiety disorders (CBT for Anxiety Treatment in Schools (CATS)).

Methods/design

The aim of this 5-year study is to evaluate both the effectiveness of CATS for urban public schools compared to the original FRIENDS as well as compare the implementation strategies (train-the-trainer vs. train-the-trainer + ongoing consultation) by conducting a three-arm, parallel group, type 2 hybrid effectiveness-implementation trial in 18 K-8 urban public schools. We will also assess the cost-effectiveness and the mediators and moderators of fidelity. Ninety therapists, 18 agency supervisors, and 360 children will participate. The interactive systems framework for dissemination and implementation guides the training and support procedures for therapists and supervisors.

Discussion

This study has the potential to demonstrate that agency therapists and supervisors who have had little to no prior exposure to evidence-based practices (EBPs) can implement an anxiety disorder EBP with fidelity. Comparisons of the implementation strategies would provide large urban mental health systems with data to make decisions about the adoption of EBPs.

Trial registration

ClinicalTrials.gov, NCT02651402

Clearing Hurdles: The Challenges of Implementation of Mental Health Evidence-Based Practices in Under-resourced Schools

Schools have become the main provider of services to children with mental health needs. Although there is substantial literature on barriers to implementation of evidence-based practices (EBPs) in under-resourced school districts, less has been written on how to overcome those barriers. Providing mental health services in the school setting presents a tremendous opportunity to increase access to quality mental health care for underserved youth. This review provides a brief overview of the barriers to successful implementation and sustainment of EBPs in under-resourced public schools and provides recommendations for overcoming them. The discussion is organized around an established conceptual framework adapted for the delivery of services in under-resourced schools that focuses on interdependent factors that exist at the individual-, team, school-, and macro-levels. This manuscript explores some recommendations and strategies for effectively addressing challenges related to implementation of EBPs. Research ideas are offered to bridge the research-to-practice gap that impacts many under-resourced public school districts.

Measuring reflection on participation in quality improvement activities for maintenance of certification

PURPOSE

To validate a measure of reflection on participation in quality improvement (QI) activities and to identify associations with characteristics of QI projects, participants, and teams.

METHOD

This was a prospective validation study of all Mayo Clinic team participants who submitted QI projects for maintenance of certification (MOC) credit from 2010 to 2012. The authors developed a measure of reflection on participation in QI activities and explored associations between participants' overall reflection scores and characteristics of projects, participants, and teams.

RESULTS

A total of 922 participants (567 physicians) on 118 teams completed QI projects and reflections. Factor analysis revealed a two-dimensional model with good internal consistency reliabilities (Cronbach alpha) for high (0.85) and low (0.81) reflection. Reflection scores (mean [standard deviation]) were associated with projects that changed practice (yes: 4.30 [0.51]; no: 3.71 [0.57]; P < .0001), changed the health care system (yes: 4.25 [0.54]; no: 4.03 [0.62]; P < .0001), and impacted patient safety (P < .0001). Physicians' reflection scores (4.27 [0.57]) were higher than support staff scores (4.07 [0.55]; P = .0005). A positive association existed between reflection scores and the number of QI roles per participant (P < .0001). There were no associations with participant gender, team size, or team diversity.

CONCLUSIONS

The authors identified associations between participant reflection and the impact of QI projects, participants' professional roles, and participants' involvement with projects. With further study, the authors anticipate that the new measure of reflection will be useful for determining meaningful engagement in MOC.

Challenges to collaboration in school mental health and strategies for overcoming them

BACKGROUND

This article reviews challenges to collaboration in school mental health (SMH) and presents practical strategies for overcoming them.

METHODS

The importance of collaboration to the success of SMH programs is reviewed, with a particular focus on collaboration between school- and community-employed professionals. Challenges to effective collaboration between school- and community-employed professionals in SMH are considered. Strategies for overcoming challenges to effective collaboration are presented.

RESULTS

Marginalization of the SMH agenda, limited interdisciplinary teamwork, restricted coordination mechanisms, confidentiality concerns, and resource and funding issues are key challenges to collaboration. Strategies targeted toward each of these challenges may help improve the effectiveness of SMH programs and ultimately student outcomes.

CONCLUSIONS

Collaboration between school- and community-employed professionals is critical to the success of SMH programs. Despite its promise, the success of SMH programs can be jeopardized by ineffective collaboration between school- and community-employed professionals. Strategies to overcome marginalization, promote authentic interdisciplinary teamwork, build effective coordination mechanisms, protect student and family confidentiality, and promote policy change and resource enhancements should be addressed in SMH improvement planning.

Assessing an interdisciplinary health care model: the Governor's Wellmobile Program

This article assesses the applicability of Bronstein's (2003) generic model of interdisciplinary collaboration in the context of a newly created collaboration providing community-based health care services, the Governor's Wellmobile Program. An analysis of the program's quarterly reports and interviews with faculty and students involved in the collaboration offers an assessment of the model and implications for interdisciplinary social work practice in community health care delivery.