This project proposes to improve successful mental health service linkage in Child Welfare Services (CWS) by adapting and testing the After Action Review (AAR) team effectiveness intervention to augment the Child Family Team (CFT) services intervention. Despite being both required and a collaborative approach to service planning, CFT meetings are implemented with questionable fidelity and consistency, rarely including children and families as intended. By inclusion of child and family voice, the AAR-enhanced CFT should lead to increased fidelity to the CFT intervention and greater levels of parental satisfaction with the service and shared decision-making, thus resulting in enhanced follow-through with Action Plans and linkage to mental health care for children.
The proposed project will address the following aims: Aim 1. Conduct a qualitative needs assessment targeting the ongoing implementation of the CFT services intervention in a large, publicly funded, CWS. A qualitative inquiry consisting of interviews and focus groups with key stakeholders will result in the preparation of an action plan to address identified gaps between the current and desired CFT services intervention outcomes. Aim 2. Adapt and tailor the AAR implementation strategy to address the CFT services intervention needs. Aim 3. Assess mechanisms of the AAR team effectiveness intervention for CFT implementation.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Enrollment
280
After-action reviews, or debriefs, are a relatively simple, inexpensive, and quick, tool to improve learning, performance, and the effectiveness of teams and individuals. After-action reviews are active self-learning processes wherein participants reflect on specific performance episode to actively engage in self-discovery and improve learning in a non-punitive/non-judgmental manner to result in enhanced performance. This proposal aims to apply the team effectiveness intervention of the after-action review (AAR) to the services intervention of the Child and Family Team (CFT) meetings currently used in the CWS.
UC San Diego - IN STEP Children's Mental Health Research Center
San Diego, California, United States
Collaboration & Satisfaction About Care Decisions (CSACD)
Items from the Satisfaction subscale of the Collaboration \& Satisfaction About Care Decisions (CSACD) measure was used in this study to assess satisfaction with the decision-making process, and satisfaction with the decision itself. Each participant completes the CSACD Satisfaction items immediately following their completion of the intervention (\<1 hour). Participants respond to each item using a 7-point likert-type scale ranging from 1=strongly disagree to 7=strongly agree. Higher values indicate greater satisfaction.
Time frame: through study completion, ~9 months
San Diego (SD) County Behavioral Health Administrative Data
For child welfare involved youth with behavioral health treatment plans, SD County Behavioral Health Administrative Data will be assessed to determine successful service linkage. Data indicate whether or not a child welfare involved youth utilized behavioral health services at any time through study completion.
Time frame: through study completion, ~9 months
Mathieu Team Processes Scale
Three subscales of the Mathieu Team Processes Scale were administered to participants immediately following study participation (\<1 hour) to assess the team process of the CFT. The subscales included goal specification, strategy formulation, and coordination. Participants respond on a scale ranging from 1=Not at all to 5=to a very great extent. Scale scores are computed by calculating the average item response. Higher scores indicate better team processes.
Time frame: through study completion, ~9 months
Acceptability, Feasibility, and Appropriateness of Intervention Measure
This 12-item measure will be administered to CFT+AAR participants immediately following completion of the CFT+AAR intervention (\<1 hour). The measure includes three subscales assessing the After-Action Review's 1) Acceptability (appealing, liked, and welcomed in their setting), 2) Appropriateness (fitting, suitable, and applicable in their setting), and Feasibility (possible and doable in their setting). Each item is rated using the following response options: 1=completely disagree, 2=disagree, 3=neither agree nor disagree, 4=agree, and 5=completely agree. Subscale scores are calculated by averaging responses for items representing acceptability, appropriateness, and feasibility, respectively. Higher scores reflect greater acceptability, appropriateness, and feasibility.
Time frame: through study completion, ~9 months
Card-Sorting Task
Card sorting elicits individual mental models to understand how participants structure their knowledge. In closed card sorts, participants are similarly given a set of key concepts, but participants are given pre-defined categories that each concept must be sorted into. Within team environments, card sorting can be used to examine the degree to which team members are thinking about key concepts in a similar manner (e.g., team mental models) by comparing the categories and sorted content across members. For this proposal, each participant will complete the card sorting task immediately following completion of the intervention (\<1 hour). The card sort task includes 11 tasks that participants bust organize into CFT member roles. Card sorts can be scored by analyzing team-level same bucket counts. Team-level same bucket count scores range from 0 to 11. Higher scores indicate greater shared mental model.
Time frame: through study completion, ~9 months
McAllister Affect-Based Trust
The 5-item scale assesses perceptions of affect-based trust amongst CFT members. Items center on individual's perceptions that team members can share ideas freely, that team members listen to one another, that team members care for one another, and that team members are invested in working well with one another. Each participant will complete the measure immediately following their completion of the intervention (\<1 hour). Participants respond on a scale ranging from 1=strongly disagree to 7=strongly agree. Scale scores are computed by calculating the average item response. Higher scores indicate greater trust.
Time frame: through study completion, ~9 months
Psychological Safety
Edmondson's 7-item Psychological Safety Climate Measure evaluates perceptions of the work environment (in this case, the CFT meeting) as being one wherein policies and procedures foster a safe and comfortable space for interpersonal risk. Each participant will complete the Psychological Safety Climate Measure immediately following their completion of the intervention (\<1 hour). Participants respond on a scale ranging from 0=doesn't apply at all to 4=entirely applies. Overall scale scores are computed by calculating the average item response. Higher scores indicate greater psychological safety.
Time frame: through study completion, ~9 months
State-Wide CFT Fidelity Tool
The CFT Meeting Observation Tool is intended to support agencies in evaluating quality of and adherence to intended practice of child and family team (CFT) meetings. Research team observers of the CFT will complete the observation tool throughout the duration of CFT observation indicating the extent to which certain CFT quality practices were present during the CFT meeting. Response options range from 1=strongly disagree to 4=strongly agree. A CFT fidelity score is calculated by taking the average score across items. Higher scores reflect greater fidelity.
Time frame: through study completion, ~9 months
Knoll and Van Dick Silence Measure
Knoll and Van Dick's Silence Measure includes two subscales representing acquiescent silence and quiescent silence. Participants respond on a scale ranging from 1=strongly disagree to 7=strongly agree. Scale scores are computed by calculating the average item response. Higher scores indicate greater acquiescent and quiescent silence.
Time frame: through study completion, ~9 months
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