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
320
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
RECRUITINGCollaboration & Satisfaction About Care Decisions (CSACD)
The 6-item collaboration subscale assesses collaboration, shared responsibilities for planning, open communication, and coordination. The 3-item satisfaction subscale assesses satisfaction with the decision-making process, and satisfaction with the decision itself. Although originally developed about care decisions for intensive care patients, it has since been used to measure collaboration and satisfaction with treatment planning plans associated with after-action reviews. Each participant will complete the CSACD immediately following their completion of the intervention (\<1 hour). Participants respond on a 7-point likert-type scale ranging from 1=strongly disagree to 7=strongly agree. Subscale scores are computed by calculating the average item response for items representing collaboration, and items representing satisfaction, respectively. Only including the subscales regarding satisfaction.
Time frame: through study completion, ~9 months
San Diego (SD) County Behavioral Health Administrative Data
During the CFT meetings, behavioral health needs initially screened via the CANS assessment will likely be confirmed for many child/families with open CWS cases. For children/families with behavioral health treatment plans, SD County Behavioral Health Administrative Data will be assessed to determine successful service linkage.
Time frame: through study completion, ~9 months
Mathieu Team Processes Scale
The 10 first-order constructs (e.g. strategy formulation, coordination, conflict management) map to three second order constructs (i.e. transition, action, and interpersonal). This measure will be administered to CFT+AAR participants immediately following completion of the CFT+AAR intervention (\<1 hour) to assess the team process of the CFT. Participants respond on a scale ranging from 1=Not at all to 5=to a very great extent, and scale scores are computed by calculating the average item response. Participants respond to questions regarding goal specification, strategy formulation, and coordination.
Time frame: through study completion, ~9 months
Acceptability, Feasibility, and Appropriateness of Intervention Measure
This 9-item measure will be administered to CFT+AAR participants immediately following completion of the CFT+AAR intervention (\<1 hour) to assess the extent to which the After-Action Review is appealing, liked, and welcomed in their setting (acceptability); fitting, suitable, and applicable in their setting (appropriateness); possible and doable in their setting (feasible). Each of the 9 items is rated using the following response options: 1=completely disagree, 2=disagree, 3=neither agree nor disagree, 4=agree, and 5=completely agree. Three subscales can be created by averaging responses for items representing acceptability, appropriateness, and feasibility, respectively.
Time frame: through study completion, ~9 months
Participant demographics professional characteristics
Participant age, gender, race, ethnicity, marital status, education level, primary language, and working status/profession will be collected of all participants immediately following completion of the intervention (\<1 hour).
Time frame: through study completion, ~9 months
Card-Sorting Task
Card sorting elicits individual mental models to understand how participants structure their knowledge. In open card sorts participants are provided with a set of key concepts and asked to sort them into categories. Each participant then creates a label for each category. 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). In doing so, the concepts contained in the card sort will be representative of specific CFT roles, task responsibilities, and goals.
Time frame: through study completion, ~9 months
McAllister Affect-Based Trust
This 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 WAI-SR immediately following their completion of the intervention (\<1 hour). Participants respond on a scale ranging from 1=strongly disagree to 7=strongly agree, and scale scores are computed by calculating the average item response.
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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, and overall scale scores are computed by calculating the average item response.
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. Results can be used to provide information regarding the current status/progress of CFT implementation, guide the work of agency CFT implementation or leadership teams, identify workforce development and organizational support needs, and support Continuous Quality Improvement (CQI) processes. Observers of the CFT will complete throughout the duration of CFT observation.
Time frame: through study completion, ~9 months
Knoll and Van Dick Silence Measure
Knoll and Van Dick's 2-Item Silence Measure present scales to assess acquiescent silence and quiescent silence. Participants respond on a scale ranging from 1=strongly disagree to 7=strongly agree, and scale scores are computed by calculating the average item response.
Time frame: through study completion, ~9 months