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Evaluating Strategies to Promote Effective, Multidisciplinary Team Collaboration in School Mental Health
Abstract
Multidisciplinary teams of school- and community-employed mental health, health, and educational staff work together in schools to offer a full continuum of mental health promotion, prevention, early intervention, and treatment services and supports. Intentional teaming structures and practices are essential to ensure teams deliver effective, coordinated services and supports. The current study investigated the extent to which continuous quality improvement strategies improved school mental health team performance during a 15-month national learning collaborative for 24 school district teams. All teams significantly improved their average teaming performance from baseline to the end of the collaborative (t(20) = −5.20, p < .001). Plan-Do-Study-Act (PDSA) cycles allowed teams to rapidly evaluate specific quality improvement changes to improve their performance. Teams with the most improvement focused on increasing multidisciplinary team membership, avoiding duplication and promoting efficiency, and connecting to community mental health providers/resources.
... The benefits of interdisciplinary teams have been identified widely across industries (e.g., [39,40]), and these findings are consistent within the SMH setting. Cross-sectional [41], pre-post evaluation [42], and interview data [20,21] indicated that as teams had higher levels of interdisciplinary representation, they provided more SMH services across tiers, reported higher-quality teamwork, and perceived a greater ability to address a range of student behavioral problems. Cross-sectional survey data [43] showed a positive association between the level of interdisciplinary collaboration and team members' positive regard when completing team-related tasks. ...
... Similarly, evidence-based evaluation practices (such as Plan Do Study Act or PDSA cycles) have helped teams identify barriers, adjust, and expand universal mental health screening [24]. Across studies, team members have qualitatively reported that using evidence-based practice guidelines helps alleviate decision-making burdens and more accurately address student needs [20,29,42], emphasizing the importance of teams' access to evidence-based guidelines. ...
... Qualitative [20,21,23] and cross-sectional [25] data indicate that team members who were engaged (i.e., available, actively involved, reliable, and enthusiastic about team activities), "fit" together, and had positive camaraderie also had more effective interdisciplinary collaboration and teamwork. Several members commented that active participation and positive team member relationships help facilitate clarity about member roles and responsibilities [42,43]. Members also perceived regular meeting attendance and greater contribution from members as positively impacting the team's atmosphere and ability to make progress towards goals [21]. ...
School mental health (SMH) teams have been widely recommended to support multi-tiered mental health program implementation in schools. Available research suggests emerging best practices that promote effective SMH teaming and indicates the importance of having team members who are highly engaged (e.g., actively involved, retained on the team). Despite evidence that these factors improve team functioning, there is limited knowledge of SMH team prevalence, best practice use, and factors impacting member engagement among a diverse sample of elementary schools. This study surveyed a cross-sectional sample of elementary principals (n = 314) across the United States whose schools implement multi-tiered SMH programs. Most principals (89%, n = 280) reported using teams to organize these programs. Schools in urban/suburban communities, with 300 or more students, or with specific school funding for SMH activities were more likely to have SMH teams. Only one-third of principals reported that their team members participated in related training. Other SMH team best practices were commonly reported (by two-thirds or more teams). Results of a linear regression model indicate that larger teams (six or more members) and teams with access to resources had significantly higher member engagement scores. The study’s findings provide recommendations for practice and future research directions.
... 4. Pelatihan dan pendidikan: memberikan pelatihan kepada anggota tim mengenai keterampilan kolaborasi yang efektif, penyelesaian konflik, serta pentingnya pendekatan interdisipliner dapat meningkatkan keberhasilan tim. Program pendidikan yang memperkenalkan pemahaman tentang disiplin ilmu lain juga dapat memperkuat integrasi pengetahuan (Bohnenkamp et al, 2023). ...
Buku Keperawatan Dasar untuk Perawat Baru ini hadir sebagai upaya untuk memberikan panduan dan pemahaman yang komprehensif bagi para perawat yang baru memulai kariernya di dunia keperawatan.
Buku ini dapat membantu perawat baru memahami konsep dasar dalam praktik keperawatan, baik dalam hal keterampilan teknis maupun dalam pemberian perawatan holistik pada pasien.
Buku ini membahas:
Bab 1 Pendahuluan Keperawatan: Pengertian dan Ruang Lingkup
Bab 2 Etika dan Hukum Dalam Keperawatan
Bab 3 Komunikasi Terapeutik Dalam Keperawatan
Bab 4 Teknik Pengukuran Tanda Vital: Tekanan Darah, Suhu, Nadi, dan Pernapasan
Bab 5 Pengelolaan Pasien dengan Penyakit Kronis
Bab 6 Pengelolaan Nyeri dalam Keperawatan
Bab 7 Manajemen Cairan dan Elektrolit
Bab 8 Teknik Pemberian Obat (Oral dan Injeksi)
Bab 9 Keperawatan Anak dan Remaja
Bab 10 Keperawatan Psikiatri: Dasar Pemahaman dan Terapi
Bab 11 Dokumentasi Keperawatan
Bab 12 Kolaborasi Tim Kesehatan dan Peran Perawat
... The Whole School, Whole Community, Whole Child model, developed by the Centers for Disease Control and Prevention and the Association for Supervision and Curriculum in 2015, has ten components, which include advocating for counseling, psychological, and social services in schools; uplifting the importance of physical education and activity; and encouraging community involvement, among others. The model also includes high-level actions outlined for each of the ten components and has been applied to school mental health promotion (Lever et al., 2023). In this article, we provide a blueprint of the myriad stakeholders across ecological levels who can partner with schools to promote youth well-being in a comprehensive approach that is broader than the framework provided in the Whole School, Whole Community, Whole Child model. ...
Globally, 250 million children and adolescents experience mental health conditions. Many more go undiagnosed and untreated, and still others experience psychological distress that, while not rising to the level of a clinical diagnosis, impacts their future outcomes. While schools have been, and continue to be, central for youth well-being, the demand for mental health services and the broader recognition of the importance of youth mental health necessitates an integrated, whole-community approach that supports schools as a central, but not sole, hub. Thus, the Global Alliance for Behavioral Health and Social Justice’s Safe and Humane Schools Task Force asserts that, to build a sustainable pathway to promote youth and ultimately community well-being, in addition to preventing future mental health crises, the meaningful involvement of community stakeholders is required. Subsequently, in this article, the Safe and Humane Schools Task Force puts forth a blueprint toward youth mental wellness. The blueprint draws on an interdisciplinary approach, incorporating evidence-based literature, lived experiences, and recommendations from diverse stakeholders, particularly youth. Specifically, the blueprint provides a model for identifying traditional and nontraditional stakeholders across socioecological levels. This blueprint then describes guiding principles for stakeholders to use as part of an interdisciplinary and child rights-based approach. The key themes of the principles are participation, collaboration, belonging and social connection, accountability, and safety and security. Innovative examples of how stakeholders have incorporated these principles to advance youth mental health promotion and crisis prevention are included. Potential barriers to, and facilitators for, the blueprint are addressed. Finally, a recommended series of questions is included to be used by stakeholders to adapt this blueprint according to local context.
... School psychology researchers can also draw on the scholarship of Bryk et al. (2010) network improvement communities (NICs), through which teams identify a problem of practice and then engage in implementation of an intervention to address it, followed by data collection that provides quick feedback on what is working and what is not. Often, the work of NICs involves Plan-Do-Study-Act (PDSA) cycles (Tichnor-Wagner et al., 2017), which allows for rapid implementation and adjustment of efforts using data collected through continuous improvement strategies (Bohnenkamp et al., 2023). ...
... Vytvoření širokých multidisciplinárních týmů školních a komunitních pracovníků duševního zdraví, zdravotníků a pedagogického personálu, dětí a rodičů v rámci škol s nabídkou kontinuální podpory duševního zdraví, prevence, podpory včasné intervence, vykazuje vysokou efektivitu a dobrou propojenost s komunitou oproti menším více izolovaným týmům (Bohnenkamp et al., 2023). V programu FAST sestavuje multidisciplinární implementační tým programu škola. ...
CÍLE: Cílem je představit inovativní metodiku – program FAST (Families and Schools Together, USA) a výsledky jeho pilotního ověření v podmínkách českých škol. TEORETICKÁ VÝCHODISKA: Sociální práce a programy pro podporu duševního zdraví jsou stále důležitější, zejména v souvislosti s rostoucím počtem dětí s duševními problémy. Jedním z programů úspěšných nejen v USA je program FAST, který byl pilotně ověřen na českých školách. Program je specifický tím, že jej implementuje multidisciplinární tým pedagogů, sociálních pracovníků a rodičů. METODY: Program byl realizován v 6 bězích na 4 ZŠ, celkem se zapojilo 55 rodin. Dotazníkového šetření se zúčastnilo 45 rodičů, z nichž 31 vyplnilo zpětnou vazbu po skončení programu. VÝSLEDKY: Představení programu a výsledky pilotního ověření poukazují na potenciál pro využití v českém školství. Program je pro rodiče srozumitelný, zajímavý a přínosný. V oblasti měření dopadu se podařilo prokázat staticky mírné, ale významné posuny ve dvou ze tří oblastí, na které program cílí.
IMPLIKACE PRO SOCIÁLNÍ PRÁCI: Program FAST nabízí strukturovaný přístup k podpoře rodičovských kompetencí a vytváření neformálních skupin, zlepšujících sociální fungování a přispívajících k prevenci duševních problémů u dětí. Sociální pracovníci mají významnou roli v péči o duševní zdraví dětí a zapojení rodičů do komunikace se školou.
Klíčová slova
program FAST; duševní zdraví; rodičovské kompetence; školní sociální práce; prevence duševních problémů
Increasing youth behavioral health needs in the United States have underscored the essential role school nurses can play in mitigating them. In response, the District of Columbia Department of Health developed the Behavioral Health Referral Process (BHRP) as a standardized guide, integrating school nurses into multidisciplinary teams and improving students' access to behavioral health services. To assess the BHRP's strengths and opportunities while understanding factors that could impact its implementation, key informant interviews were conducted using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework with seven school nurses and school nurse managers working in DC schools. Participants anticipated challenges related to the BHRP, from managing competing priorities to overcoming stigmas. Still, nurses reported the BHRP will enable a more coordinated referral process that promotes student linkage to care. The findings can inform efforts to assess and optimize school behavioral health referral processes as part of larger, comprehensive care systems.
School systems need practical and effective quality improvement strategies to advance school mental health promotion, prevention, and treatment services. Collectively, these efforts can be used to promote child and adolescent mental health, well-being, and academic success. The current study reports on the feasibility, initial impacts of, and recommendations from a national, multi-level learning collaborative conducted by the National Center for School Mental Health, University of Maryland School of Medicine and administered throughout the United States. The mixed-methods evaluation results support the feasibility of a learning collaborative and reinforce its positive initial impact on comprehensive school mental health system change. Participants indicated comprehensive school mental health quality improvements such as collaboration across diverse partners and spread of evidence-informed best practices that support high-quality services for students. The multi-level learning collaborative model is promising for future efforts to advance the dissemination of comprehensive school mental health systems and other state and local system change efforts. School mental health learning collaboratives may help address the ongoing youth mental health crisis by promoting high-quality mental health supports and services for youth.
The UMHC Framework was created to provide greater, evidence-informed clarity about the ways in which universities could develop their whole-university approaches to supporting the mental health and wellbeing of staff and students. The second edition of the Charter has been updated to reflect research and guidance published since the release of the first edition in 2019.
Implementation science has grown considerably in school mental health over the past decade, driven by the persistent gaps between knowledge about “what works” to promote student well-being and what is typically delivered in schools. In 2014, Owens and colleagues outlined an implementation research agenda for the field of school mental health, emphasizing professional development and coaching, evidence-based practice fidelity, and sustainment. This paper provides a 10-year progress review across these domains and articulates an updated research agenda focused on: (1) pragmatic implementation strategies, (2) implementation mechanisms explaining the connection between implementation strategies and outcomes, (3) strategic intervention redesign to promote implementation, and (4) de-implementation of low-value practices. We propose critical research questions in these areas and conclude by highlighting contemporary study designs and methods (i.e., hybrid trial designs; sequential, multiple assignment, randomized trials; rapid qualitative approaches; economic analyses) that can be leveraged to investigate implementation research questions in school mental health over the next decade. In doing so, we hope to promote shared understanding of evolving implementation research priorities and opportunities to promote equitable, pragmatic, and sustainable implementation efforts in school mental health and drive synergy across projects.
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.
Research Findings: One in 5 preschool-aged children (under age 5) have a serious mental health difficulty that can have lasting negative effects. Most children under age 5 (63%) attended preschool, day care centers, Head Start, or another prekindergarten program. This leaves early childhood programs well-positioned to support the wellbeing of our earliest learners if they could offer gold standard multi-tiered systems of support for mental health care. However, there is not currently a measure for preschool teams to self-assess and improve their school mental health quality. To address this gap, we adapted an existing measure of school mental health quality for K-12 schools to preschools. Measure development included initial modifications by a preschool quality workgroup, a modified Delphi procedure including 3 rounds of data collection, and a Principal Component Analysis. The resulting measure, the School Mental Health Quality Assessment – Preschool (SMHQA-PS) consists of 46 Likert-style items covering 6 domains of preschool mental health system. Practice and Policy: This measure provides an evidence-informed tool to assist preschool mental health teams in advancing the quality of mental health supports in preschools while creating consistent language for families, school teams, researchers, and policymakers to use across school mental health programs in Pre-K-12 schools.
Long waiting times for Child and Adolescent Mental Health Services (CAMHS) have been linked to poorer outcomes for those seeking care. CAMHS teams in England have seen recent increases in referrals, resulting in challenging waiting times nationally. Although recent health policy has brought an increase in funding and staffing, it is believed that only 25% of those needing care receive it. Between trusts, there is considerable variation in waiting times, leaving many waiting longer than others waiting for care. East London Foundation Trust has been seen to have higher waiting times for CAMHS than other organisations across the country between June 2017 and September 2018, seven CAMHS teams were supported to use quality improvement (QI) as part of a collaborative learning system with the aim of improving access and flow. Each team was encouraged to understand their system using basic demand and capacity modelling alongside process mapping. From this teams created project aims, driver diagrams and used Plan Do Study Act cycles to test changes iteratively. Measurement and data were displayed on control charts to help teams learn from changes. Teams were brought together to help learn from each other and accelerate change through a facilitated collaborative learning system. Of the seven teams that began the collaborative learning system, six completed a project. Across the collaborative learning system collectively there were improvements in average waiting times for first, second and third appointments, and an improvement in the number of appointments cancelled. For the individual teams involved, three saw an improvement in their project outcome measures, two just saw improvements in their process measures and one did not see an improvement in any measure. In addition to service improvements, teams used the process to learn more about their pathway, engage with service users and staff, build QI capability and learn together.
A meta-analysis was conducted to examine the relative rates of youth mental health service utilization across settings among the general population and among those with elevated mental health symptoms or clinical diagnoses. Rates of school-based mental health were compared to outpatient, primary care, child welfare, juvenile justice, and inpatient. Nine studies presented rates of mental health service use for general-population youth in the U.S., and 14 studies presented rates for youth with elevated symptoms or clinical diagnoses. Random effects meta-analysis was used to calculate mean proportions of youth receiving care in each sector. Of general population youth, 7.28% received school mental health services. Rates for other sectors are as follows: 7.26% in outpatient settings, 1.76% in primary care, 1.80% in inpatient, 1.35% in child welfare, and 0.90% juvenile justice. For youth with elevated mental health symptoms or diagnoses, 22.10% of youth were served by school-based mental health services, 20.56% outpatient settings, 9.93% primary care, 9.05% inpatient, 7.90% child welfare, and 4.50% juvenile justice. Schools and outpatient settings are the most common loci of mental health care for both the general population and samples of youth with elevated symptoms or clinical diagnoses, although substantial amounts of care are also provided in a range of other settings. Results hold potential for informing resource allocation, legislation and policy, intervention development, and research. Given that mental health services are delivered across many settings, findings also point to the need for interconnection across child-serving sectors, particularly schools and outpatient clinics.
Learning collaboratives (LCs) have often been used to improve somatic health care quality in hospitals and other medical settings, and to some extent to improve social services and behavioral health care. This initiative is the first demonstration of a national, systematic LC to advance comprehensive school mental health system quality among school district teams. Twenty-four districts representing urban, rural, and suburban communities in 14 states participated in one of two 15-month LCs. Call attendance (M = 73%) and monthly data submission (M = 98% for PDSA cycles and M = 65% for progress measures) indicated active engagement in and feasibility of this approach. Participants reported that LC methods, particularly data submission, helped them identify, monitor and improve school mental health quality in their district. Qualitative feedback expands quantitative findings by detailing specific benefits and challenges reported by participants and informs recommendations for future research on school mental health LCs. Rapid-cycle tests of improvement allowed teams to pursue challenging and meaningful school mental health quality efforts, including mental health screening in schools, tracking the number of students receiving early intervention (Tier 2) and treatment (Tier 3) services, and monitoring psychosocial and academic improvement for students served.
This study tested an integrated package for high-quality school mental health (SMH) services involving quality assessment and improvement, family engagement and empowerment, modular evidence-based practice, and implementation support. Within a two-year randomized controlled trial, 35 clinicians, who provided services to 529 students and their families, were randomly assigned to the enhanced quality assessment and improvement intervention condition and a comparison condition focused on promoting personal and staff wellness. Significant clinician-level findings were found for increased use and fidelity of evidence-based practices and greater use of structured assessments and sessions involving family members. Results are discussed in relation to needed methodological improvements in SMH treatment outcome research and increasing use of evidence-based practices by clinicians by adding accountability and incentives to training, coaching, and implementation support.
Background
It is challenging to conduct and quickly disseminate findings from in-depth qualitative analyses, which can impede timely implementation of interventions because of its time-consuming methods. To better understand tradeoffs between the need for actionable results and scientific rigor, we present our method for conducting a framework-guided rapid analysis (RA) and a comparison of these findings to an in-depth analysis of interview transcripts.
Methods
Set within the context of an evaluation of a successful academic detailing (AD) program for opioid prescribing in the Veterans Health Administration, we developed interview guides informed by the Consolidated Framework for Implementation Research (CFIR) and interviewed 10 academic detailers (clinical pharmacists) and 20 primary care providers to elicit detail about successful features of the program. For the RA, verbatim transcripts were summarized using a structured template (based on CFIR); summaries were subsequently consolidated into matrices by participant type to identify aspects of the program that worked well and ways to facilitate implementation elsewhere. For comparison purposes, we later conducted an in-depth analysis of the transcripts. We described our RA approach and qualitatively compared the RA and deductive in-depth analysis with respect to consistency of themes and resource intensity.
Results
Integrating the CFIR throughout the RA and in-depth analysis was helpful for providing structure and consistency across both analyses. Findings from the two analyses were consistent. The most frequently coded constructs from the in-depth analysis aligned well with themes from the RA, and the latter methods were sufficient and appropriate for addressing the primary evaluation goals. Our approach to RA was less resource-intensive than the in-depth analysis, allowing for timely dissemination of findings to our operations partner that could be integrated into ongoing implementation.
Conclusions
In-depth analyses can be resource-intensive. If consistent with project needs (e.g., to quickly produce information to inform ongoing implementation or to comply with a policy mandate), it is reasonable to consider using RA, especially when faced with resource constraints. Our RA provided valid findings in a short timeframe, enabling identification of actionable suggestions for our operations partner.
Electronic supplementary material
The online version of this article (10.1186/s13012-019-0853-y) contains supplementary material, which is available to authorized users.
Recent studies indicate that the majority of school psychologists’ time continues to be dedicated to SPED related activities. Despite ongoing calls for school psychologists to expand their roles, why many practitioners do not deliver more comprehensive services is not well understood. This qualitative study investigated facilitators of and barriers to comprehensive and integrated services using the National Association of School Psychologists Model for Comprehensive and Integrated School Psychological Services as the guiding framework. Thirteen full-time, school-based practitioners from across the US participated in semi-structured interviews. Constant-comparative analysis was used to generate themes. Results indicated that practitioners experienced a number of systemic barriers to (e.g., heavy caseload; inconsistent district policies, priorities, and role definitions; lack of stakeholder involvement) and facilitators of (e.g., resources, graduate training and professional development) comprehensive and integrated service delivery. Participants’ perspectives regarding changes needed to expand their services focused on systemic issues as well. Implications for research and practitioners’ efforts to advocate for systems change are discussed.
Each mental health discipline offers unique contributions to the development and operation of school-based mental health programs. The collaboration of professionals from different disciplines with each other, as well as with health and educational staff, is essential for service delivery in school settings. Conversely interprofessional conflicts and turf issues can impede the development of effective school-based mental health programs. The authors, who represent counseling, nursing, psychiatry, psychology and social work, discuss the roles and competencies of each profession in providing school-based mental health services. Training requirements within each discipline that relate to school mental health are described Barriers to effective interdisciplinary collaboration, and methods of overcoming them, are delineated.
Objective:
Policy makers have increasingly turned to learning collaboratives (LCs) as a strategy for improving usual care through the dissemination of evidence-based practices. The purpose of this review was to characterize the state of the evidence for use of LCs in mental health care.
Methods:
A systematic search of major academic databases for peer-reviewed articles on LCs in mental health care generated 421 unique articles across a range of disciplines; 28 mental health articles were selected for full-text review, and 20 articles representing 16 distinct studies met criteria for final inclusion. Articles were coded to identify the LC components reported, the focus of the research, and key findings.
Results:
Most of the articles included assessments of provider- or patient-level variables at baseline and post-LC. Only one study included a comparison condition. LC targets ranged widely, from use of a depression screening tool to implementation of evidence-based treatments. Fourteen crosscutting LC components (for example, in-person learning sessions, phone meetings, data reporting, leadership involvement, and training in quality improvement methods) were identified. The LCs reviewed reported including, on average, seven components, most commonly in-person learning sessions, plan-do-study-act cycles, multidisciplinary quality improvement teams, and data collection for quality improvement.
Conclusions:
LCs are being used widely in mental health care, although there is minimal evidence of their effectiveness and unclear reporting in regard to specific components. Rigorous observational and controlled research studies on the impact of LCs on targeted provider- and patient-level outcomes are greatly needed.
Plan-do-study-act (PDSA) cycles provide a structure for iterative testing of changes to improve quality of systems. The method is widely accepted in healthcare improvement; however there is little overarching evaluation of how the method is applied. This paper proposes a theoretical framework for assessing the quality of application of PDSA cycles and explores the consistency with which the method has been applied in peer-reviewed literature against this framework.
NHS Evidence and Cochrane databases were searched by three independent reviewers. Empirical studies were included that reported application of the PDSA method in healthcare. Application of PDSA cycles was assessed against key features of the method, including documentation characteristics, use of iterative cycles, prediction-based testing of change, initial small-scale testing and use of data over time.
73 of 409 individual articles identified met the inclusion criteria. Of the 73 articles, 47 documented PDSA cycles in sufficient detail for full analysis against the whole framework. Many of these studies reported application of the PDSA method that failed to accord with primary features of the method. Less than 20% (14/73) fully documented the application of a sequence of iterative cycles. Furthermore, a lack of adherence to the notion of small-scale change is apparent and only 15% (7/47) reported the use of quantitative data at monthly or more frequent data intervals to inform progression of cycles.
To progress the development of the science of improvement, a greater understanding of the use of improvement methods, including PDSA, is essential to draw reliable conclusions about their effectiveness. This would be supported by the development of systematic and rigorous standards for the application and reporting of PDSAs.
Interprofessional team collaboration is an important component of school mental health, but authentic collaboration is often difficult to achieve in practice and there is little research available to inform strategies for strengthening collaboration. Using a sample of 428 members of interprofessional teams in school mental health, this study found that teams may not prioritize the nurturing of team processes by reflecting on what is (and what is not) working. The findings suggest that physical space, time to collaborate, positive relationships between collaborators, and previous affirming experiences of collaboration influence the functioning of interprofessional teams in schools.
Collaboration between community mental health professionals and school professionals involves sharing knowledge and resources
to accomplish more than could be achieved by practicing in isolation. Despite its role in school mental health (SMH), there
is little research evidence that collaboration is associated with improved outcomes. This qualitative study used focus group
methodology to explore collaboration among 26 mental health and school professionals. The constant comparative method was
used to analyze focus group data. Central categories that emerged from the analysis included the importance of integrating
professionals from collaborating agencies into the school community, communication between school professionals and community
providers, and the perceived positive contributions of SMH collaboration for engaging families in schools. Study findings
are interpreted from a social capital perspective and implications for SMH practice and research are offered.
KeywordsCollaboration–School professionals–Mental health professionals–Families–Social capital–Urban communities
Teams are an integral component of quality improvement efforts in healthcare organizations. Quality improvement teams may involve persons either from the same or different disciplines. In either case, the selection of team members may be critical to the team's success. However, there is little research to guide selection of team members for quality improvement teams. In this paper, we use tools from social network analysis (SNA) to derive principles for the design of effective clinical quality improvement teams and explore the implementation of these principles using social network data collected from the inpatient general medicine services at a large academic medical center in Chicago, USA. While the concept of multidisciplinary teams focuses on the importance of the professional background of team members, SNA emphasizes the importance of the individual and collective connections of team members, both to persons outside the team and to each other. SNA also focuses on the location of individuals and groups between other actors in the flow of information and other resources within larger organizational networks. We hypothesize that external connections may be most important when the collection or dissemination of information or influence are the greatest concerns, while the relationship of team members to each other may matter most when internal coordination, knowledge sharing, and within-group communication are most important. Our data suggest that the social networks of the attending physicians can be characterized sociometrically and that new sociometric measures such as "net degree" may be useful in identifying teams with the greatest potential for external influence.
This review examines the history and contemporary landscape of school mental health, describing evidence that schools are an essential component of the system of child and adolescent care and providing recommendations to advance this vital care delivery system. This literature review of scientific data and shifts to policy and practice in school mental health documents the evolution of collaboration between the education and mental health systems to support student mental health. This review describes best practices and provides examples for achieving the standards of the comprehensive school mental health systems model in states and local communities. Data demonstrate that multitiered systems of mental health support and services in schools, including mental health promotion, prevention, early intervention, and treatment, improve academic and psychosocial functioning and reduce risk of poor outcomes, including mental illness and school failure. Policy and practice shifts in the field reflect a movement toward integrating mental health systems into the education sector, including preparing the education workforce to promote mental health and to support early identification of and intervention to address mental illness. To create a full continuum of mental health supports for students, states and districts can draw on national best practices and state exemplars as they install multitiered systems of mental health supports in all schools, conduct universal student mental health monitoring, and coordinate school and community mental health systems.
Objective
Disease containment of COVID-19 has necessitated widespread social isolation. We aimed to establish what is known about how loneliness and disease containment measures impact on the mental health in children and adolescents.
Method
For this rapid review, we searched MEDLINE, PSYCHINFO, and Web of Science for articles published between 01/01/1946 and 03/29/2020. 20% of articles were double screened using pre-defined criteria and 20% of data was double extracted for quality assurance.
Results
83 articles (80 studies) met inclusion criteria. Of these, 63 studies reported on the impact of social isolation and loneliness on the mental health of previously healthy children and adolescents (n=51,576; mean age 15.3) 61 studies were observational; 18 were longitudinal and 43 cross sectional studies assessing self-reported loneliness in healthy children and adolescents. One of these studies was a retrospective investigation after a pandemic. Two studies evaluated interventions. Studies had a high risk of bias although longitudinal studies were of better methodological quality. Social isolation and loneliness increased the risk of depression, and possibly anxiety at the time loneliness was measured and between 0.25 to 9 years later. Duration of loneliness was more strongly correlated with mental health symptoms than intensity of loneliness.
Conclusion
Children and adolescents are probably more likely to experience high rates of depression and probably anxiety during and after enforced isolation ends. This may increase as enforced isolation continues. Clinical services should offer preventative support and early intervention where possible and be prepared for an increase in mental health problems.
The Interconnected Systems Framework (ISF) blends school mental health practices, systems, and resources into all levels of a multitiered system of supports (e.g., positive behavior interventions and supports). The ISF aims to improve mental health and school performance for all students by emphasizing effective school-wide promotion and prevention; early identification; and social-emotional, behavioral, and mental health intervention. Teaming is 1 of 3 foundational components of quality ISF implementation at school, district, and state levels. After introducing the ISF, the authors highlight the core implementation components (i.e., teaming, data-based decision making, and evidence-based practices) and then elaborate on characteristics of well-functioning ISF teams. The authors provide a case example to illustrate each characteristic and review 5 measures teams may consider using to evaluate their functioning and SF implementation.
Standardized health performance measurement has increasingly become an imperative for assuring quality standards in national health care systems. As compared to somatic health performance measures, behavioral health performance measures are less developed. There currently is no national standardized performance measurement system for monitoring comprehensive school mental health in the USA. Drawing upon related initiatives in the school mental health field and national performance standards for behavioral health care in non-school settings, the current study describes the identification, development, and refinement of quality and sustainability performance measures for comprehensive school mental health. A three-phase method involving literature review and expert consensus, nominal group decision-making, and a modified Delphi process resulted in the development of two performance assessments, which include 12 domains and 67 indicators. Future directions for national performance measurement among school mental health systems to drive improvement in quality and sustainability are considered.
As a result of federal mandates such as the Individuals with Disabilities Education Improvement Act of 2004 (IDEA) as well as the increasing use of methods such as Positive Behavior Intervention Support (PBIS) and Response to Intervention (RtI) for providing necessary school services to students, interdisciplinary teams have become the norm rather than the exception in schools (Algozzine, Newton, Horner, Todd, & Algozzine, 2012; Nellis, 2012). School-based teams operate under a variety of names (student assistance teams, pre-referral teams, peer intervention teams, instructional consultation teams, teacher assistance teams, school improvement teams) and have an array of functions, including student referral and evaluation, planning service delivery, implementing evidence-based practices, and achieving systems change (Bahr & Kovaleski, 2006; Bahr, Whitten, & Dieker, 1999; Nellis, 2012).
There is growing evidence that efficacious autism-related interventions rarely are adopted or successfully implemented in public schools, in part because of the lack of fit between the intervention and the needs and capacities of the school setting. There is little systematic information available regarding the barriers to implementation of complex interventions such as those addressing social engagement for children with autism. The present study used field notes from an implementation trial to explore barriers that emerged during the training of school personnel and subsequent implementation of a social skills intervention. A number of barriers at the individual (training) and school levels (policies surrounding recess, staffing, prioritization of competing demands, level of respect and support, and availability of resources) interfered with the continued use and sustainment of the intervention. We offer potential strategies to overcome these barriers and provide directions for future research in this critical area.
School-based teams are central to referrals, problem solving and decision-making in school mental health (SMH). Although the use of teams in SMH appears commonplace, research on these teams, however, is much more limited in scope. Using best practice teaming principles as a conceptual framework, this exploratory study examined the purpose, structure and function of 41 school-based servicedelivery teams from 19 schools. Descriptive analyses revealed wide variations in teaming practices. Challenges related to youth and family members being involved in teams, as well as varied team leadership, were noted. In addition, teams discussed numerous topics as part of meetings. The discussion of data, however, was a topic that a limited number of teams discussed. Implications for SMH practice and research are offered.
Research supports that school districts' prereferral consultation teams adhere less closely to quality consultation procedures and are less effective than those conducted through university research projects (e.g., Bahr, Whitten, Dieker, Kocarek, & Manson, 1999). This study investigated whether this finding might be due to incompatibilities between school settings and recommended team consultation practices. First, self-assessment surveys and case evaluation activities verified that teams in this school district-led project were not fully implementing research-recommended team consultation procedures. Then, focus group discussions verified through follow-up ratings were used to describe why the research-recommended procedures were not followed. Results suggest that school teams consider the recommended team consultation procedures to be unfamiliar, discrepant from existing staff roles, unnecessarily complex, and often inefficient. In too many cases, administrative support for team activities is inconsistent and the teams lack sufficient intervention resources to have an impact on student success. Team recommendations for improving the consultation procedures are discussed.
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Each mental health discipline offers unique contributions to the development and operation of school-based mental health programs. The collaboration of professionals from different disciplines with each other, as well as with health and educational staff, is essential for service delivery in school settings. Conversely, interprofessional conflicts and turf issues can impede the development of effective school-based mental health programs. The authors, who represent counseling, nursing, psychiatry, psychology, and social work, discuss the roles and competencies of each profession in providing school-based mental health services. Training requirements within each discipline that relate to school mental health are described. Barriers to effective interdisciplinary collaboration, and methods of overcoming them, are delineated
This article reviews challenges to collaboration in school mental health (SMH) and presents practical strategies for overcoming them.
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.
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.
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.
Primary health care is undergoing significant organizational change, including the development of interdisciplinary health care teams. Understanding how teams function effectively in primary care will assist training programs in teaching effective interprofessional practices. This study aimed to explore the views of members of primary health care teams regarding what constitutes a team, team effectiveness and the factors that affect team effectiveness in primary care. Focus group consultations from six teams in the Department of Family Medicine at Queen's University were recorded and transcribed and qualitative analysis was used to identify themes. Twelve themes were identified that related to the impact of dual goals/obligations of education and clinical/patient practice on team relationships and learners; the challenges of determining team membership including nonattendance of allied health professionals except nurses; and facilitators and barriers to effective team function. This study provides insight into some of the challenges of developing effective primary care teams in an academic department of family medicine. Clear goals and attention to teamwork at all levels of collaboration is needed if effective interprofessional education is to be achieved. Future research should clarify how best to support the changes required for increasingly effective teamwork.
Expanded school mental health (ESMH) programs involve the provision of comprehensive mental health services for youth in schools, including assessment, intervention, prevention, and consultation. Related to increased awareness of the benefits of these programs, and growing disenchantment with traditional forms of mental health service delivery for children, ESMH programs are growing rapidly in the United States. Coinciding with the growth of these programs is a developing interface between and among education and mental health professionals in schools. In this interface, there is an increasing need for real collaboration; however, associated with differences in professional training, language, and expectations, and related to "turf," such collaboration is often an elusive prospect. In this article, we review historical trends that provide background to the growing education-mental health interface in schools. We discuss tensions that arise between staff of various disciplines when ESMH programs are developed, and provide recommendations on strategies to develop truly collaborative approaches to the provision of comprehensive mental health services in schools.
Social workers have worked with colleagues from other disciplines since the early days of the profession; yet, they were without clear models to guide this interdisciplinary work. The author uses multidisciplinary theoretical literature and conceptual and research pieces from social work literature to support the development of such a model. First, current trends relevant to interdisciplinary practice are noted to emphasize its importance. The article describes a two-part model. Part one of the model consists of five components that constitute interdisciplinary collaboration between social workers and other professionals: interdependence, newly created professional activities, flexibility, collective ownership of goals, and reflection on process. Part two of the model consists of four influences on collaboration: professional role, structural characteristics, personal characteristics and a history of collaboration. Implications for social work practice are discussed.
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