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Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) is an evidence-based approach for teams that can be adapted for school mental health. TeamSTEPPS has been widely disseminated in health care settings with promising outcomes. TeamSTEPPS is designed to build competencies in the areas of leadership, situation monitoring, mutual support, and communication and has been associated with improvements in teamwork and communication as well as patient outcomes, such as decreased seclusion in psychiatric hospitals. This approach has yet to be extended as an implementation strategy in school or community mental health teams. If an evidence-based team approach like TeamSTEPPS can be successfully applied to school mental health teams, it could provide a cost-effective strategy for improving student mental health services and bolstering existing EBP implementation efforts, which to date generally have been insufficient in producing long-term clinician behavior change. In Aim 1 the investigators will capture key stakeholder perspectives about challenges in collocated school mental health services through formative work to inform collaborative planning and capacity building activities in Aim 2. Then, in Aim 2 the investigators will identify inter-organizational challenges and required components of TeamSTEPPS to adapt. The investigators will establish an advisory board and adapt TeamSTEPPS. The product of Aim 2 will be an adapted TeamSTEPPS, directed toward both school mental health and school-employed personnel, and specific, tailored implementation strategies to improve services in schools in conjunction with TeamSTEPPS. Finally, In Aim 3 the investigators will explore the feasibility, acceptability, and utility of TeamSTEPPS and the strategies generated in Aim 2 on inter-professional collaboration, teamwork, and student outcomes in eight schools.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Schools implementing TeamSTEPPS | Experimental | Select schools will take a participatory approach to collaboratively identify solutions to challenges in collocated school-based mental health services based upon the feedback of stakeholders and use TeamSTEPPS to support mental health team-school collaboration. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| TeamSTEPPS | Behavioral | TeamSTEPPS is an evidence-based approach for teams that can be adapted for school mental health. Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS), has been widely disseminated in health care settings with promising outcomes. TeamSTEPPS is designed to build competencies in the areas of leadership, situation monitoring, mutual support, and communication and has been associated with improvements in teamwork and communication as well as patient outcomes, such as decreased seclusion in psychiatric hospitals. |
| Measure | Description | Time Frame |
|---|---|---|
| Feasibility of Intervention Measure (FIM) | Reliable and validated 4-item tool to assess perceptions of the feasibility of an intervention (in this case, TeamSTEPPS training). Each item may be scored 1 = "completely disagree", 2 = "disagree", 3 = "neither agree nor disagree", 4 = "agree", or 5 = "completely agree." An overall mean score (possible score range from 1 to 5) across the 4 items is computed, where higher scores indicate more positive perceptions of intervention feasibility. | assessed immediately post-training in TeamSTEPPS (on average, 4 hours after completion of baseline measures) |
| Acceptability of Intervention Measure (AIM) | Reliable and validated 4-item observational tool to assess perceptions of the acceptability of an intervention (in this case, TeamSTEPPS training). Each item may be scored 1 = "completely disagree", 2 = "disagree", 3 = "neither agree nor disagree", 4 = "agree", or 5 = "completely agree." An overall mean score (possible score range from 1 to 5) across the 4 items is computed, where higher scores indicate greater perceptions of intervention acceptability. | assessed immediately post-training in TeamSTEPPS (on average, 4 hours after completion of baseline measures) |
| Measure | Description | Time Frame |
|---|---|---|
| Oxford Non-Technical Skills (NOTECHS) Scale | Validated 4-item observational tool to assess teamwork and cognitive skills in teams. Items reflect team skills in leadership and management; teamwork and cooperation; problem-solving and decision making; and situational awareness. An observer codes team behavior in each domain using 3-5 items rated from 1 (Below Standard) to 4 (Excellent). An overall mean score, ranging from 1 to 4, is computed across items, where higher scores indicate stronger teamwork skills. |
| Measure | Description | Time Frame |
|---|---|---|
| Expanded School Mental Health Collaboration Instrument (ESMHCI) | 59-item tool to assess perceptions of aspects of collaboration between school professionals and mental health professionals from collaborating agencies on a continuous scale. An average score is calculated, with higher scores indicating strengths and lower scores indicating areas to consider improving or targeting. Responses for all items on the scale are measured on one of two, four-point Likert-type scales (1 = never to 4 = often for items related to Types of Collaboration; and 1 = strongly disagree to 4 = strongly agree for items related to Influences on Collaboration and Perceived Benefits of Collaboration). A mean total score is computed, with possible scores ranging from 1 to 4, with higher scores indicating stronger collaboration. |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Courtney Benjamin Wolk, PhD | University of Pennsylvania | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| University of Pennsylvania | Philadelphia | Pennsylvania | 19104 | United States |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 33555258 | Derived | Kuriyan A, Kinkler G, Cidav Z, Kang-Yi C, Eiraldi R, Salas E, Wolk CB. Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) to Improve Collaboration in School Mental Health: Protocol for a Mixed Methods Hybrid Effectiveness-Implementation Study. JMIR Res Protoc. 2021 Feb 8;10(2):e26567. doi: 10.2196/26567. |
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We will make data from our trial available for other researchers by uploading it to the National Clinical Trials Database. The proposed research will include data from 95 school mental health providers, teachers, and administrators and supervisors overseeing school mental health services in Philadelphia public schools. The final dataset will include quantitative (socio-demographic characteristics, school characteristics, outcomes, and contextual predictors of implementation) data. We will collect identifiers required to create a Global Unique Identifier (GUID) that will allow for inclusions in the National Database of Clinical Trials. We also will include recommended language in our consent forms related to obtain participant permission to upload their data to the National Database.
The descriptive data will be uploaded every six months during data collection periods of the study. All other data will be submitted at time of the publication of the manuscripts describing our main findings.
Any data directly shared with other investigators would entail a data-use agreement, signed by the research team, our system partners, and the individual(s) requesting data, and that accounts for (1) commitment to using the data only for research and as outlined and approved in the agreement; (2) IRB approval at the host institution, (3) a plan for securing the data using appropriate technology, and (4) an agreed upon plan to destroy or return the data upon completion. In such cases, we will make the data and associated documentation available to users under our own auspices, such as by sending an encrypted hard-drive to users.
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Participants were existing employees working across three partner school districts. There was no randomization or assignment to study arms/conditions, though because participants naturally existed within the three districts, we report some analyses by district unit. All participants across all districts received the same intervention (i.e., TeamSTEPPS training).
Participants were school staff recruited from school mental health teams working across three school districts.
| ID | Title | Description |
|---|---|---|
| FG000 | Schools Implementing TeamSTEPPS | We conducted a quasi-experimental, single-arm pilot study of an adapted TeamSTEPPS curriculum for school mental health team members. Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS), has been widely disseminated in health care settings with promising outcomes. TeamSTEPPS is designed to build competencies in the areas of leadership, situation monitoring, mutual support, and communication and has been associated with improvements in teamwork and communication as well as patient outcomes, such as decreased seclusion in psychiatric hospitals. All participants, who were employees working across three partner school districts, completed training in TeamSTEPPS, the primary intervention. |
| Title | Milestones | Reasons Not Completed | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
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| ID | Title | Description |
|---|---|---|
| BG000 | Schools Implementing TeamSTEPPS | We conducted a quasi-experimental, single-arm pilot study of an adapted TeamSTEPPS curriculum for school mental health team members. Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) is designed to build competencies in the areas of leadership, situation monitoring, mutual support, and communication and has been associated with improvements in teamwork and communication as well as patient outcomes, such as decreased seclusion in psychiatric hospitals. All participants across all school districts received training in TeamSTEPPS which is the primary intervention in this trial. |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Data was missing for one participant |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | |||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Feasibility of Intervention Measure (FIM) | Reliable and validated 4-item tool to assess perceptions of the feasibility of an intervention (in this case, TeamSTEPPS training). Each item may be scored 1 = "completely disagree", 2 = "disagree", 3 = "neither agree nor disagree", 4 = "agree", or 5 = "completely agree." An overall mean score (possible score range from 1 to 5) across the 4 items is computed, where higher scores indicate more positive perceptions of intervention feasibility. | Staff that completed TeamSTEPPS training | Posted | Mean | Standard Deviation | score on a scale | assessed immediately post-training in TeamSTEPPS (on average, 4 hours after completion of baseline measures) |
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Participants were enrolled, on average, for a 1 year period.
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Schools Implementing TeamSTEPPS | We conducted a quasi-experimental, single-arm pilot study of an adapted TeamSTEPPS curriculum for school mental health team members. Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS), has been widely disseminated in health care settings with promising outcomes. TeamSTEPPS is designed to build competencies in the areas of leadership, situation monitoring, mutual support, and communication and has been associated with improvements in teamwork and communication as well as patient outcomes, such as decreased seclusion in psychiatric hospitals. |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Dr. Courtney Wolk | University of Pennsylvania | 215-746-6099 | courtney.wolk@pennmedicine.upenn.edu |
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot_SAP | Yes | Yes | No | Study Protocol and Statistical Analysis Plan | Aug 20, 2025 | Aug 21, 2025 | Prot_SAP_000.pdf |
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| Assessed at baseline (i.e., on average, 1 week prior to training in TeamSTEPPS), immediately post-training in TeamSTEPPS (on average, 1 week after completion of baseline observation), and at 6- and 12-month follow-ups. |
| Assessed at baseline (i.e., pre-training in TeamSTEPPS) and and at 6- and 12-month follow-ups. Six- and 12-month follow-up scores were averaged to create a single follow-up score. |
| TeamSTEPPS Teamwork Perceptions Questionnaire (T-TPQ) | Self-report measure of individual perceptions of group-level team skills and behavior. It is based upon the five core components of teamwork that comprise TeamSTEPPS, totaling 35 items. Items are rated continuously on a five-point scale from strongly disagree = 1 to strongly agree = 5. A mean total score is computed by averaging all items (possible score range = 1 to 5). Higher scores indicate more favorable perceptions of teamwork. | Assessed at baseline (i.e., pre-training in TeamSTEPPS) and at 6- and 12-month follow-ups. Six- and 12-month follow-up scores were averaged to create a single follow-up score. |
| TeamSTEPPS Teamwork Attitudes Questionnaire (T-TAQ) | Self-report measure of individual attitudes related to the core components of teamwork captured within TeamSTEPPS. Six items measure each of the core teamwork constructs, for a total of 30 items. Items are rated continuously on a five-point scale from strongly disagree = 1 to strongly agree = 5. A mean total score is calculated across items with a possible score range of 1 to 5. Higher scores indicated more positive attitudes toward teamwork. | Assessed at baseline (i.e., pre-training in TeamSTEPPS) and at 6- and 12-month follow-ups. Six- and 12-month follow-up scores were averaged to create a single follow-up score. |
| Mean |
| Standard Deviation |
| years |
|
| Sex: Female, Male | Data were missing for two participants | Count of Participants | Participants |
|
| Ethnicity (NIH/OMB) | Count of Participants | Participants |
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| Race (NIH/OMB) | Count of Participants | Participants |
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| Primary | Acceptability of Intervention Measure (AIM) | Reliable and validated 4-item observational tool to assess perceptions of the acceptability of an intervention (in this case, TeamSTEPPS training). Each item may be scored 1 = "completely disagree", 2 = "disagree", 3 = "neither agree nor disagree", 4 = "agree", or 5 = "completely agree." An overall mean score (possible score range from 1 to 5) across the 4 items is computed, where higher scores indicate greater perceptions of intervention acceptability. | Staff that completed TeamSTEPPS training | Posted | Mean | Standard Deviation | score on a scale | assessed immediately post-training in TeamSTEPPS (on average, 4 hours after completion of baseline measures) |
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| Secondary | Oxford Non-Technical Skills (NOTECHS) Scale | Validated 4-item observational tool to assess teamwork and cognitive skills in teams. Items reflect team skills in leadership and management; teamwork and cooperation; problem-solving and decision making; and situational awareness. An observer codes team behavior in each domain using 3-5 items rated from 1 (Below Standard) to 4 (Excellent). An overall mean score, ranging from 1 to 4, is computed across items, where higher scores indicate stronger teamwork skills. | Staff trained in TeamSTEPPS, observed in district teams. When multiple observations occurred by multiple raters at a time point, we computed mean (SD) ratings across raters. | Posted | Mean | Standard Deviation | units on a scale | Assessed at baseline (i.e., on average, 1 week prior to training in TeamSTEPPS), immediately post-training in TeamSTEPPS (on average, 1 week after completion of baseline observation), and at 6- and 12-month follow-ups. | School Districts | School Districts |
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| Other Pre-specified | Expanded School Mental Health Collaboration Instrument (ESMHCI) | 59-item tool to assess perceptions of aspects of collaboration between school professionals and mental health professionals from collaborating agencies on a continuous scale. An average score is calculated, with higher scores indicating strengths and lower scores indicating areas to consider improving or targeting. Responses for all items on the scale are measured on one of two, four-point Likert-type scales (1 = never to 4 = often for items related to Types of Collaboration; and 1 = strongly disagree to 4 = strongly agree for items related to Influences on Collaboration and Perceived Benefits of Collaboration). A mean total score is computed, with possible scores ranging from 1 to 4, with higher scores indicating stronger collaboration. | Staff that completed TeamSTEPPS training | Posted | Mean | Standard Deviation | score on a scale | Assessed at baseline (i.e., pre-training in TeamSTEPPS) and and at 6- and 12-month follow-ups. Six- and 12-month follow-up scores were averaged to create a single follow-up score. |
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| Other Pre-specified | TeamSTEPPS Teamwork Perceptions Questionnaire (T-TPQ) | Self-report measure of individual perceptions of group-level team skills and behavior. It is based upon the five core components of teamwork that comprise TeamSTEPPS, totaling 35 items. Items are rated continuously on a five-point scale from strongly disagree = 1 to strongly agree = 5. A mean total score is computed by averaging all items (possible score range = 1 to 5). Higher scores indicate more favorable perceptions of teamwork. | Staff that completed TeamSTEPPS training | Posted | Mean | Standard Deviation | score on a scale | Assessed at baseline (i.e., pre-training in TeamSTEPPS) and at 6- and 12-month follow-ups. Six- and 12-month follow-up scores were averaged to create a single follow-up score. |
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| Other Pre-specified | TeamSTEPPS Teamwork Attitudes Questionnaire (T-TAQ) | Self-report measure of individual attitudes related to the core components of teamwork captured within TeamSTEPPS. Six items measure each of the core teamwork constructs, for a total of 30 items. Items are rated continuously on a five-point scale from strongly disagree = 1 to strongly agree = 5. A mean total score is calculated across items with a possible score range of 1 to 5. Higher scores indicated more positive attitudes toward teamwork. | Staff that completed TeamSTEPPS training | Posted | Mean | Standard Deviation | score on a scale | Assessed at baseline (i.e., pre-training in TeamSTEPPS) and at 6- and 12-month follow-ups. Six- and 12-month follow-up scores were averaged to create a single follow-up score. |
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| 90 |
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| 90 |
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| 90 |
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| Title | Measurements |
|---|---|
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| 12 month follow-up |
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