(PS9-9) Staff and Leader Perceptions of Barriers and Facilitators to Implementing an Adapted Teamstepps Team Training Model for School Mental Health Teams

Background 

Schools play a significant role as providers of mental health services for youth. However, collaboration between school mental health teams and education personnel can be challenging due to a lack of shared mission, agenda, and priorities. These challenges stem from limited time and resources among teachers and mental health providers, as well as issues with communication and vaguely defined roles. TeamSTEPPS, an evidence-based team training strategy, is designed to enhance competencies in leadership, situation monitoring, mutual support, and communication among healthcare teams. While promising, its effectiveness in improving school mental health services remains untested.

Methods

We adapted TeamSTEPPS in partnership with school personnel and piloted it in 3 school districts. As part of this larger study, we conducted semi-structured qualitative interviews, informed by the Consolidated Framework for Implementation Research (CFIR), with 14 school personnel to understand their experiences with the adapted TeamSTEPPS training and implementation strategies. Interviewees also completed the TeamSTEPPS Teamwork Attitudes Questionnaire (T-TAQ), TeamSTEPPS Teamwork Perceptions Questionnaire (T-TPQ), and Maslach Burnout Inventory- Human Services (MBI-HSS) before TeamSTEPPS trainings and at two follow-up time points. Interview analysis was guided by an integrated approach that includes the identification of a priori attributes of interest (i.e., constructs from the CFIR framework and key TeamSTEPPS domains), combined with the identification of emergent codes and themes. Utilizing a mixed methods convergent QUAL + Quan design, we will explore contextual predictors related to the integration of TeamSTEPPS. We will visually inspect the distributions of survey scores to determine if logical cut points exist per measure, and these will be used when appropriate for mixed methods analyses.

Results

Participants were predominantly female (93%), white (79%), and non-Hispanic (93%), and in counseling (29%), administration (21%), school psychology (21%), social work (21%), and teaching (7%) roles. Qualitative analysis revealed that the adapted TeamSTEPPS training was viewed as acceptable and feasible and enhanced communication and efficiency (e.g., in team meetings). Barriers included competing initiatives, lack of staff openness, and difficulties identifying internal champions. Increased administrative buy-in and ongoing implementation supports were desired. Baseline surveys reflected moderate emotional exhaustion (M= 24.4, SD=12.4), high personal accomplishment (M=40.2, SD=5.0), and low depersonalization (M=5.1, SD=5.1) on the MBI-HSS. T-TPQ and T-TAQ total scores were M=132.8 (SD=15.2) and M= 132.9 (SD=10.3), respectively, suggesting favorable attitudes toward and perceptions of teamwork. Additional longitudinal and mixed methods analyses are ongoing.

Discussion

Preliminary findings suggest participants found TeamSTEPPS helpful but identified barriers in school that could hinder implementation success. Our pending mixed methods analyses will illuminate varying characteristics among those who viewed TeamSTEPPS as feasible and acceptable.