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The implementation of a team training intervention for school mental health: Lessons learned.

ABSTRACT: Children obtain more mental health services through schools than through any other system. In urban, low-resource schools, mental health care often is provided by teams of contracted community mental health workers. Implementation of intended services may struggle in the context of challenges related to team functioning. Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) is an efficacious approach for improving team functioning in health care. In collaboration with stakeholders, we adapted TeamSTEPPS for school mental health teams and pilot-tested it in 3 schools participating in an ongoing implementation of cognitive-behavioral therapy. In total, 3 teams randomized to receive TeamSTEPPS were compared with 3 teams who did not participate in TeamSTEPPS. Feasibility and acceptability of the adapted TeamSTEPPS and the impact on team skills and behavior were assessed through qualitative interviews and field notes and quantitatively over the course of 1 school year. In this article, we describe the process of adapting and implementing TeamSTEPPS. In addition to providing the researchers' perspective, we illustrate participant perspectives using qualitative data when possible. Key challenges included leader and staff turnover, logistical barriers (e.g., difficulty securing private space for qualitative interviews in schools), and navigating the protection of participant rights and autonomy given that prospective participants were employed by an agency with a vested interest in their participation. Concrete suggestions for overcoming challenges are provided to guide future research. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

SUBMITTER: Wolk CB

PROVIDER: S-EPMC6395502 | biostudies-literature | 2019 Mar

REPOSITORIES: biostudies-literature

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Project description:BackgroundThis study was a retrospective evaluation of an unsuccessfully implemented team-based, chronic disease management program, with an aim to understand more about implementation barriers. The program, the Chronic Disease Management Initiative (CDMI) was a new collaborative model of care for patients with COPD. It utilized customized health information and interactive tools, mainly smartphones, for ongoing disease management. The program's goal was to demonstrate that integrated team-based models of care could improve patient care, as well as reduce readmission rates and emergency department visits. The program planning for CDMI began in 2017, followed by the implementation and evaluation period in 2018. After a 10-month implementation period, the program was unable to enroll a sufficient number of patients to examine if there was an improvement in patient outcomes.MethodsA retrospective case-study design using multiple data sources was used to gather feedback from participants involved in CDMI. Data collection occurred throughout planning and implementation and continued into early 2019. Semi-structured interviews were conducted, and transcripts were analyzed using NVivo 10 software. This was followed by content analysis.ResultsAnalysis revealed four key themes as barriers to CDMI's implementation: 1) lack of a needs assessment with key stakeholders; 2) lack of buy-in from medical staff; 3) inadequate patient engagement and; 4) contextual barriers. Planners did not conduct a proper needs assessment, nor include patients in the study design. In addition, there was insufficient consideration for how CDMI should be integrated into the usual COPD care plan, leading to confusion in roles and responsibilities. Poor communication between the implementation team and healthcare providers implementing the program, led to a lack of buy-in and engagement.ConclusionThe key themes resonate with what is already known in the literature. This study supports the importance of using a theoretically grounded plan for implementation. Using a model only in the planning stages is insufficient even when an intervention is based on evidence to support higher quality care. It is imperative to consider practical and contextual factors of program implementation and their interactions. By detailing the 'failed implementation' of this intervention, we hope to share important lessons about the need to plan implementation processes early in program planning.

Project description:BACKGROUND:Depression and anxiety is a major public health problem, in Sweden and internationally. Internet-based interventions are increasingly acknowledged as promising approaches for individuals with varying degrees of mental health problems. We present findings from the implementation of myCompass, a fully automated self-guided intervention of Australian origin, in a Swedish context. METHODS:We (i) share our experience of the E-health study platform (i.e., regarding security aspects, functionality) to which the myCompass intervention was linked, and (ii) report findings from the empirical evaluation of myCompass (i.e., prerequisites, execution, study outcomes), in a community sample of individuals (N?=?837) reporting mild-to-moderate levels of depression, anxiety and stress. Outcomes were calculated with repeated measures ANOVA and linear mixed models. RESULTS:The E-health study platform proved to be an efficient tool enabling randomization, informed consent and evaluation to be administered in a fully automated manner. The study rendered substantial interest initially with 1207 individuals enrolling, however it failed to maintain engagement of those enrolled with only few participants logging in more than once or twice following registration. A smaller subgroup of "active users" (n?=?35) had a markedly higher activity in the program, however their treatment results were not significantly better than those of the control group. CONCLUSION:Based on the large number of dropouts and also modest use of the intervention overall, only tentative speculations can be made regarding its effectiveness in a Swedish context. The number of individuals remaining active in the intervention is much more limited that the number of individuals initially signing up. Moreover, the transportation of interventions across countries and cultures may need more careful consideration, and pilot-trials before attempting large-scale trials are recommended. TRIAL REGISTRATION:MyCompass was retrospectively registered at ClinicalTrials.gov . NCT03659630 September 3rd 2018, and was given the protocol ID 2015/1268-31/2?+?2016/88.

Project description:Background:Hypertension (HTN) affects nearly 1 billion people globally and is a major cause of morbidity and mortality. In low- and middle-income countries (LMICs), HTN represents an unmet health care gap that can be addressed by strengthening national health care systems. The National Heart, Lung, and Blood Institute recently funded the T4 Translation Research Capacity Building Initiative in Low Income Countries (TREIN) program to build capacity in dissemination and implementation (D&I) research in HTN in LMICs. The Special Programme for Research and Training in Tropical Diseases (TDR) at the World Health Organization (WHO) recently developed a massive open online course (MOOC) to train in D&I. Herein, we report on the use of the TDR WHO MOOC in D&I for the TREIN program in Rwanda, assessing feasibility of the MOOC and D&I competencies after MOOC training. Methods:Participants in one-group MOOC training completed pre- and post-training questionnaires to assess dissemination and implementation (D&I) competency outcomes and feasibility. D&I competencies were measured by use of a scale developed for a US-based training program, with the change in competency scores assessed by paired t test. Feasibility was measured by completion of homework and final project assignment and analyzed using descriptive statistics. Results:Of the 92 trainees enrolled, 35 (38%) completed all MOOC components. D&I competency scores showed strong evidence of improvements from pre- to post-test. The full-scale average score improved by an average of 1.09 points, representing an effect size of 1.25 (CI 0.48-2.00); all four subscales also showed strong evidence of improvements. Trainees reported challenges to MOOC course completion that included technological issues (i.e., limited internet access) and competing demands (i.e., work, family). Conclusions:In the context of LMIC training, the MOOC course was feasible and course completion showed improvement in D&I competency scores. While the program was designed with a focus on training for tropical diseases, there is potential for scalability to a wider audience of health care researchers, workers, administrators, and policymakers in LMIC interested in D&I research in non-communicable diseases.

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The implementation of a team training intervention for school mental health: Lessons learned.

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