http://informahealthcare.com/jic ISSN: 1356-1820 (print), 1469-9567 (electronic) J Interprof Care, 2015; 29(2): 162–164 ! 2015 Informa UK Ltd. DOI: 10.3109/13561820.2014.934957
SHORT REPORT
Exploring the impact of a pre-service interprofessional educational intervention for school mental health trainees Aidyn L. Iachini1, Mary Ellen Warren2, Joni W. Splett3, Melissa W. George3, Leslie K. Taylor3 and Mark D. Weist3
J Interprof Care Downloaded from informahealthcare.com by UMEA University Library on 04/01/15 For personal use only.
1
College of Social Work, 2Department of Neuropsychiatry and Behavioral Science, and 3Department of Psychology, University of South Carolina, Columbia, USA Abstract
Keywords
With collaborative interprofessional teams integral to school mental health (SMH) service delivery, pre-service educational strategies are needed to promote interprofessional collaboration among SMH trainees. The current study evaluated the effectiveness, feasibility, and acceptability of a pre-service, interprofessional SMH educational intervention focused on promoting the cross-disciplinary competencies essential for SMH practice. Eight SMH trainees participated in the study. Using a mixed-method design, quantitative pre/post competency data were collected via trainee self-report. Qualitative data were collected through a focus group and reflection journals. Results indicate that the intervention promoted competency in all areas, with significant growth in the provision of learning supports to youth. Key factors influencing intervention feasibility included time/scheduling, changing school team composition, and project coordination. Trainees’ perceptions of the educational intervention were related to buy-in, clinical experience, and role flexibility. Implications for the design of pre-service interprofessional SMH education strategies are discussed.
Evaluation research, interprofessional education, interprofessional collaboration
Introduction Collaborative interprofessional teams are integral to school mental health (SMH), as they maximize expertise, help garner resources for youth, and support participating SMH professionals’ growth and development (Iachini, Anderson-Butcher, Mellin, 2013; Mellin & Weist, 2011). Interprofessional learning approaches are needed that prepare students for engagement in these SMH teams during their educational experiences and prior to professional practice (Splett, Coleman, Maras, Gibson, & Ball, 2010). While descriptions of such approaches exist (Koller & Bertel, 2006), only one study to date has explored the impact of a pre-service interprofessional opportunity in SMH (Splett et al., 2010). Qualitative findings of the Splett et al. (2010) study reveal this intervention helped promote interprofessional learning among students who participated. More studies are needed that empirically examine the impact of these pre-service interprofessional interventions for SMH trainees (i.e. graduate students or medical residents preparing for professional roles in SMH; professions commonly represented within SMH in the United States (US) include social work, psychology, psychiatry, nursing, and counseling) preparing for SMH practice. This paper shares evaluative data on the effectiveness, feasibility, and acceptability of an interprofessional, pre-service SMH educational intervention implemented at a university in the southeastern US. The intervention consisted of two inter-related
Correspondence: Aidyn L. Iachini, College of Social Work, University of South Carolina, 328 DeSaussure, Columbia 29208, USA. E-mail: [email protected]
History Received 6 December 2013 Revised 18 April 2014 Accepted 11 June 2014 Published online 2 July 2014
components, including ten monthly two-hour meetings for SMH trainees focused on interprofessional collaboration underpinned by seven related competencies for SMH practice (Ball, AndersonButcher, Mellin, & Green, 2010), and a school-based component where trainees worked in interprofessional teams to implement a SMH intervention and met monthly to discuss student cases.
Methods This study employed a sequential mixed-method design (Creswell & Clark, 2007), collecting data in the form of surveys, a focus group and reflection journals. Participants Ten female SMH trainees participated in the first cohort of this pilot interprofessional intervention. Of those, one trainee discontinued participation after the second month and another joined during the third month. The final sample for this study consisted of eight SMH trainees (two master’s of social work students, four psychology doctoral students, and two adolescent/ child psychiatry residents). Data collection SMH trainees completed an adapted 59-item SMH Inventory (Bronstein, Ball, Mellin, Wade-Mdivanian, & Anderson-Butcher, 2011) at pre- and post-intervention to assess perceptions of their competence across SMH competency domains using a 6-point response scale (1 ¼ Strongly Disagree and 6 ¼ Strongly Agree). Trainees also completed monthly reflection journals as part of the intervention, reporting on challenges and successes to interprofessional collaboration. In addition, a two-hour,
Pre-service intervention in school mental health
DOI: 10.3109/13561820.2014.934957
semi-structured focus group was conducted with trainees after the intervention had ended in order to gain further insight into the feasibility and acceptability of the interprofessional approach. Analysis Quantitative data were analyzed by the use of paired-sample t-tests and effect sizes (Cohen’s d). Qualitative data were deductively analyzed by two researchers coding for quotes related to feasibility and acceptability. Coding schemes were discussed until consensus was reached. A terminal member check was conducted with a trainee (Krefting, 1991). Ethical considerations
J Interprof Care Downloaded from informahealthcare.com by UMEA University Library on 04/01/15 For personal use only.
This study was approved by human-subjects review boards of the University and School District.
Results Results are presented in three sections linked to perceptions of effectiveness, feasibility and acceptability. Effectiveness Improvements in SMH competencies, including a significant improvement in provision of learning supports, t(7) ¼ 2.36, p ¼ 0.050, were found (Table 1). Improvements in supports for mood disorders and key policies/laws approached significance, t(7) ¼ 2.29, p ¼ 0.056 and t(7) ¼ 2.09, p ¼ 0.075. Effect sizes indicate moderate to high growth in all competencies except personal/professional growth. Feasibility Qualitative analyses revealed three feasibility themes: ‘‘time/ scheduling’’; ‘‘changing school team composition’’ and ‘‘project coordination’’. First, professional requirements created inconsistencies in time that trainees could devote to the school-based component. One trainee stated, ‘‘It seems difficult to collaborate with my team when we never see one another’’ (social work trainee). Second, differing needs across schools and trainees resulted in changing team composition and not all professions being available in each school. As one trainee mentioned, ‘‘. . . we were all from the same discipline. I think that ended up being the case in some of the schools . . .’’ (psychology trainee). Third, involvement of individuals from three professions created challenges in project coordination: . . . when we got to the training, a lot of time was spent on logistics and administrative issues . . . So I just think that having–those meetings–separate from the trainings, we would have had a lot more time to spend on learning new clinical skills. (psychology trainee)
Acceptability Three acceptability themes emerged: ‘‘buy-in’’; ‘‘clinical experience’’, and ‘‘role flexibility’’. First, trainees reported different levels of buy-in to the intervention. One reported: I think that multidisciplinary, or interdisciplinary, stuff happened in the planning phases on the leadership level . . . when it came down to our level and being in the schools, I didn’t see that happening . . . . (psychology trainee) Differences in school personnel buy-in to support the school component also were noted, ‘‘. . . I still feel like an outsider who is bugging them when I need something’’ (psychology trainee). Second, trainee’s clinical experience varied. One mentioned, ‘‘. . . for the people who were more versed in therapy, I think the clinical skills [taught in the training] were kind of below what I needed right now’’ (psychology trainee). Third, trainees indicated role-flexibility was advantageous because people could fulfill different responsibilities, but this sometimes resulted in inequity. One trainee reported, ‘‘Maybe my experience wasn’t going as well because I felt like I was doing heavy amounts of recruiting and could not feel the team spirit’’ (social work trainee).
Discussion This study highlights the promise of this interprofessional educational intervention. Findings indicate growth across the cross-disciplinary SMH competencies, with significant improvement in providing learning supports to youth. This is similar to the findings of Splett et al. (2010), where competency growth in interprofessional collaboration also was documented among SMH trainees involved in a pre-service educational intervention. Our qualitative findings also support the findings of others (Cook, Davis, & Vanclay, 2001; Fronek et al., 2009), particularly with regard to the influence of buy-in, coordination, and scheduling constraints on the feasibility and acceptability of such education. The findings of this study need to be considered, however, in light of the study limitations, including the small number of participants who completed the intervention and the use of a self-report method to assess competency growth. Together, our findings signal two important design issues when developing these pre-service SMH strategies. First, mapping discipline-specific requirements and placement options for students could help identify challenges and maximize collaborative learning. Second, assessment of trainee experiences and goals could help design more individualized SMH educational content. In summary, despite the preliminary nature of the study, findings provide encouraging evidence that pre-service interprofessional education may influence interprofessional learning among SMH trainees. Future efforts should focus on the key
Table 1. Pre- to post-intervention competency scores. Competency
Range
Key policies/laws Interprofessional collaboration Cross-systems collaboration Provision of learning supports Provision of supports for mood disorders Data-driven decision-making Personal/professional growth Cultural competence
8–42 8–44 8–39 12–67 7–41 5–28 6–36 5–30
163
Pre-scores (M, SD) 20.63 29.00 23.00 34.50 23.38 16.25 22.38 20.63
Post-scores (M, SD)
(6.09) (9.41) (10.52) (11.59) (11.87) (6.78) (8.94) (7.80)
*p50.10; **p50.05; 0.80 large effect size (ES)1 0.50 moderate ES2 0.20 small ES3.
30.25 35.75 28.75 49.25 32.75 19.25 25.88 25.38
(8.41) (7.64) (5.89) (11.25) (6.80) (3.62) (6.36) (4.27)
T
d
2.09* 1.30 1.46 2.36** 2.29* 1.03 0.88 1.53
1.311 0.792 0.672 1.291 0.971 0.552 0.453 0.762
164
A. L. Iachini et al.
design factors identified as they may maximize the impact of interprofessional education on participating trainee outcomes.
Acknowledgements Support for the study was provided by the Office of the Vice President for Research, University of South Carolina. We also would like to acknowledge the school leaders, school mental health trainees, and other graduate and undergraduate students who helped support this project.
Declaration of interest The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.
J Interprof Care Downloaded from informahealthcare.com by UMEA University Library on 04/01/15 For personal use only.
References Ball, A., Anderson-Butcher, D., Mellin, E.A., & Green, J.H. (2010). A cross-walk of professional competencies involved in expanded school mental health: An exploratory study. School Mental Health, 2, 114–124. Bronstein, L. R., Ball, A., Mellin, E. A., Wade-Mdivanian, R., & Anderson-Butcher, D. (2011). Advancing collaboration between school-and agency-employed school-based social workers: A mixedmethods comparison of competencies and preparedness. Children & Schools, 33, 83–95.
J Interprof Care, 2015; 29(2): 162–164
Cook, A., Davis, J., & Vanclay, L. (2001). Shared learning in practice placements for health and social work students in East London: A feasibility study. Journal of Interprofessional Care, 15, 185–190. Creswell, J. W., & Clark, V. L. P. (2007). Designing and conducting mixed methods research. Thousand Oaks, CA: Sage publications. Fronek, P., Kendall, M., Ungerer, G., Malt, J., Eugarde, E., & Geraghty, T. (2009). Towards healthy profession-client relationships: The value of an interprofessional training course. Journal of Interprofessional Care, 23, 16–29. Iachini, A.L., Anderson-Butcher, D., & Mellin, E.A. (2013). Exploring best practice teaming strategies: Implications for school mental health practice and research. Advances in School Mental Health Promotion, 6, 139–154. Koller, J. R., & Bertel, J. M. (2006). Responding to Today’s mental health needs of children, families and schools: revisiting the preservice training and preparation of school-based personnel. Education & Treatment of Children, 29, 197–217. Krefting, L. (1991). Rigor in qualitative research: The assessment of trustworthiness. The American Journal of Occupational Therapy, 45, 214–222. Mellin, E. A., & Weist, M. D. (2011). Exploring school mental health collaboration in an urban community: a social capital perspective. School Mental Health, 3, 81–92. Splett, J.W., Coleman, S., Maras, M.A., Gibson, J.E., & Ball, A. (2010). Learning by teaching: Reflections on developing a curriculum for school mental health collaboration. Advances in School Mental Health Promotion, 4, 27–38.
SHORT REPORT
Exploring the impact of a pre-service interprofessional educational intervention for school mental health trainees Aidyn L. Iachini1, Mary Ellen Warren2, Joni W. Splett3, Melissa W. George3, Leslie K. Taylor3 and Mark D. Weist3
J Interprof Care Downloaded from informahealthcare.com by UMEA University Library on 04/01/15 For personal use only.
1
College of Social Work, 2Department of Neuropsychiatry and Behavioral Science, and 3Department of Psychology, University of South Carolina, Columbia, USA Abstract
Keywords
With collaborative interprofessional teams integral to school mental health (SMH) service delivery, pre-service educational strategies are needed to promote interprofessional collaboration among SMH trainees. The current study evaluated the effectiveness, feasibility, and acceptability of a pre-service, interprofessional SMH educational intervention focused on promoting the cross-disciplinary competencies essential for SMH practice. Eight SMH trainees participated in the study. Using a mixed-method design, quantitative pre/post competency data were collected via trainee self-report. Qualitative data were collected through a focus group and reflection journals. Results indicate that the intervention promoted competency in all areas, with significant growth in the provision of learning supports to youth. Key factors influencing intervention feasibility included time/scheduling, changing school team composition, and project coordination. Trainees’ perceptions of the educational intervention were related to buy-in, clinical experience, and role flexibility. Implications for the design of pre-service interprofessional SMH education strategies are discussed.
Evaluation research, interprofessional education, interprofessional collaboration
Introduction Collaborative interprofessional teams are integral to school mental health (SMH), as they maximize expertise, help garner resources for youth, and support participating SMH professionals’ growth and development (Iachini, Anderson-Butcher, Mellin, 2013; Mellin & Weist, 2011). Interprofessional learning approaches are needed that prepare students for engagement in these SMH teams during their educational experiences and prior to professional practice (Splett, Coleman, Maras, Gibson, & Ball, 2010). While descriptions of such approaches exist (Koller & Bertel, 2006), only one study to date has explored the impact of a pre-service interprofessional opportunity in SMH (Splett et al., 2010). Qualitative findings of the Splett et al. (2010) study reveal this intervention helped promote interprofessional learning among students who participated. More studies are needed that empirically examine the impact of these pre-service interprofessional interventions for SMH trainees (i.e. graduate students or medical residents preparing for professional roles in SMH; professions commonly represented within SMH in the United States (US) include social work, psychology, psychiatry, nursing, and counseling) preparing for SMH practice. This paper shares evaluative data on the effectiveness, feasibility, and acceptability of an interprofessional, pre-service SMH educational intervention implemented at a university in the southeastern US. The intervention consisted of two inter-related
Correspondence: Aidyn L. Iachini, College of Social Work, University of South Carolina, 328 DeSaussure, Columbia 29208, USA. E-mail: [email protected]
History Received 6 December 2013 Revised 18 April 2014 Accepted 11 June 2014 Published online 2 July 2014
components, including ten monthly two-hour meetings for SMH trainees focused on interprofessional collaboration underpinned by seven related competencies for SMH practice (Ball, AndersonButcher, Mellin, & Green, 2010), and a school-based component where trainees worked in interprofessional teams to implement a SMH intervention and met monthly to discuss student cases.
Methods This study employed a sequential mixed-method design (Creswell & Clark, 2007), collecting data in the form of surveys, a focus group and reflection journals. Participants Ten female SMH trainees participated in the first cohort of this pilot interprofessional intervention. Of those, one trainee discontinued participation after the second month and another joined during the third month. The final sample for this study consisted of eight SMH trainees (two master’s of social work students, four psychology doctoral students, and two adolescent/ child psychiatry residents). Data collection SMH trainees completed an adapted 59-item SMH Inventory (Bronstein, Ball, Mellin, Wade-Mdivanian, & Anderson-Butcher, 2011) at pre- and post-intervention to assess perceptions of their competence across SMH competency domains using a 6-point response scale (1 ¼ Strongly Disagree and 6 ¼ Strongly Agree). Trainees also completed monthly reflection journals as part of the intervention, reporting on challenges and successes to interprofessional collaboration. In addition, a two-hour,
Pre-service intervention in school mental health
DOI: 10.3109/13561820.2014.934957
semi-structured focus group was conducted with trainees after the intervention had ended in order to gain further insight into the feasibility and acceptability of the interprofessional approach. Analysis Quantitative data were analyzed by the use of paired-sample t-tests and effect sizes (Cohen’s d). Qualitative data were deductively analyzed by two researchers coding for quotes related to feasibility and acceptability. Coding schemes were discussed until consensus was reached. A terminal member check was conducted with a trainee (Krefting, 1991). Ethical considerations
J Interprof Care Downloaded from informahealthcare.com by UMEA University Library on 04/01/15 For personal use only.
This study was approved by human-subjects review boards of the University and School District.
Results Results are presented in three sections linked to perceptions of effectiveness, feasibility and acceptability. Effectiveness Improvements in SMH competencies, including a significant improvement in provision of learning supports, t(7) ¼ 2.36, p ¼ 0.050, were found (Table 1). Improvements in supports for mood disorders and key policies/laws approached significance, t(7) ¼ 2.29, p ¼ 0.056 and t(7) ¼ 2.09, p ¼ 0.075. Effect sizes indicate moderate to high growth in all competencies except personal/professional growth. Feasibility Qualitative analyses revealed three feasibility themes: ‘‘time/ scheduling’’; ‘‘changing school team composition’’ and ‘‘project coordination’’. First, professional requirements created inconsistencies in time that trainees could devote to the school-based component. One trainee stated, ‘‘It seems difficult to collaborate with my team when we never see one another’’ (social work trainee). Second, differing needs across schools and trainees resulted in changing team composition and not all professions being available in each school. As one trainee mentioned, ‘‘. . . we were all from the same discipline. I think that ended up being the case in some of the schools . . .’’ (psychology trainee). Third, involvement of individuals from three professions created challenges in project coordination: . . . when we got to the training, a lot of time was spent on logistics and administrative issues . . . So I just think that having–those meetings–separate from the trainings, we would have had a lot more time to spend on learning new clinical skills. (psychology trainee)
Acceptability Three acceptability themes emerged: ‘‘buy-in’’; ‘‘clinical experience’’, and ‘‘role flexibility’’. First, trainees reported different levels of buy-in to the intervention. One reported: I think that multidisciplinary, or interdisciplinary, stuff happened in the planning phases on the leadership level . . . when it came down to our level and being in the schools, I didn’t see that happening . . . . (psychology trainee) Differences in school personnel buy-in to support the school component also were noted, ‘‘. . . I still feel like an outsider who is bugging them when I need something’’ (psychology trainee). Second, trainee’s clinical experience varied. One mentioned, ‘‘. . . for the people who were more versed in therapy, I think the clinical skills [taught in the training] were kind of below what I needed right now’’ (psychology trainee). Third, trainees indicated role-flexibility was advantageous because people could fulfill different responsibilities, but this sometimes resulted in inequity. One trainee reported, ‘‘Maybe my experience wasn’t going as well because I felt like I was doing heavy amounts of recruiting and could not feel the team spirit’’ (social work trainee).
Discussion This study highlights the promise of this interprofessional educational intervention. Findings indicate growth across the cross-disciplinary SMH competencies, with significant improvement in providing learning supports to youth. This is similar to the findings of Splett et al. (2010), where competency growth in interprofessional collaboration also was documented among SMH trainees involved in a pre-service educational intervention. Our qualitative findings also support the findings of others (Cook, Davis, & Vanclay, 2001; Fronek et al., 2009), particularly with regard to the influence of buy-in, coordination, and scheduling constraints on the feasibility and acceptability of such education. The findings of this study need to be considered, however, in light of the study limitations, including the small number of participants who completed the intervention and the use of a self-report method to assess competency growth. Together, our findings signal two important design issues when developing these pre-service SMH strategies. First, mapping discipline-specific requirements and placement options for students could help identify challenges and maximize collaborative learning. Second, assessment of trainee experiences and goals could help design more individualized SMH educational content. In summary, despite the preliminary nature of the study, findings provide encouraging evidence that pre-service interprofessional education may influence interprofessional learning among SMH trainees. Future efforts should focus on the key
Table 1. Pre- to post-intervention competency scores. Competency
Range
Key policies/laws Interprofessional collaboration Cross-systems collaboration Provision of learning supports Provision of supports for mood disorders Data-driven decision-making Personal/professional growth Cultural competence
8–42 8–44 8–39 12–67 7–41 5–28 6–36 5–30
163
Pre-scores (M, SD) 20.63 29.00 23.00 34.50 23.38 16.25 22.38 20.63
Post-scores (M, SD)
(6.09) (9.41) (10.52) (11.59) (11.87) (6.78) (8.94) (7.80)
*p50.10; **p50.05; 0.80 large effect size (ES)1 0.50 moderate ES2 0.20 small ES3.
30.25 35.75 28.75 49.25 32.75 19.25 25.88 25.38
(8.41) (7.64) (5.89) (11.25) (6.80) (3.62) (6.36) (4.27)
T
d
2.09* 1.30 1.46 2.36** 2.29* 1.03 0.88 1.53
1.311 0.792 0.672 1.291 0.971 0.552 0.453 0.762
164
A. L. Iachini et al.
design factors identified as they may maximize the impact of interprofessional education on participating trainee outcomes.
Acknowledgements Support for the study was provided by the Office of the Vice President for Research, University of South Carolina. We also would like to acknowledge the school leaders, school mental health trainees, and other graduate and undergraduate students who helped support this project.
Declaration of interest The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.
J Interprof Care Downloaded from informahealthcare.com by UMEA University Library on 04/01/15 For personal use only.
References Ball, A., Anderson-Butcher, D., Mellin, E.A., & Green, J.H. (2010). A cross-walk of professional competencies involved in expanded school mental health: An exploratory study. School Mental Health, 2, 114–124. Bronstein, L. R., Ball, A., Mellin, E. A., Wade-Mdivanian, R., & Anderson-Butcher, D. (2011). Advancing collaboration between school-and agency-employed school-based social workers: A mixedmethods comparison of competencies and preparedness. Children & Schools, 33, 83–95.
J Interprof Care, 2015; 29(2): 162–164
Cook, A., Davis, J., & Vanclay, L. (2001). Shared learning in practice placements for health and social work students in East London: A feasibility study. Journal of Interprofessional Care, 15, 185–190. Creswell, J. W., & Clark, V. L. P. (2007). Designing and conducting mixed methods research. Thousand Oaks, CA: Sage publications. Fronek, P., Kendall, M., Ungerer, G., Malt, J., Eugarde, E., & Geraghty, T. (2009). Towards healthy profession-client relationships: The value of an interprofessional training course. Journal of Interprofessional Care, 23, 16–29. Iachini, A.L., Anderson-Butcher, D., & Mellin, E.A. (2013). Exploring best practice teaming strategies: Implications for school mental health practice and research. Advances in School Mental Health Promotion, 6, 139–154. Koller, J. R., & Bertel, J. M. (2006). Responding to Today’s mental health needs of children, families and schools: revisiting the preservice training and preparation of school-based personnel. Education & Treatment of Children, 29, 197–217. Krefting, L. (1991). Rigor in qualitative research: The assessment of trustworthiness. The American Journal of Occupational Therapy, 45, 214–222. Mellin, E. A., & Weist, M. D. (2011). Exploring school mental health collaboration in an urban community: a social capital perspective. School Mental Health, 3, 81–92. Splett, J.W., Coleman, S., Maras, M.A., Gibson, J.E., & Ball, A. (2010). Learning by teaching: Reflections on developing a curriculum for school mental health collaboration. Advances in School Mental Health Promotion, 4, 27–38.
