Adapting TeamSTEPPS for school mental health teams: development of an implementation research logic model.

Introduction: Multidisciplinary school mental health (SMH) teams play a key role in delivering mental health services to children. However, poor workflow, inefficient communication, and limited resources, compromise SMH service delivery. Despite robust literature demonstrating the efficacy of team science interventions, such as the Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS), research on these interventions with SMH teams is limited. Methods: We conducted qualitative interviews with SMH team members, teachers, and school administrators who had participated in a hybrid effectiveness-implementation trial of TeamSTEPPS. Participants identified barriers and facilitators to implementation of the adapted TeamSTEPPS intervention, which were then organized according to the Consolidated Framework for Implementation Research (CFIR). An Implementation Research Logic Model was developed, aligning implementation determinants with implementation strategies and proposed mechanisms by which the strategies impact outcomes. Results: Barriers to the successful implementation of the adapted TeamSTEPPS intervention included a lack of financing and resources, the intervention not being a relative priority, mission misalignment, poor work infrastructure to support, unmotivated innovation recipients and leaders, and insufficient planning. Proposed implementation strategies included providing dynamic training for leadership and SMH team members, centralizing technical assistance, development and distribution of educational materials, and ongoing consultation about implementation supports/when challenges arose, developing local policies that support implementation, establishing mandates for change, pruning competing initiatives, and providing reminders of strategies to school personnel. Proposed implementation outcomes (e.g., acceptability, feasibility), service outcomes (e.g., Observation of use of TeamSTEPPS strategies, Perceptions of teaming, Attitudes toward teamwork), and "client outcomes" (e.g., student service use, absences, suspensions, grade promotion) were also identified. Discussion: Lessons from the implementation process and recommendations for future directions are highlighted to inform the delivery and sustainment of team science interventions, such as TeamSTEPPS, for use with SMH teams.