6 - (IOP 12) Examining the Relationship Between Team Functioning and Implementation Stress for a School-based, Team-enhanced Psychosocial Treatment for Youth with ADHD

Background: The Collaborative Life Skills (CLS) program is a school-based intervention that coordinates evidence-based classroom behavioral management, behavioral parent training, and child skills training strategies for children with attention and behavioral challenges related to ADHD. CLS is delivered by trained school mental health providers (SMHPs) and effective implementation relies on teamwork among SMHPs, children, parents, and teachers. To address implementation gaps, we enhanced CLS implementation with team-based strategies based on team effectiveness research. We will present findings from a field trial investigating the usability, feasibility, and appropriateness of the enhanced CLS-Teams protocol and its impacts on key team mechanisms, such as team processes (i.e., goal specification, coordination) and affective emergent states (i.e., trust, cohesion, psychological safety). We hypothesized that higher ratings from team members on goal specification, coordination, cohesion, trust, and psychological safety would be associated with lower ratings of CLS implementation stress from team members and higher ratings of usability, feasibility, and acceptability, as well as more consistent parent group attendance and teacher implementation of classroom strategies.

Methods: Participants were SMHPS from 4 urban public elementary schools in California and 21 student-parent-teacher teams. Children were in grades 2-5, mostly male (90%), from diverse ethnical/racial and socio-economic backgrounds (71% qualified for free/reduced lunch). Following the intervention, parents, teachers, and SMHPs all completed measures of team mechanisms, a measure of CLS implementation stress, and ratings of the usability, feasibility, and acceptability of the intervention. Parent group attendance and teacher implementation of classroom strategies were collected throughout implementation.

Results: Team members rated CLS-Teams’ usability (M = 4.02/5), feasibility (M = 4.35/5), and acceptability (M = 4.32/5) high and implementation stress low (M = 1.83/5). Parent group attendance (71%) and teacher classroom strategy implementation (80%) were high. Three-level models accounted for nesting of individuals (Level 1) within teams (Level 2) within schools (Level 3). Higher ratings of affective emergent states (trust, cohesion, psychological safety) and coordination were each associated with less CLS implementation stress (bs ranging from -.21 to -.13, ps < .05) and higher usability ratings (bs ranging from .28 to .34, ps < .05). Higher ratings of cohesion (b = 1.23, p < .001) and coordination (b = .87, p = .01) were each associated with better parent group attendance.

Conclusion: Team affective emergent states and processes, such as trust, psychological safety, cohesion, and coordination may be key targets for enhancing school-based implementation of interventions for children with attention and behavioral challenges. Team effectiveness research provides an empirical foundation for developing tailored team-based implementation strategies to support school-based implementation. Implications of these findings, as well as emerging findings from an ongoing cluster randomized trial of CLS-Teams will be discussed.