4 - (IOP 12) Enhancing School-based ADHD Interventions with Team Strategies: Insights from an Open Trial

The Collaborative Life Skills Program (CLS) is a school-based ADHD intervention that trains school mental health providers (SMHPs) to deliver three evidence-based behavioral treatments (i.e., parent training, classroom behavior management, child skills training) to provide around-the-clock support to children in grades 2-5. Previous trials of CLS have shown its effectiveness in improving ADHD symptoms, academic performance, and social functioning. These studies also found that consistent daily coordination among SMHPs, caregivers, and teachers was central to maximizing CLS implementation and child outcomes. CLS-T integrates evidence-based team development strategies into CLS to enhance processes (e.g., trust and cohesion among team members) vital to effective teamwork. CLS-T includes three team-based tools created with Google Suite: (1) Team Plans to define roles and goals; (2) Handoff Forms to support school-family communication about individualized behavioral goals; and (3) Tracking Sheets for ongoing progress monitoring. This study presents the iterative CLS-T development process – with discovery, design, and testing phases – in partnership with school stakeholders.

We conducted a single-armed open trial of CLS-T with four schools from two diverse districts in Northern and Southern California. The sample comprised 21 child-caregiver-teacher-SMHP teams (child and caregiver ns=21, teacher n = 16 teachers, SMHP n = 4). Up to 6 families, 6 teachers, and 1 SMHP participated per school. Children were from diverse racial/ethnic (43% Latine, 14% Asian, 14% non-Hispanic white, 29% multiracial/unknown) and economic backgrounds (38% had family incomes of <$49,999, 38% $50,000 to $99,999, 24% $200,000<). Post-treatment measures assessed for comfort with (0 = not at all to 10 = very) and ease and helpfulness of the CLS-T tools (1 = very difficult/not helpful; 5 = very easy/helpful) as well as perceived levels of trust and cohesion among team members. Post-treatment focus interviews queried participants’ experience and suggestions for improving CLS-T.

All team members reported high comfort with (Ms = 7.4 to 9.5), ease (Ms = 4.1 to 4.6) and helpfulness (Ms = 4.1 to 4.7) of the Team Plans and Handoff Forms. Caregivers and SMHPs reported high comfort with (Ms = 8.3), ease (Ms = 4.4, 4.1) and helpfulness (Ms = 4.7, 4.6) of the Tracking Sheets, with 62% of caregivers using them multiple days per week. Teacher ratings of Tracking Sheets were more neutral (Ms = 6.3, 3.6, 3.3), with some reporting that they forgot to check them. Nested models showed that perceived comfort, ease, and helpfulness of the tools were positively associated with team trust and cohesion (bs = .04 to .39, ps <.05). Stakeholder feedback highlighted enhanced school-home problem solving as well as needed modifications to streamline tool use and improve team member accountability.

Preliminary findings support the usability and acceptability of integrating team-based strategies into school-based ADHD interventions using cost-free technology. CLS-T has the potential to improve school-home collaborative teamwork in diverse community settings. Design modifications and emerging findings from the ongoing randomized controlled trial evaluating CLS-T will also be discussed.