TEAMS R34 #1 After-Action Reviews in Child Welfare Services

NCT05629013 | Recruiting

• 2 other identifiers: 803821P50MH126231-01A1
• Study Type: interventional
• Target: 320
• Locations: 1 country
• Sites: 1

Brief Summary

This project proposes to improve successful mental health service linkage in Child Welfare Services (CWS) by adapting and testing the After Action Review (AAR) team effectiveness intervention to augment the Child Family Team (CFT) services intervention. Despite being both required and a collaborative approach to service planning, CFT meetings are implemented with questionable fidelity and consistency, rarely including children and families as intended. By inclusion of child and family voice, the AAR-enhanced CFT should lead to increased fidelity to the CFT intervention and greater levels of parental satisfaction with the service and shared decision-making, thus resulting in enhanced follow-through with Action Plans and linkage to mental health care for children.

Conditions

Mental Health Issue; Children, Adult

Keywords

Child Welfare Services; Team Effectiveness Research; Shared Decision Making

Outcome Measures

Primary Outcomes (3)

• Collaboration & Satisfaction About Care Decisions (CSACD)

  The 6-item collaboration subscale assesses collaboration, shared responsibilities for planning, open communication, and coordination. The 3-item satisfaction subscale assesses satisfaction with the decision-making process, and satisfaction with the decision itself. Although originally developed about care decisions for intensive care patients, it has since been used to measure collaboration and satisfaction with treatment planning plans associated with after-action reviews. Each participant will complete the CSACD immediately following their completion of the intervention (\<1 hour). Participants respond on a 7-point likert-type scale ranging from 1=strongly disagree to 7=strongly agree. Subscale scores are computed by calculating the average item response for items representing collaboration, and items representing satisfaction, respectively. Only including the subscales regarding satisfaction.

  through study completion, ~9 months

• San Diego (SD) County Behavioral Health Administrative Data

  During the CFT meetings, behavioral health needs initially screened via the CANS assessment will likely be confirmed for many child/families with open CWS cases. For children/families with behavioral health treatment plans, SD County Behavioral Health Administrative Data will be assessed to determine successful service linkage.

  through study completion, ~9 months

• Mathieu Team Processes Scale

  The 10 first-order constructs (e.g. strategy formulation, coordination, conflict management) map to three second order constructs (i.e. transition, action, and interpersonal). This measure will be administered to CFT+AAR participants immediately following completion of the CFT+AAR intervention (\<1 hour) to assess the team process of the CFT. Participants respond on a scale ranging from 1=Not at all to 5=to a very great extent, and scale scores are computed by calculating the average item response. Participants respond to questions regarding goal specification, strategy formulation, and coordination.

  through study completion, ~9 months

Secondary Outcomes (7)

• Acceptability, Feasibility, and Appropriateness of Intervention Measure

  through study completion, ~9 months

• Participant demographics professional characteristics

  through study completion, ~9 months

• Card-Sorting Task

  through study completion, ~9 months

• McAllister Affect-Based Trust

  through study completion, ~9 months

• Psychological Safety

  through study completion, ~9 months

Study Arms (2)

Child Family Team (CFT) as Usual

NO INTERVENTION

The CFT is a family meeting model that is an existing mechanism being implemented systemwide in San Diego County Child Welfare Services (CWS). Each child or youth is required to have a CFT meeting within sixty days of entering the CWS to identify areas of behavioral, emotional, or social needs, and to complete an initial case Action Plan.

Child Family Team (CFT) with After Action Review (AAR)

EXPERIMENTAL

CFT is being augmented with the after-action review.

Behavioral: After-Action Review

Interventions

After-Action Review BEHAVIORAL

After-action reviews, or debriefs, are a relatively simple, inexpensive, and quick, tool to improve learning, performance, and the effectiveness of teams and individuals. After-action reviews are active self-learning processes wherein participants reflect on specific performance episode to actively engage in self-discovery and improve learning in a non-punitive/non-judgmental manner to result in enhanced performance. This proposal aims to apply the team effectiveness intervention of the after-action review (AAR) to the services intervention of the Child and Family Team (CFT) meetings currently used in the CWS.

Child Family Team (CFT) with After Action Review (AAR)

Eligibility Criteria

• Age: 6 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

• (For leaders) Employed as one of several CWS leadership positions: CWS Director, CWS Deputy Director, CWS Regional Manager; (For caseworkers) Employed as a caseworker in one of the two participating regions for the proposed study.
• Plans to remain employed for at least six months beyond study initiation
• Speaks English or Spanish
• Member of CFT with one of the participating CWS caseworkers. CFT members can include mental health services provider, Court Appointed Special Advocate (CASA), educational representative, and other supports
• Speaks English or Spanish
• Parent/caregiver of child aged 6-17 with an open CWS case
• Initial CFT meeting for open CWS case has not yet been held (Aim 3)
• Speaks English or Spanish
• Child aged 6-17 with an open CWS case
• Mental health services need/s (identified by the CWS caseworker via CANS screening in advance of the initial CFT meeting, during which consensus is reached regarding the Action Plan and service referral)

Sponsors & Collaborators

• University of California, San Diego: lead
• National Institute of Mental Health (NIMH): collaborator

Study Sites (1)

UC San Diego - IN STEP Children's Mental Health Research Center

San Diego, California, 92123, United States

RECRUITING

Related Publications (1)

• Sklar M, Kenneally R, Aarons GA, Fettes DL. Applying after-action reviews to child and family teams to improve mental health service linkage within child welfare services: a study protocol. Implement Sci Commun. 2023 Oct 5;4(1):121. doi: 10.1186/s43058-023-00479-3.

  PMID: 37798808 DERIVED

Central Study Contacts

Marisa Sklar, PhD.

CONTACT

858-966-7703; masklar@health.ucsd.edu

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Assistant Professor

Study Record Dates

• First Submitted: November 2, 2022
• First Posted: November 29, 2022
• Study Start: July 28, 2023
• Primary Completion: May 31, 2025
• Study Completion (Estimated): May 31, 2027
• Last Updated: February 5, 2026

Record last verified: 2026-02

Data Sharing

• IPD Sharing: Will not share

Locations

US (1)