Applying After-Action Reviews to Child and Family Teams to Improve Mental Health Service Linkage within Child Welfare Services

对儿童和家庭团队进行事后审查，以改善儿童福利服务中的心理健康服务联系

• 批准号: 10677045
• 负责人: GREGORY AARONS
• 金额: $ 17.9万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-05 至 2027-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10677045
• 关键词: Acceleration; Acute; Address; Adolescent; Agreement; Behavioral; Caregivers; Child; Child Abuse and Neglect; Child Mental Health; Child Welfare; Child health care; Clinical; Communication; Competence; Complex; County; Data Sources; Development; Education; Effectiveness; Effectiveness of Interventions; Elements; Event; Excision; Family; Family member; Focus Groups; Funding; Impairment; Individual; Intention; Intervention; Interview; Language; Learning; Medical; Mental Health; Mental Health Services; Mental disorders; Methods; Military Personnel; Natural Language Processing; Needs Assessment; Outcome; Parents; Performance; Preparation; Process; Published Comment; Recording of previous events; Recurrence; Research; Risk; Services; Social Development; Source; Specific qualifier value; System; Testing; Transcript; Voice; Work; Youth; adverse childhood events; anxiety symptoms; child mental health service; child services; collaborative approach; depressive symptoms; early adolescence; effectiveness research; empowerment; implementation strategy; improved; innovation; meetings; member; novel; patient engagement; pediatric trauma; pilot test; pressure; satisfaction; service intervention; shared decision making; therapy development; tool; trauma symptom; traumatized children; treatment planning

PROJECT SUMMARY (R34#1 After Action Reviews in CWS) Half of child-welfare involved children and adolescents meet criteria for at least one current mental disorder1. Shared decision-making for Action Plans is vital to the mental health and wellbeing of children and families in Child Welfare Services (CWS), with fewer child removals and fewer recurrences2, thus resulting in decreased risk of child trauma, behavioral concerns, and mental health concerns. Yet, neither parents nor caseworkers perceive that Action Plans include mutual influence3, and parents feel they have no voice or input4. Child and family team (CFT) meetings are required for each child or youth within sixty days of entering CWS, and are family-centered and collaborative ways to develop individualized, effective service plans based on mutual agreement5. Relying on teamwork approaches, CFT meetings intend to give children and families a voice in creating and guiding their case plans6, suggest children do better when connected to their families and empower families to work with CWS agencies7,8, and address organizational need for teams to perform “complex, interdependent, dynamic, and ambiguous tasks.”9 Yet, in CWS CFT meetings, the quality of teamwork can be impaired by the inherent challenges of serving multiple needs and viewpoints that vary across family members and professionals, as well as the pressures and constraints of CWS. Innovations from team effectiveness research hold promise in facilitating improvements in shared decision-making within CWS. The after-action review (AAR) is a relatively simple, inexpensive, quick, and powerful tool to improve learning, performance, and the effectiveness of teams and individuals. AARs are active self-learning processes wherein team members reflect on specific performance episode to actively engage in self-discovery and improve learning in a non- punitive/non-judgmental manner. AARs have become a common tool that organizations have leveraged in military, medical, educational, and other applications, to improve individual and team performance by approximately 20-25%. This proposal aims to apply the team development intervention of the after-action review (AAR) to improve implementation of the Child and Family Team (CFT) meetings currently used in the CWS. This proposal will tailor and assess the impact of the AAR on enhancing CFT outcomes by addressing the following: Specific Aim 1. Conduct a qualitative needs assessment targeting the ongoing implementation of the CFT clinical intervention in a large, publicly funded, County CWS system; Specific Aim 2. Adapt and tailor the AAR team effectiveness intervention to address the CFT services intervention needs; Aim 3. Assess mechanisms of the AAR team effectiveness intervention for CFT implementation and a novel application of natural language processing methods. Aim 3.a. Pilot-test the AAR implementation strategy on improving CFT outcomes, and explore team mechanisms; Aim 3b. Identify and leverage CFT communication language data sources that are feasible, naturally occurring, and appropriate for the CWS context to submit to methods core for aggregation across projects.

项目摘要（CWS 行动审查后的 R34#1） 一半的儿童福利所涉及的儿童和青少年符合至少一种当前精神障碍的标准1。 行动计划的共同决策对于儿童和家庭的心理健康和福祉至关重要 儿童福利服务 (CWS)，减少儿童转移和复发2，从而减少 然而，父母和社会工作者都没有考虑到儿童创伤、行为问题和心理健康问题的风险。 认为行动计划包括相互影响3，并且父母认为他们没有发言权或意见4。 每个儿童或青少年都需要在进入 CWS 后 60 天内召开家庭团队 (CFT) 会议，并且 以家庭为中心的协作方式，在相互的基础上制定个性化、有效的服务计划 CFT 会议旨在通过团队合作的方式让儿童和家庭有发言权。 制定和指导他们的案例计划6，建议儿童在与家人联系时做得更好，并赋予他们权力 家庭与 CWS 机构7,8 合作，并满足团队执行“复杂、 相互依赖、动态且模糊的任务。”9 然而，在 CWS CFT 会议中，团队合作的质量可能会受到影响。 因满足家庭成员不同的多种需求和观点而面临的固有挑战而受到损害 和专业人士，以及来自团队效率的 CWS 创新的压力和约束。 研究有望促进 CWS 内共同决策的改进。 复习（AAR）是一种相对简单、廉价、快速且强大的工具，可用于提高学习、表现和 团队和个人的有效性是团队成员积极的自我学习过程。 反思具体的表现事件，积极参与自我发现并提高非非学习能力 惩罚性/非评判性的方式已成为组织利用的常用工具。 军事、医疗、教育和其他应用，通过以下方式提高个人和团队绩效 大约20-25% 该提案旨在应用事后审查的团队发展干预。 (AAR)，以改进 CWS 目前使用的儿童和家庭小组 (CFT) 会议的实施。 该提案将通过解决以下问题来定制和评估 AAR 对增强 CFT 成果的影响： 具体目标 1. 针对 CFT 临床的持续实施进行定性需求评估 干预大型、公共资助的县 CWS 系统； 具体目标 2. 调整和调整 AAR 团队 满足 CFT 服务干预需求的有效性干预；目标 3. 评估 CFT 的机制； AAR 团队对 CFT 实施的有效性干预和自然语言的新颖应用 目标 3.a. 试点测试 AAR 实施策略以改善 CFT 结果； 探索团队机制；目标 3b。 可能的、自然发生的并且适合 CWS 上下文提交到方法核心进行聚合 跨项目。