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

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.

Study Overview

• Status: Recruiting
• Conditions: Mental Health Issue; Children, Adult
• Intervention / Treatment: Behavioral: After-Action Review

Detailed Description

The proposed project will address the following aims:

Aim 1. Conduct a qualitative needs assessment targeting the ongoing implementation of the CFT services intervention in a large, publicly funded, CWS. A qualitative inquiry consisting of interviews and focus groups with key stakeholders will result in the preparation of an action plan to address identified gaps between the current and desired CFT services intervention outcomes.

Aim 2. Adapt and tailor the AAR implementation strategy to address the CFT services intervention needs.

Aim 3. Assess mechanisms of the AAR team effectiveness intervention for CFT implementation.

• Study Type: Interventional
• Enrollment (Estimated): 320
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Marisa Sklar, PhD.; Phone Number: 242703 858-966-7703; Email: masklar@health.ucsd.edu

Study Locations

• United States
  • California
    • San Diego, California, United States, 92123
      • Recruiting
      • UC San Diego - IN STEP Children's Mental Health Research Center
      • Principal Investigator: Gregory Aarons, PhD
      • Principal Investigator: Danielle Fettes, PhD
      • Contact: Marisa Sklar, PhD; Phone Number: 242703 8589667703; Email: masklar@health.ucsd.edu

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 6 years and older (Child, Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

Inclusion Criteria for CWS leaders and/or caseworkers

1. (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.
2. Plans to remain employed for at least six months beyond study initiation
3. Speaks English or Spanish

Inclusion Criteria for formal and informal CFT members

1. 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
2. Speaks English or Spanish

Inclusion Criteria for parents/caregivers with active CWS cases

1. Parent/caregiver of child aged 6-17 with an open CWS case
2. Initial CFT meeting for open CWS case has not yet been held (Aim 3)
3. Speaks English or Spanish

Inclusion Criteria for children with active CWS cases (for mental health service linkage data extraction only*)

1. Child aged 6-17 with an open CWS case
2. 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)

Exclusion Criteria:

Individuals who do not meet inclusion criteria are not eligible to participate in this study.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
No Intervention: Child Family Team (CFT) as Usual; 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.
Experimental: Child Family Team (CFT) with After Action Review (AAR); CFT is being augmented with the after-action review.	Behavioral: After-Action Review; 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.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
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
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
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 Outcome Measures

Outcome Measure	Measure Description	Time Frame
Acceptability, Feasibility, and Appropriateness of Intervention Measure	This 9-item measure will be administered to CFT+AAR participants immediately following completion of the CFT+AAR intervention (<1 hour) to assess the extent to which the After-Action Review is appealing, liked, and welcomed in their setting (acceptability); fitting, suitable, and applicable in their setting (appropriateness); possible and doable in their setting (feasible). Each of the 9 items is rated using the following response options: 1=completely disagree, 2=disagree, 3=neither agree nor disagree, 4=agree, and 5=completely agree. Three subscales can be created by averaging responses for items representing acceptability, appropriateness, and feasibility, respectively.	through study completion, ~9 months
Participant demographics professional characteristics	Participant age, gender, race, ethnicity, marital status, education level, primary language, and working status/profession will be collected of all participants immediately following completion of the intervention (<1 hour).	through study completion, ~9 months
Card-Sorting Task	Card sorting elicits individual mental models to understand how participants structure their knowledge. In open card sorts participants are provided with a set of key concepts and asked to sort them into categories. Each participant then creates a label for each category. In closed card sorts, participants are similarly given a set of key concepts, but participants are given pre-defined categories that each concept must be sorted into. Within team environments, card sorting can be used to examine the degree to which team members are thinking about key concepts in a similar manner (e.g., team mental models) by comparing the categories and sorted content across members. For this proposal, each participant will complete the card sorting task immediately following completion of the intervention (<1 hour). In doing so, the concepts contained in the card sort will be representative of specific CFT roles, task responsibilities, and goals.	through study completion, ~9 months
McAllister Affect-Based Trust	This 5-item scale assesses perceptions of affect-based trust amongst CFT members. Items center on individual's perceptions that team members can share ideas freely, that team members listen to one another, that team members care for one another, and that team members are invested in working well with one another. Each participant will complete the WAI-SR immediately following their completion of the intervention (<1 hour). Participants respond on a scale ranging from 1=strongly disagree to 7=strongly agree, and scale scores are computed by calculating the average item response.	through study completion, ~9 months
Psychological Safety	Edmondson's 7-item Psychological Safety Climate Measure evaluates perceptions of the work environment (in this case, the CFT meeting) as being one wherein policies and procedures foster a safe and comfortable space for interpersonal risk. Each participant will complete the Psychological Safety Climate Measure immediately following their completion of the intervention (<1 hour). Participants respond on a scale ranging from 0=doesn't apply at all to 4=entirely applies, and overall scale scores are computed by calculating the average item response.	through study completion, ~9 months
State-Wide CFT Fidelity Tool	The CFT Meeting Observation Tool is intended to support agencies in evaluating quality of and adherence to intended practice of child and family team (CFT) meetings. Results can be used to provide information regarding the current status/progress of CFT implementation, guide the work of agency CFT implementation or leadership teams, identify workforce development and organizational support needs, and support Continuous Quality Improvement (CQI) processes. Observers of the CFT will complete throughout the duration of CFT observation.	through study completion, ~9 months
Knoll and Van Dick Silence Measure	Knoll and Van Dick's 2-Item Silence Measure present scales to assess acquiescent silence and quiescent silence. Participants respond on a scale ranging from 1=strongly disagree to 7=strongly agree, and scale scores are computed by calculating the average item response.	through study completion, ~9 months

Collaborators and Investigators

• Sponsor: University of California, San Diego
• Collaborators: National Institute of Mental Health (NIMH)

Publications and helpful links

General Publications

• 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.

Study record dates

Study Major Dates

• Study Start (Actual): July 28, 2023
• Primary Completion (Actual): May 31, 2025
• Study Completion (Estimated): May 31, 2027

Study Registration Dates

• First Submitted: November 2, 2022
• First Submitted That Met QC Criteria: November 16, 2022
• First Posted (Actual): November 29, 2022

Study Record Updates

• Last Update Posted (Actual): February 5, 2026
• Last Update Submitted That Met QC Criteria: February 2, 2026
• Last Verified: February 1, 2026

More Information

Terms related to this study

• Keywords: Shared Decision Making; Child Welfare Services; Team Effectiveness Research
• Other Study ID Numbers: 803821; P50MH126231-01A1 (U.S. NIH Grant/Contract)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No