Adapting and Implementing TeamSTEPPS in School Mental Health
Phase: NA
Conditions: Child Behavior Problem, Multidisciplinary Communication, Interprofessional Relations
Sponsor: University of Pennsylvania

 
 
 
 
 
 
 
 
STUDY PROTOCOL & STATISTICAL ANALYSIS PLAN 
 
STUDY TITLE: ADAPTING AND IMPLEMENTING TEAMSTEPPS IN SCHOOL MENTAL HEALTH 
NCT04440228 
AUGUST 20, 2025 
 
 

Project Aim 3 - Explore the feasibility, acceptability, and utility of TeamSTEPPS plus the strategies 
generated in Aim 2 on inter-professional collaboration, teamwork, and outcomes in schools.  
 
PROTOCOL 
Procedure. The primary implementation outcomes are feasibility and acceptability of the adapted 
TeamSTEPPS, consistent with recommendations for selecting appropriate outcomes for pilot phase research. 
We also explored collaboration and teamwork, assessed via self-report and observation, behavioral and 
educational outcomes for students, and potential contextual predictors of implementation which will allow us to 
identify measures that are sensitive to change for future trials. Inter-professional collaboration, which has been 
identified as a key factor in quality school mental health promotion, is assessed via self-report and observation. 
We will collect self-report data at baseline (i.e., before engagement in TeamSTEPPS) and for the school year 
following participation at two time points each school year (fall, spring).  
Participants. Participants completing research measures include members of school mental health teams and 
school personnel from participating schools.  
Dependent Variables and Measures 
Self-Report Measures. Self-report measures of inter-professional collaboration and teamwork and feasibility 
and acceptability will be completed by participating mental health team members and school personnel.  
Dependent measures:  
Expanded School Mental Health Collaboration Instrument (ESMHCI). Mental health team members will complete 
the Expanded School Mental Health Collaboration Instrument- Community version (ESMHCI-CV). School 
personnel will complete the Expanded School Mental Health Collaboration Instrument- School version (ESMHCI-
SV). The 59-item ESMHCI assess perceptions of three aspects of collaboration (i.e., types, influences, and 
benefits) between school professionals and mental health professionals from collaborating agencies on a 
continuous scale. Scores can be calculated individually or among groups working in the same school. For each 
subscale, an average score is calculated with higher scores indicating strengths and lower scores indicating 
areas to consider improving or targeting. Preliminary psychometric studies are promising and indicate validity 
and internal consistency.  
TeamSTEPPS Teamwork Perceptions Questionnaires (T-TPQ). The T-TPQ is a self-report measure of individual 
perceptions of group-level team skills and behavior. It is based upon the five core components of teamwork that 
comprise TeamSTEPPS. Each construct is represented by seven questions, totaling 35 items. Items are rated 
continuously on a five-point scale from “strongly disagree” = 1 to “strongly agree” = 5. A total score is computed 
by averaging all items and higher scores indicate more favorable perceptions.  
TeamSTEPPS Teamwork Attitudes Questionnaire (T-TAQ). The T-TAQ is a self-report measure of individual 
attitudes related to the core components of teamwork captured within TeamSTEPPS. Six items measure each 
of the core teamwork constructs, for a total of 30 items. Items are rated continuously on a five-point scale from 
“strongly disagree” = 1 to “strongly agree” = 5. A mean total score is calculated across items with higher scores 
indicating more positive attitudes.  
The Acceptability of Intervention Measure (AIM) and Feasibility of Intervention Measure (FIM) are each reliable 
and valid 4-item tools to assess teacher, counselor, and leader perceptions of the acceptability and feasibility of 
TeamSTEPPS.  
Exploratory contextual predictors 
Evidence Based Practice Attitude Scale (EBPAS). The EBPAS is a 15-item self-report measure of attitudes 
toward adoption of EBPs. It consists of four subscales: appeal (is EBP intuitively appealing), requirements (would 
an EBP be used if required), openness (general openness to innovation), and divergence (perceived divergence 
between EBP and current practice). Items are rated from 0 (Not at all) to 4 (Very great extent). Higher scores 
indicate more positive attitudes, with the exception of divergence which is reverse coded.  
Maslach Burnout Inventory Human Services Survey (MBI). The MBI is a 22 item self-report measure of burnout. 
Three subscales measure emotional exhaustion, depersonalization, and reduced personal accomplishment. 
Items are rated from 0 (Never) to 6 (Everyday) with higher scores on emotional exhaustion and depersonalization 
and lower scores on personal accomplishment (reverse scored) indicating higher levels of burnout.  

Observations. We will conduct observations in schools who implement TeamSTEPPS. For each school 
observation, a trained observer from the research team will observe team dynamics, service provision, and 
interactions among mental health providers, school personnel, and students. Observations will occur at baseline 
(i.e., before engagement in TeamSTEPPS), at the completion of TeamSTEPPS trainings, and for 1 school year 
following participation at two time points each school year (fall, spring). Observations will include detailed field 
notes and use of the adapted NOTECHS for school mental health teams.  
 
STATISTICAL DESIGN AND POWER 
Qualitative analysis. We will load all field notes and interview transcripts into NVivo for data management and 
analysis. Analysis will be guided by an integrated analytic approach. 
Quantitative analysis. Quantitative analysis of feasibility will examine the proportion of schools who enroll/those 
invited and participants who attend TeamSTEPPS training/those eligible to participate in the school. We also will 
examine the distribution of AIM and FIM scores to quantitatively assess acceptability and feasibility, respectively.   
Collaboration and teamwork are assessed observationally (i.e., NOTECHS) and via self-report (e.g., ESMHCI, 
T-TPQ). Mean total and domain scores on the NOTECHS will be computed for each school. Individual and 
school scores will be calculated for the self-report measures.  
The analytic approach consisted of three phases. First, preliminary analyses were conducted using paired t-tests 
to evaluate simple pre-to-post changes in the primary outcome measures: teamwork perceptions (T-TPQ), 
teamwork attitudes (T-TAQ), and collaboration (ESMHCI-SV). For the main analysis, we fitted linear mixed-
effects regression models for each outcome variable, specifying random intercepts for participant ID to account 
for repeated measures and within-individual clustering. The core model included a binary post-training indicator 
as the primary predictor, along with the baseline value of the corresponding outcome as a covariate. To account 
for participant characteristics, we included a set of individual-level covariates: age, gender, race/ethnicity, 
education level, licensure status, professional role (clinical vs. school staff), years in the field, burnout (measured 
by the MBI-HSS subscales: emotional exhaustion, depersonalization, and personal accomplishment), and 
practice attitudes (EBPAS). These variables reflect clinician background, experience, and attitudes that may 
influence response to training. In parallel, we incorporated organizational-level covariates reflecting the structural 
and contextual features of training implementation. These included training group structure (small group, large 
group), school size, teacher-student ratio, building team size, and the number of team members trained. To 
examine whether training effects varied across these individual and organizational dimensions, we fitted 
comprehensive interaction models. These included all main effects plus full interaction terms between the post-
training indicator and each individual- and organizational-level covariate. This allowed us to identify potential 
moderators of training impact and determine whether particular subgroups responded differentially to the 
intervention. Statistical significance was evaluated at the α = 0.05 level.  
Abbreviations 
AIM 
Acceptability of Intervention Measure 
EBP 
Evidence-based practice 
EBPAS 
Evidence-Based Practice Attitudes Scale 
ESMHCI 
Expanded School Mental Health Collaboration Instrument  
FIM 
Feasibility of Intervention Measure  
MBI-HSS  
Maslach Burnout Inventory – Human Services Scale 
NOTECHS 
Oxford Non-Technical Skills scale 
TeamSTEPPS 
Team Strategies and Tools to Enhance Performance and Patient Safety 
T-TPQ 
TeamSTEPPS Teamwork Perceptions Questionnaires