Interprofessional Collaboration in Schools: A Concurrent Mixed Methods Study

Purpose/Background: Studies examining student-level outcomes associated with interprofessional team collaboration in schools remain anecdotal despite repeated calls for well-designed and rigorous research. The aim of the current study was to use a mixed methods approach to: 1) explore perceptions of team collaboration among stakeholders on school-based interprofessional teams; and, 2) examine whether the perceived levels of collaboration among interprofessional teams influence students’ access to basic needs, physical health symptoms, and school behaviors.

Methods: The current study used a concurrent nested mixed-method research design (Creswell, 2009) which included 27 semi-structured interviews and examination of five student-level outcomes. Qualitative data were gathered to assess how team collaboration was perceived among stakeholders on four Consultation, Assessment, Referral, and Education (CARE) Teams in four Title I elementary schools. To explore the first aim of the study, qualitative data were analyzed using analyzed thematically whereby the researchers developed initial codes, looked for themes, reviewed themes, and defined and named themes using NVivo X software. In alignment with the second aim, de-identified quantitative data on direct behavior ratings (DBRs) for 431 students referred to each of the four CARE Teams were examined. The five outcomes examined a two-time points (students’ first and final DBR during the academic year) included: whether or not the student had access to basic needs; whether the student had physical health symptoms; and, indicators quantifying students' school behaviors (i.e., academically engaged, respectful, and disruptive). As a final step, themes from the qualitative data gathered from each school were examined in comparison to paired sample t-tests (considered significant if p < 0.05) on each of the five outcome variables.

 Results: Qualitative findings indicated interprofessional team collaboration improved coordination of and access to services, as well as consistent follow-through on plans in the four schools. However, one of the CARE Teams reported evident barriers to interprofessional collaboration including challenges in finding time to meet and strained relationships among team members. Comparatively, quantitative data showed all schools saw improvements in access to basic needs for students referred to CARE Teams. Yet CARE Teams that reported greater facilitators for team collaboration (e.g., time to meet, trust, and positive relationships) in three of the four schools were associated with marked improvements in physical health symptomology and school behaviors for students served by CARE Teams.

Conclusion/Implications: Results point to the important contributions interprofessional teams can make in schools by improving service coordination to in turn promoting positive outcomes for vulnerable students. Although the explored links between CARE Team processes and student-level outcomes are proximal, interprofessional collaboration on school-based teams may contribute more broadly to distal outcomes for students such as improved behaviors and academic performance. Schools and districts can advocate for school-based teaming structures and also intentionally work to train and coordinate efforts so teams are more successful in working together to address student needs.