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Measuring interprofessional team collaboration in
expanded school mental health: Model refinement and
scale development
ELIZABETH A. MELLIN
1
, LAURA BRONSTEIN
2
,
DAWN ANDERSON-BUTCHER
3
, ANTHONY J. AMOROSE
4
,
ANNA BALL
3
, & JENNIFER GREEN
5
1
The Pennsylvania State University, Counselor Education, Counseling Psychology, Rehabilitation &
Human Services, University Park, Pennsylvania,
2
Binghamton University, Social Work, Binghamton,
New York,
3
Ohio State University, Social Work, Columbus, Ohio,
4
Illinois State University, School of
Kinesiology and Recreation, Normal, Illinois, and
5
Miami University, Oxford, Ohio, USA
Abstract
Expanded school mental health (ESMH) utilizes interprofessional collaboration to implement learning
support and mental health promotion strategies in schools. This study reports on the early
development and initial psychometric examination of a new scale, the Index of Interprofessional
Team Collaboration for Expanded School Mental Health (IITC-ESMH), for measuring the
functioning of interprofessional teams. Exploratory factor analysis results, using data collected from
436 members of interprofessional teams in schools, yielded a 26-item scale with a four-factor model (a)
Reflection on Process, (b) Professional Flexibility, (c) Newly Created Professional Activities, and (d) Role
Interdependence. Cronbach’s alphas for the four factors were .91, .91, .84, and .80 respectively. The
findings from this study provide evidence to support the IITC-ESMH as a reliable instrument for
measuring interprofessional collaboration.
Keywords: Interprofessional collaboration, expanded school mental health, school-family-community
partnerships, scale development
Introduction
In the face of decreasing resources and increasing pressures to demonstrate improvements
in academic outcomes (Atkins, Frazier, Adil, & Talbott, 2003), schools are expected to
address nonacademic barriers to learning such as poverty, emotional and behavioral issues,
and family problems (Anderson-Butcher, Stetler, & Midle, 2006). Such barriers are often
interrelated across school, family, and community systems. US federal educational and
mental health reform initiatives such as the No Child Left Behind Act of 2001 (2002) and
the New Freedom Commission on Mental Health (2003) emphasize the importance of
Correspondence: Dr Elizabeth A. Mellin, PhD, The Pennsylvania State University, Counselor Education, Counseling Psychology,
Rehabilitation & Human Services, 327 Cedar Building, University Park, PA 16802, USA. E-mail: eam20@psu.edu
Journal of Interprofessional Care,
September 2010; 24(5): 514–523
ISSN 1356-1820 print/ISSN 1469-9567 online Ó2010 Informa UK, Ltd.
DOI: 10.3109/13561821003624622
collaboration. Expanded school mental health (ESMH), which utilizes partnerships among
schools, families, and communities to implement learning supports and mental health
promotion strategies, is a model of practice that is responding to these reform initiatives
(Weist, 1997). In ESMH, individuals from different professions, along with youth and
families, integrate their unique skills and assets to deliver services that support healthy youth
development (Paternite, Weist, Axelrod, Anderson-Butcher, & Weston, 2006). To
capitalize on this practice approach, the purpose of this study is to develop a scale for
measuring interprofessional collaboration in ESMH.
Interprofessional collaboration in expanded school mental health
Interprofessional collaboration refers to teamwork with individuals from other professions
(Mu & Brasic Royeen, 2004). In the context of ESMH, this may include collaboration
among teachers, school nurses, school-hired (e.g., school social workers), and community-
based mental health professionals (e.g., clinical mental health counselors). Although
collaboration is a promising practice approach, authentic collaboration is often difficult to
achieve (Waxman, Weist, & Benson, 1999). Turf issues (Bemak, 2000), pre-existing
responsibilities (Weist, Proescher, Prodente, Ambrose, & Waxman, 2001), and a lack of
understanding of school culture among community-based professionals (Rappaport, Osher,
Greenberg Garrison, Anderson-Ketchmark, & Dwyer, 2003) have all been cited as
challenges to collaboration in ESMH. Given these challenges, it is likely that many
interprofessional teams may not be well-functioning. Explicit models of collaboration, along
with instruments that operationalize the practice, are needed to help determine how well
teams are functioning, whether they are effective, and to identify strategies to strengthen
collaboration.
Along with the need for instruments to be utilized for practice, researchers could benefit
from resources to help examine the assumption that collaboration improves outcomes
(Schmitt, 2001). Literature specific to collaboration within ESMH, however, can largely be
categorized as program descriptions. As a result, there has been a failure to clearly
distinguish collaboration from related concepts such as coordination, cooperation, and
communication (Mellin, 2009). A review of the literature on collaboration in ESMH,
however, reveals that shared decision-making and responsibilities (Anderson-Butcher &
Ashton, 2004), mutual respect (Weist et al., 2001), interdependence (Weist, Ambrose, &
Lewis, 2006), and reflection (Hilton, Sohani, Fellow-Smith, & McNeil, 2006) are important
elements of collaboration.
Model for interprofessional collaboration
One model (Bronstein, 2003) describes elements of interprofessional collaboration and
appears to be relevant to conceptualizations of collaboration in ESMH. This model
describes five elements of optimum collaboration. Interdependence, in which collaborators
rely on interactions with other professionals to accomplish goals and tasks, is a key element
of collaboration. Newly Created Professional Activities, which refer to collaborative acts,
programs and structures that allow for the accomplishment of goals that could not be
achieved independently, support this element. Flexibility, which is conceptualized as being
closely related to, but distinct from, interdependence, refers to the deliberate blurring of
professional roles. Collective Ownership of Goals, which refers to shared responsibility in the
entire process of reaching goals, including joint design, definition, development, and
achievement is necessary to facilitate the collaborative process. Finally, Reflection on Process,
Measuring interprofessional team collaboration 515
which refers to collaborators’ attention to their process of working together and the
outcomes of their efforts, is critical to collaboration (Bronstein, 2003).
An instrument that operationalizes this model, The Index of Interdisciplinary [sic]
Collaboration (IIC; Bronstein, 2002), was created to measure how social workers perceive
their collaboration with other professionals. Items such as ‘‘Teamwork with professionals
from other disciplines is not important to my ability to help clients’’ and ‘‘I utilize other
(non-social work) professionals for their particular expertise’’ were created to measure the
five elements of collaboration. Both factor analysis and Cronbach’s alpha indicated
moderate support for elements of interprofessional collaboration. Based on the findings,
Bronstein recommended that future research should further refine the model and create
profession and setting-specific versions. The purpose of the current study, therefore, is to
further refine the model and examine the psychometric properties of an instrument for
measuring collaboration in ESMH.
Methods
Participants
The sample for this study included 436 members of interprofessional teams in schools
across the United States. Females accounted for 88% (n¼382) of the participants. A
majority of the participants were White (non-Hispanic; 82%, n¼356). Other racial and
ethnic backgrounds represented included African-American (7%, n¼30), Hispanic (7%,
n¼32), American Indian/Alaskan Native (1%; n¼5), and Asian/Pacific Islander (1%,
n¼4). The ages of the majority of participants were between 35 and 54 (56%, n¼247).
Many of the participants (70%, n¼304) reported earning a Master’s degree as their terminal
degree and these were most frequently earned within social work (33%, n¼145), counseling
(18%, n¼78), nursing (16%, n¼68), and psychology (15%, n¼64). Approximately 60%
(n¼259) of the participants had at least 16 years of professional experience.
Participants were asked to identify the type of interprofessional collaboration they would
be basing their responses on. School Mental Health (34%, n¼149), Individualized
Education Program (23%, n¼100), and Student Support (17%, n¼75) teams were the
most frequent collaborations rated. Participants represented school-employed (e.g., school
counselors; 41%, n¼180) and community-based mental health professionals (e.g., clinical
psychologists; 25%, n¼108), in addition to school nurses (19%, n¼83), and educators
(7%, n¼33).
Procedures
Instrument development. Steps of scale construction described by DeVellis (2003) were used
to develop the IITC-ESMH. A thorough review of the literature was conducted to identify
elements of collaboration in ESMH. Using this review of the literature and the Index of
Interdisciplinary [sic] Collaboration (IIC; Bronstein, 2002), the research team initially
developed 51 items to measure interprofessional collaboration.
Establishing validity. Using the procedures outlined by DeVellis (2003), 21 geographically
diverse (e.g., representing United States such as Illinois, Ohio, Virginia, Maryland) experts
in ESMH were consulted to establish content validity for, and pilot test, the IITC-ESMH.
The domain experts were members of the Mental Health Education Integration Consortium,an
interprofessional group that includes researchers, practitioners, policy makers, and graduate
516 E. A. Mellin et al.
students who are committed to improving collaboration between mental health professionals
and school systems. Using an online data collection tool, the experts were presented with a
definition of each element of the model and were asked to: (a) use a 3-point, Likert-type
scale (1 ¼high to 3 ¼low) to rate the relevance of each item to the elements; (b) indicate any
awkward or confusing items and suggest alternative wordings; and (c) specify other items
that may be relevant to measuring each element. The experts were offered $10 gift cards as
appreciation for their involvement. Feedback from the content validity check and pilot test,
which included deleting, adding, and improving the clarity of items, was incorporated into
the IITC-ESMH.
The revised IITC-ESMH included 45 items that aimed to measure five elements
(Interdependence,Newly Created Professional Activities,Flexibility,Collective Ownership of Goals,
Reflection on Process) of collaboration. Several items were worded negatively to reduce
agreement bias among respondents (DeVellis, 2003). The IITC-ESMH uses a 5-point
Likert-type scale (1 ¼never to 5 ¼always) to rate the frequency of collaborative elements
within teams.
Sampling and data collection
After receiving Human Subjects approval from the Institutional Review Board at each of
our universities, the IITC-ESMH and demographic questionnaire were distributed via an
online data collection tool to a national, self-identified, and voluntary sample of
professionals. Participants were contacted through the listserv from the Center for School
Mental Health at the University of Maryland. A recruitment email was sent that included
a link to the informed consent, the online data collection tool, and an invitation to enter
a drawing to win 1 of 30 $25.00 gift cards. Follow-up messages were distributed to the
listserv 7 and 14 days after the initial recruitment email. One message was also sent via
the Center for Mental Health in Schools at the University of California, Los Angeles
listserv.
Data analysis
Although confirmatory factor analysis (CFA) is the preferred method of analysis when
supporting theory is used in scale development (Brown, 2006), exploratory factor analysis
(EFA) was used for three reasons. First, Bronstein’s model (2003) remains tentative and, in
the current study, some of the original elements were altered consistent with the ESMH
literature. More specifically, the conceptualization of Flexibility was broadened to include
attention to flexibility in thinking. In other words, items were developed to assess how open
collaborators were to new ideas from other professions. This is consistent with the literature
in ESMH that emphasizes the importance of mutual respect (Weist et al., 2001) and the
recognition and use of knowledge and skills from each profession (Rappaport et al., 2003).
In addition although Bronstein’s (2003) conceptualization of Collective Ownership of Goals
does include families as partners in creating client-centered goals, there are few items in the
original instrument that address the inclusion of families (Bronstein, 2002). Given the major
emphasis on joint decision-making and shared responsibilities with families in ESMH
(Weist, 1997), the significant role of families was emphasized. Secondly, Bronstein’s model
(2003) and instrument (2002) were developed to describe and measure the attitudes of
individual practioners from the social work profession toward interprofessional collaboration
across contexts (e.g., hospice, prisons, hospitals). The IITC-ESMH, however, was
specifically developed to measure perceptions of interprofessional team collaboration across
Measuring interprofessional team collaboration 517
professions within the specific context of ESMH. Finally, given this was the first attempt to
develop a scale to assess perceived functioning of interprofessional teams in ESMH, the
analysis remains exploratory although a CFA is the next logical step for cross-validating the
underlying factor structure with another sample.
An EFA using principal axis factoring with a promax rotation was therefore used to
examine the factor structure of the IITC-ESMH. An oblique rotation was used given the
expectation that the underlying elements would correlate The conservative standard of 5–10
participants per item for factor analysis (Netemeyer, Bearden, & Sharma, 2003) was
employed. The sample was large enough to limit data analysis to complete cases; 436 out of
517 (84%) of responses were used. Descriptive statistics and internal consistency estimates
were also calculated.
Results
Before proceeding with the primary analysis, the Kaiser-Meyer-Olkin Measure (KMO;
Kaiser, 1974) and Bartlett’s (1954) test of sphericity were used to determine the
appropriateness of conducting a factor analysis. An observed KMO value of .97 and a
significant (p5.01) Test of Sphericity indicated that the data supports the use of a factor
analysis.
Using a combination of the Kaiser-Guttman rule (retaining factors with eigenva-
lues 41.0) and an examination of the scree plot (Tabachnick & Fidell, 2007), the initial
EFA analysis indicated that the 45 items on the IITC-ESMH were represented by six
underlying factors accounting for 60.49% of the total variance. An examination of the factor
loadings, however, indicated that a number of items on the scale either failed to meet the
minimum criterion loading of .45, which represents 20% of overlapping variance
(Tabachnick & Fidell, 2007), or were found to cross-load on multiple factors. Given the
desire to identify the most parsimonious factor solution, the decision was made to eliminate
these 19 items and run the EFA again.
The results of the second EFA indicated that the 26-item version of the IITC-ESMH
included four factors. The total variance accounted for in the solution was 63.25%. Table I
presents the 26 items and factor loadings from the principal axis factor analysis. The table
also indicates the underlying element of collaboration each item was initially expected to
represent.
Factor 1, which is labeled Reflection on Process, accounted for 44.98% of the variance and
included 8 items. This label was selected given that all of the items were developed to
represent the reflection of process element of interprofessional collaboration. The second
factor, which accounted for 7.90% of the variance, included 9 items primarily reflecting
elements of interdependence (5 items) and flexibility (3 items). This factor was labeled
Professional Flexibility as it seemed to measure both flexibility in thinking and roles as well as
the behaviors (e.g., respect, compromise) that support flexibility. Four of the 5 items that
made up Factor 3 were designed to assess newly created professional activities. As such, this
factor retained its original name, Newly Created Professional Activities. This factor accounted
for 5.59% of the variance. The final factor was labeled Role Interdependence given all four of
these items were designed to assess the interdependence element of collaboration and the
word ‘‘role’’ is present in 3 out of the 4 items. This factor included 4 items and accounted
for 4.78% of the variance. As expected, there were positive correlations among the factors.
As shown in the upper diagonal of Table II, the factor correlation matrix from the EFA
shows rvalues ranging from .55–.72. A similar pattern emerged when considering the
relationships among the factors based on subscale scores. Specifically, subscale scores were
518 E. A. Mellin et al.
Table I. Items and factor loadings for the IITC-ESMH (N¼436).
Factor
Item 1234
1. Team members discuss strategies to improve their working
relationship. [REF]
.81 7.10 .06 .06
2. The team works together to resolve problems among members. [REF] .78 .02 .00 .02
3. The team incorporates feedback about its
process to strengthen its effectiveness. [REF]
.78 .01 .07 .01
4. The team informally and/or formally
evaluates how they work together. [REF]
.77 .04 .08 7.13
5. Team members talk about similarities and differences
among their professional roles in working with youth. [REF]
.66 7.06 .07 .06
6. Members of the team address conflicts with each other directly. [REF] .65 .29 7.10 7.13
7. The team discusses the degree to which each professional
should be involved with a particular youth. [REF]
.62 7.01 7.10 .18
8. Team members talk about ways to involve additional
professionals with various expertise in the team. [REF]
.58 7.07 .21 .11
9. There are ‘‘turf’’ issues among members of the team. [INT] 7.09 .91 .00 7.20
10. The team does not welcome new ideas about how to
help youth. [FLEX]
7.08 .69 .20 7.05
11. Team members respect one another even when they have
different ideas about how to help youth. [FLEX]
.24 .67 7.06 7.06
12. The team has appropriate expectations of the roles of members
in supporting youth. [INT]
7.02 .65 7.20 7.03
13. The team respects the opinion and input of each member. [INT] 7.03 .63 7.03 .28
14. There is open communication among team members. [INT] 7.03 .62 7.05 .30
15. Team members focus on understanding the perspectives of others
rather than defending their own specific opinions. [FLEX]
.19 .60 .06 7.06
16. The team supports each member in his or her work with youth. [INT] .01 .54 7.02 .31
17. There is freedom to be different and disagree within the team. [COL] .28 .50 7.05 .16
18. New practices related to working with youth occur as a result of the
diversity of ideas among team members. [NEW]
.00 7.04 .82 .07
19. Working with team members who have multiple perspectives
results in new programs available to help youth. [NEW]
.04 7.05 .78 .02
20. The roles and/or responsibilities of team members change as a
result of teamwork. [NEW]
.01 7.06 .72 7.03
21. As a result of working as a team, services/supports for youth are
delivered in new ways. [NEW]
.03 .14 .66 .01
22. Team members take on tasks outside their role when necessary. [FLEX] .09 .15 .49 7.15
23. The team depends on members with varying roles (e.g., teacher,
mental health professional, paraprofessional, special educator, family
member, etc) to implement specific activities. [INT]
7.09 .04 .04 .80
24. The team relies on members with varying roles (e.g., teacher, mental
health professional, paraprofessional, special educator, family
member, etc) to accomplish its goals. [INT]
7.10 .06 .05 .72
25. The team makes distinctions among the roles and responsibilities
of each member. [INT]
.28 7.20 7.16 .60
26. The team consults with members who have a variety of
perspectives about how to address the needs of youth. [INT]
.10 .12 .10 .60
Initial Eigenvalue 11.70 2.06 1.45 1.24
Percent Variance 44.98 7.90 5.59 4.78
Note. Pattern Matrix from the Principal Axis Factor Analysis with a Promax Rotation. Abbreviation following each
item reflects the component of collaboration initially predicted: INT, Role Interdependence; NEW, Newly Created
Professional Activities; FLEX, Professional Flexibility; COL, Collective Ownership of Goals; REF, Reflection on
Process.
Measuring interprofessional team collaboration 519
calculated taking an average of the scores of the items loading on a specific factor. These
relationships are presented in the lower diagonal of Table II.
Table II also presents the descriptive statistics and internal consistency estimates (a) for
the factors based on the subscale scores. The mean score for each factor was above the scale
midpoint, with the highest score found on the interdependence subscale. Cronbach’s a
coefficients suggested moderate to high internal consistency for each factor.
Discussion
To support the collaborative efforts of schools, families, and communities and to begin to
link interprofessional collaboration to outcomes, this study built upon initial efforts
(Bronstein, 2002, 2003) by refining an existing model for collaboration and developing an
instrument for measuring team functioning for ESMH. The findings of this study provide
evidence to support the emergent IITC-ESMH as a reliable instrument for measuring
collaboration.
Factors of the IITC-ESMH
Findings from this study suggest that the 26-item IITC-ESMH is an easy to use, brief tool
for measuring the functioning of interprofessional teams. This tool, which is grounded in a
model for interprofessional collaboration (Bronstein, 2003) and ESMH literature, includes
four factors that assess the functioning of interprofessional teams.
The first factor, Reflection on Process, measures the frequency of team reflection. This
factor considers how teams evaluate their working relationships and incorporate feedback
about process to support their ongoing collaboration. This factor is consistent with
Bronstein’s original conceptualization of the role of reflection in collaboration and
accounted for the largest amount of variance in the scale. This type of factor has been
identified by others as being important to team functioning. For instance, Hilton et al.
(2006) argue that in order to maximize interprofessional practice, collaborators much spend
as much time discussing how they work together as they do specific clients. By spending
time examining whether their efforts are successful, interprofessional teams may promote
accountability for their work as well as begin to link their efforts to specific outcomes.
The second factor, Professional Flexibility, assesses how flexible teams function in relation
to expanding and blurring roles and responsibilities. In addition, it includes behaviors that
Table II. Correlations, descriptive statistics, and internal consistency estimates (a) for the IITC-ESMH factors
(N¼436).
1. 2. 3. 4.
1. Reflection on Process .91 .67 .65 .61
2. Professional Flexibility .67 .91 .55 .72
3. Newly Created Professional Activities .64 .54 .84 .55
4. Role Interdependence .58 .68 .49 .80
M 3.16 3.86 3.35 4.07
SD .79 .65 .65 .66
Note. The mean (M) and standard deviation (SD) statistics and the bivariate correlations presented in the lower
diagonal are based on subscale scores. Correlations in the upper diagonal reflect the relationships among the factors
identified in the EFA. All correlations are significant at p5.05. Internal consistency estimates (a) are presented on
the diagonal.
520 E. A. Mellin et al.
support flexibility such as communication, mutual respect, and compromise. Several
authors have identified this as an important component for collaboration. Scholars within
the ESMH field (Anderson-Butcher, et al., 2006; Rappaport et al., 2003; Weist et al., 2001)
have highlighted the importance of mutual respect and the utilization of the knowledge and
skills from different professions as key features of well-functioning interprofessional teams.
Although Bronstein originally conceptualized communication, respect, and the valuing of
input from other professionals as behaviors that characterize interdependence (and thus
were originally included as items in the interdependence subscale), the results of this study
seem to suggest that these qualities support flexibility in professional thinking and roles. In
other words, professionals may be more open to new ideas and ways of working if they value
and respect their collaborators.
The third factor, Newly Created Professional Activities, assesses the extent of innovation
associated with the merging of multiple professional perspectives. This factor reflects
changes in programs, service delivery, and policies that perhaps might not be possible
without collaboration. Collaboration between a teacher and mental health professionals, for
example, may result in a new referral process that improves access to services for youth and
families. Weiss, Anderson, & Lasker (2002) also address this element of collaboration in
their description of partnership synergy, or the merging of different viewpoints and abilities
that allow for the creation of new approaches and strategies.
The final factor, Role Interdependence, measures the extent to which team members rely on
interactions with other professionals to accomplish goals and activities. This factor assesses
the extent to which collaborators perceive that the work of other professionals is needed to
meet intended goals and accomplish planned activities. Interdependence, the idea that the
work could not be done without relying on others, is a key feature of interprofessional
collaboration that has been consistently noted within the literature (D’Amour, Ferrada-
Videla, Rodriguez, & Beaulieu, 2005). In ESMH, for example, teachers and school-hired
mental health professionals often rely on one another to deliver and evaluate the outcomes of
specific learning support services for students with disabilities.
Consistent with Bronstein’s model (2003) and the conceptual ESMH literature, the
results of the EFA and moderate-to-high internal consistency estimates provide support for
these four elements of well-functioning ESMH teams. Although four out of the five
hypothesized factors were well represented, Collective Ownership of Goals was not. This may
have resulted from the emphasis on families as collaborators within the items included to
measure this particular element. As previously noted, consistent with the ESMH literature
that emphasizes the importance of shared goals and responsibilities with families, items
developed for this element of collaboration emphasized their involvement (e.g., ‘‘Goals
developed for youth reflect the perspectives of youth and/or families’’). Although the
conceptual literature on collaboration in ESMH highlights the importance of collaborating
with families, perhaps, in practice, professionals do not perceive families as members of
interprofessional teams.
Limitations
The findings of this study should be understood within the context of its limitations. There
are three primary limitations of this study. First, the convergent validity of the IITC-ESMH
was not examined. Future research is needed to assess the degree to which the instrument is
related to theoretically similar concepts such as team cohesion. Second, research is needed
to assess the test-retest reliability of the IITC-ESMH. As noted by Bronstein (2002),
however, because the functioning of interprofessional teams tends to fluctuate (e.g.,
Measuring interprofessional team collaboration 521
introduction of new members, changes in resources), studies that utilize shorter intervals
between administrations may yield more accurate representations of the reliability rather
than reflecting changes in the team. Finally, a CFA is needed to further examine the factors
of the IITC-ESMH. Using another sample, future research can substantiate whether the
factors represent four elements of interprofessional collaboration. Others might explore the
validity of the measure through the observation of real-life team functioning in connection
with the IITC-ESMH.
Implications for future research
The IITC-ESMH is a tool that may be useful for examining interprofessional collaboration
within ESMH teams. More specifically, the IITC-ESMH could be used to examine how
issues such as school/organizational support (e.g., time allotted for collaboration) or
personal characteristics (e.g., trust, attitudes toward other professions) impact the
functioning of interprofessional teams. The IITC-ESMH, along with measures of related
constructs such as multi- and transprofessional collaboration, could be used to explore the
types of collaborative practices that are actually occurring in ESMH. Finally, as educational
and mental health systems are both increasingly attending to accountability, the IITC-
ESMH could be used to examine relationships between collaboration and anticipated
outcomes such as increased academic success or emotional wellbeing for youth. Future
research might also explore the extent to which families are considered members of
interprofessional teams, and if necessary, items measuring Collective Ownership of Goals
could be revised and validated with another sample. Finally, because Reflection on Process
accounted for such a large amount of the variance in the scale, future research might
investigate the validity of its priority for measuring collaboration in ESMH. More
specifically, research that considers the impact of reflection on process to multidimensional
(e.g., access to services, school climate, social capital) outcomes may be particularly relevant
to understanding the relationship between collaboration and healthy youth development
within ESMH. In addition to further refining models and instruments related to
collaboration, research is needed to examine the assumption that this practice approach
will improve outcomes (Schmitt, 2001). More specifically, both qualitative and quantitative
research designs could be used to explore the impact of collaboration on intended
outcomes. Research methods that allow for in-depth examination of the inter-relationships
between individuals and their environments, such as ecomapping (Ray & Street, 2005) and
social network analysis (Hatala, 2006), may be useful for understanding the relationship
between collaboration and outcomes such as access to services, school attendance, and
resource maximization. Longitudinal or randomized controlled trial approaches can help
support attempts to understand not only whether interprofessional collaboration impacts
outcomes, but how the work is achieved.
Declaration of interest: The authors report no conflicts of interest. The authors alone are
responsible for the content and writing of the paper.
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