Introduction

Multidisciplinary and early intervention teams are at the heart of health policy internationally, including for children’s mental health services (Mental Health Taskforce, 2016). A specialist multidisciplinary team is a group of professionals from different disciplines who engage in a collective action (D’Amour et al., 2005; Leathard, 1994). This includes joint meetings to develop a hypothesis or ‘best guess’ about the origins of an individual’s difficulties which informs an intervention plan (i.e. formulation and intervention planning; Brown & Clark, 2014; Geach et al., 2018). Children who experience difficulties with social and emotional functioning, self-regulation, and mental health may present one or more predisposing factors, such as a diagnosed mental or neurodevelopmental condition, and they may have special educational needs in the area of social, emotional, and mental health (SEMH;Footnote 1 (Department for Education & Department of Health & Social Care, 2014). In the current paper, we use the term digitally mediated team communication to describe a health service delivery model in which specialists provide expertise to education staff regarding individual children with SEMH support needs via digital communication technologies, with a focus on multidisciplinary team formulation and intervention planning meetings via videoconferencing technology and full involvement of education professionals.

SEMH support needs during childhood impact on peer relationships and education, as well as increase the risk of developing a mental health condition in adulthood (McGorry et al., 2011). The educational setting is a critical environment for support (Brown, 2018). The National Institute for Health and Care Excellence (NICE, 2022) guidelines recommend implementation of a whole-school approach and targeted individual or group-based supported where required, with specialist mental health input across health and education to guide intervention (British Psychological Society, 2021; Department of Health & Department for Education, 2017; Lee et al., 2018). Expertise from a range of professionals is often required for this group of young people, including behavioural, social-communication, and mental health input (Department for Education & Department of Health & Social Care, 2014). With current evidence largely from care pathways implementing a multidisciplinary team approach for health conditions such as cancer, it is suggested that multidisciplinary team communication offers an enhanced, patient-centred approach (Burke et al., 2016; Reeves et al., 2017; Rickards & Kitts, 2018; Taylor et al., 2010), and improves coordination, teamwork and communication, and clinical decision-making (Kruis et al., 2016; Saint-Pierre et al., 2018). There is evidence of high levels of satisfaction with multidisciplinary team communication amongst professionals in child health and social care (e.g. Brown & White, 2010; Cooper et al., 2016; Oliver et al., 2010; Percy‐Smith, 2006; Siraj-Blatchford & Siraj, 2009; Wong & Sumsion, 2013), although there is a paucity of evidence relating to outcomes for SEMH support needs. Despite the benefits of multidisciplinary team working, this is not usual practice, particularly at initial contacts with mental health services where input from different services and professionals can occur sequentially with multiple referrals. Numerous inefficiencies of working in professional silos in health services have been acknowledged, resulting in long waits for support and complex systems to navigate (Department of Health & NHS England, 2015; Department of Health & Department for Education, 2017).

Digital communication technologies (including videoconferencing) can be used to make team communication less costly and more accessible for professionals (Hilty et al., 2018a, 2018b). This is particularly relevant in rural locations (Hilty et al., 2018a, 2018b), as well as in the context of restrictions related to the COVID-19 pandemic in recent years (Rains et al., 2021). Effective communication is critical for enhancing professional practice and improving outcomes in a context where the actions of education staff are influenced by diverse, multidisciplinary team expertise (Marlow et al., 2017). It is important to understand the feasibility of conveying rich information to frontline staff, including education staff, via videoconferencing technology. A recent systematic review (Jones et al., 2021) focussing on evaluations of digitally mediated team communication in children’s health and mental health services identified seven studies which generally reported positive staff perceptions, predominantly for severe and/or complex concerns. With regard to multidisciplinary team formulation and intervention planning for child mental health via videoconferencing technology, only one study was identified for inclusion in the review (Volpe et al., 2014).

This is the first study to examine digitally mediated team communication for supporting education staff regarding emerging (mild-to-moderate) SEMH support needs in primary school settings. A child identified with emerging SEMH difficulties would display low-to-medium level or low-frequency difficulties with: self-regulation; low self-esteem and general resilience; socialising, leading to some social isolation; immature social/ emotional skills affecting ability to establish and maintain friendships; following classroom routines and adult direction; and appropriate learning behaviour (Leicestershire County Council, 2019, pg. 4). At the other end of the continuum, children identified with complex SEMH support needs present with high level, frequent, and persistent difficulties in these areas, with ‘behaviour that can be unpredictable and dangerous, with intense episodes of emotional and/ or challenging behaviour, high level of anxiety making daily life extremely difficult, severely disrupting the learning of self and others’ (Leicestershire County Council, 2019, pg. 9). We are aware of one observational study which described telephone consultation between education staff and a psychologist in secondary education (Oppetit et al., 2018), with feasibility as a model of mental health prevention indicated by data such as the reason behind the call and care pathway information. Furthermore, there is indication that problem-solving consultation between education staff and a school psychologist via videoconferencing is both effective and acceptable to education staff (Bice-Urbach & Kratochwill, 2016; Fischer et al., 2016, 2018). In the current study, the focus is on multidisciplinary team formulation and intervention planning via videoconferencing technology, rather than professional-to-professional consultation. Timely multidisciplinary team support for primary school settings could increase responsiveness of education staff as an extended mental health workforce to address high unmet community need (American Academy of Child and Adolescent Psychiatry [AACAP] Committee on Telepsychiatry and AACAP Committee on Quality Issues, 2017), as well as prevent the escalation of children’s support needs to requiring specialist mental health intervention in adolescence (Arango et al., 2018; McGorry, 2007; Spenrath et al., 2011).

The current study aimed to evaluate digitally mediated team communication as a novel approach for responding to emerging SEMH support needs in primary school settings in the UK. The pilot project coincided with the timing of restrictions related to the COVID-19 pandemic where the use of digital communication technologies in everyday practice became more necessary (Jones et al., 2020). Multidisciplinary team meetings for children with emerging SEMH support needs are not usual practice, and thus, the practice within the pilot project was different from the status quo during the pandemic. The research question for this study is: What is the feasibility and acceptability of digitally mediated team communication for responding to emerging SEMH support needs in primary school settings?

Method

Study Design and Setting

The SOMEHOW (Social, emOtional and MEntal Health service using technOlogy in Wiltshire) project was a pilot project across two academic years (2019/20, 2020/21) based in a large, geographically dispersed county in the UK (Department for Environment, Food & Rural Affairs, 2014). The SOMEHOW project piloted a service model in which a multidisciplinary team formulated specialised action plans for referred children (aged 4–10 years) presenting with early signs of SEMH needs via videoconferencing technology (i.e. digitally mediated team communication). The purpose was to support education staff and parents/carers to respond to the needs of individual children in primary school settings and at home. The pilot project supported a cluster of five primary schools recruited through an expression of interest process. Participating schools had received practitioner training in the Thrive® Approach (Fronting the Challenge Projects Ltd., 2023), which is a whole-school approach to emotional well-being. The multidisciplinary team had representation from the Educational Psychology Service, Behaviour Support Service, Child and Adolescent Mental Health Service, Specialist Special Educational Needs Service, and Speech and Language Therapy Service representing several different care providers.

A pre-/post-study design was used as a process evaluation of digitally mediated team communication and pilot test of feasibility and perceived value (HM Treasury, 2011). This research used multiple indices in order to facilitate richness of data, augment interpretation of findings, and seek convergence of findings (i.e. triangulation; Collins et al., 2006; Leech & Onwuegbuzie, 2010). We assessed the perceived value of digitally mediated team communication for supporting professional practice and making progress towards personalised goals from the perspective of education staff and parents/carers. We assessed the processes (i.e. activities involved in the implementation of the SOMEHOW project) via feasibility and acceptability outcomes. Data were collected for the purpose of the pilot evaluation. Goal setting and measuring progress towards goals using the Goal-Based Outcomes tool (Law, 2011) formed part of the formulation and intervention planning process (the service model). During the SOMEHOW project, focus groups were conducted with the multidisciplinary team and education staff which is reported in a separate paper (Jones et al., in submission).

Participants

Participants were education staff and parents/carers from the participating schools. Referrals to SOMEHOW were eligible if the child was aged 4–10 years, had SEMH difficulties above what would be expected for their developmental age, and where there had been no change as perceived or monitored by education staff despite implementation of universal strategies (i.e. delivered to all children) including the Thrive® Approach; SENCos were encouraged to complete whole-class screening on the Thrive-Online platform to measure change; however, this was not a necessity. The following was implemented to monitor and enhance fidelity of the Thrive® Approach: the first author chaired quarterly review/network meetings with the SENCos which the Thrive® Regional Manager attended on an annual basis to support the practice of the Thrive® practitioners, and the Regional Manager delivered a three-hour session to the senior leaders of the participating schools to support them with a strategic overview of the Thrive® Approach. Exclusion criteria included referrals where there had been direct involvement from a specialist service in relation to SEMH previously or the child had an education health care plan.

Measures

Perceived Value of Digitally Mediated Team Communication

Team Formulation Questionnaire

The 26-item Team Formulation Questionnaire (TFQ; Hollingworth & Johnstone, 2014) examines staff perceptions of team formulation. Participants rate the extent to which team formulation is helpful or unhelpful on a 7-point Likert scale (1 = ’Very unhelpful’ and 7 = ’Very helpful’) for each item. Higher scores indicate greater perceived helpfulness of team formulation. The 26-item TFQ measures the proposed benefits of team formulation (Division of Clinical Psychology, 2011): team working, intervention planning, confidence and hope, staff understanding of problems, perceived causes of and control over mental health problems, and negative staff perceptions. A ten-item, adapted version of the questionnaire was created for teachers to complete in the current project. SENCos completed an adapted full version of the questionnaire. SENCos were asked to think about their overall experience of team formulation for all the children involved in the project when considering the extent to which team formulation was helpful for supporting teachers.

Goal-Based Outcomes

The Goal-Based Outcomes (GBO) tool (Law, 2011) is a measure of progress towards personalised goals, which can be used to capture the goals of staff and parent/carers (Law & Jacob, 2015). Participants rate the level of goal attainment pre-intervention and post-intervention on a scale of 0 (not met at all) to 10 (fully met). The GBO tool has been used across a range of clinical settings for children (Lloyd et al., 2019) and has acceptable internal consistency with a Cronbach’s α of 0.71 and 0.73 for T1 and T2, respectively (Edbrooke-Childs et al., 2015).

Acceptability of Digitally Mediated Team Communication

Experience of Service

An Experience of Service Survey was created for education staff and parents/carers, informed by similar measures (Care Quality Commission, 2020; Brown et al., 2014; Hollingworth & Johnstone, 2014). Items measured four areas: personnel (e.g. ‘I feel that the SOMEHOW team listened to me’); entering the SOMEHOW service (e.g. ‘I was given enough information about the help available digitally from the SOMEHOW team’); during the SOMEHOW service (e.g. ‘I feel that the SOMEHOW team are working together to help with the problem(s)’); and the help received (e.g. ‘I feel that the written plan from SOMEHOW will be useful for helping my child in the future’). Three items are scored on a scale of 0 to 10 (where 0 = very poor experience/not at all useful and 10 = very good experience/very useful), and all other items are scored as ‘Certainly true’, ‘Partly true’, ‘Not true’, or ‘Don’t know’. The content, format, and response items are adapted for the different groups (examples provided are for the parent/carer group).

Feasibility of Digitally Mediated Team Communication

Access to Services

Access to services was measured by academic year by measuring the number of children that met the project’s eligibility criteria, waiting time (measured as wait time in days from referral to the multidisciplinary team formulation and intervention planning meeting), and number of referrals for which the multidisciplinary team indicated appropriate referrals to alternative support or guidance.

The Multidisciplinary Team Meeting Observation Tool

The multidisciplinary team meeting observation tool (MDT-MOT©; Green Cross Medical Ltd; Harris et al., 2016) is a tool developed to measure multidisciplinary team performance, underpinned by optimal components of multidisciplinary team working. The 10 domains include attendance at multidisciplinary team meetings, leadership and chairing in multidisciplinary team meetings, team working and culture, personal development and training, physical environment of the meeting venue, technology and equipment available for use in multidisciplinary team meetings, organisation and administration during meetings, patient-centred care, clinical decision-making processes, and post-meeting coordination of service (Harris et al., 2016). These domains are rated on a five-point rating scale, where a score of ‘5’ represents optimal effectiveness, a score of ‘3’ represents effectiveness that exhibits some degree of agreement with the optimum, but not consistently, and a score of ‘1’ represents no or little agreement with the defined optimum. The tool was developed for routine use in cancer multidisciplinary team meetings. The current study used a nine-item, adapted version of the MDT-MOT©. The physical environment of the meeting venue was not assessed as this domain was not relevant to a study of digitally mediated, multidisciplinary team meetings. Descriptive anchors for scores at the lower, mid, and upper end of the rating scale were developed for the nine domains, informed by the examples of three domains of team working in Harris et al.’s (2016) paper (Fig. 1, pp. 334). The first author rated the multidisciplinary team meetings using session data and observations recorded. A member of the multidisciplinary team independently rated 10% of multidisciplinary team meetings. Inter-rater reliability was 100% concordant.

Travel Time and Cost Savings

Savings in travel time and cost were calculated by academic year. The first author (LJ) calculated the average travel time (hours, minutes) for services if multidisciplinary team meetings were taking place face-to-face (round-trip), by multiplying the estimated time from professionals’ workplaces to the proposed location for face-to-face team meetings (primary school) by the number of multidisciplinary team meetings over an academic year (39 weeks). The first author (LJ) calculated the average travel cost for services by multiplying the estimated travel distance (miles) from professionals’ workplaces to the proposed location for face-to-face multidisciplinary team meetings (primary school) by the number of multidisciplinary team meetings and then multiplying by the price of travel per mile (£0.45; the standard mileage rate for the NHS and local council) over an academic year (39 weeks).

Other Parent/Carer-Reported and Staff-Reported Outcomes

The Strengths and Difficulties Questionnaire

The 25-item teacher-reported and parent-reported Strengths and Difficulties Questionnaire (SDQ; Goodman, 1997) was used in the current study, using the categories for the UK version of the questionnaire. The SDQ comprises five scales with five items each: (1) Emotional symptoms subscale, (2) Conduct problems subscale, (3) Hyperactivity/inattention subscale, (4) Peer relationships problem subscale, and (5) Prosocial behaviour subscale. The total difficulties score ranges from 0 to 40; the score is categorised as Close to average (teacher-reported: 0–11; parent-reported: 0–13), Slightly raised (teacher-reported: 12–15; parent-reported: 14–16), High (teacher-reported: 16–18; parent-reported: 17–19), and Very high (teacher-reported: 19–40; parent-reported: 20–40). The SDQ has demonstrated reliability and validity, with the internal consistency reported as 0.82 (Goodman, 2001).

The Thrive ® -Online Assessment Tool

Thrive®-Online (Fronting the Challenge Ltd, 2023) is a web-based screening assessment tool measuring emotional developmental need in children. The assessment provides a percentage score (0–100%) which measures age-related progress in ‘Being’, ‘Doing’ and ‘Thinking’ stages of development. Higher percentage scores indicate greater security at each of the developmental strands, with a percentage of 50% or below indicating a need for support.

Procedures

Prior to beginning the study, the first author (LJ) organised and chaired face-to-face meetings with the Special Educational Needs Coordinators (SENCos) from the five participating schools and the members of the multidisciplinary team in order to co-produce the working principles and processes. The first author identified IT solutions for formulation and intervention planning meetings and information storage. Meetings via videoconferencing were conducted via Microsoft Teams (Advanced Encryption Standard (AES) 256-bit encrypted), with the use of video and the screen sharing feature to share the written plan visually as it is being developed in real-time. Information was stored on a SharePoint Collaboration Site for data sharing across services with restricted access for the duration of the project. Agreements were put in place with the participating schools and agencies around information sharing and responsibilities for the individuals involved, including access to good ICT and internet and appropriate, confidential working space. The first author coordinated all meetings and attended the meetings for coordination support and monitoring and evaluation purposes.

Referral Process

Special Educational Needs Coordinators (SENCos) referred children to the multidisciplinary team with parental consent. The Parent/Carer Information Leaflet and Informed Consent Form clearly stated that they were free to withdraw from the project at any time for any reason without prejudice to future care, without affecting their legal rights, and with no obligation to give the reason for withdrawal. The parent/carer was allowed as much time as wished to consider the information, and the opportunity to ask any questions to decide whether they want their child to be referred and to participate in the research project.

Formulation and Intervention Process

The multidisciplinary team screened the referrals for eligibility. For each referral, there was an initial consultation, a panel formulation meeting, a planning meeting, and panel review meeting. The panel formulation meetings attended by the multidisciplinary team were held bi-weekly for two hours via videoconferencing technology; one child was discussed (1.5 h), and the remaining time was allocated for screening (two referrals) and/or panel review (two referrals) during these meetings. Understanding about attachment relationships (Bowlby, 1969), development of self-worth (Rogers, 1959) and self-efficacy (Bandura, 1977a), the active role of the child in their own development and relationships (Bandura, 1977b; Bronfenbrenner, 1979), and the role of the system (i.e. parents/carers and education staff) for supporting social and emotional development in childhood (Bronfenbrenner, 1979; Erikson, 1950) informed the development of the child’s difficulties and summarising the core difficulties during the formulation and intervention planning meetings. For example, with an understanding of Bowlby’s (1969) attachment theory, a child’s difficulties with emotional regulation and social competence with peers might be hypothesised to result from their needs not being consistently met in terms of feeling safe and secure in relationships, in the context of parenting that is inconsistent or neglectful (Groh et al., 2017). Some children with SEMH difficulties may feel a sense of shame, doubt their abilities, and become overly dependent on others, and this might be understood in terms of their need of developing a sense of independence and autonomy not being met (Erikson, 1950). Intervention planning would be theoretically informed, for example, to focus on unconditional positive regard from others to develop self-acceptance (Rogers, 1959), or observing/shadowing a model to increase self-belief (Bandura, 1977a). The formulation process was led by the Educational Psychologist and this professional presented the core difficulties visually in a mind-map format on the written plan to the parents/carers and education staff during the planning meeting. The consultation and planning meetings with education staff and parents/carers were delivered by a subgroup of the multidisciplinary team (the Educational Psychology Service and Behaviour Support Service) via videoconferencing technology, with one exception where the initial consultation was delivered face-to-face prior to the restrictions related to the COVID-19 pandemic. These meetings took place on alternative weeks to the multidisciplinary team meetings at a time convenient to the subgroup members and lasted approximately one hour for each child. Education staff and parents/carers delivered the action plan, with up to three review consultations within 12 months. Figure 1 provides further information about the SOMEHOW process.

Fig. 1
figure 1

The SOMEHOW process and journey for education staff, parents/carers, and children

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Data Collection Process

Baseline SDQ and Thrive®-Online assessment data for the children involved were collated by SENCos prior to the initial consultation and shared via email to the first author via a secure email route. At the end of the planning meeting (see Fig. 1), the professionals used the GBO tool to agree up to three personalised goals with the education staff and with the parents/carers, with potential for overlap in goals. The goals for education staff and parents/carers were recorded and rated on a scale of 0 (not met at all) to 10 (fully met) at the planning meeting (baseline assessment). At review, the professionals used the GBO tool and asked the education staff and parents/carers to rate the level of goal attainment on a scale of 0 (not met at all) to 10 (fully met) at the three-month (T1), six-month (T2), and 12-month (T3) review consultations. The first author asked SENCos to collate the SDQ and Thrive assessment data and to share the data via email. Following the three-month review consultation (T1), the class teacher completed a ten-item, adapted version of the Team Formulation Questionnaire to assess the perceived value of team formulation when supporting the individual child. Education staff and parents/carers completed the Experience of Service Survey at the three-month review consultation. At the end of the two-year pilot project, SENCos anonymously completed an adapted full version of the Team Formulation Questionnaire. Surveys were completed online via the Qualtrics platform. All participants provided informed consent before taking part in any surveys during the project.

Data Analysis

Descriptive statistics were used to characterise the participants. Non-parametric tests were used for analyses due to the small sample size. A data completeness requirement of 60% was used for all statistical analyses (Köpcke et al., 2013). A Bonferroni adjustment (alpha value of 0.017) was used to compare the following combinations for the GBO measure (where the Friedman test was not possible due to missing data): baseline to 3-month (T1), baseline to 6-month (T2), and 3-month (T1) to 6-month (T2). Effect sizes (r) were calculated.

Results

Descriptive Characteristics

Of the 21 children referred, 15 children were accepted into the SOMEHOW project, and education staff and parents/carers of those children participated. Six children were not accepted for reasons including an existing referral made to another service (n = 2), identified area of concern was not considered to be SEMH (n = 2), and limited evidence of use of universal school-based strategies (n = 2). Of the 15 children, 11 (73.3%) were male and four (26.7%) were female, and the median age was 6.0 years (range 4.0–9.0 years). At baseline, teacher-reported SDQ scores ranged from 8.0 (close to average) to 25.0 (very high), with a median score of 18.5 (high; n = 14). Parent-reported SDQ scores ranged from 15.0 (slightly raised) to 27.0 (very high), with a median score of 21.0 (very high; n = 8). The Thrive® assessment score ranged from 15 to 46 (median = 37) at baseline (n = 8), with scores in this range explained by Thrive® Approach as indicating a gap in social-emotional development (Fronting the Challenge Projects Ltd., 2023).

Fourteen (93%) of the 15 teachers involved were female. Of the teachers who completed surveys about the support received (n = 11), the median age was 39.0 years (range 28.0–50.0 years), most were female (91%), and teaching experience (number of years teaching) ranged from 4.0 to 28.0 years (median = 14.0 years). Of the 15 parents/carers involved, nine (60%) were mothers, one (7%) was a father, four (27%) were mothers and fathers who gave joint responses, and one (7%) was a carer. Six (40% of 15) parents/carers completed an experience survey: four (67%) mothers and two (33%) mothers and fathers.

Perceived Value of Digitally Mediated Team Communication

Professional Practice

The median total score for teachers on the 10-item TFQ was 61 (out of 70; range 42–66, n = 11), which indicates positive perceptions of team formulation for supporting practice in primary school settings (see Fig. 2).

Fig. 2
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Perceived Usefulness of Multidisciplinary Team Formulation, Percentage of Education Staff Endorsing ‘Helpful’ (6) or ‘Very Helpful’ (7), n = 11

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The adapted 26-item TFQ was completed by 80% (4/5) of the SENCos from the participating schools. SENCos gave positive ratings, with a median total score of 134 (out of 147; range 114–147), and median ratings on each of the items (out of 7) ranging from 5 (somewhat helpful) to 7 (very helpful).

Progress Towards Goals

Changes in teacher-reported and parent-reported progress towards goals are provided in Table 1. For teachers, ratings for progress towards goals were significantly higher at T1 (median = 6.0, n = 9) than at baseline (median = 3.5, n = 12), T = 36, p = 0.011, r = 0.60. Ratings were significantly higher at T2 (median = 6.0, n = 11) than at baseline (median = 3.5, n = 12), T = 55, p = 0.005, r = 0.60. Ratings at T1 were not significantly different to ratings at T2. For parents/carers, ratings for progress towards goals were significantly higher at T2 (median = 6.0, n = 9) than at baseline (median = 3.5, n = 12), T = 28, p = 0.017, r = 0.56. Other comparisons were not made due to insufficient data. Effect sizes for teacher and parent-reported progress towards goals were large (Cohen, 1988).

Table 1 Average ratings on the goal-based outcomes measure (ratings 0 to 10) by education staff and parents/carers
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Acceptability of Digitally Mediated Team Communication

Figure 3a–c presents the teacher (n = 11) and parent/carer (n = 6) experience of service, with positive perceptions regarding patient-centred support and the help received. Parents/carers had confidence in education staff to support their child, although they had mixed views about provision of information and usefulness of the written plan.

Fig. 3
figure 3

a Experience of the SOMEHOW process by class teachers, n = 11. b Experience of the SOMEHOW process by parents/carers, n = 6. c Teacher (n = 11) and parent/carer (n = 6) perceptions on 0–10 scale of child experience (0 = very poor experience, 10 = very good experience), and usefulness of developing the action plan and the written action plan itself (0 = not at all useful, 10 = very useful), median ratings

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Feasibility of Digitally Mediated Team Communication

Access to Services

In the first academic year of the project, nine referrals were received of which four (44.4%) were accepted, with a median wait time of 135 days (range 83–157 days). In the second academic year, 11 (91.7%) of 12 referrals received were accepted, with a median wait time of 28 days (range 14–71 days).

Of the six referrals that were ineligible for the project, two (33.3%) had been referred to a service by education staff and parents/carers at the time of referral. The multidisciplinary team indicated two (33.3%) referrals to an alternative service at the time of screening and suggested appropriate guidance and resources for two (33.3%) referrals at the time of screening.

Multidisciplinary Team Working

Table 2 shows the median ratings for each scale item on the adapted MDT-MOT©. Total ratings on this measure ranged from 35 to 44 (out of 45; median = 41), which indicates effective multidisciplinary team working.

Table 2 Median ratings on the MDT-MOT© (n = 15)
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Travel Time and Cost Savings

Table 3 presents the time and cost savings in the current study by professionals attending multidisciplinary team meetings via videoconferencing technology rather than attending meetings face to face.

Table 3 Travel time and cost savings per child, per academic year, and in total
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Discussion

This study used multiple indices to examine digitally mediated team communication for responding to emerging SEMH support needs in primary school settings. Taken together, the findings from this study provide preliminary support for the feasibility and acceptability of this health service delivery model. The current study found positive perceptions of team formulation for supporting practice in primary school settings, with high total scores on the TFQ for teachers and SENCos and indication of perceived helpfulness across survey items (i.e. score greater than 4), comparable to the ratings on the TFQ in Hollingworth and Johnstone’s (2014) with a sample comprising of a range of professions (social workers, psychiatrists, occupational therapists, community psychiatric nurses, in-patient ward staff, nurse therapists, and support workers). With regard to team performance, there was consistency in performance across domains, as found in Harris et al.’s (2016) study with nine of the 10 multidisciplinary teams performing well in six or more domains (out of 10 domains); the SOMEHOW multidisciplinary team performing well (‘good’ or ‘very good’, i.e. score greater than 3) in nine domains (out of nine domains). Previous evaluations have demonstrated the acceptability of face-to-face multidisciplinary team communication amongst professionals in child health and social care (e.g. Brown & White, 2010; Cooper et al., 2016; Oliver et al., 2010; Percy‐Smith, 2006; Siraj-Blatchford & Siraj, 2009; Wong & Sumsion, 2013). Previous evaluations have demonstrated the perceived value and acceptability of digitally mediated team communication for supporting frontline staff in primary care and mental health services through access to specialist guidance (Jones et al., 2021). The current study replicated these findings with education staff and was the first to use a pre-/post-measure of staff perceptions, as well as to include measures of team communication processes, parent/carer experience, and potential cost-avoidance of multidisciplinary team meetings via videoconferencing by eliminating the travel burdens of face-to-face meetings.

Drawing on the knowledge of professionals from different professional backgrounds was helpful to education staff and, coupled with findings of perceived progress towards personalised goals, suggests that the process of conveying rich information via videoconferencing technology was a success (Marlow et al., 2017). The feasibility of clinical decision-making, effective communication, and patient-centred support via videoconferencing was further indicated by experience of service data and multidisciplinary team meeting observational data. The findings of team communication via videoconferencing technology in this study align with studies assessing the feasibility and acceptability of service provision (including direct specialist care) via videoconference technology (Barnett et al., 2021), which is important for future planning of organisational aspects of child mental health service provision in a post-COVID-19 world (Barnett et al., 2021; Jones et al., 2020).

In a context of school-based intervention and increasing expectations of education staff (Department for Education, 2018), the findings of this study suggest that multidisciplinary team formulation and intervention planning is valued and appropriately matched to the management of emerging SEMH support needs as the presenting challenge to education staff. With relation to scaffolding theory (Vygotsky & Cole, 1978), this takes into account the professional role and skillset of education staff, as well as the available resources to deliver intervention in a naturalistic, convenient setting for children (Gloff et al., 2015; Hilty et al., 2018a, 2018b). This study aligns with increasing calls for specialist input to guide intervention in community settings including education, as well as recommendations to implement a multidisciplinary team approach across complexity of need rather than for severe mental health concerns only (e.g. Hilty et al., 2018a, 2018b), in order to ensure the most appropriate form of intervention is delivered first time (British Psychological Society, 2021).

This study provided a more comprehensive account of enhanced professional practice as a result of digitally mediated team communication using a triangulation method, which accessed teacher, parent/carer, and SENCo perceptions. Teachers’ perceptions of team formulation indicate that the support was helpful for developing a better understanding of the child’s needs and self-efficacy in supporting the child, and parents/carers and SENCos reported confidence in education staff to support the child. Additionally, education staff perceived that they were better able to work collaboratively with parents/carers, which is critical for developing consistency in the day-to-day interactions that the child experiences as part of a social model of intervention (Bronfenbrenner & Ceci, 1994). Over the course of the SOMEHOW project, progress towards goals as perceived by education staff and parents/carers increased with a large effect size. Using an idiographic measure to examine outcomes of team formulation, it was possible to capture relevant change for the child and the system around the child (Bronfenbrenner & Ceci, 1994; Edbrooke-Childs et al., 2015). Changes in key adult perceptions of the child’s presenting needs and sustaining the high-quality environment across school transitions may have long-term positive impact on the child’s developmental trajectory as well as on future service use (Bailey et al., 2017; Early Intervention Foundation, 2023), and this could be an area for future longitudinal research.

This pilot study was conducted in one geographical location and therefore the sample sizes were small. Additional study limitations include missing data, the inability to conduct reliability analyses, and the inability to access the child voice due to inappropriateness of questionnaire methodology and lack of age-specific measures for primary school-age children after reviewing the literature. Furthermore, there were challenges during the two-year pilot study, as observed in the wider healthcare literature (Weller et al., 2014). Recruitment processes and waiting time in the first year were affected by ‘teething issues’, including shared understanding of the referral criteria, as well as the COVID-19 pandemic. The referral criteria was somewhat subjective to the multidisciplinary team in relation to frequency of difficulties, and future research could seek to quantify this more precisely using a scale of frequency. Identification of videoconference technology and compatible systems for multidisciplinary team information sharing across different care providers and agencies was a challenge during development of the project. The accelerated use of digital communication technologies due to the COVID-19 pandemic resulted in more conducive structures to facilitate digitally mediated team communication (Jones et al., 2020).

This project sheds light on implementing a multidisciplinary health service delivery model with full involvement of education staff and parents/carers. It was important to have a team of professionals who could share their expertise and be open and respectful of the views of others (Abbott et al., 2005), as well as governance and accountability to prioritise multidisciplinary team meetings for early support needs in a context of pressured services (Johnstone, 2018). In a digital context, having an initial face-to-face meeting and having clarity of responsibilities around information sharing were important for effective team communication (Jones et al., 2020).

Conclusion

Digitally mediated team communication was valued for responding to emerging SEMH support needs in primary school settings, with education staff and parents/carers perceiving positive change through the individualised strategies that they implemented. Findings indicate that use of digital communication technologies is a feasible and acceptable way of delivering multidisciplinary team formulation and intervention planning meetings. Further research with larger samples is needed to evaluate service efficiency and outcomes of this health service delivery model compared to usual care.