Adapting and Testing an Intervention to Integrate Workforce Mental Health Into Pre-K-8 School Emergency Preparedness Via Shared Leadership and Peer Support

The burden of poor physical and mental health is high in the Pre-K-8 school workforce. While school employees had lower than average non-fatal occupational injury and illness rates overall in 2019, they had significantly higher rates of injury due to violence (35.5 per 10,000 FTEs vs overall 4.4 per 10,000 FTEs; R100).In addition, mental health needs are higher among teachers than the general population and are a contributing factor to burnout and teacher/staff turnover. Recent estimates of the burden of the COVID-19 pandemic has shed light on the impact that an emergency can have on the education sector workforce, with teachers feeling ill-equipped to adapt to increased expectations associated with safety protocols, online learning and student mental health. Thus, there is an urgent need to enhance emergency preparedness amongst the schools' workforce and a specific need to ensure that they can respond to the needs of others while maintaining their own mental health.

Nearly all public schools have emergency preparedness plans in place. However, disaster plans are often developed at the district level without teacher and staff involvement. This can result in limited knowledge of emergency preparedness and can undermine buy-in and decrease motivation to comply with safety protocols, including disaster drills. Furthermore, the lack of initial consultation and limited decision making authority can be a source of stress among teachers. Teachers and staff may experience anxiety about their roles and responsibilities in a crisis, including keeping themselves and children safe and managing expectations from parents and other stakeholders. It is reasonable to expect some teachers and staff to have strong reactions to drills for active shooter events, weather emergencies and/or disease outbreaks. Staff with a history of trauma exposure, at the school of elsewhere, may be especially vulnerable. Investigators propose that the key to enhancing emergency preparedness in this population is to incorporate 'psychological preparedness' within a disaster management framework. In other words, to provide the school workforce with awareness of their likely psychological response to threat and coping skills/strategies for management of that response. Importantly, such workforce-focused mental health integrated approaches to emergency preparedness are likely to work best if implemented via peer support and shared leadership frameworks. Such approaches have the potential to enhance the effectiveness and sustainability of existing efforts.

Investigators hypothesize that a half-day training intervention for Pre-K-12 schools that emphasizes integration of psychological preparedness with emergency preparedness, via shared leadership and peer support, will increase - H1: the emergency preparedness climate; H2: shared leadership for emergency preparedness; H3: peer support and social cohesion associated with emergency preparedness; H4: confidence (in emergency preparedness); and H5: psychological preparedness. Investigators also hypothesize that investigators will observe (H6) an increase in overall mental health and wellbeing, and a reduction in (H7) emergency preparedness-specific burnout. Thus, the impact of this intervention will be on the school workforce's capability to respond to emergencies while maintaining their well-being.

Specific Aim 1: Adapt and implement an integrated workforce mental health intervention into Pre-K-8 school emergency preparedness via shared leadership and peer support.

• Review emergency preparedness plans/drills and mental health supports at 6 Pre-K-12 schools
• Co-create training curriculum with participating schools and district officials (N = 64, 6 focus groups with 36 participants and 28 interview participants) Specific Aim 2: Evaluate the impact of a half day mental health integrated emergency preparedness intervention in Pre-K-12 schools via shared leadership and peer support.
• Matched waitlist control comparison with 6 Pre-K-12 schools (N = 300) in a diverse school district. Data collected for all 6 schools at baseline, and two time points following the intervention.