Preventing Youth Violence Through Building Equitable Communities

Not Applicable

• Conditions: Violence in Adolescence; Suicide
• Interventions: Behavioral: Culturally Responsive Practices (CRP); Behavioral: Culturally-Responsive Schoolwide Positive Behavior Interventions and Supports (C-SWPBS)

• Registration Number: NCT05639426
• Lead Sponsor: University of South Alabama

Brief Summary

Interpersonal or community violence is a long-standing health disparity that disproportionately affects African American youth, and suicide is disproportionately increasing among African American youth. This project evaluates the impact of a multisystemic prevention program designed to reduce health disparities in violence by promoting equity in African American youths' experiences in education systems. This intervention has the potential to reduce morbidity and mortality among African American youth, promote overall quality of life, and reduce the societal costs associated with both interpersonal violence and suicidality.

Detailed Description

Violence disproportionately affects African American youth. In addition to death and injury, violence exposure has significant psychological consequences, including traumatic stress symptoms and internalizing problems. Self-directed violence has shown startling and disproportionate growth among African American youth, with suicide rates nearly doubling from 2007 to 2018. Current prevention strategies have limited effectiveness, perhaps due to their failure to address the causal role of structural racism in violence. The primary aim of this proposed project is to examine the extent to which an intervention addressing structural racism in education reduces interpersonal violence and suicide among middle school-aged youth, with a focus on populations experiencing health disparities (African Americans; low-income communities). The proposed project will examine community-level changes using a multiple baseline experimental design that randomizes the start of the intervention in four communities, each comprising a police precinct and middle school. The intervention will consist of school-based intervention components including a culturally responsive, community-inclusive adaptation of a whole-school climate intervention (School-wide Positive Behavior Interventions and Supports) and culturally responsive practices training and coaching. Outcomes will be measured using archival data from the schools as well as survey data from youth and school personnel. Aim 1 is to evaluate the extent to which targeting structural and cultural racism reduces interpersonal violence among youth, as measured by individual-level and school-level data. Aim 2 is to evaluate the extent to which targeting structural and cultural racism reduces suicidality among youth, as measured by completed suicides and proximal precedents for suicide, including attempts and ideation. Aim 3 is to evaluate the extent to which targeting structural and cultural racism reduces both overall rates and disproportionality of school-based exclusionary discipline practices and increases culturally relevant pedagogy. Aim 4 is to evaluate specific intervention components by determining their effects on hypothesized mechanisms of change at the individual, teacher, and school levels. This intervention has the potential to reduce morbidity and mortality among African American youth, promote overall quality of life, and reduce the societal costs associated with both interpersonal violence and suicidality. Furthermore, effective strategies to address structural racism have the potential to facilitate groundbreaking public health prevention of health disparities.

Study Timeline

• Study Start: 2022-09-28
• Study First Submitted: 2022-11-01
• Study First Submitted QC: 2022-11-25
• Study First Posted: 2022-12-06
• Status Verified: 2024-02
• Last Update Submitted: 2024-02-05
• Last Update Posted: 2024-02-06
• Primary Completion: 2027-01-31
• Study Completion: 2027-05-15

Recruitment & Eligibility

• Status: ENROLLING_BY_INVITATION
• Sex: All
• Target Recruitment: 1672

Inclusion Criteria

• Youth will be eligible for the study if they attend a participating school, are capable of providing assent, and are able to understand spoken or written English.
• School personnel will be eligible if they are currently employed at a participating school.

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Exclusion Criteria

• Unable to give assent or consent.

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Study & Design

• Study Type: INTERVENTIONAL
• Study Design: SINGLE_GROUP

Arm && Interventions

Group	Intervention	Description
Strengthening Opportunities for Achievement and Resilience	Culturally Responsive Practices (CRP)	Strengthening Opportunities for Achievement and Resilience (SOAR) is an intervention condition consisting of both Culturally-Responsive Schoolwide Positive Behavior Interventions and Supports (C-SWPBS) and Culturally Responsive Practices (CRP). It is a year-long, school-level intervention.
Strengthening Opportunities for Achievement and Resilience	Culturally-Responsive Schoolwide Positive Behavior Interventions and Supports (C-SWPBS)	Strengthening Opportunities for Achievement and Resilience (SOAR) is an intervention condition consisting of both Culturally-Responsive Schoolwide Positive Behavior Interventions and Supports (C-SWPBS) and Culturally Responsive Practices (CRP). It is a year-long, school-level intervention.

Primary Outcome Measures

Name	Time	Method
Change in youth self-reported exposure to community violence	Trajectories of change will be assessed through data collected every three months from August to May (the school year) over the course of five years (through study completion)	A random sample of youth will complete surveys every three months over the school year for the entire project period. To assess exposure to community violence, youth will complete the Survey of Children's Exposure to Violence scale. Youth self-report will be aggregated to the community level to assess trajectories of community-level change over time as part of the multiple baseline design.
Change in youth self-reported suicide capacity	Trajectories of change will be assessed through data collected every three months from August to May (the school year) over the course of five years (through study completion)	A random sample of youth will complete surveys every three months over the school year for the entire project period. To assess suicide capacity, youth will complete the Suicide Capacity Scale. Youth self-report will be aggregated to the community level to assess trajectories of community-level change over time as part of the multiple baseline design.
Change in youth self-reported suicide ideation	Trajectories of change will be assessed through data collected every three months from August to May (the school year) over the course of five years (through study completion)	A random sample of youth will complete surveys every three months over the school year for the entire project period. To assess suicide ideation, youth will complete the suicide subscale of the Mood and Feelings Questionnaire. Youth self-report will be aggregated to the community level to assess trajectories of community-level change over time as part of the multiple baseline design.
Change in inclusive pedagogy	Trajectories of change will be assessed through data collected every three months from August to May (the school year) over the course of five years (through study completion)	Participating teachers in each school will provide example lesson plans on every three months. These lesson plans will be coded by trained graduate students in education using the Rubric for Culturally Responsive Lessons and Assignments, which will result in an inclusive pedagogy score. These scores will be aggregated to the community level to assess trajectories in community-level change over time as part of the multiple baseline design.
Change in school discipline incidents for violent behavior	Trajectories of change will be assessed through data collected every three months from August to May (the school year) over the course of five years (through study completion)	We will collect archival data from the school system by participating school and quantify the number of violence-related discipline incidents (office discipline referrals, suspensions, and expulsions) that occur every three months. Violence-related discipline incidents will be aggregated to the community level to assess trajectories in community-level change over time as part of the multiple baseline design.
Change in youth self-reported interpersonal violence perpetration	Trajectories of change will be assessed through data collected every three months from August to May (the school year) over the course of five years (through study completion)	A random sample of youth will complete surveys every three months over the school year for the entire project period. To assess interpersonal violence perpetration, youth will complete the Problem Behavior Frequency Scales- Adolescent Revised, Physical Aggression subscale. Youth self-report will be aggregated to the community level to assess trajectories of community-level change over time as part of the multiple baseline design.
Change in teacher-reported youth interpersonal violence perpetration	Trajectories of change will be assessed through data collected every three months from August to May (the school year) over the course of five years (through study completion)	Teachers will complete surveys on a random sample of youth every three months over the school year for the entire project period. To assess youth interpersonal violence perpetration, teachers will complete the Problem Behavior Frequency Scales - Teacher Report, Physical Aggression subscale. Teacher report of youth will be aggregated to the community level to assess trajectories of community-level change over time as part of the multiple baseline design.
Change in youth self-reported interpersonal violence victimization	Trajectories of change will be assessed through data collected every three months from August to May (the school year) over the course of five years (through study completion)	A random sample of youth will complete surveys every three months over the school year for the entire project period. To assess interpersonal violence perpetration, youth will complete the Problem Behavior Frequency Scales- Adolescent Revised, Physical Victimization subscale. Youth self-report will be aggregated to the community level to assess trajectories of community-level change over time as part of the multiple baseline design.
Change in teacher-reported youth interpersonal violence victimization	Trajectories of change will be assessed through data collected every three months from August to May (the school year) over the course of five years (through study completion)	Teachers will complete surveys on a random sample of youth every three months over the school year for the entire project period. To assess youth interpersonal violence perpetration, teachers will complete the Problem Behavior Frequency Scales - Teacher Report, Victimization subscale. Teacher report of youth will be aggregated to the community level to assess trajectories of community-level change over time as part of the multiple baseline design.
Change in youth self-reported suicide attempts	Trajectories of change will be assessed through data collected every three months from August to May (the school year) over the course of five years (through study completion)	A random sample of youth will complete surveys every three months over the school year for the entire project period. To assess suicide attempts and plans, youth will complete three items from the Youth Risk Behavior Surveillance Survey, which will be summed to create a suicide attempts/plans index. Youth self-report will be aggregated to the community level to assess trajectories of community-level change over time as part of the multiple baseline design.
Change in school-reported youth suicide-related incidents	Trajectories of change will be assessed through data collected every three months from August to May (the school year) over the course of five years (through study completion)	We will collect archival data from the each participating school and quantify the number of youth suicide-related incidents based on suicide protocols administered by the school counselor every three months. Youth suicide-related incidents will be aggregated to the community level to assess trajectories in community-level change over time as part of the multiple baseline design.
Change in youth-reported race-based discrimination experiences	Trajectories of change will be assessed through data collected every three months from August to May (the school year) over the course of five years (through study completion)	A random sample of youth will complete surveys every three months over the school year for the entire project period. To assess perceived racial discrimination, youth will complete the Adolescent Discrimination Distress Index. Youth self-report will be aggregated to the community level to assess trajectories of community-level change over time as part of the multiple baseline design.
Change in base rates in exclusionary discipline	Trajectories of change will be assessed through data collected every three months from August to May (the school year) over the course of five years (through study completion)	We will collect archival data from the school system by participating school and quantify the number of exclusionary discipline incidents (a combined measure of suspensions and expulsions) that occur every three months. Exclusionary discipline incidents will be aggregated to the community level to assess trajectories in community-level change over time as part of the multiple baseline design.
Change in youth-reported perceptions of police	Trajectories of change will be assessed through data collected every three months from August to May (the school year) over the course of five years (through study completion)	A random sample of youth will complete surveys every three months over the school year for the entire project period. To assess their perceptions of police legitimacy, youth will complete the Perceptions of Police scale. Youth self-report will be aggregated to the community level to assess trajectories of community-level change over time as part of the multiple baseline design.
Change in racial disparities in exclusionary discipline	Trajectories of change will be assessed through data collected every three months from August to May (the school year) over the course of five years (through study completion)	We will collect archival data from the school system by participating school and quantify the number of exclusionary discipline incidents (a combined measure of suspensions and expulsions) for Black youth and White youth that occur every three months. We will use that data to create an indicator of disproportionate exclusionary discipline based on the number of exclusionary discipline events per Black youth and per White youth separately in proportion to the number of White youth and Black youth in the school. Exclusionary discipline disproportionality will be aggregated to the community level to assess trajectories in community-level change over time as part of the multiple baseline design.

Secondary Outcome Measures

Name	Time	Method
Change in youth self-reported traumatic stress symptoms	Trajectories of change will be assessed through data collected every three months from August to May (the school year) over the course of five years (through study completion)	A random sample of youth will complete surveys every three months over the school year for the entire project period. To assess symptoms of posttraumatic stress disorder, youth will complete the Checklist of Children's Distress. Youth self-report will be aggregated to the community level to assess trajectories in community-level change over time as part of the multiple baseline design.
Change in youth self-reported depressive symptoms	Trajectories of change will be assessed through data collected every three months from August to May (the school year) over the course of five years (through study completion)	A random sample of youth will complete surveys every three months over the school year for the entire project period. To assess symptoms of depression, youth will complete the Short Mood and Feelings Questionnaire. Youth self-report will be aggregated to the community level to assess trajectories of community-level change over time as part of the multiple baseline design.
Change in youth self-reported general internalizing symptoms	Trajectories of change will be assessed through data collected every three months from August to May (the school year) over the course of five years (through study completion)	A random sample of youth will complete surveys every three months over the school year for the entire project period. To assess internalizing symptoms, youth will complete the Emotional Problems subscale of the Strengths and Difficulties Questionnaire. Youth self-report will be aggregated to the community level to assess trajectories of community-level change over time as part of the multiple baseline design.

Trial Locations

Locations (1)

University of South Alabama; 🇺🇸 Mobile, Alabama, United States