Preventing Youth Violence Through Building Equitable Communities

Official title

Preventing Youth Violence Through Building Equitable Communities: An Evaluation of a Systemic Intervention

Overview

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 middle schools. 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.

Interventions

• Behavioral Culturally Responsive Practices (CRP)
  The CRP component of the intervention targets pedagogy, curriculum, and potential teacher biases and discriminatory behavior. This component will consist of two intensive 4-hour workshops delivered by Morton and Billingsley in each school's first intervention year as well as one-hour annual boosters (Backpacks for Success and Culturally Relevant Pedagogy). All teachers and school administrators will participate in the workshops. The purpose of Backpacks for Success is to increase participants' a
• Behavioral Culturally-Responsive Schoolwide Positive Behavior Interventions and Supports (C-SWPBS)
  We will implement SWPBS according to the equity-focused framework established by the Center on PBIS, with an increased emphasis on community integration. SWPBS involves creating a school team of 6-10 people, including at least one administrator, teachers, and staff members. We will include at least three community stakeholders on each C-SWPBS team to integrate the culture of the community, reducing institutional and cultural racism. Community stakeholders may be parents or other invested members

Primary outcome measures

• Change in youth self-reported interpersonal violence perpetration [Time frame: 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)]
• Change in teacher-reported youth interpersonal violence perpetration [Time frame: 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)]
• Change in school discipline incidents for violent behavior [Time frame: 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)]
• Change in youth self-reported interpersonal violence victimization [Time frame: 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)]
• Change in youth self-reported exposure to community violence [Time frame: 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)]
• Change in teacher-reported youth interpersonal violence victimization [Time frame: 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)]
• Change in youth self-reported suicide attempts [Time frame: 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)]
• Change in youth self-reported suicide capacity [Time frame: 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)]
• Change in youth self-reported suicide ideation [Time frame: 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)]
• Change in school-reported youth suicide-related incidents [Time frame: 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)]

Secondary outcome measures (3)

• Change in youth self-reported traumatic stress symptoms [Time frame: 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)]
• Change in youth self-reported depressive symptoms [Time frame: 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)]
• Change in youth self-reported general internalizing symptoms [Time frame: 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)]

Eligibility criteria

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.

Exclusion criteria

• Unable to give assent or consent.

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

Randomized

Model

Single group

Masking

Open label

Primary purpose

Prevention

Study locations

United States · 1 center

• University of South Alabama — Mobile

Identifiers

NCT: NCT05639426 · 21-454 · R01MD017477

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗