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      Irie Classroom Toolbox: a study protocol for a cluster-randomised trial of a universal violence prevention programme in Jamaican preschools

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          Abstract

          Introduction

          We aim to determine the effectiveness of a school-based violence prevention programme implemented in Jamaican preschools, on reducing the levels of aggression among children at school, and violence against children by teachers.

          Methods and analysis

          This is a 2-arm, single-blind, cluster-randomised controlled trial with parallel assignment. Clusters are 76 preschools in Kingston, and all teachers and classrooms in the selected schools are included in the study. In addition, a random sample of up to 12 children in the 4-year-old classes have been selected for evaluation of child-level outcomes. The intervention involves training teachers in classroom behaviour management and in strategies to promote children's social-emotional competence. Training is delivered through five full-day workshops, monthly in-class coaching over 2 school terms, and weekly text messages. The primary outcome measures are: (1) observed levels of child aggression and (2) observed violence against children by teachers. Secondary outcomes include observations of the levels of children's prosocial behaviour and the quality of the classroom environment, teachers’ reports of their mental health, teacher-reported child mental health, direct tests of children's self-regulation and child attendance.

          Ethics and dissemination

          If this intervention were effective at improving the caregiving environment of young children in school, this would have significant implications for the prevention of child mental health problems, and prevention of violence against children in low and middle-income countries where services are often limited. The intervention is integrated into the school system and involves training existing staff, and thus, represents an appropriate strategy for large-scale implementation and benefits at the population level. Ethical consent for the study was given by the School of Psychology Ethics and Research Committee, Bangor University (ref: 2014-14167), and by the University of the West Indies Ethics Committee (ref: ECP 50,14/15).

          Trial registration number

          ISRCTN11968472; Pre-results.

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          Most cited references19

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          The relationship between cognition and action: performance of children 3 1/2-7 years old on a Stroop-like day-night test.

          One hundred and sixty children 3 1/2-7 years of age (10 M, 10 F at each 6-month interval) were tested on a task that requires inhibitory control of action plus learning and remembering two rules. They were asked to say "day" whenever a black card with the moon and stars appeared and to say "night" when shown a white card with a bright sun. Children < 5 years had great difficulty. They started out performing well, but could not sustain this over the course of the 16-trial session. Response latency decreased from 3 1/2 to 4 1/2 years. Children < 4 1/2 years performed well when they took very long to respond. To test whether the requirement to learn and remember two rules alone was sufficient to cause children difficulty, 80 children 3 1/2-5 years old were tested on a control version of the task ("say 'day' to one abstract design and 'night' to another"). Even the youngest children performed at a high level. We conclude that the requirement to learn and remember two rules is not in itself sufficient to account for the poor performance of the younger children in the experimental condition.
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            School-based interventions for aggressive and disruptive behavior: update of a meta-analysis.

            Research about the effectiveness of school-based psychosocial prevention programs for reducing aggressive and disruptive behavior was synthesized using meta-analysis. This work updated previous work by the authors and further investigated which program and student characteristics were associated with the most positive outcomes. Two hundred forty-nine experimental and quasi-experimental studies of school-based programs with outcomes representing aggressive and/or disruptive behavior were obtained. Effect sizes and study characteristics were coded from these studies and analyzed. Positive overall intervention effects were found on aggressive and disruptive behavior and other relevant outcomes. The most common and most effective approaches were universal programs and targeted programs for selected/indicated children. The mean effect sizes for these types of programs represent a decrease in aggressive/disruptive behavior that is likely to be of practical significance to schools. Multicomponent comprehensive programs did not show significant effects and those for special schools or classrooms were marginal. Different treatment modalities (e.g., behavioral, cognitive, social skills) produced largely similar effects. Effects were larger for better-implemented programs and those involving students at higher risk for aggressive behavior. Schools seeking prevention programs may choose from a range of effective programs with some confidence that whatever they pick will be effective. Without the researcher involvement that characterizes the great majority of programs in this meta-analysis, schools might be well-advised to give priority to those that will be easiest to implement well in their settings.
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              The Good School Toolkit for reducing physical violence from school staff to primary school students: a cluster-randomised controlled trial in Uganda

              Summary Background Violence against children from school staff is widespread in various settings, but few interventions address this. We tested whether the Good School Toolkit—a complex behavioural intervention designed by Ugandan not-for-profit organisation Raising Voices—could reduce physical violence from school staff to Ugandan primary school children. Methods We randomly selected 42 primary schools (clusters) from 151 schools in Luwero District, Uganda, with more than 40 primary 5 students and no existing governance interventions. All schools agreed to be enrolled. All students in primary 5, 6, and 7 (approximate ages 11–14 years) and all staff members who spoke either English or Luganda and could provide informed consent were eligible for participation in cross-sectional baseline and endline surveys in June–July 2012 and 2014, respectively. We randomly assigned 21 schools to receive the Good School Toolkit and 21 to a waitlisted control group in September, 2012. The intervention was implemented from September, 2012, to April, 2014. Owing to the nature of the intervention, it was not possible to mask assignment. The primary outcome, assessed in 2014, was past week physical violence from school staff, measured by students' self-reports using the International Society for the Prevention of Child Abuse and Neglect Child Abuse Screening Tool—Child Institutional. Analyses were by intention to treat, and are adjusted for clustering within schools and for baseline school-level means of continuous outcomes. The trial is registered at clinicaltrials.gov, NCT01678846. Findings No schools left the study. At 18-month follow-up, 3820 (92·4%) of 4138 randomly sampled students participated in a cross-sectional survey. Prevalence of past week physical violence was lower in the intervention schools (595/1921, 31·0%) than in the control schools (924/1899, 48·7%; odds ratio 0·40, 95% CI 0·26–0·64, p<0·0001). No adverse events related to the intervention were detected, but 434 children were referred to child protective services because of what they disclosed in the follow-up survey. Interpretation The Good School Toolkit is an effective intervention to reduce violence against children from school staff in Ugandan primary schools. Funding MRC, DfID, Wellcome Trust, Hewlett Foundation.
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                Author and article information

                Journal
                BMJ Open
                BMJ Open
                bmjopen
                bmjopen
                BMJ Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2044-6055
                2016
                10 May 2016
                : 6
                : 5
                : e012166
                Affiliations
                [1 ]School of Psychology, Bangor University , Bangor, Gwynedd, UK
                [2 ]Tropical Medicine Research Institute, University of the West Indies , Mona, Kingston, Jamaica
                [3 ]Centre for the Evaluation of Development Policies, Institute of Fiscal Studies , London, UK
                [4 ]International Food Policy Research Institute , Washington DC, USA
                Author notes
                [Correspondence to ] Dr Helen Baker-Henningham, h.henningham@ 123456bangor.ac.uk
                Article
                bmjopen-2016-012166
                10.1136/bmjopen-2016-012166
                4874121
                27165651
                31f0879c-3818-4af2-918c-8c62fe9c93e8
                Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

                This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

                History
                : 5 April 2016
                : 19 April 2016
                Categories
                Mental Health
                Protocol
                1506
                1712
                1699

                Medicine
                violence prevention,low and middle-income countries,preschool,cluster randomised trial

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