Title: INCLUSIVE trial: Initiating change locally in bullying and aggression through the school environment
Funder: Department of Health and Social Care

Abstract: We will undertake a cluster-randomised trial to evaluate the effectiveness and cost-effectiveness of the INCLUSIVE intervention in reducing aggression and bullying in 40 English secondary schools. Main research question: Is the INCLUSIVE intervention effective and cost-effective in reducing aggression and bullying in 11-15 year olds in English schools Intervention Schools in the intervention arm will implement the INCLUSIVE intervention over 3 years, 2 of which involve external facilitation. INCLUSIVE is a school-led intervention which combines changes to the school environment with the promotion of social and emotional skills and restorative practices through: the formation of a school action group involving students and staff supported by an external facilitator to review local data on needs, determine priorities, and develop and implement an action plan for revising relevant school policies/rules and other actions to improve relationships at school and reduce aggression; staff training in restorative practices; and a new social and emotional skills curriculum. The intervention combines strong fidelity of inputs, processes and core components with the capacity for tailoring non-core components to local needs. Delivery: The intervention will be delivered by schools, through the school action groups, supported by educational facilitators. Funding: We are seeking intervention funding from charities that funded these costs in our pilot trial (Paul Hamlyn Foundation, Big Lottery Fund). NHS components: There are no NHS staff involved in the delivery of this intervention. 1. Participants: 40 state-supported secondary schools in England. INCLUSIVE is designed to affect all students in participating schools, however outcomes will be assessed among students in year 8 in the 1st intervention year, moving through to year 10 in the 3rd year. 2. Comparator: Normal practice. 3. Outcomes Primary: Two primary outcomes at individual student level will be assessed at baseline and at the 36 month follow-up: 1. Aggressive behaviours in school: measured by the Edinburgh Study of Youth Transitions and Crime school misbehaviour subscale (ESYTC) 2. Bullying and victimisation: measured by the Gatehouse Bullying Scale (GBS) Secondary: Student level and teaching staff level secondary outcomes will be assessed at the 24 months and 36 month surveys. School level outcomes will be assessed at 24 and 36 months. a. Student level: Quality of life: Paediatric Quality of Life Inventory (PedsQL) Psychological function: Strengths and Difficulties Questionnaire (SDQ) Well-being: Short Warwick-Edinburgh Mental Well-Being Scale (SWEMWBS), Health risk behaviours: Smoking, alcohol & illicit drug use, sexual risk behaviours NHS use: Use of categories of NHS services in past year Contact with police: in past year b. Teaching staff level: stress, quality of life, work absences. c. School level: Truancy and exclusion rates. Economic evaluation: Child Health Utility Questionnaire (CHU-9D), staff quality of life, costs. Process: An integral process evaluation will examine intervention delivery and receipt, fidelity, coverage, acceptability and contextual influences; and explore intervention logic model and causal pathways. Impact: A universal intervention that reduces anti-social behaviour and risk behaviours and improves well-being in secondary schools has broad potential to reduce the high costs of anti-social behaviour and reduce inequalities.

Lay abstract: We want to evaluate whether a programme of activities called “INCLUSIVE” is able to help secondary schools in England reduce bullying and aggression among their students. We want to prevent bullying and aggression because they can make people more vulnerable to depression and anxiety in later life, they are linked to other harmful behaviours like drug use, and they can disrupt people’s education. There is growing evidence that the most effective way to prevent such problems in young people is to work with schools to change the school environment relating to discipline and well-being. INCLUSIVE is based on several successful international programmes. The programme involves several elements. First, staff and students work together in an “action group” to improve how the school is run, ensuring students have a say. Second, school staff manage discipline differently, focusing on repairing relationships rather than just punishing bad behaviour. This is called “restorative practice”. Third, students are taught social and emotional skills, helping them to get on better together. We want to recruit 40 schools who are interested in knowing whether INCLUSIVE works. Twenty of them will deliver INCLUSIVE and 20 will not. With the schools’ full cooperation, this will be decided randomly, like tossing a coin. In all of these 40 schools, we will follow a group of students who are about to go into year 8 (age 12/13 years old) at the beginning of the project. We will ask these students to fill in a questionnaire about bullying and aggression, as well as other health topics, right at the beginning of the project, before schools even know whether they will deliver INCLUSIVE or not. We will then repeat these questionnaires 24 and then 36 months later, when the students are in year 9 and then year 10. This will let us see if students in INCLUSIVE schools report less bullying and aggression than those in schools not delivering INCLUSIVE. We will also ask students and teaching staff questions about other issues to assess if INCLUSIVE improves student well-being and mental health and substance use and reduces teacher stress and absenteeism. We will also observe what happens in the schools to make sure INCLUSIVE is delivered as we intended it. And we will do interviews with staff and students to ask them whether they thought INCLUSIVE was practically possible to deliver and whether they liked it. Finally, we will calculate the cost of the programme to see if any benefits it brings are really worth the money it has cost.

Research activity codes: 3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING
Health categories: MENTAL HEALTH