Preventing Youth Violence Through Building Equitable Communities

Study Overview
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Brief Summary
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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 and law enforcement 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
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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. 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 and law enforcement 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. 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 (a) 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; (b) law enforcement-based intervention components representing procedural justice interventions, including training and coaching on de-escalation with trauma-exposed youth and training in disproportionate minority contact, and (c) an integrated community intervention that includes increased collaboration among youth-serving agencies to reduce the burden on law enforcement, and strategies for community-building between police officers, school personnel, and youth through team-oriented contact. Outcomes will be measured using archival data from the schools and police department as well as survey data from youth, school personnel, and police officers. Aim 1 is to evaluate the impact on interpersonal violence among youth, as measured by individual-level, school-level, and precinct-level data. Aim 2 is to evaluate the impact on suicidality among youth, as measured by completed suicides and proximal precedents for suicide, including attempts and ideation. Aim 3 is to evaluate the impact on overall rates and disproportionality of school-based exclusionary discipline practices; effective pedagogy; and overall rates and disproportionality of juvenile arrests and police use-of-force. Aim 4 is to evaluate specific intervention components by determining their effects on hypothesized mechanisms of change at the individual, teacher, school, and law enforcement 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

Official Title
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Preventing Youth Violence Through Building Equitable Communities: An Evaluation of a Multisystemic Intervention

Conditions
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Suicide, Violence in Adolescence

Intervention / Treatment
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* Behavioral: Integrated Community-Level Intervention


Participation Criteria
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Eligibility Criteria
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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. Police personnel will be eligible if they are currently employed at a participating precinct. Exclusion Criteria: Unable to give assent or consent.

Ages Eligible for Study
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Minimum Age: 9 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Integrated Community-Level Intervention<br>The multisystemic, multicomponent intervention will consist of: (a) 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 for teachers; (b) law enforcement-based intervention components representing procedural justice interventions, including training in disproportionate minority contact, and training and coaching on de-escalation with trauma-exposed youth for police officers (DEWTY); and (c) an integrated community intervention that includes community-building between police officers, school personnel, and youth through team-oriented contact. | Behavioral: Integrated Community-Level Intervention<br>* The multisystemic, multicomponent intervention will consist of: (a) 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 for teachers; (b) law enforcement-based intervention components representing procedural justice interventions, including training in disproportionate minority contact, and training and coaching on de-escalation with trauma-exposed youth for police officers (DEWTY); and (c) an integrated community intervention that includes community-building between police officers, school personnel, and youth through team-oriented contact (the Justice Alliance).<br>* Other names: Strengthening Opportunities for Achievement and Resilience (SOAR);|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in youth self-reported interpersonal violence perpetration | 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. | 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 | 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. | 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 | 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. | 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 juvenile arrests for violent behavior | We will collect archival data from the police department by participating precinct and quantify the number of violence-related juvenile arrests (18 years old and younger) that occur every three months. Violence-related juvenile arrests will be aggregated to the community level to assess trajectories in community-level change over time as part of the multiple baseline design. | Trajectories of change will be assessed through data collected every three months over the course of five years (through study completion) | 
| Change in youth self-reported interpersonal violence victimization | 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. | 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 | 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. | 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 | 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. | 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 police-reported community violence | We will collect archival data from the police department by participating precinct and quantify the number of likely violence-related incidents by coding dispatch calls that indicate violence (e.g., assault; shots fired). Violence-related juvenile arrests will be counted and aggregated to the community level to assess trajectories in community-level change over time as part of the multiple baseline design. | Trajectories of change will be assessed through data collected every three months over the course of five years (through study completion) | 
| Change in youth self-reported suicide attempts | 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. | 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 | 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. | 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 | 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. | 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 | 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. | 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-reported race-based discrimination experiences | 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. | 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-reported perceptions of police | 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. | 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 inclusive pedagogy | 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. | 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 base rates in exclusionary discipline | 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. | 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 racial disparities in exclusionary discipline | 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. | 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 police use-of-force towards juveniles | We will collect archival data from the police department based on case reports by participating precinct and quantify the number of use-of-force events (e.g., physical restraint, handcuffing, drawing or discharging a weapon) towards juveniles (youth 18 years old and younger) that occur every three months. Use-of-force will be aggregated to the community level to assess trajectories in community-level change over time as part of the multiple baseline design. | Trajectories of change will be assessed through data collected every three months over the course of five years (through study completion) | 
| Change in juvenile disproportionate minority contact with the police | We will collect archival data from the police department based on arrest records by participating precinct and quantify the number of juvenile arrests (youth 18 years old and younger), disaggregated by race, that occur every three months. We will use that data to create an indicator of disproportionate minority contact with the police based on arrests per Black youth and per White youth separately in proportion to the precinct-level population of White youth and Black youth. Disproportionate minority contact will be aggregated to the community level to assess trajectories in community-level change over time as part of the multiple baseline design.. | Trajectories of change will be assessed through data collected every three months over the course of five years (through study completion) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in youth self-reported traumatic stress symptoms | 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. | 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 | 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. | 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 | 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. | 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) |