Childhood Resiliency Effects for School-wide Treatment in Belize City

Study Overview
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Brief Summary
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The purpose of the study is to use existing school resources and improve identification, referral and local support for children that exhibit exposure to childhood trauma resulting from environmental violence in Belize City. The Ministry of Education has identified the goals of the project to reduce violent behaviors in primary school children and supporting those children that have been exposed to violence or other malicious behavior that would inhibit normal school functioning. In addition, the MOE is supporting additional resources and data collection for a comprehensive evaluation of student behavior and academic performance.

Detailed Description
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Belize is a country with a developing economy based primarily on agriculture and tourism. Crime and violence are emerging as a threat to the country's governance and business climate. The number of homicides in Belize have increased by more than 30% from 2003-2006. This notion of violence, in particular gang violence, is extremely concerning because the population of Belize is very young. Almost half of the population of Belize is under the age of 18. The youth of Belize are becoming engaged in criminal and delinquent behaviors at an early age that have both individual and societal consequences. In addition to the violence rates among youth in Belize there is also an educational crisis that must be addressed. Education in Belize is compulsory between the ages of 5-14 and in 2001 93% of 5-14 year old children attended school. Although primary school is mandatory (up to age 14), only about 75% of youth complete primary school and only 25% graduate from secondary school. With few students completing high school it is likely that many may turn to gang related and other illegal activities if they are not prepared to undertake better job opportunities, have not been provided with environmental assets that protect from involvement in risky behavior, and if they are exposed to community/family values that condone gang activity. A number of studies have demonstrated that school-based interventions have moderate effects in reducing violence (average of d = .20 across studies). Combining a sound school-based intervention in Belize that is primarily targeted toward students and teachers, but combined with school-based community/family components designed to heighten awareness of the necessity of protective assets, implemented with local and international support teams, and that fosters positive norms may enhance the effects.

Official Title
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Childhood Resiliency Effects for School-wide Treatment in Belize City

Conditions
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Child Behavior

Intervention / Treatment
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* Behavioral: Positive Action
* Behavioral: Control


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Enrolled in primary schools under the authority of the Belize Ministry of Education in the Belize District Enrolled in eight grades referred to as Infant 1 and 2 (generally aged 5 and 6 years), and 1st through 6th Standard (comprising ages 7 - 12 years) Exclusion Criteria: None

Ages Eligible for Study
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Minimum Age: 4 Years
Maximum Age: 12 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Positive Action Curriculum<br>A school-wide program was implemented in the experimental schools referred to as Positive Action and was integrated with the existing Health and Family Life Education curriculum. | Behavioral: Positive Action<br>* Based upon a Cognitive Behavioral Therapy model, intervened schools were engaged in providing curriculum, school infrastructure elements, and parent/community involvement activities around a single model aimed to provide positive support for behaviors. Six areas were identified: self-concept, body/mind, responsible self-management, treating others they way you want to be treated, telling yourself the truth, and continual improvement of self.<br>|
| Active Comparator: Control/Comparison Group<br>Business as usual with students in non-intervened schools | Behavioral: Control<br>* Business as usual with students in non-itervened schools<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Social-Emotional and Character Development Scale | 28 item self-report scale. A sum of item responses yields an overall score and sub scale scores for self-control, pro-social behavior, respect for teachers, respect for parents, honesty, and self-development. Higher scores represent improved functioning. Scores may be reported as raw, percentiles, t-scores, or normal curve equivalent scores. | Nine (9) months from the beginning of the school year until the end of the school year to coincide with treatment | 
| Peer Affiliation Scale | 7 item self-report scale. A sum of item responses yields a score ranging from 5 to 35 with higher scores representing greater affiliation with peers. Scores may be reported as raw, percentiles, t-scores, or normal curve equivalent scores. | Nine (9) months from the beginning of the school year until the end of the school year to coincide with treatment | 
| Behavior Assessment for Children (BASC) | 6 item sub scale from the BASC comprising a self-report for Anxiety, with higher scores indicting behaviors representative of anxious thought. Scores may be reported as raw, percentiles, t-scores, or normal curve equivalent scores. | Nine (9) months from the beginning of the school year until the end of the school year to coincide with treatment | 
| Substance Use and Violent Tendencies Scale | Adapted from a CDC measure, this self-report scale contains 11 items that when summed, higher scores represent greater substance use and participation in violence. Scores may be reported as raw, percentiles, t-scores, or normal curve equivalent scores. | Nine (9) months from the beginning of the school year until the end of the school year to coincide with treatment | 
| Belief in Moral Center Scale | An 11 item self-report measure where higher scores represent belief or adherence to social morality. Item responses are summed, and scores may be reported as raw, percentiles, t-scores, or normal curve equivalent scores. | Nine (9) months from the beginning of the school year until the end of the school year to coincide with treatment | 
| Self-Report Scale of Rewards for Pro-Social Behavior | A 6 item self-report measure recording how much of the time Parents and Teachers notice when the respondent is nice to others. Item responses are recorded on a 4-point scale. A sum of item responses yield summary scores and may be reported as raw, percentiles, t-scores, or normal curve equivalent scores. | Nine (9) months from the beginning of the school year until the end of the school year to coincide with treatment | 
| School Self-Esteem Scale | A 4 item self-report measure asking students how they feel about themselves with respect to school and schoolwork. Item responses are recorded on a 4-point scale. A sum of item responses yield summary scores and may be reported as raw, percentiles, t-scores, or normal curve equivalent scores. | Nine (9) months from the beginning of the school year until the end of the school year to coincide with treatment | 
| Neighborhood Youth Inventory | A 9 item self-report measure about experiences of the respondent in their neighborhood. Item responses are recorded on a 4-point scale. A sum of item responses yield summary scores and may be reported as raw, percentiles, t-scores, or normal curve equivalent scores. | Nine (9) months from the beginning of the school year until the end of the school year to coincide with treatment | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Positive Youth Development