Clinical trial NCT05621603: Workforce Mental Health Emergency Preparedness
Official title: Adapting and Testing an Intervention to Integrate Workforce Mental Health Into Pre-K-8 School Emergency Preparedness Via Shared Leadership and Peer Support
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Mental Health
Burnout, Psychological
Lead sponsor: Colorado School of Public Health
Sponsor class: OTHER
Collaborators: name: National Institute for Occupational Safety and Health (NIOSH/CDC)
First posted: 2022-11-18
Enrollment: 519
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
Allocation: RANDOMIZED
Intervention model: PARALLEL
Intervention model description: We will employ a matched waitlist control comparison design. Schools (6) will be randomly assigned to either the training arm or the control arm. Schools assigned to the control arm will eventually receive the training.
Primary purpose: PREVENTION

Brief summary: School leaders, staff, and teachers are tasked with keeping children safe from acts of violence, natural hazards and other emergencies while encouraging learning. Disaster plans are often developed without teacher involvement, resulting in limited knowledge of emergency preparedness, undermining buy-in and limited motivation to comply with safety protocols, including disaster drills. The lack of initial consultation and limited decision-making authority can also be sources of stress for teachers. Teachers and staff may experience anxiety about their roles and responsibilities in a crisis. This research project proposes that the key to enhancing emergency preparedness in this population is to incorporate 'psychological preparedness' within a disaster management framework. In other words, to provide the school workforce with awareness of their likely psychological response to threat and coping skills/strategies for management of that response. Importantly, workforce-focused mental health integrated approaches to emergency preparedness are likely to work best if implemented via peer support and shared leadership frameworks. This project involves adaptation and implementation of an integrated workforce mental health intervention into Pre-K-12 school emergency preparedness via shared leadership and peer support. This includes co-creating training curriculum with Pre-K-12 schools, labor organizations, and district officials, implementing and evaluating the impact of the intervention. A matched waitlist control comparison research design will be used with six Pre-K-12 schools. The hypothesized outcomes of the intervention are increases in H1: emergency preparedness climate; emergency preparedness specific H2: shared leadership; H3: peer support and social cohesion; H4: confidence (in emergency preparedness); and H5: psychological preparedness. The project also anticipates H6: increases in overall mental health and well-being, and H7: a reduction in emergency preparedness-specific burnout.

Detailed description: The burden of poor physical and mental health is high in the Pre-K-8 school workforce. While school employees had lower than average non-fatal occupational injury and illness rates overall in 2019, they had significantly higher rates of injury due to violence (35.5 per 10,000 FTEs vs overall 4.4 per 10,000 FTEs; R100).In addition, mental health needs are higher among teachers than the general population and are a contributing factor to burnout and teacher/staff turnover. Recent estimates of the burden of the COVID-19 pandemic has shed light on the impact that an emergency can have on the education sector workforce, with teachers feeling ill-equipped to adapt to increased expectations associated with safety protocols, online learning and student mental health. Thus, there is an urgent need to enhance emergency preparedness amongst the schools' workforce and a specific need to ensure that they can respond to the needs of others while maintaining their own mental health.

Nearly all public schools have emergency preparedness plans in place. However, disaster plans are often developed at the district level without teacher and staff involvement. This can result in limited knowledge of emergency preparedness and can undermine buy-in and decrease motivation to comply with safety protocols, including disaster drills. Furthermore, the lack of initial consultation and limited decision making authority can be a source of stress among teachers. Teachers and staff may experience anxiety about their roles and responsibilities in a crisis, including keeping themselves and children safe and managing expectations from parents and other stakeholders. It is reasonable to expect some teachers and staff to have strong reactions to drills for active shooter events, weather emergencies and/or disease outbreaks. Staff with a history of trauma exposure, at the school of elsewhere, may be especially vulnerable. Investigators propose that the key to enhancing emergency preparedness in this population is to incorporate 'psychological preparedness' within a disaster management framework. In other words, to provide the school workforce with awareness of their likely psychological response to threat and coping skills/strategies for management of that response. Importantly, such workforce-focused mental health integrated approaches to emergency preparedness are likely to work best if implemented via peer support and shared leadership frameworks. Such approaches have the potential to enhance the effectiveness and sustainability of existing efforts.

Investigators hypothesize that a half-day training intervention for Pre-K-12 schools that emphasizes integration of psychological preparedness with emergency preparedness, via shared leadership and peer support, will increase - H1: the emergency preparedness climate; H2: shared leadership for emergency preparedness; H3: peer support and social cohesion associated with emergency preparedness; H4: confidence (in emergency preparedness); and H5: psychological preparedness. Investigators also hypothesize that investigators will observe (H6) an increase in overall mental health and wellbeing, and a reduction in (H7) emergency preparedness-specific burnout. Thus, the impact of this intervention will be on the school workforce's capability to respond to emergencies while maintaining their well-being.

Specific Aim 1: Adapt and implement an integrated workforce mental health intervention into Pre-K-8 school emergency preparedness via shared leadership and peer support.

* Review emergency preparedness plans/drills and mental health supports at 6 Pre-K-12 schools
* Co-create training curriculum with participating schools and district officials (N = 64, 6 focus groups with 36 participants and 28 interview participants) Specific Aim 2: Evaluate the impact of a half day mental health integrated emergency preparedness intervention in Pre-K-12 schools via shared leadership and peer support.
* Matched waitlist control comparison with 6 Pre-K-12 schools (N = 300) in a diverse school district. Data collected for all 6 schools at baseline, and two time points following the intervention.

The output of our project will be a curriculum manual and online toolkit for schools, including the resources necessary for schools to independently assess, implement and evaluate baseline levels of key outcomes and the impact of training content. Resources will be developed and disseminated to schools with the assistance of the Outreach Core, which has proven experience working with 15 school districts in our region. This project addresses NIOSH Emergency Preparedness and Response Cross-Sector Program Goal concerning safety climate (#1) and will specifically address two NIOSH NORA Healthy Work Design \& Well-being objectives: #4: Reduce work organization-related chronic health conditions among workers and #6: Improve the safety, health, and well-being of workers through healthier work design and better organizational practices.

Eligibility criteria: Inclusion Criteria:

* Pre-K-12 schools, including school leadership, teacher, and staff

Exclusion Criteria:

* Schools other than Pre-K-12

Only adults are enrolled in this workforce-focused study

Primary outcomes:
measure: Psychological Preparedness (measuring change from pre to post intervention)
timeFrame: Immediately prior to intervention with follow-up approximately 2-4 weeks after the intervention is implemented
measure: Emergency Preparedness Climate (measuring change from pre to post intervention)
timeFrame: Immediately prior to intervention with follow-up approximately 2-4 weeks after the intervention is implemented
measure: Shared leadership for Emergency Preparedness (measuring change from pre to post intervention)
timeFrame: Immediately prior to intervention with follow-up approximately 2-4 weeks after the intervention is implemented
measure: Peer Support and Social Cohesion associated with Emergency Preparedness (measuring change from pre to post intervention)
timeFrame: Immediately prior to intervention with follow-up approximately 2-4 weeks after the intervention is implemented
measure: Confidence in Emergency Preparedness (measuring change from pre to post intervention)
timeFrame: Immediately prior to intervention with follow-up approximately 2-4 weeks after the intervention is implemented
Secondary outcomes:
measure: Stress/Work Stress (measuring change from pre to post intervention)
timeFrame: Immediately prior to intervention with follow-up approximately 2-4 weeks after the intervention is implemented
measure: Depression (measuring change from pre to post intervention)
timeFrame: Immediately prior to intervention with follow-up approximately 2-4 weeks after the intervention is implemented
measure: Anxiety (measuring change from pre to post intervention)
timeFrame: Immediately prior to intervention with follow-up approximately 2-4 weeks after the intervention is implemented
measure: Post-traumatic stress disorder (measuring change from pre to post intervention)
timeFrame: Immediately prior to intervention with follow-up approximately 2-4 weeks after the intervention is implemented
measure: Mental well-being (measuring change from pre to post intervention)
timeFrame: Immediately prior to intervention with follow-up approximately 2-4 weeks after the intervention is implemented
measure: Burnout (measuring change from pre to post intervention)
timeFrame: Immediately prior to intervention with follow-up approximately 2-4 weeks after the intervention is implemented
Other outcomes:
Locations:
city: Aurora
country: United States
facility: University of Colorado Anschutz Medical Campus
state: Colorado
Study officials:
affiliation: Colorado School of Public Health
name: Courtney Welton-Mitchell, PhD
role: PRINCIPAL_INVESTIGATOR
References: