Designing School-based Interventions
Posted on May 17, 2007
Read practical advice about designing and implementing a violence prevention program in schools by Lisa Jaycox (bio), Daniel F. McCaffrey (bio), Beverly Weidmer Ocampo (bio), Gene A. Shelley (bio), Susan M. Blake (bio), Joan Kub (bio), and Donna J. Peterson (bio).
- constraints related to research design
- recruitment of schools and individuals
- implementation issues
In another project called Break the Cycle (a non-profit organization in Los Angeles), the original plan to randomize at the school level had to be changed. At these year-round schools, children were on one of three "tracks," with very little overlap of courses and sports, so that children on different tracks had very little contact with one another. It was decided then to randomize at the track level, across schools.
For the other project, Promoting Healthy Relationships (University of Arizona), neither randomization nor matching was feasible. The program was implemented in a rural area, with only one middle school and one high school. The total number of children in the schools was small as well, which can allow transfer of knowledge between intervention and control groups. The evaluation was therefore designed as a pre-post study.
Consent procedures should be considered carefully when conducting school-based research on sensitive topics. Passive consent (a consent letter that is signed only if the parent does NOT want her child in the study) is usually not recommended when studying topics such as IPV or drug use with teens. On the other hand, active consent can result in fewer participants and a biased sample. One way to approach this problem is to increase time and money spent on recruitment efforts, such as having the research team be responsible for distributing and collecting consents.
Also, the consent form itself can be the cause of recruitment problems. IRB's have requirements relating to language used on consents that can be off-putting. For example, the term "Principal Investigator"; had negative connotations for members of the rural Arizona tribal community, so the term was changed to "Principal Researcher." In addition, consent forms should be translated as needed to ensure a more representative sample.
There is so much pressure put on schools to meet testing standards these days, that any project which takes them "off task" may not be welcomed. The schools that we were working in were faced with budget cuts, teacher layoffs, and increased workloads. Therefore, it was essential to the success of the projects that our research staff take on some of the burden. For example, in the Break the Cycle project, the school staff were supposed to prepare and deliver the call slips that allowed students to leave their classrooms for assessments. This was very time-consuming, and the school staff was not completely reliable in delivering the slips, so the research staff took on the task.
Originally, all three programs asked teachers to be responsible for talking to their students about the project, sending home consent packets, and following up. However, this turned out to be too much of a burden on teachers who were already overloaded, so the research teams decided to take on those tasks. The research staff also provided incentives such as ice cream certificates to classrooms who had at least an 80% return rate (allowing or denying permission).
Relationship between principal and teachers
We also needed to take into account the administrator-teacher relationship, which can vary among schools. Some administrators talk with teachers before agreeing to participate, while others may agree without consulting their staff, leaving teachers feeling forced to participate. These teachers may then pass a resentful attitude towards the project on to their students, which can negatively affect recruitment and retention. It's important, therefore, to gain support from teachers and staff as well as from the principal before beginning the project.
Another issue is reporting of child abuse. State laws differ, but mandatory reporting of suspected abuse can come up against the assurance of confidentiality. Each of the programs handled these challenges differently. Because Arizona's state law requires reporting of all instances of dating violence, the Break the Cycle team felt that teens would be more forthcoming if this portion of the survey was anonymous. The team provided a list of resources about dating violence, and the school counselor was present on survey days in case students had any concerns. On the other hand, the Respect Me project used individual identifiers for their surveys, but stressed that all discussion would remain confidential. They also told their students that the research team would need to tell the authorities if a student reported abuse.
The school-based research team should understand that, just as each school has a different culture, there are many cultures that exist within each school. Different groups (teachers, students in general, ethnic student groups) may require distinct methods of forming a partnership.
A critical element for any research team working in schools is flexibility; research staff need to be able to adapt to changes in a stressful environment while maintaining the integrity of the research. The team should expect modifications to the implementation, and be able to make immediate changes to protocol as needed. Some of these changes may be based on discussions over several meetings, while other may need to be made on the spot. When faced with a need to change protocol, the research team should consider the following questions:
- Will it result in any ethical or confidentiality violations?
- Is it feasible?
- Will it affect the ability to discern differences between intervention and comparison groups?
- Will there be spillover from intervention to comparison group?
- Will the quality of data be affected?
- Understand and be sensitive to the school's cultures
- Get everyone on board, including the district administrator, principal, teachers, and other staff who will be involved at any point during the study
- Keep in contact with school staff throughout the project
- Minimize burden on staff
- Provide incentives for returning consents, as well as for participating
- Plan to spend a lot of time on consent forms (including translation if needed, distribution, and reminders)
- Allow flexibility in implementation and allow time to deal with last minute changes
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