Childhood Resiliency Effects for School-wide Treatment in Belize City (CREST)

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.

Study Overview

• Status: Completed
• Conditions: Child Behavior
• Intervention / Treatment: Behavioral: Positive Action; Behavioral: Control

Detailed Description

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.

• Study Type: Interventional
• Enrollment (Actual): 6296
• Phase: Not Applicable

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 4 years to 12 years (CHILD)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

Description

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

Study Plan

How is the study designed?

Design Details

• Primary Purpose: PREVENTION
• Allocation: RANDOMIZED
• Interventional Model: PARALLEL
• Masking: NONE

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
EXPERIMENTAL: Positive Action Curriculum; 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; 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.
ACTIVE_COMPARATOR: Control/Comparison Group; Business as usual with students in non-intervened schools	Behavioral: Control; Business as usual with students in non-itervened schools

What is the study measuring?

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

Collaborators and Investigators

• Sponsor: University of North Texas, Denton, TX
• Investigators: Principal Investigator: Darrell M Hull, Ph.D., University of North Texas Health Science Center

Study record dates

Study Major Dates

• Study Start: September 1, 2011
• Primary Completion (ACTUAL): June 1, 2012
• Study Completion (ACTUAL): June 1, 2012

Study Registration Dates

• First Submitted: January 6, 2017
• First Submitted That Met QC Criteria: January 17, 2017
• First Posted (ESTIMATE): January 20, 2017

Study Record Updates

• Last Update Posted (ESTIMATE): January 20, 2017
• Last Update Submitted That Met QC Criteria: January 17, 2017
• Last Verified: January 1, 2017

More Information

Terms related to this study

• Keywords: Positive Youth Development
• Other Study ID Numbers: 11403

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO