Transforming Adolescent Mental Health Through Accessible, Scalable, Technology-supported Small-group Instruction

Adolescence is a developmental period of significant risk for anxiety, depressive symptoms, and suicidality, and the investigators propose to target key peer-based risk and protective factors using Cooperative Learning (CL). CL is a small-group instructional approach that can enhance peer relations and reduce peer-related risks, as well as promote academic engagement and achievement and reduce racial disparities. CL will be delivered with the aid of technology that automates the design and delivery of CL lessons, promoting rapid implementation, scalability, high fidelity, accessibility, and sustainability.

Study Overview

• Status: Active, not recruiting
• Conditions: Suicidal Ideation; Anxiety Depression
• Intervention / Treatment: Behavioral: PeerLearning.net

Detailed Description

Internalizing symptoms (i.e., anxiety, depressive symptoms, suicidality) are alarmingly common among adolescents. In 2019, nearly 37% of high school students reported feeling anxious, sad, or hopeless, representing an increase from 2017 (i.e., 31%), and nearly 19% seriously considered suicide, an increase from 2017 (17%). The coronavirus pandemic has exacerbated this problem, with research finding that social isolation resulting from the pandemic was linked to higher levels of stress, fear, loneliness, anxiety, depression, and suicide ideation among adolescents. Importantly, ethnic/racial disparities have been documented in internalizing symptoms, with more negative outcomes for Latinas and Black males. Current universal school-based approaches to prevention have reported uneven or limited effects, or no effects at all. Questions have also been raised regarding cost and accessibility. Despite the uneven track record of universal school-based (Tier 1) approaches, which has led some to recommend an emphasis on targeted (Tier 2) approaches, Tier 1 programs possess several advantages. First, given the demographic heterogeneity in risk factors, as well as disparate access to high-quality, culturally-sensitive health care, schools remain attractive as Tier 1 programs can ensure equitable access to primary prevention services. Second, universal programs avoid the difficulty of identifying adolescents at risk, and third, Tier 1 programs minimize the risk of stigmatizing adolescents who seek out or are referred to services. In this project, submitted to the Transformative Research Award initiative, the investigators will use cooperative learning (CL) as a universal (Tier 1) school-based prevention program to target malleable peer-based risk factors and subsequently evaluate how change in these mechanisms can reduce adolescent internalizing symptoms. CL targets various forms of maladaptive peer relations that create stress and comprise a significant risk factor for internalizing symptoms in adolescence; CL also promotes peer protective factors that can reduce the likelihood of internalizing symptoms (e.g., peer acceptance). CL has also been found to promote more cross-race interaction and interracial attraction, greater cross-ethnic academic support, and more frequent cross-ethnic friendships. To support teachers in implementing CL, the investigators will use a Web-based software platform that provides an accessible, high-fidelity mechanism to deliver CL lessons. The investigators will not only test for intervention effects, but will also evaluate the relative strength of specific, theoretically-derived change mechanisms, and uncover key issues/barriers related to implementation that will allow the investigators to dynamically adjust our implementation approach to achieve maximum impact during subsequent scale-up. This project is designed to establish feasibility with teachers and schools and counter potential threats to implementation fidelity while also creating a roadmap to enhanced scalability and sustained implementation. Significant results from this project could inspire broad uptake of this approach in educational contexts, potentially addressing a significant public health need during a time of crisis due to the coronavirus pandemic.

• Study Type: Interventional
• Enrollment (Estimated): 1200
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Arizona
    • Tempe, Arizona, United States, 85281
      • Arizona State University
  • Oregon
    • Eugene, Oregon, United States, 97401
      • U of Oregon
  • Wisconsin
    • Madison, Wisconsin, United States, 53706
      • U of Wisconsin

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• All students and teachers in target grades in participating schools.

Exclusion Criteria:

• None.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Implementation of PeerLearning.net; Teachers in implementation schools will be given access to training and resources to implement PeerLearning.net as a core component of instruction. Investigators will not create specific requirements of teachers but will ask that they deliver lessons with PeerLearning.net at least four times per month. Investigators will monitor all teacher usage and thus will be able to promote greater usage by (1) publicly acknowledging teachers that are using it frequently and experiencing success, and (2) targeting teachers who use it infrequently with additional resources and support to encourage more frequent use.	Behavioral: PeerLearning.net; PeerLearning.net provides an easy-to-use, scalable, and widely accessible means to support teachers in effectively designing and delivering high-fidelity Cooperative Learning (CL) lessons and, in turn, it has the potential to amplify the positive effects of CL found in previous research. Using PeerLearning.net, teachers design their lesson by selecting from among a set of typical CL lesson templates (e.g., jigsaw, peer tutoring, group projects) which they can customize and populate with their own curriculum and materials. These design templates represent the optimal, high-fidelity design that is required in order for CL to be successful. During lesson delivery, PeerLearning.net manages membership in learning groups, distributes instructional materials, directs student activities according to a pre-specified timetable, supports teacher observations of student behavior, and delivers post-lesson group activities and reviews.
No Intervention: Pre-Intervention; Teachers in pre-intervention schools will continue with business as usual (i.e., typical instruction). Based upon previous experience in conducting research in school settings, teachers in pre-intervention schools will likely use CL very infrequently, and without the benefit of technology support.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Generalized Anxiety Disorder 7	Anxiety (scores zero to 3, higher scores imply worse outcome)	Fall of Year 1
Generalized Anxiety Disorder 7	Anxiety (scores zero to 3, higher scores imply worse outcome)	Spring of Year 1
Generalized Anxiety Disorder 7	Anxiety (scores zero to 3, higher scores imply worse outcome)	Fall of Year 2
Generalized Anxiety Disorder 7	Anxiety (scores zero to 3, higher scores imply worse outcome)	Spring of Year 2
Generalized Anxiety Disorder 7	Anxiety (scores zero to 3, higher scores imply worse outcome)	Fall of Year 3
Generalized Anxiety Disorder 7	Anxiety (scores zero to 3, higher scores imply worse outcome)	Spring of Year 3
Generalized Anxiety Disorder 7	Anxiety (scores zero to 3, higher scores imply worse outcome)	Fall of Year 4
Generalized Anxiety Disorder 7	Anxiety (scores zero to 3, higher scores imply worse outcome)	Spring of Year 4
Patient Health Questionnaire	Depressive symptoms (scores zero to 3, higher scores imply worse outcome)	Fall of Year 1
Patient Health Questionnaire	Depressive symptoms (scores zero to 3, higher scores imply worse outcome)	Spring of Year 1
Patient Health Questionnaire	Depressive symptoms (scores zero to 3, higher scores imply worse outcome)	Fall of Year 2
Patient Health Questionnaire	Depressive symptoms (scores zero to 3, higher scores imply worse outcome)	Spring of Year 2
Patient Health Questionnaire	Depressive symptoms (scores zero to 3, higher scores imply worse outcome)	Fall of Year 3
Patient Health Questionnaire	Depressive symptoms (scores zero to 3, higher scores imply worse outcome)	Spring of Year 3
Patient Health Questionnaire	Depressive symptoms (scores zero to 3, higher scores imply worse outcome)	Fall of Year 4
Patient Health Questionnaire	Depressive symptoms (scores zero to 3, higher scores imply worse outcome)	Spring of Year 4
Youth Risk and Behavior Survey	Suicide ideation (scores zero to 6, higher scores imply worse outcome)	Fall of Year 1
Youth Risk and Behavior Survey	Suicide ideation (scores zero to 6, higher scores imply worse outcome)	Spring of Year 1
Youth Risk and Behavior Survey	Suicide ideation (scores zero to 6, higher scores imply worse outcome)	Fall of Year 2
Youth Risk and Behavior Survey	Suicide ideation (scores zero to 6, higher scores imply worse outcome)	Spring of Year 2
Youth Risk and Behavior Survey	Suicide ideation (scores zero to 6, higher scores imply worse outcome)	Fall of Year 3
Youth Risk and Behavior Survey	Suicide ideation (scores zero to 6, higher scores imply worse outcome)	Spring of Year 3
Youth Risk and Behavior Survey	Suicide ideation (scores zero to 6, higher scores imply worse outcome)	Fall of Year 4
Youth Risk and Behavior Survey	Suicide ideation (scores zero to 6, higher scores imply worse outcome)	Spring of Year 4
Service Assessment for Children and Adolescents	Service utilization (scores zero to 20, higher scores imply worse outcome)	Fall of Year 1
Service Assessment for Children and Adolescents	Service utilization (scores zero to 20, higher scores imply worse outcome)	Spring of Year 1
Service Assessment for Children and Adolescents	Service utilization (scores zero to 20, higher scores imply worse outcome)	Fall of Year 2
Service Assessment for Children and Adolescents	Service utilization (scores zero to 20, higher scores imply worse outcome)	Spring of Year 2
Service Assessment for Children and Adolescents	Service utilization (scores zero to 20, higher scores imply worse outcome)	Fall of Year 3
Service Assessment for Children and Adolescents	Service utilization (scores zero to 20, higher scores imply worse outcome)	Spring of Year 3
Service Assessment for Children and Adolescents	Service utilization (scores zero to 20, higher scores imply worse outcome)	Fall of Year 4
Service Assessment for Children and Adolescents	Service utilization (scores zero to 20, higher scores imply worse outcome)	Spring of Year 4

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Everyday Discrimination Scale	Discrimination (scores zero to 4, higher scores imply worse outcome)	Fall of Year 1
Everyday Discrimination Scale	Discrimination (scores zero to 4, higher scores imply worse outcome)	Spring of Year 1
Everyday Discrimination Scale	Discrimination (scores zero to 4, higher scores imply worse outcome)	Fall of Year 2
Everyday Discrimination Scale	Discrimination (scores zero to 4, higher scores imply worse outcome)	Spring of Year 2
Everyday Discrimination Scale	Discrimination (scores zero to 4, higher scores imply worse outcome)	Fall of Year 3
Everyday Discrimination Scale	Discrimination (scores zero to 4, higher scores imply worse outcome)	Spring of Year 3
Everyday Discrimination Scale	Discrimination (scores zero to 4, higher scores imply worse outcome)	Fall of Year 4
Everyday Discrimination Scale	Discrimination (scores zero to 4, higher scores imply worse outcome)	Spring of Year 4
University of Illinois Bully Scale	Bullying and victimization (scores 1 to 5, higher scores imply worse outcome)	Fall of Year 1
University of Illinois Bully Scale	Bullying and victimization (scores 1 to 5, higher scores imply worse outcome)	Spring of Year 1
University of Illinois Bully Scale	Bullying and victimization (scores 1 to 5, higher scores imply worse outcome)	Fall of Year 2
University of Illinois Bully Scale	Bullying and victimization (scores 1 to 5, higher scores imply worse outcome)	Spring of Year 2
University of Illinois Bully Scale	Bullying and victimization (scores 1 to 5, higher scores imply worse outcome)	Fall of Year 3
University of Illinois Bully Scale	Bullying and victimization (scores 1 to 5, higher scores imply worse outcome)	Spring of Year 3
University of Illinois Bully Scale	Bullying and victimization (scores 1 to 5, higher scores imply worse outcome)	Fall of Year 4
University of Illinois Bully Scale	Bullying and victimization (scores 1 to 5, higher scores imply worse outcome)	Spring of Year 4
Child Peer Social Skills Scale	Peer acceptance (scores 1 to 5, higher scores imply better outcome)	Fall of Year 1
Child Peer Social Skills Scale	Peer acceptance (scores 1 to 5, higher scores imply better outcome)	Spring of Year 1
Child Peer Social Skills Scale	Peer acceptance (scores 1 to 5, higher scores imply better outcome)	Fall of Year 2
Child Peer Social Skills Scale	Peer acceptance (scores 1 to 5, higher scores imply better outcome)	Spring of Year 2
Child Peer Social Skills Scale	Peer acceptance (scores 1 to 5, higher scores imply better outcome)	Fall of Year 3
Child Peer Social Skills Scale	Peer acceptance (scores 1 to 5, higher scores imply better outcome)	Spring of Year 3
Child Peer Social Skills Scale	Peer acceptance (scores 1 to 5, higher scores imply better outcome)	Fall of Year 4
Child Peer Social Skills Scale	Peer acceptance (scores 1 to 5, higher scores imply better outcome)	Spring of Year 4
Perceived Stress Scale	Stress (scores 0 to 4, higher scores imply worse outcome)	Fall of Year 1
Perceived Stress Scale	Stress (scores 0 to 4, higher scores imply worse outcome)	Spring of Year 1
Perceived Stress Scale	Stress (scores 0 to 4, higher scores imply worse outcome)	Fall of Year 2
Perceived Stress Scale	Stress (scores 0 to 4, higher scores imply worse outcome)	Spring of Year 2
Perceived Stress Scale	Stress (scores 0 to 4, higher scores imply worse outcome)	Fall of Year 3
Perceived Stress Scale	Stress (scores 0 to 4, higher scores imply worse outcome)	Spring of Year 3
Perceived Stress Scale	Stress (scores 0 to 4, higher scores imply worse outcome)	Fall of Year 4
Perceived Stress Scale	Stress (scores 0 to 4, higher scores imply worse outcome)	Spring of Year 4
Adolescent Stress Questionnaire	Social stress (scores 1 to 5, higher scores imply worse outcome)	Fall of Year 1
Adolescent Stress Questionnaire	Social stress (scores 1 to 5, higher scores imply worse outcome)	Spring of Year 1
Adolescent Stress Questionnaire	Social stress (scores 1 to 5, higher scores imply worse outcome)	Fall of Year 2
Adolescent Stress Questionnaire	Social stress (scores 1 to 5, higher scores imply worse outcome)	Spring of Year 2
Adolescent Stress Questionnaire	Social stress (scores 1 to 5, higher scores imply worse outcome)	Fall of Year 3
Adolescent Stress Questionnaire	Social stress (scores 1 to 5, higher scores imply worse outcome)	Spring of Year 3
Adolescent Stress Questionnaire	Social stress (scores 1 to 5, higher scores imply worse outcome)	Fall of Year 4
Adolescent Stress Questionnaire	Social stress (scores 1 to 5, higher scores imply worse outcome)	Spring of Year 4
Classroom Life Scale	Peer academic support (scores 1 to 5, higher scores imply better outcome)	Fall of Year 1
Classroom Life Scale	Peer academic support (scores 1 to 5, higher scores imply better outcome)	Spring of Year 1
Classroom Life Scale	Peer academic support (scores 1 to 5, higher scores imply better outcome)	Fall of Year 2
Classroom Life Scale	Peer academic support (scores 1 to 5, higher scores imply better outcome)	Spring of Year 2
Classroom Life Scale	Peer academic support (scores 1 to 5, higher scores imply better outcome)	Fall of Year 3
Classroom Life Scale	Peer academic support (scores 1 to 5, higher scores imply better outcome)	Spring of Year 3
Classroom Life Scale	Peer academic support (scores 1 to 5, higher scores imply better outcome)	Fall of Year 4
Classroom Life Scale	Peer academic support (scores 1 to 5, higher scores imply better outcome)	Spring of Year 4
School Attendance	Degree of truancy (scores 0 to 4, lower scores imply better outcome)	Fall of Year 1
School Attendance	Degree of truancy (scores 0 to 4, lower scores imply better outcome)	Spring of Year 1
School Attendance	Degree of truancy (scores 0 to 4, lower scores imply better outcome)	Fall of Year 2
School Attendance	Degree of truancy (scores 0 to 4, lower scores imply better outcome)	Spring of Year 2
School Attendance	Degree of truancy (scores 0 to 4, lower scores imply better outcome)	Fall of Year 3
School Attendance	Degree of truancy (scores 0 to 4, lower scores imply better outcome)	Spring of Year 3
School Attendance	Degree of truancy (scores 0 to 4, lower scores imply better outcome)	Fall of Year 4
School Attendance	Degree of truancy (scores 0 to 4, lower scores imply better outcome)	Spring of Year 4
Reasons for Non-Attendance	Social issues causing non-attendance (scores 0 to 4, lower scores imply better outcome)	Fall of Year 1
Reasons for Non-Attendance	Social issues causing non-attendance (scores 0 to 4, lower scores imply better outcome)	Spring of Year 1
Reasons for Non-Attendance	Social issues causing non-attendance (scores 0 to 4, lower scores imply better outcome)	Fall of Year 2
Reasons for Non-Attendance	Social issues causing non-attendance (scores 0 to 4, lower scores imply better outcome)	Spring of Year 2
Reasons for Non-Attendance	Social issues causing non-attendance (scores 0 to 4, lower scores imply better outcome)	Fall of Year 3
Reasons for Non-Attendance	Social issues causing non-attendance (scores 0 to 4, lower scores imply better outcome)	Spring of Year 3
Reasons for Non-Attendance	Social issues causing non-attendance (scores 0 to 4, lower scores imply better outcome)	Fall of Year 4
Reasons for Non-Attendance	Social issues causing non-attendance (scores 0 to 4, lower scores imply better outcome)	Spring of Year 4
UCLA Loneliness Scale	Loneliness (scores 1 to 3, lower scores imply better outcome)	Fall of Year 1
UCLA Loneliness Scale	Loneliness (scores 1 to 3, lower scores imply better outcome)	Spring of Year 1
UCLA Loneliness Scale	Loneliness (scores 1 to 3, lower scores imply better outcome)	Fall of Year 2
UCLA Loneliness Scale	Loneliness (scores 1 to 3, lower scores imply better outcome)	Spring of Year 2
UCLA Loneliness Scale	Loneliness (scores 1 to 3, lower scores imply better outcome)	Fall of Year 3
UCLA Loneliness Scale	Loneliness (scores 1 to 3, lower scores imply better outcome)	Spring of Year 3
UCLA Loneliness Scale	Loneliness (scores 1 to 3, lower scores imply better outcome)	Fall of Year 4
UCLA Loneliness Scale	Loneliness (scores 1 to 3, lower scores imply better outcome)	Spring of Year 4
Secondary School Readiness Inventory	School engagement (scores 1 to 5, higher scores imply better outcome)	Fall of Year 1
Secondary School Readiness Inventory	School engagement (scores 1 to 5, higher scores imply better outcome)	Spring of Year 1
Secondary School Readiness Inventory	School engagement (scores 1 to 5, higher scores imply better outcome)	Fall of Year 2
Secondary School Readiness Inventory	School engagement (scores 1 to 5, higher scores imply better outcome)	Spring of Year 2
Secondary School Readiness Inventory	School engagement (scores 1 to 5, higher scores imply better outcome)	Fall of Year 3
Secondary School Readiness Inventory	School engagement (scores 1 to 5, higher scores imply better outcome)	Spring of Year 3
Secondary School Readiness Inventory	School engagement (scores 1 to 5, higher scores imply better outcome)	Fall of Year 4
Secondary School Readiness Inventory	School engagement (scores 1 to 5, higher scores imply better outcome)	Spring of Year 4
Substance use	Use of tobacco, alcohol, and marijuana (scores 1 to 5, lower scores imply better outcome)	Fall of Year 1
Substance use	Use of tobacco, alcohol, and marijuana (scores 1 to 5, lower scores imply better outcome)	Spring of Year 1
Substance use	Use of tobacco, alcohol, and marijuana (scores 1 to 5, lower scores imply better outcome)	Fall of Year 2
Substance use	Use of tobacco, alcohol, and marijuana (scores 1 to 5, lower scores imply better outcome)	Spring of Year 2
Substance use	Use of tobacco, alcohol, and marijuana (scores 1 to 5, lower scores imply better outcome)	Fall of Year 3
Substance use	Use of tobacco, alcohol, and marijuana (scores 1 to 5, lower scores imply better outcome)	Spring of Year 3
Substance use	Use of tobacco, alcohol, and marijuana (scores 1 to 5, lower scores imply better outcome)	Fall of Year 4
Substance use	Use of tobacco, alcohol, and marijuana (scores 1 to 5, lower scores imply better outcome)	Spring of Year 4

Collaborators and Investigators

• Sponsor: University of Oregon
• Collaborators: University of Wisconsin, Madison; Arizona State University; Oregon Research Institute

Study record dates

Study Major Dates

• Study Start (Actual): September 1, 2023
• Primary Completion (Estimated): June 15, 2027
• Study Completion (Estimated): June 15, 2027

Study Registration Dates

• First Submitted: March 20, 2023
• First Submitted That Met QC Criteria: May 12, 2023
• First Posted (Actual): May 16, 2023

Study Record Updates

• Last Update Posted (Estimated): October 3, 2025
• Last Update Submitted That Met QC Criteria: September 29, 2025
• Last Verified: September 1, 2025

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Behavioral Symptoms; Self-Injurious Behavior; Suicide; Behavior; Suicidal Ideation
• Other Study ID Numbers: STUDY00000719

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: Investigators will ensure that project data is submitted according to the NIH Data Sharing Regimen (i.e., descriptive/raw data will be submitted semi-annually, and submission of all other data will occur at the time of publication, or prior to the end of the grant, whichever occurs first). Consent forms will reflect this submission of data to be shared. Investigators will store study data as Excel datasets. Research staff will document the study protocol and datasets on a publicly accessible website that will include surveys, names and labels for all variables and values, and calculations for composite scores. Investigators will remove personal identifiers from datasets and replace them with randomly assigned identifiers.
• IPD Sharing Time Frame: As noted above, descriptive/raw data will be submitted semi-annually, and submission of all other data will occur at the time of publication, or prior to the end of the grant, whichever occurs first.
• IPD Sharing Access Criteria: There is no criteria.
• IPD Sharing Supporting Information Type: ICF

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No