The Irie Classroom Toolbox, a universal violence-prevention teacher-training programme, in Jamaican preschools: a single-blind, cluster-randomised controlled trial.
The Irie Classroom Toolbox, a universal violence-prevention teacher-training programme, in Jamaican preschools: a single-blind, cluster-randomised controlled trial.
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DOI：
10.1016/s2214-109x(21)00002-4
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发表时间：
2021-04
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通讯作者：
Walker SP
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作者：
Baker-Henningham H;Bowers M;Francis T;Vera-Hernández M;Walker SP
暴力是一个主要的全球公共卫生问题，幼儿期干预措施对于初级预防暴力十分重要。我们测试了Irie课堂工具箱，一个预防暴力的教师培训项目是否减少了教师对儿童的暴力行为，并减少了牙买加幼儿园（针对3-6岁儿童）班级范围内的儿童攻击行为。我们在金斯顿和圣安德鲁的76所幼儿园进行了单盲、集群随机对照试验，使用简单随机法从120所符合条件的幼儿园中随机选择。纳入标准为2 - 4个班级的儿童；每班至少10名学生；而且位于市区。我们将学龄前儿童（1:1）随机分配到Irie课堂工具箱干预组或未接受干预的等候名单组，使用由独立统计学家匿名生成的计算机随机序列。“工具箱”包括培训教师进行课堂行为管理和提高儿童的社会情感能力。所有的评估员都被分组分配。所选学校的所有教师和教室都参与了研究。在每所学校中，我们使用简单随机方法随机选择12名4岁的儿童来评估儿童结果。工具箱干预措施于次年8月至4月实施。教师和课堂测量在基线（暑期学期，即5月至6月），干预后（干预8个月后，即次年5月至6月）和1年随访（即2年后的5月至6月）进行。主要结果是观察到教师对儿童的暴力行为（包括身体暴力和心理攻击）发生在一个完整的上学日，以及班级范围内的儿童暴力行为发生在另一个上学日的五个20分钟间隔内，所有这些都是在干预后和1年随访中测量的，并通过治疗意向进行分析。本试验已在ISRCTN注册，注册号为ISRCTN11968472。在2015年6月22日至2016年4月29日期间（基线测量完成后），我们将38所幼儿园（119名教师）分配到工具箱干预组，将38所幼儿园（110名教师）分配到对照组。干预学校的441名儿童和对照学校的424名儿童参与了评估。所有学校都被纳入干预后和随访分析。干预后，与对照学校相比，干预学校教师对儿童的暴力行为较少（中位数为3 [IQR 0 - 11]对15[3 - 35]；效应值为- 67.12%，95% CI为- 8071至- 53.52,p< 0.0001），随访1年（中位数为3 [IQR 0 - 9]对6[1-16]；效应值为- 53.86,95% CI为- 71.08至- 36.65,p< 0.0001）。在干预后（效应值为0.07,95% CI为- 0.16至0.29,p= 0.72）或1年随访（- 0.14,- 0.42至0.16,p= 0.72），各组间全班级儿童攻击行为无差异。在牙买加的幼儿园，Irie课堂工具箱有效地减少了教师对儿童的暴力行为。该工具箱是为在资源匮乏环境中工作的训练不足的教师设计的，对其他低收入中低收入国家的幼儿从业人员也应有效。需要进一步的研究来进一步发展工具箱以减少班级范围内的儿童攻击行为。医学研究委员会，惠康信托基金，英国援助，以及国家健康研究所。
Violence is a leading global public health problem, and interventions in early childhood are important in the primary prevention of violence. We tested whether the Irie Classroom Toolbox, a violence-prevention teacher-training programme reduced violence against children by teachers and reduced class-wide child aggression in Jamaican preschools (catering to children aged 3–6 years). We did a single-blind, cluster-randomised controlled trial in 76 preschools in Kingston and St Andrew, randomly selected, using simple randomisation, from 120 eligible preschools. Inclusion criteria were two to four classes of children; at least ten children per class; and located in an urban area. We randomly assigned preschools (1:1) to either the Irie Classroom Toolbox intervention or waiting-list control that received no intervention, using a computer-generated randomisation sequence by an independent statistician masked to school identity. The Toolbox involved training teachers in classroom behaviour management and promoting child social-emotional competence. All assessors were masked to group assignment. All teachers and classrooms in the selected schools participated in the study. Within each school, we used simple randomisation to randomly select up to 12 children aged 4 years for evaluation of child outcomes. The Toolbox intervention was implemented from August to April the following year. Teacher and classroom measures were done at baseline (the summer school term; ie, May to June), post-intervention (after 8 months of intervention; ie, May to June of the following year), and 1-year follow-up (ie, May to June 2 years later). The primary outcomes were observations of violence against children (including physical violence and psychological aggression) by teachers occurring across one full school day, and class-wide child aggression occurring over five 20-min intervals on another school day, all measured at post-intervention and 1-year follow-up and analysed by intention to treat. This trial is registered with ISRCTN, number ISRCTN11968472. Between June 22, 2015, and April 29, 2016, (after baseline measurements were completed), we assigned 38 preschools (with 119 teachers) to the Toolbox intervention and 38 preschools (with 110 teachers) to control. 441 children in the intervention schools and 424 in the control schools were included in the evaluation. All schools were included in the post-intervention and follow-up analyses. There were fewer counts of violence against children by teachers in the intervention schools compared with control schools at post-intervention (median counts 3 [IQR 0–11] vs 15 [3–35]; effect size −67·12%, 95% CI −80·71 to −53·52, p<0·0001) and 1-year follow-up (median counts 3 [IQR 0–9] vs 6 [1–16]; effect size −53·86, 95% CI −71·08 to −36·65, p<0·0001). No differences between groups were found for class-wide child aggression at post-intervention (effect size 0·07, 95% CI −0·16 to 0·29, p=0·72) or 1-year follow-up (−0·14, −0·42 to 0·16, p=0·72). In Jamaican preschools, the Irie Classroom Toolbox effectively reduced violence against children by teachers. The Toolbox was designed for use with undertrained teachers working in low-resource settings and should be effective with early childhood practitioners in other LMICs. Additional research is needed to further develop the Toolbox to reduce class-wide child aggression. Medical Research Council, Wellcome Trust, UK Aid, and the National Institute of Health Research.