Implementing Fourth R in US schools: feasibility, fidelity, and sustainability

 描述(由申请人提供)：每年约有25%的美国青少年遭受约会伴侣的身体、心理或性虐待。许多青少年约会暴力(TDV)的受害者经历了一系列破坏性的后果，包括急性和慢性心理和身体健康问题、自杀、犯罪、危险的性行为、药物滥用和学业失败。此外，TDV的肇事者更有可能实施其他形式的暴力，成年后继续实施亲密伴侣暴力的风险增加。尽管TDV是一个普遍存在的问题，但它在很大程度上是可以预防的。一个有效的方案，第四个R，将促进健康的人际关系技能和预防TDV纳入现有的学校课程。第四，R部分与州和联邦的健康课程要求保持一致，从而将资源紧张的学校的时间和财务负担降至最低。它既包括课堂活动，也包括学校层面的部分内容，在这些部分中，教师接受关于健康关系教学的专门培训，学生组成“安全的学校委员会”。Fourth R在加拿大5000多所学校以及美国和欧洲的几个地点使用，多项系统评估和国家机构已将其确定为为数不多的有前景的TDV预防计划之一。事实上，第四个R已经被证明可以减少身体上的TDV实施，增加人际关系和同伴抵抗技能，并增加避孕套的使用。第四R方案的有效性在高危青年中尤为明显。制定一个有效的预防计划，如第四个R，只是方程式的一部分。在真实世界环境中以逼真和可持续的方式实施该计划是另一个可能更困难的部分。因此，在第四个R之前 在广泛传播和实施的过程中，了解学校、教师和学生层面的因素如何影响计划的可行性、保真度和可持续性是至关重要的。同样令人感兴趣的是这个加拿大项目是如何翻译和改编成适用于美国城市、郊区和农村高中的。我们建议对教师进行培训，让他们在德克萨斯州10所种族、经济和地理不同的高中连续4批9年级学生实施第四R。本实施研究将采用混合方法设计，其主要目的是(1)评估最初的可行性、质量、可接受性、参与度、适应性和对第四R的满意度；(2)检查高保真实施的学校、教师和学生水平的障碍以及与干预方案的低保真度的相关性；(3)通过评估在研究过程中在保真度、可行性、可接受性、满意度和参与度方面的变化，确定经验的可持续性和对实施的影响；以及(4)评估初始实施保真度和随时间的变化对学生态度、知识、技能、意图、以及与青少年约会暴力有关的行为。

 DESCRIPTION (provided by applicant): Each year, approximately 25% of US teens sustain physical, psychological, or sexual abuse by dating partners. Many victims of teen dating violence (TDV) experience a host of devastating consequences, including acute and chronic mental and physical health problems, suicidality, delinquency, risky sexual behavior, substance abuse, and academic failure. Moreover, perpetrators of TDV are more likely to perpetrate other forms of violence and are at increased risk for continuing intimate partner violence in adulthood. Although TDV is a pervasive problem, it is largely preventable. One efficacious program, the Fourth R, integrates the promotion of healthy relationship skills and prevention of TDV into existing school curricula. Fourth R components are aligned with state and federal curriculum requirements in health, thus minimizing time and financial burdens placed upon resource-strapped schools. It includes both classroom activities and school-level components in which teachers receive specialized training on teaching about healthy relationships and students form "safe school committees." Fourth R is used in over 5,000 schools in Canada, as well as several sites throughout the United States and Europe, and multiple systematic reviews and national agencies have identified it as one of only a few promising TDV prevention programs. Indeed, Fourth R has been shown to reduce physical TDV perpetration, increase relationship and peer resistance skills, and increase condom use. The effectiveness of Fourth R has been especially pronounced among high-risk youth. Developing an efficacious prevention program such as the Fourth R is only part of the equation. Implementing the program in real-world settings with fidelity and sustainability is the other, perhaps more difficult, part. Thus, prior to the Fourth R undergoing widespread dissemination and implementation, it is crucial to understand how factors at the school, teacher, and student levels affect program feasibility, fidelity, and sustainability. Also of interest is how this Canadian program is translated and adapted for use in US urban, suburban, and rural high schools. We propose to train teachers to implement Fourth R with 4 successive cohorts of 9th-grade students in 10 ethnically, economically, and geographically diverse high schools in Texas. The primary aims of this implementation study, which will use a mixed methods design, are to (1) assess initial feasibility, quality, acceptabilit, engagement, adaptation, and satisfaction with Fourth R, (2) examine school-, teacher-, and student-level barriers to high-fidelity implementation and correlates of low fidelity to the intervention protocol, (3) determine sustainability and impact of experience on implementation by assessing changes over the course of the study in fidelity, feasibility, acceptability, satisfaction, and engagement, and (4) evaluate effects of initial implementation fidelity and change over time on students' changes in attitudes, knowledge, skills, intentions, and behavior related to teen dating violence.