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

 描述（由申请人提供）：每年，大约25%的美国青少年遭受约会伙伴的身体，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毁灭性的后果，包括急性和慢性精神和身体健康问题，自杀，犯罪，危险的性行为，药物滥用和学业失败。此外，性暴力和家庭暴力的肇事者更有可能实施其他形式的暴力，成年后继续遭受亲密伴侣暴力的风险也更大。虽然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，即第四个R方案，将促进健康关系技能和预防TDV纳入现有的学校课程。第四R部分与州和联邦健康课程要求保持一致，从而最大限度地减少了资源紧张的学校的时间和财政负担。它包括课堂活动和学校一级的组成部分，其中教师接受关于健康关系教学的专门培训，学生组成“安全学校委员会”。“Fourth R在加拿大的5,000多所学校以及美国和欧洲的几个地点使用，多个系统评价和国家机构已将其确定为少数几个有希望的TDV预防计划之一。事实上，第四个R已被证明可以减少身体TDV犯罪，增加关系和同伴抵抗技能，并增加安全套的使用。Fourth R的有效性在高危青年中尤其明显。制定一个有效的预防计划，如第四个R只是等式的一部分。在现实世界中以保真度和可持续性实施该计划是另一个，也许更困难的部分。在第四个R之前， 在广泛传播和实施过程中，了解学校、教师和学生层面的因素如何影响方案的可行性、忠实性和可持续性至关重要。同样令人感兴趣的是，这个加拿大项目是如何翻译和适应美国城市，郊区和农村高中的使用。我们建议培训教师实施第四R与4个连续的9年级学生在10个种族，经济和地理上不同的高中在得克萨斯州的队列。这项实施研究的主要目的是，将使用混合方法设计，（1）评估最初的可行性，质量，可接受性，参与度，适应性和对Fourth R的满意度，（2）检查学校，教师和学生层面的高保真实施障碍以及低保真度与干预协议的相关性，（3）通过评估研究过程中在忠诚度、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）评估初始实施忠诚度和随时间变化对学生在青少年约会暴力相关态度、知识、技能、意图和行为变化的影响。

 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.