The "Irie Classrooms Toolbox": a cluster randomised trial of a universal violence prevention programme in Jamaican preschools.

暴力是一个主要的世界性公共卫生问题，在牙买加非常普遍。对幼儿期的干预是暴力初级预防的一个重要组成部分。对幼儿照料者进行行为策略培训，以减少对儿童的攻击，提高儿童的社会技能，可以1）防止儿童早期形成反社会行为，2）减少照料者对儿童的暴力行为。尽管教育部努力消除体罚，但体罚在牙买加各地的学校中仍然广泛使用，尽管法律禁止在幼儿园实行体罚，但体罚在牙买加学前教育中仍然很普遍。牙买加少年儿童行为问题的发生率尚未准确确定，但估计在12%-21%之间。幼儿教师报告儿童行为问题作为一个主要的问题，并感到装备不足，以处理them.We已经表明，教师培训使用循证儿童行为管理策略提供了一个更情绪化的支持课堂环境，并使用更少的体罚。这意味着全班儿童的行为得到改善;高危儿童的行为问题减少，他们在学校和家里的社交技能得到提高。通过几年来与牙买加学前教师的合作，我们制定了一项干预措施，包括指导教师使用一个“工具箱”，其中包括相关、易于使用、有效和灵活的关键行为管理战略。该干预措施通过参与性和实用的方法进行，并经过专门设计，具有可扩展性、低成本且适合在资源匮乏的环境中使用，教师的正规教师培训有限。我们现在计划在76所幼儿园（228间教室）评估这一干预措施，以确定大规模传播培训是否会带来好处。幼儿园将被随机分配到一组，其中所有教师在第一年接受干预（38所幼儿园，114间教室），第二组将在一年后接受干预（38所幼儿园，114间教室）。干预措施将包括5个全天的讲习班，每月的课堂支持和每周的短信在一个学年的过程中。我们将评估干预措施对班级范围内儿童攻击性和教师使用体罚和言语虐待的影响。我们还将评估干预措施是否有益于课堂环境的质量，儿童亲社会行为的班级范围措施，教师的心理健康和儿童的自我调节，心理健康和出勤率。我们将研究实施干预措施的相关问题，包括衡量教师在课堂上采用策略的程度、影响教师接受干预措施的因素以及教师对工具箱和培训内容的看法。这将有助于我们完善工具箱，以确保其适用于大规模实施。将进行一项经济评估，以确定与向教师提供干预措施有关的成本以及成本与所获收益的比率，这项研究有可能在牙买加产生巨大的公共卫生影响，在人口一级减少攻击性和改善儿童心理健康。我们与牙买加负责幼儿教育的政府机构和培训机构保持着密切联系，并相信，如果这项研究显示出积极的结果，干预措施将被纳入正在进行的教师培训倡议。此外，该干预措施也适用于其他低收入和中等收入国家的学前和小学早期教育，有可能成为防止暴力侵害儿童和促进儿童心理健康的全球举措的重要组成部分。

Violence is a leading worldwide public health problem with a very high prevalence in Jamaica. Interventions in early childhood are an important component in the primary prevention of violence. Training young children's caregivers in behavioural strategies to reduce child aggression and promote child social skills can 1) prevent the early development of antisocial behaviour in children and 2) reduce violence against children by caregivers. Corporal punishment is widely used in schools across Jamaica despite efforts by the Ministry of Education to eliminate it. Although banned by law in early childhood institutions, corporal punishment is still common in Jamaican preschools. The prevalence of conduct problems in young Jamaican children has not been accurately determined but estimates suggest it is between 12%-21%. Preschool teachers report child behaviour problems as a major concern and feel ill equipped to deal with them.We have shown that teachers trained to use evidence-based child behaviour management strategies provide a more emotionally supportive classroom environment and use less corporal punishment. This translates to improvements in class-wide child behaviour; reductions in high-risk children's conduct problems and increases in their social skills at school and at home. Through several years working with preschool teachers in Jamaica, we have developed an intervention that involves guiding teachers in the use of a "toolbox" of key behaviour management strategies that are relevant, easy to use, effective and flexible. The intervention is delivered through participatory and practical methods and has been specifically designed to be scalable, low cost and suitable for use in low resource settings with teachers with limited formal teacher training. We now plan to evaluate this intervention in 76 preschools (228 classrooms) to determine if benefits are obtained when the training is disseminated on a large scale. The preschools will be randomly assigned to a group in which all teachers receive the intervention in year 1 (38 preschools, 114 classrooms) and a second group that will receive the intervention a year later (38 preschools, 114 classrooms). The intervention will involve 5 full-day workshops, monthly in-class support and weekly text messages over the course of a school year. We will evaluate the effect of the intervention on class-wide measures of child aggression and teachers' use of corporal punishment and verbal abuse. We will also evaluate whether the intervention benefits the quality of the classroom environment, class-wide measures of children's prosocial behaviour, teachers' mental health and children's self-regulation, mental health and attendance. We will examine issues surrounding implementation of the intervention including measuring the degree to which teachers adopt the strategies in the classroom, factors affecting teachers' uptake of the intervention and teachers' views on the components of the toolbox and the training. This will help us to refine the toolbox to ensure its' suitability for implementation at scale. An economic evaluation will be conducted to ascertain the costs associated with delivering the intervention to teachers and the ratio of costs to the benefits obtained.This study has the potential to make an enormous public health impact in Jamaica with benefits to reduced aggression and improved child mental health at the population level. We have close links with the government agencies and training institutions responsible for early childhood education in Jamaica and are confident that, if this study shows positive results, the intervention will be integrated into on-going teacher training initiatives. Furthermore, the intervention would be suitable for use at the preschool and early primary school level in other low and middle-income countries with potential to be an important component of global initiatives to prevent violence against children and to promote child mental health.