Project Activities
The researchers conducted a randomized control trial to test the efficacy of RAP Club on eighth grade students' mental health and academic outcomes, with assessments at baseline, post-intervention, and 4-month follow up. The researchers also conducted a cost analysis to determine the average cost of delivering RAP Club. Key informants, including principals and teachers, were interviewed to explore reasons for program adoption and barriers and facilitators to program sustainment.
Structured Abstract
Setting
This study took place in an urban school district in Maryland.
Sample
Six hundred and thirty-one grade 8 students from 29 schools participated in the study. Study participants were predominantly African American, and 60 percent were girls. The sample included both general education and special education inclusion students. Key informants (selected principals and teachers) were also interviewed about their experiences with the program.
Intervention
RAP Club is a 12-session trauma-informed prevention program designed to promote self-regulation and coping skills for upper middle school students. These capacities are associated with improved mental health and academic performance. RAP Club was adapted from Structured Psychotherapy for Adolescents Responding to Chronic Stress (SPARCS), a trauma-informed treatment that targets adolescents exposed to chronic stress and trauma. The main components of the intervention include cognitive behavioral therapy strategies (e.g., methods for effective communication, problem solving), mindfulness strategies (e.g., teaching awareness of emotional states, using a mindful approach), and psychoeducation (e.g., lessons about how stress and trauma affect the body). The intervention is delivered in a group format and is facilitated by a trained adult and young adult community member. It is typically delivered twice per week over 6 weeks in 45-minute sessions. Previous research on RAP Club showed evidence of promise for improving teacher-reported academic competence, classroom behavior, emotion regulation, and social competence, as well as reducing students' internalizing symptoms and conduct problems and raising academic performance.
Research design and methods
The research team randomly assigned 631 students to receive either the RAP Club intervention or the Healthy Topics active control program. RAP Club was implemented by a trained staff member from the research team and a young adult community co-facilitator twice a week for 6 weeks, with support and engagement from a school mental health provider or teacher. Healthy Topics was implemented by a trained study staff member and a young adult community co-facilitator twice a week for 6 weeks, with support and engagement from a teacher. Student surveys were administered at baseline, immediately following the 6-week intervention period, and 4 months after the intervention. Following the intervention, the researchers conducted focus groups at a subset of participating schools to explore student experiences in the program. The researchers also conducted individual interviews with a subset of principals and teachers to obtain further feedback on the intervention. Costing data was collected for RAP Club to inform future implementation of the program.
Control condition
In the control condition, students received Healthy Topics, a 12-session health education curriculum designed by the researchers to serve as a comparison to RAP Club.
Key measures
Direct assessments of student mental health included the following standardized measures: the Child PTSD Symptom Scale (CPSS), Children's Depression Inventory — Short Form (CDI-S), Patient Reported Outcomes Measurement Information System Pediatric Item Bank v2.0 — Anxiety (PROMIS), Youth Outcomes Questionnaire — Self Report (YOQSR), and 8 items assessing Adverse Childhood Experiences from the National Survey of Children's Health (NSCH). Demographic items developed by the investigators were also administered. Focus groups were also conducted with some intervention participants. Teachers completed the following standardized measures: Strengths and Difficulties Questionnaire (SDQ), Teacher Rating of Social Competence Scale (TRSCS), and Academic Competence Evaluation Scale (ACES). The researchers also accessed data from school records, including end-of-year grades, test scores from the Maryland State Assessment, and students' attendance, probations, and suspensions.
Data analytic strategy
The research team used multilevel modeling to estimate the effect of RAP Club while accommodating the hierarchical structure of the data. The researchers analyzed qualitative data from focus groups and interviews by developing thematic coding schemes.
Cost analysis strategy
The research team calculated costs for delivering the RAP Club and Healthy Topics groups, including monetary costs, personnel time, space, and overhead costs.
Key outcomes
The main findings of the project are as follows:
People and institutions involved
IES program contact(s)
Products and publications
Pre-registration site: The study was pre-registered at clinicaltrials.gov (Identifier NCT03906682): https://clinicaltrials.gov/study/NCT03906682.
ERIC Citations: Find available citations in ERIC for this award here.
Publicly available data: Data will be made publicly available through ICPSR at the University of Michigan.
Select Publications:
Arnold, K.T., Pollack Porter, K.M., Frattaroli, S., Durham, R.E., Clary, L.K., & Mendelson, T. (2021). Multilevel barriers and facilitators to sustainability of a universal trauma-informed school-based mental health intervention following an efficacy trial: A qualitative study. School Mental Health, 13, 174-185.
Arnold, K.T., Pollack Porter, K.M., Frattaroli, S., Durham, R.E., Mmari, K., Clary, L.K., & Mendelson, T. (2020). Factors that influenced adoption of a school-based trauma-informed universal mental health intervention. Prevention Science, 21, 1081-1092.
Mendelson, T., Clary, L., Sibinga, E., Tandon, S.D., Musci, R., Mmari, K., Salkever, D., Stuart, E., & Ialongo, N. (2020). A randomized controlled trial of a trauma-informed school prevention program for urban youth: Rationale, design, and methods. Contemporary Clinical Trials, 90, 105895.
Mendelson, T., Sheridan, S.C., & Clary, L.K. (2021). Research with youth of color in low-income communities: Strategies for recruiting and retaining participants. Research in Social and Administrative Pharmacy, 17, 1110-1118.
Moore, S., Arnold, K., Beidas, R., & Mendelson, T. (2021). Specifying and reporting implementation strategies used in a school-based prevention efficacy trial. Implementation Research and Practice, 2. Webb, L., Jackson, D., Jindal, M., Alang, S., Mendelson, T., & Clary, L. (2022). Anticipation of racially motivated police brutality and youth mental health. Journal of Criminal Justice, 83, 101967.
Webb, L.,Musci, R.& Mendelson, T. (2021). Co-occurring mental health symptoms in urban adolescents: Comorbidity profiles and correlates.Journal of Clinical Child and Adolescent Psychology, 1-13.
Webb, L., Sibinga, E., Musci, R., Clary, L.K., & Mendelson, T. (2021). Confirming profiles of comorbid psychological symptoms in urban youth: Exploring gender differences and trait mindfulness. Journal of Youth and Adolescence, 50, 2249-2261.
Supplemental information
- School administrators chose to adopt RAP Club based on a range of individual-, school-, and macro-level factors (Arnold, Pollack Porter, Frattaroli et al., 2020).
- Several barriers and facilitators to sustaining RAP Club at project schools were identified at the individual-, school-, and macro-level factors (Arnold, Pollack Porter, Frattaroli, Durham, Clary, & Mendelson, 2021).
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