Built to Last: Testing a Whole-School Restorative Approach to Reducing Aggressive Behaviors Against the ‘Normalization Process Theory'

Introduction: To overcome the problems of translating complex interventions from trial settings into routine practice new theories and frameworks have been developed. Focusing specifically on two concepts from the RE-AIM framework, the Normalisation Process Theory (NPT) suggests four criteria for successful ‘Implementation’ and ‘Maintenance’: (1) coherence/‘sense making’; (2) cognitive participation/‘engagement’; (3) capacity for collective action; and (4) reflexive monitoring (Murray et al, 2012). This presentation will describe the process of testing a new complex intervention, the INCLUSIVE project, against NPT criteria prior to a phase-III cluster RCT to ensure it could be rolled-out and maintained.

Methods: The INCLUSIVE intervention is a new whole-school restorative approach to reducing aggression and bullying in secondary schools. It provides a standard process for changing the school environment in line with evidenced ‘protective’ factors but is also designed to promote local ownership and responsiveness. An action group (comprising students and staff) reviews survey data on students’ views about school to determine priorities and implement a school-improvement plan. School staff are trained in restorative practices and deliver a new social and emotional skills curriculum, also locally-tailored according to needs-assessment data.  A pilot trial (MRC phase-II) took place at eight schools in England in 2011-12 (n=1136). Students, staff and intervention providers reported their experiences of the process via interviews (n=38) and focus groups (n=132).

Results: The intervention was adopted and implemented by all four intervention schools as planned. However, the NPT framework suggests refinements necessary to promote long-term sustainability via integration into routine practice: (1) some students and staff found the multiple components “confusing” suggesting the need for more coherent presentation and improved branding to promote ‘sense making’; (2) the intervention needs to engage a wider range of students and staff outside the action group to make it sustainable; (3) the training and curriculum need to be “even more bespoke” to be embedded into routine practices and reach the whole school; (4) student surveys mobilise and “challenge” schools to monitor change and should be repeated to maintain “momentum”.

Conclusions: It is hard to justify large-scale trials of school-based intervention that are unlikely to be ‘normalised’ into routine practice and this study provides a best practice model for exploratory trials. Limitations of the NPT will also be discussed (e.g. lack of focus on policy-level barriers and facilitators), as will how the concept of ‘normalisation’ could be integrated with Rogers (2003) notions of ‘diffusion’ and ‘maintenance’.