The Irie Classroom Toolbox: A Cluster Randomised Trial of a Universal Violence Prevention Programme in Jamaican Preschools

Introduction: Violence is a leading global public health problem and makes a substantial contribution to the burden of disease at the global level. 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) reduce violence against children by caregivers and 2) prevent the early development of antisocial behaviour in children.

Methods: The study was a two-arm, single blind, cluster randomised controlled trial with parallel assignment. Clusters were 76 preschools in Kingston, and all teachers and classrooms in the selected schools were included in the study (total of 229 teachers). In addition, a random sample of up to 12 children in the 4-year old class was selected for evaluation of child-level outcomes giving a total of 865 children. The intervention involved training teachers in classroom behaviour management and in strategies to promote children's social-emotional competence. Training was delivered through 5 full-day workshops, monthly in-class coaching for eight months and fortnightly text messages. The primary outcome measures were: i) observed violence against children by teachers and ii) observed levels of child aggression. Secondary outcomes included observations of the levels of children’s prosocial behaviour and the quality of the classroom environment using the CLASS Pre-K, teachers' reports of their mental health, teacher-reported child mental health and direct tests of children’s inhibitory control.

Results: All analyses were intention to treat. Using hierarchical multiple regression analyses, significant benefits of intervention were found for direct observations of teachers’ use of violence against children (Effect size (ES)=-0.52, p<0.0001); no benefits were found to observations of children’s classwide aggression (B=-0.05, p=0.74). Significant benefits were also found for children’s class-wide prosocial behaviour (ES=0.41, p=0.003), the quality of the classroom environment: emotional support (ES=0.62, p<0.0001), classroom organisation (ES=0.42, p<0.001) and instructional support (ES=0.48, p=0.001) and to teacher well-being (ES=0.22, p<0.0001) and children’s inhibitory control (ES=0.17, p=0.014). No benefits were reported to teacher-reported child mental health (ES=-0.03, p=0.85) or prosocial skills (ES=0.02, p=0.68). However, fewer children in intervention schools were in the clinical range for behaviour difficulties at post-test (Odds ratio: 0.54, p=0.055).

Conclusions:  A low-cost teacher-training programme, developed for use in low and middle-income countries, significantly reduced teachers’ use of violence against children.