title: Initiating change locally in bullying and aggression through the school environment (INCLUSIVE): a pilot randomised controlled trial.
abstract: BACKGROUND
  Youth bullying and other aggressive behaviours are a major public health concern owing to their impact on adolescent physical and mental health and well-being. Whole-school restorative approaches have been identified as a promising method of addressing aggressive behaviour but there have been no randomised trials undertaken to examine their effects.
  
  
  OBJECTIVE
  To examine the feasibility and acceptability of implementing and trialling the INCLUSIVE (initiating change locally in bullying and aggression through the school environment) intervention in English secondary schools.
  
  
  METHODS
  Cluster randomised controlled pilot trial in eight schools (1 : 1 computer-generated random allocation post baseline by a statistician blind to the identity of clusters) and process evaluation.
  
  
  METHODS
  Secondary schools in England (purposively sampled to ensure diversity).
  
  
  METHODS
  Year 8 students (aged 12-13 years), teachers, other school staff and intervention providers.
  
  
  METHODS
  Whole-school restorative approach to address bullying and aggression, involving the following standard processes: school action group formation and external facilitation to review needs assessment data, identify priorities, and plan and monitor school-level actions; staff training in restorative practices; and a new social and emotional skills curriculum.
  Standard practice.
  
  
  METHODS
  (1) The primary outcome of interest was the feasibility and acceptability of delivering and trialling the intervention according to prespecified criteria; (2) process data were analysed to explore participants' experiences of implementing and trialling the intervention and how these varied according to school context; and (3) indicative primary outcomes (aggressive behaviour measures), secondary outcomes, intermediate outcomes and economic evaluation methods were piloted.
  
  
  METHODS
  Students (n = 1144 baseline; n = 1114 follow-up) and teachers (n = 387 baseline; n = 336 follow-up) were surveyed at the start and end of the 2011-12 academic year (baseline September 2011; follow-up June-July 2012). A total of 1017 students surveyed at baseline remained in the study at follow-up (89%). Other quantitative data were collected via intervention provider checklists (n = 4) and action group surveys (n = 44); qualitative data were collected via interviews (n = 34), focus groups (n = 20) and observations of action group meetings (n = 16).
  
  
  RESULTS
  (1) All prespecified feasibility and acceptability criteria were met. (2) Qualitative data indicated that all intervention components and the trial design were feasible and acceptable to students and staff, including in more disadvantaged school contexts. Qualitative data also suggested that student participation may be a core component in improving relationships and engagement across the school. The later-than-planned project start (July) and the timing of the baseline surveys (September), which needed to be completed pre allocation, caused delays in launching the intervention, staff training and other intervention outputs. (3) Three pilot primary outcomes were examined (completion rate at follow-up range: 91.7-94.2%) and the Gatehouse Bullying Scale and the Edinburgh Study of Youth Transitions and Crime school misbehaviour subscale were acceptable, discriminating and reliable measures of bullying and aggression in this context. Our pilot economic analyses support the use of the Child Health Utility 9D scale with this population and the feasibility of cost-utility analysis, although this should be supplemented with a cost-consequence analysis. There was no evidence of harm.
  
  
  CONCLUSIONS
  It is feasible and acceptable to implement and trial the INCLUSIVE intervention in English secondary schools, although a longer lead-in time is required to enable timely intervention outputs to occur. A Phase III cluster randomised controlled trial is required to examine the effectiveness and cost-effectiveness over a 3-year period of implementation for reducing aggressive behaviours, promoting mental health and well-being, and reducing health inequalities.
  
  
  BACKGROUND
  Current Controlled Trials ISRCTN88527078.
  
  
  BACKGROUND
  The National Institute for Health Research Health Technology Assessment programme (research), the Paul Hamlyn Foundation, the Big Lottery Fund and the Coutts Charitable Trust (intervention). The report will be published in full in Health Technology Assessment; Vol. 19, No. 53. See the NIHR Journals Library website for further project information.
authors.affiliation: Institute of Education, University College London, London, UK.
authors.forename: Chris
authors.initials: C
authors.lastname: Bonell
authors.affiliation: Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), Cardiff University, Cardiff, UK.
authors.forename: Adam
authors.initials: A
authors.lastname: Fletcher
authors.affiliation: Institute of Child Health, University College London, London, UK.
authors.forename: Natasha
authors.initials: N
authors.lastname: Fitzgerald-Yau
authors.affiliation: Institute of Child Health, University College London, London, UK.
authors.forename: Daniel
authors.initials: D
authors.lastname: Hale
authors.affiliation: Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Allen
authors.affiliation: Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Diana
authors.initials: D
authors.lastname: Elbourne
authors.affiliation: Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Jones
authors.affiliation: Medical Research Council/Chief Scientist Office Social and Public Health Sciences, Glasgow, UK.
authors.forename: Lyndal
authors.initials: L
authors.lastname: Bond
authors.affiliation: Social Science Research Unit, Institute of Education, University College London, London, UK.
authors.forename: Meg
authors.initials: M
authors.lastname: Wiggins
authors.affiliation: Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Alec
authors.initials: A
authors.lastname: Miners
authors.affiliation: Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Rosa
authors.initials: R
authors.lastname: Legood
authors.affiliation: Department of Child and Adolescent Psychiatry, Kings College London, London, UK.
authors.forename: Stephen
authors.initials: S
authors.lastname: Scott
authors.affiliation: Institute of Child Health, University College London, London, UK.
authors.forename: Deborah
authors.initials: D
authors.lastname: Christie
authors.affiliation: Institute of Child Health, University College London, London, UK.
authors.forename: Russell
authors.initials: R
authors.lastname: Viner
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior / Q000523:psychology*; D000374:Aggression / Q000523:psychology*; D058445:Bullying / Q000517:prevention & control*; D002648:Child; D003362:Cost-Benefit Analysis; D004739:England; D005178:Faculty; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D016134:Organizational Policy; D010379:Peer Group; D010865:Pilot Projects; D036301:Qualitative Research; D012574:Schools / Q000191:economics / Q000458:organization & administration*; D012931:Social Environment