Good School Toolkit-Secondary Schools Pilot Trial

Physical, sexual and emotional violence against children and adolescents are widespread, and school is a prime risk environment where children and adolescents are exposed to such violence. Main perpetrators of violence against children and adolescents include peers, intimate partners, and in some settings, including Uganda, school staff. In Uganda, sexual and intimate partner violence are one of the top 10 leading causes of disease burden.
Raising Voices, a Ugandan non-governmental organisation, has developed the Good School Toolkit, an intervention to prevent violence from school staff towards students, and peer violence between students. It is a whole-school approach which aims to reduce multiple forms of violence and change power dynamics underpinning violence, by changing the operational culture of the school. We tested the Toolkit in a randomised controlled trial in 2012-2014, where 21 schools received the Toolkit and 21 received it after the study ended. The Toolkit was highly successful in reducing physical and emotional violence from school staff to students and peer violence between students.
In 2015-16, we decided to adapt the Toolkit so that it could be used in secondary schools. We partnered with two secondary schools, and spoke to administration, teachers, students and key stakeholders in Kampala to explore their violence prevention needs. We found that the levels of sexual violence and violence in intimate partnerships were higher among secondary school students versus primary school students. We created and tested new activities to address this and to address gender inequality in schools.
Now, we will conduct a pilot test of this new adapted Toolkit. Our aims are to: understand whether the new Toolkit is acceptable and understandable to secondary school staff, students, caregivers and other stakeholders; feasible to implement in secondary schools; to test measures that we can use in a larger study to determine the effectiveness of the Toolkit; and to explore whether secondary schools, staff, and students are willing to participate in larger-scale research on violence prevention.
We will partner with 8 schools in wider Kampala, Uganda. Half will receive the new Toolkit intervention, over a period of 18 months, and the other half will receive the Toolkit after the end of the 18 months. The research team will conduct surveys, observations, qualitative focus group discussions and interviews with staff, students, caregivers and other stakeholders to understand whether the intervention is acceptable, understandable, and feasible to deliver. The research team will feed back results iteratively to the Raising Voices' team implementing the Toolkit, so that refinements to the Toolkit can be made in real time.
At the end of the project, we will have a fully optimised Good School Toolkit for secondary schools, and information we need to efficiently plan a larger randomised controlled trial to test the effectiveness of the Toolkit in reducing physical, sexual and emotional violence between staff and students, between student peers and within student intimate partnerships.

The Good School Toolkit-Secondary School is a whole-school intervention to prevent physical, sexual and emotional violence against students, from school staff, peers, and within student intimate partnerships. We will conduct a phase 2 cluster randomised controlled trial with 2 arms and parallel assignment. 8 schools will be selected from a list of eligible schools in Kampala, stratified by faith/non-faith status and level of financial resources. Schools will be pair-matched and randomly allocated to receive the Toolkit plus usual care versus usual care and wait-listed to receive the Toolkit. The Toolkit will be implemented over 18 months.
We will conduct a survey with all staff (about 200) and 960 randomly selected students in all 8 schools before randomisation, and again after the 18 month implementation. Observations, qualitative focus groups discussions and individual interviews will be conducted with students, staff, administration, caregivers and key stakeholders throughout the 18 month implementation.
The main outcome of this phase 2 trial is whether criteria for progression to a phase 3 trial are met, defined as: >80% of staff and students reporting acceptability and >80% reporting understanding in endline survey; >3 of 4 intervention schools implementing with fidelity at endline; >6 of 8 schools agree to participate in the baseline survey; >6 of 8 schools participating in the baseline survey agree to be randomised, >6 of 8 of schools randomised agree to endline data collection; >70% of eligible students respond to surveys.
Findings from the research will be fed back to Raising Voices iteratively during the implementation period so that the intervention can be refined and optimised. If a phase 3 trial is warranted, it would represent the first test of a whole school approach to prevent these multiple forms of violence in sub-Saharan Africa.

For this pilot trial, our impact objectives are: 1) to inform the development of interventions to prevent violence in adolescence, both directly via Raising Voices, in Uganda generally and internationally. Our aim is to feed into intervention development with partners who will make interventions publicly available; 2)To raise awareness about and promote understanding of the issue of violence during childhood, adolescence and young adulthood and how this can impact on young people's well being and life trajectory; 3) On a longer-term basis, to contribute to the building of interest and capacity in Ugandan junior academics and in the non-governmental organistion sector, in research methods around randomised controlled trials and on violence in adolescence and young adulthood.
To inform intervention development, within the team, Raising Voices will be able to use the results of our study directly to inform its own future intervention development. Dr Devries will also make use of the results directly in ongoing intervention development work to prevent violence against children in Tanzania, Cote d'Ivoire, and other settings, where her project teams are engaged in long term intervention development and testing programs in partnership with various non-governmental organisations.
Externally, we will share results with other groups who develop interventions, via the Gender-Based Violence prevention Network, which is a network of more than 300 NGOs and civil society organisations in east and southern Africa, coordinated by Raising Voices; the Sexual Violence Research Initiative, which is a global network and includes academics, practitioners and policy makers, coordinated by the South African Medical Research Council; and the Child Protection in Crisis Learning group, which is a global network of academics and practitioners, coordinated by Columbia University. Findings will also be presented at LSHTM Centre for Evaluation meetings, where a new interest group of academics is forming under the leadership of Dr Caroline Free, around systematising and documenting intervention development.