A randomised controlled implementation trial of the feasibility and effectiveness of school staff delivery of a selective substance use and mental health program during the COVID-19 pandemic.

BACKGROUND

Preventure is a selective school-based personality-targeted program that has shown long-term benefits in preventing student alcohol use, internalising and externalising problems when delivered by psychologists. In this first Australian randomised controlled trial of school staff implementation of Preventure, we aimed to examine i) acceptability, feasibility, and fidelity and ii) effectiveness of Preventure on student alcohol use, internalising, and externalising symptoms.

METHODS

A cluster-randomised controlled implementation trial was conducted in Sydney, Australia and was guided by the RE-AIM framework (Glasgow et al. 1999); which measures reach, effectiveness, adoption, implementation, and maintenance. Schools were randomly assigned to either the Preventure intervention or active control (health education as usual). Nominated school staff from intervention schools received training and delivered the program to students with elevated scores on one of four personality types targeted in the program. School staff completed surveys on RE-AIM measures, which were analysed using descriptive statistics and thematic analysis. Students completed surveys at baseline and six months post-intervention; mixed-effects regression examined intervention by time interactions on alcohol use, internalising and externalising problems, at six-month follow-up. The study was prospectively registered with the Australian New Zealand Clinical Trials Registry (ACTRN12620000790943, registration date 6 August 2020).

RESULTS

553 students across 8 schools participated in the baseline survey. Of these, 40% had elevated scores on one of the four personality profiles, resulting in 220 students in the current study (102 students in intervention schools, 118 students in control schools; mean age 13.6, 45.7% female). Most RE-AIM domains showed high ratings, with school staff showing good adherence and confidence in delivery. However, teachers reported difficulties with feasibility, particularly a lack of time. Student outcomes: There were significant improvements in depression and conduct problems across both intervention and control across time. There were no significant main or interaction effects of the intervention on student alcohol use, internalising, or externalising problems.

DISCUSSION

Teachers and students rated the program highly. However, concerns around feasibility may limit teacher-led application of the program in the Australian context. Alternative approaches, such as delivery by dedicated personnel within schools without a teaching load, may be critical in implementing such evidence-based interventions at scale.

TRIAL REGISTRATION

The study was prospectively registered with the Australian New Zealand Clinical Trials Registry, registration number: ACTRN12620000790943, registration date: 6 August 2020.