The EmpaTeach intervention for reducing physical violence from teachers to students in Nyarugusu Refugee Camp: A cluster-randomised controlled trial

Abstract

Background School-based violence prevention interventions offer enormous potential to reduce children’s experience of violence perpetrated by teachers, but few have been rigorously evaluated globally and, to the best of our knowledge, none in humanitarian settings. We tested whether the EmpaTeach intervention could reduce physical violence from teachers to students in Nyarugusu Refugee Camp, Tanzania. Methods and findings We conducted a 2-arm cluster-randomised controlled trial with parallel assignment. A complete sample of all 27 primary and secondary schools in Nyarugusu Refugee Camp were approached and agreed to participate in the study. Eligible students and teachers participated in cross-sectional baseline, midline, and endline surveys in November/December 2018, May/June 2019, and January/February 2020, respectively. Fourteen schools were randomly assigned to receive a violence prevention intervention targeted at teachers implemented in January–March 2019; 13 formed a wait-list control group. The EmpaTeach intervention used empathy-building exercises and group work to equip teachers with self-regulation, alternative discipline techniques, and classroom management strategies. Allocation was not concealed due to the nature of the intervention. The primary outcome was students’ self-reported experience of physical violence from teachers, assessed at midline using a modified version of the ISPCAN Child Abuse Screening Tool–Child Institutional. Secondary outcomes included student reports of emotional violence, depressive symptoms, and school attendance. Analyses were by intention to treat, using generalised estimating equations adjusted for stratification factors. No schools left the study. In total, 1,493 of the 1,866 (80%) randomly sampled students approached for participation took part in the baseline survey; at baseline 54.1% of students reported past-week physical violence from school staff. In total, 1,619 of 1,978 students (81.9%) took part in the midline survey, and 1,617 of 2,032 students (79.6%) participated at endline. Prevalence of past-week violence at midline was not statistically different in intervention (408 of 839 students, 48.6%) and control schools (412 of 777 students, 53.0%; risk ratio = 0.91, 95% CI 0.80 to 1.02, p = 0.106). No effect was detected on secondary outcomes. A camp-wide educational policy change during intervention implementation resulted in 14.7% of teachers in the intervention arm receiving a compressed version of the intervention, but exploratory analyses showed no difference in our primary outcome by school-level adherence to the intervention. Main study limitations included the small number of schools in the camp, which limited statistical power to detect small differences between intervention and control groups. We also did not assess the test–retest reliability of our outcome measures, and interviewers were unmasked to intervention allocation. Conclusions There was no evidence that the EmpaTeach intervention effectively reduced physical violence from teachers towards primary or secondary school students in Nyarugusu Refugee Camp. Further research is needed to develop and test interventions to prevent teacher violence in humanitarian settings. Trial registration clinicaltrials.gov (NCT03745573)

School violence, depression symptoms, and school climate: a cross-sectional study of Congolese and Burundian refugee children

“…The evidence on the negative effects of adverse experiences in childhood is well established and exposure to violence, as well as to stressors related to displacement and the refugee experience, are known risk factors for developing mental health disorders [ 54 , 55 ]. To date only one intervention to prevent and reduce school violence in humanitarian settings has been rigorously tested [ 40 ] and while the evidence on effective school-based ways to support mental health and psychosocial wellbeing of refugee children is growing, there remain large evidence gaps [ 56 , 57 ].…”

“…We used data from the baseline survey of the Preventing Violence Against Children in Schools (PVACS) study which is a cluster randomized controlled trial assessing the effectiveness of the EmpaTeach intervention to change teacher practices and reduce use of violence in schools [ 40 ]. A cross-sectional survey was conducted between November and December 2019 with a representative sample of teachers and students in all 27 primary and secondary schools in the camp.…”

“…Surveys were conducted with students in grade 2 or above and aged 9 years and over, as they were able to understand and respond to questions during pre-testing of the instruments. Additional details on sampling and consent procedures are described elsewhere [ 40 ].…”

“…In this study we used survey data collected from students and teachers at baseline, as part of a cluster randomised trial evaluating the effectiveness of a school-based violence prevention intervention in Nyarugusu Refugee Camp in Tanzania [ 40 ], to estimate the prevalence of school violence and depression symptoms among school children and adolescents and we explored the association between student outcomes and dimensions of school climate, based on the hypothesis that positive school climates would be associated with students’ feelings of safety in school and reduced misbehaviours, which could lead to lower levels of violence and depression. We hypothesised that school environments that promote caring relationships between students and teachers, characterised by high levels of trust, that offer opportunities to engage in decision making and to develop skills, would make both students and teachers feel more connected and empowered reducing opportunities for conflict and for experiencing adverse mental health outcomes.…”

Teacher violence from the perspectives of teachers and students and related factors: A survey in Southern Iran

“…Secondary prevention programs in schools provide students with additional training and academic support in disadvantaged areas, so they can reduce violence and the socioeconomic consequences of adolescents’ school delay ( Romero et al, 2018 ). Fabbri et al (2021) demonstrated that teachers with low salary acted more aggressively ( Fabbri et al, 2021 ). Devries et al (2021) believed that economical condition, availability of facilities, a large number of students and supporting system for teaching affected teachers’ behaviors ( Devries et al, 2021 ).…”