Background
Self-harm affects approximately 17% of adolescents and is a leading risk factor for suicide. Early prevention is needed during late childhood before the onset of self-harm. Schools are an ideal prevention setting, as they are wide-reaching and have inbuilt socio-emotional learning systems. However, few school-based self-harm prevention programs currently exist. To address this gap, the Black Dog Institute (with Orygen) secured MRFF funding to co-design and test a novel self-harm prevention intervention (called “Bridge-to-Better (B2B)”) in NSW primary schools. This protocol describes the trial to evaluate the effectiveness of the B2B program at preventing the onset of self-harm and increasing psychological wellbeing in children, whilst also investigating implementation.
Method and analysis
This cluster randomised controlled trial will involve over 6,500 students in Years 3-6 (aged 8-12 years) from 72 government and independent primary schools across NSW. Schools will be randomised to receive either the full B2B program or a simplified version (attention matched control). The full B2B program is delivered by teachers during regular lessons and provides emotion regulation training along with structures and practices to promote social connectedness. The simplified version only has classroom structures to promote connectedness. Both versions are delivered over 26 weeks. B2B was co-designed with three groups of stakeholders: n = 120 students in 4 x primary and 2 x secondary schools, n = 18 education leadership, wellbeing and classroom staff and n = 6 adolescents with lived experience of self-harm (advisors).
Survey data will be collected at baseline (0 weeks), post-intervention (26 weeks) and 6-months post-intervention (52 weeks). The dual primary outcomes are child self-harm and psychological wellbeing. Secondary child health outcomes include emotion regulation self-efficacy and social connectedness. Implementation outcomes include teacher-reported program acceptability, feasibility, appropriateness and adoption. Post-intervention follow-up interviews will be conducted with teachers to understand how (if at all) they integrated the B2B program into routine teaching practices.
Discussion
This is a world first large-scale trial of a universal, self-harm prevention intervention in NSW primary schools. If found to be effective, B2B can be scaled across NSW schools via our partnership with the NSW Department of Education to potentially benefit 695,650 children attending NSW primary schools. There is also the potential for national scalability, where the program could benefit 2.27 million Australian primary school students. Our findings will also advance what is known about how to prevent suicide at a previously unconsidered point – adolescent self-harm.