Positive impacts of a universal trauma-informed intervention on student mental health: The Project POWER trial

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The move from eighth grade into high school is a particularly important developmental transition that involves both opportunities and challenges.

“The move from eighth grade into high school is a particularly important developmental transition that involves both opportunities and challenges (Benner, 2011).”

• cites Benner, 2011 sourceSupported

Classified as probably not a substantial claim.

There is a particular need for universal interventions to promote protective factors in schools serving low-income communities, given these students' high level of trauma exposure, emotional symptoms, and academic challenges.

“There is a particular need for universal interventions to promote protective factors in schools serving low-income communities, given these students’ high level of trauma exposure, emotional symptoms, and academic challenges (Atkins et al., 2010).”

• cites Atkins et al., 2010 sourcePartly supported

  The “Integration of Promotion, Prevention and Intervention” section (page not available in our copy) supports classroom- and school-wide programs for children with mental health needs and notes particular resource constraints in high-poverty communities. It also links mental health difficulties to poorer school performance. It does not substantiate the stated high level of trauma exposure among students in those communities or specifically frame universal programs as promoting protective factors. (LLM, conf=0.85)

  Experimental — accuracy not yet measured

May combine two claims.

Stress and trauma exposure has physiological effects on the developing brain and stress response system, disrupting adolescents' capacities for emotion regulation and executive functioning and heightening risks for emotional and behavioral problems.

“stress and trauma exposure has physiological effects on the developing brain and stress response system (Lupien et al., 2009), disrupting adolescents’ capacities for emotion regulation and executive functioning (Compas, 2006; McLaughlin & Lambert, 2017) and heightening current and downstream risks for emotional and behavioral problems”

• cites Lupien et al., 2009 sourceNot checked — no full text of the source
• cites Compas, 2006 sourceNot checked — no full text of the source
• cites McLaughlin & Lambert, 2017 sourcePartly supported

  Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

  Experimental — accuracy not yet measured

Classified as probably not a substantial claim.

CBT strategies are empirically supported for treatment of depression, generalized anxiety disorder, and PTSD.

“CBT strategies modify thoughts and behavior to promote healthy emotional functioning and are empirically supported for treatment of depression, generalized anxiety disorder, and PTSD (Butler et al., 2006).”

• cites Butler et al., 2006 sourceSupported

May combine two claims.

The public education system is under-resourced and ill equipped to address the level of mental health need using "pull out" models, such as indicated programs.

“The public education system is under-resourced and ill equipped to address this level of need using “pull out” models, such as indicated programs (Atkins et al., 2010; Baker et al., 2006).”

• cites Atkins et al., 2010 sourceSupported
• cites Baker et al., 2006 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

Adolescence is a developmental stage characterized by increasing rates of emotional and behavioral symptoms and disorders.

“adolescents draw on myriad assets and resources that promote positive youth development, they also experience emotional and behavioral symptoms and disorders at increasing rates during this developmental stage (Merikangas et al., 2022).”

• cites Merikangas et al., 2022 sourcePartly supported

  The Mood disorders in youth section reports rising depression onset during adolescence, and the Anxiety disorders in youth section describes increasing anxiety rates. The Summary says conduct disorder tends to begin in early adolescence. These passages support an adolescent increase in some disorders, but do not establish increasing rates of emotional and behavioral symptoms and disorders as a whole; page numbers are unavailable in our copy. (LLM, conf=0.82)

  Experimental — accuracy not yet measured

May combine two claims.

Most school-based programs that address mental health focus on aggressive and disruptive behavior only, and do not address internalizing mental health issues.

“most school-based programs that address mental health focus on aggressive and disruptive behavior only, and do not address more “silent” or internalizing mental health issues (Hahn et al., 2007; Wilson & Lipsey, 2007).”

• cites Hahn et al., 2007 sourceNot checked — no full text of the source
• cites Wilson & Lipsey, 2007 sourcePartly supported

  The Background and Results (pages unavailable) show that this meta-analysis focuses on school-based programs to reduce aggressive and disruptive behavior. They do not establish that most school-based mental-health programs have that focus. The Results also include internalizing problems, such as anxiety and depression, among the outcomes examined, so the paper does not support the claim that such issues are not addressed. (LLM, conf=0.85)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing).

How youth navigate critical transition points, such as entry into high school, may significantly affect their social and academic success and long-term wellbeing.

“How youth navigate critical transition points, such as the entry into high school, may have particular significance for their social and academic success and thus for their long-term social, emotional, financial, and physical wellbeing (Benner, 2011; Evans et al., 2018).”

• cites Benner, 2011 sourcePartly supported

  The Conclusions (page unavailable) say that how adolescents manage the high school transition can have lasting implications for life trajectories and prospects. The paper also discusses academic performance and socioemotional well-being, supporting the claim’s general point. Our copy does not establish the more specific claim about long-term financial and physical well-being. (LLM, conf=0.84)

  Experimental — accuracy not yet measured
• cites Evans et al., 2018 sourcePartly supported

  The Introduction describes successful transition in terms of social, academic, and emotional adaptation. The academic-achievement section links lower achievement in early adolescence to lower occupational achievement and income across the lifespan, supporting the longer-term financial aspect. The passages do not establish the sentence’s further claim about long-term physical wellbeing. (LLM, conf=0.84)

  Experimental — accuracy not yet measured

Classified as probably not a substantial claim.

The RAP Club curriculum was adapted for delivery in a school context as a universal prevention program.

“The RAP Club curriculum was adapted for delivery in a school context as a universal prevention program (Mendelson et al., 2015).”

• cites Mendelson et al., 2015 sourceSupported

May combine two claims.

CBT skills modify thoughts and behaviors to reduce anxiety, depressive, and PTSD symptoms and promote healthy coping.

“CBT skills modify thoughts and behaviors to reduce anxiety, depressive, and PTSD symptoms and promote healthy coping (Butler et al., 2006).”

• cites Butler et al., 2006 sourceSupported

May combine two claims.

Improvements in youth emotion regulation are associated with decreased psychopathology and enhanced psychological resilience.

“improvements in youth emotion regulation are associated with decreased psychopathology (Moltrecht et al., 2021) and enhanced psychological resilience (Polizzi & Lynn, 2021).”

• cites Moltrecht et al., 2021 sourceSupported
• cites Polizzi & Lynn, 2021 sourceNot checked — no full text of the source

May combine two claims.

Adolescents exposed to chronic stress or trauma often struggle with self-regulation because adversity triggers neuro-biological events that alter development of the stress response system, impairing self-regulation in response to stress.

“Adolescents exposed to chronic stress or trauma often struggle with self-regulation: adversity triggers neuro-biological events that alter development of the stress response system (Andersen, 2003; Andersen & Teicher, 2009; Shonkoff et al., 2009; Teicher et al., 2002), impairing a child’s ability to self-regulate in response to stress (Blair, 2010; West et al., 2001).”

• cites Andersen, 2003 sourceNot checked — no full text of the source
• cites Andersen & Teicher, 2009 sourceSupported
• cites Shonkoff et al., 2009 sourceNot checked — no full text of the source

May combine two claims.

Mindfulness practices build present-focused awareness, improving regulation of thoughts and emotions and thus reducing stress, anxiety, and depression.

“Mindfulness practices build present-focused awareness through experiential activities (Brown & Ryan, 2003), improving regulation of thoughts and emotions and thus reducing stress, anxiety, and depression (Chiesa & Serretti, 2010; Hofmann et al., 2010; Lutz et al., 2008; Tang et al., 2009).”

• cites Brown & Ryan, 2003 sourceNot checked — no full text of the source
• cites Chiesa & Serretti, 2010 sourceNot checked — no full text of the source
• cites Hofmann et al., 2010 sourcePartly supported

  The Results (page unavailable) report improved anxiety and mood symptoms after mindfulness-based therapy. The Conclusion describes present-focused awareness and proposes that responding more reflectively can counter stressors, but presents that mechanism as a belief. The review does not establish improved regulation of thoughts and emotions as the cause of symptom reductions or report stress reduction as an analyzed outcome. (LLM, conf=0.84)

  Experimental — accuracy not yet measured

May combine two claims.

Universal prevention programs have potential to improve not only student mental health but also school climate and culture more broadly.

“Importantly, universal prevention programs have potential to improve not only student mental health but also school climate and culture more broadly (Bradshaw et al., 2009; Kuyken et al., 2022) for instance, by increasing prosocial interactions.”

• cites Bradshaw et al., 2009 sourceNot checked — no full text of the source
• cites Kuyken et al., 2022 sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

RAP Club was adapted over many years of work in the Baltimore community, including community-based participatory research with Black emerging adults and piloting with upper middle school students.

“Finally, the RAP Club intervention was adapted over many years of work in the Baltimore community, including community-based participatory research with Black emerging adults (Mance et al., 2010; Tandon et al., 2011) and piloting with upper middle school students in City Schools (Mendelson et al., 2015).”

• cites Mance et al., 2010 sourceNot checked — no full text of the source
• cites Tandon et al., 2011 sourceNot checked — no full text of the source
• cites Mendelson et al., 2015 sourceSupported

May combine two claims.

School administrators in the trial perceived a need for RAP Club and felt that the program content was relevant and useful.

“Our research suggests that school administrators in our trial perceived a need for RAP Club and felt that the program content was relevant and useful (Arnold et al., 2020).”

• cites Arnold et al., 2020 sourceSupported

May combine two claims.

Students growing up in contexts with high levels of stress and trauma exposure are more likely to experience mental health problems and academic challenges.

“Students growing up in contexts with high levels of stress and trauma exposure deserve universal interventions tailored for their needs because they are more likely to experience mental health problems and academic challenges (Atkins et al., 2010; Baker et al., 2006).”

• cites Atkins et al., 2010 sourcePartly supported

  The 'Integration of Promotion, Prevention and Intervention' section says children's mental health difficulties can impair school performance and discusses classroom-wide supports, including in high-poverty communities (page unavailable). But it does not establish that students exposed to high levels of stress and trauma are more likely to have mental health and academic problems, or specify universal interventions tailored to that exposure. (LLM, conf=0.85)

  Experimental — accuracy not yet measured
• cites Baker et al., 2006 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Six hundred and forty-four 8th grade students recruited across the 29 schools were randomized, and 631 completed the baseline survey.

“Six hundred and forty-four 8th grade students recruited across the 29 schools were randomized and, of those, 631 completed the baseline survey (see Figure 2).”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The average age of the 631 participants at enrollment was 13.2 years old, and 60.1% self-identified as female.

“The average age of the 631 participants at time of enrollment was 13.2 years old, and 60.1% of participants self-identified as female.”

Probably not a substantial claim: may not pass S3 (load-bearing).

As the study partnered with K-8 schools, all participants entered new schools in ninth grade.

“As we partnered with K-8 schools in the trial, all participants entered new schools in ninth grade.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Across all four cohorts, following program completion, 92.2% of the 631 participants completed the post-intervention survey, 77.5% completed the 4-month follow up, and 51.3% completed the 12-month follow up.

“Across all four cohorts, following program completion, 92.2% of the 631 participants completed the post-intervention survey, 77.5% completed the 4-month follow up, and 51.3% completed the 12-month follow up (see Figure 2).”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The 4-month follow-up completion rate was close to 90% for cohorts 1 through 3; due to COVID-19, surveys were administered remotely to cohort 4, reducing the 4-month follow-up completion rate to 48.3% for cohort 4.

“The 4-month follow-up completion rate was close to 90% for cohorts 1 through 3; however, due to the COVID-19 pandemic, surveys had to be administered remotely to cohort 4 over Qualtrics, which reduced the 4-month follow up completion rate to 48.3% for cohort 4.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Participants came from a variety of racial and ethnic backgrounds with approximately 66% identifying as Black or African American, 16% as Latinx, 8% as multiracial, 6% as White, 2% as American Indian or Alaska Native, 1% as Asian, and <1% as Native Hawaiian or other Pacific Islander.

“Participants came from a variety of racial and ethnic backgrounds with approximately 66% identifying as Black or African American, 16% as Latinx, 8% as multiracial, 6% as White, 2% as American Indian or Alaska Native, 1% as Asian, and <1% as Native Hawaiian or other Pacific Islander.”

May combine two claims.

At 12-month follow-up, both boys and girls showed significant improvements across all four mental health domains, regardless of initial PTSD symptoms.

“At 12-month follow-up, however, both boys and girls showed significant improvements across all four mental health domains, regardless of initial PTSD symptoms.”

Classified as probably not a substantial claim.

RAP Club was offered to students without screening for risk factors or symptoms associated with mental health problems.

“As a universal intervention, RAP Club was offered to students without screening for risk factors or symptoms associated with mental health problems.”

May combine two claims.

Of the 29 schools, 24 provided data on the number of students in self-contained special education classes; these schools all reported having 10 or fewer students in self-contained special education classes across grades 6-8, suggesting the number of 8th graders excluded from the pool of potential participants for this reason was quite small.

“Of the 29 schools who participated in the trial, 24 provided us with data on the number of students in self-contained special education classes. These schools all reported having 10 or fewer students in self-contained special education classes across grades 6–8, suggesting the number of 8th graders excluded from our pool of potential participants for this reason was quite small.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Students racialized as Black or Latinx may be exposed to increased levels of racism and discrimination in high school or may experience isolation when transitioning into high schools with fewer students of color.

“Students racialized as Black or Latinx may be exposed to increased levels of racism and discrimination in high school or may experience isolation when transitioning into high schools with fewer students of color (Benner & Graham, 2009).”

• cites Benner & Graham, 2009 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

Study procedures and documents were approved by the Johns Hopkins Bloomberg School of Public Health and Baltimore City Public Schools Institutional Review Boards.

“Study procedures and documents were approved by the Johns Hopkins Bloomberg School of Public Health and Baltimore City Public Schools Institutional Review Boards.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Many students falter during the transition to high school, particularly White and Black boys, launching a trajectory that may end in academic difficulties or failure to graduate.

“Many students falter during this shift, particularly White and Black boys (Sutton et al., 2018), launching a trajectory that may end in academic difficulties or failure to graduate (Allensworth & Easton, 2005).”

• cites Sutton et al., 2018 sourceNot checked — no full text of the source
• cites Allensworth & Easton, 2005Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Spanish-speaking study team members and teachers provided support to students in understanding survey items and unfamiliar phrases, maximizing the number of students able to participate.

“Spanish-speaking study team members and teachers at these schools were able to provide support to students in understanding specific survey items and unfamiliar phrases used in program sessions, maximizing the number of students able to participate.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Other investigators did not have access to lists of randomized students.

“Other investigators did not have access to lists of randomized students.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Fewer than 5 students were excluded from the trial because of foster care.

“We were unable to obtain the necessary permissions to include foster care students in this trial; fewer than 5 students were excluded on that basis.”

Classified as probably not a substantial claim.

Participating students were randomly assigned within schools to the intervention or active control arm by the project statistician using a random number generator.

“Participating students were then randomly assigned within schools to the intervention (RAP Club) or active control (Healthy Topics) arm by the project statistician using a random number generator.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

These stressors impact student mental health and wellbeing, often negatively affecting academic performance.

“These stressors impact student mental health and wellbeing, often negatively affecting academic performance (Benner & Graham, 2009).”

• cites Benner & Graham, 2009 sourceNot checked — no full text of the source

May combine two claims.

Universal intervention approaches that include all students in a grade or school have advantages over targeted approaches, including potential for integration into the curriculum, broad positive impacts on school climate, avoiding stigmatization, and avoiding logistical barriers of screening.

“universal intervention approaches that include all students in a grade or school have several advantages (Mendelson et al., 2019). For instance, universal interventions have potential for integration into the curriculum and for broad, positive impacts on school climate. As they are more inclusive, universal approaches generally avoid stigmatizing specific students”

• cites Mendelson et al., 2019 sourceNot checked — no full text of the source

Classified as probably not a substantial claim.

RAP Club is a 12-session universal prevention program adapted from SPARCS.

“RAP Club is a 12-session universal prevention program adapted from Structured Psychotherapy for Adolescents Responding to Chronic Stress (DeRosa et al., 2006; DeRosa & Pelcovitz, 2009), a group treatment for adolescents with trauma-related issues resulting from chronic stress and adversity.”

• cites DeRosa et al., 2006Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites DeRosa & Pelcovitz, 2009Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

RAP Club has mental health benefits for 8th graders, which increase in strength and scope across the high school transition.

“Findings indicate RAP Club has mental health benefits for 8th graders, which increase in strength and scope across the high school transition.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Sex, baseline levels of psychological distress, and exposure to ACEs have been identified as significant moderators in some intervention studies, although findings have been mixed.

“Sex, baseline levels of psychological distress, and exposure to adverse childhood experiences (ACEs) have been identified as significant moderators in some intervention studies, although findings have been mixed.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

HT matched RAP Club in group size and session length and was co-facilitated by trained study staff and a young adult community member, with training provided to a health or physical education teacher.

“HT matched RAP Club in group size and session length and, like RAP Club, was co-facilitated by trained study staff and a young adult community member, with training provided to a health or physical education teacher in program delivery.”

Classified as probably not a substantial claim.

These core components are designed to boost students' self-regulatory capacities.

“These core components are designed to boost students’ self-regulatory capacities.”

May combine two claims.

The intervention and control groups did not differ by sex, race, or mean number of adverse childhood experiences.

“The intervention and control groups did not differ by sex, race, or mean number of adverse childhood experiences, but the average age of intervention participants was significantly higher than control participants (13.28 vs. 13.17, p = 0.01).”

May combine two claims.

There were no significant differences between 12-month completers and non-completers on intervention arm, sex, race, baseline anxiety symptoms, or baseline PTSD symptoms.

“There were no significant difference between those who completed the 12-month assessment and those who did not with respect to intervention arm, sex, race, baseline anxiety symptoms, or baseline PTSD symptoms.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Mental health symptoms were student reported and were not assessed using clinician-rated interviews or parent or teacher reports.

“Mental health symptoms were student reported; symptoms were not assessed using clinician-rated interviews or parent or teacher reports.”

Classified as probably not a substantial claim. May combine two claims.

Self-regulation difficulties place youth at risk for externalizing and internalizing symptoms, as well as academic problems.

“Self-regulation difficulties place youth at risk for externalizing and internalizing symptoms (Aldao et al., 2010; Folk et al., 2014; Izard et al., 2002; Silk et al., 2003), as well as academic problems (Siebert et al., 2017).”

• cites Aldao et al., 2010 sourceNot checked — no full text of the source
• cites Folk et al., 2014 sourceNot checked — no full text of the source
• cites Izard et al., 2002 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

Intervention participants had a significantly higher average age than control participants (13.28 vs. 13.17, p = 0.01).

“The intervention and control groups did not differ by sex, race, or mean number of adverse childhood experiences, but the average age of intervention participants was significantly higher than control participants (13.28 vs. 13.17, p = 0.01).”

Probably not a substantial claim: may not pass S3 (load-bearing).

The four-item PROMIS Pediatric Anxiety scale showed good reliability in the sample at baseline (α = .83).

“The scale demonstrated good reliability in our sample at baseline (α = .83).”

Probably not a substantial claim: may not pass S3 (load-bearing).

The 11-item behavioral dysfunction subscale had adequate internal consistency in the sample (α = 0.76).

“this scale had adequate internal consistency in our sample (α = 0.76).”

Probably not a substantial claim: may not pass S3 (load-bearing).

The Children's Depression Inventory Short Form showed good reliability in the sample at baseline (α = .86).

“The CDI-S demonstrated good reliability in our sample at baseline (α = .86).”

Probably not a substantial claim: may not pass S3 (load-bearing).

The Youth Outcome Questionnaire - Self Report showed excellent reliability in the sample at baseline (α = .94).

“The YOQSR demonstrated excellent reliability in our sample at baseline (α = .94).”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

At the 4-month follow-up, 489 participants completed the survey, a 77.5% retention rate.

“At the 4-month follow-up, 489 participants completed the survey (77.5% retention).”

May combine two claims.

There were no significant differences between 4-month completers and non-completers on intervention arm, sex, race, age, baseline anxiety, PTSD, or depression symptoms, or baseline ACEs.

“There were no significant differences between those who completed the 4-month assessment and those who did not with respect to intervention arm, sex, race, age, baseline anxiety, PTSD, or depression symptoms, or baseline ACEs.”

May combine two claims.

Both intervention and active control programs were implemented with adequate fidelity, and participants in each program had relatively high attendance and engagement and low disruption.

“Both the intervention and active control programs were implemented with adequate fidelity, and participants in each program had relatively high levels of attendance and engagement and low levels of disruption.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Four-month participation differed by cohort (p < 0.01), with reduced completion in cohort 4 due to COVID-19 school closures.

“Those reporting Latinx ethnicity (p = 0.01) were more likely to not participate at the 4-month assessment, however, and participation differed by cohort (p < 0.01), with reduced survey completion in cohort 4 due to school closures at the onset of the COVID-19 pandemic.”

May combine two claims.

Twelve-month follow-up completion rates differed by cohort (p < 0.01), with lower participation from cohorts 1 and 4 and higher participation from cohorts 2 and 3.

“Twelve-month follow-up completion rates also differed by cohort (p < 0.01), with lower participation from cohort 1 (35.2%) and cohort 4 (37.6%) and higher participation from cohorts 2 (60.8%) and 3 (68.1%).”

Probably not a substantial claim: may not pass S3 (load-bearing).

Healthy Topics delivery was rated as having higher average quality than RAP Club delivery.

“Delivery of HT was rated as having higher average quality than delivery of RAP Club (mean (SD) = 2.93 (0.21) vs. 1.85 (0.56), p < 0.001).”

May combine two claims.

Two trained coders independently rated 25% of randomly selected session videos for each program, and interrater reliability between them exceeded 80% for both programs.

“For each program, two coders independently rated 25% of the session videos (approximately 40 videos per program) that were randomly selected to represent implementation across schools, cohorts, instructors, and sessions.”

• Also stated in: § Fidelity · plain

  “Interrater reliability between the two coders was above 80% for each program (HT = 91.0%, RAP = 94.0%)”

May combine two claims.

A gold standard coder independently rated 20% of the randomly selected videos, and agreement between the two trained coders and the gold standard coders exceeded 80% for each program.

“For each arm, a gold standard coder with experience in program instruction provided additional independent coding on 20% of the randomly selected videos to ensure consistent quality of coding.”

• Also stated in: § Fidelity · plain

  “interrater reliability of the two trained coders with the gold standard coders was above 80% (HT = 92.2%−94.4%, RAP = 83.5%−84.8%).”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

Psychoeducation promotes understanding of how stress and trauma affect the body, increasing student awareness of stress and emotions and laying the groundwork for student engagement with program skills.

“Psychoeducation promotes understanding of how stress and trauma affect the body, increasing student awareness of stress and emotions and laying the groundwork for student engagement with program skills.”

Classified as probably not a substantial claim.

Each model included sex, cohort, baseline depressive, anxiety, and PTSD symptoms, age, and race/ethnicity as covariates.

“We included sex (male/female), cohort, baseline mental health measures (depressive, anxiety, and PTSD symptoms), age, and race/ethnicity (Black/White/Latinx) as covariates in each model.”

Classified as probably not a substantial claim. May combine two claims.

The intervention core components are mindfulness, CBT skills, and psychoeducation about the impact of stress and trauma on the body.

“the intervention core components are mindfulness, CBT skills, and psychoeducation about the impact of stress and trauma on the body.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Post-test participation differed by cohort, with cohort 2 having the lowest completion rate (85.1%, p < 0.01).

“Participation differed by cohort, with cohort 2 having the lowest rate of post-test survey completion (85.1%, p < 0.01).”

May combine two claims.

There were no significant differences between post-test completers and non-completers on intervention arm, sex, race, ethnicity, age, baseline anxiety, PTSD, or depression symptoms, or baseline ACEs.

“There were no significant differences between those who completed the post assessment and those who did not with respect to intervention arm, sex, race, ethnicity, age, baseline anxiety, PTSD, or depression symptoms, or baseline ACEs.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The Child PTSD Symptom Scale showed excellent reliability in the sample at baseline (α = .92).

“The overall scale demonstrated excellent reliability in the sample at baseline (α = .92).”

Probably not a substantial claim: may not pass S3 (load-bearing).

Participants reporting Latinx ethnicity were more likely to not participate at the 4-month assessment (p = 0.01).

“Those reporting Latinx ethnicity (p = 0.01) were more likely to not participate at the 4-month assessment, however, and participation differed by cohort (p < 0.01), with reduced survey completion in cohort 4 due to school closures at the onset of the COVID-19 pandemic.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

At the 12-month follow-up, 324 participants completed the assessment, a 51.3% retention rate.

“At the 12-month follow-up, 324 participants completed the assessment (51.3% retention rate).”

May combine two claims.

Twelve-month completers tended to be younger (p < 0.01) and less likely to report Latinx ethnicity (p < 0.01), with lower baseline depressive (p = 0.02) and ACEs (p = 0.02) scores than non-completers.

“Those who completed the 12-month follow-up tended to be younger than non-participants (p < 0.01) and less likely to report Latinx ethnicity (p < 0.01), with lower baseline depressive (p = 0.02) and ACEs (p = 0.02) scores than non-participants.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Baseline measures of depression, anxiety, and PTSD were each within one standard deviation of one another across cohorts.

“Baseline measures of depression, anxiety, and PTSD were each within one standard deviation of one another across cohorts.”

Classified as probably not a substantial claim.

The study used an intent-to-treat approach in its multilevel models.

“Using an intent to treat approach, multilevel models (Bryk & Raudenbush, 1992; Hedeker & Gibbons, 1994, 1996a, 1996b) were estimated to test the effect of RAP Club while accommodating the hierarchical structure of the data.”

Classified as probably not a substantial claim.

Missing data were handled by calculating inverse probability weights that included intervention status, baseline assessments, and demographics.

“To handle missing data, we calculated inverse probability weights.”

• Also stated in: § Statistical Analyses · plain

  “We included intervention status, baseline assessments, and demographics in the equation used to create the inverse probability weights.”

May combine two claims.

The higher quality ratings for Healthy Topics than RAP Club may attenuate intervention impact, although adherence ratings did not differ between programs.

“Ratings of the quality of intervention delivery were higher for HT than for RAP Club, potentially because RAP Club is a more complex program to deliver. This difference may attenuate intervention impact; adherence ratings, however, did not differ between the programs.”

May combine two claims.

The findings indicate that RAP Club has mental health benefits for upper middle school students, and these benefits were sustained and strengthened across the transition into high school.

“In summary, our findings indicate that the RAP Club intervention has mental health benefits for upper middle school students, which were sustained and strengthened across the important transition into high school.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The study used a binary measure of sex and did not identify non-binary or trans youth or youth with other sex identities.

“Finally, we used a binary measure of sex in the current study and did not identify non-binary or trans youth or youth with other sex identities.”

Classified as probably not a substantial claim. May combine two claims.

RAP Club addresses key gaps in school-based services, including the need for a universal trauma-informed approach for adolescents in communities with common chronic stress and trauma exposure and the inclusion of mindfulness as a core component.

“RAP Club addresses key gaps in school-based services and supports, including the need for a universal trauma-informed approach for adolescents growing up in communities where chronic stress and trauma exposure are common and inclusion of mindfulness as a core intervention component to enhance emotion awareness and regulation.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The COVID-19 pandemic affected follow-up assessments for Cohort 4; school closures reduced participation.

“With respect to cohort effects, the COVID-19 pandemic affected follow up assessments for Cohort 4; due to school closures, follow up surveys were administered via electronically via links sent over email, rather than in person, significantly reducing participation.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The pandemic did not disrupt baseline or post-intervention data collection or program delivery.

“However, we were fortunate that the pandemic did not disrupt baseline or post-intervention data collection or program delivery.”

May combine two claims.

Strengths include a rigorous trial design with an active control comparator and a relatively large student sample enrolled across 29 schools.

“Strengths of the current study include a rigorous trial design with an active control comparator program and relatively large student sample enrolled across 29 schools.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The study did not enroll students in self-contained special education classrooms because the programs and assessments were not well aligned with those students' needs.

“We did not enroll students in self-contained special education classrooms because the programs and assessments were not well aligned with those students’ needs.”

May combine two claims.

Participating students were randomized within schools, which carries some risk of cross-program contamination if intervention participants discuss program content with control participants.

“In the current trial, participating students were randomized within schools. This design carries some risk of cross-program contamination if intervention participants discuss program content with control participants.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The study was unable to offer the programs in Spanish at this stage.

“We were also unable to offer the programs in Spanish at this stage in the research, which would have facilitated engaging additional students.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Volunteers are not representative of all students in a grade; they are likely more motivated and have more engaged parents.

“Volunteers are not representative of all students in a grade; they are likely to be more motivated and to have more engaged parents and thus may have more internal resources and external supports.”

May combine two claims.

The study enrolled a racially and ethnically diverse adolescent sample living predominantly in under-resourced communities with high rates of violence and other traumatic stressors.

“The study also enrolled a racially and ethnically diverse adolescent sample of students who lived predominantly in under-resourced communities with high rates of violence and other traumatic stressors, an important population that has often been neglected in school-based intervention trials.”