DESCRIPTION (provided by applicant): The mission of the Healthy Youth Development Prevention Research Center (UMN PRC) is to collaborate with health departments, related agencies and community partners to develop and disseminate actionable knowledge and practices that promote healthy development and health equity among all young people. Our specific aims, reflected in our unit-specific work plans, include the use of interdisciplinary research, training, community education, TA, capacity-building, strategic communications, and evaluations to build health, competence, and capacity throughout the second decade of life and beyond, and to build capacity in partners working with and on behalf of young people. Our long-term objectives focus on expansion of scientific knowledge and increased use of evidence-based public health programs that advances the national health agenda as reflected in Healthy People 2020's adolescent-focused goals (5 of 7 priority areas), promotes health equity as articulated in the National Prevention Strategy, and addresses CDC adolescent-related Winnable Battles (i.e., reproductive health). The UMN PRC core project, Partnering for Healthy Student Outcomes (PHSO) is a comparative study of the relative effectiveness of a school-based, social-emotional learning (SEL) prevention program for students attending culturally diverse, economically disadvantaged middle schools in the Minneapolis-St. Paul, MN metro area. Our primary research question is: Will a multi-year, school-based prevention program, infused with professional development (PD) aimed at increasing the capacity of middle school teacher teams to engage their students in learning, yield changes in middle school students' health risk behaviors and academic outcomes that exceed outcomes from a school-based student-focused prevention program alone? The research has two primary aims: Primary Aim 1: Conduct a pilot study to determine the feasibility and acceptability of a school-based, SEL+PD program (Positive Action plus teacher-team professional development and support) designed to reduce health risk behaviors (violence, bullying, substance use, sexual risk behaviors) and increase academic achievement among middle school students; and Primary Aim 2: Implement a SEL plus teacher-team professional development program and evaluate its effectiveness on student outcomes compared to a SEL program alone. We will evaluate the two conditions in a matched pairs, randomized trial involving approximately 840 students in 4 urban middle level schools across 3 school years.

I. INFRASTRUCTURE AND ADMINISTRATION (Index of acronyms in Appendices Table of Contents) A. Mission, Goals and Priorities. Minnesota is a prime arena for addressing social inequities in health. Rapidly changing demographic composition has contributed new strengths as well as challenges to our health, education, and social service systems. MN leads in East African, Latino and SE Asian immigration; Minneapolis has the second largest urban American Indian population in the US. Our communities of color are relatively young in terms of percentage of families with children, and particularly in Minneapolis and St. Paul, health disparities are intermingled with economic distress and social segregation. The stark reality confronting our communities and our systems of care is the deepening need for partnerships that meld community experience with scholarship and public health (PH) practice-based knowledge. We believe, in the words of the Lancet International Advisory Group on Adolescent Health, that "...failure to invest in the second decade of life, despite the availability of proven and promising prevention and health promotion strategies, will jeopardize earlier investments in health, substantially erode the quality and length of human life, and escalate human suffering, inequity, and social instability."1 The University of Minnesota Healthy Youth Development Prevention Research Center (UMN PRC) is dedicated to nurturing partnerships that will co-create the fusion of knowing and doing through its core mission: through collaboration with health departments, related agencies & community partnerships, develop and disseminate actionable knowledge and practices that promote healthy development & health equity among all young people, and, in so doing, advance adolescent-focused Healthy People 2020 (HP 2020) goals, elements of the National Prevention Strategy, and CDC Winnable Battles, particularly reproductive health. B. Organizational Structure and Linkages. Initially funded by the CDC in 1996 as the National Teen Pregnancy Prevention Research Center, UMN PRC is embedded in an institutional context highly conducive to achieving its core mission, goals and objectives, and leveraging complementary resources that expands its reach and impact. As in Org Charts (App D), UMN PRC is part of an Academic Health Center (AHC) that includes the Schools of Medicine, Nursing, Public Health, and the UMN's CTSA. UMN PRC faculty/staff are appointed in these AHC schools along with the College of Education & Human Development. The AHC is under the direct authority of the UMN President, whose community engagement activities are conducted under the auspices of the Office of Public Engagement to which UMN PRC members play an ongoing advisory role. Likewise, the UMN CTSA partners with the PRC to strengthen its own inter-collegiate community engagement portfolio of applied public health research, training, outreach and advocacy. UMN PRC is located within the Division of General Pediatrics & Adolescent Health (DOGPAH), with its 35- year history and expertise in adolescent health research and translation, training, TA, community partnerships, strategic communications, and dissemination of evidence to promote effective programs, policy and public health practice. At its inception, UMN PRC capitalized on this experience through immediate formation of a Community Advisory Network, and involvement of community partners, health departments and related agencies in the crafting of our earliest core research focused on preventing teen pregnancy and sexual risk behaviors (Prime Time). This early research evolved into school and clinic-based interventions that engaged community members, educators and PH professionals in youth-development strategies to prevent teen pregnancy, violence involvement, and school dropout. Our earliest intra- and inter-collegiate linkages with the Konopka Institute for Best Practices in Adolescent Health (and its State Adolescent Health Resource Center that provides TA and consultation to the nation's network of State Adolescent Health Coordinators), the Center for Adolescent Nursing (with its extensive history of adolescent health research and preparation of the scholarly and practice workforce), and the School of Public Health, nurtured the early development of an interdisciplinary faculty and staff, linked across academic units, with a shared commitment to prevention science, community engagement, applied research and its translation into action. C. Staffing Plan. UMN PRC 2014-2019 will be guided by a Leadership Team comprised of Director Resnick, Deputy Director Sieving, and Team Leaders: Oliphant (Community), Shea (Communications), Jordan (Training), Shlafer (Evaluation) and McMorris (Research). The UMN PRC Org Chart (App D) depicts the Leadership Team that will provide overall direction to the PRC, the interdisciplinary teams for each unit, their key activities, and reporting lines within the broader context of the Division. We developed this organizational structure in our initial funding cycle, honed and refined over time, recognizing that a Leadership Team that includes CAN co-chairs (nominated & elected as per CAN by-laws) is essential to a PRC that is nimble and responsive to priorities and concerns from health departments and other community partners. The UMN PRC led the March 2008 PRC national network pre-conference ¿Structured for Success¿ that explicated the PRC network¿s experiences with varying infrastructure arrangements. With the goal of enhancing each PRC's capacity to increase its own effectiveness through infrastructure modification and improvements, this marked the 1st time in the history of the network that PRC directors/representatives shared with each other the various infrastructure arrangements crosscutting the national network. D. Leveraged Resources and Institutional Commitments. Since its inception, UMN PRC has garnered approximately $21,000,000 in research and training grants, PRC Special Interest Projects, foundation grants, contracts and external sales. Documented in Letters of Support and shown in the UMN Org Relationships Chart, the UMN institutional commitment in this competitive renewal application equals approximately $365,000, i.e., annual match dollars for each of 5 years of the project period from the Office of the Vice President for Research ($10,000), the AHC ($20,000), Department of Pediatrics ($20,000), CTSA (15% Training Team Leader Jordan salary and fringe support, ~$23,000), and the Division of General Pediatrics & Adolescent Health (office space, administrative, financial and technological support). E. Qualifications and History of PRC Director. On faculty since 1981, Michael Resnick, PhD, Professor of Pediatrics, Nursing, and Public Health, holds the Konopka Chair in Adolescent Health & Development. He is the founding PD/PI (1996) of the UMN PRC. With colleagues, his work has had a transformative impact on shaping the field of adolescent health in the US and globally. Beginning in the 1980s, under his leadership of the National Adolescent Health Resource Center (funded by MCHB/HRSA/DHHS), the MN Adolescent Health Survey and the subsequent American Indian Adolescent Health Survey (the largest survey of American Indian and Alaskan Native youth ever undertaken at the time) formed the basis for the CDC in creating the National Youth Risk Behavior Survey (YRBS). Resnick served as a consultant to the CDC as the YRBS was being developed, which today, is implemented in nearly every state across the country. His federal congressional testimony on the findings of the Indian Adolescent Health Survey helped propel Congress to authorize more than $30 million for adolescent mental health for young people on reservations, a 1st in the history of the Indian Health Service. Resnick was also invited under two presidential administrations to be a keynote speaker at White House conferences on youth. It is this interweaving of research and the translation of research to improve the health and well-being of young people that has characterized his career. It is also because of his growing reputation that in the mid 1990s he was invited to be a Co-PI on the National Longitudinal Study of Adolescent Health (Add Health) where, leading the MN team he had lead responsibility for crafting the initial adolescent health survey component of that study. That landmark research was released in 1997 with Resnick as lead author in JAMA. 2 This seminal article has been cited more than nearly any other publication in the field of adolescent health and led to widespread prominence of the theme that has epitomized his research: the influence of connectedness on adolescent health and well-being. Resnick's work has had a profound impact on the field of adolescent health, ranging from our own federal Office of Adolescent Health to the work of transnational institutions such as the World Health Organization, the Pan American Health Organization, UNICEF, and more recently, the Lancet International Advisory Group on Adolescent Health, where we see adoption of the healthy youth development paradigm that flows directly from Resnick's work. In this area of research and research translation, no measures are more frequently used, than those developed by Resnick with his interdisciplinary team at UMN. The use of this research on how to best advance health equity in young people, assuring their ability to enter into rapidly changing social contexts and a very complex global economy, embodies what Resnick has long defined as a goal of his career: to use science, translation, dissemination and evidence-based advocacy to assure that we regard adolescents as whole human beings in the context of family, peers, school and community, not as a simple set of risk indicators. It is his ability to translate that research that has resulted in global impact. He has been invited to speak at policy and research forums in Australia, New Zealand, Canada, Portugal, Britain, Malaysia, Iceland, Germany, Switzerland, and Turkey. And because of his international reputation he has attracted fellows and trainees from not only across the United States but from Spain, Australia, New Zealand, Ghana, China, Barbados, Argentina, Uruguay, Israel, and Canada, seeking to learn how to conduct research into healthy youth development and to translate that work to set public health priorities and policies that benefit youth. Resnick has been PI or Co-I on numerous federal and foundation research grants focusing on health and risk behaviors, resiliency and protective factors in the lives of young people, with emphasis on issues related to adolescent sexual behaviors, teen pregnancy, violence and school drop-out. He has been PI on $17.7 million in external grants (NIH, CDC, MCHB, foundations) and co- PI/co-author on an additional $8.7 million in external grants (counting awards of >$100,000). He has 177 peer reviewed journal articles, book chapters, reviews, and monographs, many reflecting his active mentoring of newer faculty, fellows, and staff. He has served as a consultant/reviewer for WHO, NSF, CDC, NIH, the Society for Adolescent Health & Medicine, the Guttmacher Institute, the Natl Campaign to Prevent Teen & Unplanned Pregnancy, and several international research councils. He has received 4 outstanding teaching and research awards. His PRC commitment will be 25%, supported by a combination of PRC funds and resources from his Endowed Chair and match dollars. F. Multidisciplinary Faculty and Staff with Demonstrated Experience. The UMN Org Chart shows the academic appointments and inter-linkages of faculty and staff across the Schools of Medicine, Nursing, and Public Health, and within our Division (DOGPAH) that create the group comprising UMN PRC. A particular strength of this team is its intercollegiate, interdisciplinary composition, years of continuity in terms of working relationships, and extensive experience in partnering with state, county and local health departments, related agencies, and an array of community partners that share a commitment to nurturing healthy adolescent development and the promotion of health equity among all young people. A table in Facilities & Resources lists the PRC members, their areas of expertise and those who hold 1o and 2o appointments in AHC schools and elsewhere at UMN. Our embeddedness in collaborative networks further flows from a long series of core, community-partnered PRC projects that link scholarship, practice and dissemination of evidence with our broader constituents and partners, foremost among them - state and local health departments, schools and youth-serving agencies. As noted in a table in Facilities & Resources, PRC members are partnered with national, regional, state and local collaborating organizations in a variety of capacities: research, TA, training, evaluation, program and policy development, enactment, and diffusion. These relationships provide the basis for our proposed scope of work, designed to address adolescent-focused national health goals, elements of the National Prevention Strategy, and the CDC's Winnable Battles. G. Ongoing-prevention Projects & Activities. UMN PRC members are engaged in a wide array of prevention/health promotion activities supported by a diverse portfolio of funding that reflects our interdisciplinary composition and well-established partnerships. These research, training and dissemination activities will underpin much of UMN PRC's plan for activities over the next 5 years, involving state, county and local departments of health, related agencies, community organizations and scholarly partners that share a commitment to healthy youth development, the dual strategy of reducing risk while enhancing protective factors and capacity in the lives of young people, and enhancing health equity that promotes positive life trajectories for youth, particular those living in challenging social environments. UMN PRC On-going Prevention Projects and Activities Supported by non-PRC Funds (alphabetically listed) Project / Activity Award Type Funding Source Total Award Funding Dates College Resources and Sexual Health Research MCHB, HRSA $706,293 2010-14 Doula Support for Pregnant Jailed Women Research UMN Prog Hlth Dispar $25,000 2013-13 Evaluation of a Restorative Justice Program for Youth Research MN Dept Public Safety $53,872 2010-13 Evaluation of Big Brothers Big Sisters School-Based Mentoring Program Research OJJDP, Dept of Justice $239,978 2012-15 Interdisciplinary Research Training in Primary Care Training BHPr, HRSA $2,267,867 2012-17 Leadership Education in Adolescent Health Training MCHB, HRSA $1,893,725 2012-17 MN Com Networks Ctr for Eliminating CA Disp; Outreach, Res, Training Center NIH $4,618,891 2010-15 MN Partnership for School Connectedness Research IES, US Dept of Ed $1,490,000 2010-14 Observations of Children's Visits with Jailed Parents Research UMN OVPR Grant-in-Aid $37,033 2013-14 Project EAT-IV: Eating and Activity in Adolescents & Young Adults (R01) Research NIDDK, NIH $2,973,317 2013-17 Promoting Hlth & Pos Youth Devel for Somali, Latino, & Hmong Youth Research Natl Inst Minority Hlth,NIH $1,102,231 2013-16 Reducing Stigma, Promot Resilience: Pop Hlth Interv for LGBTQ Youth Research Canadian Inst of Hlth Res $399,225 2012-17 State Adolescent Health Resource Center Center MCHB, HRSA $1,500,000 2009-14 Transitions in Adult Health Care for Youth with Mobility Limitations Research NCBD, CDC $2,375,000 2009-14 UMN Knowledge to Practice in Adolescent Health Training MCHB, HRSA $289,787 2013-16 Understanding Dispar in Obesity & Weight Behaviors by Sexual Identity Research NICHD, NIH $230,187 2012-14 Using Developmentally Appropriate Educational Materials to Improve Child Behavioral Health & Family Relationships with Jailed Parents Research UW-Madison/UMN CTSA CHEA $149,805 2013-15 II. COMMUNITY ENGAGEMENT, PARTNERSHIPS, AND TECHNICAL ASSISTANCE A. Collaboration with Community Health Departments and Other Stakeholders. UMN PRC has an extensive history of collaborating with and providing technical assistance (TA) to local, county and state departments of health. As shown in the Work Plan, these ties will continue as we engage in work that connects with community and increases the capacity of the PH workforce, i.e., we will capitalize on these relationships as evidenced through Letters of Support. Community Advisory Network: Headed by Team Leader Oliphant, UMN PRC will utilize the expertise of our Community Advisory Network (CAN). Members of CAN are professionals who have broad expertise in community-based health issues with young people and are employed by PH departments, departments of education, and community-based non-profits. Half of the current members work in city, county and state public health departments thereby strengthening the CAN-UMN PRC connection to public health. CAN advises on various aspects of UMN PRC, including the core research project, community engagement efforts, PH policies, training priorities, and dissemination strategies. Also, CAN provides invaluable guidance on accessing youth-serving professionals, such as nurse practitioners and physicians, teachers, and other public health professionals and will continue to advise on best means for reaching target populations and ensuring greater reach and impact of Center activities. Past examples of CAN involvement include advising on dissemination of the state's policy plan for teen pregnancy prevention, development of topics for training in the Summer Institute, and advising on the core research projects such as assessing the need of out-of-school youth. Letters of Support detail activities, roles and responsibilities, and partnerships goals for 2014-19. Led by 2 co-chairs (elected by the whole body of the CAN to serve 2-year terms), the entire CAN meets quarterly with additional ad hoc meetings as needed; co-chairs also participate in monthly Leadership Team meetings. Co-chairs and all CAN members fulfill duties as outlined by the UMN PRC's CAN job descriptions, rules/policies, and community engagement agreement, all created and approved by CAN (App D). A bi- monthly electronic newsletter assures communication with CAN, the Youth Advisory Board (described below), and local, state and national partners. UMN PRC co-chairs have always actively engaged in the National Community Committee (NCC), serving as chairs or members of the Oral Health Special Interest Group, Policies & Procedures, and Fund Development. Oliphant and at least one co-chair have regularly attended all NCC activities and participate in NCC monthly telephone calls. Oliphant has the trust of CAN and extensive connections to community members, including UMN PRC's target populations. A founding member of the now highly organized NCC, Oliphant has led UMN PRC's CAN since its inception. Youth Advisory Board. UMN PRC will build on its existing Division's Youth Advisory Board (YAB). YAB currently consists of 8 adolescents and young adults (ages 14-21 yrs) who have been trained on adolescent health issues, including teaching interviewing skills to health providers. YAB will be expanded to include 3 youth who have been participating as peer educators in our current PRC core Latino teen pregnancy prevention research project. YAB members are paid on an hourly basis with PRC match funding. Guided by Oliphant, YAB will follow a Youth-on-Boards training model for its monthly meetings designed to advise on various UMN PRC activities. One YAB member elected by YAB will participate in CAN and PRC Leadership Team meetings. In addition, YAB members will be engaged in community activities, providing TA to health departments for the development of programming as well as providing training and feedback around interviewing skills to medical and oral health professionals. Thus, YAB members will serve as technical experts and teachers to practitioners who need training in best practices for interviewing adolescents on specific topics related to the HP 2020 goals identified in the Community Engagement Work Plan. B. Community Support and Engagement. UMN PRC will collaborate and provide TA to several departments of health and education in its proposed scope of work, to commence in Fall 2014, including: 1. Oral Health and HPV-An Adolescent Health Initiative: The Minnesota Department of Health (MDH) and UMN PRC will collaborate to develop a best-practice approach for MN dentists and oral health providers to increase the awareness of Human Papillomavirus (HPV) and the link to oropharyngeal cancer (OPC). MDH's Oral Health Program and UMN PRC will develop a module for interviewing skills for dental health providers that focuses on HPV, HPV vaccine and adolescent-friendly services, especially in school settings. This work is an extension of the MDH Oral Health State Plan and the PRC's NCC Oral Health Work Group with approaches based on CDC's recommendations for approaching high-risk groups for HPV-associated OPCs and current trends in the incidence of HPV-positive OPCs. YAB members will provide direction on module development and teach the module to oral healthcare providers. Sparked by conversations with the Natl Oral Health Alliance, NCC, and MDH, this novel approach of using adolescents to teach oral health providers is the 1st of its kind. Key stakeholders include the MN Oral Health Program and MDH Center for Health Promotion. Under the director's leadership, we will have access to the statewide network of dental providers and entry into annual conferences of oral health providers to teach the new module. 2. Adolescent Health Clinics Standards of Care and MN's DASH HIV Grant: Hennepin County (which includes Minneapolis) Human Services and Public Health Department efforts to standardize clinical care for adolescents are a systems-level innovation critical for improved adolescent sexual health outcomes. The standards align with federal-level initiatives in the Office of Adolescent Health, CDC's Divs. of Reproductive Health and Adolescent & School Health (DASH) that emphasize the use of standards-based approaches. We will partner with Hennepin County, MDH and MDE staff funded by CDC DASH and the Natl Network of State Adolescent Health Coordinators with the State Adolescent Health Resource Center (SAHRC) to expanded adoption of clinical standards. This partnership will target new Hennepin County clinics, statewide clinics in school districts targeted through the DASH grant, and nationally, clinics in other states, via the training of State Adolescent Health Coordinators involved in sexual health programs. The partnership will leverage diffusion of innovation strategies to accomplish this goal: segmenting audiences based on adoption and thought-leader status, identifying and promoting the relative advantages of adoption, and addressing compatibility, complexity and trial-ability. These will be promoted via 1) applied communications strategies and products (UMN PRC and Hennepin County will co-create a tool kit); 2) experiential training facilitated by the YAB that will offer clinics real-world experience effectively engaging adolescents; and 3) through inter- personal interactions and relationships, likely accomplished through the formation of a national Collaborative Innovation Network that will allow partners to directly support one another. We regularly partner with SAHRC to support state PH department collaborations to improve systems approaches to adolescent health. 3. MN Chlamydia Partnership (MCP): MDH identified chlamydia as a leading cause of morbidity in MN. Seeking an innovative strategy for its prevention and control, the STD Clinical Specialist Infertility Prevention Project Coordinator (MDH STD and HIV Section) and key stakeholder has requested the UMN PRC to provide TA on future MCP activities. Specifically, through monthly planning meetings and in-the-field TA, we will collaborate on models of care and dissemination of best practices for chlamydia control. These approaches are grounded in the MN State Plan for Chlamydia Prevention developed in a current partnership between MDH and UMN PRC. We will work collaboratively both locally and in greater Minnesota to provide county and local public health as well as community-based health non-profits on non-traditional approaches to the prevention and control of this sexually transmitted disease as outlined in the MN State Plan. 4. Minneapolis Urban Initiative for Reproductive Health: UMN PRC and the Minneapolis Urban Initiative for Reproductive Health under the guidance of key stakeholder, Minneapolis Health Department, will collaborate on development of an innovative model to provide sexual health education to students along with their teachers and coaches in this large urban school district. We will provide TA on implementation of evidence-based sexual health curricula in all 6-8th grade classrooms in the district, as well as in the district's charter and alternative schools. UMN PRC will also provide leadership in development of a program designed to assist coaches in preventing sexual bullying within school sports teams and among team members. 5. Minneapolis Blueprint for Youth Violence Prevention: Minneapolis and its health department are widely-recognized for ground-breaking work in implementing a comprehensive, multi-sectorial plan to prevent youth violence: Blueprint for Action: Preventing Youth Violence. As one of a select group of cities invited to join the Urban Networks to Increase Thriving Youth (UNITY) through a CDC-funded cooperative agreement, Minneapolis promotes collaboration across public and private sectors and adoption of a comprehensive approaches to violence prevention. True to a PH model, the Blueprint lays out 1o, 2o, and 3o prevention goals along with 34 action steps to reduce and prevent youth violence. An executive committee including PRC, government, nonprofit, business and youth representation provides oversight. 6. It's That Easy: It's That Easy (ITE) offers parent educators with the training and tools needed to empower parents to connect with their children, share family values, and engage in conversations about sexuality and relationships. ITE is a train-the-trainer model for youth-serving organizations and health/education departments in urban and rural areas as well as culturally-specific groups, e.g., tribal nations. Co-sponsors are MDH, MDE, and TeenWise MN, a statewide non-profit for teen pregnancy prevention. We will assist in expanding an ITE dissemination plan and serve as content experts to curriculum and website development. 7. Diffusion of Innovation with State Adolescent Health Resource Center (SAHRC): Given our co- location with SAHRC, we are uniquely poised to promote innovative models of partnership with local and state health departments reaching national audiences. SAHRC (described in Letter of Support) provides TA to the nation¿s adolescent health staff in state health departments and serves as facilitator for the National Network of State Adolescent Health Coordinators - the membership organization for all state adolescent health coordinators. Recognizing that many UMN PRC community-based projects align well with work underway in other states, UMN PRC will partner with SAHRC to 1) disseminate relevant, highly applied evidence; 2) frame information for adoption of innovation by highlighting advantages and compatibility with existing values and practices; 3) facilitate adoption by engaging adolescent health coordinator networks, identifying an avant-garde of early adopters, and providing them with strategic TA for piloting of innovations. III. COMMUNICATION AND DISSEMINATION A. Infrastructure for Communication and Dissemination. UMN PRC offers an infrastructure of resources and personnel to support communication and dissemination activities with the expertise and capacity to translate research findings and evidence-based practices to various audiences while aligning with diffusion of innovation practices. Since its inception in 1996, UMN PRC has prioritized communications/dissemination - most notably by Resnick, UMN PRC Director (in conjunction with former Division Director, R. Blum), whose dissemination vision included landmark analyses of the National Longitudinal Study of Adolescent Health and translation of these research findings into a monograph series (supported by the Robert Wood Johnson Foundation) for specific audience segments (education, health care, parent/family support professionals) as well as for general public audiences. Dissemination strategies also included partnership with a recognized PR firm (Burness Communications) that resulted in legislative and national press briefings. Resnick has elevated this priority by hiring Shea, Communications Team Leader, a marketing and communications professional with >20 years of communications experience in both hi-tech advertising executive and community/academic settings. Shea directs all PRC communications activities, sets strategy, framing and messaging direction, writes copy and handles graphic design assignments. Shea's expertise is sought by local, state, and national partners and she is frequently asked to consult with adolescent health professionals and organizations. Shea also is recognized locally for her work on state sexual health plans targeting policy and systems changes including A Work in Progress: Building a Minnesota State Plan for Teen Pregnancy Prevention and Parenting (2003) and Recommendations for Action from the UMN Chlamydia Partnership - A Special Report (2012). Shea and Resnick's work is conducted in collaboration with and informed by UMN PRC members and community partners (examples below). External vendors with expertise in graphic design, PR/media relations, video production and social media strategy/production enhance UMN PRC's communications capacity. Given the scope of proposed communications objectives, a .6 FTE will be added to current staff FTE. Communications capacity is also supported by the UMN which offers a wealth of communications related resources including the AHC and University Relations PR and communications staff, AHC computer technical support, printing and video production capabilities, website design and content management as well as a host of collaboration (e.g. the Communicators Forum) and training (social media; web technologies) opportunities. B. Website. UMN PRC has the capacity, expertise and technical support to further develop and maintain a UMN PRC website. The web infrastructure is supported through the AHC which provides consultants and an easy-to-use content management system, enabling the PRC to maintain the site locally. UMN has recently migrated to a suite of Google-powered communication and collaboration tools and, through search engine optimization, delivers highly ranked Google search results. C. Communications Plan. UMN PRC will develop a center-wide communications plan, including 5-year goals, objectives, and activities, that integrates communication activities into research, training, evaluation, and community activities. In the past PRC funding cycle, we created communications plans for partner organizations: Hennepin County, the UMN Chlamydia Partnership, Public Health departments in Kandiyohi County and the city of Worthington and Iowa's Youth Development Initiative. The formal UMN PRC Communications plan will be developed in collaboration with PRC center and core research project faculty and staff, CAN, community partners, local and national public health departments as well as advisors from national organizations. As in the Work Plan (App B), such collaboration is required as UMN PRC intends not only to support center and core research project day-to-day functions and relationships with communications (Comm Goal 2), but also to change environmental systems by: a) addressing the critical barriers inhibiting health and education agency collaboration (Comm Goal 1); and b) increasing the widespread adoption of effective adolescent health, disparities reduction, and communications strategies (Comm Goal 3). Given Shea's expertise and work with community partnerships, additional communications activities are included in Section II (above): Community Engagement, Partnerships and Technical Assistance, detailing UMN PRC's intention to encourage systems change through state health department diffusion of clinical standards specific to the sexual health needs of adolescent populations. Routine communications activity (Comm Goal 2) will support the daily functioning of the PRC, increase awareness of accomplishments and maintain connection with partners. We innovate these basic strategies by approaching them in an audience-centric way with clearly defined goals in mind. An audience-centric, goal- oriented approach will inform UMN PRC's choice of media (print products, presentations, posters, webinars, social media, etc.), how information is prioritized and how messages are framed. Beyond the basics, UMN PRC communications will ambitiously address systems change goals. These goals are achievable due to UMN PRC's strong, active partnership with public health innovators and our intention to apply diffusion of innovation principles. Comm Goal 1 will leverage the core research project's investigation of healthy youth development strategies that simultaneously improve adolescent health and education outcomes (outcomes prioritized by HP 2020). UMN PRC will contribute to the national conversation by describing how classroom-based implementation of healthy youth development strategies through the professional development of teachers creates an effective framework for increased collaboration between health and education agencies in state systems (detailed in Core Research Project Plan). UMN PRC Comm Goal 3 builds on Shea's track record of successful communications efforts. Since 2005, she has provided nearly 200 communications/framing capacity-building engagements for state and local health and education departments, conferences, federal agencies, national membership organizations, community based organizations and public health students. Her work is modeled after that of her research colleagues, i.e., staying abreast of relevant framing/communications research and translating it for use in the field. Most recently, research has focused on framing challenges regarding determinants of health and health disparities. This research indicates that the dissemination of health disparities data can elicit responses that reinforce existing prejudices, while messages and data that illuminate environmental and societal health factors generate responses about policy action and personal engagement. Clearly, there are major implications PH health partners to apply framing research is an innovative, in-demand and effective way of supporting the NCCDPHP's goal of achieving health equity by eliminating health disparities. D. Capacity/Experience with Dissemination. UMN PRC has extensive experience in this arena - the promotion of research project activity and translation and dissemination of adolescent health research and best practices. One exemplar is documented in the communications plan for UMN PRC's survey of MN parents' attitudes and preferences about sexuality education in public schools (PI: Eisenberg). To reach the scientific community, findings were published in a variety of journals, Jrnl of Adolescent Health, Perspectives on Sexual and Repro Health. And, recognizing the importance of this work in informing policies and clinical and PH practice, the research team convened a meeting of CAN and community partners to develop a communication and dissemination plan. The group identified goals, priority audiences, timing, and message framing. Based on their insights, two versions of a research translation fact sheet were developed, one targeting legislative policy makers distributed by PRC advocacy partners (TeenWise, MN AIDS Project, Planned Parenthood) directly to state policymakers. The general fact sheet was mailed to 5,000+ individuals, targeting school principals and district staff, parent associations, school nurses, health educators, community health service directors, county commissioners, PH nursing directors, school-based health centers, out-of-school time organizations, state dropout prevention organizations, and survey participants who requested a copy of the findings. Electronic copies were emailed to 5 listservs and PRC distribution lists. The fact sheet was delivered to all TeenWise MN conference attendees, which also afforded an opportunity to present the findings via poster and breakout sessions. Findings were also presented at the UMN's Medical School Grand Rounds. E. Experience Communicating Research Projects through Marketing Materials and the Media. While additional examples of UMN PRC research-project communication activities are included in UMN PRC core research plan, the example noted above for the Parent Sex Education Survey also included outreach to mass media venues. To extend the reach of communications about the parent survey, UMN PRC developed press releases and template language to be used by other organizations wishing to disseminate the findings. Press releases were sent to over 55 media contacts, yielding 13 instances of press coverage (e.g., print, electronic), including 6 personal interviews with Resnick or Eisenberg. UMN-PRC web site featured all the parent survey information including fact sheets, press releases, and journal articles. Interested parties accessed and downloaded these materials at no cost. Requests for multiple hard copies were also fulfilled. The Parent Survey also had national exposure through newswire coverage by the Health Behavior News Service with distribution at teen pregnancy prevention conferences across the US. IV. TRAINING A. Training Needs. Since the late 1970s, an interdisciplinary cadre from the Schools of Medicine, Nursing, Public Health, and Social Work and the Institute for Child Development have taught undergraduate and graduate students, post-doctoral fellows, residents, and providers to increase knowledge and skills (K/S) for conducting, translating, and utilizing research to enhance programs, practice, and policies serving youth. Three decades of educating scientists, PH practitioners, and community partners in HP/DP of youth health issues attests to our capacity to offer diverse training activities and modalities to reach local, regional and national audiences from multiple settings. Our training plan addresses several urgent needs: 1) disparities in young people's health and their social determinants; 2) inconsistent uptake of evidence-based approaches for PH practice; 3) deficits in workforce capacity to address even the most common health problems of youth; 3 4) insufficient CE options that utilize demonstrably effective learning methodologies. The need for adolescent health training to improve the size and capacity of the workforce prepared to work with youth is evident. A 2009 IOM report, Adolescent Health Services: Missing Opportunities, 3 focused a chapter on "Preparing a Workforce to Meet the Health Needs of Adolescents" (led by former PRC faculty, Bearinger [LoS]). In response to insufficient numbers of practitioners prepared in K/S for adolescent health work, the report called for innovative and accessible CE options to assure that "at all levels of professional education, providers in all disciplines serving adolescents are equipped to work effectively with this age group." Likewise, in 2012 NCC members identified "effective communication and advocacy with diverse populations, particularly those most vulnerable," as an area of keen interest, while also valuing evidence-based practice for implementation/intervention science in reproductive health, i.e., pregnancy [a CDC winnable battle] and STI prevention and youth development strategies within a life course perspective. Perhaps, the most promising strategy for improving capacities of the PH workforce is best stated in HP 2020 - "to improve the health status of adolescents and young adults by building the capacity of professionals across all state and local relevant public health and youth-serving programs to address the needs of this population." Thus, UMN PRC aims to create, offer, evaluate, refine and disseminate training curricula using innovative approaches for reaching a diverse workforce of scientists and PH practitioners, many from our PRC partnerships. As in the Work Plan, whether cohort research training, onsite CE for community partners, or online instructional options, a set of principles guides all our training: community engagement, developmental potential, evidence-based practice, health equity, HP/DP, life course perspective, and prevention science. B. Training Plan. Led by Jordan, our training plan is structured to reach and teach future scientists, PH practitioners, and community partners utilizing: 1) formal UMN courses and fellow and resident training; 2) innovative, blended-method CE options designed primarily for community/PH practitioners; 3) sponsorship, planning, and teaching opportunities with PRC partners. Key examples follow: 1. UMN Curricular, Course, Fellow, and Resident Training: Cohort Research Training: UMN PRC's training of future scientists utilizes a rigorous, structured curriculum that teaches K/S for conducting applied PH research and prepares trainees to translate and diffuse research into practice and policy. The curriculum moves learners through research training in a cohort model with tangible milestones expected for all pre- and post-docs trainees in all disciplines (typically medicine, nursing, nutrition, psychology, public health, social work). The algorithm for the cohort research training (App D) ensures that all trainees achieve key milestones on a 12-month curricular plan with 4 curricular threads: research, advocacy, dissemination, and resource development. By year-end, all trainees must: 1) teach faculty- mentored resident training seminars; 2) submit e1 manuscript to a peer-reviewed journal; 3) present e1 scientific paper at UMN, regional, or national meetings; 4) give verbal testimony to a mock hearing panel; and 5) first author e1 internal or external grant proposal. Spurred in part by a CDC-Institutional Research Training grant, between 2004 and 2011 72 trainees (1:5 from URMs) have completed research training; >95% are now in academic/PH research settings. Regular semi-annual and follow-up evaluations guide curricular changes, including feedback from each trainee's Scholarly Oversight Committee. UMN Courses: UMN PRC faculty annually teach 2 undergraduate and 6 graduate courses in adolescent health and development, community-based research, and prevention science; courses are in Schools of Nursing, Public Health, and Child Psychology. Cohort research trainees complete required formal coursework side-by-side with other students across a host of disciplines and academic programs, and sometimes with community members. UMN course evaluation surveys provide feedback to hone instructional plans. 2. Innovative, On-site, and Blended-method CE Options for Community and PH Practitioners: Adolescent Health Summer Institute: In 1994, the Center for Adolescent Nursing (Bearinger, LoS) launched an Adolescent Health Summer Institute (AHSI) designed to diffuse applied adolescent health research into practice and improve K/S for effectively working with young people at individual and population levels. Each year, participants (e 65) represent many disciplines and sectors - local, state, international health and social service professionals, 1o and 2o teachers, coaches principals, school board members, librarians, program leaders, as well as trainees from the Cohort Research Training program. Opportunities to listen to, and connect with professionals in practice enhances students' learning. In 2001, UMN PRC joined the AHSI planning and teaching team, now comprised of experts from MDH, MDE, and TeenWise MN (LoS). Led by Sieving, the 4-day curriculum emphasizes a life course perspective, highlighting protective factors that promote healthy youth development. Learners examine adolescent health research, add skills for evidence-based practice, and generate new strategies for programs, policies and practices, i.e., HP 2020 priorities and those expressed by PH/ adolescent health practitioners. Recent topics have included interviewing adolescents; designing and evaluating effective youth programs; youth violence prevention; linking youth development and sexuality education; engaging youth and parents. We use "Table Teachers" to ensure optimal teacher/learner ratio. Professional Adult Table Teachers (PATTs) are primarily PRC community partners as are the "Young Adult Table Teachers" (YATTs) who teach in tandem with PATTs. Led by Oliphant, YATTs receive formal training for this role. PRC faculty have also created an adolescent actors troupe who develop patient scenarios used for instruction in interviewing and assessment, e.g. in AHSI and resident training. Daily evaluation allows for ready adaptation in response to feedback; summative and 6- month follow-up evaluations guide the creation of subsequent AHSIs; 19 years of evaluations show consistent themes: relevance of topics to PH practitioners; innovation of teaching strategies; array of disciplines among participants and faculty. Assuring these qualities is at the heart of planning each year. Web-based Offerings. To reach those in the workplace, UMN PRC proposes to create 3 asynchronous, online healthy youth development and prevention science modules (1 CEU each), with topics determined by UMN PRC CAN, YAB and faculty. With the Center for Adolescent Nursing, Oliphant will design the modules in Fall 2014 to be offered in Spring 2015. In addition, 1-hour webinars will add to the web-based options for PH and community practitioners. With several years of experience in webinar instruction, the State Adolescent Health Resource Center (housed in DOGPAH [Teipel, LoS]) will provide technical expertise with Shlafer, who will lead this training initiative. At 6 months post-CE offerings, using an online survey instrument (REDCap), we will assess participants' uptake of K/S gained through web-based offerings. 3. Sponsorship, Planning, and Teaching Opportunities with PRC Partners: PRC faculty and staff contribute to various local, regional and national training activities that help us achieve our training goals. In Year 1, we will co-sponsor, serve on planning committees, and teach at 3 annual events: MN Reproductive Health (RH) Update (Region V training program in RH practice, research & technology), UMN SPH Summer PH Institute (N=250 students in 2013) and TeenWise MN 2-day conference. With the vast network of UMN PRC relationships, it is anticipated that the opportunities for supporting training offered by our partners will continue to expand. Led by Oliphant and Jordan, the PRC Leadership Team and CAN will prioritize and plan yearly for this component of our training goal and objectives. V. EVALUATION Building on years of experience and expertise, UMN PRC has extant infrastructure to support both process and outcome evaluations of Work Plan goals, objectives, and activities (App B). As depicted in the logic model (in App B), evaluation assesses each of the following major outcomes of UMN PRC activities: 1) translation of research to practice; 2) environmental systems changes; 3) widespread use of evidence-based programs and policies; 4) enhanced community capacity for HP/DP; 5) skilled PH professionals and community members; 6) expanded resources for applied PH research; and 7) increased recognition and support for PRCs. A. Evaluation Plan. UMN PRC's evaluation approach will be fully developed and implemented during Year 1. Throughout the 5-year award period, it will focus on effective monitoring of activities, and strategic internal and external use of evaluation data, to improve the impact, productivity and quality of UMN PRC's research, infrastructure, community engagement, communication, and training efforts. And, given the ample expertise in youth development and evaluation research, UMN PRC¿s evaluation unit will provide evaluation expertise to designated community partners. Over the next 5 years, we will utilize a variety of methods to elicit and collect evaluation data to support our 3 Evaluation Goals (in App B). Together, achieving these goals will: 1) demonstrate our contribution to the impact of the national PRC network, 2) improve UMN PRC¿s own productivity and quality, and 3) enhance the evaluation capacity of PH practitioners in health departments, other state agencies (e.g., MDE), and community organizations through effective and productive partnerships. 1. Systematic Reporting to National PRC Network. Guided by the Work Plan that explicitly links activities and objectives to the 7 PRC outcomes named above, we will develop and implement an evaluation plan that monitors our collective contributions that promote adolescent health and health equity for all youth, i.e., the evaluation plan will rigorously and accurately capture the outputs, outcomes, and impacts related to UMN PRC infrastructure and administration; community engagement, partnerships, and TA; communication and dissemination; and training activities. Key indicators that link specific outputs with outcomes will be finalized and monitored, as tabled below. Each year, the evaluation team will guide UMN PRC members to collect data that systematically monitors outputs (e.g., scholarly accomplishments, product dissemination, increases in funding from new sources, formation of new partnerships) and measures the extent to which outputs achieve intended outcomes for the 5 PRC units (e.g., adoption of evidence-based programs and policies by health departments and other community partners, use of adolescent health disparities framing). As part of Goal 1, we will annually participate in the national PRC program evaluation activities, as required by the CDC. B. Using Evaluation Data to Improve UMN PRC Impact, Productivity and Quality. UMN PRC will use evaluation results to enhance our structure, function, and impact in accordance with our mission and goals. Quarterly, the Leadership Team will use internal evaluation results in an explicit feedback loop to adjust and priorities, resource allocation, staffing patterns, and operations. Evaluation reports and presentations will regularly communicate UMN PRC progress and effectiveness to the Leadership Team, CAN, YAB, the national PRC network and other stakeholders; feedback from these partners will inform modifications in our goals, objectives, and activities necessary to increase our overall impact, productivity, and quality. C. Enhancing Local Evaluation Capacity of PH Practitioners. UMN PRC will collaborate with local and state health departments, other state agencies (e.g., MDE), and community organizations on research and evaluation activities to support the widespread use of evidence-based programs, practices, and policies, and to enhance community capacity to conduct HP/DP research. Evaluation goals will be achieved in three ways. First, the evaluation team will continue to support existing PRC partnerships. For example, Evaluator Beckman will provide ongoing services to the Restorative Measures Program, a partnership of the Minneapolis Public Schools and Legal Rights Center, Inc. (which uses restorative family conferencing as an with middle and high-school students recommended for expulsion). Since 2007, PRC expertise has helped this partnership show promising results related to school/family connection, improved school behaviors and academic performance. Also, consistent with UMN PRC precedent, the evaluation team will provide evaluation expertise to partners who implement curricula from two of our previous and ongoing core research projects - ¿Encuentro! and Lead Peace - via pre-post surveying and analysis of process and outcome data. Second, we will engage in new evaluation partnerships with Hennepin County Health Department, MDH, and MDE. Using techniques of implementation science and developmental evaluation, Beckman will provide evaluation services to Better Together Hennepin's Standards of Care project to assist in evaluating translation of research to practice. Guided by stakeholder input, these services may take several forms, e.g., developmental evaluation techniques to capture lessons learned about implementing standards of clinical care; engaging the YAB's youth action research component to compare adolescent clinics that have/have not adopted the standards of care. With MDE, Senior Evaluator Plowman will evaluate the Promoting Adolescent Health Through School-Based HIV/STD Prevention and School-Based Surveillance project. DASH/CDC recently funded this project for building schools' capacity to reduce HIV/STD infections; our evaluation efforts include leading the study design, survey development, statistical analysis, and dissemination of study results. Third, UMN PRC will partner with health departments and community organizations to support their identified research and evaluation needs through contracts and external sales agreements, as we have successfully done since 1996. We will also write internal and external proposals to support evaluation research with new and existing partners. We will continue current partnerships and pursue other opportunities to serve as evaluation teams for local organizations with grants from MDH's Eliminating Health Disparities Initiative. These grants have included partnerships to provide evaluation TA to TeenWise MN and Aqui Para T¿, a local clinic-based youth development program serving Latino youth and their families. Beyond building capacity, these partnerships will provide additional sources of revenue, thereby expanding resources for applied PH research, increasing recognition and support for UMN PRC and helping us to achieve an infrastructure goal of augmenting net PRC budget by e 10% annually. D. Evaluation Team. Our team is well suited to carry out the proposed evaluation activities. As a developmental psychologist, Team Leader Shlafer has a rich theoretical background in development science, life course theory, and risk/protective factors. She contributes strong methodological and statistical skills and experience providing evaluation services to community partners and state agencies. Senior Evaluator Plowman has been a part of UMN PRC's evaluation team for more than 10 years, serving as a lead staff involved in national PRC program evaluation activities. She has worked on multiple youth health research and evaluation projects, along with programs for parents and youth-serving professionals. She has worked on numerous federal grants, providing longitudinal follow-up expertise to achieve a 96% retention rate at 30- month follow-up with a population of high-risk, urban 13-17 year-old females recruited through clinic settings. She has successfully secured multiple external sales agreements with local partners to evaluate their programming. She also has extensive experience with both quantitative and qualitative evaluation methods. Evaluator Beckman joined the UMN PRC in 2006 after working 8 years in local and international community- based PH programs. In the UMN PRC, she has been the project director on two major federal grants, including our most recent core research project, ¿Encuentro!, and has provided qualitative and quantitative evaluation services to multiple local partners. She uses mixed methods designs to better understand quantitative methods and results. She has extensive expertise with community partners in eliciting program theories linking activities to outcomes and building appropriately-sized and effective evaluation plans to assess effectiveness. E. Infrastructure and Resources for Evaluation Activities: In addition to scientific and technical expertise among faculty and staff, UMN PRC also has state-of-the-art resources to support evaluation activities. All analytic and word processing software packages necessary to complete the proposed evaluations are available (e.g., SPSS, NVivo, Excel, Word, Access, HLM multi-level modeling software). UMN PRC will utilize an effective research data capture system (REDCap), flexible enough to meet changing data collection needs for proposed process evaluations (e.g., online surveys, data entry of attendance logs, training evaluation surveys). In sum, UMN PRC staff, facilities, and resources are well prepared to implement the proposed evaluation activities with methodological rigor and maximum impact. National PRC Network Outcomes translation of research to changes to environmental UMN PRC Program Indicators and Measures of Success # of community committee members (CAN & YAB), attendance* X X # of faculty & staff supported by CDC funds* X X X X X X X # & type of partnerships with health depts., state agencies (e.g., education) & community orgs.* X X X X X X X # & amount of core & SIP projects* X X X X X X # & type of other research projects funded by internal & external awards* X X X X X X X # & type of contracts and external sales agreements X X X X X X # of books & book chapters by faculty & staff* X X X # of peer-reviewed journal publications by faculty & staff* X X X # of scientific publications citing UMN PRC work* X # of scientific presentations by faculty & staff* X X X # of publications & presentations for inter-professional audiences X X X X X X # of publications & presentations for lay audiences & community partners by faculty & staff X X X # of expert testimonies given by faculty & staff X X X X # of media interviews and media exposure regarding UMN PRC activities X X X # of publications & presentation with research-informed health disparity frames X X X X # & type of faculty & staff participating on key advisory boards X X # of students working with UMN PRC, by discipline & academic level* X X # of people trained by UMN PRC, by audience type* X X X X X X # of local/national partnerships resulting in adoption of evidence-based practices or programs X X X # of UMN PRC-tested interventions found to be effective* X X X X # of effective UMN PRC-tested interventions adopted outside original study* X X X X # of new prevention grants or contracts awarded to UMN PRC partners X X X X X X Increased practice Increased systems widespread use of evidence- based programs & policies Increased community capacity to conduct research Enhanced professionals & community members Increased number of skilled PH Expanded resources for applied PH research Increased recognition & support of PRC research & activities * indicates required measure of success for National PRC Network evaluation VI. SPECIFIC AIMS OF THE CORE RESEARCH PROJECT Addressing disparities in education and academic achievement is critical to reducing inequities in health across the life span and to reaching Healthy People 2020 objectives,4 an insight long held by CDC in its commitment to healthy schools and healthy students. Early adolescence is a time of profound physical, emotional, cognitive and social transformation with substantial impacts on both education and health outcomes. Transitioning from elementary school to middle school is an important milestone for young people, full of challenges and opportunities that have enduring impacts on adult trajectories of health, higher education, and work.5-7 Unfortunately, often the norm for these difficult middle school years is for school engagement and student achievement to drop, and for adolescent health risk behaviors -fighting, bullying, drinking, smoking, and sexual initiation-to spike.8-11 School-based prevention efforts that target social and emotional learning (SEL) during this critical "window of opportunity" promote students' access to experiences, opportunities, and supports that facilitate adoption and maintenance of health-promoting behaviors into adulthood.12,13 Schools have an important role to play in raising healthy young people by fostering cognitive, social and emotional development.13 School connectedness is an important protective factor, buffering young adolescents from school failure, substance use, early sexual initiation, and violence. 14,15 And key ingredients for increasing students' connections to and engagement with school are the staff and teachers they interact with every day. 16 These caring adult professionals face many competing pressures, including managing classrooms, dealing with discipline issues, and providing opportunities for meaningful student participation. Although significantly reformed, the No Child Left Behind Act remains an external pressure for educators, focused on standardized test scores as measures of effectiveness and accountability. 17 While some school administrators may be hesitant to invest in programs that focus broadly on school connectedness and prevention of problem behaviors,18-20 recent evidence demonstrates that adoption of evidence-based prevention programs also improve academic outcomes.18,21 One such program is Positive Action (PA),22 primarily implemented in elementary schools, which teaches skills such as self-control, honesty, and positive interactions with peers (Section C.6.b). Schools throughout the US are adopting SEL programs; however, implementation has far outpaced systematic development of a credible body of evidence to ground and guide these efforts in a clear understanding of 'what works', with whom, and why. With an expanded evidence base, schools will be better equipped to make informed decisions about adoption of effective SEL programs and how to implement them with fidelity. Thus, the UMN PRC core project, Partnering for Healthy Student Outcomes (PHSO), is a comparative study of the relative effectiveness of a school-based, SEL prevention program for students attending culturally diverse, economically disadvantaged middle schools in the Minneapolis-St. Paul, MN metropolitan area. Our primary research question is: Will a multi-year, school-based prevention program, infused with professional development aimed at increasing the capacity of middle school teacher teams to engage their students in learning, yield changes in middle school students' health risk behaviors and academic outcomes that exceed outcomes from delivery of the school-based prevention program alone? The professional development (PD) model includes 4 elements: a training institute, implementation of a student engagement plan, booster sessions, and individual coaching (Section C.6.c). We will evaluate 2 conditions in a matched pairs, randomized trial involving approximately 840 students in 4 suburban middle level schools. One condition (SEL) will implement the Positive Action SEL program. The second condition, Positive Action plus teacher team professional development (SEL+PD), will implement the SEL curriculum and also target teacher teams at each middle grade level with professional development training and support. This approach allows us to test whether adding a model of training and targeted support for middle school teacher teams improves the effectiveness and sustainability of a SEL program. This study has 2 primary aims to be achieved through a university-school-health department partnership: Primary Aim 1: Conduct a pilot study to determine the feasibility and acceptability of a school-based, SEL+PD program designed to reduce health risk behaviors (violence, bullying, substance use, sexual risk behaviors) and increase academic achievement among middle school students. Primary Aim 2: Implement SEL and SEL+PD programs and compare their effectiveness in achieving positive student outcomes using a matched pairs, randomized design across 3 middle school years. Aim 2a: Compare fidelity of SEL program implementation across the 2 intervention conditions. Aim 2b: Compare relative effects of the 2 intervention conditions on student behavior outcomes including violence, bullying, substance use, sexual risk behaviors, and academic achievement. Aim 2c: Compare effects of the 2 intervention conditions on hypothesized protective factors (e.g., social & emotional skills, school connectedness & student engagement). Aim 2d: Test potential moderators of student health and academic outcomes (e.g., levels of student engagement, race/ethnicity, gender & poverty) within the 2 intervention conditions. Area Objective Adolescent Health AH-3: Increase proportion of adolescents who are connected to a positive adult AH-5: Increase educational achievement of adolescents AH-7: Reduce proportion of adolescents who have been offered, sold, or given an illegal drug on school property AH-11: Reduce rate of adolescent perpetration of, and victimization by, crime Injury & Violence Prevention IPV-34: Reduce physical fighting among adolescents IPV-35: Reduce bullying among adolescents IPV-36: Reduce weapon carrying on school property Substance Abuse & Tobacco Use SA-2: Increase proportion of students never using substances (alcohol, marijuana, illicit drugs) SA-13.1-2: Reduce proportion of adolescents reporting use of alcohol, any illicit drugs or marijuana during past 30 days SA-14.4: Reduce proportion of adolescents aged 12-17 years engaging in binge drinking during the past month SA-21: Reduce proportion of adolescents who use inhalants TU-2: Reduce tobacco use by adolescents TU-3: Reduce initiation of tobacco use among adolescents Family Planning FP-9.2-3: Reduce proportion of male and female adolescents aged 15 yrs & under who have never had sexual intercourse VII. RESEARCH STRATEGY A. Significance. The number of 10-24 year olds living in the US is expected to reach 64 million by 2020.23,24 Nearly 2/3 of premature deaths and 1/3 of the total disease burden globally are associated with behaviors that began during adolescence. 25 Social and behavioral risks, such as violence, substance use, and high risk sexual behavior, in addition to dropping out of school, threaten the healthy development of young people.26,27 For example, homicide is the 2nd leading cause of death for young people, 27 and in one year alone, over 1.5 million US adolescents were victims of nonfatal crimes at school. 28 Reductions in behaviors that undermine healthy development are priorities reflected in our nation's youth-focused health objectives. 29 Initiation of many of these health risk behaviors-physical fighting, tobacco use, drinking-tends to occur during the middle school years (ages 11-14). Recent reports estimate that 33% of adolescents started using alcohol by 8th grade, and 15% of 8th graders have ever been drunk.10 Bullying is prevalent; between 10-30% of students are involved in bullying behaviors (i.e., physical, verbal, social, cyber) at school.30 While smoking has declined in the past decade, every day nearly 4,000 youth under the age of 18 smoke their first cigarette. 31 Targeting the developmental period of early adolescence with evidence-based efforts to prevent multiple problem behaviors is critical to successfully achieving national health objectives. Currently almost half of US youth are from communities of color-a proportion expected to rise in coming decades.23 It is clear that we need all our youth to become productive adults, with skills and perspectives to meet challenges of 21st century work, politics, community and personal relationships. Unfortunately, evidence of racial/ethnic disparities in adolescent health behaviors abound; e.g., Youth Risk Behavior Surveillance (YRBS) data show higher rates of weapon carrying, physical fighting, marijuana use, and unprotected sex among African American and Hispanic youth compared to Whites.32 Disparities are also evident in educational outcomes.33 During the 2009-10 school year, students of color (29% American Indian, 37% Hispanic and Black students) were far more likely to attend high-poverty schools (measured by free/reduced-price lunch eligibility) than Asian American (12%) and White (6%) students. Dropout rates in 2010 for Black (9%) Table 1: Healthy People 2020 objectives and Hispanic (10%) youth were double that of Whites (5%); American Indian and immigrant Hispanic youth drop out of school at 3 and 6 times the rate of Whites, respectively.33 Disparities in high school graduation rates are shocking when translated into monetary figures; a 2010 comparison of individuals who receive 12 years of education vs. those who stop just short of a high school diploma yielded a $300,000 difference in lifetime earnings.34 Educational disparities result in long-lasting health and social costs. A.1. Healthy People 2020's Focus on Healthy Youth Development. Healthy People (HP) serves as a compass for the field of public health. For the first time, HP 2020 clusters many adolescent health objectives into a single category. Table 1 displays the HP 2020 objectives that are closely aligned with our specific aims. Some draw from adolescent-specific objectives, others from specific health issues (i.e., injury and violence prevention). Importantly, 2 of the HP 2020 objectives, focused on increasing connections to positive adults (e.g., teachers and school staff) and academic achievement, are consistent with UMN PRC's healthy youth development (HYD) paradigm which identifies and promotes factors that protect adolescents against health- jeopardizing behaviors and adverse outcomes. Specific protective attributes identified in multiple studies of resilient youth include the development of a close relationship with at least one caring, consistent adult who values and rewards pro-social behavior 35 and a sense of connectedness to school. 2,36 Greater school connectedness has been associated with (1) better academic outcomes, including higher academic performance, staying in school longer, and school completion; 37, 38-41 and (2) lower levels of involvement in risk behaviors that jeopardize health and learning. 42 The Institute of Medicine (1997) suggests that "in some situations, a healthful psychosocial environment (in school) may be as important-or even more important- than classroom health education in keeping students away from drugs, alcohol, violence, sexual risk behaviors, and the rest of today's social morbidities." This proposal targets schools as important contexts that impact adolescent health. A.2. Suburban Middle Schools as Contexts for Promoting Adolescent Health in Minnesota In 2011, over 15,000 of the 85,000+ public schools in the US served nearly 9 million middle school age students.43 Middle schools often begin with 6th grade and end with 8th grade, but some students in middle level grades are served by schools configured differently (e.g., schools serving grades 5-7 or grades 7-9). In this proposal, we use the term "middle school" to refer to the intermediary phase of schooling separate from elementary and high school, and include school configurations serving grades 5-9. We focus on the middle school years because they can be a time of vulnerability for many young adolescents as they try to make sense out of their own developmental changes and identities, at the same time that they are trying to comprehend and respond to new expectations in a different school structure. 44 Diversity. Minnesota reflects the national trend of becoming more diverse, with 25% of the total state population in 2035 projected to be persons of color.45 In the Minneapolis/ St. Paul metro area, the proportion of residents of color is projected to climb from 25% of area residents in 2010 to nearly half (43%) by 2040; 46 many will be adolescents attending metro area public schools. Educational Achievement. Approximately 75% of US public high school students in the class of 2009 graduated on time.33 Minnesota was ranked 3rd (at just over 87%) among states reporting 2009 graduation counts. However, this high ranking hides an enormous gap between White students and students of color, similar to the national figures noted above. In 2005, MN White students exceeded the national average of graduation rates by nearly 6 points; in contrast, MN students of color and American Indian students averaged 10-17 points below the national average for graduation rates. 47 Unfortunately, achievement disparities appear early among MN elementary students; in 2011, gaps between African American and White, Latino and White, and low- income and more affluent students' 4th grade reading scores were all greater than national averages. 48 In Hennepin County, home to 3 of our study partner schools, the story is similar. Although 8,500 students graduate each year, about 2,000 students drop out.49 The Accelerating Graduation by Reducing Achievement Disparities (A-GRAD) initiative was launched in 2006 by the county's health department, with the overarching goal of creating a long-range plan to ensure that all youth graduate from high school. To reach this goal, A- GRAD acknowledges the importance of reducing risk and building protective factors in as many places (school, family, community) and as many ages (early childhood, middle school, high school) as possible. Table 2. MN Student Survey Data corresponding to Healthy People 2020 Areas Although dropping out usually Minnesota HP 2020 % of student reporting Boys Girls Adolescent Health 6th 9th 6th 9th ..like school very much 17% 11% 26% 14% ..all my teachers show respect for students 54% 33% 58% 32% ..all my teachers interested in me 26% 12% 28% 9% ..teachers at school care about me very much 31% 15% 33% 13% ..been offered, sold or given illegal drugs at school 3% 18% 1% 12% Injury & Violence Prevention ..threatened by a student 31% 24% 20% 15% ..been kicked, bitten, or hit 42% 28% 27% 15% ..hit or beat up another person 3% 3% 2% 1% ..carried a gun or weapon on school property 3% 6% 1% 2% Substance Abuse & Tobacco Use ..used tobacco, last 30 days 3% 13% 2% 15% ..used alcohol only, last yr 8% 17% 6% 19% ..used alcohol, marijuana, & other drugs, last yr 3% 14% 3% 14% Family Planning ..ever had sexual intercourse na 22% na 18% occurs in high school, the process of disengaging from school begins much earlier.50 In high-poverty environments, a student's experience in middle level grades strongly impacts the odds of graduating from high school. 51-53 Further, school transitions, especially between elementary and middle school and between middle and high school, have been associated with increases in emotional, academic, and behavioral difficulties, 44 and may result in disengagement and withdrawal from school. 54 Connections to Teachers & School Engagement. Data from the 2010 MN Student Survey (MSS) provide insights into middle grade student experience (Table 2). The MSS, completed every 3 years with 6th, 9th and 12th grade students, is a tool to monitor student risk and protective factors. Questions about school connectedness and student engagement highlight changes in youths' perceptions of school between 6th and 9th grades. In the 2010 MSS, 17% of 6th grade boys and 26% of 6th grade girls indicated that they "like school very much;" these ratings drop substantially for both 9th grade boys and girls. While over half of 6th graders reported that all of their teachers show respect for students, only a third of 9th graders make the same claim. Data show that school disconnection and disengagement increase during the middle grade years. Health Risk Behaviors. MSS data indicate high rates of engaging in violent and bullying behavior among 6th graders, especially for boys but girls' rates are not negligible (Table 2). Rates of violent behaviors (threatening, hitting or beating up others, carrying a weapon) and victimization decrease slightly by 9th grade with sizeable numbers of youth continuing to report these behaviors. At the same time, rates of tobacco, alcohol, marijuana, and other drug use are doubling and tripling for both boys and girls during middle grades. Questions about sexual behavior, not included on 6th grade surveys, indicate that by 9th grade, about 1 in 5 boys (22%) and girls (18%) have ever had sex. The high prevalence of MN students reporting health risk behaviors illustrate the importance of public health prevention efforts targeted by HP 2020. A.3. School-based, Universal SEL Programs. In the last 30 years, the prevention science field has moved from testing youth interventions focused on single health risk behaviors (drinking, risky sex, bullying) to multiple-domain prevention programs that focus not only on co-occurring risk behaviors55,56 but also on healthy youth development.57,58 Social and emotional learning (SEL) has been a particular emphasis, with an underlying premise that SEL skills (getting along with others, being honest) are not fixed traits that students either possess or lack, but instead are malleable and will improve over time, when intentionally taught.59 A recent meta-analysis of 213 programs highlights the evidence base behind effective SEL programs.13 In brief, SEL programs improve skills and attitudes about self, others, and school; and they reduce conduct problems, increase prosocial behaviors, and improve academic performance on achievement tests and grades. However, gaps exist in the evidence base around SEL programs, including effectiveness in improving academic achievement, strengthening specific SEL skills, and reducing health compromising behaviors. Positive Action is one SEL program that demonstrates effects across multiple domains of youth behavior in 2 major effectiveness trials. 60-64 Thus, it is a prime candidate for replication in a comparative effectiveness study, which represents a key step in health promotion program testing.65,66 A.4. Evidence Gaps in School-based Prevention Programs. The Guide to Community Preventive Services 67 summarizes evidence gaps for school-based programs to reduce adolescent violence and aggressive behavior, based on a recent review of 53 studies. 68 Similarly, Positive Action program creators identified further research needs around SEL programming. 22 Below we highlight 5 evidence gaps addressed by this comparative effectiveness study. 1. PHSO will test whether the effectiveness of a universal school-based program is moderated by the predominant race/ethnicity of the student population. Four partner schools were recruited for their diverse student demographic characteristics (Section C.4.); thus, we will test for differential effects of programming in schools that are predominantly African American and Latino. 2. PHSO will also evaluate whether the school-based program is equally effective for high-risk and low risk youth. Our planned subgroup analyses include evaluation of differential program effects on students eligible for free/reduced lunch vs. not eligible (proxy for poverty) and academically disengaged vs. engaged students. Results will provide important information about whether particular groups of high risk students benefit more or less from SEL programming with regard to health and academic outcomes. 3. The PA program has primarily been studied in elementary schools. An outstanding question is what is the effectiveness of this program in free-standing middle schools? Thus, we will evaluate whether the SEL program impact student outcomes when implemented in middle schools during a pivotal developmental period. 4. How and why SEL programs actually work is a gap regarding programs targeting violence prevention. This study addresses this question in two ways. First, our student survey will include multiple measures of potential mediators of the SEL program (e.g., varied measures of social & emotional skills including intra- personal, interpersonal, and stress management, school connectedness, and student engagement detailed in Section C.7.b). Thus, results will increase understanding of processes that mediate the effects of SEL programming on youth health and academic outcomes. Second, this study will explicitly test whether professional development (PD) focused on increasing middle school teachers' capacities to engage their students in learning is a mechanism for enhancing SEL program outcomes. 5. Although beyond the work scope and funding provided, this study will provide preliminary data to assess the economic benefits of school-based SEL programs. We will collect detailed intervention cost data and collaborate with the CDC to perform cost analyses estimating the cost-benefits of study intervention conditions; CDC will provide guidance in collecting and accessing information to be used to examine return on investment. We will also seek opportunities to collaborate with our UMN colleagues with health economic expertise to examine cost-benefits of the study's interventions. B. Innovation. Several innovative features of the proposed study will contribute to bridging the gap between scholarly evidence and public health practice. ¿ Magnifying the Effectiveness of a Student-focused Prevention Program through the Addition of an Innovative Model of Teacher Team Professional Development As depicted in the conceptual model (Figure 1, Section C.6.a), our intervention targets attributes through which SEL programs are likely to work, including opportunities for student engagement 69-71 and school connectedness.2,36 The PD program for teacher teams in the SEL+PD condition is explicitly designed to address and eliminate barriers to middle school students' opportunities for engagement and school connectedness. A recent CDC report 40 noted that connectedness may be increased through school staff dedicating their time, attention, and emotional support to students. Distinct from school connectedness, student engagement is defined by Co-I Christenson and other educational researchers as active student participation in academic activities and commitment to/investment in learning.72, 73 Reschly and Christenson emphasize that intentional changes in school environment may lead to increases in student engagement.72 Likewise, an essential role of the SEL environment involves fostering student engagement and connectedness as means to promote positive outcomes. The proposed project is innovative because in testing whether the PD enhancement magnifies impact of the SEL program in improving student health and academic outcomes, we advance scientific knowledge of how and why SEL programs work. ¿ Identifying Effective Approaches for Building Middle Schools' Capacities for Youth Health Promotion Effective methods for increasing the capacities of communities, and schools in particular, to undertake successful health promotion and prevention efforts are only beginning to emerge.74,75 The CDC recently convened a work group to generate new ideas for bridging science and practice.74,75 The proposed study addresses a priority need articulated by that work group, namely, the need for research on how to effectively build capacity to implement preventive interventions in schools. Moving research findings into practice involves 3 interactive systems: 1) the Prevention Synthesis and Translation System, which distills information and prepares innovations for implementation;, 2) the Prevention Support System, which supports those who put innovations into practice, and 3) the Prevention Delivery System, which implements innovations in real-world settings. The Prevention Support System has 2 primary support functions: innovation-specific capacity building (e.g., training, technical assistance & coaching) and general capacity building (e.g., enhancing teachers' skills & expanding schools' partnerships in ways that go beyond implementing a specific innovation).76 Both are important to adoption of effective interventions, and both may be particularly critical for middle schools where existing resources and promotion of HYD are limited. This study models an innovative strategy for implementing the PA program, with a team of research staff and local PH department partners with HYD expertise providing innovation-specific support tailored to each school's resources and the adoption of this innovative SEL program. To support teacher teams in implementing developmentally responsive instructional and classroom management methods, a team of research staff and seasoned teachers will provide ongoing general support tailored to each teacher team in the SEL+PD condition. We will investigate the effectiveness of both forms of support in building middle schools' capacities for promoting HYD as an evidence-based approach to preventing negative health and academic outcomes. To evaluate effectiveness of our prevention support system, we will examine organizational outcomes (e.g., teachers' continued use of developmentally responsive instructional methods, schools' sustained use of evidence-based SEL programs) as well as assess processes (e.g., satisfaction with trainings). ¿ Implementation of a Comparative Effectiveness Study in Middle School Settings Replication of effectiveness studies represents an important prevention science contribution to public health.65,66 A vital part of efforts to expand the evidence base about effective prevention programs (including those focused on promoting HYD), replications also spur growth of new interventions based on theoretical and empirical considerations. 65,66 Systematic variations in the specifics of previous PA effectiveness studies 60-64 -including changes in the setting (middle schools vs. K-8 schools) and implementation (comparative effectiveness of SEL and SEL+PD intervention conditions)-will expand the evidence base regarding for whom, in what contexts, and under what conditions this SEL program is effective. Further, adding involvement in cyber-bullying to assessed student outcomes will provide information on prevalence and intervention effects on this emerging but already widespread form of youth risk behavior.77,78 With an expanded evidence base, schools and public health practice organizations will be better equipped to make informed decisions about adoption of SEL and prevention programs.65,66 In addition, study findings will contribute to prevention science and the scientific understanding of core elements of effective SEL programs. C. Approach. C.1. Introduction. The proposed research involves 4 middle level schools in the Minneapolis-St. Paul metropolitan area that are similar in terms of excess risk for youth violence, bullying, substance use, sexual risk behaviors, and academic disengagement. Schools will be matched into similar pairs and then randomized to study condition, receiving SEL+PD or SEL only. No formal control group will be included because the PA program has demonstrated efficacy,60-64and our focus is on relative effectiveness, not absolute effectiveness. 79 Programming will target middle level students for 3 consecutive years. The primary endpoints for evaluating the comparative effectiveness of the 2 conditions are differences between trajectories of health outcomes (e.g., fighting, bullying, smoking, drinking) and academic achievement (grades, test scores, attendance). Outcomes will be measured via online surveys and school records. Process measures will assess implementation of intervention components together with relevant contextual characteristics of each school. C.2. Justification & Preliminary Studies. Research team members bring complementary expertise in intervention research with middle school staff and students, as well as research on protective factors that buffer young people from involvement in bullying and violence, substance use, sexual risk behaviors and academic risk behaviors. This section briefly describes research relevant to the proposed study. C.2.a. Research on Teacher Professional Development. An Institute for Education Sciences (IES) research grant (2010-2013; Resnick PI; McMorris, Harwell & Christenson, Co-Is; Snyder, project director; Moore, project interventionist) enabled development and pilot testing of Minnesota Partnership for School Connectedness (MPSC), a teacher professional development program focused on enhancing teachers' capacity to engage students in learning. Intervention. This PD model for middle school teachers involved a 1-year program with four elements: 1) a 3- day Training Institute prior to the start of the school year; 2) classroom implementation of a Student Engagement Plan, including teacher observations and coaching by trained staff; 3) three 1-day teacher trainings during quarters 2-4 of the school year; and 4) attention to school context via regular communication with participating middle level school principals. In the IES study, this model was pilot tested with 1 6th grade teacher per school. Findings. The MPSC project demonstrated promising findings with teachers, and more particularly, with the least engaged students in MPSC teachers' classrooms. The Classroom Atmosphere, Instruction, and Management (AIMS) instrument 80 was used to assess implementation of teaching and classroom management strategies taught during MPSC training sessions; data collected during 4 classroom observations were analyzed using repeated measures ANOVA and yielded significant increases in ratings of teacher behavior on many AIMS constructs (e.g., sense of community, focus on student effort, high expectations). Impact on student outcomes was assessed through analysis of student-reported engagement and standardized test scores. In general, 6th grade students in MPSC schools during 2010-11 were affectively and cognitively engaged at high levels. Based on Co-I Christenson's expertise, we rank ordered students using data from self-reported engagement measures and identified a group of disengaged students with scores in approximately the bottom 13%. We compared disengaged students to their engaged classmates using repeated measures ANOVA with covariates. For engaged students, scores on measures of teacher-student relationship and relevance of school work decreased slightly over time. In contrast, scores increased significantly over time for disengaged students. Further, when we compared engaged and disengaged students on standardized reading scores, we found a trend level difference (p=0.12) between slopes. While scores decreased from 5th to 6th grade for engaged students, reading test scores remained stable over time for disengaged students. These are promising results, given that the MPSC pilot study did not include a comparison group in 2010-11. During Spring 2012, with a new set of 6th graders, we surveyed a comparison group of students whose teachers were not participating in the MPSC program. Engaged students, whether taught by teachers in the MPSC program or comparison group teachers, reported equally high levels of engagement. In contrast, disengaged students from MPSC teacher classrooms reported significantly higher levels of engagement than their disengaged classmates in comparison classrooms. This difference translates to a large effect size (Cohen's d = 0.82); on average, disengaged students in MPSC teacher classrooms reported 16% higher engagement scores than did disengaged students in comparison classrooms. Key Areas for Further Research. Building on the MPSC model, the teacher team PD component of the proposed PHSO intervention includes all 4 core subject teachers from the SEL+PD study cohort's grade level, providing a more intensive support for teacher teams which we hypothesize will result in greater impacts on student engagement. When students experience positive relationships with teachers throughout the school day, they feel more connected to school; positive health and academic outcomes are more likely. 40,81 In addition to individual coaching, entire grade-level teaching teams in SEL+PD schools will be involved in team coaching. We hypothesize that this coaching will foster a climate of collaboration among teacher teams and place priority on engaging students in the SEL+PD condition throughout middle school. In contrast to MPSC schools, schools in the proposed PHSO study are more diverse in terms of student race/ethnicity and have greater numbers of economically disadvantaged and academically disengaged students. Given the particular impact of the MPSC model on disengaged students, this model seems particularly promising for schools characterized by high numbers of disengaged students. C.2.b. Middle Grades Intervention Research. Findings, evaluation instruments and partnerships from the Lead Peace demonstration study (UMN PRC core research, 2004-09) and the Lead Peace program (2009-13) inform the proposed study. The Lead Peace study leadership team included partners from Minneapolis Public Schools, Hennepin County Social Services (HCSS) and UMN PRC; Sieving was PI, McMorris was Co-I. Study Design, Schools, Sample. The goal of Lead Peace was to develop, implement and evaluate a services learning program for 6-8th grade students from impoverished suburban neighborhoods that improves students' pro-social involvement in schools and communities; and reduces risks for violence involvement. The demonstration study involved 5 K-8 schools in ethnically diverse, economically disadvantaged neighborhoods of Minneapolis. Schools were assigned to a comparison condition (n=3) or a Lead Peace program condition (n=2). Students in the 8th grade class of 2009 formed the demonstration study sample. Student self-report surveys were completed at the start of 6th grade and the end of 6th, 7th, and 8th grades. Intervention. The Lead Peace service learning program addressed risk and protective factors for bullying and violence among middle school youth. 82 Developed by Lead Peace partners, the program emphasized opportunities for students to practice social skills including communication, problem-solving and conflict resolution; develop emotional self-control skills; and build caring relationships with peers and adults. Lead Peace classes were led weekly by a team from the intervention schools, HCSS, and UMN PRC. From 2006-09, Lead Peace partners successfully implemented service learning in program schools, involving as many as 130 students in 45 50-minute sessions/year. Students completed over 40 service projects. Student Survey. Prior to fielding the survey, we piloted the instrument with 6th graders and refined items to be understandable and relevant to targeted youth. 83 The survey was administered in classrooms by trained survey teams. To increase comprehension for students with lower reading levels or limited English proficiency, questions were read out loud by survey staff. Staff were available to answer youths' questions in Hmong and Spanish, second languages spoken in study schools. 84 Program Outcomes. To assess school-level change, outcomes analyses employed data from cross-sectional samples present at each survey point. An analysis of intervention effects from the end of 7th grade to the end of 8th grade found that students in the Lead Peace condition had greater interpersonal skills, more cooperative peer behaviors, and stronger connectedness to peers and schools than did students in the control condition. 85 Key Elements of Partnership. Analysis of process evaluation data identified elements that may be critical for successful partnerships between schools, community organizations and university groups involved in middle school intervention research. Key elements included: Fit of intervention with partner organizations' missions; regular communication between partners; shared decisions related to programming and evaluation; partners' sharing of credibility, expertise and resources; allowing time for relationships to develop between partners; recognizing each other's priorities; flexibility with program and evaluation; and school principal support. 86 Protective Factors. Findings reinforce the importance of programming focused on building young teens' social and emotional skills, pro-social connectedness and intentions to contribute to their communities. Sieving and McMorris examined relationships between students' social and emotional skills, bullying and violence. Students reporting greater interpersonal skills and stress management skills were significantly less likely to engage in bullying and violence. 87 In a 2nd analysis, Sieving et al found high levels of school connectedness to be protective against bullying and violence involvement. 82 In a 3rd analysis, Sieving et al found that clear intentions to contribute to one's community was protective against violence. 83 In a 4th analysis, McMorris, Sieving et al investigated relations between violence, hopefulness, family and school connectedness, and found that hopefulness may be an important mediator in relationships between social connections and violence involvement. 88 Sustaining the Effort. At the close of the demonstration study, Lead Peace partners articulated clear benefits of service learning programming for students, families, schools and community, and expressed a strong desire to sustain the school-community-university model. Thus, with foundation funding and in-kind support from all partners, Lead Peace was implemented with a second cohort of 150 middle grade students enrolled in partner schools. To evaluate outcomes, students completed self-report surveys prior to starting the program in 6th grade, and at the end of 6th, 7th and 8th grades. To assess changes that occurred over the course of the 3-year program, UMN PRC compared students¿ survey responses at the end of 8th grade to their responses at the start of 6th grade. Findings from this pre-/post-program evaluation indicated a 25% reduction (p<0.01) in school conduct problems among Lead Peace students from the start of 6th grade to the end of 8th grade. Findings also indicated a 28% drop (p<0.01) in being a victim of bullying and a 25% reduction in fighting (p=0.04) over this time period. Reductions in bullying and fighting are particularly remarkable, given that violent behaviors typically increase during adolescence, peaking at ages 16-18 years. 89 C.2.c. Additional Youth Development Intervention Research. C.2.c.1. Prime Time Intervention Research. Sieving and colleagues received NIH funding (2006-11) to conduct a randomized controlled trial of Prime Time, a multi-component intervention with adolescent girls at high risk for early pregnancy that reduces precursors of teen pregnancy including sexual risk taking, violence involvement and school dropout. The intervention employed an innovative combination of 1-on-1 case management and youth peer leadership groups, piloted in a UMN PRC demonstration study (1999-2004). 90 Prime Time intervention effects were found for sexual risk behaviors at a 12-month (post-baseline) interim point 91 and at the end of the 18-month intervention. 92 We also found lower levels of bullying among the intervention group at the end of the 18-month intervention 91 and lower levels of violence victimization among intervention participants with strong family connections. 93 Examining a positive indicator of emerging adulthood, 72% of intervention teens versus 37% of controls who had completed high school were in college/technical school at the final 30-month follow-up survey. Intervention involvement led to significant improvements in condom and dual method contraceptive use that lasted for at least one full year following the intervention's conclusion. 94 These findings add to a growing evidence base supporting positive youth development approaches for reducing sexual risk among vulnerable adolescent females. C.2.c.2. School-based Restorative Justice. Since 2008, Minneapolis Public Schools has offered restorative justice services to students recommended for expulsion, in partnership with the nonprofit Legal Rights Center. The LRC utilizes Family and Youth Restorative Conferences (FYRC) as a restorative intervention for responding to situations involving serious disciplinary incidents. FYRC is based in a youth development frame, implemented in a way which allows schools to provide resources as part of disciplinary action and acknowledges the reality that some behavioral incidents require students to be temporarily removed from school. LRC and MPS partners invited McMorris et al to evaluate FYRC outcomes, including data from student and parent surveys collected from March 2010-August 2012 and from students' MPS records (attendance, suspensions, & academic achievement), during the year prior, year of incident, and year after incident. The sample included a total of 83 students (ages 11-17 years) and 90 parents who completed pre-conference surveys during the evaluation period. Of these, 59 students and 73 family members filled out the post-conference survey (approximately 6 weeks later), yielding follow-up rates of 71% and 81%, respectively. Together, survey and school records data indicate that FYRC has a positive impact. Survey data demonstrate that FYRC effectively increases parent connection and student engagement at school, as well as parent-child communication. School records data suggests that RCP participation disrupts school disengagement and/or dropout trajectories that often result from serious behavioral incidents and ensuing suspensions. 95 C.2.d. Youth Risk & Resilience Health Research: Washington/Victoria Youth Cohort Study. In addition to her expertise in complex multi-method evaluations, McMorris has research expertise in etiology of youth risk behaviors and international comparisons. With funding from NIAAA and NIDA, McMorris et al have examined a multitude of risk and protective factors for substance use and violence among statewide samples of youth in Washington State (n=2866) and Victoria, Australia (n=2864), using standardized methods to recruit and administer an adaptation of the Communities That Care youth survey to representative samples from both states. Striking differences in substance use were noted across the two states, with Victoria students reporting higher rates of alcohol, tobacco and inhalant use, whereas Washington students reported higher rates of marijuana use. 96 In an analysis that directly informs alcohol policy, McMorris et al used study data to compare harm minimization and zero-tolerance policies. Adult-supervised settings for alcohol use resulted in higher levels of harmful alcohol consequences, contrary to harm-minimization predictions that supervised alcohol use or early-age alcohol use will reduce the development of youth alcohol problems. 97 In other analyses of problem behavior, rates of bullying and violent behaviors were generally comparable across the two states 96 and predictors of violent behaviors were remarkably common. 98 Some risk factors were more prevalent in each country such as suspensions and arrests in the US and restorative measures in Australia, reflecting different policy orientations toward youth risk behavior. 99 C.2.e. Summary. Together, investigators have a strong record of experience with study conceptualization, design, instrumentation, intervention development, implementation, evaluation, and analysis. We are strong collaborators in community partnerships and school-based interventions. Our work is focused in the areas of adolescent health and risk behaviors including bullying and violence, substance use, sexual risk behaviors and school failure. Individuals' complementary backgrounds create an interdisciplinary research team with a rich array of skills to bring to the proposed study. The team also brings extensive experience in using research knowledge to inform community programs, practice and policy. C.3. Research Design. The core research project will employ a cluster randomized design with longitudinal (repeated measures) data 100 to assess middle school student health and academic achievement outcomes. This comparative effectiveness study will randomly assign the SEL+PD or SEL only conditions to a school (cluster) and follow students over time as they receive multiple "doses" of an intervention during 3 middle school years. A pilot study will be conducted in Year 1, and the 3-year trial will occur in Years 2-4; Year 5 will be devoted primarily to dissemination and sustainability efforts. Pilot Study. The first year will be devoted to a pilot study to develop and refine procedures and protocols for delivery of the combined professional development and SEL intervention (SEL+PD). Working with 1 middle school, we will target an older grade available at the school (7th grade) and its corresponding teacher teams (see School 1/Year 1 in Table 3), instead of targeting the transition year (6th grade). Pilot testing with 7th graders will avoid contamination of the intervention cohort, who will not have matriculated into middle school in Yr 1. Randomized Controlled Trial (RCT). Prior to Year 2, the pilot school and the other 3 participating schools will be randomized to 1 of 2 conditions in the RCT and will maintain their intervention status for the duration of the study. In Year 2, the RCT will target transition year students (i.e., 6th graders) and follow these students for 3 years as they progress through middle school and participate in programming in the 2 conditions (SEL+PD or SEL only). In schools randomized to the SEL+PD condition, both school staff and grade level teacher teams will be involved in intervention programming. School staff will deliver the SEL curriculum to students, supported and coached by PHSO staff and health educators from county/local health departments. In addition, 2 teacher teams in each school, consisting of 4 teachers per team who teach 6th grade core subjects (e.g., math, science), will be trained using the PD model (see Section C.6.c). Schools' schedules will ensure that each participating student in SEL+PD schools will encounter a 4-member teacher team in their classes. In schools randomized to the SEL only condition, school staff will deliver the SEL curriculum to students, supported and coached by PHSO staff and health educators from county/local health departments. In Year 3, we follow participating students as they advance (i.e., to 7th grade). Different teacher teams will be targeted for PD in schools randomized to the SEL+PD condition. Depending on staff turnover, a combination of new and returning school staff will deliver the SEL curriculum to students in both conditions. In Year 4, a similar process follows for the students once they move on to 8th grade. Altogether students will receive 3 "doses" of an intervention (6th, 7th, 8th grades). This sustained dosage schedule offers an important opportunity to study the effects of the interventions on health and educational outcomes. Table 3 depicts the proposed study's research design and timeline. Table 3. Study Design: Randomized Pairs (schools) with Longitudinal Data Collection Year 1 10/14 - 9/15 7th grade Year 2 10/15- 9/16 6th grade Year 3 10/16- 9/17 7th grade Year 4 10/17- 9/18 8th grade Year 5 10/18- 9/19 Condition 1: SEL + PD of teacher-teams Sch 1 Tx1-pilot Pretest Surveys; Listening Sessions w/ Students Collect School Records Tx1y1 Fall Surveys Spring Surveys Collect School Records Implementation Measures Tx1y2 Spring Surveys Collect School Records Implementation Measures Tx1y3 Spring Surveys Collect School Records Implementation Measures (sustain) Sch 3 Tx1y1 Fall Surveys Spring Surveys Collect School Records Implementation Measures Tx1y2 Spring Surveys Collect School Records Implementation Measures Tx1y3 Spring Surveys Collect School Records Implementation Measures (sustain) Condition 2: SEL only Sch 2 Tx2y1 Fall Surveys Spring Surveys Collect School Records Implementation Measures Tx2y2 Spring Surveys Collect School Records Implementation Measures Tx2y3 Spring Surveys Collect School Records Implementation Measures PD training ins titute Sch 4 Tx2y1 Fall Surveys Spring Surveys Collect School Records Implementation Measures Tx2y2 Spring Surveys Collect School Records Implementation Measures Tx2y3 Spring Surveys Collect School Records Implementation Measures PD training ins titute C.4. School Partners. Four Twin Cities metro area middle schools with diverse student populations will participate. They were selected based on the following criteria: First, only middle level settings where students enter a distinctly different building, transitioning from an elementary school experience, were considered. Second, school principals demonstrated: a willingness to participate in planning, development and evaluation processes focused on the PHSO model; and an agreement to implement and evaluate PHSO program components and strategies (letters of support). Thirty-two Twin Cities' area middle schools with diverse student populations were identified. Schools that outperformed statewide averages for either reading or math scores on the MN Comprehensive Assessment (MCA), MN's standardized tests, were removed, leaving 16. Schools were chosen with respect to their level of diversity, geographic location (straddling urban and suburban neighborhoods), number of students receiving free/reduced lunch, ethnicity/race, and number of English language learners (Table 4). Finally, prioritizing schools with greatest receptiveness to participating in PHSO reduced the sample to 4 schools including: a) Brooklyn Center IB World School & Arts Magnet (grades 6-12) in Brooklyn Center, a suburb north of Minneapolis, with some of the state's lowest performing students on the MCA. Of the PHSO schools, Brooklyn Center has the highest proportion of students eligible for free/reduced lunch at 77.1% (>2x the state average), and the highest proportion of Black students at 41.8% (>4x the state mean). b) Brooklyn Junior High School (grades 7-9) in Brooklyn Park, a suburb north of Minneapolis and Minnesota's sixth largest city. Brooklyn Junior High is unique in that it will allow us to test the model in a junior high setting, with 7th grade as the transition year into the middle level setting. With a 7th grade student population of about 300 students, Brooklyn Junior High also comprises PHSO's largest entering grade. c) Richfield Middle School (grades 6-8) in a suburb south of Minneapolis, has the highest proportion of English Learners (33.7%) of the 4 schools. It has an American Indian population that exceeds the statewide average and a Latino student population of 40%. d) Heritage E-STEM Middle School (grades 5-8) in a suburb adjacent to St. Paul, and has a large Latino population. Although the entrance year is 5th grade, we will implement PHSO in Heritage beginning in 6th. Due to their similar racial/ethnic characteristics, the first 2 schools (Brooklyn Center & Brooklyn Junior High) will be the first matched pair of schools, and the last 2 schools (Richfield & Heritage) will be the second matched pair. Within each pair, schools will be randomly assigned to SEL and SEL+PD conditions. Schools will receive remuneration each year during the RCT for program participation and evaluation activities. C.5. Study Sample & Recruitment. Four schools have been recruited and agreed to participate in the proposed study. These schools were purposively sampled because they have above average percentages of students eligible for a free/reduced price lunch and show substantial racial/ethnic diversity (Table 4). During the pilot year, we anticipate targeting a sample of 120 students in the pilot school. A total sample size of approximately 840 students is available for the RCT, based on current class sizes. For both the pilot and RCT, student assent/parent consent will first be discussed in classrooms several weeks prior to survey administration. Students will be given consent form packets (information letter, parent consent form) and asked to have their parents sign and return the form, providing written permission or refusal for study participation (Appendix E includes draft consent and assent forms). Parents will also be given MN State Data Brooklyn Center IB World School & Arts Magnet, Brooklyn Center Brooklyn Junior High, Brooklyn Park* Richfield Middle School, Richfield Heritage E-STEM Middle School, West St. Paul # of 6th graders 116 311 250 165 % proficient on MN Comprehensive Assessment (MCA) standardized tests (6th grade) 2012 Math: 59.9% 20.0% 41.0% 41.1% 44.0% 2011 Math 50.3% 28.9% 36.8% 23.7% 28.1% 2012 Reading 76.3% 38.1% 61.5% 59.0% 68.6% 2011 Reading 75.1% 50.4% 61.3% 51.8% 63.3% 2012 School demographic characteristics (%'s reflect entire school population) English Learners 7.7% 12.9% 13.0% 33.7% 11.9% Free/Reduced Lunch Eligible 37.2% 77.1% 58.2% 70.4% 39.2% American Indian 2.1% 0.3% 0.4% 2.3% 1.3% Asian 6.8% 18.0% 28.5% 7.6% 6.2% Hispanic 6.8% 19.0% 6.5% 39.7% 25.5% Black 9.7% 41.8% 33.7% 22.3% 10.3% White 74.4% 20.6% 30.9% 28.2% 56.8% * 7th grade is transition year for this school Table 4. Partner Schools' Academic and Demographic Data the opportunity to verbally consent or refuse via phone calls from trained research staff who will conduct calls in English, Spanish and Hmong. Incentives for returning signed consent forms may include movie tickets for individual students and classroom pizza parties for high rates of return. We have successfully used similar techniques to obtain a parent response rate of 95% with 6th graders in diverse K-8 schools. 84 During Years 3-4, we will obtain parental consent only for new students who enter study schools; all students will be asked for assent prior to each survey administration. C.6. Intervention. This section includes the conceptual model for PHSO and describes the intervention's youth SEL curriculum, teacher team PD components, ongoing engagement with school administrators, and the Year 1 pilot test of the combined SEL+PD program. C.6.a. Conceptual Model for Intervention. Figure 1. Conceptual Model The resilience paradigm, 101 the theory of triadic influence, 102 the social development model, 103 and research findings on risk and protective factors for bullying and violence, substance use, sexual risk behaviors and school failure among multi-ethnic groups of young teens living in impoverished neighborhoods inform the conceptual model for the PHSO intervention. Figure 1 depicts teens' involvement in bullying, violence, substance use, sexual risk behaviors and academic risk behaviors as inter-related. In turn, these behaviors are influenced by selected environmental and individual attributes repeatedly associated with these behaviors and amenable to change through interventions. Broad structural factors such as poverty, not explicitly included in the model, have overarching influences on youth health and educational outcomes (not directly amenable to change through interventions) that are important to consider as potential moderators of intervention effects. 57,104 C.6.b. Youth SEL Curriculum: Positive Action (PA). The proposed study will use one of the leading evidence-based SEL curricula for young teens from ethnically diverse backgrounds, Positive Action (PA; see recommended lists of programs such as CASEL; 105 U Colorado Blueprints; 106 National Registry; 107 OJJDP Model programs 108). The PA program is grounded in self-esteem enhancement theory 109 and social-ecological theories of health behavior. 102,103 The program assumes that individuals will use a wide range of cognitive, affective, and behavioral strategies to help acquire and sustain feelings of self-worth. Positive outcomes follow to the extent that young people are adequately prepared and supported in satisfying their motivation for self- esteem through adaptive beliefs, values, and actions. To this end, PA includes a scoped, sequenced K-12 curriculum that introduces the desire to feel good about oneself, while teaching students skills (e.g., self- control, positive peer interactions, honesty) to act on this desire in ways that are adaptive for self and others. Table 5. Positive Action Curriculum Units146 Unit 1: Self-Concept. The relationship of thoughts, feelings, and actions (behavior). Units 2-6 teach young teens what actions are positive in various domains of life, that they feel good when they do positive actions & that they then have more positive thoughts & future actions. Unit 2: Positive Actions for Body & Mind. Body: exercise, hygiene, nutrition, avoiding substance use, sleep, safety. Mind: creative thinking, learning, studying, decision making, problem-solving. Unit 3: Positive Actions for Managing Yourself Responsibly. Self-control. Managing human resources of time, energy, thoughts, actions, feelings, talents, possessions. Unit 4: Positive Actions for Getting Along with Others. Treat others the way you like to be treated, code of conduct (e.g., respect, fairness, kindness, courtesy, empathy, responsible), conflict resolution, communication skills, forming relationships, working cooperatively, community service. Unit 5: Positive Actions for Being Honest with Yourself & Others. Self-honesty, integrity, not blaming others, not making excuses, not rationalizing; self-appraisal; being in touch with reality. Unit 6: Positive Actions for Improving Yourself Continually. Goal setting, problem solving, decision making, believe in potential, have courage to try, turn problems into opportunities, persistence. Experimental evaluations support PA effectiveness in improving academic outcomes and reducing bullying, violent behaviors, early sexual intercourse, and substance use. 61,62,110,111 The sequenced PA middle grades curriculum includes 20-minute lessons for each grade (www.positiveaction.net). The total time students are exposed to this curriculum during a school year is about 1 hour per week. The curriculum includes 6 core units (Table 5) that encourage interactions between teacher and students through structured discussions and activities and among students through small group activities including role-plays and skills practice. 110 PA will be delivered by staff teams (e.g., social workers, health teachers, behavioral specialists) from each study school. Several weeks before the start of each school year in the RCT, Oliphant (the study's PA program coordinator) and local/county health department staff with expertise in implementing youth development programs will lead a 4-hour training for all school staff delivering PA at the study cohort's grade level (e.g., 6th grade in 2015-16). Midway through each school year, Oliphant and her health department colleagues will lead a 2-hour training booster session for all school staff delivering PA; sessions will highlight content of remaining PA lessons and give school staff opportunities to share effective implementation strategies. In addition, Oliphant and health department staff will meet with each school's PA program teams quarterly during the school year. These meetings will problem-solve PA implementation strategies in ways that are tailored to each school's resources. Oliphant and her health department colleagues will be available for consultation as needed. C.6.c. Teacher Team Professional Development. To maximize school-based support and reinforcement for positive academic and health behaviors among middle school students, the SEL+PD condition of the proposed study will employ an innovative approach to the teacher team PT model tested in the MPSC study (Section C.2.a). This approach consists of 4 elements: 1) a 3-day Training Institute to ground training for the school year; 2) classroom implementation of a Student Engagement Plan; 3) 3 one-day Teacher Team booster sessions; 4) purposeful attention to school context through regular communication with school principals. A 3-day Training Institute (held 3-4 weeks prior to the start of the school year) provides the foundation for school-year classroom coaching, covering 3 core content areas. The first, stages of adolescent development, is based on the premise that effective middle grade teachers understand the developmental uniqueness of this age group, and what this developmental stage means for learning strategies. 112 The second area, positive youth development, places youth development in an ecological framework and recognizes the need to attend to protective factors in assessments and interventions. 113 The third area is student engagement, a fundamental construct for understanding school dropout and completion. 72,114 Content for the institute and quarterly teacher team booster sessions (described below) are in Appendix F. The Training Institute teaching manual was developed through an IES-funded MPSC study (Section C.2.a.). The institute will utilize a variety of adult education methods. Teacher teams will practice applying what they learned in role play situations with trained adolescent actors. Time will scheduled for reflection on applying each day's content to the classroom. Each teacher will create a Student Engagement Plan that describes their learning goals for the year, strategies they intend to apply, and areas where additional information and/or coaching is needed. Ensuring that such strategies are applicable to real-world school settings, Training Institute faculty will include 2 middle grade teachers recognized as skilled in engaging students. Known as Teacher Team Facilitators, they will co-teach sections on applying research to practice. Classroom implementation involves teachers' guided implementation of their Student Engagement Plans throughout the school year. Changes in practice, especially in complex settings such as schools, take place over time, rely on varying degrees of external expertise, and are most likely to occur with ongoing coaching support. 115,116, 117 Thus, formal observation (prior to coaching) and coaching itself will occur 3x during the school year, with the first session occurring several weeks after teachers begin implementing their Engagement Plans. Project evaluation staff will use a standardized observation tool to assess classroom quality. Coaching will occur within days of classroom observations at each SEL+PD school, draw on the observations, be structured as a collaborative experience using tools such as the Co-Active Coaching Model, 118 and involve both 1-on-1 and teacher team sessions using guidelines in Appendix F. Ongoing coaching is known to result in much greater implementation of new classroom management strategies than what is achieved by teachers who complete initial training but do not have long-term coaching support. 116 Teacher Team booster sessions provide opportunities for peer learning, sharing of experiences, and reviewing or introducing new material. Teacher teams will attend 3 one-day meetings during the course of the school year. The intent is to build a learning community of middle grade teachers in a way that supports their adoption of innovative classroom practices. Without structured opportunities for reflection and growth, teachers are likely to revert to more familiar patterns of interaction with students. 119 Attending to school context will be central to teachers' ability to sustain changes they are making in the classroom. 120 Meetings with school principals will be held throughout the school year. These meetings will inform principals about changes in teachers' classroom practices so that they can communicate innovative practices for enhancing student engagement with school staff as well as with students' families. In addition, challenges in implementing teachers' student engagement plans will be discussed. In each year of the RCT, Teacher Team Professional Development will be offered to math, science, language arts, and social studies teachers in the study cohort's grade level in SEL+PD schools. Teachers will be incentivized to participate (and substitute teachers provided to cover training days). Moore will serve as primary trainer and coach for teacher teams. Having co-designed and implemented all elements of this PD model with middle school teachers in the MPSC study, Moore is uniquely qualified to adapt the model for teacher teams and put it into practice in SEL+PD schools. C.6.d. Ongoing Engagement with School Administration. From Lead Peace and MPSC studies, we have found that an essential element of intervention success and sustainability is ongoing communication with school administration aimed at building knowledge and support of the innovation. 86 Thus, project director Snyder will hold regular meetings with study school principals (and others if desired) to update them on implementation of the PA program and, in the SEL+PD condition, on the teacher-team PD process. C.6.e. Year 1 Pilot Test of Combined SEL+PD Intervention, Modification of Intervention. In Year 1, we will pilot test the study's combined SEL+PD intervention with 7th grade students and teachers in a single study school (Aim 1). UMN PRC staff will take the lead in training and support of pilot school staff implementing SEL (Oliphant) and PD (Moore) intervention components. This pilot study will focus on acceptability and feasibility of implementing of both intervention components. The pilot will illuminate necessary modifications to intervention delivery during the randomized trial as required by time/resource limitations of participating schools. For example, findings may lead to a different configuration of staff or to revisions in scheduling of SEL sessions within a school week. No modifications will be made to content of core PA lessons or materials. C.7. Evaluation Overview. The evaluation plan includes assessment of implementation and student outcomes. Implementation of the multi-component program will be assessed through process measures, such as exposure, participation and receptivity. Youth health outcomes (violence, bullying, substance use, sexual risk behavior) and risk and protective factors (SEL skills, school connection, student engagement) targeted by the program will be measured via self-report surveys during each school year. Academic achievement, attendance and behavioral referral outcomes will be measured via school records. Qualitative data will include interviews with principals and focus groups with school staff. C.7.a. Process Evaluation. Data collection tools and methods for evaluating intervention fidelity and acceptability (in support of Aim 2a) are summarized in Appendix E (Table 1). Intervention fidelity incorporates 3fundamental concepts context, adherence, and competence. 121-123 Context refers to prerequisites that must be in place for a program to operate, in addition to aspects of a school/neighborhood environment that affect implementation. To measure context, we will utilize interviews with school principals and focus groups with school staff and teacher team members. For example, we will compile a neighborhood/school mapping narrative to describe dynamics and characteristics of surrounding neighborhoods for each participating school. In Year 5, interviews with all 4 school principals and select school staff and teachers will assess school climate and the degree to which programming is sustained following the RCT. Adherence refers to students' exposure to school-based intervention activities, their receptivity to activities, and variations in implementation activities. For example, to assess student exposure and receptivity to the SEL program and activities, attendance at each classroom session will be recorded and a report on each SEL unit will be completed by school staff to evaluate the extent to which school staff use the SEL core program components. To measure adherence of teacher teams to the PD model, we will use a PD Requirement Checklist to track attendance and participation in trainings, observations, and individual/team coaching sessions. Competence refers to the level of skill demonstrated by school staff in applying the core intervention components. We will assess competence through observations of teacher team members' teaching practice using Classroom AIMS, 80 completed 3x per school year by two raters, in at least 2 classrooms for each teacher in the SEL+PD condition. Surveys of teacher teams will assess changing team dynamics and attributes that make for an effective teacher team to promote student engagement. Observations of school staff delivering the SEL curriculum will take place 3x during the school year, during each year of program implementation for both conditions (SEL; SEL+PD). PHSO staff will complete observations using standard checklists that assess classroom climate, completeness of implementation, student engagement and understanding of SEL content. C.7.b. Evaluation of Outcome Behaviors. Data from student surveys completed twice in Year 2 (e.g., start and end of 6th grade), and at the end of Years 3-4 (e.g., end of 7th & 8th grades) will form the basis for the health outcomes evaluation. The student survey instrument will include measures of risk behaviors, potential moderating and mediating factors. The student survey will build upon the MPSC survey (Appendix E) and the Lead Peace survey. As new measures will be added, we will ask our community, youth, and national advisors (Section C.10) to review the final student survey for acceptability to middle school students and their parents. Health behavioral outcomes include violence, bullying, substance use and sexual risk behaviors. Measures of these behaviors will be adapted from Add Health14,15 and YRBS.32 Measures of cyber-bullying, an emerging youth risk behavior, will be included. 77 Appendix E includes a summary table of reliability coefficients for indices used in the MPSC and Lead Peace student surveys to measure behaviors and protective factors (i.e., potential mediators & moderators). For example, surveys will contain Student Engagement Inventory (SEI) subscales (Teacher-Student Relationship and Control and Relevance of School Work 124) and subscales from the Engagement vs. Disaffection with Learning scale,125 the School Attitude Assessment Survey-Revised, 126 School Connectedness Scale,127 and Healthy Kids Survey.128 Finally, we will use measures of interpersonal and stress management skills, hopefulness, and peer cooperative behaviors from the Lead Peace survey. 129 School Records: Students' quarterly grades and attendance data will be obtained each year, with standardized math and reading scores. Data on eligibility for free/reduced lunch and ELL status will also be obtained. Identifying less engaged students (for Aim 2d subgroup analysis). Important subgroups to explore for differential intervention effects include students identified as disengaged at baseline of RCT. Students will be identified as disengaged based on responses to 2 subscales from the SEI, 124 a self-report measure with strong evidence supporting its ability to accurately characterize engagement. 130 Scores will be rank-ordered within each school; students who score in the lowest 15% will be designated as disengaged learners for subgroup analyses. C.8. Analysis Plan for Health & Academic Outcomes. We will use both descriptive and inferential analyses to examine impacts of the intervention on student outcomes with cross-sectional and longitudinal data (in support of Aim 2). Health and academic outcomes will be analyzed separately. For cross-sectional data, we will examine descriptive statistics including Cohen's d 131 for schools within RCT conditions, which will provide insight into the magnitude and pattern of intervention effects. For example, a d-statistic near 0 when comparing schools 1 and 2 in the SEL+PD condition suggests that on average, student responses on an outcome such as bullying were similar across schools, which speaks to within-condition consistency. In contrast, a large d-statistic (e.g., 1.3) suggests that average student responses on an outcome were not similar across schools and raises concerns of within-condition consistency. A specific focus of descriptive work will be computing d-statistics for condition 1 (SEL+PD) vs. 2 (SEL) on our outcomes to provide an overall look at intervention impact. Per recommended practice, confidence intervals for the d-statistics will be reported.132 To examine student change over time in middle school and its moderators, we will treat the data as repeated measures nested within students and fit multilevel models for each outcome variable. 133 Initially we will examine longitudinal data (e.g., self-reported violent behavior, bullying) for evidence of linearity and then fit within-student models to estimate linear and quadratic change (e.g., health behaviors increase rapidly and then plateau). We will then use two-level models to explore patterns among estimated rates of change in student behaviors. In Aim 2b analyses, the key predictor in between-student models will be intervention condition (SEL+PD vs. SEL only); models will also include 5th grade standardized test scores to control for prior ability and demographic variables. The goal will be to identify whether receiving the SEL+PD intervention results in greater change in health outcomes over time compared to the SEL only intervention. Dependency associated with students nested within schools will not be formally modeled due to small #s of schools. However, intra-class correlations (ICCs) will be estimated for each school to provide descriptive evidence of this dependency. We will also include schools as fixed effects in the between-student model to statistically account for any between-school variation (and because the pilot school will have begun the intervention earlier than other schools). To control for compounding of Type I error rates, 134 we will use an a'=1-(1-a)1/m a adjusted error rate computed as where is the unadjusted Type I error rate, m = number of statistical tests associated with multilevel analyses of a given outcome, and a' is the adjusted Type I error rate.135 We will use an overall a =.15 per outcome, which resembles a family-wise error rate strategy often associated with planned comparisons in ANOVA. For Aim 2c analyses, multilevel modeling will examine mediating mechanisms through which interventions affect student outcomes.136,137 For example, effects may be mediated by a student's level of engagement or stress management skills. Identification of such mechanisms can substantially enhance explanations of the impact of SEL+PD or SEL alone on health and education outcomes. Testing of mediation processes will utilize Baron & Kenny's classic approach, supplemented with asymmetric confidence limits for indirect effects (bootstrapping) as recommended by MacKinnon and colleagues. 136,137 To fulfill Aim 2d which focuses on moderating effects, multilevel models will examine the effects of being in subgroups (e.g., academically engaged or disengaged students, FRL status, race/ethnicity, gender). Findings will provide evidence about whether student engagement (or poverty status, race/ethnicity, or gender) moderates patterns of student change in health and education outcomes over time. An exploratory analysis will investigate whether intervention effectiveness is moderated by the predominant race/ethnicity of a school; i.e., we will test for differences in intervention effects among Latino students who attend schools that are primarily Latino vs. schools that are primarily African American. Attrition & Bias. In this longitudinal study, student attrition may result in missing data that bias inferences. 138 The attrition rate for students who do not complete the 3-year study may be as high as 40%. Most attrition will be due to student mobility or changing schools for reasons other than grade promotion. 139 This rate is higher than US average school mobility rates of 15-20% but is consistent with rates for higher poverty schools. 140 Missing data due to attrition will be treated as missing completely at random (MCAR) and will not bias estimated effects or statistical tests. 141 To assess the impact of missing data, we will conduct sensitivity analyses using (i) all available data, (ii) only students who provided complete data, and (iii) imputed data values in which missing values are imputed using available data, assuming missing data are MCAR or missing at random (MAR). 141 If the pattern of effects and their magnitude are similar across (i), (ii), and (iii), the inference is that our findings appear to be insensitive to missing data. Following the What Works Clearinghouse (WWC)134 criteria, the proposed design helps to ensure, but does not guarantee, that schools (clusters) are equivalent at the beginning of the study and, thus, apriori cluster differences (selection bias) is a concern. To respond to this possibility, we will match schools into pairs as best we can on demographic characteristics before randomization, and we will also employ various statistical control variables and perform analyses designed to assess sensitivity of our findings to selection bias. C.9. Power Analyses. We used the Optimal Design 142 statistical program to estimate power for the expected sample size, assuming a 2-level model with repeated measures (level 1) nested within students (level 2). Two effects are of particular interest: overall intervention effect (SEL+PD vs. SEL) averaging across repeated measures and students, and the effect of intervention condition on linear growth rates. Power calculations depend on a complex mix of factors including number of repeated measures, number of students, effect sizes, and ICCs. Power and sample size calculations below are for a test of overall intervention effect on linear growth rates as this will require (other things being equal) larger sample sizes. 143 We assumed a 3-year RCT with 4 repeated measurements and no attrition.142 A total sample of 300 students will produce a test of intervention effect on growth rates with power of approximately .90 to detect a standardized effect of .40 (a small-moderate effect).131 Effect sizes of this magnitude characterize results from previous tests of the PA program.110 Based on a projected sample of 840 students, attrition will have negligible impact on power. In sum, this study accomplishes several objectives consistent with a comparative effectiveness trial of a school-based program targeting student health and achievement. Interventions will be delivered in authentic educational settings, providing a realistic assessment of their effects on student behaviors. Cross-sectional and longitudinal data offer a rich characterization of intervention impact. Findings will illuminate the power of middle schools as contexts for nurturing positive health and academic outcomes among young teens. C.10. Involvement with Community Partners and National Advisors. In existence since 1996, the UMN PRC's Community Advisory Network (CAN) will provide advisory support for PHSO. CAN members represent an array of adolescent health and youth development organizations. During regular meetings, the PHSO research team will seek CAN members' guidance on intervention plans. Because youth voice will be important for informing PHSO implementation, we will also ask members of PRC's Youth Advisory Board (YAB) to provide feedback and direction based on their own recollections of what middle school students need to support their development. Community support for the proposed core research is evidenced in detailed letters of support from the PRC CAN, Minneapolis, Dakota and Hennepin County Health Departments. A 6-member PHSO national advisory board includes experts in types of student engagement: academic-Drs. M. Gettinger, U WI; affective- E. Skinner, Portland State U; behavioral- J. Finn, SUNY; cognitive- J. Appleton, Gwinnett Co Schools, GA. R. Catalano (U WA) will lend his expertise as a prevention scientist and adolescent health promotion leader (LoS). Resnick will offer expertise in school connectedness. The Board will advise on intervention components, review progress, recommend changes, and guide input on final products. C.11. Communication/Dissemination. As noted earlier in this application, UMN PRC will develop a formal communications plan in collaboration with PHSO's community partners, participants and national advisors. While strategies will be shaped by partner input, documenting our team's approaches, materials and insights will be of great value for promoting systems change and keeping key stakeholders and community partners informed about the core project. In addition to information materials about PHSO (e.g., fact sheets, website), we will develop promotional materials for partner schools. Their key audiences (school districts, families, community) will drive development of communications assets likely to include stories for PTA newsletters, letters to parents, and articles for school district public relations. To support relations with schools, we will replicate strategies from our successful Lead Peace research project, including annual production of school- specific data reports; these colorful, easily accessible, clearly written "Snapshot" reports provide findings on student achievement and health behaviors that matter to school administrators and teachers. PHSO will also reach scholarly audiences by publishing 4-5 articles; targeting peer reviewed scientific journals including Journal of School Health and Journal of Adolescent Health. As PHSO crosses several disciplines, findings will be promoted at conferences for public health researchers (e.g., APHA) and agencies (e.g., Association of Maternal and Child Health Professionals), in addition to education venues (e.g., Association for Supervision and Curriculum Development [ASCD]). Translation of research findings will inform a "Linking Learning & Health Summit"-a Year 5 public event where findings will be shared with partners, community member, innovators, future funders and policy makers. We will attempt national exposure for this event through webinars, online availability of presentations. As HYD champions, we believe it is essential to "walk the walk." Thus, our plan includes an opportunity for voices of young people to be heard and amplified, by engaging and documenting their perceptions, experiences and reactions to participating in PHSO. Based on the process selected to engage youth (e.g., PhotoVoice), we will produce and disseminate a dedicated communications product and infuse youth voices into other products; e.g., findings may inform a companion piece to Youth Voices on Staying in School & Dropout Prevention in Minnesota, a 2009 monograph created by Snyder, Moore and Shea (see Appendix D). It is possible to motivate systems change by promoting the concepts, strategies and results of this research project. Goal #1 from the Communications Section states our intention to Increase changes to environmental systems through improved health/education partnerships at local, state and national levels. UMN PRC will contribute to the national discussion by promoting editorial content inspired by PHSO to national venues that reach health/education integration thought leaders. While UMN PRC has strong access to and expertise in public health systems, we need equally strong collaborators from across the aisle. We have such a partner with ASCD, leader of the Whole Child Initiative-an effort to change the conversation about education from a focus on narrowly defined academic achievement to one that promotes the long-term development and success of youth. ASCD will act as a strategic advisor in implementation of a communications plan to add concepts from our core research project to the national health/education agenda (ASCD letter of support). Our collaboration with UMN SAHRC also shapes efforts to innovate health/education systems integration. Shea and SAHRC Director Teipel have a unique perspective regarding under what circumstances state and national health and education agencies partner effectively, based on experiences conducting adolescent health systems capacity assessments and training federally-funded public health professionals on how framing and communications strategies can help "cross the chasm" between agencies. With SAHRC's input, we will promote a credible scope of work for state adolescent health staff looking to partner with education agencies: as topical experts and supports to schools on adolescent development and HYD strategies. If the proposed study yields evidence that PD is an effective addition to SEL programs, UMN PRC will make materials from the study's PD materials available via a web-based resource library. UMN PRC and SAHRC will engage state adolescent health staff with this resource and the possibility of adopting a systems-bridging role. C.12. Future Directions/Sustainability. Sustainability is the process of ensuring adequate infrastructure capacity and innovations that can be integrated into systems' ongoing operations. It should begin shortly after decisions to test an innovation. Cultivating champions, ensuring resources and expertise are available, and developing administrative structures and formal linkages needed to sustain the innovation all require attention. The innovation itself must have specific attributes including alignment with needs of stakeholders, positive relationships among partners, quality implementation, evidence of effectiveness, and ownership among partners and stakeholders. 86, 144 To maximize the likelihood of sustained impact, UMN PRC will attend to these factors from the beginning. Our role in building school and community partners' capacities to implement SEL and PD intervention components is detailed in Section C.6. Specific activities are planned for Years 4-5 to foster sustainability. First, we will offer the 3-day Training Institute prior to the 2018-19 school year as "delayed" PD for interested teacher teams from SEL only schools. Second, we will evaluate programming in all 4 partner schools during Year 5 to determine what implementation is taking place after the RCT. Year 5 interviews with school staff will assess the extent to which schools have assumed ownership of SEL and PD program components. In addition to these activities, UMN PRC will convene school, health department and university partners and stakeholders for strategic planning purposes early in Year 5. Experience and evidence from implementing this comparative effectiveness study will inform partners' decisions about what elements of PHSO are worthy of sustaining, what attributes are in place and what additional resources are needed to sustain this innovation. To leverage resources to mainstream the program within participating school districts, UMN PRC will assist project partners in communicating about the program, identifying funding sources, writing grants, and potentially conducting research with a larger group of schools to further document the effects of this innovative program.145