Abstract
Effective school-based universal interventions to prevent or reduce mental health problems among upper middle school students are lacking, particularly for student populations with chronic exposure to adversity. To address this gap, we conducted an efficacy trial that compared RAP (Relax, Aware, Personal rating) Club, a trauma-informed universal intervention, with an active control health education program called Healthy Topics (HT). We hypothesized that, compared with HT, RAP Club would improve student mental health. Eighth graders across 29 public schools serving under-resourced urban communities were randomized to receive RAP Club or HT (n = 644). Both programs were delivered during school by study staff and co-facilitated by young adults from the community. Multilevel models were estimated to test group differences in self-reported mental health outcomes at post-test and 4- and 12-month follow-ups. As compared with HT, RAP Club significantly reduced post-traumatic stress disorder (PTSD) symptoms (β = -2.69, p = 0.02, d = -0.30) and trended toward reduction of depressive symptoms (β = -0.62, p = 0.05, d = -0.24) at 4-month follow up and significantly reduced symptoms of PTSD (β = -3.48, p = 0.02, d = -0.39), depression (β = -1.52, p = 0.01, d = -0.42), and anxiety (β = -3.69, p = 0.02, d = -0.36), as well as behavior problems (β = -2.19, p = 0.02, d = -0.37), at 12-month follow-up. Findings indicate RAP Club has mental health benefits for eighth graders, which increase in strength and scope across the high school transition. Future research should explore implementation strategies to promote program sustainability and scale up.