BehaviorNCT04026477
Evaluation of Link for Equity (School Staff Population)
A study testing Immediate Universal Trauma-Informed Care and Cultural Humility Training and Waitlisted Universal Trauma-Informed Care and Cultural Humility Training in people with Behavior, run by University of Minnesota at 1 site in United States.
Trial summary
The investigators propose to develop and evaluate Link for Equity, a trauma-informed system of care. Link, a system of support for ACE-affected children, is composed of universal school Trauma-Informed Care. Read more about this study
- Who is it for?
- Ages 18 years and olderHealthy volunteers can take part
- Conditions the study is for
- Behavior
- What is being tested?
- Immediate Universal Trauma-Informed Care and Cultural Humility Training and Waitlisted Universal Trauma-Informed Care and Cultural Humility Training
- Type of treatment
- Lifestyle or therapy programme
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 1,612 participants
- Where
- 1 siteUnited States
- Study dates
- 1 Aug 2019to 11 Sep 2025
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- All sexes
- Healthy volunteers accepted
- Adult, Older adult
Who may be able to join
- Employees of the participating school districts
- Willingness to complete study surveys
Who cannot join
- School staff not employees of the participating school districts
- School staff who refuse to complete study procedures
Trial locations and contacts
1 site in 1 country.
United States1 site
University of Minnesota
Minneapolis, Minnesota, 55455
About this study
Official title: Evaluation of Link for Equity: A Program to Reduce Racial/Ethnic School Violence Disparities (School Staff Population)
The investigators propose to develop and evaluate Link for Equity, a trauma-informed system of care. Link, a system of support for ACE-affected children, is composed of universal school Trauma-Informed Care. Preventing Racism through Awareness and Action (PRAA) is a perspective-taking racism/discrimination prevention intervention for school staff that increases awareness of racism and how it impacts students and promotes empathy for students of color. Link for Equity will be translated to be culturally responsive for 12 secondary public schools in metropolitan and rural Minnesota with substantial racial/ethnic minority students and racial/ethnic disparities in school discipline and violence. Using a nested, rigorous, and ethically acceptable randomized waitlist control design, the investigators will implement and evaluate Link for Equity sequentially for two years in each school. The overall goal is to evaluate if Link for Equity can reduce school violence disparities.
Read the detailed description
Significance of Research Question/Purpose: Youth violence is an emergent nationwide public health issue. Almost two-thirds of public schools across America report one or more violent incidents on their campus annually. In 2014, approximately 850,000 non-fatal victimizations occurred among 12-18 year-old students; this includes 486,400 assaults and serious violent victimizations. About 22% of children in the U.S. reported being bullied at school in 2011, and one in 10 students report being threatened or injured with a weapon on school property in the past year.
Racial/ethnic minority youth are at increased risk for school violence. African American, Latino, and American Indian youth report higher rates of in-school physical fighting, weapon carrying, and gang presence compared to white youth. The highest rates of severe violence are reported in urban high schools with high minority enrollment, and large samples and reviews indicate Black and Latino youth engage in more bullying than other racial groups.
Accumulation of adverse child experiences (ACEs), or childhood traumas such as abuse, neglect, household dysfunction, and racial discrimination, place children at high risk for violent behaviors. Multiple ACEs are more prevalent among American Indian (40%), Hispanic (31%) and black children (33%) compared with white children (21%). ACEs have acute and cumulative detrimental impacts on the physiological, cognitive, behavioral and psychological health of children, and children with increased ACEs are more likely to engage in violent behaviors at school.
For example, the Olweus Anti-bullying Program, which was shown to be effective in Norway yet ineffective among Washington's racial/ethnic minority students, is implemented widely. A number of gaps in addressing risks for youth violence remain. Many programs are limited to didactic instruction in the classroom, or solely target children with significant behavioral concerns. Systems-based approaches are the most promising sustainable models because they capitalize on infrastructures and services offered at school. This study will evaluate a systems-based model, Link for Equity. Link is combines Trauma-Informed Care (TIC) and psychological first aid in a culturally sensitive manner. Link for Equity offers cultural humility training that specifically targets racial/ethnic microaggressions to prevent racial discrimination in discipline referrals of racial and ethnic minority students.
The aims are to:
Aim 1: Adapt, implement, and measure the effect of Link for Equity on school violence disparities.
Aim 2: Measure the effect of Link for Equity on racial discrimination by teachers (2a), and assess if teachers' racial discrimination mediates the effect of Link for Equity on school violence (2b).
Aim 3: Explore connectedness and stress mechanisms through which Link for Equity impacts school violence disparities.
- Conditions
- Behavior
- Being tested
- Immediate Universal Trauma-Informed Care and Cultural Humility Training, Waitlisted Universal Trauma-Informed Care and Cultural Humility Training
- Medical subject headings
- Behavior
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Immediate Universal Trauma-Informed Care and Cultural Humility TrainingBehavioural
Instructional video and workshop
Waitlisted Universal Trauma-Informed Care and Cultural Humility TrainingBehavioural
Instructional video and workshop following waitlist period
| Study group | Role | What they receive |
|---|---|---|
| Immediate Universal Trauma-Informed Care and Cultural Humility Training | Experimental | Universal Trauma-Informed Care and Cultural Humility Training. After video and workshop training, staff will have ability to recognize trauma and racism and its impact on school procedures, practices, and children themselves. Staff will be able to apply core principles of cultural humility. Staff will examine their own cultural identity and how it influences their interactions and relationships with students of diverse cultural backgrounds (Principle 1). Staff will learn ways that privilege and oppression relate to their cultural identity and identify ways to flatten power hierarchies between themselves and students, including handling misbehavior from a trauma-informed, culturally humble perspective (Principle 2). Staff will problem-solve ways for their schools to be accountable for equitable discipline practices (Principle 3). Receives: Behavioral: Immediate Universal Trauma-Informed Care and Cultural Humility Training |
| Waitlist Universal Trauma-Informed Care and Cultural Humility Training | Active comparator | All staff from waitlisted schools will receive Universal Trauma-Informed Care and Cultural Humility Training at the end of the waitlist period. Receives: Behavioral: Waitlisted Universal Trauma-Informed Care and Cultural Humility Training |
What is being measured
The primary outcome is the main question the study is designed to answer.
Change in Color Blind Racial Attitudes Scale (CoBRAS) Score
This is a 20-item scale that measures denial of racism and white privilege and rejection of the belief that action is needed to eradicate the negative consequences of racism. Items are scored on a scale from 1 (strongly disagree) to 6 (strongly agree). Total scores are calculated by summing scores from all 20 items. Possible total scores range from 20-120 with higher scores indicating a stronger attitude of color-blindness.
Measured: baseline and 2 years
Change in Acceptability of Racial Microaggressions Scale (ARMS) Score
Attitudes towards racial microaggressions will be measured using two subscales of the Acceptability of Racial Microaggressions Scale (ARMS): Color Evasion and Power Evasion. The Color Evasion subscale contains 8 statements and the power evasion subscale contains 7 statements, which staff score for appropriateness on a scale of 1 to 6. The scores for the Color Evasion subscale are averaged. The resulting score ranges from 1 to 6, with a higher score indicating higher acceptability of color evasion microaggressions. Likewise, the Power Evasion subscale scores are average, with final scores ranging from 1 to 6, and higher scores indicating a higher acceptability of power evasion microaggressions.
Measured: baseline and 2 years
Change in Attitudes Related to Trauma-Informed Care Scale (ARTIC) Score
Attitudes related to trauma-informed care will be measured with the Attitudes Related to Trauma-Informed Care Scale (ARTIC), developed by the Traumatic Stress Institute. The ARTIC-10 Education version is a validated measure containing 10 questions answered on a bipolar Likert scale from 1 to 7. Certain items are reversed, and the item scores are averaged. Final scores range from 1 to 7, with higher scores indicating more favorable attitudes related to trauma-informed care.
Measured: baseline and 2 years
Change in Scale of Ethnocultural Empathy Score
Ethnocultural Empathy will be measured using the validated Scale of Ethnocultural Empathy. The scale contains 31 statements, rated from 1 (strongly agree that this describes me) to 6 (that strongly disagree that this describes me). Certain items are reversed, and the item scores are averaged. Final scores range from 1 to 6, with higher scores indicating higher levels of ethnocultural empathy.
Measured: baseline and 2 years
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted19 Jul 2019
- Study start1 Aug 2019
- Primary completion11 Sep 2025
- Study completion11 Sep 2025
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (1)Papers the sponsor has linked to this study.
- Other trials for BehaviorStudies of the same condition, open and under way.
- More trials run by University of MinnesotaThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Other
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Enrolment
- 1,612 participants (actual)
Sponsor and investigators
- Lead sponsor
- University of Minnesota
- Sponsor type
- University, hospital or other
- Collaborators
- National Institute on Minority Health and Health Disparities (NIMHD)
- Responsible party
- Sponsor
- Investigators
- Marizen Ramirez, PhD, MPH, Principal investigator, University of MinnesotaAndrew Ryan, MS, Principal investigator, University of Minnesota
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT04026477
- Sponsor's protocol ID
- STUDY00007052
- Other IDs
- 1R01MD013801-01
- Status last verified
- Sep 2025
- First submitted
- 18 Jul 2019
- Last updated
- 19 Sep 2025
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Publications
Ramirez MR, Ryan A, Harding AB, Renfro T, Church TR, Rosebush C, Trotter AG, Xiong BN, Gonzalez J, Woods-Jaeger B. Link for Equity, a community-engaged waitlist randomized controlled trial of a culturally responsive trauma-informed care program for BIPOC students: Design features and characteristics of baseline sample. Contemp Clin Trials. 2023 Mar;126:107090. doi: 10.1016/j.cct.2023.107090. Epub 2023 Jan 18.
PubMed 36681238
Study at a glance
From the registry record, last updated by the sponsor on 19 Sep 2025. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Evaluation of Link for Equity: A Program to Reduce Racial/Ethnic School Violence Disparities (School Staff Population)
- ClinicalTrials.gov ID
- NCT04026477
- Acronym / sponsor ID
- STUDY00007052
- Conditions
- Behavior
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 1,612 participants (actual)
- Lead sponsor
- University of MinnesotaUniversity, hospital or other
- Collaborators
- National Institute on Minority Health and Health Disparities (NIMHD)
- Study start
- 1 Aug 2019 (actual)
- Primary completion
- 11 Sep 2025 (actual)
- Study completion
- 11 Sep 2025 (actual)
- First posted
- 19 Jul 2019 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
The investigators propose to develop and evaluate Link for Equity, a trauma-informed system of care. Link, a system of support for ACE-affected children, is composed of universal school Trauma-Informed Care. Preventing Racism through Awareness and Action (PRAA) is a perspective-taking racism/discrimination prevention intervention for school staff that increases awareness of racism and how it impacts students and promotes empathy for students of color. Link for Equity will be translated to be culturally responsive for 12 secondary public schools in metropolitan and rural Minnesota with substantial racial/ethnic minority students and racial/ethnic disparities in school discipline and violence. Using a nested, rigorous, and ethically acceptable randomized waitlist control design, the investigators will implement and evaluate Link for Equity sequentially for two years in each school. The overall goal is to evaluate if Link for Equity can reduce school violence disparities.
Detailed description
Significance of Research Question/Purpose: Youth violence is an emergent nationwide public health issue. Almost two-thirds of public schools across America report one or more violent incidents on their campus annually. In 2014, approximately 850,000 non-fatal victimizations occurred among 12-18 year-old students; this includes 486,400 assaults and serious violent victimizations. About 22% of children in the U.S. reported being bullied at school in 2011, and one in 10 students report being threatened or injured with a weapon on school property in the past year.
Racial/ethnic minority youth are at increased risk for school violence. African American, Latino, and American Indian youth report higher rates of in-school physical fighting, weapon carrying, and gang presence compared to white youth. The highest rates of severe violence are reported in urban high schools with high minority enrollment, and large samples and reviews indicate Black and Latino youth engage in more bullying than other racial groups.
Accumulation of adverse child experiences (ACEs), or childhood traumas such as abuse, neglect, household dysfunction, and racial discrimination, place children at high risk for violent behaviors. Multiple ACEs are more prevalent among American Indian (40%), Hispanic (31%) and black children (33%) compared with white children (21%). ACEs have acute and cumulative detrimental impacts on the physiological, cognitive, behavioral and psychological health of children, and children with increased ACEs are more likely to engage in violent behaviors at school.
For example, the Olweus Anti-bullying Program, which was shown to be effective in Norway yet ineffective among Washington's racial/ethnic minority students, is implemented widely. A number of gaps in addressing risks for youth violence remain. Many programs are limited to didactic instruction in the classroom, or solely target children with significant behavioral concerns. Systems-based approaches are the most promising sustainable models because they capitalize on infrastructures and services offered at school. This study will evaluate a systems-based model, Link for Equity. Link is combines Trauma-Informed Care (TIC) and psychological first aid in a culturally sensitive manner. Link for Equity offers cultural humility training that specifically targets racial/ethnic microaggressions to prevent racial discrimination in discipline referrals of racial and ethnic minority students.
The aims are to:
Aim 1: Adapt, implement, and measure the effect of Link for Equity on school violence disparities.
Aim 2: Measure the effect of Link for Equity on racial discrimination by teachers (2a), and assess if teachers' racial discrimination mediates the effect of Link for Equity on school violence (2b).
Aim 3: Explore connectedness and stress mechanisms through which Link for Equity impacts school violence disparities.
Study design
- Primary purpose
- Other
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Immediate Universal Trauma-Informed Care and Cultural Humility Training | Experimental | Behavioral: Immediate Universal Trauma-Informed Care and Cultural Humility TrainingUniversal Trauma-Informed Care and Cultural Humility Training. After video and workshop training, staff will have ability to recognize trauma and racism and its impact on school procedures, practices, and children themselves. Staff will be able to apply core principles of cultural humility. Staff will examine their own cultural identity and how it influences their interactions and relationships with students of diverse cultural backgrounds (Principle 1). Staff will learn ways that privilege and oppression relate to their cultural identity and identify ways to flatten power hierarchies between themselves and students, including handling misbehavior from a trauma-informed, culturally humble perspective (Principle 2). Staff will problem-solve ways for their schools to be accountable for equitable discipline practices (Principle 3). |
| Waitlist Universal Trauma-Informed Care and Cultural Humility Training | Active comparator | Behavioral: Waitlisted Universal Trauma-Informed Care and Cultural Humility TrainingAll staff from waitlisted schools will receive Universal Trauma-Informed Care and Cultural Humility Training at the end of the waitlist period. |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (2 listed)
- Employees of the participating school districts
- Willingness to complete study surveys
Key exclusion criteria (2 listed)
- School staff not employees of the participating school districts
- School staff who refuse to complete study procedures
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Immediate Universal Trauma-Informed Care and Cultural Humility TrainingInstructional video and workshop | Behavioural | Immediate Universal Trauma-Informed Care and Cultural Humility Training |
| Waitlisted Universal Trauma-Informed Care and Cultural Humility TrainingInstructional video and workshop following waitlist period | Behavioural | Waitlist Universal Trauma-Informed Care and Cultural Humility Training |
Primary outcome
Change in Color Blind Racial Attitudes Scale (CoBRAS) Score
Time frame: baseline and 2 years
This is a 20-item scale that measures denial of racism and white privilege and rejection of the belief that action is needed to eradicate the negative consequences of racism. Items are scored on a scale from 1 (strongly disagree) to 6 (strongly agree). Total scores are calculated by summing scores from all 20 items. Possible total scores range from 20-120 with higher scores indicating a stronger attitude of color-blindness.
Change in Acceptability of Racial Microaggressions Scale (ARMS) Score
Time frame: baseline and 2 years
Attitudes towards racial microaggressions will be measured using two subscales of the Acceptability of Racial Microaggressions Scale (ARMS): Color Evasion and Power Evasion. The Color Evasion subscale contains 8 statements and the power evasion subscale contains 7 statements, which staff score for appropriateness on a scale of 1 to 6. The scores for the Color Evasion subscale are averaged. The resulting score ranges from 1 to 6, with a higher score indicating higher acceptability of color evasion microaggressions. Likewise, the Power Evasion subscale scores are average, with final scores ranging from 1 to 6, and higher scores indicating a higher acceptability of power evasion microaggressions.
Change in Attitudes Related to Trauma-Informed Care Scale (ARTIC) Score
Time frame: baseline and 2 years
Attitudes related to trauma-informed care will be measured with the Attitudes Related to Trauma-Informed Care Scale (ARTIC), developed by the Traumatic Stress Institute. The ARTIC-10 Education version is a validated measure containing 10 questions answered on a bipolar Likert scale from 1 to 7. Certain items are reversed, and the item scores are averaged. Final scores range from 1 to 7, with higher scores indicating more favorable attitudes related to trauma-informed care.
Change in Scale of Ethnocultural Empathy Score
Time frame: baseline and 2 years
Ethnocultural Empathy will be measured using the validated Scale of Ethnocultural Empathy. The scale contains 31 statements, rated from 1 (strongly agree that this describes me) to 6 (that strongly disagree that this describes me). Certain items are reversed, and the item scores are averaged. Final scores range from 1 to 6, with higher scores indicating higher levels of ethnocultural empathy.
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 19 Sep 2025.
- Derived from this study: PubMed 36681238Ramirez MR, Ryan A, Harding AB, Renfro T, Church TR, Rosebush C, Trotter AG, Xiong BN, Gonzalez J, Woods-Jaeger B. Link for Equity, a community-engaged waitlist randomized controlled trial of a culturally responsive trauma-informed care program for BIPOC students: Design features and characteristics of baseline sample. Contemp Clin Trials. 2023 Mar;126:107090. doi: 10.1016/j.cct.2023.107090. Epub 2023 Jan 18.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Marizen Ramirez, PhD, MPH principal investigator
University of Minnesota
Andrew Ryan, MS principal investigator
University of Minnesota
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Immediate Universal Trauma-Informed Care and Cultural Humility Training and Waitlisted Universal Trauma-Informed Care and Cultural Humility Training in people with Behavior, run by University of Minnesota at 1 site in United States.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 2 inclusion and 2 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 19 Sep 2025. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Change in Color Blind Racial Attitudes Scale (CoBRAS) Score (time frame: baseline and 2 years). The study lists 4 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT04026477, which also lists 1 linked publication.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 19 Sep 2025.