BehaviorNCT04026490
Evaluation of Link for Equity (Students of Color Population)
A study testing Immediate Intervention and Waitlist Intervention 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 9 to 19 years
- Conditions the study is for
- Behavior
- What is being tested?
- Immediate Intervention and Waitlist Intervention
- Type of treatment
- Lifestyle or therapy programme
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 518 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 9 to 19 years
- All sexes
- No healthy volunteers
- Child, Adult
Who may be able to join
- The student study population is composed of students of color enrolled at participating schools
Who cannot join
- Children who do not identify as full/part Black/African American, Latino/Hispanic, or American Indian/Native
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 (Students of Color 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 Intervention, Waitlist Intervention
- Medical subject headings
- Behavior
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Immediate InterventionBehavioural
The Interventionist will use motivational interviewing skills, assess ethnic and racial microaggressions, and provide support, screen for posttraumatic stress, and, if appropriate, link student to advanced care. The student may meet with the Interventionist several times during the remainder of the school year. These meetings will be approximately 10-30 minutes in length and occur during the school day in a private location determined by the Interventionist. The student may be referred to additional resources as a result of the meetings. The meetings will be documented by the Interventionist using a case management system (in RedCap).
Waitlist InterventionBehavioural
In order to compare outcomes contemporaneously, students from waitlisted schools will be asked to complete baseline and follow-up surveys, which will be collected at approximately the same time as in the immediate intervention schools. The data will be captured for analysis at the end of the study. Students will complete intervention following the waitlist period.
| Study group | Role | What they receive |
|---|---|---|
| Immediate intervention | Experimental | The student will have a conversation with an Interventionist. Receives: Behavioral: Immediate Intervention |
| Waitlist intervention | Active comparator | These students will be approached for intervention for the months following the implementation of the immediate intervention group using the same procedures. Receives: Behavioral: Waitlist Intervention |
What is being measured
The primary outcome is the main question the study is designed to answer.
Change in School-based Racial and Ethnic Microaggressions Scale (SbREMS) Score
This is a 14-item scale that measures microaggressions that communicate perceptions of academic inferiority, expectations of aggression, and stereotypical misrepresentations. Respondents are instructed to indicate the number of times that a microaggression occurred in the past month from 1 (never) to 3 (regularly). Sub-scales include Academic Inferiority Microaggressions, Expectations of Aggression Microaggressions, and Stereotypical Misrepresentations Microaggressions. Items are averaged to obtain total and sub-scale scores. Higher scores indicate greater perceived frequency of racial microaggressions. Change in SbREMS score from baseline to two years post will be evaluated.
Measured: baseline and 2 years
Change in Bullying incidents
Bullying is defined in Minnesota's anti-bullying law as recurrent aggression between peers leading to a power imbalance. Bullying perpetration and victimization will be evaluated in students enrolled in this study through semiannual surveys. Bullying perpetration and victimization incidents will also be examined using office referral and disciplinary action data from school records. Self-reported bullying is collected in the school-wide population through the Minnesota Student Survey, and will also be examined. From the secondary school measures, we will use counts per students enrolled. From the MSS data, we will report the change in the percentage of students who report an incident (e.g., percent bullied).
Measured: baseline and 2 years
Change in Physical assault
Perpetration and victimization of physical assault, defined as physical harm against or by another student, will be evaluated using office referral and disciplinary action data from school records. Self-reported bullying is collected in the school-wide population through the Minnesota Student Survey, and will also be examined. From the secondary school measures, we will use counts per students enrolled. From the MSS data, we will report the change in the percentage of students who report an incident (e.g., percent of physical assaults).
Measured: baseline and 2 years
Change in Weapons carrying
Minnesota law defines a dangerous weapon as any firearm, whether loaded or unloaded, or any device designed as a weapon or through its use is capable of threatening or producing death or great bodily harm. Weapons carrying will be evaluated using office referral and disciplinary action data from school records. From the secondary school measures, we will use counts per students enrolled. From the MSS data, we will report the change in the percentage of students who report an incident.
Measured: baseline and 2 years
Change in Fighting
Incidents of fighting will be will be evaluated using office referral and disciplinary action data from school records. From the secondary school measures, we will use counts per students enrolled. From the MSS data, we will report the change in the percentage of students who report an incident.
Measured: baseline and 2 years
Change in Subjective Disciplinary Practices
Subjective disciplinary practices are referrals and actions that are issued based on a subjective decision of teachers, including verbal abuse, defiance, disrespect, and dress code violations. Subjective disciplinary practices will be evaluated using office referral and disciplinary action data from school records. From the secondary school measures, we will use counts per students enrolled. From the MSS data, we will report the change in the percentage of students who report an incident.
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
- 518 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
- NCT04026490
- Sponsor's protocol ID
- ExemptLinkEquityStudent
- 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 (Students of Color Population)
- ClinicalTrials.gov ID
- NCT04026490
- Acronym / sponsor ID
- ExemptLinkEquityStudent
- Conditions
- Behavior
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 518 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 intervention | Experimental | Behavioral: Immediate InterventionThe student will have a conversation with an Interventionist. |
| Waitlist intervention | Active comparator | Behavioral: Waitlist InterventionThese students will be approached for intervention for the months following the implementation of the immediate intervention group using the same procedures. |
Who may qualify
- Ages
- 9 to 19 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Child, Adult
Key inclusion criteria (1 listed)
- The student study population is composed of students of color enrolled at participating schools
Key exclusion criteria (1 listed)
- Children who do not identify as full/part Black/African American, Latino/Hispanic, or American Indian/Native
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 InterventionThe Interventionist will use motivational interviewing skills, assess ethnic and racial microaggressions, and provide support, screen for posttraumatic stress, and, if appropriate, link student to advanced care. The student may meet with the Interventionist several times during the remainder of the school year. These meetings will be approximately 10-30 minutes in length and occur during the school day in a private location determined by the Interventionist. The student may be referred to additional resources as a result of the meetings. The meetings will be documented by the Interventionist using a case management system (in RedCap). | Behavioural | Immediate intervention |
| Waitlist InterventionIn order to compare outcomes contemporaneously, students from waitlisted schools will be asked to complete baseline and follow-up surveys, which will be collected at approximately the same time as in the immediate intervention schools. The data will be captured for analysis at the end of the study. Students will complete intervention following the waitlist period. | Behavioural | Waitlist intervention |
Primary outcome
Change in School-based Racial and Ethnic Microaggressions Scale (SbREMS) Score
Time frame: baseline and 2 years
This is a 14-item scale that measures microaggressions that communicate perceptions of academic inferiority, expectations of aggression, and stereotypical misrepresentations. Respondents are instructed to indicate the number of times that a microaggression occurred in the past month from 1 (never) to 3 (regularly). Sub-scales include Academic Inferiority Microaggressions, Expectations of Aggression Microaggressions, and Stereotypical Misrepresentations Microaggressions. Items are averaged to obtain total and sub-scale scores. Higher scores indicate greater perceived frequency of racial microaggressions. Change in SbREMS score from baseline to two years post will be evaluated.
Change in Bullying incidents
Time frame: baseline and 2 years
Bullying is defined in Minnesota's anti-bullying law as recurrent aggression between peers leading to a power imbalance. Bullying perpetration and victimization will be evaluated in students enrolled in this study through semiannual surveys. Bullying perpetration and victimization incidents will also be examined using office referral and disciplinary action data from school records. Self-reported bullying is collected in the school-wide population through the Minnesota Student Survey, and will also be examined. From the secondary school measures, we will use counts per students enrolled. From the MSS data, we will report the change in the percentage of students who report an incident (e.g., percent bullied).
Change in Physical assault
Time frame: baseline and 2 years
Perpetration and victimization of physical assault, defined as physical harm against or by another student, will be evaluated using office referral and disciplinary action data from school records. Self-reported bullying is collected in the school-wide population through the Minnesota Student Survey, and will also be examined. From the secondary school measures, we will use counts per students enrolled. From the MSS data, we will report the change in the percentage of students who report an incident (e.g., percent of physical assaults).
Change in Weapons carrying
Time frame: baseline and 2 years
Minnesota law defines a dangerous weapon as any firearm, whether loaded or unloaded, or any device designed as a weapon or through its use is capable of threatening or producing death or great bodily harm. Weapons carrying will be evaluated using office referral and disciplinary action data from school records. From the secondary school measures, we will use counts per students enrolled. From the MSS data, we will report the change in the percentage of students who report an incident.
Change in Fighting
Time frame: baseline and 2 years
Incidents of fighting will be will be evaluated using office referral and disciplinary action data from school records. From the secondary school measures, we will use counts per students enrolled. From the MSS data, we will report the change in the percentage of students who report an incident.
Change in Subjective Disciplinary Practices
Time frame: baseline and 2 years
Subjective disciplinary practices are referrals and actions that are issued based on a subjective decision of teachers, including verbal abuse, defiance, disrespect, and dress code violations. Subjective disciplinary practices will be evaluated using office referral and disciplinary action data from school records. From the secondary school measures, we will use counts per students enrolled. From the MSS data, we will report the change in the percentage of students who report an incident.
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 Intervention and Waitlist Intervention 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 1 inclusion and 1 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 School-based Racial and Ethnic Microaggressions Scale (SbREMS) Score (time frame: baseline and 2 years). The study lists 6 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 NCT04026490, 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.