SELECT, ADAPT, EVALUATE

The VetoVille health department decided to introduce a new sexual violence prevention environmental intervention along with a skill-building program, with the goal of reducing sexual violence rates among 8th and 9th graders. To increase sexual violence protective factors, the health department partnered with a school district and an organization that provides services to the LGBTQ+ community to jointly implement the intervention.

VetoVille's health department approach included several initiatives to create a more protective environment in the schools. The health department and school district revised the school protocols for identifying and responding to sexual harassment and violence. The program implementers trained staff to engage the students in hot spot mapping to identify areas in and around the schools where students feel safe and where they do not feel safe. The staff and students worked together to create solutions and plan changes to the physical environment of the hot spots that are identified as unsafe. Then the program implementers worked with students to develop posters with positive messages about healthy masculinity and LGBTQ+ inclusivity. These efforts aimed to reduce harmful social norms, improve the school climate, and increase connectedness among the students with the ultimate goal of reducing sexual violence among high school students.

As VetoVille's health department and their partners prepared for their sexual violence prevention interventions, they reviewed similar efforts to determine common essential elements. They gathered input from subject matter experts and 8th and 9th graders. They also created their logic model and action plan and identified the estimated essential elements.

• For the WHAT essential elements, they trained staff on conducting hot spot mapping and using the findings effectively to improve and monitor the physical environment of schools. The staff were trained on protocol implementation and enforcement, which improved sexual harassment and violence identification and response. They developed and displayed key messages of positive gender norms and inclusivity.
• For the HOW essential elements, they followed guiding principles to create a safe, inclusive environment for all students. The physical environment of the schools was improved and assessed regularly to maintain improvements. New staff orientation included violence prevention training.
• For the WHO essential elements, the health department and their partners trained administrators and staff on intervention implementation. Students were involved in the planning and implementation.

After VetoVille's health department determined the essential elements of the environmental interventions, they assessed the fit of existing messaging campaigns and hot spot mapping programs. They made adaptations to better fit the school district's population and meet their objectives of increasing protective factors for those most at risk of sexual violence. The training of staff was a good fit because this will build their skills and confidence to enforce new policies and conduct hot spot mapping. They adapted the messaging campaign to enforce principles of LGBTQ+ inclusivity.

The HOW essential elements were a good fit because there is evidence that changing and monitoring the physical environment of areas identified as unsafe is protective against violence.

They will make an adaptation to the WHO essential elements to specifically engage students who identify as LGBTQ+ in a focus group because they are at increased risk of sexual violence and harassment. They gathered the students' perspectives on school hot spots. For essential elements that are determined to be good fits, no changes need to be made.

Before implementing adaptations, VETOVille's health department wanted to ensure that adaptations were likely to increase effectiveness of the interventions. Including messages of LGBTQ+ inclusivity is a green light adaptation that is expected to improve the intervention's effectiveness. This is because the content of the messaging campaign will be tailored to and developed in collaboration with the intended audience. Conducting a focus group with LGBTQ+ students is a yellow light adaptation because students might feel alienated or like they are being treated differently than other students. After this suggested adaptation is discussed with partners, program experts, and other teachers, as well as incorporating feedback from parents and students, this adaptation can be greenlit.

To assess the effectiveness of their interventions, VetoVille's health department monitored the implementation of the interventions and collected information from students six months after implementation. They conducted a survey of the 8th and 9th graders to understand the impact of the poster campaign and the changes to the school protocol and the physical environment of the identified hot spots. This data was used to improve the messaging campaign content, policy enforcement, and hot spot monitoring. VetoVille's health department plans to conduct hot spot mapping annually and make program changes as needed.