Fourth R National Scale Up Study
The Fourth R: Promoting readiness, fit and delivery system capacity to maximize reach and impact in five provinces and territories
The Fourth R is an evidence-based program developed to promote healthy relationship skills and target risk behaviours through encouraging safe decisions about substance use, sexual relationships, bullying, and violence. Phase II of our Public Health Agency of Canada (PHAC) funded project included a major scale up of the Fourth R program. In terms of reach, more than 1300 educators, 1800 pre-service teachers and 21735 youth participated in Fourth R programs in 7 provinces and territories. We developed several new programs, including the Healthy Relationships Plus Program (HRPP), a mental health promotion-enhanced small groups program. Our programs were also adapted and expanded to meet a variety of different contexts including particular Aboriginal groups, geographic settings, linguistic groups (French and English), different school systems (e.g., public versus Catholic), and different delivery contexts. Our evaluations included a cluster randomized controlled trial (RCT) of our grade 8 program in Saskatchewan, a multi-method cross-sectional evaluation of our First Nations, Métis, and Inuit (FNMI) programming, and a longitudinal evaluation of our FNMI programming.
We are currently in Phase III of our research project. Phase III focuses on the continued expansion in reach of our multi-faceted programming. There is an emphasis on creating the conditions for sustainability by addressing scale up factors and readiness and fit in the Northwest Territories, Alberta, Saskatchewan, Ontario, and Nova Scotia. Our research objectives include evaluating the successes and barriers to scale up in different delivery system contexts and developing an assessment for schools and divisions to provide suggestions to build organizational capacity.