Tobacco mosaic virus (TMV) pathosystem was shown previously to induce resistance against TMV providing an alternative approach to transgenesis. In the present study, we employed proteomics technology to elucidate the effect of TMV on tobacco as well as the effect of exogenous application of TMV p126 dsRNA molecules (dsRNAp126) at an early stage of the tobacco–TMV interaction. The proteome of tobacco leaf at 15 min post inoculation (mpi) in the presence or absence of dsRNAp126 molecules was studied. Thirty-six tobacco proteins were differentially accumulated in TMV-infected vs. healthy tobacco leaf tissue. The identified main differential TMV-responsive proteins were found to be involved in photosynthesis, energy metabolism, stress, and defense responses. Most of the virus-induced changes in the tobacco leaf proteome were not observed in the leaves treated with dsRNAp126 + TMV. The results indicated that the protein changes induced by TMV infection were counteracted by the exogenous application of dsRNAp126 molecules. Moreover, using small RNA sequencing, we showed that the exogenously applied dsRNAp126 was efficiently processed in tobacco as early as 15 min post application (mpa) to produce small interfering RNAs (siRNAs); the dicing pattern was not affected by the presence of TMV. The presence of dsRNAp126 reduced TMV p126 RNA abundance suggesting virus titer reduction via a sequence-specific mechanism, since a non-homologous dsRNA did not protect from TMV infection nor affect TMV accumulation.Exogenous application of double-stranded RNA (dsRNA) in the tobacco– RNA interference (RNAi) plays an important role in plant defense against subcellular pathogens including viruses . Double-Tobacco mosaic virus (TMV) is well-known for its high replication rate and its capacity for rapid systemic movement in order to establish a successful infection. The p126 and p183 genes  get translated at a very early stage during TMV infection . VSRs inhibit the host silencing mechanism in several ways such as the inhibition of DICER protein activity and prevention of RISC assembly . The sevnfection . Multiplnfection . Moreovenfection .in vitro-produced dsRNA molecules (“RNA-based vaccination”) targeted to TMV p126 and TMV CP genes and demonstrated its role in minimizing TMV infection and disease induction  and in the presence (defense response) of the N resistance gene. They revealed that the silencing of the endoplasmic reticulum (ER)-resident disulfide isomerases  and the calreticulins (NbCRT2 and NbCRT3) leads to a partial loss of N-mediated resistance against TMV. An iTRAQ study of The understanding of the complete mechanism underlying the events of virus–host plant interaction is crucial for the development of novel plant virus resistance strategies. TMV is a positive-sense, single-stranded RNA virus that belongs to the genus o leaves . Lee et Arabidopsis thaliana at 3 days post inoculation.Deep sequencing is a powerful means to study plant–virus interactions. In particular, the analysis of virus-derived small interfering RNAs (vsiRNAs) could reveal the hot (high number of vsiRNAs) and cold (low number of vsiRNAs) spots of the targeted virus genome indicating functional dicing by DCL proteins . Qi et ain vitro-produced dsRNA molecules derived from the p126 gene of TMV were topically applied to the plants, as described previously  were used for the inoculations in each treatment. The TMV strain used was TMV-vulgare DSMZ No. PV-0107  and was maintained on N. tabacum cv. Xanthi plants.NC_001367.1)] were produced by a two-step PCR approach and in vitro transcription protocol reported by Zucchini yellow mosaic virus (ZYMV) were produced and used as the non-homologous control treatment. A Fisher Scientific Multiskan FC Reader  was used to estimate the concentration of total nucleic acids spectrophotometrically.The dsRNAp126 molecules [nucleotides 426–1,091 of TMV  with 16 μl of TMV-infected tobacco leaf sap (5 × 105 dilution). The negative control consisted of 20 μl of water.The treatments used were as follows: (a) water (negative control), (b) TMV, and (c) dsRNAp126 + TMV. Each treatment consisted of six tobacco plants. The TMV treatment consisted of 16 μl of TMV-infected tobacco leaf sap extracted from 14-day post inoculation (dpi) TMV-infected tobacco leaves (inoculum) at 5 × 10Tobacco plants were inoculated by gently rubbing 20 μl of each treatment material into the fourth fully grown carborundum-dusted leaf. The treatment applications were performed during morning time (9:00–10:00 a.m.). The treated leaves were thoroughly washed three times using 0.05% Triton X-100 with 3 min interval between each wash, followed by a final wash with water. At 15 mpi, 300 mg of leaf tissue was collected from each of the inoculated plants  and immediately placed in liquid nitrogen for proteomic analysis. Symptom development was monitored until 20 dpi. Percentage of disease incidence was calculated based on the number of plants infected out of the total plants used for inoculation in each treatment .For each treatment, six biological replicates were performed. The treated  leaf comprised the sample. Proteins were isolated by the phenol extraction protocol reported by m/z 200) for the mass range of m/z 400–1,600 for precursor ions, followed by MS/MS scans of the top 10 most intense peaks with +2, +3, +4, and +5 charged ions above a threshold ion count of 16,0001e + 6 at 17,500 resolution using normalized collision energy of 25 eV with an isolation window of 3.0 m/z, apex trigger of 5–15 s, and a dynamic exclusion of 10 s (Thermo Fisher Scientific).Twenty micrograms of total proteins from each sample were digested with trypsin  and desalted using Pierce C18 solid-phase extraction columns according to the manufacturer’s instructions (Thermo Fisher Scientific) and dried in the SpeedVac until dry and dissolved in 5% ACN (acetonitrile) and 0.1% formic acid. The digested and desalted samples were injected (0.5 μg/5 μl) and separated on an Ultimate 3000 UPLC system  equipped with an Acclaim PepMap100 precolumn  and a C18 PepMap RSLC  using a linear gradient (0.300 μl/min). The composition of buffer A is pure water containing 0.1% formic acid. The composition of buffer B is pure water containing 0.08% formic acid and 80% ACN. The 0–4% fraction of buffer B increased from 0 to 4% in 3 min, from 4 to 10% in 12 min, from 10 to 35% in 20 min, from 35 to 65% in 5 min, and from 65 to 95% in 1 min and stayed at 95% for 10 min. The fraction of buffer B decreased from 95 to 5% in 1 min and stayed at 5% for 10 min. The Q Exactive Orbitrap mass spectrometer (Thermo Fisher Scientific) was operated in positive ion mode with a nanospray voltage of 2.1 kV and a source temperature of 250°C. Mass LTQ/FT-Hybrid ESI Pos. Mode Cal Mix  was used as an external calibrant. The instrument was operated in data-dependent acquisition mode with a survey MS scan at a resolution of 70,000 (FWHM at p ≤ 0.1). Protein statistics were applied to the summed, normalized, and selected peptide intensities. Spectra were identified using MASCOT v2.2.06 against the UniProt database taxonomy “Nicotiana” . The parameters employed to query were as follows: parent tolerance of 10 ppm, fragment tolerance of 0.02 Da, variable modification oxidation of M, fixed modification with carbamidomethyl C, and up to two missed cleavages for trypsin. The total protein false discovery rate was calculated in Scaffold 3.6.5 . Protein identifications were retained having at least one identified peptide with 95% confidence.The data of MS were acquired using Xcalibur 3.0.63 software . All the raw data obtained were converted into Mascot generic format (MGF) files by Proteome Discoverer version 1.4 . The mzxml-converted files were imported to Progenesis v4.1 software  for peptide normalization, alignment, and selection  were done using the NIPALS algorithm in Statistica 8.1 .https://labtrop.shinyapps.io/UniGO/. The tool is based on TopGO, an R package, and grasps the GO from the UniProt website and then performs a Fisher’s exact test to estimate the enrichment. To correct for multiple testing, the Holm–Bonferroni principle was applied. All ANOVA significant (p < 0.05) proteins were used as input for GO enrichment. The Excel file having the UniProt ID of each protein with corresponding GO terms (protein accession numbers in UniProt) was introduced to Cytoscape v3.4.0 for the construction of protein networks (Gene annotations were taken from UniProt. We built an in-house tool to perform Gene Ontology (GO) enrichment based on a user-defined subset of genes in the UniProt format networks .in vitro-produced TMV dsRNAp126 with 16 μl of water. Tobacco plants were inoculated by gently rubbing 20 μl of each treatment material as mentioned above. Samples for RNA extraction were pooled from six plants in every treatment. Total RNA extraction from the local leaves of four treatments was carried out at 15 mpi using TRIzol . RNA extracts (3 μg) were sent for small RNA NGS analysis to Fasteris SA . Upon small RNA library preparation, high-throughput sequencing was performed using the HiSeq 2500 Sequencing System . Inserts with the size of 20–25 nucleotides were selected and mapped against a reference sequence for the TMV genome (Accession No. NC_001367.1) employing Bowtie v2.3 (The treatments used were as follows: (a) TMV, (b) dsRNAp126 + TMV, (c) dsRNAp126, and (d) water (negative control); there were six tobacco plants per treatment. TMV or dsRNAp126 + TMV application was performed as mentioned above. DsRNAp126 treatment consisted of only 4 μl of the tie v2.3  using detie v2.3 .2 O-, TMV-, and dsRNAp126 + TMV-treated tobacco local leaves. RNA samples from two biological replicates were collected at two time points, e.g., 15 min and 24 h post treatment. Primers were designed outside the region of the p126 gene  that was used for the production of dsRNAp126. For the RT, we employed the FIREScript Reverse Transcriptase . For qPCR, we used the 5 × HOT FIREPol® EvaGreen® qPCR Supermix  in a StepOnePlus Real-Time PCR System . The Ct values were normalized with a tobacco actin gene  as an endogenous control. Quantification of TMV p126 was performed following the 2Ct–ΔΔ method (Reverse transcription (RT) quantitative PCR (RT-qPCR) was used for the estimation of TMV p126 gene abundance from Ht method . The seqFor the investigation of early events occurring after TMV infection and in order to explore the putative effect of the application of dsRNA, we employed a proteomics approach. Protein samples from six biological replicates from TMV, dsRNAp126 + TMV, and control treatments (at 15 mpi) were used to perform the proteomics analysis. The mass spectrometric data showed that a total number of 661 proteins were confidently identified with a false discovery rate of 0.6% at the protein level and 0.04% at the spectrum level. To assess whether the proteome of the control, TMV, and dsRNAp126 + TMV samples was different, a PLS-DA statistical test was performed. Components 1 (PC1) and 2 (PC2) of the PLS-DA both show a significant correlation to the treatments and explain, respectively, 24 and 8% of the variability . Componep < 0.05. Nineteen proteins were identified to be more abundant and 17 proteins were less abundant in the TMV treatment when compared with dsRNAp126 + TMV and water treatments  as compared with siRNAs outside this region (TMV-derived siRNAs) . We notiIt was also observed that in the 426–1,091 portion of the TMV genome, the profile of dsRNAp126-derived siRNAs is similar to that of TMV-derived siRNAs, e.g., the most highly abundant siRNAs are produced from the same hot spot regions in both the dsRNAp126 and TMV treatments . This su2 value of p126 abundance at 24 h in TMV treatment was 9.536, which corresponds to more than 700-fold induction relative to p126 amount at 15 min indicating a high TMV accumulation  and a low annotated rate that could explain the low identification rate. The use of gel-free proteomics for protein identification requires a well-annotated database of the host species under study to be able to identify numerous proteins.Despite the relatively low number of identified proteins, we found a significant correlation to the different treatments. Thirty-six (36) proteins were found to be differentially accumulated in the tobacco–TMV compatible interaction as early as 15 mpi. The protein changes that could contribute to resistance to TMV involve defense-related proteins such as S-adenosylmethionine synthase, cysteine proteinase inhibitor, glutathione S-transferase, malate dehydrogenase, Snakin-1, osmotin-like protein, and RNA-binding glycine-rich protein (upregulated upon TMV infection), as well as putative susceptibility factors such as phosphoglycerate kinases and OBERON-like protein (downregulated upon TMV infection) .Bamboo mosaic virus, plant GST binds to the viral RNA delivering glutathione to the viral replication complex  conferred resistance against TMV (S-adenosylmethionine synthase or SAMS (A0A0F7R532) catalyzes the formation of S-methylmethionine (SMM), which is necessary for the production of several osmoprotectant proteins . Elevate complex . Glutath complex . Malate  complex , such as complex . The ant complex . The SN1se genes . Osmotinse genes . The glyse genes . Overexpinst TMV . Furtherinst TMV .A. thaliana exhibits resistance to a potyvirus, suggesting that PGKs may function as host factors that increase susceptibility to virus infection (Turnip mosaic virus (TuMV) via interaction with the Vpg viral protein. Downregulation of OBERON-like protein decreases TuMV infection  were shown to promote the replication of several positive-strand RNA viruses . This manfection . OBERON-nfection .All the above-described proteins, identified by proteomics analysis, are involved in the efforts of the host to defend itself against TMV at a very early infection stage, however, without success since plants are systemically infected by the virus. The protein changes correlated with a successful TMV infection involve the translation-associated poly-A binding protein (upregulated upon TMV infection), as well as chloroplast-associated factors such as carbonic anhydrases, chloroplast photosystem bO4 protein, and RuBisCO activase 2 (downregulated upon TMV infection) .Poly-A-binding protein or PABP (I2FJN7) may act as a susceptibility host factor by promoting viral RNA translation . TMV 3′ N. benthamiana resulted in increased TMV accumulation (2+), thus participating in the stabilization of the oxygen-evolving complex (Carbonic anhydrase or CA enzymes (EC 4.2.1.1)  have been identified as salicylic acid-binding proteins with an antioxidant role and generally constitute part of the defense mechanism in C3 plants upon attack by various pathogens, including viruses . PsbO grmulation . PsbO pr complex . An inta complex . Interes complex . RuBisCO complex . Chlorop complex . Our fin complex . Typical complex .via its p126 protein, which possesses RNA silencing suppressor activity, could interfere with the dicing capacity of the host DCL proteins, affecting as a result the exogenously applied dsRNA processing. However, this does not seem to happen in our experimental system. In particular, the simultaneous topical application of dsRNAp126 along with TMV produced the same pattern of siRNA molecules in the region 426–1,091 nt (region of dsRNA)  , suggestf dsRNA) . This hif dsRNA) . The efff dsRNA) .Cucumber mosaic virus-2b (CMV-2b), the viral silencing suppressor, by physical binding to CMV-2b’s dsRNA-binding domain (1-Aminocyclopropane-1-carboxylate oxidase 2 isoform A (ACO2) (E5LCN0), cysteine synthase (CyS) , and isoforms of calmodulin (CaM)  compose a small group of proteins that were significantly more abundant in the dsRNAp126 + TMV treatment when compared with the water and TMV treatments. We hypothesize that these proteins are induced by dsRNA itself. No bibliographic reports exist involving ACO2 and CyS in plant virus infection. However, a calmodulin-like protein (rgd-CaM) suppresses the g domain . It woulThe dsRNAp126 application has been shown repeatedly, in the experiments described here and in our previous study , to confhttp://www.proteomexchange.org/, PXD022517; https://www.ncbi.nlm.nih.gov/genbank/, PRJNA665939.The datasets presented in this study can be found in online repositories. The names of the repository/repositories and accession number(s) can be found below: NK performed the experiments, interpreted the results, and wrote the research manuscript. MN contributed to the bioinformatics analysis of small RNA sequencing data. AK performed the RT-qPCR analysis and assisted in writing the manuscript. HM contributed to the drafting of manuscript. AV and SC designed and supervised the present research work and corrected the manuscript. All authors contributed to the article and approved the submitted version.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


The unprecedented changes and isolation measures to contain COVID-19 have had multiple psychological and social impacts, with implications for professional and personal functioning. Evidence-informed interventions that can be rapidly implemented under pandemic conditions to support mental health during such times are urgently needed.The aim of this study was to determine the acceptability and preliminary outcomes of a daily online mental health promotion program for tertiary education staff during the COVID-19 pandemic.The “Victoria University (VU) Elevenses” program was delivered as an uncontrolled intervention at Victoria University (VU) in the western metropolitan region of Melbourne, Australia. In April 2020, an email invitation was sent to all academic and professional staff inviting them to: (1) participate in the program and (2) opt-in to the research component. The “VU Elevenses” program provided 10-15–minute microinterventions comprising lifestyle and well-being strategies to promote mental health via an online meeting platform at 11 AM each weekday. A mixed methods approach was used to evaluate the program, combining structured questionnaires with semistructured interviews to investigate the experiences of staff who participated in the program.Between 16 and 90 participants provided weekly program feedback. A total of 106 university staff opted into the longitudinal research component and 10 staff participated in the interviews. Participants reported high levels of satisfaction with sessions and perceived benefits for mental health. Approximately one quarter of participants reported moderate to severe symptoms of depression, anxiety, and stress at baseline, with significant reductions in these symptoms in the first 7 weeks of the program, corresponding with easing in mandatory isolation (“lockdown”) restrictions. Symptoms of depression, anxiety, and stress all increased when lockdown measures were reintroduced, but not to the same levels as found during the initial lockdown period. Overall changes in depression and anxiety from baseline to the end of the program were explained by changes in COVID-19–related distress, whereas changes in self-compassion explained changes in stress.We show that it is feasible and acceptable to develop and deliver a program of brief interventions in a timely manner, using a simple and accessible online platform. Although participation in the program was initially associated with reduced symptoms of depression, anxiety, and stress, participants’ mental health worsened with the reintroduction of a “lockdown” period. However, as symptoms of depression, anxiety, and stress did not return to levels observed at the start of the VU Elevenses program, participation in the uncontrolled intervention may have offered a protective benefit against the impact of the second significant lockdown period. The Australian national response to the global pandemic of COVID-19 has been consistent with international approaches recommending or mandating physical distancing and self-isolation. Psychological and social risks associated with this period of rapid change and uncertainty included the inability to access workplaces; educational institutions; and social, cultural, and sporting events. Psychological stressors include concerns about income, job insecurity, and changes to work practices , with nearly one third of Australians reporting worsening household finances due to the COVID-19 pandemic during 2020 . FindingStructure and consistency in everyday life are important in preserving mental well-being during enforced periods of self-isolation and uncertainty . Using hThe study was conducted at Victoria University (VU) in the western metropolitan region of Melbourne, Australia. VU has eight Victorian campuses, with 1994 academic (teaching and research) and professional staff, 988 sessional staff (academic and polytechnic teachers), and 598 casual professional staff. Among the total VU staff, 59.64% (2135/3580) identify as female.All staff received an email invitation to participate in the online program and to opt-in to the research component. All staff were eligible to participate in the program, with no exclusion criteria or minimum attendance requirements. Using the general university mailing list, invitations to join the daily online sessions were issued over the first 2 weeks of the program, with staff asked to opt-in via email to receive ongoing meeting invitations. At the end of the program, all those who opted in to meeting invitations  were invited by email to participate in the semistructured interviews.All procedures involving human participants were approved by the Victoria University Human Research Ethics Committee (HRE20-054) and complied with the ethical standards of this institutional committee.This study followed a mixed methods design. A repeated-measures within-subjects design was used to collect data on mental health outcomes and potential mediators of change from baseline to 32 weeks after program commencement. Initially, it was planned that follow-up assessments would occur every 3 weeks. However, given that the program ran longer than anticipated due to Melbourne’s extended lockdown period, the repeated-measures time points became longer as the program progressed to reduce participant burden. Additionally, brief weekly questionnaires were used to determine the acceptability of the program over the first 13 weeks of the program. At the end of the program, we also conducted in-depth semistructured interviews in a small sample of participants to explore their experiences with VU Elevenses.The “VU Elevenses” program focused on mental health promotion, including universal, selected, and indicated prevention strategies . ParticiThe “VU Elevenses” program comprised brief (10-15 minutes), evidence-informed microinterventions and strategies to promote physical and mental well-being, utilizing an online meeting platform at 11 AM each weekday. The intervention had three main phases: (1) managing immediate concerns and stressors, (2) adjusting to working and studying remotely, and (3) preparing to return to work and study on campus. The design and implementation of the program were guided by the principles of inclusivity and accessibility, responsiveness, consistency, and connectedness. The sessions were live and unpolished to maintain authenticity and connection, and to allow for the rapid sharing of evidence-based clinical content for mental health and well-being support.A collective of VU practitioners and researchers rotated and delivered interventions relevant to one of six identified lifestyle areas  . Each miMembers of the program team planned the following week of microintervention content, resources, and presenters. Resources for further information  and links to recordings were provided to participants for each daily session via VU’s intranet. The program was evaluated for 32 weeks, from April 2020 to November 2020, with sessions each weekday for the first 24 weeks, followed by three times per week for the final 8 weeks of the program.All participants were provided with a link to a brief survey at the end of each week for the first 13 weeks of the intervention. Participants were asked to provide weekly feedback on the acceptability of the intervention by answering the following questions on a scale from 1 (strongly disagree) to 7 (strongly agree): (1) “I am generally satisfied with the sessions this week,” (2) “I found the content helpful for my mental health and well-being,” and (3) “I felt more connected with my colleagues.” To measure engagement, each respondent was asked to report the number of live sessions they attended that week. Attendance at the daily sessions was assessed at week 1, week 16, and week 32 using the online meeting platform’s participant logs.One-on-one semistructured interviews were conducted with a sample (n=10) of VU staff members who attended at least one VU Elevenses session, as previous research shows that data saturation for the most part occurs between 6 and 12 interviews . ParticiThe mental health of participants was measured using the Short Form Depression, Anxiety and Stress Scale DASS-21) . The Pit . The PiTo determine acceptability of the program, percentages of participants who agreed or strongly agreed they were satisfied with the content of the session, felt the content helped with their mental health and well-being, and thought the program made them feel more connected with their colleagues during the first 13 weeks of the program were calculated. Additionally, the average number of live daily sessions attended by respondents in a week was calculated.The semistructured interviews were digitally recorded and then transcribed verbatim. Transcripts were read and reread while listening to the recordings to ensure accuracy. Braun and Clarke’s  thematicQuantitative data analysis was performed using SPSS (v.25) and the R package. Trajectories of change in symptoms of depression, anxiety, and stress were estimated using multilevel growth curve models. First, an unconditional model with a random intercept was run for each outcome (null model). Subsequently, a series of models were run with a fixed linear effect of time (Model A), quadratic effect of time (Model B), and cubic effect of time (Model C) added. Because the time between follow-ups differed, time was entered as the number of weeks from baseline centered on the date of baseline collection. All models were fitted with a random intercept. Additionally, models were run with random slopes. However, the inclusion of random slopes did not significantly improve the fit of any model; thus, the results are reported for models with a random intercept only. The likelihood ratio test was used to compare model fits and determine which model fit the data best. Before analysis, models were checked for normality. The results indicated that depression and anxiety were not normally distributed, and therefore these outcomes were log-transformed before analysis. Because logs of zeroes cannot be computed, 1 was added to all scores of depression and anxiety before transformations were made.To determine mediators of changes in depression symptoms from baseline to the end of the program, 1-1-1 multilevel multiple mediation models were estimated using the MLmed macro tool . Models There were large amounts of missing data. Only six participants provided data at the fourth follow-up, and therefore data from this time point were excluded from analyses. Of the remaining five assessments, 43 participants only completed the baseline assessment, 18 participants completed two assessments, 8 participants completed three assessments, 15 participants completed four assessments, and 20 participants completed all five assessments. Data were available for 106 participants at baseline, 51 at the first follow-up, 42 at the second follow-up, 36 at the third follow-up, and 31 at the fifth follow-up. One-way analysis of variance and Kruskal–Wallis tests were used to determine if there was a significant difference in study variables at baseline between participants with complete data and those missing data at follow-up. Missing value analysis indicated no significant differences in symptoms of depression, anxiety, or stress, or in demographics between participants with different amounts of missing data, indicating that the data were missing completely at random. Missing data for symptoms of depression, anxiety, and stress were handled using the full information maximum-likelihood estimation method. This has been shown to reduce parameter errors compared to ad hoc approaches to handling missing data, and provides appropriate standard errors of estimations, even with substantial amounts of missing data and small sample sizes ,31.For the mediation analysis, 31 participants completed both the baseline and follow-up assessments. Results indicated that participants who completed both baseline and follow-up assessments reported significantly less COVID-19–related distress at baseline than participants who did not complete the follow-up assessment, indicating that the data were not missing completely at random. Because multilevel models cannot handle missing data for independent variables using maximum likelihood, missing values for mediator variables were imputed using multiple imputation. A total of 10 imputed data sets were created using Markov Chain Monte Carlo with predictive mean matching. Imputation models included all mediators and outcomes as predictors of missing values. Results from the multiple imputed data sets were combined using Rubin’s Rule .Attendance at the daily sessions ranged from 174 to 240 participants in the first week of the program, 63-84 at week 16, and 21-24 in the final week of the program. The number of responses to weekly feedback ranged from 16 to 90 participants. The average weekly attendance for participants who responded to the weekly feedback questionnaires ranged between 2.38 and 3.22 sessions. Participants reported high levels of satisfaction with the sessions during the first 13 weeks of the study (81.0% and 97.7% of weekly respondents agreeing or strongly agreeing that they were satisfied with the sessions they attended that week), and found the sessions they attended helpful for their mental health and well-being (80.9% and 94.2% of weekly respondents agreeing or strongly agreeing). Increased connection with colleagues was moderately endorsed (46.1% and 94.1% of weekly respondents agreed or strongly agreed).Participants in the semistructured interviews were aged, on average, 54 years (range 29-69 years), were predominantly professional staff (90%), and predominantly female (90%). Thematic analysis identified five higher-order themes: a positive program, facilitating behavior change, supporting mental health and well-being, providing social connection, and organizational support . ExploraFour lower-order themes emerged from the higher-order theme of a positive program: (1) provided purpose and structure, (2) variety of relevant content, (3) future planning, and (4) suitable time. The VU Elevenses program was reported as a positive experience for participants during the COVID-19 pandemic. The program provided structure and purpose by supporting participants to have something to look forward to during extended periods of remote working and mandated isolation. The 11 AM time was suitable and the 15-minute duration was sufficient. Further, the program provided a variety of content, ranging from practical advice, sing-a-longs, mindfulness, and physical activities. This variety was reported as positive, as participants could opt in and out of the program depending on what suited their needs. Participants reported that the mix of content kept the program refreshing and engaging. Further, participants reported that they wanted the program to continue after the immediate response to the COVID-19 pandemic.… It’s been mind-blowing. It’s been inspiring. It’s been educational. It’s taught me strategies. It’s given me physical, mental, and different perspectives to think about how to do things better during this lockdown COVID…it’s the best thing since sliced bread. It should continue. It should have happened sooner. So I think COVID has really pushed us to thinking, doing, thinking better in how we plan our days and to take care of ourselvesParticipant 6…bringing us back and reminding us to set some structure, have things to look forward to in the day, schedule in things that you want, and not just leave them to chanceParticipant 3I think there is so much value and benefit of what has happened with Elevenses that could continue on beyond, you know, what we are facing right nowParticipant 4Two lower-order themes emerged from the higher-order theme of facilitating behavior change: (1) increased awareness and (2) motivation. All participants described the VU Elevenses program as contributing to changing well-being behaviors during the COVID-19 pandemic. For example, some participants changed how they engaged with news and social media or incorporated breathing exercises into their daily lives. Participants felt the program created awareness and motivation for change, including regular prompts and reminders of strategies and skills they could implement, which facilitated implementing these changes.…one of the strategies was about minimizing access to social media, particularly around the news. Not constantly looking at the news 'cause it is what it is. And so I think that was one that I found really useful to just think about where am I getting that information… finding one or two [trusted] sources… and that helpedParticipant 2…without really consciously thinking about making behavior change, I think that just having that kind of reminder was helpfulParticipant 1…overall I think the Elevenses, was very motivational. Every time I went into it, I left feeling very positive. So if there was a day where I felt unmotivated and I felt a bit like, “Ah, I can't be bothered,” when I'd go into the session, I'd leave feeling a bit more motivatedParticipant 4One lower-order theme emerged from the higher-order theme of supporting mental health and well-being: normalizing mental health. Participants discussed how the program provided them with more confidence, insight, and understanding in managing their mental health and well-being during the COVID-19 pandemic. The online group program appeared to normalize any difficulties they were experiencing during the extended lockdown.… my mental health has definitely adjusted and moved along the journey of the pandemic. So again, I think the program was very attuned to the situation and supporting mental health... I feel strongly that it did promote wellbeing and mental health in a very accessible wayParticipant 3… I think the breathing one, I sort of kept in my mind when I was feeling stressed, to do that. And then just the recognition that this has been identified as something that maybe other people might be going through as well helpedParticipant 8One lower-order theme emerged from the higher-order theme of social connection: connected to the university. Participants reported that the program offered a space for staff to connect socially every day. Further, participants discussed feeling connected to the university and staff during the program, which seemed to provide a sense of comfort and familiarity.… and it was also really great to see some of my colleagues that I haven’t been, physically been able to connect with, this made things really much better…Participant 1…made me feel a little bit more connected to the wider university because it made me feel more connected to what people were doing within the universityParticipant 8Having access to the daily VU Elevenses program and feeling valued at work appeared to be beneficial for participants during the COVID-19 pandemic: “…that sense of connection to the organization and feeling like the organization actually values the staff has been the key thing for me.” [Participant 6]A total of 106 participants completed the baseline questionnaire. At baseline, the average age of the 106 participants was 47.34 (SD 11.82) years and 92 (86.8%) identified as female. Overall, 79 (74.5%) participants were administrative or executive staff and 26 (24.5%) were teaching or research staff. The majority  were full-time staff. At baseline, 22.9%, 15.2%, and 25.2% of participants reported moderate-to-severe symptoms of depression, anxiety, and stress, respectively.Results from the multilevel linear growth models are shown in Results from the repeated-measures correlation  showed tRepeated-measures correlation showed that COVID-19–related distress, self-compassion, and sleep quality had the strongest within-person correlations with symptoms of anxiety. Results from the mediation analysis for anxiety  showed tRepeated-measures correlation showed that COVID-19–related distress, self-compassion, and diet quality had the strongest within-person correlations with stress. Results for the mediation analysis for stress  showed tThis study examined the acceptability, outcomes, and potential mediators of daily, evidence-informed, online microinterventions to promote the mental health of staff of a tertiary education institution during the COVID-19 pandemic. Regarding program acceptability, results from weekly questionnaires showed that the vast majority of participants were satisfied with the program content, and believed that the content was helpful for their mental health and well-being. Additionally, qualitative interviews showed that participants had positive perceptions about the program’s structure and content, believed it supported their mental health and well-being, helped them implement positive behavioral change, and made them feel more socially connected and supported by the university. Results from the longitudinal analysis of mental health symptoms showed that participants had moderate-to-severe symptoms of depression, anxiety, and stress at baseline, and that symptoms declined over the first 7 weeks of the intervention. Additionally, although participants’ symptoms of depression, anxiety, and stress increased with the commencement of a second, stricter lockdown period, symptoms did not return to the levels reported at the beginning of the initial COVID-19 lockdown. This suggests that participation in the “VU Elevenses” program may have protected against worsening symptoms of depression, anxiety, and stress associated with mass lockdown, fears of an outbreak, and economic recession . AdditioThe moderate to severe symptoms of depression, anxiety, and stress reported by approximately 15%-25% of our participants at baseline are expected responses to the unknown and stressful circumstances of a health epidemic  and mandResults from this study indicate that a brief daily online intervention may be an acceptable way to provide mental health support during a time of crisis. Staff experienced the VU Elevenses program as a positive program during the COVID-19 pandemic, and the vast majority of staff agreed that they found the content helpful for their mental health and well-being. Similarly, high levels of satisfaction have been reported in multiple other online interventions during the COVID-19 pandemic ,41, indiThe longitudinal changes in mental health reported are similar to those reported in previous studies. Several studies reported worse mental health status at the beginning of the COVID-19 pandemic compared to prepandemic levels; however, mental health improved during the early months of the pandemic -45. ThisResults from the mediation analysis indicated that preintervention to postintervention changes in depression and anxiety were explained by changes in COVID-19–related distress. This suggests that the program may have provided participants with the strategies and skills to adapt their behaviors and regulate their emotions to reduce the distress associated with the pandemic. By contrast, changes in stress were explained by changes in self-compassion over time. The Elevenses intervention used several strategies to improve self-compassion, including self-compassion meditation, resetting expectations, and simple mindfulness strategies . Self-coIn line with recommendations to share information on managing stress, depression, and anxiety using telehealth  or digitThe content of our program was evidence-informed and was grounded in the six identified lifestyle intervention areas for well-being , includiSeveral limitations should be considered in the interpretation of these results. First, participants who opted into the program and the evaluation, including the semistructured interviews, may be subject to self-selection bias. Participants who value mental health promotion initiatives may be more likely to participate. Despite our intention for this program to be a universal mental health promotion and prevention intervention, only 18% of invited staff participated in the program, indicating modest reach into the target population . Indeed,This study demonstrates the acceptability of a rapidly developed program of microinterventions, delivered in a timely manner utilizing a simple and accessible low-cost online meeting platform during a time of crisis when mental health is highly likely to deteriorate. Participation in the program may have protected against worsening symptoms of depression, anxiety, and stress associated with extended COVID-19 lockdown periods, and improved symptoms of stress by increasing self-compassion.


Over the past decade there have been numerous and impassioned calls to reform the practice of solitary confinement in U.S. prisons. This article examines the development, implementation, and processes of a restrictive housing reentry program in the Oregon Department of Corrections. It draws on data from official documents, site observations, and interviews with 12 prison officials and 38 prisoners. The Step Up Program (SUP) seeks to improve the living conditions in restrictive housing over business-as-usual, alleviate physiological and psychological harms of solitary confinement, and use rehabilitative programming to increase success upon returning to the general prison population or community.The impetus to change the culture and structure of restrictive housing was primarily the result of internal administrative reform. Prisoners assigned at random to housing assignments offered accounts of their daily activities suggesting that the SUP provides more time out-of-cell and greater access to other services and activities. Program participants preferred the living conditions in the SUP because they had more opportunities for social interaction and incentives for compliant behavior. However, views on the value of programming among respondents were mixed.The launch of the SUP occurred in early 2020, which was soon followed by the COVID-19 pandemic. As a result, the program was never fully implemented as intended. As Oregon returns to more normal operations, it is possible that the SUP will be able to include even more out-of-cell time, greater socialization opportunities, and increased access to programming and other beneficial activities. As we await the opportunity to conduct prospective psychological and behavioral analyses, this study provides tentative support for the use of step down reentry programs in restrictive housing units.Preparing adults in custody for successful reentry: An experimental study of a restrictive housing exit program in Oregon. Registered 4 October 2019, https://osf.io/t6qpx/Open Science Framework,  Do we really think it makes sense to lock so many people alone in tiny cells for 23 hours a day, sometimes for months or even years at a time? That is not going to make us safer. That’s not going to make us stronger. And if those individuals are ultimately released, how are they ever going to adapt? It’s not smart.– U.S. President Barack Obama, Remarks at the NAACP Conference, July 14, 2015Ashker v. Governor of California, was settled in September of 2015, nearly 6 years after the initial pro se complaint was filed  are severely curtailed. This has led to extensive litigation based on Eighth Amendment protections against the use of cruel and unusual punishment. For example, the class-action lawsuit A second point of controversy has been an alleged overuse of restrictive confinement  allowing more time out-of-cell, higher quality interaction between prisoners and staff, and more amenities, (2) incorporating rehabilitative programming into restrictive housing units with the goal of reintegrative success, and (3) providing incentives for compliant behavior that are comparable to the privileges found in general population housing. If implemented, these changes are expected to improve prisoner well-being , decrease problem behavior, and reduce their likelihood of being sent back to restrictive housing after returning to the general prison population.Across the United States, prison systems have developed what has been termed “step down programs” in restrictive housing settings. Their purpose is to help prisoners transition from more to less restrictive conditions Ghafar, . These pIt is estimated that as many as 30 prison systems operate a step down program  the newly-devised Step Up Program (SUP) unit, and (2) the business-as-usual Intensive Management Unit (IMU). Second, we describe the origins of the SUP, including what motivated its development, the procedures for putting it into place, and opinions about it from the perspective of correctional staff tasked with its implementation. Finally, based on interview data with prisoners we describe their use of time and perceptions of programming, comparing prisoners randomized to placement in the SUP and those who remained in the IMU. These results are not intended to serve as a complete evaluation of the program, but instead to share knowledge on an operational innovation in light of the coronavirus (COVID-19) pandemic’s far-ranging effects on prisons  of the SUP. This is noteworthy for two reasons. First, researchers are typically involved in post-hoc evaluations of policies, practices, and programs. In this study, however, we were able to observe the origins and development of the SUP, which permitted our team to produce a richer account of processes and impacts. It also allowed us to share knowledge on practical and theoretical advances derived from research on restrictive housing, helping the DOC make decisions about the contours and functions of the SUP. Second, RCTs are rare in prisons .The list of eligible cases was de-identified and sent to the first author for random assignment into either the treatment group  or the control group . RCTs may raise ethical concerns in the correctional context because they deliberately withhold a “treatment” from some individuals to allow for an unbiased comparison with those who are untreated. In this study, random assignment was reasonable because bed space in the SUP was limited. Oregon officials needed a strategy to assign prisoners to the SUP who met the eligibility criteria and random assignment provided a fair procedure. This strategy also provided the opportunity for the collection of high-quality evidence to evaluate the program’s effectiveness. Still, even though prisoners understood that the invitation to enter the SUP or remain in the IMU was random, they were not mandated to move, and in fact, many exercised their right to remain in the IMU (see below). Declination to move to the SUP had no impact on prisoners’ incarceration, generally, or duration spent in the IMU, specifically.SD = 17 days). The minimum number of days was 11 and the maximum was 72. Thus, while all prisoners had some exposure to IMU, that exposure for the SUP participants was much shorter than the 7 months (~ 213 days) individuals placed in IMU normally experience in this setting.The first cohort of randomized study participants was moved to the SUP on January 7, 2020. For those assigned to SUP, the average length of stay in IMU before the transfer was 33 days . Two respondents provided consent but completed only a partial interview, missing the key sections reported in this study. The 38 consenting participants were evenly split between the treatment and control group. The authors conducted these structured interviews remotely on four multi-day occasions between April 3 and June 30, 2020.Table Mean = 30.1, SD = 6.7). The sample was predominately White (52.6%), followed by Hispanic (29.0%), Black (10.5%), American Indian (5.3%), and Asian (2.6%). Approximately three-quarters of the sample (76.3%) were identified as having a history of gang affiliation and nearly half (44.7%) had been housed in the IMU on a prior occasion. According to the Automated Criminal Risk Score (ACRS) instrument, 52.6% of the respondents were classified as low-risk, 44.7% as moderate-risk, and 2.6% as high-risk for post-release recidivism .The respondents in our analysis sample were between 20 and 45 years old at the time of the interview ; MH-1: diagnosis of mental disorder with mild acuity (23.7%); MH-R: diagnosis of a condition that either needs no active therapeutic intervention or symptoms that can be controlled through medication (36.8%); MH-2: diagnosis with one or more of 19 mental disorders, including anxiety, depression, mood, and panic disorder (13.2%); and MH-3 diagnosis with one or more of nine severe mental disorders, including bipolar, schizophrenia, and psychotic disorder (0.0%).4p > .05) with two exceptions. In the full sample (N = 56), a lower percentage of the SUP group maintained an MH-R classification than the IMU group . In the analysis sample (n = 38), the SUP group had fewer MH-R  and more MH-2 designations than the IMU group . With 15 comparisons, this is about what we would expect to occur by chance. With the exceptions noted, there were no statistically significant differences found on any of the observed characteristics between the SUP analysis and total samples or IMU analysis and total samples. Randomization resulted in well-balanced groups.The two groups (IMU vs. SUP) were statistically similar  and involved asking respondents to describe their typical day in custody, estimating how much time they spent engaged in various activities . Perceptions of the SUP involved inquiry about prisoners’ views of the program, including asking them to detail how the experience differed from the IMU and to comment on expectations regarding its potential impact on their future.Components of the interviews with prisoners focused on time use in prison and perceptions of the SUP. This study employs a mixture of descriptive, quantitative, and qualitative analyses. First, we examine the origins of reforming the IMU and the development and implementation of the SUP, relying on historical accounts, observations of the unit, and interviews with prison officials. Second, we compare the daily reported activities between participants in the SUP and the IMU to determine if there are differences in the experiences of prisoners in the respective housing units. Consistent with an intent-to-treat approach, we make comparisons based on the assigned treatment condition Lachin, ,5 but git-tests, and we report p-values albeit without asterisks. Substantive significance is assessed through the interpretation of Cohen’s d. We follow Cohen’s , statistical significance , and magnitude . Statistical significance is determined through the use of independent samples  Cohen’s  guidelinVera made the recommendation [for the step down program]. They liked the fact that we had started the out-of-cell programming, but they recommended, of course, that we do more and that we work on a step down program that [would] get folks ready for a general population.The origins for reforming the structure and culture of restrictive housing in Oregon are found in two events. First, in 2015, the Oregon DOC applied for and was selected as one of five correctional agencies to participate in the Vera Institute of Justice Safe Alternative to Segregation Initiative  in Ontario (located in eastern Oregon near the Idaho border) as the site for its first location.8The IMU is reserved for individuals who are believed to pose a serious risk to the safety of themselves, others, or the institution .The IMU operates on a five-level tiered system—Level 1 to Level 5—with prisoners assigned to lower levels having more restrictions on services and activities than those in higher levels , however, was decided exclusively by staff at the Oregon DOC. The SUP was developed to include two levels. Prisoners in Phase 1 can take part in out-of-cell activities at tables in the common area while restrained and outdoor buddy recreation with one other person in the unit. Those in Phase 2 have access to out-of-cell activities while partially restrained , buddy recreation with up to three other people in the outside recreation area, and unrestrained escorts. The authors also collaborated with Oregon DOC senior managers, SRCI administrators, and IMU security, program, and support staff to devise a strategy for evaluating the impact of the program on a variety of physiological, psychological, and behavioral indicators.The process for converting a wing of the IMU at SRCI into a 24-person, step down reentry program involved five critical tasks. First, the new unit required physical modifications to allow for greater socialization and out-of-cell time compared to the IMU. The outdoor recreational area was expanded to provide more space for prisoners to congregate together. Tables were also installed in the unit to allow prisoners the opportunity to sit and talk, play games together, and watch television outside of their cells.Second, opportunities for social interaction were significantly increased. A goal was set to provide program participants with 5–6 h of out-of-cell time per day, which is more than the 1 h per day that prisoners in the IMU receive.10Third, given the desire to improve the likelihood for a successful reentry, treatment services and other activities were enhanced in the SUP. This involved increasing the number of programs, including Free Your Mind in Segregation (FYM-S); Dialectical Behavioral Therapy (DBT); Getting Out by Going In (GOGI); Living Well; Hepatitis, HIV, AIDS Awareness Program (HHAAP); and Charting a New Course. It also involved providing opportunities for other recreational activities, such as watching movies, playing games, and participating in art projects, that are not available to those in the IMU.Fourth, a correctional case counselor was assigned to oversee the treatment plans of all the program participants. The counselor assigns prisoners to the specific programs and other services available that best match their individual risk and needs. Although prisoners in both SUP and IMU work with a case counselor, those in the former category have much greater access to programs and services that address their risks and needs.To change a culture, you’ve got to drive the culture and show people it’s okay. It’s okay to go sit down at the table and play video games with inmates. It’s okay to go sit down and observe cards or play cards … You’ve got to role model that … it’s okay to talk to somebody about their family if they ask you. I do care about your family. I do care about your kids. I do care about their success. I know you’re an inmate, but that’s important to you, so it needs to be important to me. [L] ater that’s going to pay dividends. I promise you. One case at a time.Finally, following the Norwegian model, correctional officers have been encouraged by SRCI leadership to take a more humanistic approach toward interacting with prisoners in the unit. This approach includes spending time with incarcerated individuals on the unit by playing cards, video games, or other activities together, which are not typical occurrences in the IMU. According to a senior security staff member:Down Program.” Our research team traveled to SRCI in late October 2019 for a kick-off meeting with more than two dozen line to senior staff members. During this meeting, we summarized the state of knowledge on restrictive housing and offender rehabilitation. We also discussed the motivation for the project and the research evaluation plan. During this meeting, an IMU correctional officer asked about changing the name of the Step Down Program because it was signifying to some prisoners that it was a gang drop-out program. A suggestion was made to instead call it the Step Up Program (SUP), which had a more positive connotation. After a unanimous vote among staff at the meeting, the name of the program was officially changed.The SUP was piloted on October 21, 2019. Its first residents included eight hand-selected prisoners from the IMU. Three additional individuals were also identified for placement but refused to participate. Correctional staff informed us that the trepidation toward program participation had to do with gang politics, unknowns about the program, and the original program name itself—“Step In my opinion, [the SUP is] really to make them successful when they do move out into that [general population] setting. It doesn’t take long for somebody to get uncomfortable with the [general population] setting when they’ve been in [restrictive housing]. We’ve got some of these guys that have been in there a long time. There’s no way I can feel comfortable saying, “Yeah, let’s take this person whose been in this setting and just throw them back in to this big pond and see what happens.” If we want them to be successful then we need to gradually work them out to that … They’re either going to panic and do something, just enough, to get them back, or they’re going to panic and freak out and do something major that’s going to hurt somebody.During our site visit, we toured the IMU and saw the modifications to the SUP. We also interviewed a range of correctional officials and staff about their perspectives on the new program. When asked about the goals of the SUP, one of the staff members commented, “I think that the most important thing is to get these guys out of the cell and communicate with each other and socialize.” Other staff members reported a general optimism regarding the potential benefits of the program on participants, other prisoners, staff, and the institution.Anytime we can get a guy out of restrictive housing with a lower anxiety level, that’s going to make it safer to the officer supervising the unit, the other [prisoners] in the unit. They’re not going to be on edge because they’re already used to those interactions. So basically, we are taking advantage of having the ability to test and observe in a controlled environment before we just take the cuffs off and say, “All right. Go be successful.”In the view of another staff member:As with all change I think people are really apprehensive of things, especially with dealing with people because they’re unpredictable. But I would say that a majority, yeah are supportive of it, especially the staff that worked down here just because we’re so informed … We’re more informed because we’re down here [on the unit], but the [general population] staff, maybe not just because they’re not informed.However, there was also some trepidation expressed about the program voiced among correctional staff:Some of the things that, earlier on, that folks were negative about, they’ve quickly learned that there’s things that work. Some of them even admit, they were so negative about something and then once they actually saw it implemented and they saw the results of it, it was like wow … The staff that have witnessed that themselves or have been part of it even when they were begrudgingly part of it, we’ve seen a lot of attitude change. You’re always going to have the little pockets of negative. That’s fine.Prisons are typically a beehive of activities, replete with routines and roles that are stable. Change can be difficult, even if it is perceived as being for the better. One staff member believed that others would come around to the SUP:In addition to the tour and staff interviews, we also pilot tested our survey instrument with prisoners from the first cohort of SUP participants, drawing on this experience to identify ways to refine and improve our survey tool.time spent out of one’s cell was much greater for the participants assigned to the SUP compared to those who were assigned to the IMU . Although not statistically significant at the .05 level, there was a moderate positive association detected between treatment group assignment and two activities: hanging around with other prisoners (d = .60) and watching TV (d = .55). There was also a smaller positive association between treatment assignment and participating in programming (d = .44), engaging in physical exercise (d = .35), writing (d = .35), and participating in yard time (d = .23), and a small negative association found for reading (d = −.47) and communicating with correctional officers (d = −.27). There were no substantive differences found between the two groups on the three activities of drawing, talking on the phone, or engaging in hygiene activities . To summarize, we are observing meaningful differences in the living conditions between SUP and IMU housing.To assess if the living conditions in SUP were modified as intended, we asked respondents how much time they spent in the last week engaged in a variety of activities. Table Table Well just being in close contact with other prisoners, that’s the biggest difference … [I] n regular IMU, the only time you talk to somebody is through the crack of your door. You’re not talking to other prisoner’s face to face … So just that contact around other people is a big difference.The qualitative data also suggested that the living conditions in the SUP were preferable to the IMU. When asked to describe the biggest difference between the two units, SUP participants reported having considerably more opportunities for meaningful social interaction with other prisoners. One respondent stated:You get two more phone calls a week. Once you get your level three, you get two more phone calls. We go to yard with somebody, like we know somebody on the unit with us, we can go to yard with them. It just breaks up your time better … Well it’s just more privileges … Once you get to phase two, you’re not cuffed up no more to be moved around from in the unit to come out to yard or to go to the day room. We get day room time, so we get to come out and play video games or board games, stuff like that. We go outside to rec with another person.Others saw value in the additional incentives that were available in the unit. One individual noted:We can buy more stuff on the canteen. There are just little things that you don’t think about while you’re on mainline [general population], but when you come to IMU, you miss out on.The benefits of the SUP were not limited to out-of-cell time and social interaction. Another respondent commented:Yes, I do.. . It helps me interact with people to where I’ll be able to be already somewhat used to it, as far as just going straight out to mainline [general population] and being not able to be around people.The program participants, however, shared mixed views on the value of the programming available in the unit. When asked if the amount of time spent in the SUP was enough to make a difference in their future, some responded with a positive view, such as:I’ll be honest, I’m kind of a knucklehead. The classes that are in this program... helped me sit myself down and really evaluate my life, and it’s given me tools... to deal with calming yourself down or what you’re going to do in a heated moment, real quick if there’s a way to get around certain situations that might land you in trouble, and it’s helped me evaluate more things and brought me closer with my family.Another prisoner responded:Another thing that I feel helps is you get to come out of your cell twice a day. You can go out to yard with one of your friends, and then you can go work out. And then you can get to come out and play PlayStation 4 or play cards at a table with people that you’re compatible with. So, you get that interaction that you would kind of like being on mainline. It makes the time go by really easy.He added that programming provides opportunities for interaction with other individuals:Okay. If a person truly wanted to change … if they truly wanted to change and this program was supposed to help make that a success, then yeah, they would need more time in it. I don’t really see what the goal is as of yet … yeah there would need more of it, it’s not sufficient.Others, however, saw little value in the programming in the SUP as currently implemented. As one prisoner put it:Another prisoner responded:I think we only have one [program] being in the Step Up Program, which is... I don’t even know the name of it, I can’t think of it, but it’s only like 30 min. You know what I mean? When most classes are about an hour, hour and a half.What I think it all boils down to is coming back to social interaction and stuff like that and being in a setting where you would be if you were placed in civilization and society and working from those angles, when they basically throw a book in your cell and you’re just sitting there doing book work. You gain stuff if you’re really paying attention but I mean, who does that? Nobody does that in the real world. You don’t just isolate in a box and write shit down in a notebook. That’s crazy. ... And mind you we’re going through that Coronavirus, so I will say that there is a couple options that were presented that were in a classroom setting that are not applicable at the moment, because they’re trying to not let that spread or whatever, I guess.One individual also discussed the negative impact of COVID-19 on the opportunities for socialization and treatment services in the SUP:To summarize, prisoners viewed SUP as providing them several advantages over the standard restrictive housing setting . The SUP configuration provides rewards for compliant behavior in the short run and attempts to prepare prisoners for release to general population. The differences between the two conditions, however, were not uniformly perceived.The U.S. prison system houses more than 1.4 million people on any given day Carson,  and usesCriminal justice reform is challenging , and participate in rehabilitative programming. These changes introduce greater normalcy to restrictive housing custody and, as a consequence, are expected to facilitate smoother reentry to the general prison population and eventually to the community. Although the respondents in the SUP reported communicating with correctional officers slightly less often than those in the IMU, there are two important considerations in interpreting this result. First, prisoners in the SUP may be less reliant on officers for information than those in the IMU because there are more opportunities in the unit to interact with other prisoners. Second, the length of time spent communicating with officers in both groups is decisively brief (2.4 min per day for SUP compared to 4.1 min per day for IMU). While such short durations and the differences reported between SUP and IMU might be an artifact of a prisoners’ reflection on how long they interact with officers in a given week, this finding emphasizes that efforts ought to be made to increase the prosocial interactions between correctional officers and prisoners in both units. Such an endeavor is essential for improving the culture by creating a more humanistic approach in restrictive housing.Importantly, however, the SUP in Oregon was never fully implemented as intended due to COVID-19. As the impacts of the pandemic begin to wane and prison systems return to more normal operations, the Oregon DOC will be able to increase the provisions offered in the unit . A stronger dosage of these programmatic elements should serve to further alleviate the potentially harmful aspects of this type of housing which, in turn, could improve indicators of prisoner health and well-being. As we await the opportunity to conduct prospective psychological and behavioral analyses with a larger sample size once the SUP returns to normal operations, this study provides tentative support for the use of step down reentry programs in restrictive housing units.The Oregon DOC has undertaken several efforts to reform its use of solitary confinement. As this study highlights, one of those strategies was the development and implementation of a restrictive housing step down reentry program. The authors partnered with the Oregon DOC to conduct a randomized controlled trial of the new SUP. This evaluation revealed encouraging process findings. This research found that it is possible for prison officials to create conditions in restrictive housing environments that may be perceived by prisoners as less harmful and fairer than standard solitary confinement housing. It remains an open empirical question, however, whether step down programs will improve behavior, or if instead they will, through softening punishment, undermine the goals of institutional safety and security. These results, nevertheless, should motivate researchers to investigate the uses and impacts of reentry programs, especially on prisoner populations not included in this study, such as juveniles, women, and individuals with severe mental health diagnoses, recent histories of serious institutional violence and disorder, and who will be released to the community.


The 20-week multi-component HWBG program, guided by Self-Determination Theory and Acceptance and Commitment Therapy, was designed and delivered by a member of the research team. Randomization occurred prior to baseline assessments at the class level (n=4 classes) into dose-matched treatment conditions . Process evaluation measures of recruitment, retention, adherence, and satisfaction were used to determine program feasibility. This study was designed to assess feasibility (primary outcome) and preliminary efficacy (secondary outcomes), rather than effectiveness. Preliminary efficacy of HWBG for improving mental and social health, screen-time, and physical activity were measured and analyzed using linear mixed-models.The HWBG program was evaluated using a group randomized controlled trial (RCT) in one secondary school. A convenience sample of female students in Grade 8 (mean age 14 ± 0.5 years) was recruited for the study (d=0.45) and social health (d=0.50) were observed. Small effects were observed for physical activity, and no significant intervention effects were found for levels of recreational screen time. Participant ratings showed high levels of perceived benefit and enjoyment as indicated in the evaluation data (mean rating of 4.44 out of a possible 5.0) when asked whether the program was enjoyable.“The health and well-being program” targeting adolescent girls was found to be feasible for implementation as an elective course in a secondary school setting. Participants in the HWBG program reported high levels of satisfaction, the majority of lessons (45 out of 50), were implemented as planned and adherence to the planned HWBG program content was very high. Medium positive effects on mental health (The study provides preliminary support for HWBG as a potentially feasible and enjoyable program suitable for use with adolescent girls in the secondary school setting. Potential of the study for facilitating improvements in pro-social and psychological well-being is also supported.ACTRN12617000157370. The trial was registered with the Australian New Zealand Clinical Trials Registry. What uncertainties existed regarding the feasibility?The Health and Well-being for Girls (HWBG) program was a feasible approach when delivered by a member of the research team in one secondary school. However, the feasibility of a “train the teacher model” is yet to be determined. Additional mindfulness training for teachers of HWBG may be required to ensure equally successful outcomes.What are the key feasibility findings?A health and well-being program targeting adolescent girls is feasible for implementation as an elective course in one secondary school setting. Participants in the HWBG program reported high levels of satisfaction. All lessons were implemented as planned, and adherence to the HWBG program content was very high when delivered as a curriculum program.What are the implications of the feasibility findings for the design of the main study?Findings from the study will be used to refine HWBG before progressing to a cluster FRCT involving multiple schools. Implications about the feasibility of such a high dose  or modification to make the program available for all girls in a different format.Data suggest that approximately 20% of adolescents worldwide have a diagnosed mental health illness , 106. ThThe World Health Organization defines mental health as “a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community” The causes of mental health disorders in youth are complex, but research supports that satisfying the need for interpersonal relationships are essential for good mental and physical health . High le“Positive Education” has emerged as a potential model to promote adolescents’ well-being  and has A crucial component of positive education and good mental health is connectedness , which iAdverse mental and physical health outcomes are associated with excessive recreational screen-time , and this is a global public health issue. Systematic reviews and meta-analyses provide evidence for a negative association between internalizing symptoms  and recreational screen-time in youth , 59, 108Physical activity is another lifestyle behavior that is positively associated with mental health in adolescents . HoweverIn comparison to those that are active, inactive adolescents demonstrate reduced levels of well-being and increased levels of internalizing problems  . AdolescInterventions that facilitate the development and maintenance of meaningful relationships can also produce long-term psychological benefits for adolescents , 51. Des: ACTRN12617000157370. Our results should be interpreted with caution. This study was not adequately powered to detect changes in any of the secondary outcomes. Alternatively, this study involved a convenience sample to evaluate the feasibility of the intervention when offered as an elective course to adolescent girls in year 8. Secondary outcomes were assessed to determine evidence of promise for improvements resulting from the intervention.The (HWBG) program was evaluated using a group randomized controlled trial (RCT) in one secondary school. Baseline assessments were conducted in February 2017 and were repeated at a 6-month follow-up (June 2017 immediate post-intervention). The design, conduct, and reporting of this study adhere to the Consolidated Standards of Reporting Trials (CONSORT) guidelines  and utiln=4 classes) into dose-matched treatment conditions  prior to baseline assessments. An independent researcher randomized the classes using a computer-based random number-producing algorithm. This approach ensured an equal chance of allocation to each group. Randomization occurred prior to baseline assessments, with assessors only blinded at baseline. The sample recruited for this study was a convenience sample to evaluate the feasibility of the intervention when offered as an elective course to adolescent girls in year 8. Secondary outcomes were assessed to provide insights into the effect of the program and to determine the suitability of the measures. A sample target of approximately 90 students was recruited (four classes of approximately 22 students).A member of the research team explained the program to the school principal, teachers, and students prior to recruitment. All participants  were required to provide written informed consent. All Grade 8 girls were eligible to participate in the study unless they had a medical condition preventing assessment or participation in the program, and those with signed consent forms were included. Randomization occurred at the class level . The elective subjects were provided for 5 h per fortnight, over two school terms (20 weeks) and varied considerably. Subject choices ranged from technology and science through to performing and creative arts. The wait-list control group received the intervention in full; however, evaluation data for the control group were not collected.Assessments were conducted at baseline (February 2017) and at 6 months (July 2017) by a member of the research team, who was not a teacher at the school and was blind to the treatment allocation. This member of the research team was blinded to group allocation at both time points.retention , (ii) compliance (participants’ attendance to HWBG lessons), (iii) adherence (number of HWBG lessons delivered), (iv) fidelity (components of each lesson delivered), and (v) satisfaction . The evaluation survey was administered at the completion of the program, with 16 items assessing satisfaction and perceived benefits using a 5-point Likert scale format (responses ranging from “Strongly Disagree” = 1 through to “Strongly Agree” = 5). Participants were also asked to indicate the specific activities they enjoyed and to comment on aspects of the program they did not enjoy (open-ended format).The feasibility of the program was examined using process evaluation measures of (i) Demographic information was collected , and a purpose-designed questionnaire based on previously used and published scales suitable for use with adolescent girls was administered. The following outcomes were assessed:Strength and Difficulties Questionnaire (SDQ): This one-page (25-item) self-report measure of psychological adjustment. Using a 3-point Likert scale with response options of (1 = not true to 3= certainly true). The total score of each scale is used to generate scores for conduct problems, hyperactivity, emotional symptoms, peer problems, and pro-social behavior; all but the pro-social behavior are summed to generate a total difficulties score , 37. TheI lead a purposeful and meaningful life). Items in the scale are summed to create a composite well-being score (possible range 8 to 56). The validity of the measure has been established previously  was was53] wParticipants were asked to wear a sealed Yamax SW700 pedometer  during their normal daily activities to measure physical activity for seven days (including three consecutive days and one weekend day) . This isp <0.05. The mixed models will be used to assess the preliminary efficacy of treatment (HWBG or control), time , and the group-by-time interaction. Mixed-models are consistent with the intention-to-treat principle. Kolmogorov-Smirnov test was used to determine normality of data and 95% confidence intervals calculated. The mixed model analysis was used to assess the preliminary efficacy of treatment (HWBG or control), time  and the group-by-time interaction. Cohen’s d was calculated by dividing the mean difference in change by the pooled standard deviation of change for each variable, and interpreted as 0.2=small effect, 0.5=medium effect, and 0.8=large effect , problems with peers −1.0  and internalizing −1.2 . No effects resulted for mindfulness, self-compassion, or rumination.Our results indicate medium positive effects on four efficacy measures , including total difficulties −2.0 —however, this could be interpreted as a positive outcome as a decline in physical activity levels was not observed . Furthermore, despite only small improvements in physical activity and mindfulness levels observed in the HWBG study the participants reported a very high level of enjoyment toward both of these program components.Mindfulness was ranked as the second highest component enjoyed by participants. Participants utilized the practice to increase their awareness of thoughts and emotions along with components of ACT such as acceptance, diffusion, being present, and commitment to values. Participants in HWBG learned to address and overcome barriers to participation in physical activity through the use of these therapies: “I mostly liked the physical activity because I never thought I could actually keep going in the 30 second workout, and that made me realise I could do more”. Only a small positive effect was observed for levels of total physical activity [+11183.7; 95% CI −3164.31–25531.79; Participants also commented that the HWBG program was fun and exciting. “What I enjoyed about HWBG was the practical lessons because it made me enjoy doing sport and I made a lot of new friends. I loved the chocolate meditation, but most of all just the whole program, it was really fun and exciting.” Research suggests that fun and excitement are elements that have contributed to the positive effects observed for the social and psychological health improvement levels of the participants at a 6-month follow-up , 63, 98.Medium positive effects were observed for internalizing and total difficulties among the participants in the HWBG program. Internalizing refers to symptoms of depression, anxiety, hypersensitivity, and worry problems . In geneThe Penn Resiliency Program (PRP) is a cognitive behavioral therapy program designed to reduce internalizing in adolescents. The PRP has demonstrated small but reliable reductions in depressive symptoms in adolescents ), but haMindfulness practices were used consistently in the HWBG program aiming to develop a flexibility of thinking and the ability to become an observer of the mind without getting “caught up” in negative thought patterns. Participants reported in the evaluation data that the HWBG program had a positive impact on their levels of emotional health: “Health and well-being has helped me with my everyday life. It has made me confident with who I am. I am super happy that this course has changed the way I think, because I have been in a dark headspace for a while, which definitely isn’t good”. Although initial findings have been positive, there is a need for more rigorous evaluation of mindfulness training in adolescent populations .d= .42), depression (d= .47), and anxiety/stress (d= .18) [Evidence demonstrates the importance of managing emotional health problems early in adolescence and shifting from treatment to prevention, as there are implications for school attendance, self-esteem, and prosocial behavior , 104. As(d= .18) . Further(d= .18) .Medium positive effects were observed for levels of social health and problems with peers among the participants in HWBG. This is a promising result as healthy interpersonal relationships and social support are integral to well-being, and levels of physical and mental health , 74, 97.Participants enjoyed completing the program designed for girls only and working collaboratively in this girls’ only zone. Feasibility results observe a mean result of 4.4 out of a possible 5.0 when asked whether they enjoyed working together and qualitative data reports: “I enjoyed being able to talk to other girls my age who normally I wouldn’t really talk to”. “I loved being with a group of girls only and the feeling of not being judged”. High levels of reported enjoyment of HWBG from the participants and improvements in social health indicate that strong connections were established among the participants which contributed to improved levels of well-being  and posiThe strengths of this study include the novel intervention design, adherence to CONSORT guidelines, and the assessment of outcome using assessors who were blinded to group allocation. However, there are some limitations that should be acknowledged. First, the study included a small convenience sample in one secondary school. Second, a member of the research team, who was also a teacher at the school, delivered the program. There is inherent risk of bias associated with this feasibility study as the teacher, who was also a member of the research team, designed and delivered the program and was also involved in the evaluation of the program. And although conducting a single site feasibility study is a limitation, it is an important and necessary step in testing program content and delivery under “ideal conditions” prior to large-scale implementation. Given that this study was designed to establish feasibility and preliminary efficacy of the program for use with adolescent girls in the school setting, using a member of the research team for delivery was a necessary step. Third, physical activity was assessed using pedometers, not accelerometers which are considered more appropriate for the evaluation of school-based physical activity interventions. Future studies are encouraged to use accelerometers to provide an objective measure of physical activity intensity and duration . To estaDeveloping a targeted intervention for a population group who have been recognized as “at risk” of developing a range of short- and long-term health problems  may have a profound impact. This feasibility study may have positive short- and long-term benefits for adolescent girls participating in the program, but future large-scale program implementation and dissemination in secondary schools is needed for wide scale impact. Based on the results of this study, we would recommend the program be evaluated in a cluster FRCT involving multiple schools. In this phase of research, the program should be delivered by teachers who have received training, rather than members of the research team. Progression to a full-powered trial will be dependent upon the feasibility and preliminary efficacy of the “train-the-teacher” delivery model.HWBG is a unique program that is the first of its kind to combine well-being, mental health, physical activity, mindfulness, and screen-time behaviors into one program with a theoretical grounding in Self-Determination Theory, supported by elements of Acceptance and Commitment Therapy. Training educators in mindfulness would be highly recommended for effective delivery of this intervention, as practicing mindfulness within an educational setting provides a potentially feasible and effective strategy for improving the psychological health of young people .Our findings suggest that the HWBG program is feasible for use in one school setting, based on high levels of retention, satisfaction, and fidelity. In addition, our study has provided preliminary evidence that the HWBG program may facilitate improvements in psychological and social health outcomes in adolescent girls. Based on the results of this study, we would recommend the program be evaluated in a cluster FRCT involving multiple schools before progressing to a large-scale effectiveness trial.