This paper describes the culture and components of the PAX Good Behavior Game and offers it as one model for how to enhance the well-being of populations through the diffusion of nurturing practices into several venues of society. The PAX components, also known as evidence-based kernels, are proposed to be useful in classrooms, families, organizations, criminal justice, and in improving public discussion and government. Kernels affect behavior in the short- and long-term through combinations of antecedents, reinforcers, relational networks, and physiological effects. Identifying common strategies, tools, and clear targets of change is suggested as a way to work towards evolving freely available evidence-based tools that can be combined to improve social conditions in multiple contexts.

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The PAX Good Behavior Game: One Model for Evolving a More Nurturing Society

The PAX Good Behavior Game (PAX GBG) is a behavior management strategy that has demonstrated positive effects on children’s behavior and well-being in trials conducted mainly in the USA. This study assessed the impact of the PAX GBG on students’ mental health and behavior 7 and 19 months post-baseline in Estonia. This matched-pair, cluster-randomized, waitlist-controlled, open-label trial included 42 Estonian elementary schools with 708 first-grade students. The primary outcome was children’s overall mental health rated by teachers, while secondary objectives were to examine whether the effects of the intervention extended to the home context. Teachers also rated their self-efficacy and overall classroom behavior. Intervention adherence and children’s exposure to the intervention were also measured. Modified intention to treat analysis involved 696 students on first post-baseline and 647 on second post-baseline. Intervention had positive effects on children’s mental health at the end of the first academic year, which lasted and strengthened during the second academic year. Moderation analysis demonstrated positive effects on mental health and prosocial behavior for high-risk students during the first year. A few positive effects extended to the home environment during the second academic year. Implementation fidelity was satisfactory. The intervention also had a positive lasting effect on teacher’s self-efficacy and overall classroom behavior. This study shows the positive effects of the PAX GBG in Estonian schools and supports broader implementation of the intervention in Estonian elementary schools. ClinicalTrials.gov No. NCT02865603

Effectiveness of a Universal, Classroom-Based Preventive Intervention (PAX GBG) in Estonia: a Cluster-Randomized Controlled Trial.

There continue to be challenges of transfer from research evidence to practice in education. This paper reports on the implementation of a well-evidenced Reciprocal Reading approach in 35 schools across a high poverty region in England, working cooperatively at transition between primary and secondary. The purpose of the research reported here was not to test children to establish whether Reciprocal Reading improves student outcomes, as randomised controlled trial evidence from studies in England has already established the positive impact of this approach in primary and secondary schools. Instead, a process evaluation was undertaken using naturally occurring data and staff survey data, to understand whether it is possible to implement this approach across a region with high fidelity. The theory of change exemplified in previous randomised controlled trial evaluations was used to interrogate the data in respect of teacher behaviours and attitudes, and student behaviours as reported by school staff during implementation. Findings suggest high levels of adherence to programme design and resources by schools was present across the sample during implementation, together with staff competence and positive relational factors during programme delivery. These findings are in line with health-based research where high fidelity of implementation is used as an indicator of transfer to practice. 

https://onlinelibrary.wiley.com/doi/pdfdirect/10.1002/rev3.3332

Reciprocal Reading for struggling readers: An exemplar of evidence implementation in schools


 
 Universal, school-based behaviour management interventions can produce meaningful improvements in children’s behaviour and other outcomes. However, the UK evidence base for these remains limited.
 
 
 
 The objective of this trial was to investigate the impact, value for money and longer-term outcomes of the Good Behaviour Game. Study hypotheses centred on immediate impact (hypothesis 1); subgroup effects (at-risk boys, hypothesis 2); implementation effects (dosage, hypothesis 3); maintenance/sleeper effects (12- and 24-month post-intervention follow-ups, hypothesis 4); the temporal association between mental health and academic attainment (hypothesis 5); and the health economic impact of the Good Behaviour Game (hypothesis 6).
 
 
 
 This was a two-group, parallel, cluster-randomised controlled trial. Primary schools (n = 77) were randomly assigned to implement the Good Behaviour Game for 2 years or continue their usual practice, after which there was a 2-year follow-up period.
 
 
 
 The trial was set in primary schools across 23 local authorities in England.
 
 
 
 Participants were children (n = 3084) aged 7–8 years attending participating schools.
 
 
 
 The Good Behaviour Game is a universal behaviour management intervention. Its core components are classroom rules, team membership, monitoring behaviour and positive reinforcement. It is played alongside a normal classroom activity for a set time, during which children work in teams to win the game to access the agreed rewards. The Good Behaviour Game is a manualised intervention delivered by teachers who receive initial training and ongoing coaching.
 
 
 
 The measures were conduct problems (primary outcome; teacher-rated Strengths and Difficulties Questionnaire scores); emotional symptoms (teacher-rated Strengths and Difficulties Questionnaire scores); psychological well-being, peer and social support, bullying (i.e. social acceptance) and school environment (self-report Kidscreen survey results); and school absence and exclusion from school (measured using National Pupil Database records). Measures of academic attainment (reading, standardised tests), disruptive behaviour, concentration problems and prosocial behaviour (Teacher Observation of Child Adaptation Checklist scores) were also collected during the 2-year follow-up period.
 
 
 
 There was no evidence that the Good Behaviour Game improved any outcomes (hypothesis 1). The only significant subgroup moderator effect identified was contrary to expectations: at-risk boys in Good Behaviour Game schools reported higher rates of bullying (hypothesis 2). The moderating effect of the amount of time spent playing the Good Behaviour Game was unclear; in the context of both moderate (≥ 1030 minutes over 2 years) and high (≥ 1348 minutes over 2 years) intervention compliance, there were significant reductions in children’s psychological well-being, but also significant reductions in their school absence (hypothesis 3). The only medium-term intervention effect was for peer and social support at 24 months, but this was in a negative direction (hypothesis 4). After disaggregating within- and between-individual effects, we found no temporal within-individual associations between children’s mental health and their academic attainment (hypothesis 5). Last, our cost–consequences analysis indicated that the Good Behaviour Game does not provide value for money (hypothesis 6).
 
 
 
 Limitations included the post-test-only design for several secondary outcomes; suboptimal implementation dosage (mitigated by complier-average causal effect estimation); and moderate child-level attrition (18.5% for the primary outcome analysis), particularly in the post-trial follow-up period (mitigated by the use of full information maximum likelihood procedures).
 
 
 
 Questions remain regarding programme differentiation (e.g. how distinct is the Good Behaviour Game from existing behaviour management practices, and does this makes a difference in terms of its impact?) and if the Good Behaviour Game is impactful when combined with a complementary preventative intervention (as has been the case in several earlier trials).
 
 
 
 The Good Behaviour Game cannot be recommended based on the findings reported here.
 
 
 
 This trial is registered as ISRCTN64152096.
 
 
 
 This project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 10, No. 7. See the NIHR Journals Library website for further project information.


The Good Behaviour Game intervention to improve behavioural and other outcomes for children aged 7–8 years: a cluster RCT

Designing enhanced pedagogy based on Basil Bernstein's code theory

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An efficacy randomized controlled trial of Reciprocal Reading in secondary schools: Scientific report

An efficacy randomized controlled trial of Reciprocal Reading in secondary schools

Protocol: A feasibility study and a pilot cluster randomised controlled trial of the PAX ‘Good Behaviour Game’ in disadvantaged schools

This article presents the findings of an exploratory randomised controlled trial of the PAX Good Behaviour Game (PAX GBG) in Northern Ireland. The PAX GBG is an evidence‐based universal prevention programme designed to improve mental health by increasing self‐regulation, academic engagement, and decreasing disruptive behaviour in children. The study was designed in line with the Medical Research Council guidance on the development of complex interventions and is based on the Medical Research Council framework, more specifically within a Phase 2 exploratory trial. The study used a cluster randomised controlled trial design with a total of 15 schools (19 classes) randomised to intervention and control. This article reports specifically on the outcome of self‐regulation with 355 elementary school pupils in year 3 (age M = 7.40, SD = 0.30). Participating schools in the trial were located in areas of socio‐economic disadvantage. The teachers in the intervention group received training in the delivery of the PAX GBG and implemented the PAX GBG intervention for 12 weeks. A range of pre‐ and post‐test measures, including child reported behaviours, were undertaken. After the 12 weeks of implementation, this exploratory trial provided some evidence that the PAX GBG may help improve self‐regulation (d = .42) in participating pupils, while the findings suggest that it may offer a feasible mental health prevention and early intervention approach for Northern Ireland classrooms. However, a larger definitive trial would be needed to verify the findings in this study.

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Joanne O'Keeffe

Papers

An efficacy randomized controlled trial of Reciprocal Reading in secondary schools: Scientific report

An efficacy randomized controlled trial of Reciprocal Reading in secondary schools

Protocol: A feasibility study and a pilot cluster randomised controlled trial of the PAX ‘Good Behaviour Game’ in disadvantaged schools

Reciprocal Reading for struggling readers: An exemplar of evidence implementation in schools

An Exploratory, Cluster Randomised Control Trial of the PAX Good Behaviour Game