The 2009 Report on the Prevention of Mental, Emotional and Behavioral Disorders1 from the Institute of Medicine represents a watershed in prevention research, policies and potential for a true population-level public health approach. One of the scientific findings singled out in the report involved the Good Behavior Game, (IOM, pages 158, 184, 209, 284).
The Good Behavior Game was invented by a 4th grade teacher, Muriel Saunders, from Baldwin, KS in 1967, and the first publication of impact on student behavior appeared in 1969 by researchers Harriet Barrish, Muriel Saunders and Montrose Wolf from the University of Kansas.2
The Good Behavior Game has 51 citations for experimental related studies in Psych Info, going all the way back to 1969.2 There are 19 other experimental citations in PUBMED.GOV. The Good Behavior Game is unique in the scientific literature, in that it can be adopted by an individual teacher, and produce lifetime results in reducing mental illness and substance abuse—while increasing high school graduation and college entry.3-14 These effects are the result of just one year of exposure to the Good Behavior Game in first-grade,15 16 with durable results well into young adulthood.7-11
For teachers, the Good Behavior Game is godsend, since more and more children come to school with problem behaviors and difficulty with the most fundamental skill for any learning: the ability to “turn on” their own ability to pay attention. Such self-regulation of attention is the single most predictive meta-skill that predicts standardized achievement test scores and school success. The Game, which is used during normal instruction, gives teachers a way to cultivate this essential skill that so many children lack today coming to school. The benefits for teachers and students are immediate:
o About an hour more each day in which real learning and teaching can occur.
o A 70%+ drop in attentive, disturbing or disruptive behavior.
o Less stress every day, less bullying, fewer fights and reasons for referrals.
o Few children who need hard-to-get special services.
o Better academic achievement, especially if teacher uses the time made available for instruction and learning.
PAXIS Institute has recently started supporting the implementation of the PAX Good Behavior Game in 18 Title 1 school districts being funded by the Substance Abuse and Mental Health Administration, using a new coaching model that has emerged over time from the Chicago, Ohio, Pennsylvania , and Baltimore efforts. After attending a week long training to become a PAX Game coach (this is a coaching, not a TOT model) since the game is a skill rather than a curriculum, the PAX Game coach in Tennessee was able to achieve remarkable results in eight first grade classrooms—in the last few months of the Spring semester, as shown below.
The Game is not a program that involves lessons that take up valuable curriculum time. Rather the Game is a “behavioral vaccine” or routine that is used every day—like brushing your teeth, buckling your seatbelt, or wash your hands after going to the bathroom to protect or promote one’s health, safety or wellbeing.
Every day, thousands of the students from pre-K through even high school are playing the PAX Game. Students have learned that PAX means a wonderful school or classroom, filled with productivity, peace, health and happiness. Everyday, students create more PAX by sweeping away “Spleems” by their teams in the classroom or even whole grade or school. Spleem is a made up word that stands for all the behaviors or actions that get in the way of or harm PAX. Spleems are behaviors like not doing your work, bothering others, creating a disturbance, breaking rules, etc. The definition of Spleems changes on types of activities, of course. A music class, art class, or science lab would have different Spleems than doing work in the school library, walking in the halls, or while taking a test. This helps students learn to learn how to adapt to different demands, people and tasks—which is part of life.
Spleems are called out or noted only for teams, not individual children. Staff learn to do this neutrally, so as not to create accidental attention to negative or bad behavior that some students crave—because of TV, video games, and other bad influences. The Game is played for increasing times, for a max of three times per day.
If teams do not have more than three (3) Spleems, their team wins simple fun, random activity rewards that last seconds. These are called “Granny’s Wacky Prizes,” which are based on simple things that students prefer like to do have a “10-second nap,” sit backwards in their chairs, turn and talk to a friend, do a silly cheer or dance, play tic-tack-toe, etc. There are more than 300 such fun activities that a teacher can choose from that fit circumstances and ages. These prizes also help teach students how to calm themselves quickly when exited—an increasingly rare skill today. If all teams win, the prize is extended a bit, typically. If a team does not win, they stand down for the 10 seconds or so. This helps teach children how to lose well, how to be a good sport, and the need for “effort” versus entitlement.
The training, coaching and materials cover all sorts to tricks and strategies to make the Game create more and more PAX, how to increase PAX when not playing the Game, and what to do with children who are not responsive or have special needs. The Game can be easily combined with other curricula, other prevention strategies and initiatives such as Positive Behavioral Support (PBS or PBIS), Response to Intervention (RTI), PeaceBuilders, PATHS, or Second Step to name a few.3
Training and materials are provided by PAXIS Institute to thousands of classrooms across America. PAXIS Institute is a national leader in applying prevention science to improve the wellbeing of children, families, schools, neighborhoods, businesses, and communities. PAXIS Institute may be contacted at 520-299-6770 (Arizona time) or by emailing firstname.lastname@example.org. Claire Richardson is PAXIS’ director of community and school services, and she may be reached directly at 520-907-5240 or Claire@paxis.org.
The Good Behavior Game is particularly important from a public-policy perspective, because it can be rapidly deployed to teachers who want to use it—without the need for whole school “buy-in”, without the need for curriculum adoption, and without the need to have every organization in a community “agree” to do it.
As a practical matter, the Good Behavior Game can be prescribed and reimbursed under health-care reform (both for Medicaid and private insurance), because it is highly effective in preventing DSM-IV disorders or reducing the symptoms of DSM-IV disorders as well as or better than psychotropic medications (which have many adverse consequences and wear off in time).17 The potential of the Good Behavior Game to significantly impact rising costs of psychotropic medications for disturbing, disruptive and inattentive behavior and to reduce the abuse of stimulant drugs is quite large.11 12 18 It is noteworthy that the Good Behavior Game is one of the few things ever recorded to prevent suicide in later life.8 Thus, the Game has proven prevention effects for mental illness,11 18 school failure,7 11 substance abuse,11 12 19 20 adolescent and adult crime,10 11 21 suicide,8 violent crime10 11 as well as increasing high-school graduation7 and college entry7 in exemplary research studies cited by the IOM Report.
When America’s communities and states are facing record high deficits from health-care costs, prison and law-enforcement costs, drug use, special education needs, school failure, and other issues, the Good Behavior Game represents a fantastic way for America to turn around these problems quickly—restoring the future for more of our children and our ability to compete with other countries.
In terms of policy, the Game is attractive, because it truly affects multiple high-cost centers, and it can be implemented by individual teachers, whole schools or embedded in a community effort. The Game can also be a part of health-care reform in terms of parity and cost-containment.
In July of 2011, the renown Washington State Institute for Public Policy reported on return on investments for evidence-based options to improve state-level protective and prevention outcomes, among all general prevention programs, the Good Behavior Game is the single most cost-efficient strategy, returning $96.80 per dollar spent. The net benefit to the child for his or her lifetime is $10,371 and $4,137 for the taxpayers (see http://www.wsipp.wa.gov/rptfiles/11-07-1201.pdf). While the Policy Institute estimated the cost of deliver of this universal behavior, which is cheaper than any childhood vaccination or inoculation, PAXIS has been able reduce the cost of delivery in subsequent research at Hopkins—making the strategy even more cost efficient.
For only the second time in the history of the Federal Government, the Substance Abuse and Mental Health Administration issued an RFA naming a specific prevention strategy for communities or school districts to apply for: the Good Behavior Game. PAXIS Institute is supervising 18 of the 20 school districts.
The Game is widely placed on multiple best practice lists such as:
The Surgeon General's Report
Coalition for Evidence Based Programs
Violence Prevention Blue Prints
The California Department of Education
The Good Behavior Game (like the Nurse Family Partnership and other legacy registrations) is undergoing a new review for NREPP. This is a time-consuming process, and the Nurse Family Partnership was just reposted in 2009. Since the original registration with NREPP, there have been 10 long-term studies published, multiple replications, and millions of dollars awarded by NIDA and the Institute of Education to expand the testing of the Game in some 1,500 classrooms in Baltimore alone by the Johns Hopkins Center on Prevention and Early Intervention. There are also multiple international replications.
For an annotated bibliography, please go to: http://bit.ly/PAXGBGbiblio
For More info
1. O'Connell ME, Boat T, Warner KE, editors. Preventing Mental, Emotional, and Behavioral Disorders Among Young People: Progress and Possibilities. . Washington, DC: Institute of Medicine; National Research Council, 2009.
2. Barrish HH, Saunders M, Wolf MM. Good behavior game: Effects of individual contingencies for group consequences on disruptive behavior in a classroom. Journal of Applied Behavior Analysis 1969;2(2):119-24.
3. Domitrovich CE, Bradshaw CP, Greenberg MT, Embry D, Poduska JM, Ialongo NS. Integrated models of school-based prevention: Logic and theory. Psychology in the Schools 2010;47(1):71-88.
4. Yan W, Dorothy CB, Hanno P, Elizabeth AS, Fernando AW, Sharon FL, et al. Depressed mood and the effect of two universal first grade preventive interventions on survival to the first tobacco cigarette smoked among urban youth. Drug and Alcohol Dependence 2009;100(3):194-203.
5. Witvliet M, van Lier PAC, Cuijpers P, Koot HM. Testing links between childhood positive peer relations and externalizing outcomes through a randomized controlled intervention study. Journal of Consulting and Clinical Psychology 2009;77(5):905-15.
6. McCurdy BL, Lannie AL, Barnabas E. Reducing disruptive behavior in an urban school cafeteria: An extension of the Good Behavior Game. Journal of School Psychology 2009;47(1):39-54.
7. Bradshaw CP, Zmuda JH, Kellam S, Ialongo N. Longitudinal Impact of Two Universal Preventive Interventions in First Grade on Educational Outcomes in High School. Journal of Educational Psychology 2009;101(4):926-37.
8. Wilcox HC, Kellam S, Brown CH, Poduska J, Ialongo N, Wang W, et al. The impact of two universal randomized first- and second-grade classroom interventions on young adult suicide ideation and attempts. Drug & Alcohol Dependence 2008(Special Issue):14.
9. Poduska JM, Kellam SG, Wang W, Brown CH, Ialongo NS, Toyinbo P. Impact of the Good Behavior Game, a universal classroom-based behavior intervention, on young adult service use for problems with emotions, behavior, or drugs or alcohol. Drug and Alcohol Dependence 2008;95(Suppl1):S29-S44.
10. Petras H, Kellam S, Brown CH, Muthen B, Ialongo N, Poduska J. Developmental epidemiological courses leading to antisocial personality disorder and violent and criminal behavior: Effects by young adulthood of a universal preventive intervention in first- and second-grade classrooms. Drug & Alcohol Dependence 2008(Special Issue):15.
11. Kellam S, Brown CH, Poduska J, Ialongo N, Wang W, Toyinbo P, et al. Effects of a universal classroom behavior management program in first and second grades on young adult behavioral, psychiatric, and social outcomes,. Drug & Alcohol Dependence 2008(Special Issue):24.
12. Huizink AC, van Lier PAC, Crijnen AAM. Attention deficit hyperactivity disorder symptoms mediate early-onset smoking. European Addiction Research 2008;15(1):1-9.
13. Brown CH, Kellam SG, Ialongo N, Poduska J, Ford C. Prevention of aggressive behavior through middle school using a first-grade classroom-based intervention. Recognition and prevention of major mental and substance use disorders.: Arlington, VA, US: American Psychiatric Publishing, Inc., 2007:347-69.
14. Tingstrom DH, Sterling-Turner HE, Wilczynski SM. The Good Behavior Game: 1969-2002. Behavior Modification 2006;30:225-53.
15. Ialongo NS, Werthamer L, Kellam SG, Brown CH, Wang S, Lin Y. Proximal impact of two first-grade preventive interventions on the early risk behaviors for later substance abuse, depression, and antisocial behavior. American Journal of Community Psychology 1999;27(5):599-641.
16. Dolan LJ, Kellam SG, Brown CH, Werthamer-Larsson L, et al. The short-term impact of two classroom-based preventive interventions on aggressive and shy behaviors and poor achievement. Journal of Applied Developmental Psychology 1993;14:317-45.
17. Molina BSG, Hinshaw SP, Swanson JM, Arnold LE, Vitiello B, Jensen PS, et al. The MTA at 8 Years: Prospective Follow-up of Children Treated for Combined-Type ADHD in a Multisite Study. Journal of Amer Academy of Child & Adolescent Psychiatry 2009;48(5):484-500 10.1097/CHI.0b013e31819c23d0.
18. van Lier PAC, Muthen BO, van der Sar RM, Crijnen AAM. Preventing Disruptive Behavior in Elementary Schoolchildren: Impact of a Universal Classroom-Based Intervention. Journal of Consulting & Clinical Psychology 2004;72(3):467-78.
19. Storr CL, Ialongo NS, Kellam SG, Anthony JC. A randomized controlled trial of two primary intervention strategies to prevent early onset tobacco smoking. Drug & Alcohol Dependence 2002;66(1):51.
20. Furr-Holden CD, Ialongo NS, Anthony JC, Petras H, Kellam SG. Developmentally inspired drug prevention: middle school outcomes in a school-based randomized prevention trial. Drug & Alcohol Dependence 2004;73(2):149-58.
21. Ialongo N, Poduska J, Werthamer L, Kellam S. The distal impact of two first-grade preventive interventions on conduct problems and disorder in early adolescence. Journal of Emotional & Behavioral Disorders 2001;9(3):146-60.
* The IOM Report was funded by the Center for Mental Health Services of the Substance Abuse and Mental Health Administration (SAMHSA), the National Institute of Mental Health (NIMH), the National Institute on Drug Abuse (NIDA), and the National Institute on Alcohol Abuse and Alcoholism.