None listed
Conditions
Brief summary
Poor mental health has been identified as key factor in multiple risk behaviours that contribute to premature mortality and disability. Reducing liability to mental illness at the population level (e.g., universally), appears to be crucial to disrupting trajectories to mental disorder and related harms. For successful prevention, however, interventions need to be implemented early enough to effect real change. Yet, the majority of ‘early’ universal prevention research occurs in adolescence, in secondary schools, when mental illness is already rapidly increasing. As it is strongly empirically supported that mental illness has origins in childhood, intervening in early-to-mid childhood is likely to achieve significant preventative gains. Despite this, comparatively little evidence-based prevention occurs in this developmental period. We propose a small feasibility study to trial a universal prevention program in a mid-childhood cohort (the ‘Good Behaviour Game’ [GBG]). This program has been extensively evaluated, and been shown to significantly reduce conduct disorder, ASPD, anxiety and depression, drug and alcohol dependence, and suicide attempt, with effects sustained into early adulthood. Given its expected benefits, it is important to test whether the GBG can be delivered as intended in an Australian setting, and whether it is acceptable to schools. Such work will provide empirical justification for the next iteration, i.e., a full-scale trial. This trial focuses on establishing acceptability and feasibility of the program in Australian primary schools, and providing preliminary evidence for efficacy of the program in reducing emotional and behavioural problems.
Interventions
The PAX Good Behaviour Game is a teacher-delivered program, designed to be embedded into usual classroom activities. The program is made up of multiple ‘kernels’ (i.e., evidence-based behavioural contingencies) which include: 1. Classroom Vision (sets out the agreed desirable and undesirable behaviours), 2. PAX Hands (a thumbs up/thumbs down card worn by teachers to discreetly point out to students when they are doing the right or wrong thing - and not draw attention of the whole class to the behaviour) 3. PAX Quiet (use of a harmonica to gain the children’s attention and achieve silence) 4. Granny’s wacky prizes (rewards for desirable behaviours) 5. Beat the Timer (the primary part of the program in which children are split into teams, a timer is set, and children work on task for the amount of time specified by the teacher. Children/teams who stay on task are rewarded at the end of the playing period) 6. Tootle Notes (students write positive notes about each other to reinforce positive relations between students). 7. PAX Voice (using hand signals to teach children how to modulate noise in the classroom) 8. PAX Leader (children chosen for leadership roles in the classroom to develop confidence and increase investment in the program) The kernels are designed to be used throughout the day to encourage desirable behaviour and to teach children to make positive choices. While the kernels can be used individually throughout the day, the ‘beat the timer’ part of the program is the key component which teaches self- and co-regulation. During ‘beat the timer’ the students are divided into small teams, where known disruptive students, or known shy/anxious students, are distributed evenly among the teams to create equilibrium in the classroom. The teacher then sets the timer for how long the ‘game’ will be played, and students have to work within their teams to engage in on-task/desirable behaviours until the timer ends. Any off-task or less desirable/unwanted behaviours receive one point, and at the end of the playing period, teams with three or fewer points are rewarded. When the program is first delivered, rewards are given immediately following a ‘beat the timer’ game, and then are increasingly delayed, to teach delayed self-gratification. This part of the program is played up to 3 times per day, from 10 to 40 minutes (games get longer and more frequent over time), as the children’s self-regulation and behaviour improves. In this study, the Good Behaviour Game is delivered for 12 weeks, with the expectation that teachers will deliver the primary part of the intervention (beat the timer) at least once per day for the trial's duration. In addition, at least one of the remaining eight kernels need to be delivered once per day, with teachers' having discretion regarding which kernel or kernels they will deliver. Adherence to the intervention is monitored in two key ways: 1. Four x classroom observations per classroom by a research officer trained in the Good Behaviour Game; 2. A teacher maintained daily log of the number of times Beat the Timer was played per day, for how long, which team/s won, and the number of spleems per 'game', as well as other kernels used and issues arising. The log could be kept via the PAX Up! app, and teachers were provided tablets for this purpose. A paper version of the log was also provided for teachers who preferred not to use the app.
Sponsors
Study design
Eligibility
Inclusion criteria
Schools were invited to participate in the study if: They were an Independent school in New South Wales or Victoria, Australia They had teachers in Grades 1 through to 6 who were willing to trial a classroom-based intervention They had a minimum of 15 students in each class All students received the Good Behaviour Game if the school principal agreed for their school to participate in the trial,
Exclusion criteria
Government and Catholic schools were excluded from the trial.