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An Evaluation of an Integrated Approach to Prevention and Early Intervention in the Elementary School Years

An Evaluation of an Integrated Approach to Prevention and Early Intervention in the Elementary School Years

Status
Completed
Phases
NA
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT03132805
Acronym
P2P+IY
Enrollment
5233
Registered
2017-04-28
Start date
2016-06-01
Completion date
2021-04-30
Last updated
2022-08-02

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Aggression

Brief summary

In this study, the investigators propose to examine whether the combination of a universal, elementary school-based preventive intervention with an indicated preventive and treatment intervention would yield greater impact on aggression than the universal preventive intervention alone.

Detailed description

Aggressive behavior in the elementary school years is a strong indicator of antisocial behavior, drug abuse and low educational and occupational attainment in adolescence and young adulthood. The Good Behavior Game (GBG) and Promoting Alternative Thinking Strategies (PATHS) represent two of a handful of universal, elementary school, preventive interventions which have been shown in large scale, randomized controlled trials to have an immediate and beneficial impact on aggression. Promoting Alternative Thinking Strategies seeks to accomplish reductions in aggressive behavior via teacher led instruction aimed at facilitating emotion regulation and social problem-solving, whereas the Good Behavior Game provides teachers with an efficient means of reducing aggressive behavior using social learning principles within a game-like context. Importantly, however, the effects of the Good Behavior Game on aggressive behavior proved modest in the first and second generation Johns Hopkins University Preventive Intervention Research Center randomized field trials. This has been the case for Promoting Alternative Thinking Strategies as well. The investigators recently completed a 27-school, randomized controlled trial examining whether the combination of these interventions, which the investigators refer to as PATHS to PAX, would yield significantly greater impact on aggressive behavior than the Good Behavior Game alone. The rationale for expecting greater impact was that the use of the Good Behavior Game should result in reductions in aggressive behavior, which should then facilitate the acquisition of the emotion regulation and social problem-solving skills taught in Promoting Alternative Thinking Strategies. PATHS to PAX did result in a modestly greater reduction in aggressive behavior than the Good Behavior Game alone at 1-year post-test. Yet, the most aggressive students still failed to sufficiently benefit from the PATHS to PAX intervention. Accordingly, in this application, the investigators propose to examine whether the addition of the Incredible Years (IY), an evidence-based preventive and treatment intervention aimed at reducing aggressive behavior, to PATHS to PAX would yield greater impact on these behaviors than the PATHS to PAX intervention alone. The investigators also propose to examine whether the combination of the PATHS to PAX plus the Incredible Years results in increased frequency of implementation of the PATHS to PAX intervention. It is hypothesized that relative to teachers in the PATHS to PAX alone condition, teachers in the PATHS to PAX plus Incredible Years condition will perceive PATHS to PAX as more efficacious and will therefore be more likely to implement it. Four cohorts of 12 schools each will be recruited with schools randomly assigned to 1 of 3 intervention conditions: 1) Control; 2) PATHS to PAX; or 3) PATHS to PAX plus the Incredible Years. Assessments of student outcomes will be carried out at pre-test and post-test in the fall and spring of the initial school year for each cohort and at a 6-month and 1-year follow-up. Teacher outcomes in terms of classroom behavior management self-efficacy, perceptions of the efficacy of PATHS to PAX, and teacher burn out will be assessed at 4-time points during the initial year for each cohort. Assessment of teacher implementation of PATHS to PAX will be carried out on a daily basis throughout the intervention year. Aims 1 and 2 represent the primary goals of this application, whereas Aims 3 and 4 represent secondary, or exploratory, aims: 1. To evaluate, utilizing a group randomized design, whether the combination of PATHS to PAX plus Incredible Years child and parent groups yields greater reductions in aggressive behavior than PATHS to PAX alone. 2. To examine whether the frequency of PATHS to PAX intervention implementation (i.e., number of times and minutes the Good Behavior Game is played per day and Promoting Alternative Thinking Strategies lessons taught per week) will be greater in the PATHS to PAX plus Incredible Years condition. 3. To explore whether any evidence of differential benefits in terms of student outcomes between the PATHS to PAX versus PATHS to PAX plus Incredible Years conditions at post-test are a function of differences in PATHS to PAX implementation (e.g., number of Promoting Alternative Thinking Strategies lessons administered and the number of Good Behavior Games played and the duration of the games played). In addition, the investigators will explore whether any differences in implementation across the two intervention conditions is mediated by differences in teacher behavior management self-efficacy, perceived efficacy of PATHS to PAX in improving student behavior, and teacher burn out at post-test. 4. To explore the moderating effects of teacher, parent and student characteristics on intervention outcomes by expanding the models used for Aims 1 & 2 to include interactions between those characteristics and study condition,

Interventions

BEHAVIORALPATHS to PAX

A universal classroom-based preventive intervention designed to prevent aggression.

BEHAVIORALPATHS to PAX and the Incredible Years

A universal classroom-based preventive intervention in combination with an indicated preventive intervention, both of which are designed to prevent aggression.

Sponsors

National Institute on Drug Abuse (NIDA)
CollaboratorNIH
Johns Hopkins Bloomberg School of Public Health
Lead SponsorOTHER

Study design

Allocation
RANDOMIZED
Intervention model
FACTORIAL
Primary purpose
PREVENTION
Masking
SINGLE (Outcomes Assessor)

Masking description

Outcome assessors are blind to intervention status.

Intervention model description

Schools are randomly assigned to 1 of 3 conditions, control, universal classroom-based preventive intervention, and universal classroom-based intervention plus an indicated preventive intervention. Data on student outcomes to be collected at pre- post- and 6 month follow-up. \*Enrollment numbers reflect both students and teachers who agreed to participate in the study.

Eligibility

Sex/Gender
ALL
Age
5 Years to No maximum
Healthy volunteers
Yes

Inclusion criteria

* Students enrolled in kindergarten through second grade classrooms and their teachers.

Exclusion criteria

* Students must be enrolled in regular education classrooms.

Design outcomes

Primary

MeasureTime frameDescription
Change in Direct Classroom Observations of Student Behavior Between Pre-test and Post-test, 6 Months After the Pre-test.The observations are carried out at pre-test and at post-test, 6 months after the pre-test.Classroom observations of student behavior were carried out by independent observers on two occasions, one week apart, at pre- and post-test respectively. The behaviors observed were on-task and physical aggression. Behaviors were observed in 10 second intervals and were recorded as present if they occurred at least once during a 10 second interval. The per interval on-task and physical aggression scores could range from 0-1, with 0 signifying the behavior was not observed and 1 signifying the behavior was observed. The on-task and physical aggression scores used in the analyses were the average score across all of the 10-second intervals the student was observed. (Adapted from Tapp, Wehby & Ellis, 1995).
Teacher Ratings of Student On-task and Aggressive-disruptive Behavior in the Classroom.The ratings are carried out at pre-test, post-test, 6 months after the pre-test.Change in Teacher Observation of Classroom Adaptation between pre-test and post-test, 6 months after the pre-test. Student adaptation to classroom task demands are rated by teachers over the last 3 weeks on a 6-point frequency scale (1 = almost never to 6 = almost always). The domains include authority acceptance and readiness to learn. Authority acceptance items include compliance with classroom rules, and readiness to learn items reflect attentive classroom behaviors (e.g. stays on task). The mean of the teacher ratings across the items making up each of these subscales was used in the outcome analyses. The minimum score for both the authority acceptance and readiness to learn subscales was 1 and maximum score was 6. Higher scores on both subscales reflect greater adaptation.

Secondary

MeasureTime frameDescription
Change in Peer Assessment Inventory Between Pre-test and Post-test, 6 Months After the Pre-test.The peer nomination instrument is administered at pre-test and at post-test, 6 months after the pre-test.Students are asked to nominate fellow students in terms of who they like, play with, and perceive as friends. Individual students were read aloud the names of the other students in the classroom. The student being interviewed was asked if they knew the named student. The student was then asked whether the peer nomination descriptors fit the named student (Do you like \[student\]?, Do you play with \[student\]?, and Is (s)he one of your best friends?). The student's summary score reflected the mean percentage of nominations received across the 3 items. A higher percentage reflects a student received a greater number of nominations from classmates.
Change in Pictorial Scale of Perceived Competence and Social Acceptance for Young Children Between Pre-test and Post-test, 6 Months After the Pre-test.This scale will be administered at pre-test and post-test, 6-months after the pre-test.The Change in Pictorial Scale of Perceived Competence and Social Acceptance for Young Children assesses the student's perceived competence in the domains of peer acceptance. Items on this instrument present two pictorial alternatives, one of a child displaying high competence in the social acceptance domain and one that depicts less competence. Students were asked which pictorial plate was most like him/her. After making that decision, the student is then asked if the chosen picture is really true for me and sort of true for me. Each item is scored on a 4-point scale, 4 would be the most competent and 1 would designate the least competent. The mean of the items was used in the outcome analyses.
Change in Teacher Sense of Self Efficacy Scale Between Pre-test and Post-test, 6-months After the Pre-test.This scale will be administered at pre-test and post-test, 6 months after the pre-test.This scale assesses teacher sense of self-efficacy in the instructional and classroom behavior management domains. We assessed two distinct dimensions of teachers' perceived self-efficacy that reflect skills uniquely associated with the strategies included in the two interventions. The Behavior Management Self-Efficacy Scale (Main and Hammond 2008) included 14 items regarding classroom behavior management (e.g., I am able to use a variety of behavior management techniques; α= 0.92). The Social-Emotional Learning Efficacy Scale (Domitrovich, et al., 2016) included 8 items which focused on teachers' perceived efficacy to promote social-emotional skills in students (e.g., I am able to teach children to show empathy and compassion for each other; α= 0.91). For each scale, item responses were on a 5-point Likert-type scale and were averaged. For both subscales the minimum score was 1 and maximum was 5, with higher scores indicating greater efficacy.
Change in the Maslach Burnout Inventory Between Pre-test and Post-test, 6 Months After the Pre-test.This scale will be administered at pre-test and post-test, 6 months after the pre-test.The Maslach Burnout Inventory assesses how frequently teachers experience feelings of burnout in the work place. Teachers completed the Maslach Burnout Inventory (MBI;Maslach et al. 1997) at pretest and post-test. One scale was used in the analyses: emotional exhaustion (9 items, e.g., I feel used up at the end of the workday, α=0.94). Responses were rated on a 7-point scale from never to every day with higher scores indicating greater emotional exhaustion (i.e., greater burnout). For this subscale, the minimum score was 1 and maximum score was 7. Therefore, low scores on emotional exhaustion were desired.

Countries

United States

Participant flow

Pre-assignment details

In accordance with our original protocol, we successfully recruited 48 schools over the four cohorts, which were subsequently randomized to one of three conditions. Randomization occurred at the school level and not at the teacher or student level within school. A total of 4,923 students with parental consent to participate were enrolled over the four cohorts from the 48 participating schools. A total of 310 teachers were also enrolled over the four cohorts from the 48 participating schools.

Participants by arm

ArmCount
Control
Schools which receive no intervention
1,544
PATHS to PAX
Universal classroom-based preventive intervention designed to reduce aggression. PATHS to PAX: A universal classroom-based preventive intervention designed to prevent aggression.
1,694
PATHS to PAX and the IncredibleYears
The combination of PATHS to PAX with the Incredible Years child and parent groups. PATHS to PAX and the Incredible Years: A universal classroom-based preventive intervention in combination with an indicated preventive intervention, both of which are designed to prevent aggression.
1,716
Total4,954

Withdrawals & dropouts

PeriodReasonFG000FG001FG002
Overall StudyLost to Follow-up142141113

Baseline characteristics

CharacteristicControlTotalPATHS to PAX and the IncredibleYearsPATHS to PAX
Age, Categorical
Students
<=18 years
1442 Participants4662 Participants1617 Participants1603 Participants
Age, Categorical
Students
>=65 years
0 Participants0 Participants0 Participants0 Participants
Age, Categorical
Students
Between 18 and 65 years
0 Participants0 Participants0 Participants0 Participants
Age, Categorical
Teachers
<=18 years
0 Participants0 Participants0 Participants0 Participants
Age, Categorical
Teachers
>=65 years
0 Participants0 Participants0 Participants0 Participants
Age, Categorical
Teachers
Between 18 and 65 years
102 Participants292 Participants99 Participants91 Participants
Ethnicity (NIH/OMB)
Students
Hispanic or Latino
155 Participants362 Participants42 Participants165 Participants
Ethnicity (NIH/OMB)
Students
Not Hispanic or Latino
1287 Participants4300 Participants1575 Participants1438 Participants
Ethnicity (NIH/OMB)
Students
Unknown or Not Reported
0 Participants0 Participants0 Participants0 Participants
Ethnicity (NIH/OMB)
Teachers
Hispanic or Latino
2 Participants6 Participants2 Participants2 Participants
Ethnicity (NIH/OMB)
Teachers
Not Hispanic or Latino
100 Participants286 Participants97 Participants89 Participants
Ethnicity (NIH/OMB)
Teachers
Unknown or Not Reported
0 Participants0 Participants0 Participants0 Participants
Independent Classroom Observations of Student Behavior
On-Task
0.4921 percentage of intervals observed
STANDARD_DEVIATION 0.269
0.5166 percentage of intervals observed
STANDARD_DEVIATION 0.2657
0.5379 percentage of intervals observed
STANDARD_DEVIATION 0.2783
0.5172 percentage of intervals observed
STANDARD_DEVIATION 0.2476
Independent Classroom Observations of Student Behavior
Physical Aggression
0.0021 percentage of intervals observed
STANDARD_DEVIATION 0.0124
0.0019 percentage of intervals observed
STANDARD_DEVIATION 0.0112
0.0020 percentage of intervals observed
STANDARD_DEVIATION 0.0115
0.0015 percentage of intervals observed
STANDARD_DEVIATION 0.0096
Peer Assessment Inventory0.812 percentage of nominations received
STANDARD_DEVIATION 0.187
0.815 percentage of nominations received
STANDARD_DEVIATION 0.177
0.816 percentage of nominations received
STANDARD_DEVIATION 0.17
0.816 percentage of nominations received
STANDARD_DEVIATION 0.173
Race (NIH/OMB)
Students
American Indian or Alaska Native
7 Participants42 Participants10 Participants25 Participants
Race (NIH/OMB)
Students
Asian
12 Participants37 Participants14 Participants11 Participants
Race (NIH/OMB)
Students
Black or African American
1208 Participants4018 Participants1469 Participants1341 Participants
Race (NIH/OMB)
Students
More than one race
0 Participants0 Participants0 Participants0 Participants
Race (NIH/OMB)
Students
Native Hawaiian or Other Pacific Islander
0 Participants0 Participants0 Participants0 Participants
Race (NIH/OMB)
Students
Unknown or Not Reported
0 Participants0 Participants0 Participants0 Participants
Race (NIH/OMB)
Students
White
215 Participants565 Participants124 Participants226 Participants
Race (NIH/OMB)
Teachers
American Indian or Alaska Native
0 Participants0 Participants0 Participants0 Participants
Race (NIH/OMB)
Teachers
Asian
3 Participants8 Participants1 Participants4 Participants
Race (NIH/OMB)
Teachers
Black or African American
58 Participants146 Participants47 Participants41 Participants
Race (NIH/OMB)
Teachers
More than one race
2 Participants6 Participants2 Participants2 Participants
Race (NIH/OMB)
Teachers
Native Hawaiian or Other Pacific Islander
0 Participants0 Participants0 Participants0 Participants
Race (NIH/OMB)
Teachers
Unknown or Not Reported
5 Participants14 Participants3 Participants6 Participants
Race (NIH/OMB)
Teachers
White
34 Participants118 Participants46 Participants38 Participants
Region of Enrollment
United States
1544 Participants - Students & Teachers4954 Participants - Students & Teachers1716 Participants - Students & Teachers1694 Participants - Students & Teachers
Sex: Female, Male
Students
Female
725 Participants2392 Participants847 Participants820 Participants
Sex: Female, Male
Students
Male
717 Participants2270 Participants770 Participants783 Participants
Sex: Female, Male
Teachers
Female
92 Participants270 Participants92 Participants86 Participants
Sex: Female, Male
Teachers
Male
10 Participants22 Participants7 Participants5 Participants
Teacher Observation of Child Adaptation- Revised (TOCA-R)
Authority Acceptance
5.074 units on a scale
STANDARD_DEVIATION 1.104
5.201 units on a scale
STANDARD_DEVIATION 1.028
5.217 units on a scale
STANDARD_DEVIATION 1.021
5.300 units on a scale
STANDARD_DEVIATION 0.9506
Teacher Observation of Child Adaptation- Revised (TOCA-R)
Readiness to Learn
4.115 units on a scale
STANDARD_DEVIATION 1.381
4.202 units on a scale
STANDARD_DEVIATION 1.361
4.193 units on a scale
STANDARD_DEVIATION 1.363
4.290 units on a scale
STANDARD_DEVIATION 1.336
The Behavior Management Self-Efficacy Scale & The Social-Emotional Learning Efficacy Scale
Behavior Management Self-Efficacy Scale
3.80 units on a scale
STANDARD_DEVIATION 0.54
3.84 units on a scale
STANDARD_DEVIATION 0.55
3.83 units on a scale
STANDARD_DEVIATION 0.57
3.89 units on a scale
STANDARD_DEVIATION 0.55
The Behavior Management Self-Efficacy Scale & The Social-Emotional Learning Efficacy Scale
Social-Emotional Learning Efficacy Scale
3.57 units on a scale
STANDARD_DEVIATION 0.62
3.66 units on a scale
STANDARD_DEVIATION 0.59
3.65 units on a scale
STANDARD_DEVIATION 0.59
3.76 units on a scale
STANDARD_DEVIATION 0.53
The Maslach Burnout Inventory3.64 units on a scale
STANDARD_DEVIATION 1.58
3.72 units on a scale
STANDARD_DEVIATION 1.51
3.90 units on a scale
STANDARD_DEVIATION 1.47
3.62 units on a scale
STANDARD_DEVIATION 1.49
The Pictorial Scale of Perceived Competence and Acceptance For Young Children3.352 units on a scale
STANDARD_DEVIATION 0.591
3.328 units on a scale
STANDARD_DEVIATION 0.599
3.328 units on a scale
STANDARD_DEVIATION 0.591
3.305 units on a scale
STANDARD_DEVIATION 0.614

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
EG002
affected / at risk
deaths
Total, all-cause mortality
0 / 1,6290 / 1,7920 / 1,812
other
Total, other adverse events
0 / 1,6290 / 1,7920 / 1,812
serious
Total, serious adverse events
0 / 1,6290 / 1,7920 / 1,812

Outcome results

Primary

Change in Direct Classroom Observations of Student Behavior Between Pre-test and Post-test, 6 Months After the Pre-test.

Classroom observations of student behavior were carried out by independent observers on two occasions, one week apart, at pre- and post-test respectively. The behaviors observed were on-task and physical aggression. Behaviors were observed in 10 second intervals and were recorded as present if they occurred at least once during a 10 second interval. The per interval on-task and physical aggression scores could range from 0-1, with 0 signifying the behavior was not observed and 1 signifying the behavior was observed. The on-task and physical aggression scores used in the analyses were the average score across all of the 10-second intervals the student was observed. (Adapted from Tapp, Wehby & Ellis, 1995).

Time frame: The observations are carried out at pre-test and at post-test, 6 months after the pre-test.

Population: Students enrolled within participating schools with parental consent to participate in the trial who were observed at baseline and at post-test.

ArmMeasureGroupValue (MEAN)Dispersion
ControlChange in Direct Classroom Observations of Student Behavior Between Pre-test and Post-test, 6 Months After the Pre-test.On-Task0.42 percentage of intervals observedStandard Error 0.03
ControlChange in Direct Classroom Observations of Student Behavior Between Pre-test and Post-test, 6 Months After the Pre-test.Physical Aggression0.004 percentage of intervals observedStandard Error 0.001
PATHS to PAXChange in Direct Classroom Observations of Student Behavior Between Pre-test and Post-test, 6 Months After the Pre-test.On-Task0.446 percentage of intervals observedStandard Error 0.02
PATHS to PAXChange in Direct Classroom Observations of Student Behavior Between Pre-test and Post-test, 6 Months After the Pre-test.Physical Aggression0.001 percentage of intervals observedStandard Error 0.001
PATHS to PAX and the IncredibleYearsChange in Direct Classroom Observations of Student Behavior Between Pre-test and Post-test, 6 Months After the Pre-test.On-Task0.453 percentage of intervals observedStandard Error 0.02
PATHS to PAX and the IncredibleYearsChange in Direct Classroom Observations of Student Behavior Between Pre-test and Post-test, 6 Months After the Pre-test.Physical Aggression0.001 percentage of intervals observedStandard Error 0.001
Primary

Teacher Ratings of Student On-task and Aggressive-disruptive Behavior in the Classroom.

Change in Teacher Observation of Classroom Adaptation between pre-test and post-test, 6 months after the pre-test. Student adaptation to classroom task demands are rated by teachers over the last 3 weeks on a 6-point frequency scale (1 = almost never to 6 = almost always). The domains include authority acceptance and readiness to learn. Authority acceptance items include compliance with classroom rules, and readiness to learn items reflect attentive classroom behaviors (e.g. stays on task). The mean of the teacher ratings across the items making up each of these subscales was used in the outcome analyses. The minimum score for both the authority acceptance and readiness to learn subscales was 1 and maximum score was 6. Higher scores on both subscales reflect greater adaptation.

Time frame: The ratings are carried out at pre-test, post-test, 6 months after the pre-test.

Population: Students enrolled in participating schools with parental consent to participate in the trial who were teacher rated at baseline and post-test.

ArmMeasureGroupValue (MEAN)Dispersion
ControlTeacher Ratings of Student On-task and Aggressive-disruptive Behavior in the Classroom.Readiness to Learn4.18 score on a scaleStandard Error 0.09
ControlTeacher Ratings of Student On-task and Aggressive-disruptive Behavior in the Classroom.Authority Acceptance4.98 score on a scaleStandard Error 0.06
PATHS to PAXTeacher Ratings of Student On-task and Aggressive-disruptive Behavior in the Classroom.Readiness to Learn4.50 score on a scaleStandard Error 0.06
PATHS to PAXTeacher Ratings of Student On-task and Aggressive-disruptive Behavior in the Classroom.Authority Acceptance5.19 score on a scaleStandard Error 0.07
PATHS to PAX and the IncredibleYearsTeacher Ratings of Student On-task and Aggressive-disruptive Behavior in the Classroom.Readiness to Learn4.53 score on a scaleStandard Error 0.09
PATHS to PAX and the IncredibleYearsTeacher Ratings of Student On-task and Aggressive-disruptive Behavior in the Classroom.Authority Acceptance5.14 score on a scaleStandard Error 0.06
Secondary

Change in Peer Assessment Inventory Between Pre-test and Post-test, 6 Months After the Pre-test.

Students are asked to nominate fellow students in terms of who they like, play with, and perceive as friends. Individual students were read aloud the names of the other students in the classroom. The student being interviewed was asked if they knew the named student. The student was then asked whether the peer nomination descriptors fit the named student (Do you like \[student\]?, Do you play with \[student\]?, and Is (s)he one of your best friends?). The student's summary score reflected the mean percentage of nominations received across the 3 items. A higher percentage reflects a student received a greater number of nominations from classmates.

Time frame: The peer nomination instrument is administered at pre-test and at post-test, 6 months after the pre-test.

Population: Students enrolled within participating schools with parental consent to participate in the trial who were interviewed at baseline and at post-test.

ArmMeasureValue (MEAN)Dispersion
ControlChange in Peer Assessment Inventory Between Pre-test and Post-test, 6 Months After the Pre-test.0.819 percentage of nominations receivedStandard Error 0.02
PATHS to PAXChange in Peer Assessment Inventory Between Pre-test and Post-test, 6 Months After the Pre-test.0.806 percentage of nominations receivedStandard Error 0.01
PATHS to PAX and the IncredibleYearsChange in Peer Assessment Inventory Between Pre-test and Post-test, 6 Months After the Pre-test.0.816 percentage of nominations receivedStandard Error 0.02
Secondary

Change in Pictorial Scale of Perceived Competence and Social Acceptance for Young Children Between Pre-test and Post-test, 6 Months After the Pre-test.

The Change in Pictorial Scale of Perceived Competence and Social Acceptance for Young Children assesses the student's perceived competence in the domains of peer acceptance. Items on this instrument present two pictorial alternatives, one of a child displaying high competence in the social acceptance domain and one that depicts less competence. Students were asked which pictorial plate was most like him/her. After making that decision, the student is then asked if the chosen picture is really true for me and sort of true for me. Each item is scored on a 4-point scale, 4 would be the most competent and 1 would designate the least competent. The mean of the items was used in the outcome analyses.

Time frame: This scale will be administered at pre-test and post-test, 6-months after the pre-test.

Population: Students enrolled in participating schools with parental consent to participate in the trial who were interviewed at baseline and post-test.

ArmMeasureValue (MEAN)Dispersion
ControlChange in Pictorial Scale of Perceived Competence and Social Acceptance for Young Children Between Pre-test and Post-test, 6 Months After the Pre-test.3.36 score on a scaleStandard Error 0.04
PATHS to PAXChange in Pictorial Scale of Perceived Competence and Social Acceptance for Young Children Between Pre-test and Post-test, 6 Months After the Pre-test.3.36 score on a scaleStandard Error 0.03
PATHS to PAX and the IncredibleYearsChange in Pictorial Scale of Perceived Competence and Social Acceptance for Young Children Between Pre-test and Post-test, 6 Months After the Pre-test.3.41 score on a scaleStandard Error 0.04
Secondary

Change in Teacher Sense of Self Efficacy Scale Between Pre-test and Post-test, 6-months After the Pre-test.

This scale assesses teacher sense of self-efficacy in the instructional and classroom behavior management domains. We assessed two distinct dimensions of teachers' perceived self-efficacy that reflect skills uniquely associated with the strategies included in the two interventions. The Behavior Management Self-Efficacy Scale (Main and Hammond 2008) included 14 items regarding classroom behavior management (e.g., I am able to use a variety of behavior management techniques; α= 0.92). The Social-Emotional Learning Efficacy Scale (Domitrovich, et al., 2016) included 8 items which focused on teachers' perceived efficacy to promote social-emotional skills in students (e.g., I am able to teach children to show empathy and compassion for each other; α= 0.91). For each scale, item responses were on a 5-point Likert-type scale and were averaged. For both subscales the minimum score was 1 and maximum was 5, with higher scores indicating greater efficacy.

Time frame: This scale will be administered at pre-test and post-test, 6 months after the pre-test.

Population: Consenting teachers assigned to Kindergarten - second grade in participating trial schools who were assessed at baseline and post-test.

ArmMeasureGroupValue (MEAN)Dispersion
ControlChange in Teacher Sense of Self Efficacy Scale Between Pre-test and Post-test, 6-months After the Pre-test.Teacher Sense of Social Emotional Learning Self Efficacy3.56 score on a scaleStandard Error 0.08
ControlChange in Teacher Sense of Self Efficacy Scale Between Pre-test and Post-test, 6-months After the Pre-test.Teacher Sense of Behavior Management Self Efficacy3.82 score on a scaleStandard Error 0.07
PATHS to PAXChange in Teacher Sense of Self Efficacy Scale Between Pre-test and Post-test, 6-months After the Pre-test.Teacher Sense of Social Emotional Learning Self Efficacy4.08 score on a scaleStandard Error 0.09
PATHS to PAXChange in Teacher Sense of Self Efficacy Scale Between Pre-test and Post-test, 6-months After the Pre-test.Teacher Sense of Behavior Management Self Efficacy4.23 score on a scaleStandard Error 0.07
PATHS to PAX and the IncredibleYearsChange in Teacher Sense of Self Efficacy Scale Between Pre-test and Post-test, 6-months After the Pre-test.Teacher Sense of Social Emotional Learning Self Efficacy3.92 score on a scaleStandard Error 0.08
PATHS to PAX and the IncredibleYearsChange in Teacher Sense of Self Efficacy Scale Between Pre-test and Post-test, 6-months After the Pre-test.Teacher Sense of Behavior Management Self Efficacy4.09 score on a scaleStandard Error 0.07
Secondary

Change in the Maslach Burnout Inventory Between Pre-test and Post-test, 6 Months After the Pre-test.

The Maslach Burnout Inventory assesses how frequently teachers experience feelings of burnout in the work place. Teachers completed the Maslach Burnout Inventory (MBI;Maslach et al. 1997) at pretest and post-test. One scale was used in the analyses: emotional exhaustion (9 items, e.g., I feel used up at the end of the workday, α=0.94). Responses were rated on a 7-point scale from never to every day with higher scores indicating greater emotional exhaustion (i.e., greater burnout). For this subscale, the minimum score was 1 and maximum score was 7. Therefore, low scores on emotional exhaustion were desired.

Time frame: This scale will be administered at pre-test and post-test, 6 months after the pre-test.

Population: Consenting teachers assigned to Kindergarten - second grade in participating trial schools who were assessed at baseline and post-test.

ArmMeasureValue (MEAN)Dispersion
ControlChange in the Maslach Burnout Inventory Between Pre-test and Post-test, 6 Months After the Pre-test.4.02 score on a scaleStandard Error 0.19
PATHS to PAXChange in the Maslach Burnout Inventory Between Pre-test and Post-test, 6 Months After the Pre-test.3.10 score on a scaleStandard Error 0.23
PATHS to PAX and the IncredibleYearsChange in the Maslach Burnout Inventory Between Pre-test and Post-test, 6 Months After the Pre-test.3.40 score on a scaleStandard Error 0.2

Source: ClinicalTrials.gov · Data processed: Feb 4, 2026