A Cluster-randomized Control Trial of PAX Good Behavior Game in Swedish Elementary Schools

Summary

Two important challenges that primary school in Sweden is confronted by are increasing levels of mental illness among children and adolescents and increasing rates of stress related symptoms and sick leave associated with mental illness in primary school teachers. Primary school is an important arena to address these issues.

PAX is implemented as a part of the regular classroom activities and gives the teacher tools to promote behaviors that are constructive and learning oriented. The programme has been shown to improve student health and performance both short- and long-term. The teachers also receive tools to lessen stressors in their working environment. A Swedish uncontrolled pilot study showed increased well-being in children and reduced teacher stress as well as improved work related well-being at post-intervention.

The aim of this project is to study the effects of PAX on student well-being and teacher stress. In a cluster-randomized design, 84 teachers from 28 schools (clusters) will be randomized to either implement PAX, or to an active control group that receives the same amount of support but with different content. The PAX group will get a two-day education in PAX at the start of the term, followed by an implementation-term. The measurements include self-assessment, blind observer assessments, objectively measuring sound levels, data on sick leave and qualitative interviews.

Baseline measurements are performed before implementation and primary end point is one year after. Costs and savings related to PAX will be measured and put in relation to the quality-adjusted life years of students and teachers. Long-term effects on student performance, health and participation in society will be evaluated in a follow-up project.

Conditions

• Well-being in Elementary School Children
• Mental Health in Elementary School Children
• Work-related Stress in Teachers
• Academic Performance in Elementary School Children

Interventions

BEHAVIORAL

PAX Good Behavior Game

PAX GBG is packaged into ten specific tools that the teachers are trained to introduce in in their classroom management practice. The program introduces verbal and visual cues that facilitate prosocial and attentive behaviors One of the core elements of the program is the PAX-game, meaning that the children - while focusing on ordinary school tasks like math - get to play a game in teams where each team tries to make as few classroom rules infractions as possible during a certain period of time. The teams that succeed in achieving predetermined goals get a reward (often a fun and desirable activity) that serves as a reinforcer of prosocial and task-oriented behaviors. Supervision is performed individually with each teacher and included that the PAX-trainer observes a lecture given by the teacher before each supervision session.

BEHAVIORAL

Count on Me!

Count on me! is set in adventure game where the child has an avatar that travels thru different worlds/platforms by using their mathematical skills. The child starts of in the home of the avatar, in a house like environment, where the child discovers a magical map that brings the child into a different world called Numberia. During the adventures in Numberia the child learns that it has certain skills, called the mathemagical powers, that will be used to liberate Numberia from the evil Prince Claw that has captured all the beautiful things (e.g., the birds that used to sing in the forest). Count on me! was developed within a behavior analytic framework using a nonlinear programming process.

BEHAVIORAL

Collegial Learning Community

Collegial learning community is a feasible way of professional learning for teachers according to the five cyclical steps. The teachers go through the first step that is to assess the skill or knowledge gaps for students, using various data sources (for example testing, grades, surveys, student interviews). The second step is to reflect upon what skills the teacher needs to acquire in order to help the students to meet the goals. The third step is to deepen the professional knowledge and skills. The fourth step is engaging the students in the new practice, and in the fifth step to evaluate the impact the new practice has had on student outcomes. In Collegial learning community teachers take help from their peers in each of these steps in a structured way. For example, way of deepening tacit or procedural knowledge (in step two) is to visit a colleague during class and make observations on their classroom practice.

Sponsors & Collaborators

• Stockholm University

  collaborator OTHER

• Karolinska Institutet

  collaborator OTHER

• Uppsala University

  collaborator OTHER

• KTH Royal Institute of Technology

  collaborator OTHER

• Vestigio (NGO)

  collaborator UNKNOWN

• Linnaeus University

  lead OTHER

Principal Investigators

• Viktor Kaldo, PhD · Linnaeus University

Study Design

Allocation

RANDOMIZED

Purpose

PREVENTION

Masking

NONE

Model

PARALLEL

Eligibility

Min Age

6 Years

Max Age

10 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2021-04-21

Primary Completion

2026-06-15

Completion

2027-06-15

Countries

• Sweden

Study Locations