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

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,

Inclusion Criteria:

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

Exclusion Criteria:

- Students must be enrolled in regular education classrooms.