Effects of Good Behavior Game in a Swedish Sample

Study Overview
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Brief Summary
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This project seeks to study the impact of Good Behavior Game (GBG), a behavior management program, on classroom environment and problem behavior in K-3 classrooms. The goal of this randomized trial is to study the impact of Good Behavior Game (GBG), a behavior management program, on classroom environment and problem behavior in K-3 classrooms in Sweden. The main question it aims to answer is: • Does GBG decrease problem behaviors in K-3 classrooms? Teachers in the intervention group will be trained in GBG and asked to implement it in their respective classrooms. Teachers in the comparison group will provide usual practice.

Detailed Description
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Background: Early conduct problems are prevalent and a prominent risk factor for several adverse health-related and psychosocial outcomes in later life. Good Behavior Game (GBG) is a promising school-based behavior management program with the potential of reaching many children in their formative years. Primary objective: To study the effectiveness of Good Behavior Game in reducing problem behaviors in Swedish K-3 classrooms under real-world conditions. Secondary objectives: To investigate changes in problem behaviors in common school areas, classroom climate, teacher collective efficacy, on-task behavior, and behavioral management practices as a result of teacher training in GBG. The study also seeks to investigate implementation as a moderator, as well as potential barriers and facilitators in regards to implementation. Type of trial: Cluster-randomized controlled trial Trial design and methods: Recruitment of schools in a Swedish municipality started early 2021. In May 2021, 5 schools were randomized to either intervention group or wait-list (service-as-usual). Data collection started in August 2021 and ended in June 2022. The intervention group received training in GBG from September 2021 to May 2022 by certified trainers who also collected fidelity data through observations throughout the school year. Teacher ratings and observer data was collected at baseline (August 2021), along with a first (November 2021) and second follow-up (May 2022, primary endpoint) throughout the first school year of implementation. Statistical methodology and analysis: Statistical analysis will primarily include frequentist intent-to-treat analysis, and comparisons of estimates with a corresponding Bayesian model using weakly informative priors.

Official Title
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Good Behavior Game - a Randomized Controlled Study Among Young Children in Swedish Primary Schools.

Conditions
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Problem Behavior

Intervention / Treatment
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* Behavioral: Good Behavior Game


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Eligibility is based on school or classroom level factors. Schools must have at least one classroom with a group of students enrolled in grades K, 1, 2, or 3. Exclusion Criteria: Special education classrooms are not eligible, though inclusive classrooms with a minority of students needing special education can be included.

Ages Eligible for Study
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Minimum Age: 5 Years
Maximum Age: 10 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: All participants in the intervention group receive the same GBG intervention. The control condition consists of service-as-usual (SAU).
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Good Behavior Game<br>28 classes receiving Good Behavior Game intervention | Behavioral: Good Behavior Game<br>* Universal school-based intervention reinforcing prosocial behaviors and discouraging disruptive behaviors in young students.<br>|
| No Intervention: Service-as-usual<br>16 classes receiving usual classroom teaching | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Teacher-rated problem behavior in the classroom | A teacher-rated scale listing 20 common problem behaviors in the classroom. The teachers bases their ratings on the week before. Every item is rated on a scale from 0 (no times last week) to 4 (several times a day). | Baseline | 
| Teacher-rated problem behavior in the classroom | A teacher-rated scale listing 20 common problem behaviors in the classroom. The teachers bases their ratings on the week before. Every item is rated on a scale from 0 (no times last week) to 4 (several times a day). | 3 months | 
| Teacher-rated problem behavior in the classroom | A teacher-rated scale listing 20 common problem behaviors in the classroom. The teachers bases their ratings on the week before. Every item is rated on a scale from 0 (no times last week) to 4 (several times a day). | 9 months (primary endpoint) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Classroom Atmosphere Measure | Measure of 10 different behavioral classroom factors rated by an independent observer after 30 minutes of observing a classroom. The observer scores every item on a scale from 1-5, were 1 is generally considered very low and 5 is considered very high. A rating of 0 is used when the item/factor is not applicable or possible to rate. The following items are rated: Students' level of compliance during structured time Students seem to handle transitions well Students consistently follow rules appropriate to settings Students' level of cooperation Students attempt problem-solving Students express feelings appropriately Students' level of interest/enthusiasm/involvement Classroom is focused and on-task Classroom responsive to individual differences in students' needs, feelings, etc. Classroom is supportive of students' efforts | Baseline | 
| Classroom Atmosphere Measure | Measure of 10 different behavioral classroom factors rated by an independent observer after 30 minutes of observing a classroom. The observer scores every item on a scale from 1-5, were 1 is generally considered very low and 5 is considered very high. A rating of 0 is used when the item/factor is not applicable or possible to rate. The following items are rated: Students' level of compliance during structured time Students seem to handle transitions well Students consistently follow rules appropriate to settings Students' level of cooperation Students attempt problem-solving Students express feelings appropriately Students' level of interest/enthusiasm/involvement Classroom is focused and on-task Classroom responsive to individual differences in students' needs, feelings, etc. Classroom is supportive of students' efforts | 3 months | 
| Classroom Atmosphere Measure | Measure of 10 different behavioral classroom factors rated by an independent observer after 30 minutes of observing a classroom. The observer scores every item on a scale from 1-5, were 1 is generally considered very low and 5 is considered very high. A rating of 0 is used when the item/factor is not applicable or possible to rate. The following items are rated: Students' level of compliance during structured time Students seem to handle transitions well Students consistently follow rules appropriate to settings Students' level of cooperation Students attempt problem-solving Students express feelings appropriately Students' level of interest/enthusiasm/involvement Classroom is focused and on-task Classroom responsive to individual differences in students' needs, feelings, etc. Classroom is supportive of students' efforts | 9 months | 
| Classroom Environment Scale | Teacher rates 15 items about the classroom climate (e.g. how well students cooperate, task-orientation etc.). The items are rated on a 0-3 likert scale, some being reverse-coded. | Baseline | 
| Classroom Environment Scale | Teacher rates 15 items about the classroom climate (e.g. how well students cooperate, task-orientation etc.). The items are rated on a 0-3 likert scale, some being reverse-coded. | 9 months | 
| On-task behavior: Planned activity check/PLACHECK | Group-based measure of on task behavior in classroom. Rated by an independent assessor. Score is based on number of children on-task divided by total number of children in the classroom. On-task behavior is rated after 3-minute intervals for a total of 18 minutes. An average of the percentage scores is used as an outcome. | Baseline | 
| On-task behavior: Planned activity check/PLACHECK | Group-based measure of on task behavior in classroom. Rated by an independent assessor. Score is based on number of children on-task divided by total number of children in the classroom. On-task behavior is rated after 3-minute intervals for a total of 18 minutes. An average of the percentage scores is used as an outcome. | 3 months | 
| On-task behavior: Planned activity check/PLACHECK | Group-based measure of on task behavior in classroom. Rated by an independent assessor. Score is based on number of children on-task divided by total number of children in the classroom. On-task behavior is rated after 3-minute intervals for a total of 18 minutes. An average of the percentage scores is used as an outcome. | 9 months | 
| Teacher-rated problem behavior in school | A teacher-rated scale listing 20 common problem behaviors in the school's common/shared areas. The teachers bases their ratings on the week before. Every item is rated on a scale from 0 (no times last week) to 4 (several times a day). | Baseline | 
| Teacher-rated problem behavior in school | A teacher-rated scale listing 20 common problem behaviors in the school's common/shared areas. The teachers bases their ratings on the week before. Every item is rated on a scale from 0 (no times last week) to 4 (several times a day). | 3 months | 
| Teacher-rated problem behavior in school | A teacher-rated scale listing 20 common problem behaviors in the school's common/shared areas. The teachers bases their ratings on the week before. Every item is rated on a scale from 0 (no times last week) to 4 (several times a day). | 9 months | 
| Collective teacher efficacy | Teacher rates 12 items on the perceived efficacy of teachers as a collective being able to teach the students attending the school. Items are rated on a 0-5 likert scale, some being reverse-coded. | Baseline | 
| Collective teacher efficacy | Teacher rates 12 items on the perceived efficacy of teachers as a collective being able to teach the students attending the school. Items are rated on a 0-5 likert scale, some being reverse-coded. | 9 months | 
| Positive behavior support | The teacher rates 9 items on their own use of several practices that aim to increase desirable behaviors in the classroom. The teacher will report based on the last 30 days. The items can be rated on a scale from 0 (0 times) to 7 (more than 20 times). | Baseline | 
| Positive behavior support | The teacher rates 9 items on their own use of several practices that aim to increase desirable behaviors in the classroom. The teacher will report based on the last 30 days. The items can be rated on a scale from 0 (0 times) to 7 (more than 20 times). | 9 months | 
| Behavioral correction | The teacher rates 8 items on their own use of several practices that aim to punish, reduce or correct undesirable behaviors in the classroom. The teacher will report based on the last 30 days. The items can be rated on a scale from 0 (0 times) to 7 (more than 20 times). | Baseline | 
| Behavioral correction | The teacher rates 8 items on their own use of several practices that aim to punish, reduce or correct undesirable behaviors in the classroom. The teacher will report based on the last 30 days. The items can be rated on a scale from 0 (0 times) to 7 (more than 20 times). | 9 months | 
| Observed general praise | An independent observer counts the number of times the teacher uses general praise towards one or more students by the teacher. General praise counts as praise were the behavior eliciting praise is not specified, for example good job. Can also be non-verbal. The observation and counting lasts for 30 minutes. | Baseline | 
| Observed general praise | An independent observer counts the number of times the teacher uses general praise towards one or more students by the teacher. General praise counts as praise were the behavior eliciting praise is not specified, for example good job. Can also be non-verbal. The observation and counting lasts for 30 minutes. | 3 months | 
| Observed general praise | An independent observer counts the number of times the teacher uses general praise towards one or more students by the teacher. General praise counts as praise were the behavior eliciting praise is not specified, for example good job. Can also be non-verbal. The observation and counting lasts for 30 minutes. | 9 months | 
| Observed specific praise | An independent observer counts the number of times behavioral specific praise is used towards one or more students by the teacher. Behavioral specific praise counts as praise or feedback that also entails a description of the behavior eliciting praise, such as good work reading that out loud. The observation and counting lasts for 30 minutes. | Baseline | 
| Observed specific praise | An independent observer counts the number of times behavioral specific praise is used towards one or more students by the teacher. Behavioral specific praise counts as praise or feedback that also entails a description of the behavior eliciting praise, such as good work reading that out loud. The observation and counting lasts for 30 minutes. | 3 months | 
| Observed specific praise | An independent observer counts the number of times behavioral specific praise is used towards one or more students by the teacher. Behavioral specific praise counts as praise or feedback that also entails a description of the behavior eliciting praise, such as good work reading that out loud. The observation and counting lasts for 30 minutes. | 9 months | 
| Observed reprimands | An independent observer counts the number of times reprimands are used towards one or more students by the teacher. Reprimands are verbal or non-verbal cues were the teacher demands on students ceasing a certain behavior or otherwise point out a behavior that should not be occuring. The observation and counting lasts for 30 minutes. | Baseline | 
| Observed reprimands | An independent observer counts the number of times reprimands are used towards one or more students by the teacher. Reprimands are verbal or non-verbal cues were the teacher demands on students ceasing a certain behavior or otherwise point out a behavior that should not be occuring. The observation and counting lasts for 30 minutes. | 3 months | 
| Observed reprimands | An independent observer counts the number of times reprimands are used towards one or more students by the teacher. Reprimands are verbal or non-verbal cues were the teacher demands on students ceasing a certain behavior or otherwise point out a behavior that should not be occuring. The observation and counting lasts for 30 minutes. | 9 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Problem Behavior, School, Prevention