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The Good Behaviour Game intervention to improve behavioural and other outcomes for children aged 7–8 years: a cluster RCT

Neil Humphrey Orcid Logo, Alexandra Hennessey Orcid Logo, Patricio Troncoso Orcid Logo, Margarita Panayiotou Orcid Logo, Louise Black Orcid Logo, Kimberly Petersen Orcid Logo, Lawrence Wo Orcid Logo, Carla Mason Orcid Logo, Emma Ashworth Orcid Logo, Kirsty Frearson Orcid Logo, Jan R Boehnke Orcid Logo, Rhys Pockett Orcid Logo, Julia Lowin, David Foxcroft Orcid Logo, Michael Wigelsworth Orcid Logo, Ann Lendrum Orcid Logo

Public Health Research, Volume: 10, Issue: 7, Pages: 1 - 100

Swansea University Authors: Rhys Pockett Orcid Logo, Julia Lowin

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DOI (Published version): 10.3310/vkof7695

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BackgroundUniversal, school-based behaviour management interventions can produce meaningful improvements in children’s behaviour and other outcomes. However, the UK evidence base for these remains limited.ObjectiveThe objective of this trial was to investigate the impact, value for money and longer-...

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Published in: Public Health Research
ISSN: 2050-4381 2050-439X
Published: National Institute for Health and Care Research (NIHR) 2022
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However, the UK evidence base for these remains limited.ObjectiveThe objective of this trial was to investigate the impact, value for money and longer-term outcomes of the Good Behaviour Game. Study hypotheses centred on immediate impact (hypothesis 1); subgroup effects (at-risk boys, hypothesis 2); implementation effects (dosage, hypothesis 3); maintenance/sleeper effects (12- and 24-month post-intervention follow-ups, hypothesis 4); the temporal association between mental health and academic attainment (hypothesis 5); and the health economic impact of the Good Behaviour Game (hypothesis 6).DesignThis was a two-group, parallel, cluster-randomised controlled trial. Primary schools (n&#x2009;=&#x2009;77) were randomly assigned to implement the Good Behaviour Game for 2 years or continue their usual practice, after which there was a 2-year follow-up period.SettingThe trial was set in primary schools across 23 local authorities in England.ParticipantsParticipants were children (n&#x2009;=&#x2009;3084) aged 7&#x2013;8 years attending participating schools.InterventionThe Good Behaviour Game is a universal behaviour management intervention. Its core components are classroom rules, team membership, monitoring behaviour and positive reinforcement. It is played alongside a normal classroom activity for a set time, during which children work in teams to win the game to access the agreed rewards. The Good Behaviour Game is a manualised intervention delivered by teachers who receive initial training and ongoing coaching.Main outcome measuresThe measures were conduct problems (primary outcome; teacher-rated Strengths and Difficulties Questionnaire scores); emotional symptoms (teacher-rated Strengths and Difficulties Questionnaire scores); psychological well-being, peer and social support, bullying (i.e. social acceptance) and school environment (self-report Kidscreen survey results); and school absence and exclusion from school (measured using National Pupil Database records). Measures of academic attainment (reading, standardised tests), disruptive behaviour, concentration problems and prosocial behaviour (Teacher Observation of Child Adaptation Checklist scores) were also collected during the 2-year follow-up period.ResultsThere was no evidence that the Good Behaviour Game improved any outcomes (hypothesis 1). The only significant subgroup moderator effect identified was contrary to expectations: at-risk boys in Good Behaviour Game schools reported higher rates of bullying (hypothesis 2). The moderating effect of the amount of time spent playing the Good Behaviour Game was unclear; in the context of both moderate (&#x2265;&#x2009;1030 minutes over 2 years) and high (&#x2265;&#x2009;1348 minutes over 2 years) intervention compliance, there were significant reductions in children&#x2019;s psychological well-being, but also significant reductions in their school absence (hypothesis 3). The only medium-term intervention effect was for peer and social support at 24 months, but this was in a negative direction (hypothesis 4). After disaggregating within- and between-individual effects, we found no temporal within-individual associations between children&#x2019;s mental health and their academic attainment (hypothesis 5). Last, our cost&#x2013;consequences analysis indicated that the Good Behaviour Game does not provide value for money (hypothesis 6).LimitationsLimitations included the post-test-only design for several secondary outcomes; suboptimal implementation dosage (mitigated by complier-average causal effect estimation); and moderate child-level attrition (18.5% for the primary outcome analysis), particularly in the post-trial follow-up period (mitigated by the use of full information maximum likelihood procedures).Future workQuestions remain regarding programme differentiation (e.g. how distinct is the Good Behaviour Game from existing behaviour management practices, and does this makes a difference in terms of its impact?) and if the Good Behaviour Game is impactful when combined with a complementary preventative intervention (as has been the case in several earlier trials).ConclusionThe Good Behaviour Game cannot be recommended based on the findings reported here.</abstract><type>Journal Article</type><journal>Public Health Research</journal><volume>10</volume><journalNumber>7</journalNumber><paginationStart>1</paginationStart><paginationEnd>100</paginationEnd><publisher>National Institute for Health and Care Research (NIHR)</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint>2050-4381</issnPrint><issnElectronic>2050-439X</issnElectronic><keywords/><publishedDay>16</publishedDay><publishedMonth>5</publishedMonth><publishedYear>2022</publishedYear><publishedDate>2022-05-16</publishedDate><doi>10.3310/vkof7695</doi><url/><notes/><college>COLLEGE NANME</college><department>Public Health</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>PHAC</DepartmentCode><institution>Swansea University</institution><apcterm>External research funder(s) paid the OA fee (includes OA grants disbursed by the Library)</apcterm><funders>National Institute for Health and Care Research</funders><lastEdited>2022-05-18T11:33:30.7663825</lastEdited><Created>2022-05-16T10:51:47.0219880</Created><path><level id="1">Faculty of Medicine, Health and Life Sciences</level><level id="2">School of Health and Social Care</level></path><authors><author><firstname>Neil</firstname><surname>Humphrey</surname><orcid>0000-0002-8148-9500</orcid><order>1</order></author><author><firstname>Alexandra</firstname><surname>Hennessey</surname><orcid>0000-0002-9341-4709</orcid><order>2</order></author><author><firstname>Patricio</firstname><surname>Troncoso</surname><orcid>0000-0003-2204-1893</orcid><order>3</order></author><author><firstname>Margarita</firstname><surname>Panayiotou</surname><orcid>0000-0002-6023-7961</orcid><order>4</order></author><author><firstname>Louise</firstname><surname>Black</surname><orcid>0000-0001-8140-3343</orcid><order>5</order></author><author><firstname>Kimberly</firstname><surname>Petersen</surname><orcid>0000-0002-4941-6897</orcid><order>6</order></author><author><firstname>Lawrence</firstname><surname>Wo</surname><orcid>0000-0001-6438-5745</orcid><order>7</order></author><author><firstname>Carla</firstname><surname>Mason</surname><orcid>0000-0001-6037-4950</orcid><order>8</order></author><author><firstname>Emma</firstname><surname>Ashworth</surname><orcid>0000-0002-5279-4514</orcid><order>9</order></author><author><firstname>Kirsty</firstname><surname>Frearson</surname><orcid>0000-0002-3805-4376</orcid><order>10</order></author><author><firstname>Jan R</firstname><surname>Boehnke</surname><orcid>0000-0003-0249-1870</orcid><order>11</order></author><author><firstname>Rhys</firstname><surname>Pockett</surname><orcid>0000-0003-4135-7383</orcid><order>12</order></author><author><firstname>Julia</firstname><surname>Lowin</surname><order>13</order></author><author><firstname>David</firstname><surname>Foxcroft</surname><orcid>0000-0001-9752-7527</orcid><order>14</order></author><author><firstname>Michael</firstname><surname>Wigelsworth</surname><orcid>0000-0003-3361-6293</orcid><order>15</order></author><author><firstname>Ann</firstname><surname>Lendrum</surname><orcid>0000-0002-4469-4804</orcid><order>16</order></author></authors><documents><document><filename>60029__24084__12c399b7a3c24ce5a5dea9f93c056c73.pdf</filename><originalFilename>3039568.pdf</originalFilename><uploaded>2022-05-16T11:02:50.7843875</uploaded><type>Output</type><contentLength>1409468</contentLength><contentType>application/pdf</contentType><version>Version of Record</version><cronfaStatus>true</cronfaStatus><documentNotes>Copyright &#xA9; 2022 Humphrey et al. 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spelling 2022-05-18T11:33:30.7663825 v2 60029 2022-05-16 The Good Behaviour Game intervention to improve behavioural and other outcomes for children aged 7–8 years: a cluster RCT 8a3882ebcc6a8fb3b2c13fc2ff716bf2 0000-0003-4135-7383 Rhys Pockett Rhys Pockett true false a9897f4e67e285093fefafcb1c954364 Julia Lowin Julia Lowin true false 2022-05-16 PHAC BackgroundUniversal, school-based behaviour management interventions can produce meaningful improvements in children’s behaviour and other outcomes. However, the UK evidence base for these remains limited.ObjectiveThe objective of this trial was to investigate the impact, value for money and longer-term outcomes of the Good Behaviour Game. Study hypotheses centred on immediate impact (hypothesis 1); subgroup effects (at-risk boys, hypothesis 2); implementation effects (dosage, hypothesis 3); maintenance/sleeper effects (12- and 24-month post-intervention follow-ups, hypothesis 4); the temporal association between mental health and academic attainment (hypothesis 5); and the health economic impact of the Good Behaviour Game (hypothesis 6).DesignThis was a two-group, parallel, cluster-randomised controlled trial. Primary schools (n = 77) were randomly assigned to implement the Good Behaviour Game for 2 years or continue their usual practice, after which there was a 2-year follow-up period.SettingThe trial was set in primary schools across 23 local authorities in England.ParticipantsParticipants were children (n = 3084) aged 7–8 years attending participating schools.InterventionThe Good Behaviour Game is a universal behaviour management intervention. Its core components are classroom rules, team membership, monitoring behaviour and positive reinforcement. It is played alongside a normal classroom activity for a set time, during which children work in teams to win the game to access the agreed rewards. The Good Behaviour Game is a manualised intervention delivered by teachers who receive initial training and ongoing coaching.Main outcome measuresThe measures were conduct problems (primary outcome; teacher-rated Strengths and Difficulties Questionnaire scores); emotional symptoms (teacher-rated Strengths and Difficulties Questionnaire scores); psychological well-being, peer and social support, bullying (i.e. social acceptance) and school environment (self-report Kidscreen survey results); and school absence and exclusion from school (measured using National Pupil Database records). Measures of academic attainment (reading, standardised tests), disruptive behaviour, concentration problems and prosocial behaviour (Teacher Observation of Child Adaptation Checklist scores) were also collected during the 2-year follow-up period.ResultsThere was no evidence that the Good Behaviour Game improved any outcomes (hypothesis 1). The only significant subgroup moderator effect identified was contrary to expectations: at-risk boys in Good Behaviour Game schools reported higher rates of bullying (hypothesis 2). The moderating effect of the amount of time spent playing the Good Behaviour Game was unclear; in the context of both moderate (≥ 1030 minutes over 2 years) and high (≥ 1348 minutes over 2 years) intervention compliance, there were significant reductions in children’s psychological well-being, but also significant reductions in their school absence (hypothesis 3). The only medium-term intervention effect was for peer and social support at 24 months, but this was in a negative direction (hypothesis 4). After disaggregating within- and between-individual effects, we found no temporal within-individual associations between children’s mental health and their academic attainment (hypothesis 5). Last, our cost–consequences analysis indicated that the Good Behaviour Game does not provide value for money (hypothesis 6).LimitationsLimitations included the post-test-only design for several secondary outcomes; suboptimal implementation dosage (mitigated by complier-average causal effect estimation); and moderate child-level attrition (18.5% for the primary outcome analysis), particularly in the post-trial follow-up period (mitigated by the use of full information maximum likelihood procedures).Future workQuestions remain regarding programme differentiation (e.g. how distinct is the Good Behaviour Game from existing behaviour management practices, and does this makes a difference in terms of its impact?) and if the Good Behaviour Game is impactful when combined with a complementary preventative intervention (as has been the case in several earlier trials).ConclusionThe Good Behaviour Game cannot be recommended based on the findings reported here. Journal Article Public Health Research 10 7 1 100 National Institute for Health and Care Research (NIHR) 2050-4381 2050-439X 16 5 2022 2022-05-16 10.3310/vkof7695 COLLEGE NANME Public Health COLLEGE CODE PHAC Swansea University External research funder(s) paid the OA fee (includes OA grants disbursed by the Library) National Institute for Health and Care Research 2022-05-18T11:33:30.7663825 2022-05-16T10:51:47.0219880 Faculty of Medicine, Health and Life Sciences School of Health and Social Care Neil Humphrey 0000-0002-8148-9500 1 Alexandra Hennessey 0000-0002-9341-4709 2 Patricio Troncoso 0000-0003-2204-1893 3 Margarita Panayiotou 0000-0002-6023-7961 4 Louise Black 0000-0001-8140-3343 5 Kimberly Petersen 0000-0002-4941-6897 6 Lawrence Wo 0000-0001-6438-5745 7 Carla Mason 0000-0001-6037-4950 8 Emma Ashworth 0000-0002-5279-4514 9 Kirsty Frearson 0000-0002-3805-4376 10 Jan R Boehnke 0000-0003-0249-1870 11 Rhys Pockett 0000-0003-4135-7383 12 Julia Lowin 13 David Foxcroft 0000-0001-9752-7527 14 Michael Wigelsworth 0000-0003-3361-6293 15 Ann Lendrum 0000-0002-4469-4804 16 60029__24084__12c399b7a3c24ce5a5dea9f93c056c73.pdf 3039568.pdf 2022-05-16T11:02:50.7843875 Output 1409468 application/pdf Version of Record true Copyright © 2022 Humphrey et al. This work was produced by Humphrey et al. under the terms of a commissioning contract issued by the Secretary of State for Health and Social Care. This is an Open Access publication distributed under the terms of the Creative Commons Attribution CC BY 4.0 licence true eng http://creativecommons.org/licenses/by/4.0/
title The Good Behaviour Game intervention to improve behavioural and other outcomes for children aged 7–8 years: a cluster RCT
spellingShingle The Good Behaviour Game intervention to improve behavioural and other outcomes for children aged 7–8 years: a cluster RCT
Rhys Pockett
Julia Lowin
title_short The Good Behaviour Game intervention to improve behavioural and other outcomes for children aged 7–8 years: a cluster RCT
title_full The Good Behaviour Game intervention to improve behavioural and other outcomes for children aged 7–8 years: a cluster RCT
title_fullStr The Good Behaviour Game intervention to improve behavioural and other outcomes for children aged 7–8 years: a cluster RCT
title_full_unstemmed The Good Behaviour Game intervention to improve behavioural and other outcomes for children aged 7–8 years: a cluster RCT
title_sort The Good Behaviour Game intervention to improve behavioural and other outcomes for children aged 7–8 years: a cluster RCT
author_id_str_mv 8a3882ebcc6a8fb3b2c13fc2ff716bf2
a9897f4e67e285093fefafcb1c954364
author_id_fullname_str_mv 8a3882ebcc6a8fb3b2c13fc2ff716bf2_***_Rhys Pockett
a9897f4e67e285093fefafcb1c954364_***_Julia Lowin
author Rhys Pockett
Julia Lowin
author2 Neil Humphrey
Alexandra Hennessey
Patricio Troncoso
Margarita Panayiotou
Louise Black
Kimberly Petersen
Lawrence Wo
Carla Mason
Emma Ashworth
Kirsty Frearson
Jan R Boehnke
Rhys Pockett
Julia Lowin
David Foxcroft
Michael Wigelsworth
Ann Lendrum
format Journal article
container_title Public Health Research
container_volume 10
container_issue 7
container_start_page 1
publishDate 2022
institution Swansea University
issn 2050-4381
2050-439X
doi_str_mv 10.3310/vkof7695
publisher National Institute for Health and Care Research (NIHR)
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str School of Health and Social Care{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}School of Health and Social Care
document_store_str 1
active_str 0
description BackgroundUniversal, school-based behaviour management interventions can produce meaningful improvements in children’s behaviour and other outcomes. However, the UK evidence base for these remains limited.ObjectiveThe objective of this trial was to investigate the impact, value for money and longer-term outcomes of the Good Behaviour Game. Study hypotheses centred on immediate impact (hypothesis 1); subgroup effects (at-risk boys, hypothesis 2); implementation effects (dosage, hypothesis 3); maintenance/sleeper effects (12- and 24-month post-intervention follow-ups, hypothesis 4); the temporal association between mental health and academic attainment (hypothesis 5); and the health economic impact of the Good Behaviour Game (hypothesis 6).DesignThis was a two-group, parallel, cluster-randomised controlled trial. Primary schools (n = 77) were randomly assigned to implement the Good Behaviour Game for 2 years or continue their usual practice, after which there was a 2-year follow-up period.SettingThe trial was set in primary schools across 23 local authorities in England.ParticipantsParticipants were children (n = 3084) aged 7–8 years attending participating schools.InterventionThe Good Behaviour Game is a universal behaviour management intervention. Its core components are classroom rules, team membership, monitoring behaviour and positive reinforcement. It is played alongside a normal classroom activity for a set time, during which children work in teams to win the game to access the agreed rewards. The Good Behaviour Game is a manualised intervention delivered by teachers who receive initial training and ongoing coaching.Main outcome measuresThe measures were conduct problems (primary outcome; teacher-rated Strengths and Difficulties Questionnaire scores); emotional symptoms (teacher-rated Strengths and Difficulties Questionnaire scores); psychological well-being, peer and social support, bullying (i.e. social acceptance) and school environment (self-report Kidscreen survey results); and school absence and exclusion from school (measured using National Pupil Database records). Measures of academic attainment (reading, standardised tests), disruptive behaviour, concentration problems and prosocial behaviour (Teacher Observation of Child Adaptation Checklist scores) were also collected during the 2-year follow-up period.ResultsThere was no evidence that the Good Behaviour Game improved any outcomes (hypothesis 1). The only significant subgroup moderator effect identified was contrary to expectations: at-risk boys in Good Behaviour Game schools reported higher rates of bullying (hypothesis 2). The moderating effect of the amount of time spent playing the Good Behaviour Game was unclear; in the context of both moderate (≥ 1030 minutes over 2 years) and high (≥ 1348 minutes over 2 years) intervention compliance, there were significant reductions in children’s psychological well-being, but also significant reductions in their school absence (hypothesis 3). The only medium-term intervention effect was for peer and social support at 24 months, but this was in a negative direction (hypothesis 4). After disaggregating within- and between-individual effects, we found no temporal within-individual associations between children’s mental health and their academic attainment (hypothesis 5). Last, our cost–consequences analysis indicated that the Good Behaviour Game does not provide value for money (hypothesis 6).LimitationsLimitations included the post-test-only design for several secondary outcomes; suboptimal implementation dosage (mitigated by complier-average causal effect estimation); and moderate child-level attrition (18.5% for the primary outcome analysis), particularly in the post-trial follow-up period (mitigated by the use of full information maximum likelihood procedures).Future workQuestions remain regarding programme differentiation (e.g. how distinct is the Good Behaviour Game from existing behaviour management practices, and does this makes a difference in terms of its impact?) and if the Good Behaviour Game is impactful when combined with a complementary preventative intervention (as has been the case in several earlier trials).ConclusionThe Good Behaviour Game cannot be recommended based on the findings reported here.
published_date 2022-05-16T04:17:47Z
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