Classroom effects of a preventive behavioral management program: A pragmatic cluster-randomized trial of Good...

Good Behavior Game (GBG) is a school-based intervention designed to reduce conduct problems, while increasing on-task behavior and a positive classroom climate. Earlier studies have shown positive long-term effects in several outcomes, making GBG a promising method of universal prevention. This study evaluates the effectiveness of a translated and adapted version of GBG in a pragmatic, cluster-randomized controlled, parallel group superiority trial. Schools with K-3 students were eligible for recruitment. Five schools were recruited to either receive training in GBG or continue with business-as-usual. Schools were allocated using stratified randomization. The outcomes included teacher-rated conduct problems in the classroom (primary outcome) and common school areas, observer-rated on-task behavior, along with teacher- and observer-rated classroom climate. All 43 classrooms had teacher-rated measures, while a subset of 20 classrooms were randomly assigned to also receive the observer-rated measures by blinded and independent observers. Measurements were conducted at the start (pre-intervention), middle (3-month follow-up), and end of the school year (9-month follow-up and primary endpoint). Measurements had a 100% response rate and all classrooms were included in the analysis using Bayesian mixed effects models. Conduct problems in the classroom, on-task behavior and classroom climate had effects in a positive direction. Partially in line with the mechanics of GBG, there was no effect on conduct problems in common school areas over time. Effects for all outcomes were imprecise, as highest posterior density intervals overlapped for changes over time between the intervention and control group. Although imprecise, effects were directionally consistent with earlier research. Taken together, this study lends tentative support for cross-cultural transportation and adaptation of GBG to a pragmatic context, without major external provision of resources or personnel. Trial registration: ClinicalTrials.gov, No. NCT05794893.