Morning Zen

A Prevention Valentine in Honor of Parkland: There is Solid Practical Science to Prevent School Violence

February 14, 2019

It’s 20 years since Columbine, and it’s one year since Parkland.  American has the proven behavioral science to reduce such violence, and it’s just since 2010 that it started to be used in the real world.

After Columbine, I was among the 25 people invited to meet with the Attorney General, the Secretary of Education, and the Surgeon General about practical, proven, scalable science prevent violence in schools. Just ten days before the Columbine mass shootings, my work was featured in People Magazine (April 5, 1999, pp. 151-3) to reduce violence and increase peace in schools. Just two years before, the Centers for Disease Control (CDC) staff published study showing my work [1, 2]—the first whole school system of behavioral supports—prevented medically coded violent injuries in schools, using a CDC Epidemiological to investigate an “outbreak” of peaceful, positive behavior in Pima County Arizona [3, 4].

At the small meeting with the Cabinet leaders on the issue of youth violence, I met Dr. Sheppard Kellam who was doing parallel work at Johns Hopkins. The data he presented were astounding [5-7]. I did not know precisely what he was doing and asked him what the strategy was. He responded, “the Good Behavior Game.” I knew precisely what that was because it was invented at my graduate program at the University of Kansas [8] and similar to my dissertation work [9] for teaching self-regulation and co-regulation with peers. The key mechanism is increasing peer-to-peer reinforcement of safe or prosocial behavior, not punishing consequences for “bad” behavior.

In the fall of 1999, we began immediate replications, successively improving the ease of adoption, implementation, maintenance, and generalization of the original Hopkins recipe created and coached by the very brilliant Dr. Jaylan Turkkan [10]. Today, it takes six hours to effectively instruct a teacher how to use the Hopkins recipe, which is now called the PAX Good Behavior Game. Hopkins colleagues have proven teachers can even successfully implement the strategy via an online course [11]—a vital dissemination strategy for remote situations or for isolated interested teachers. Teachers benefit if they get 4-6 mentoring visits, with the incredibly refined, proven, coaching methods [12, 13].

It’s 50 years now since the Good Behavior Game was first published, and my colleagues and I have six randomized trials showing powerful results. Importantly, there is now a randomized, population-level study showing the real-world version, the PAX Good Behavior Game, can actually reduce or prevent psychiatric and behavioral disorders at a population level [14].

In 2010, the U.S. Center for Mental Health Services (CMHS) funded 20 sites to replicate the Good Behavior Game in the real world. My colleagues and I supervised 18 of those sites, which were all successful—because we had been steadily refining how to implement beginning in the fall of 1999—initially with about 200+ classrooms in that school year alone and reported in a paper in 2002 [15], which has more than 1,000 citations. Since that time, the U.S. and international implementation of the PAX Good Behavior Game (as a behavioral vaccine to prevent mental, emotional, and behavioral disorders) has skyrocketed.  From 2016 to present alone, more than 30,000 teachers have been trained and supported in its use in the U.S., Canada, Europe (Ireland, Northern Ireland, Estonia, and Sweden), Australia, and Brazil. This has impacted more than 1 million children, and now scientific colleagues are looking at the possibility of population-level benefits—already proven for childhood psychiatric disorders as well as improved reading and math skills [14, 16].

My colleagues at the Oregon Research Institute are now developing methods to look for real-world impact on juvenile crime, cardiovascular disease, parenting, and other problems related to self-regulation and group regulation.  My colleagues at Hopkins have just won funding to investigate the impact of our Hopkins longitudinal samples at age 35. Colleagues at Penn State have proven that PAX GBG has powerful benefits when implemented in afterschool settings, with just 1.5 hours a day of exposure [17].

The PAX Good Behavior Game that has emerged from the first study 50 years ago in 1969 and the incredibly sophistical randomized trials started in 1989 that show it is possible to change the developmental trajectory from first grade through the early twenties—reducing and even preventing lifetime aggressive, bullying and violent behavior, alcohol and tobacco use, high-risk sexual behaviors, reducing teen pregnancy, serious drug use while also increasing academic success such as high-school graduation and colleague entry. Now, we have proof that it is successfully scalable in the US in multiple states [14, 16-18]—including examples of how not to implement the Good Behavior Game [19].  Ohio, Oregon, New Mexico, New York, and Arizona are well on their way toward population-level implementation. You can see a population-level example of Ohio at Other states have out-posts of excellence: Massachusetts, Florida, West Virginia, Indiana, Georgia, and California.

Is this cost effective? Yes, with a rate of return-on-investment (ROI) of 60/70 to 1 [20]. How does that compare to other universal public-health campaigns to reduce mortality and morbidity like the polio vaccine that obliterated the terrifying epidemic of my childhood? The ROI for the polio vaccine was 3-to-1 [21]. The relative differences graphic from the Hopkins studies provide a snapshot of the potential effects from the longitudinal studies.

How many more cases of mental illness, shootings, suicides, or overdoses must America endure? Fifty years ago, three people I knew invented something that could change the world—Harriet Barrish, a fellow graduate student, Muriel Saunders, a first-year teacher, and Montrose Wolf who was on my dissertation committee “re-invented” and the tested the earliest implementation of the good behavior game, which mimics child-rearing practices among indigenous peoples.

I write this on the anniversary of Parkland High School shootings. And, just two months from now is the 20th anniversary of the Columbine shootings and the article in People Magazine. Tomorrow will be the premier of a documentary in Tucson where I live about this work, entitled: “How Are the Children?” The movie tells the world there is a successful, scalable universal prevention strategy that can save lives.

If citizens and communities do not act now, then when?  If not us, then who? It took 50 years to get to this level of science for a practical solution. If not the Good Behavior Game, then what is better, less costly, more scalable, and more effective to save the futures of our children?

  1. Embry, D.D., et al., PeaceBuilders: A theoretically driven, school-based model for early violence prevention. American Journal of Preventive Medicine, 1996. 12(5, Suppl): p. 91.
  2. Embry, D.D., Does your school have a peaceful environment? Using an audit to create a climate for change and resiliency. Intervention in School and Clinic, 1997. 32: p. 217-222.
  3. Krug, E.G., et al., The impact of an elementary school-based violence prevention program on visits to the school nurse. American Journal of Preventive Medicine, 1997. 13(6): p. 459-63.
  4. Brener, N.D., et al., Nurses’ logs as an evaluation tool for school-based violence prevention programs. Journal of School Health, 1997. 67(5): p. 171-4.
  5. Kellam, S.G., et al., The course and malleability of aggressive behavior from early first grade into middle school: Results of a developmental epidemiology-based preventive trial. Journal of Child Psychology and Psychiatry, 1994. 35: p. 259-281.
  6. Dolan, L.J., et al., The short-term impact of two classroom-based preventive interventions on aggressive and shy behaviors and poor achievement. Journal of Applied Developmental Psychology, 1993. 14: p. 317-345.
  7. Werthamer-Larsson, L., S.G. Kellam, and L. Wheeler, Effect of first-grade classroom environment on shy behavior, aggressive behavior, and concentration problems. American Journal of Community Psychology, 1991. 19(4): p. 585-602.
  8. Barrish, H.H., M. Saunders, and M.M. Wolf, Good behavior game: Effects of individual contingencies for group consequences on disruptive behavior in a classroom. Journal of Applied Behavior Analysis, 1969. 2(2): p. 119-124.
  9. Embry, D.D., The safe-playing program: A case study of putting research into practice., in Human Services That Work: From Innovation to Standard Practice, S. Paine and B. Bellamy, Editors. 1984, Brookes Co.: Baltimore, MD. p. 624.
  10. Turkkan, J., The Good Behavior Game Manual. 1988, John Hopkins School of Hygiene and Public Health, Department of Mental Hygiene: Baltimore, MD. p. 38.
  11. Becker, K.D., et al., Online training for teachers delivering evidence-based preventive interventions. School Mental Health, 2014. 6(4): p. 225-236.
  12. Becker, K.D., et al., Supporting universal prevention programs: A two-phased coaching model. Clinical Child and Family Psychology Review, 2013. 16(2): p. 213-28.
  13. Becker, K.D., et al., Coaching teachers to improve implementation of the good behavior game. Administration and Policy in Mental Health and Mental Health Services Research, 2013: p. No Pagination Specified.
  14. Jiang, D., et al., A Comparison of Variable- and Person-Oriented Approaches in Evaluating a Universal Preventive Intervention. Prev Sci, 2018. 19(6): p. 738-747.
  15. Embry, D.D., The Good Behavior Game: a best practice candidate as a universal behavioral vaccine. Clinical Child & Family Psychology Review, 2002. 5(4): p. 273-97.
  16. Weis, R., K.J. Osborne, and E.L. Dean, Effectiveness of a universal, interdependent group contingency program on children’s academic achievement: A countywide evaluation. Journal of Applied School Psychology, 2015. 31(3): p. 199-218.
  17. Smith, E.P., et al., Promoting Afterschool Quality and Positive Youth Development: Cluster Randomized Trial of the Pax Good Behavior Game. Prev Sci, 2018. 19(2): p. 159-173.
  18. Streimann, K., et al., Effectiveness of a universal classroom-based preventive intervention (PAX GBG): A research protocol for a matched-pair cluster-randomized controlled trial. Contemporary Clinical Trials Communications, 2017. 8(Supplement C): p. 75-84.
  19. Humphrey, N., et al., Good Behaviour Game: Evaluation report and executive summary. 2018, University of Manchester: Manchester, UK. p. 124.
  20. Aos, S., et al. Good Behavior Game, Return on Investment: Evidence-Based Options to Improve Statewide Outcomes. 2013. 8.
  21. Thompson, K.M. and R.J. Tebbens, Retrospective cost-effectiveness analyses for polio vaccination in the United States. Risk Anal, 2006. 26(6): p. 1423-40.
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About the Author

Dennis Embry

Dennis Embry is a prominent prevention scientist in the United States and Canada, trained as clinician and developmental and child psychologist. He is president/senior scientist at PAXIS Institute in Tucson and co-investigator at Johns Hopkins University and the Manitoba Centre for Health Policy. Dr. Embry serves as a National Advisory Council member and Chief Science Advisor to the Children’s Mental Health Network. His work and that of colleagues is cited in 2009 the Institute of Medicine Report on The Prevention of Mental, Emotional, and Behavioral Disorders Among Young People. Clinically his work has focused on children and adults with serious mental illnesses. In March 2014, his work and the work of several signatories was featured in a Prime-TV special on the Canadian Broadcast Corporation on the prevention of mental illnesses among children—which have become epidemic in North America.

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