Dissemination and Implementation Science: The Game Is out There, and Its Play or Get Played: Implementation of the Good Behavior Game in Manchester

This abstract was presented at the 2018 Society for Prevention Research Annual Meeting which was held May 29 – June 1, 2018 in Washington, DC, US.

Neil Humphrey University of Manchester, UK

Introduction: The Good Behavior Game (GBG) is a universal behavior management intervention in which children are rewarded for following four class rules: (1) we will work quietly; (2) we will be polite to others; (3) we will get out of seats with permission; and (4) we will follow directions. It has an extensive evidence base demonstrating its efficacy (Flower et al, 2014), but few studies have examined the association between levels of implementation and outcome variability. We report on the implementation and process evaluation (IPE) strand of a major efficacy trial of the GBG in England (SPR #26300), with the aim of addressing this significant gap in the evidence base. 

Methods: Implementation of the GBG (e.g. dosage, fidelity/quality, participant responsiveness) was assessed in 54 classes across 35 schools via independent structured observations and an online data capture tool used by participating teachers. Each class/teacher was classified as ‘low’, ‘moderate’ or ‘high’ for each aspect of implementation using a distributional cut-point method (low, < -1 SD; moderate, -1 to +1 SD; and high, > +1 SD). Children’s (N=1,420) behavioral outcomes (concentration problems, disruptive behaviour, pro-social behavior) were assessed using the Teacher Observation of Children’s Adaptation checklist (TOCA-C; Koth, Bradhsaw & Leaf, 2009). Analyses were conducting using two-level (class, child) hierarchical-level models in MLWin. Missing data were addressed via multiple imputation in REALCOM-Impute. 

Results: Higher levels of participant responsiveness were consistently associated with significantly improved behavioral outcomes (e.g. reduced concentration problems). Fidelity/quality yielded mixed findings. Contrary to our predictions, the effects of dosage and reach appeared to be negative (e.g. higher levels of dosage were associated with significantly reduced pro-social behaviour). 

Conclusions: Results of this study suggest that the variability in implementation of the GBG, in particular children’s levels of interest and enthusiasm for it, may be an important moderator of intervention outcomes. However, playing the GBG more frequently may not be beneficial. We are therefore left to speculate that higher dosage may be a reflection of class-level need (e.g. teachers implement the GBG more frequently because there are elevated levels of behavioral problems among their students).