PAX Good Behavior Game®: Helping Elementary School Students (and Teachers)

Close up of a smiling elementary aged girl with curly hair styled in two ponytails

Over the last four years, Nationwide Children’s Hospital has helped implement an innovative behavior model in nearly 40 elementary schools across eight counties in central and southeastern Ohio. In the last two school years, schools that the hospital has supported have seen a decrease in classroom behavior that may cause disruption by an average of 30% to 36%

This universal prevention model, called the PAX Good Behavior Game, equips teachers and school professionals with strategies to improve children’s self-regulation, cultivate positive peer relationships, and enrich the school climate. Nationwide Children’s began working with schools to implement PAX in 2014. Since 2018, Nationwide Children’s has helped the program have an impact on more than 10,000 students.

“Research studies have found positive long-term outcomes among children from classrooms that implemented PAX in elementary school, including reduced rates of substance use and suicidal ideation in adolescence and young adulthood,” says Samanta Boddapati, PhD, NCSP, a psychologist at Nationwide Children’s and the PAX Prevention clinical manager. “In the short term, schools see improvements in behavior, test scores, and school climate, and that’s been our experience in Ohio schools as well.”

PAX consists of trauma-informed, evidence-based strategies that are directly implemented by teachers and school professionals in the context of the classroom during routine activities or instruction. PAX takes a child-centered approach to allow students to identify and co-create a positive classroom environment with their teacher and peers. When implemented school-wide, PAX enhances consistency by providing shared language and strategies across the entire school building. 

Nationwide Children’s model of consultation follows a trajectory of support that emphasizes both implementation and sustainability. The hospital provides technical assistance, professional development, and sustainability planning.  In the long-term, the goal is to help schools feel confident in maintaining PAX with internal and local resources.

The hospital’s approach is also focused on integrating and aligning PAX with other evidence-based practices and requirements, including Positive Behavioral Intervention and Supports (PBIS).  In Ohio, House Bill 318 (Supporting Alternatives for Fair Education [SAFE] Act) includes requirements for schools to implement PBIS through multi-tiered system of support for behavior and mental health. PAX integrates well with PBIS to teach and reinforce prosocial behaviors with all students.

“Nationwide Children’s Hospital works closely in collaboration with schools and community organizations to build capacity for strong PAX implementation,” says Dr. Boddapati. “Our partnerships across central and southeast Ohio have provided the foundation for PAX to flourish. We work with schools, community behavioral health providers, mental health boards, state agencies, and other educational entities.”

Nationwide Children’s has accelerated its work with PAX over the last four years. In 2018, funding from the Ohio Department of Mental Health and Addiction Services provided an opportunity to expand PAX outside of Franklin County. In 2019, investment from the Nationwide Foundation through the Nationwide Foundation Pediatric Innovation Fund paved the way for regional expansion in southeastern Ohio. Nationwide Children’s Hospital and the Muskingum Area Mental Health and Recovery Services Board braided funding to reach schools in five counties, in partnership with Allwell Behavioral Health. In 2021, with investment from Cardinal Health and in partnership with Hopewell Health Centers, Nationwide Children’s expanded their reach to two new counties.

In addition to PAX , Nationwide Children’s also provides PAX Tools® workshops for community members and youth-serving organizations. PAX Tools is a collection of strategies that are based in the same principles of PAX that are intended for delivery with community audiences. Nationwide Children’s Hospital has also recently worked with PAXIS Institute on PAX Tools for Human Services® to expand the reach of PAX Tools to human service settings.

PAX is developed and disseminated by PAXIS Institute. Visit for more information about PAX Good Behavior Game, PAX Tools, and PAX Tools for Human Services.

Samanta Boddapati

“Research studies have found positive long-term outcomes among children from classrooms that implemented PAX in elementary school, including reduced rates of substance use and suicidal ideation in adolescence and young adulthood.”

Samanta Boddapati, PhD, NCSP, PAX Prevention Clinical Manager