How Can We Sustain and Expand a Proven Program to Improve Elementary-Age Mental Health?
Elementary school-aged children report mental health concerns at higher rates than ever before – and suicide has become the 8th leading cause of death for children 5 to 11.
Pediatric behavioral health experts emphasize the importance of programs that can be used in schools and in the community to teach skills that help improve long-term mental health outcomes, such as emotional regulation, problem-solving and relationship-building. A recent report led by Behavioral Health experts at Nationwide Children’s Hospital and a host of partners suggests how one successful program could be sustained and expanded in Ohio’s schools.
The program, called the PAX Good Behavior Game®, is used by teachers and school staff in their classrooms and school environments to help children self-regulate and develop prosocial skills. Since 2014, Nationwide Children’s has partnered with elementary schools and community providers to implement and sustain PAX across nine counties in central and southeast Ohio in more than 600 classrooms.
The Ohio Department of Mental Health and Addiction Services also has had a significant role in increasing access to the PAX Good Behavior Game and PAX Tools, the program’s out-of-classroom community extension.
“One of the most unique things about the PAX Good Behavior Game® is the amount of research that shows positive outcomes for children,” says Samanta Boddapati, PhD, NCSP, a psychologist at Nationwide Children’s and the PAX Prevention clinical manager.
Studies show the strategies within PAX support behavioral skill development in elementary school students while ultimately increasing high school graduation rates and reducing suicidal ideation and substance abuse later in adulthood.
“In May 2023, Nationwide Children’s was awarded support from the Ohio Department of Mental Health and Addiction Service, through a grant from the federal Substance Abuse and Mental Health Services Administration,” explains Dr. Boddapati. “Our objective was to better understand the model’s successes, gaps, funding streams and implementation strategies to ultimately provide recommendations for developing an infrastructure for PAX efforts in Ohio.”
Nationwide Children’s collaborated with Miami University's Discovery Center for Evaluation, Research and Professional Learning, Ohio University Center for Intervention Research in Schools, Miami University Ohio School-Based Center of Excellence for Prevention and Early Intervention, Prevention Action Alliance, PAXIS Institute, and the Ohio Mental Health Network for School Success to evaluate the current state of PAX Good Behavior Game and PAX Tools in Ohio.
In November 2024, the team published a report titled “Enhancing Ohio’s Model for Implementing and Sustaining The PAX Good Behavior Game and PAX Tools.”
“Understanding what's working and where the challenges are can help create an infrastructure for PAX statewide,” says Dr. Boddapati. “We want to expand and reach underserved schools and community partners in the state while sustaining what has already been implemented.”
Results from the evaluation suggest that the PAX Good Behavior Game® is being implemented in approximately one in five schools across Ohio. The comprehensive report includes several key findings about what might help sustain PAX efforts across Ohio as well as certain implementation barriers in both schools and local community programs.
School administrators and community leaders who use PAX strategies identified several essential supportive resources, including consultation, local community agency involvement, leadership support and professional connections to other PAX users. Some of the barriers identified in the report include perceived challenges around implementing more than one prevention model as well as misperceptions about the purpose of PAX strategies.
Dr. Boddapati says that Nationwide Children's will collaborate with its partners from the report to develop resources that support readiness, training, implementation, and fidelity for school staff and community facilitators by making resources more adaptable to individualized local needs.
“We’re focused on continuing statewide support while making some of our regional resources more applicable to local partners,” says Dr. Boddapati. “We will be working on the integration of PAX strategies into existing practices to help ensure that the supports meet local needs.”
Published January 2025
“Understanding what's working and where the challenges are can help create an infrastructure for PAX statewide. We want to expand and reach underserved schools and community partners in the state while sustaining what has already been implemented.”
