Implementing the PAX Good Behavior Game Glenn Thomas, PhD - - PowerPoint PPT Presentation

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Implementing the PAX Good Behavior Game

Glenn Thomas, PhD

Nationwide Children’s Hospital The Ohio State University

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Disclosures

• Dr. Thomas Glenn
• Salary Support from Nationwide Children’s Hospital
• No other potential conflicts of interest

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Keep Us Well

Keep Us Well

Asthma Prematurity Behavioral Health HNHF

Healthy Neighborhoods, Healthy Families

• Modeled after successful revitalization

programs across the country, HNHF seeks to remove barriers to the health and well-being of thousands of families in our neighborhood (zip codes 43205, 43206, & 43207) using a multi-pronged approach.

• As part of the NCH focus on wellness

and population health, the 2013-2018 strategic plan expands the hospital’s commitment to the HNHF zone and calls for improvements in home, work and school environments as a pilot to demonstrate how best outcomes will come from best communities.

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Behavioral Health Services

• Individual and Family Treatment
• PAX Good Behavior Game (grades 1-5)
• Signs of Suicide (grades 6 -12)

Primary Care for Children & Adolescents

• Well Child Health Supervision Visits
• Sick care
• Immunizations
• Consultation with the School RN
• Linkage with other primary and specialty services

Other Services

• School-based Asthma Therapy
• Care coordination
• Partnership for dental services

Full Menu of Services

Source: Team Analysis

Caring for At-Risk Youth in Columbus, Ohio

The NCH & CCS Partnership

Target Schools in Year 1

Columbus City Schools Demographic Data

Performance Index

D

Select Risk Factors

% of Enrollment Economically Disadvantaged 79.0% Four Year Graduation Rate 77.00% Mobility (in the building less than 1 full academic year) 18.9%

Enrollment: 53,327

Source: Ohio Department of Education Interactive Local Report Card. Columbus City Schools 2013-2014 *Adequate Yearly Progress

=10,000 students

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PAX CCS Schools Demographic Data

School Performance Index Grade Economic Disadvantage Discipline (Disciplinary actions per 100 students) Mobility (Students in building

less than 1 academic year)

Broadleigh Elementary

D NA NA NA

Fairwood Alternative Elementary

D 93.4% 55 26.9%

Lincoln Park Elementary

D 95.0% 20.4 16.4%

Linden STEM Academy

D NA NA NA

Livingston Elementary

F 91.7% 158.8 25.3%

Moler Elementary

D 90.8% 61.7 25.3%

Ohio Avenue Elementary

D 92.3% 36.4 16.7%

Parsons Elementary

C 86.6% 23.1 15.9%

Siebert Elementary

D 91.8% 19.5 9.7%

Southwood Elementary

D 94.6% 67.3 25.5

Watkins Elementary

D 86.0% 37.8 20.0%

Source: HNHF team

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Canal Winchester Schools

• School-based behavioral health services in 2

elementary schools in the Canal Winchester School District

• Exurban
• Also includes prevention services
• Partially funded by Franklin County Alcohol Drug

and Mental Health Board

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Canal Winchester Schools Demographic Data

Performance Index

B

Select Risk Factors

% of Enrollment Economically Disadvantaged 29.40% Four Year Graduate Rate 94.5% Mobility (in the building less than 1 full academic year) 9.20%

Enrollment: 3, 457

Source: Ohio Department of Education Interactive Local Report Card. Canal Winchester Schools 2013- 2014 *Adequate Yearly Progress

=1,000 students

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Implementation Timeline

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10 20 30 40 50 60 2013-14 2014-15 2015-16 2016 CCS Classrooms CW Classrooms CCS Schools CW Schools

2013-14 Columbus City Schools Classroom Spleem Data

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5 10 15 20 25 30 35 40 45 50 Baseline Time 1 Time 2 Time 3

Spleems/student/hour

Ohio - 1st grade Moler - 1st grade Moler- 2nd grade

2014-15 Columbus City Schools Classroom Spleem Data

5 10 15 20 25 30 35 40 45 Baseline Time 1 Time 2 Time 3 Time 4

Spleems/student/hour

Average

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2014-15 Canal Winchester Classroom Spleem Data

5 10 15 20 25 30 Baseline October December March May

Spleems/student/hour

Average

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2015-16 Columbus City Schools School Spleem Data

5 10 15 20 25 30 35 40 45 50

13.34 13.94 12.28

Average

20.61 19.95 20.52 13.35 7.60

Spleems/student/hour

2015-16 Canal Winchester Schools School Spleem Data

2 4 6 8 10 12

4.43 5.04 2.79

Average

8.75 3.33 2.63 4.34 2.65

Spleems/student/hour

2016 (2nd Semester) CCS Classroom Spleem Data

0.0 20.0 40.0 60.0 80.0 100.0 120.0 Baseline March April May

Spleems/student/hour

Average

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60.3 63.6 40.4 36.2

Data Challenges

• Functional definition of spleems
• Baseline data
• Consistent sampling of classrooms
• Resource intensive
• No comparison data
• Ratings of teachers who were trained but did not do it
• Rating teachers who did not get GBG training
• Obtaining meaningful data from schools

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Lessons Learned

• Large urban school districts pose challenges
• Increasing resources can also increase demands on

school administrators

• Buy-in from administrators important
• Address locally as well as at senior leadership level
• Buy-in from teachers critical
• Clinician support makes a significant difference (not

necessarily clinical services)

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Lessons Learned, continued

• PAX Partner training significantly increase clinicians’

proficiency

• Need champions at all levels
• Champions can develop locally: word of mouth
• Incentives helpful ≠ culture change
• Consider implementation for entire school
• “Competing” interventions in community
• Funding

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Acknowledgements

• David Axelson, MD
• Lisa Alfriend
• Jessie Cannon
• Tara Clark
• Columbus City Schools and Canal Winchester Teachers
• Misti Dorsey
• Kady Ermisch
• Mary Kay Irwin
• Brittany Johnson
• Audrey Lombardo
• Kara Penniman, LISW
• Kam Twymon, LPCC-S
• Douglas Wolf

Contact Information: Glenn Thomas, PhD Glenn.Thomas@nationwidechildrens.org

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