This week, our occasional healthcare series “Vital Signs” takes a look at ways to prevent disease and save the health care system money.
We start with a question: If children learn how to behave in school at an early age, will it improve their health?
Oregon health officials say it will. So as part of the Affordable Care Act, the Oregon health system is paying to have teachers play a game called The Good Behavior Game in poorer schools — even though on the surface it has nothing to do with health.
The hope is that kindergarteners who play the game today won’t start smoking and taking drugs when they get to high school — and hence save the health system millions of dollars.
Teacher Cami Railey sits at a kidney-shaped table, surrounded by four kids at Danebo Elementary in Eugene.
She’s about to teach them the “Sssss” sound and the “Aaaa” sound.
But first — as she does every day — she goes over the rules of the Good Behavior Game.
“You’re going to earn your stars today by sitting in the learning position. That means your bottom is on the bottom of your seat, backs on the back of your seat. Excellent job, just like that. Jaden, can you skooch your chair in just a little bit?” Railey asks.
The Good Behavior Game runs in the background of the class — think of it like background music.
So, for exhibiting good learning behavior, like sitting quietly; keeping their eyes on the teacher; and working hard, the kids get a star and some stickers.
And for negative behavior, like being disrespectful or daydreaming, they get frowny faces.
“Raise your hand if you can tell me what happens if we get four frownies. What happens?” Railey asks.
“We lose the game,” Kelina Kearney responds.
“We lose the game if we get four frownies. Are we going to get four frownies?”
Kindergartener Kelina Kearny shakes her head.
Once the rules are introduced, Railey can start the lesson in earnest. “Get ready sound: sssss. Yessss. Again. Get ready sound …. “
Railey has used the technique for years.
“So The Good Behavior Game is not a curriculum, but it’s a tool that teachers use while they’re teaching a curriculum. And the purpose of the Good Behavior Game is to help keep kids on task and focused and it’s to encourage students to make positive behavior choices and to increase their academic and social success in the classroom.”
And Railey is not just hoping that it’ll improve their success.
There’s more than 20 years of research supporting the game’s effectiveness.
The nonprofit, nonpartisan group Coalition for Evidence-Based Policy, found that by age 13, the game reduced the number of kids who started to smoke by 26 percent — and reduced the number of kids who started to take hard drugs by more than half.
By age 19, kids who had played the game were 21 percent more likely to graduate from high school.
“The Good Behavior Game is more than just a game that you play in the classroom. It’s actually been called a behavioral vaccine,” says Jennifer Webster, disease prevention coordinator for Trillium Community Health Plan.
The fact that a kindergarten teacher in Eugene is using the Good Behavior Game isn’t unusual.
What’s unusual is that one of Oregon’s new Coordinated Care Organizations — the Trillium Community Health Plan — is setting aside nearly $900,000 a year to get teachers to play the game.
“I mean it teaches kids self control and delayed gratification. And these things have been shown to reduce substance abuse in the future. It reduces behavioral disorders almost immediately,” Websters says.
The money will pay for teachers to play the game in 50 classrooms in Lane County. These are classrooms where at least 70 percent of the students qualify for free or reduced lunches.
“Trillium recognizes there is an intersection of health and education. What we’re doing is we’re not only looking at prevention as a way to control costs. We want these kids, when they grow up, to live longer and healthier lives and be productive members of the community. So it’s an investment that has a financial component, but it also has a quality of life component,” says Trillium spokeswoman, Debi Farr.
That financial component is not small.
The Oregon Health Authority estimates that tobacco use cost Oregonians $2.4 billion dollars in 2009. That was for the medical treatment of sick smokers and the loss of productivity.
Put another way, the state estimates each pack of cigarettes that someone smoked, cost Oregonians about $13.
So what does the Bethel School District think about working with the local health service?
Superintendent, Colt Gill says focusing on prevention is a fantastic idea.
“We hear over and over again, would you rather spend ‘x’ number of dollars on a person who is in prison every day or would you rather spend a tenth of that cost on their education to prevent them from ever taking that road in life. And that’s the path that we’re trying to go down, that prevention road.”
Some have questioned having health organizations get involved in areas not traditionally related to health — like the classroom.
But Trillium prevention coordinator Jennifer Webster doesn’t see the risk.
“This is really what needs to be done. I mean, if we’re really going to achieve the triple aim of reducing costs, and improving care and improving outcomes, what we really need to focus on is prevention. that’s what going to really make the triple aim successful. So I actually don’t see this as a risk at all,” says Webster.
Back in the classroom, I put the tough questions to kindergartener Kalina Kerney.
Kristian Foden-Vencil: “Do you think kids like learning more when you play the Good Behavior Game?”
Kelina Kearney: “Yes”
Kristian Foden-Vencil: “Why is that?”
Kelina Kearney: “Because every time when we guess something, we get more and more stars.”
Not all the $900,000 Trillium is spending goes for the Good Behavior Game. Some of the money is earmarked to pay pregnant smokers to give up the habit.
There’s also a plan to have kids try and buy cigarettes at local stores — then reward store owners who refuse to sell to them.
Trillium estimates it spends about $1.33 per member, per month on such prevention efforts. The hope is that over time, these efforts will save money.