Strong evidence
The Good Behavior Game has RCT evidence that a brief classroom intervention in first and second grade reduced suicide ideation and attempts more than a decade later.
Evidence base
What the research says, in plain language.
Nevada Loves Kids is not a treatment. It is a prevention program built around skills that already have research behind them. Below is a short, honest summary of what we know, what we don't, and why we designed the program this way.
Important caution
The MYRIAD trial found that universal school mindfulness alone did not improve adolescent mental health. Skills matter most when taught in context, not isolation.
Clear gap
Most prevention funding and research focuses on teens and crisis care. The 6–12 window — where identity is still forming — is comparatively underserved.
Broader toolkit
CBITS, Roots of Empathy, Positive Action, and the Penn Resilience Program all have RCT evidence for improving youth mental health, behavior, and social-emotional skills.
1. The crisis
Suicide is rising among children and preteens.
According to the Centers for Disease Control and Prevention (CDC), suicide is now the second leading cause of death among U.S. children ages 10–14. Suicide rates in that age group more than doubled over the last decade. These are not just numbers; they represent children who reached a point of despair before reaching high school.
At the same time, the Substance Abuse and Mental Health Services Administration (SAMHSA) reports that roughly 60% of youth who experience a major depressive episode do not receive mental health treatment. The system is built largely around crisis response and treatment, which means help often arrives after the pain has already reached a breaking point.
The question is not whether we need more treatment. We do. The question is whether we can also reach children earlier, before the crisis.
2. The strongest evidence
The Good Behavior Game changed long-term suicide risk.
The Good Behavior Game (GBG) is a simple first- and second-grade classroom strategy. Teachers divide the class into teams, and teams earn rewards for following rules and staying focused. It is low-cost, easy to implement, and does not require specialist clinicians.
In a randomized controlled trial — the gold standard for evidence — researchers followed the children into young adulthood. They found that children who played the GBG had significantly lower rates of suicide ideation and attempts than children in the usual classroom, more than ten years after the program ended (Wilcox et al., Drug and Alcohol Dependence, 2008; Kellam et al.).
This is an RCT-grade result. It tells us that brief, early, skill-building work in the childhood years can alter a person's life trajectory in ways that matter. The GBG is listed by Blueprints for Healthy Youth Development and has been recognized by SAMHSA as an evidence-based approach.
What made the difference? The GBG taught self-regulation, attention, social cooperation, and the belief that one's behavior matters — the same kinds of capacities Nevada Loves Kids builds in a small-group format.
3. The caution
Mindfulness alone is not enough.
The MYRIAD trial, a large cluster randomized controlled trial in UK schools, tested a universal mindfulness program for early adolescents. It found that the program did not reduce mental health problems or improve well-being compared with ordinary schooling (Kuyken et al., Evidence-Based Mental Health, 2022).
That does not mean breathing exercises are useless. It means that mindfulness, taught in isolation, is not the magic answer. The trial did find benefits for school culture and teacher burnout, which suggests that the environment matters too.
For Nevada Loves Kids, the MYRIAD result is a guide. Meditation and breath work are one of ten capacities, not the whole program. They are taught alongside self-regulation, communication, self-efficacy, goal setting, character, and purpose so that children can use them in real relationships and real challenges.
4. The gap
Preteen prevention is the overlooked middle.
Most public attention and prevention funding goes to teenagers and crisis services. That is understandable: adolescence is when many mental health problems become visible and suicide risk peaks. But by adolescence, the internal story is often already set: "Nothing helps," "No one is coming," "This is just who I am."
The 6–12 age window is different. Identity is still forming, the brain is highly plastic, and a child's interpretation of adversity is still open to revision. Programs that reach children at this age — like the GBG — can change the trajectory before the teen years arrive.
Yet small-group, trauma-aware, practical resilience programs for the 6–12 window are rare compared with adolescent counseling, crisis hotlines, and hospital-based care. Nevada Loves Kids is designed to fill that gap.
5. The broader toolkit
Other programs we draw from.
The Good Behavior Game is the strongest direct evidence for our approach, but it is not the only rigorously tested program that points the same direction. We also look to four other evidence-based models that inform the Nevada Loves Kids capacities.
Cognitive Behavioral Intervention for Trauma in Schools (CBITS). Developed at the UCLA-Duke National Center for Child Traumatic Stress, CBITS is a structured, school-based group intervention for children who have experienced trauma. Randomized trials show it reduces PTSD, depression, and anxiety symptoms while improving grades and behavior (Stein et al., Journal of the American Academy of Child & Adolescent Psychiatry, 2003). It shows that trauma-informed, skill-building groups can work in real school settings.
Roots of Empathy. A classroom program in which a parent and infant visit regularly, giving children the chance to observe attachment, emotion, and empathy in real time. Independent randomized trials report reduced aggression and increased empathy, perspective-taking, and prosocial behavior (Schonert-Reichl et al., 2012; Santos et al., 2012). It is a practical example of how social-emotional skills can be taught through relationships.
Positive Action. A school-wide social-emotional and character program built around the principle that positive thoughts lead to positive actions, positive feelings, and a positive self-concept. Randomized controlled trials in multiple states show reduced substance use, violence, and disciplinary problems, along with improved attendance and academic outcomes (Beets et al., American Journal of Health Behavior, 2009; Lewis et al., 2013). It is listed by Blueprints for Healthy Youth Development and SAMHSA's National Registry of Evidence-based Programs and Practices.
Penn Resilience Program (PRP). A school-based program derived from cognitive therapy and learned-optimism research, originally developed at the University of Pennsylvania. A meta-analysis of 17 studies found that PRP reduced depressive symptoms among children and adolescents up to 12 months after the program, with larger effects when delivered by trained clinicians or educators (Brunwasser & Gillham, Journal of Consulting and Clinical Psychology, 2008). It is a direct ancestor of the cognitive-reframing and self-talk work we include in our self-efficacy capacity.
None of these programs is a complete answer. Together they form a toolkit: trauma-informed groups, empathy and relationship skills, character and positive behavior, and cognitive resilience.
What we do with this evidence
We teach integrated capacities, not isolated techniques.
Nevada Loves Kids brings the lessons from the GBG, CBITS, Roots of Empathy, Positive Action, the Penn Resilience Program, and the MYRIAD trial together. We teach ten practical capacities in small-group, trauma-aware sessions for children ages 6–12. The program is not therapy, not a replacement for medical care, and not a standalone mindfulness class.
It is a prevention layer: a structured, early, skill-building experience that gives children internal tools before they need crisis services. The goal is to raise the protective factors that peer-reviewed research already links to better outcomes — self-regulation, executive function, supportive relationships, empathy, a sense of meaning, and the belief that one's actions matter.
Lower suicide rates by raising resilience, purpose, and self-trust.
Sources and references
Read the original research.
Wilcox, H. C., Kellam, S. G., Brown, C. H., Poduska, J. M., Ialongo, N. S., Wang, W., & Anthony, J. C. (2008). The impact of two universal randomized first- and second-grade classroom interventions on young adult suicide ideation and attempts. Drug and Alcohol Dependence, 95, S60–S73. This is the main RCT finding that the Good Behavior Game reduced later suicide ideation and attempts.
Kuyken, W., Ball, S., Crane, C., Ganguli, P., Jones, B., Montero-Marin, J., Nuthall, E., Raja, A., Taylor, L., Tudor, K., Viner, R. M., Allwood, M., Aukland, L., Dunning, D., Casey, T., De Wilde, K., Haagensen, J., Lawlor, D. A., Lord, L., … MYRIAD Team (2022). Effectiveness and cost-effectiveness of universal school-based mindfulness training compared with normal school provision in reducing risk of mental health problems and promoting well-being in adolescence: the MYRIAD cluster randomised controlled trial. Evidence-Based Mental Health, 25(3), 99–109.
Centers for Disease Control and Prevention (CDC). WISQARS Leading Causes of Death Reports, 2023. Data on suicide as the second leading cause of death among children ages 10–14 and the doubling of rates over the prior decade.
Substance Abuse and Mental Health Services Administration (SAMHSA). National Survey on Drug Use and Health (NSDUH). Estimates that roughly 60% of youth with a major depressive episode do not receive mental health treatment.
Blueprints for Healthy Youth Development. Good Behavior Game program rating and review. An independent registry that rates preventive interventions based on evidence standards.
Stein, B. D., Jaycox, L. H., Kataoka, S. H., Wong, M., Tu, W., Elliott, M. N., & Fink, A. (2003). A mental health intervention for schoolchildren exposed to violence: A randomized controlled trial. Journal of the American Academy of Child & Adolescent Psychiatry, 42(3), 311–318. The main RCT of CBITS showing reduced PTSD and depression symptoms.
Schonert-Reichl, K. A., Kitil, M. J., & Levesque, C. (2012). Effectiveness and feasibility of the Roots of Empathy program. International Journal of Emotional Education, 4(2), 59–67. Independent evaluation of the empathy and aggression outcomes.
Beets, M. W., Flay, B. R., Vuchinich, S., Snyder, F. J., Acock, A. C., Li, K. K., Burns, K., Washburn, I. J., & Durlak, J. (2009). Use of a social and character development program to prevent substance use, violent behaviors, and sexual activity among elementary-school students in Hawaii. American Journal of Health Behavior, 33(6), 676–686. RCT of the Positive Action program.
Brunwasser, S. M., & Gillham, J. E. (2008). A meta-analytic review of the Penn Resiliency Program's effect on depressive symptoms. Journal of Consulting and Clinical Psychology, 76(6), 1042–1054. Meta-analysis of 17 studies.