See Examples of PAX in Action:
Many states have adopted PAX programming as a strategic solution to meet the growing need for population-level prevention.
State agencies—such as the Texas Health and Human Services Department and the Arizona Health Care Cost Containment System—sought effective, scalable approaches to address the far-reaching impact of the opioid epidemic, limited access to prevention resources, and a workforce that was increasingly overstretched. By investing in scalable, evidence-based solutions like PAX, state agencies have shown how thoughtful implementation can address urgent public health challenges while creating lasting, community-wide change.
Texas:
The Texas Health and Human Services Commission (HHSC) implemented a statewide, school- and community-based PAX initiative from 2020 to 2025. This effort made PAX strategies broadly accessible to both educators and community members across the state. As a result, more than 11,000 individuals were trained in PAX, creating a consistent, trauma-informed approach to behavior support across diverse settings.
The outcomes have been substantial. Participating schools and communities reported improved academic and behavioral outcomes for students, along with stronger emotional well-being among youth. Educators also experienced enhanced professional satisfaction, a reduction in workplace stress, and overall improvements in wellness—demonstrating that prevention efforts like PAX can strengthen entire systems, not just individuals.
New Mexico:
New Mexico’s Office of Substance Abuse Prevention (OSAP) offers another powerful example of a successful, systems-level PAX initiative.
Since 2019, OSAP has led a statewide implementation of schoolwide PAX, with over 4,000 educators and support staff trained in the PAX Good Behavior Game. This multi-year investment has resulted in consistent improvements in classroom environments across the state—reducing disruptions, supporting positive student behavior, and creating safer, more supportive learning spaces.
Recognizing the value of prevention beyond the classroom, OSAP recently expanded its efforts to include community-based PAX Tools. This expansion brings trauma-informed strategies into homes, early childhood programs, and other community settings—ensuring that the benefits of PAX extend across the broader ecosystem of youth support.
A key strength of New Mexico’s approach is its intentional focus on early childhood and tribal communities. OSAP has demonstrated how PAX can be adapted to meet the diverse needs of families, schools, and communities statewide.
Kansas:
Kansas, through the leadership of the Department for Aging and Disability Services (KDADS), offers a compelling example of how PAX can be leveraged to strengthen prevention efforts across both educational and behavioral health systems.
Between 2023 and 2025, Kansas made PAX training available statewide to both schools and community-based organizations. In that time, more than 633 educators were trained in the PAX Good Behavior Game, while over 731 participants engaged in PAX Tools training—bringing practical, trauma-informed strategies into homes and youth-serving environments.
Kansas’s implementation model stands out for its focus on Tier 1 prevention within psychiatric residential treatment facilities (PRTFs), a setting where proactive behavioral strategies are especially important. In addition, the state prioritized the integration of PAX within youth development programs—ensuring that young people experience consistent support in both formal and informal settings.
Kansas also became one of the first states to pilot a youth-led PAX prevention initiative, empowering young leaders to promote behavioral wellness and positive community norms among their peers.
By investing in both adult- and youth-centered training, and by expanding PAX into mental health and out-of-school time settings, Kansas is setting a strong precedent for how states can use PAX as a flexible, system-wide prevention framework that meets the needs of diverse populations.
Ohio:
Ohio stands as a leading example of how agencies can work together to support population-level prevention.
From 2017 to 2025, PAX implementation in Ohio has been supported by multiple partners, including the Ohio Boys & Girls Club Alliance, Nationwide Children’s Hospital, and the Ohio Department of Mental Health and Addiction Services. Together, these organizations made trauma-informed, evidence-based strategies accessible to schools, families, and community-based programs across the state.
Through these efforts, Ohio has trained more than 20,000 individuals in both the PAX Good Behavior Game and PAX Tools. This includes educators, school and community-based professionals, parents and caregivers, and a broad range of local stakeholders. As a result, PAX strategies have become embedded within diverse youth-serving settings—supporting improved behavioral, academic, and wellness outcomes for both children and adults.
Notably, the success of local county-level implementation efforts served as a catalyst for broader adoption. What began as localized success stories evolved into a statewide initiative—demonstrating Ohio’s ability to operationalize evidence-based practices at scale and foster systems change.
Ohio’s story illustrates the power of multi-sector collaboration, long-term investment, and local innovation in creating a truly comprehensive and sustainable approach to prevention.
Arizona:
Arizona offers a powerful example of how cross-agency collaboration can create a wide-reaching prevention infrastructure.
Funded through initiatives led by the Arizona Governor’s Office of Youth, Faith, and Families (GOYFF), the Arizona Department of Education, and the Arizona Health Care Cost Containment System (AHCCCS), PAX programming has been made available to educators and communities across the state from 2019 to 2025. More than 13,000 individuals have been trained in the PAX Good Behavior Game and PAX Tools, reinforcing a shared approach to promoting prosocial behavior and emotional wellness.
Arizona’s PAX implementation has resulted in measurable improvements for both youth and adults. Students experienced better academic performance and behavior, while educators and staff reported increased wellness and reduced workplace stress. These outcomes reflect the broad and sustained impact of evidence-based strategies when implemented with fidelity.
Arizona’s approach also includes innovative applications of PAX Tools in congregate care. At Red Hawk Ranch, professionals at every level were trained in PAX Tools to support youth in care with consistent, trauma-informed strategies. This comprehensive approach helped improve outcomes for both staff and residents in high-need settings.
One of Arizona’s most inspiring examples of systems change comes from the state’s correctional system. Recovery Support Specialists (RSSs) from the Bachman and Manzanita units of the Arizona Department of Corrections were trained as PAX Tools Community Educators. These RSSs used PAX strategies to mentor fellow residents and began facilitating workshops to support peers during re-entry. These workshops equipped individuals with tools to strengthen family relationships, ease transitions, and build resilience—illustrating how PAX can promote healing and reintegration.
Arizona’s story demonstrates how PAX can serve as a flexible framework for strengthening systems—from schools and treatment programs to correctional institutions and family supports.
Washington:
Washington State exemplifies how a strong organizational partnership can scale trauma-informed prevention strategies across youth development systems to improve outcomes for both young people and the adults who support them.
Through leadership and funding from the Washington Boys & Girls Club Alliance, Washington became one of several states to provide PAX Tools training to all Boys & Girls Club (BGC) staff statewide. Each level of the organization—from frontline staff to leadership—received training, ensuring that PAX strategies were implemented consistently and intentionally across clubs.
This system-wide approach resulted in meaningful improvements. Youth demonstrated reduced conflict with both peers and adults, contributing to safer, more positive environments in club settings. Staff also reported reduced stress and improved professional satisfaction. Remarkably, after just eight weeks of PAX Tools implementation, clubs observed a measurable reduction in symptoms of depression among participating youth.
Washington’s model demonstrates the power of equipping an entire organization with shared, trauma-informed tools. By embedding PAX Tools across all roles and responsibilities, the Washington BGC network has created a sustainable culture of prevention and resilience—one that uplifts both young people and the caring adults who serve them.