Examining the effectiveness of the pax-good behaviour game in improving the mental health and academic outcomes of First Nations children in Canada: A clustered randomized controlled trial using administrative data.
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(Chartier) Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.; Manitoba Centre for Health Policy, University of Manitoba, 408-727 McDermot Avenue, Winnipeg, MB, R3E 3P5, Canada.
(Turner) Cree Nation Tribal Health Centre, The Pas, MB, Canada.
(Jiang, Au, McCulloch, Brownwell, Santos) Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
(Murdock) Manitoba First Nations Education Resource Centre, Winnipeg, MB, Canada.
(Martinson, Boyd) Healthy Child Manitoba Office, Government of Manitoba, Winnipeg, MB, Canada.
(Bolton, Sareen) Department of Psychiatry and Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
(Turner) Cree Nation Tribal Health Centre, The Pas, MB, Canada.
(Jiang, Au, McCulloch, Brownwell, Santos) Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
(Murdock) Manitoba First Nations Education Resource Centre, Winnipeg, MB, Canada.
(Martinson, Boyd) Healthy Child Manitoba Office, Government of Manitoba, Winnipeg, MB, Canada.
(Bolton, Sareen) Department of Psychiatry and Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
Year
2026
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Social Psychiatry and Psychiatric Epidemiology
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Social Psychiatry and Psychiatric Epidemiology
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Abstract
Purpose: PAX Good Behaviour Game (PAX-GBG), a school-based mental health promotion approach, has been shown to improve children's mental health and academic outcomes. Given that these effects have yet to be shown in Indigenous populations, a partnership with First Nations communities was created to evaluate PAX-GBG's effectiveness among First Nations children living in Canada.
Methods: In this clustered randomized controlled trial, we used population-based administrative data that allowed de-identified individual-level linkages. Our cohort from 20 First Nations schools was assigned to PAX-GBG (n = 468) or wait-list control (n = 255). We used multi-level regression modeling and propensity score weighting to estimate group differences in mental health and academic outcomes over time (2011-2020).
Results: PAX-GBG group children had significantly greater decreases in conduct problems (β:-1.08, standard error(se):0.2505, p < .0001), hyperactivity-inattention (β:-1.13, se:0.3617, p = .0018), and peer problems (β:-1.10, se:0.3043, p = .0003) and a greater increase in prosocial scores (β:2.68, se:0.4139, p < .0001) than control group children. The percentage of PAX-GBG group children meeting academic expectations was higher than control group children. However, only third-grade numeracy (odds ratio (OR):4.30, confidence interval (CI):1.34 - 13.77) and eighth-grade reading and writing (OR:2.78, CI:1.01 - 7.67) were statistically significant. We found no evidence that PAX-GBG was associated with less emotional problems, diagnosed mental disorders, or greater student engagement or mathematics.
Conclusion: These findings suggest that PAX-GBG is a promising intervention in improving First Nations children's mental health and academic outcomes. What remains unclear is whether these findings are generalizable to all First Nations and how adding supports for program implementation would influence these findings.
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