Abstract
Purpose PAX Good Behaviour Game (PAX-GBG), a school-based mental health promotion approach, has been shown to improve children’s mental health outcomes and academic achievement. 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 randomized to PAX-GBG (n = 469, 11 schools) or wait-list control (n = 256, 9 schools). 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 (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.Conclusion These findings suggest that PAX-GBG was effective in improving First Nations children’s mental health and academic outcomes. Examining what works in Indigenous communities is crucial because approaches that are effective in some populations may not be culturally appropriate for others.