School personnel and community members' perspectives in implementing PAX good behaviour game in first nations grade 1 classrooms.

First Nations peoples in Canada have a history of poor mental health outcomes, as the result of colonisation and the legacy of residential schools. The PAX Good Behaviour Game (PAX-GBG) is a school-based intervention shown to improve student behaviour, academic outcomes, and reduce suicidal thoughts and actions. This study examines the use of PAX-GBG in First Nations Grade 1 classrooms in Manitoba. Researchers collected qualitative data via interviews and focus groups from 23 participants from Swampy Cree Tribal Council (SCTC) communities. Participants reported both positive effects and challenges of implementing PAX-GBG in their classrooms. PAX-GBG created a positive environment where children felt included, recognised, and empowered. Children were calmer, more on-task, and understood the behaviours that are expected of them. However, for many reasons, PAX-GBG is not being used consistently across SCTC schools. Participants described barriers in implementation due to teacher turnover, lack of on-going training and support, developmental and behavioural difficulties of students, and larger community challenges. Participants provided suggestions on how to improve PAX-GBG to be a better fit for these communities, including important cultural and contextual adaptations. PAX-GBG has the potential to improve outcomes for First Nations children, however attention must be given to implementation within community context.

Introduction

Canadian Indigenous people have a long history of enduring discrimination and marginalisation. The term “Indigenous” in Canada refers to the first people of North America and includes the First Nations, Métis, and Inuit [1]. Stemming from colonialism, on-going societal patterns create barriers to the health and well-being of this population [2]. For example, poor mental health is higher among Indigenous persons who have had a family member attend a residential school [3], demonstrating the intergenerational impact of Canadian policies. The Truth and Reconciliation Commission of Canada has called on the government to eliminate gaps in health between Indigenous and non-Indigenous Canadians. Among the outcomes to be addressed are mental health and suicide rates [4].

The PAX Good Behaviour Game (PAX-GBG) is an evidence-based strategy designed to create nurturing classrooms for improved student mental health. It is an approach that teachers use in their classrooms to encourage a more positive environment. It is a way of teaching that is embedded in the classroom environment, guided by teachers as a way of managing classroom dynamics. This approach consists of a collection of activities that take place each school day that encourage students to collaborate on their ideal classroom [5].

There are several PAX-GBG strategies that can be implemented in the classroom. For example, Granny’s Wacky Prizes are safe behaviours that are normally not allowed in class, but are permitted by teachers as rewards. Tootles are notes for students written by either fellow students or their teachers, as a way to recognise their accomplishments or positive behaviours. The See, Hear, Feel, Do Exercise is an activity in which students brainstorm what their ideal classroom would be like/Students have the opportunity to create a chart as a classroom containing what they would like to see, hear, feel, and do more of as a class. This chart is revised throughout the year.

Previous research has shown PAX-GBG can reduce aggression and suicidal behaviours in youth [6], reduce disruptive behaviours [7], and improve academic achievement [8]. While PAX-GBG has been effective in improving classroom behaviour, little research exists on adapting it to a specific culture. The current study aimed to understand how PAX-GBG has been used in Grade 1 classrooms of rural and remote First Nations communities in Manitoba, and to explore what adaptations are recommended to make PAX-GBG a more effective fit for these classrooms.

This study addresses the following research questions:

How is PAX-GBG being used in First Nations communities in Manitoba?

What are the experiences of school personnel in implementing PAX-GBG in Grade 1 classrooms?

What are the barriers and facilitators to the effectiveness of PAX-GBG in First Nations communities?

What adaptations could improve the effectiveness of PAX-GBG in First Nations communities?

Methods

Study design and background

The Swampy Cree Suicide Prevention Team developed the study concept and design. The Canadian Institute for Health Research provided funding, along with the First Nations Inuit Health Branch. Additional research partners included the Swampy Cree Tribal Council (SCTC), Cree Nation Tribal Health, Healthy Child Manitoba, the Manitoba First Nations Education Resource Centre, the PAXIS Institute, and the University of Manitoba.

This project utilised a “two-eye seeing” approach, which recognises contributions from both Indigenous and Western perspectives. This approach was put into practice by having SCTC members join the research team, holding community meetings, involving the community in developing the study design, and reviewing and interpreting results. For further details, refer to an earlier publication of the study protocol [9].

Participants

The study population included people of 5 First Nations communities from northwestern Manitoba, Canada. Researchers chose these communities as they offered a mixture of participants who had used PAX-GBG and those who had not. PAX-GBG was introduced to Manitoba to 50% of Grade 1 classrooms in 2011; therefore not all teachers received training. Researchers sought the perspectives of 5 teachers, 3 school administrators, 2 school support staff, and 13 community members including parents, grandparents, and elders.

Data collection and analysis

This study utilised the qualitative methods of 8 individual interviews and 4 focus groups to gather the “story” of how participants viewed PAX-GBG in their schools. Data collection occurred from September 2016 to November 2018 in the SCTC communities. Data were gathered using audio recordings and note taking during interviews. Once no new themes emerged, researchers stopped seeking new interviews.

Audio recordings were transcribed and line-by-line analysis of the transcripts was conducted. Two researchers coded the data separately and uncovered the underlying themes. The themes were reviewed and discussed by these researchers to ensure agreement in their findings. A third researcher reviewed the findings to ensure the data supported the themes. This step confirmed agreement on emerging themes. Researchers presented the results to some of the participants to confirm that the themes reflected their perceptions.

Ethics

Approval was obtained from the University of Manitoba Health Research Ethics Board. This study is compliant with the First Nations Government, Information Centre regulations of Ownership, Control, Access, and Possession (OCAP) as the First Nations research partners oversaw all aspects of the research process. OCAP principles are designed to ensure that First Nations communities have governance over the research in which their people are involved [10].

Results

Participants reported benefits and challenges to using PAX-GBG, as well as contextual factors that hindered the success of PAX-GBG. This section discusses perspectives provided by participants and suggestions for future directions to help PAX-GBG succeed in these communities. A summary of their views on specific PAX-GBG strategies is found in Table 1.

Table 1.

PAX-GBG intervention strategies, reported strengths and challenges

Intervention Component	Description	Benefits Reported	Reported Challenges
PAX-GBG and Granny’s Wacky Prizes	This intervention incorporates structured activities and strategies to improve student behaviour. It allows students to create their ideal classroom by paying attention to their behaviour, as well as their peers’ behaviour. This intervention teaches students to follow instruction and provides rewards for staying on task. Granny’s Wacky Prizes are safe behaviours that are normally prohibited in class. Prizes are motivators for children to participate in PAX-GBG.	PAX-GBG was said to be a useful set of tools, and that students’ behaviours improved. Students enjoyed the prizes, and it gave the children a break by getting out of their seats.	PAX-GBG could be time-consuming to implement initially. This was amplified if there were students who experienced behavioural or learning challenges. Some of the prizes were considered not age appropriate. Some students would become jealous if they did not receive a prize.
Harmonica and PAX Quiet Peace Sign	The harmonica is a musical instrument used to get students’ attention. The PAX Quiet Peace Sign is a non-verbal transition cue to signal a shift in attention or task. This strategy aims to help reduce loss of classroom productivity.	Using the harmonica was a positive thing for the classroom as it has a calming sound and reduced the need to yell to get students to pay attention. The PAX Quiet Peace Sign helped keep students on task, and was used every day.	Some students did not understand the purpose of the harmonica. After a while, the harmonica no longer was able to grab students’ attention. The PAX Quiet Peace sign did not always work, as students may not have been looking at the teacher.
PAX Hands, PAX Feet, PAX Voice	A tool that allows teachers to communicate expectations using the appropriate voice level. This strategy teaches students acceptable ways to hold one’s hands and feet when walking in the halls or making transitions.	This strategy was helpful with large groups of children, such as lining up.	Some children who did not participate in PAX-GBG teased their peers who used PAX Hands and PAX feet.
PAX Sticks	Random calling for student selection that encourages students to maintain their focus in the classroom.	PAX Sticks was a positive strategy to help children feel included and recognised. PAX Sticks give confidence to some children who answered questions, because anyone can answer at any time. PAX Sticks were also used to place children into different groups.	None Reported
See Hear Feel Do Exercise	Teachers and students create a chart of what they would see, hear, do and feel more their classroom, as well as a contrasting chart of what they would see, hear, do and feel less of. This chart is posted in the classroom to be revised throughout the school year.	This exercise was empowering to students, as they have an opportunity to discuss what they would like to see more or less of in their classroom. Students were likely to participate in PAX-GBG because they were a part planning the rules.	Some students struggled to understand this exercise, as they did not have experience expressing their emotions.
Tootles	Peer-to-peer (student-to-student, student-to-teacher, teacher-to-teacher, teacher-to-student) written notes of thanks, appreciation and recognition of accomplishment.	Tootles encouraged class participation by providing recognition to the students.	If students did not know how to write yet, the teacher became responsible for the extra work of writing Tootles. At times, Tootles become a source of competition and arguments between students.

Benefits of PAX-GBG

Participants reported that PAX-GBG is a useful set of tools that improved students’ self-regulation and overall attitudes about school. They related that the positive reinforcement used in PAX-GBG builds students’ self-esteem and provided a much-needed way to manage disruptive classroom behaviour. PAX-GBG encouraged teamwork and respect between students, and helped create structure while including fun in the classroom.

“[PAX-GBG] … teaches the kids to be responsible for themselves … to regulate, to think about their behaviour before they do it.”

“[We] wanted to incorporate a lot more fun activities in order to get the students’ attention and working together in groups.”

Many participants who had used PAX-GBG reported that students responded well to the programme and that the effects were long lasting. One participant described seeing good behaviours from students who had been in classrooms that used PAX-GBG.

“Students that are in Grade 6 now, [they] were my Grade 1s and I find that when they see me, their behaviour changes … it’s like they have respect for me just like I have respect for them.”

There were many positive comments on specific PAX-GBG strategies. Granny’s Wacky Prizes gave students a chance to take a break from their work, which helped prevent students from feeling frustrated. Feedback for students in the form of Tootles encouraged desired behaviour by recognising students who acted appropriately. The harmonica and PAX Quiet Peace Sign were useful in getting students’ attention. PAX Hands, PAX Feet, and PAX Voice helped manage large groups of students in the classroom and transitioning from one activity to another throughout the day. PAX Sticks allowed children to answer questions in class with confidence, and the See, Hear, Feel, Do Exercise reportedly empowered the students to imagine their ideal classroom. Regarding the PAX-GBG training, participants found that it was effective, and that the workbook provided was user-friendly. They enjoyed the interactive nature of the group work during training, and that the training improved their understanding of their students’ behaviour.

“[The training] helped me a lot because it helped me understand kids and the way they are.”

Challenges of PAX-GBG

Participants reported that PAX-GBG could be initially time-consuming. One teacher related that despite liking the idea of PAX-GBG, there is a lack of time to put it all together. It could also take longer to implement if there are new students in the class who are not familiar with PAX-GBG, or if students in the classroom struggle with behavioural and learning challenges.

“[Some students are] really causing a lot of havoc in the classroom and I’m slowly reaching them but it’s taking a little longer”.

Participants reported some challenges with specific PAX-GBG strategies. Granny’s Wacky Prizes were found to not always be age-appropriate. Not all participants used Tootles as some of them disliked this terminology. Some participants reported that other students who did not participate in PAX-GBG teased their students for using PAX Hands, PAX Feet, and PAX Voice. Finally, not all students grasped the concept of the See, Hear, Feel, Do Exercise.

Suggestions to improve PAX-GBG

Suggestions for improving PAX-GBG included enhancements to training, adding peer support, expanding PAX-GBG to other grade levels, adjusting PAX-GBG to be more culturally relevant, and engaging the wider community.

Enhancements to PAX-GBG training

Participants emphasised the importance of consistency in using PAX-GBG and maintained that more classrooms should use the programme. They suggested training students studying Education at University, so they have PAX-GBG in their toolbox.

“If we had enough people trained … so it’s consistent … success is going to be that much greater the more people we have involved, the more these kids know that these are the rules within the school.”

Several participants suggested that training take place within their schools for the opportunity to see PAX-GBG demonstrated, and allow the teachers to practice with their students. Also suggested was longer training and refresher courses such as a full-day workshop where teachers can prepare PAX-GBG materials. Geographical distance to training was a reported issue as it usually takes place in the southern provincial capital of Winnipeg. Hosting training in a more northern city could make it easier for staff to try PAX-GBG.

“It’s hard to go that far for training … it’s a two-day training, but it’s taking four days away”.

Mentor role and support groups

Having mentors was noted as a way to track progress of PAX-GBG. One participant suggested having monthly meetings with a mentor and others who use PAX-GBG to discuss how other communities experience PAX-GBG, as well as to solve challenges together.

“We need to have some type of team or a group where people who’ve had the training … can come and kind of just debrief … discuss and adapt.”

Expanding to additional grades

Participants reported the potential for PAX-GBG to be used from Nursery school to Grade 12. Older students may want more age appropriate games and prizes, but younger children would enjoy the games and PAX-GBG might provide a behavioural foundation for later years.

“You can train these little ones and they will understand everything. As they get older … they will get more knowledgeable about respect and their behaviour.”

Another recommendation was a “good behaviour club” for students. One participant reported seeing a group called “Dream Makers” at another school, which helped the students feel more positive about school. This participant said that these “Dream Makers” created initiatives such as anti-bullying posters, and that these students appeared articulate and self-confident.

A culturally appropriate fit

Indigenous traditions are important to community members and school staff as cultural traditions and values were believed to help children learn respect.

“When you’re doing a project, it’s not always a western or a First Nations project, but whatever project it is, you can incorporate [the] traditions, [the] values, and [the] beliefs”

Some participants suggested Cree language materials be provided since some teachers use it in their classrooms. It was acknowledged that translating the PAX-GBG materials into Cree would be arduous, especially because some words have no literal translation. It was suggested that an Elder could lead a ceremony to introduce PAX-GBG to the schools.

Granny’s Wacky Prizes could be more culturally based such as using a drum, howling like a wolf, or crawling like a turtle. Other ideas for cultural adaptation included smudging, and using an Eagle whistle or hand drums rather than the harmonica.

“When I don’t smudge with my kids in the morning, they are more energised … [smudging] calms them down.”

“[The eagle whistle] is more culturally appropriate … I think you can still get their attention.”

“[The harmonica] is not something our kids would know … [the eagle whistle] is something they can relate to, and there’s also teaching that go along with that.”

Community engagement

Participants saw value in having community members involved in using PAX-GBG. They discussed the importance of having a leader, someone in the community who could champion the programme, and including parents, grandparents, and extended family. Participants said PAX-GBG could help them better communicate with their children and learn about behaviour management.

“[What] makes a project or a programme successful in the community is the enthusiasm that the leader has … and how they get the community involved.”

One participant suggested inviting parents to the school to see PAX-GBG being used with their children. Participants discussed distributing flyers, phoning parents, having a community member visit homes to explain PAX-GBG, and implementing the training in parenting programmes.

“It’s good that [PAX-GBG] is community-based, but in order to utilize a programme like this it’s always the parents – what do they feel about it?”

“We need to take a more holistic look at how we’re going to include the family.”

Offering food or honorariums to attendees of school gatherings was suggested to help increase community involvement. Suggestions for including other service providers and organisations were the Elders’ Club or the Chief and Council.

“It takes a community to raise a child … if you change [a] behaviour, then you change everything else around you.”

Community context

Some participants shared the challenges experienced in their communities that could create barriers for successful implementation of PAX-GBG. These included the high-teacher turnover, community history, developmental and behavioural challenges of students, the relationship between the schools and larger community, and the school environment.

High teacher turnover in first nations schools

High teacher turnover was said to create inconsistency in the schools. For example, students may not know what is expected of them if some teachers use PAX-GBG and some teachers do not. It is also difficult to keep staff trained in PAX-GBG without having funding to replace them while they are away at training.

Community history

Participants discussed the impact of residential schools and the loss of Indigenous language, respect, and connections. The trauma in these communities combined with a lack of mental health services makes it hard for some parents to put the needs of their children ahead of their own. One participant remarked that while it used to “take a village” to raise a child, that responsibility is now falling on the teachers. Many children do not have positive interactions with others outside of school, and they may be exposed to violence and substance abuse.

“We just seem to be so divided and so individualistic that we’ve really lost that sense of connectedness.”

“Our community right now is in crisis. We have drug issues … alcohol issues … many of our children come to school, they don’t feel safe, they’re hungry … they don’t have that full attention from their parents.”

Student developmental and behavioural challenges

Participants noted that many children are developmentally delayed and have learning disabilities, which could make implementing PAX-GBG difficult. Several children struggle with a variety of disorders that impede learning including Attention Deficit/Hyperactivity Disorder, Foetal Alcohol Spectrum Disorder, and Autism Spectrum Disorder. Participants believed these students have difficulty following rules, and some students may refuse to participate in PAX-GBG.

“A lot of [them] are developmentally delayed, sometimes up to three grade levels behind.”

Schools and the larger community

Participants note that parents may think negatively about school possibly due to their experience in residential schools. Some community members also might not feel welcomed by the school. Parents do not always attend important meetings, such as parent-teacher interviews. This may make community involvement in PAX-GBG challenging.

“There are parents who come to this school … somebody will look at them and say ‘what are you doing here?”, not ‘good morning, how are you?’ … That welcome is not there.”

Discussion

This study highlights the benefits to using PAX-GBG. Participants reported that PAX-GBG creates a positive environment where children show respect and feel empowered. Students were calmer, more likely to stay on task, and understood the behaviours that are expected of them. However, for many reasons, PAX-GBG is not being used consistently across SCTC schools. Participants described barriers in implementation due to contextual challenges such as high teacher turnover, lack of on-going training and support, developmental and behavioural difficulties of the students, and larger challenges faced by the community.

These results align with previous literature that has explored the effects of school-based interventions with similar populations. Crooks and colleagues found that such interventions in Indigenous schools could improve academic achievement, bolster a sense of belonging for students, and increase overall confidence of students [11]. A study from the Netherlands found that PAX-GBG lead to more on-task behaviour from students [12]. A recent Alberta study examining PAX-GBG implementation found that support from school staff and other stakeholders was important for successful implementation [13].

Despite the international use of PAX-GBG [14], there is a lack of research on adapting PAX-GBG to be culturally appropriate for Indigenous populations. In the current study, proposed cultural and community adaptations include using the Cree language, having more culturally relevant instruments and prizes, expanding PAX-GBG to all grade levels, involving youth, and finding ways to get parents involved in the school and PAX-GBG. These changes reflect the larger desire for participants to see their culture and community strengthened. The aspiration for community involvement supports literature on the importance of community in Indigenous cultures. The common Indigenous worldview emphasises the value of togetherness and social support [15].

The themes highlighted in the data of the current study closely align with the First Nations Mental Wellness Continuum Framework (FNMWCF). This framework encompasses numerous aspects of well being which are ingrained in First Nations culture [16]. Components of the FNMWCF are important to consider in implementing any intervention in First Nations communities. Using PAX-GBG in First Nations communities provided an opportunity to strengthen well being through integrating cultural teachings in schools. The information gathered has informed cultural adaptations of PAX-GBG in First Nations communities in Manitoba.

Strengths and limitations

The first strength of this study is the collaboration with stakeholders, and partnerships with the community in designing and conducting the study. Working with First Nations communities while respecting Indigenous cultural and contextual history is critical in promoting the mental health of this population. The involvement of Healthy Child Manitoba, PAX-GBG developers, and Indigenous organisations was crucial for potential adaptations to programme implementation. The second strength is the variety of participants that researchers were able to interview. Gathering data from 23 community members, school faculty and school staff from 5 different First Nations communities provided rich information to better understand their viewpoints on PAX-GBG.

A limitation to this study is the potential for positive bias of the research team. This could have lead to participants providing especially positive comments and curbing the criticism of PAX-GBG. In this sense, there is the possibility to that some participants may have overstated the potential benefits of PAX-GBG. Finally, one focus group did not permit audio recording, which possibly reduced the amount of data extracted from this interview.

Conclusion

This study examined the use of PAX-GBG in Grade 1 classrooms of First Nations communities in Manitoba. The results showed that PAX-GBG has the potential for improving the classroom and school environment for students, however implementation has its challenges. Recommendations for successful implementation in SCTC communities include improved training and on-going support for those using PAX-GBG, incorporating the Cree language and culture, and expanding PAX-GBG to involve the whole school and community. While PAX-GBG shows promise in these schools, decision makers should consider the community context in order to promote successful implementation and sustainability of PAX-GBG.