ObjectivesPAX-Good Behaviour Game (PAX-GBG) is associated with improved mental health among youth. First Nations community members decided on a whole school approach to facilitate PAX-GBG implementation, by offering intervention training to all staff members in their schools. Our objective is to gain a greater understanding of how this approach was viewed by school personnel, in order to improve implementation in remote and northern First Nations communities.DesignWe conducted a qualitative case study using semi-structured interviews.SettingInterviews were conducted in First Nations schools located in northern Manitoba, Canada, in February 2018.ParticipantsWe used purposive sampling in selecting the 23 school staff from First Nations communities.InterventionPAX-GBG is a mental health promotion intervention that teachers deliver in the classroom alongside normal instructional activities. It was implemented school-wide over 4 months from October 2017 to February 2018.Outcome measuresWe inquired about the participants’ perception of PAX-GBG and the whole school approach. We applied an iterative coding system, identified recurring ideas and classified the ideas into major categories.ResultsImplementing the PAX-GBG whole school approach improved students’ behaviour and created a positive school environment. Students were learning self-regulation, had quieter voices and demonstrated awareness of the PAX-GBG strategies. All teachers interviewed had used the programme. Support from school administrators and having all school personnel use the programme consistently were facilitators to successful implementation. Challenges included the timing of training, lack of clarity in how to implement and implementing among students in older grades and those with special needs.ConclusionsThe whole school approach to implementing PAX-GBG was viewed as an acceptable and feasible way to extend the reach of PAX-GBG in order to promote the mental health of First Nations youth. Recommendations included ensuring school leadership support, changes to the training and cultural and literacy adaptations.

Indigenous women are increasingly returning to culturally based birthing practices to assert their sovereignty over their bodies and their birthing experience generally. The impact of colonization on birthing experiences for First Nations women in Canada has been profound and extends into generations of families. First Nations women across Canada have traditionally birthed in their communities surrounded by families and community, observing many traditions around pregnancy and birthing including placenta burying and belly button ceremonies. These traditions and this circle of care and support resulted in resiliency, strength and a connection to the land and family. In Manitoba, Indigenous women are becoming trained and engaged in supporting their fellow Indigenous relatives and community members as Indigenous doulas or birth workers. This paper describes the experiences of the first cohort of Indigenous doulas trained in Winnipeg, Manitoba by the Manitoba Indigenous Doula Initiative (MIDI), also known as Wiijii'idiwag Ikwewag, and describes the specific contributions and impacts of Indigenous doulas who support Indigenous women during pregnancy and birth. Through qualitative interviews, our participants described various understandings of their work, purpose and their impacts on the women and families they support. Four recurring themes which emerged across the interviews included: prior negative birthing experiences, clashes with mainstream health and social services, the understanding of doulas as advocates, and empowerment and disempowerment. These themes all spoke to ongoing challenges Indigenous women continue to face during their pregnancies and births in mainstream healthcare systems, as well as highlighting the key forms of support that doulas can provide to ensure the self-determination and well-being of the women they work with.

PAX Good Behaviour Game (PAX-GBG) is an evidence-based approach to co-create a nurturing environment where all children can thrive. This school-based approach was identified as a promising intervention for suicide prevention by First Nations communities in Manitoba, Canada. To enhance this mental health promotion approach, PAX Dream Makers was developed. It is a youth-led addition to PAX-GBG for middle and high school students. This study’s aim was to examine, from the communities’ perspectives, the influence of PAX Dream Makers on youth as well as its strengths, challenges and suggestions for future improvements. A case study method was conducted using interviews and focus groups with 30 youth and 17 adult mentors and elders. Participants reported that PAX Dream Makers provided support and encouragement to the youth, increased their resilience and provided an opportunity to be positive role models. It strengthened PAX-GBG implementation in schools. Challenges included: adult mentors availability, frequent teacher turn-over and community mental distress. Suggestions expressed were: being mindful of cultural and community contexts, increasing community leadership’s understanding of PAX-GBG and better recruitment of mentors and youth. PAX Dream Makers approach was well-received by communities and holds great promise for promoting the well-being of First Nations youth.