Support Groups Versus Primary Mental Healthcare on Disability and Continuity of Care: Community Trial [Support Groups for Recovery].

Based on the need to implement strategies to reduce recovery gaps in mental health with the community as axes of recovery, the objective of the present study was to assess the impact on psychosocial disability and care continuity in individuals with suicidal behavior, of the clinical and community components of the Mental Health Gap Action Program (mhGAP), versus exclusive psychiatric care. For this, a controlled community trial carried out in 2023 was conducted, comprising intervention groups: Support Group (SG), mhGAP Group (mhGAPG) and a Control Group (CG). Self-report measurements were collected pretest and posttest, utilizing the Psychosocial Disability Scale and the Alberta Continuity of Care Scale. The study involved the participation of 94 individuals with a history of suicidal behavior, with 30 individuals in the SG, 34 in the mhGAP group, and 30 in the CG. Categorical variables were summarized using frequency distribution tables. Descriptive statistics were used to examine participants' characteristics at the study outcome and estimate treatment compliance. The Mann-Whitney U Test examined differences in sociodemographic variable frequencies. The Jarque-Bera test confirmed a normal distribution for psychological variables, warranting the use of parametric tests. Differences in mean values across groups, each with two measurements per individual, were assessed using a type II repeated measures ANOVA. There were significant differences based on the intervention, with the effect being greater in the SG across all domains. Significant improvement was observed in all domains of the disability and continuity of care scale within the intervention groups. Both groups showed improvement, with better results for the SG. In conclusion, a methodology is proposed for implementing support groups based on core components, which effectively enhances psychosocial disability and the continuity of mental health care, especially in suicidal behavior.

Intrinsic Motivation and Institutional Limitations: Key Implementation Determinants of Psychological First Aid Training.

Psychological first aid (PFA) trainings are conducted to train frontline care workers in practical and emotional support to people who have been recently affected by stressful events. The aim of this study was to describe the determinants of the implementation behavior of a PFA training strategy in Chile and to provide theoretical information on the factors that influence trainers' self-efficacy. For this purpose, the Determinants of Implementation Behavior Questionnaire, administered online to a sample of 117 PFA trainers throughout Chile, was used. The results indicate that the main facilitators for implementation originate in the intrinsic motivation of the trainers, while the barriers are mainly found in the limited institutional opportunities offered by the context. Evidence was also found on the effect of motivation and context on trainer self-efficacy. PFA trainers may need to invest a lot of psychological resources to overcome the barriers encountered during implementation.

Validation of an instrument to guide the implementation of strategies for mental health care in Colombia.

Objectives: To validate the implementation drivers scale among first-level mental health care professionals in Colombia. The scale is designed as a tool to guide the implementation of strategies that effectively reduce gaps in mental health care. Methods: The Active Implementation Framework was adopted, which is a widely used model for measuring implementation. The participants included 380 individuals (55.56% men) - 349 health personnel trained in the Mental Health Gap Action Programme (mhGAP) and 31 territorial personnel in charge of planning mental health strategies at the territorial level in Colombia. To assess the critical dimensions of mhGAP implementation, we developed a scale of 18 items based on the active implementation framework. We conducted content validity assessments and exploratory factor analysis to evaluate the scale. We used the Organizational Readiness for Knowledge Translation scale as a comparative standard. Results: The implementation drivers scale identified four dimensions: system enablers for implementation, accessibility of the strategy, adaptability and acceptability, and strategy training and supervision. These dimensions had Cronbach alpha values of 0.914, 0.868, 0.927, and 0.725, respectively, indicating high internal consistency. In addition, all dimensions demonstrated adequate correlation with the Organizational Readiness for Knowledge Translation scale. Conclusion: The implementation drivers scale effectively determines the adaptability and implementation of various components of mental health programs, particularly those focusing on community-based approaches and primary care settings. As such, this scale can contribute to the more effective implementation of strategies outlined by global and local political frameworks, thus improving mental health care.

Validation of an instrument to guide the implementation of strategies for mental health care in Colombia / Validación de un instrumento para orientar la implementación de las estrategias de atención de salud mental en Colombia / Validação de um instrumento para orientar a implementação de estratégias de atenção à saúde mental na Colômbia

[ABSTRACT]. Objectives. To validate the implementation drivers scale among first-level mental health care professionals in Colombia. The scale is designed as a tool to guide the implementation of strategies that effectively reduce gaps in mental health care. Methods. The Active Implementation Framework was adopted, which is a widely used model for measuring implementation. The participants included 380 individuals (55.56% men) – 349 health personnel trained in the Mental Health Gap Action Programme (mhGAP) and 31 territorial personnel in charge of planning mental health strategies at the territorial level in Colombia. To assess the critical dimensions of mhGAP implementa- tion, we developed a scale of 18 items based on the active implementation framework. We conducted content validity assessments and exploratory factor analysis to evaluate the scale. We used the Organizational Read- iness for Knowledge Translation scale as a comparative standard. Results. The implementation drivers scale identified four dimensions: system enablers for implementation, accessibility of the strategy, adaptability and acceptability, and strategy training and supervision. These dimensions had Cronbach alpha values of 0.914, 0.868, 0.927, and 0.725, respectively, indicating high internal consistency. In addition, all dimensions demonstrated adequate correlation with the Organizational Readiness for Knowledge Translation scale. Conclusion. The implementation drivers scale effectively determines the adaptability and implementation of various components of mental health programs, particularly those focusing on community-based approaches and primary care settings. As such, this scale can contribute to the more effective implementation of strategies outlined by global and local political frameworks, thus improving mental health care.

[RESUMEN]. Objetivos. Validar la escala de impulsores de implementación en profesionales de la salud mental del nivel de atención primaria en Colombia. La escala está diseñada como una herramienta para orientar la implementación de estrategias que permitan reducir de manera efectiva las desigualdades existentes en la atención de salud mental. Métodos. Se adoptó el marco de implementación activa, que es un modelo ampliamente utilizado para medir este tipo de implementaciones. Los participantes fueron 380 personas (55,56% hombres), de las cuales 349 eran profesionales de la salud capacitados mediante el Programa de acción mundial para superar las brechas en salud mental (mhGAP, por su sigla en inglés) y 31 formaban parte del personal territorial encargado de planificar estrategias de atención de salud mental a nivel territorial en Colombia. Para evaluar los dominios cruciales de la implementación del mhGAP, elaboramos una escala de 18 puntos basada en el marco de implementación activa. Para evaluar la escala se realizaron determinaciones de la validez de contenido y un análisis factorial exploratorio. Como patrón de referencia se utilizó la escala Predisposición Organizacional a la Transferencia del Conocimiento para el Cambio de Práctica Clínica. Resultados. La escala de impulsores de la implementación determinó cuatro dominios: facilitadores del sistema para la implementación, accesibilidad de la estrategia, adaptabilidad y aceptabilidad, y capacitación en la estrategia y supervisión. Estos dominios presentaron valores de alfa de Cronbach de 0,914, 0,868, 0,927 y 0,725, respectivamente, lo que indica una coherencia interna elevada. Además, todos los dominios mostraron una correlación adecuada con la escala Predisposición Organizacional a la Transferencia del Conocimiento para el Cambio de Práctica Clínica. Conclusión. La escala de impulsores de la implementación permite determinar de manera efectiva la adaptabilidad y la implementación de diversos componentes de los programas de salud mental, en particular de los que se centran en enfoques basados en la comunidad y en entornos de atención primaria. En este sentido, esta escala puede contribuir a una implementación más eficaz de las estrategias esbozadas en los marcos políticos locales y mundiales, con la consiguiente mejora de la atención de salud mental.

[RESUMO]. Objetivos. Validar a escala de determinantes da implementação entre profissionais do primeiro nível de atenção à saúde mental na Colômbia. A escala foi concebida como uma ferramenta para orientar a implementação de estratégias que reduzam efetivamente as lacunas na atenção à saúde mental. Métodos. Foi adotada a Estrutura de Implementação Ativa, um modelo amplamente utilizado para medir a implementação. O estudo incluiu 380 indivíduos (55,56% homens): 349 profissionais de saúde treinados no Programa de Ação para Reduzir as Lacunas em Saúde Mental (mhGAP, na sigla em inglês) e 31 profissionais dos territórios encarregados de planejar estratégias de saúde mental em nível territorial na Colômbia. Para avaliar as dimensões essenciais da implementação do mhGAP, criou-se uma escala de 18 itens com base na Estrutura de Implementação Ativa. Foram realizadas avaliações da validade do conteúdo e uma análise fato- rial exploratória para avaliar a escala. A escala de prontidão organizacional para tradução de conhecimentos (OR4KT, na sigla em inglês) foi utilizada como padrão de comparação. Resultados. A escala de determinantes da implementação identificou quatro dimensões: facilitadores sistêmicos de implementação; acessibilidade da estratégia; adaptabilidade e aceitabilidade; e capacitação e monitoramento da estratégia. Essas dimensões tiveram valores de alfa de Cronbach de 0,914, 0,868, 0,927 e 0,725, respectivamente, indicando alta consistência interna. Além disso, todas as dimensões demonstraram correlações adequadas com a escala OR4KT. Conclusão. A escala de determinantes da implementação avalia efetivamente a adaptabilidade e a imple- mentação de vários componentes dos programas de saúde mental, especialmente componentes que se concentram em abordagens baseadas na comunidade e ambientes de atenção primária. Dessa forma, essa escala pode contribuir para uma implementação mais efetiva de estratégias delineadas por estruturas políticas mundiais e locais, melhorando assim a atenção à saúde mental.

Mutual Aid Groups for Loneliness, Psychosocial Disability, and Continuity of Care.

The objective of the present study was to evaluate the effectiveness of mutual help groups in continuity of care, loneliness and psychosocial disability in a Colombian context. For this, a quasi-experimental design is used, with pre- and post-intervention assessments due to non-randomized participant allocation. The study involved 131 individuals with mental disorders. The Psychosocial Disability Scale, The Alberta Scale of Continuity of Services in Mental Health, the UCLA Scale and the Zarit Caregiver Burden Scale were employed. The intervention was based on the core components of mutual aid groups. Significant differences (p < 0.001) were observed for the study variables, particularly in Loneliness, Continuity of Care, and various domains of psychosocial disability. A large effect size was found for these variables after the intervention. Most variables exhibited a moderate to large effect. This study demonstrates the effectiveness of mutual groups facilitated by mental health personnel at the primary care level.

Design and validation of a scale of core components of community interventions in mental health.

AIMS: To develop and validate an instrument to identify the core components of community strategies for mental health, especially mutual aid groups: The Mutual Aid Scale . METHODS: 135 community strategies leaders participated in the study. The core components are active agency, coping strategies, recognition, and management of emotions, problem-solving strategies, supportive interaction, trust, self-identity construction, and strengthening of social networks. With these components a scale was designed. Content validity was carried out in addition to an exploratory factor analysis. RESULTS: Two dimensions resulted, strengthening of agency capacity and Coping strategies, and the internal consistency of both factors was acceptable, with a Cronbach's alpha of 0.722 and 0.727, respectively. The Kaiser-Meyer-Olkin (KMO) statistic was used with a score of 0.831 and the Barlett Sphericity Test, with a significant value of 265.175. CONCLUSION: This scale identifies the components of community interventions for mental health and can contribute to a better implementation of these strategies. It also articulates autonomous community processes with strategies developed in health services.

Validation of an instrument to guide the implementation of strategies for mental health care in Colombia / Validación de un instrumento para orientar la implementación de las estrategias de atención de salud mental en Colombia / Validação de um instrumento para orientar a implementação de estratégias de atenção à saúde mental na Colômbia

ABSTRACT Objectives. To validate the implementation drivers scale among first-level mental health care professionals in Colombia. The scale is designed as a tool to guide the implementation of strategies that effectively reduce gaps in mental health care. Methods. The Active Implementation Framework was adopted, which is a widely used model for measuring implementation. The participants included 380 individuals (55.56% men) - 349 health personnel trained in the Mental Health Gap Action Programme (mhGAP) and 31 territorial personnel in charge of planning mental health strategies at the territorial level in Colombia. To assess the critical dimensions of mhGAP implementation, we developed a scale of 18 items based on the active implementation framework. We conducted content validity assessments and exploratory factor analysis to evaluate the scale. We used the Organizational Readiness for Knowledge Translation scale as a comparative standard. Results. The implementation drivers scale identified four dimensions: system enablers for implementation, accessibility of the strategy, adaptability and acceptability, and strategy training and supervision. These dimensions had Cronbach alpha values of 0.914, 0.868, 0.927, and 0.725, respectively, indicating high internal consistency. In addition, all dimensions demonstrated adequate correlation with the Organizational Readiness for Knowledge Translation scale. Conclusion. The implementation drivers scale effectively determines the adaptability and implementation of various components of mental health programs, particularly those focusing on community-based approaches and primary care settings. As such, this scale can contribute to the more effective implementation of strategies outlined by global and local political frameworks, thus improving mental health care.

RESUMO Objetivos. Validar a escala de determinantes da implementação entre profissionais do primeiro nível de atenção à saúde mental na Colômbia. A escala foi concebida como uma ferramenta para orientar a implementação de estratégias que reduzam efetivamente as lacunas na atenção à saúde mental. Métodos. Foi adotada a Estrutura de Implementação Ativa, um modelo amplamente utilizado para medir a implementação. O estudo incluiu 380 indivíduos (55,56% homens): 349 profissionais de saúde treinados no Programa de Ação para Reduzir as Lacunas em Saúde Mental (mhGAP, na sigla em inglês) e 31 profissionais dos territórios encarregados de planejar estratégias de saúde mental em nível territorial na Colômbia. Para avaliar as dimensões essenciais da implementação do mhGAP, criou-se uma escala de 18 itens com base na Estrutura de Implementação Ativa. Foram realizadas avaliações da validade do conteúdo e uma análise fatorial exploratória para avaliar a escala. A escala de prontidão organizacional para tradução de conhecimentos (OR4KT, na sigla em inglês) foi utilizada como padrão de comparação. Resultados. A escala de determinantes da implementação identificou quatro dimensões: facilitadores sistêmicos de implementação; acessibilidade da estratégia; adaptabilidade e aceitabilidade; e capacitação e monitoramento da estratégia. Essas dimensões tiveram valores de alfa de Cronbach de 0,914, 0,868, 0,927 e 0,725, respectivamente, indicando alta consistência interna. Além disso, todas as dimensões demonstraram correlações adequadas com a escala OR4KT. Conclusão. A escala de determinantes da implementação avalia efetivamente a adaptabilidade e a implementação de vários componentes dos programas de saúde mental, especialmente componentes que se concentram em abordagens baseadas na comunidade e ambientes de atenção primária. Dessa forma, essa escala pode contribuir para uma implementação mais efetiva de estratégias delineadas por estruturas políticas mundiais e locais, melhorando assim a atenção à saúde mental.

RESUMEN Objetivos. Validar la escala de impulsores de implementación en profesionales de la salud mental del nivel de atención primaria en Colombia. La escala está diseñada como una herramienta para orientar la implementación de estrategias que permitan reducir de manera efectiva las desigualdades existentes en la atención de salud mental. Métodos. Se adoptó el marco de implementación activa, que es un modelo ampliamente utilizado para medir este tipo de implementaciones. Los participantes fueron 380 personas (55,56% hombres), de las cuales 349 eran profesionales de la salud capacitados mediante el Programa de acción mundial para superar las brechas en salud mental (mhGAP, por su sigla en inglés) y 31 formaban parte del personal territorial encargado de planificar estrategias de atención de salud mental a nivel territorial en Colombia. Para evaluar los dominios cruciales de la implementación del mhGAP, elaboramos una escala de 18 puntos basada en el marco de implementación activa. Para evaluar la escala se realizaron determinaciones de la validez de contenido y un análisis factorial exploratorio. Como patrón de referencia se utilizó la escala Predisposición Organizacional a la Transferencia del Conocimiento para el Cambio de Práctica Clínica. Resultados. La escala de impulsores de la implementación determinó cuatro dominios: facilitadores del sistema para la implementación, accesibilidad de la estrategia, adaptabilidad y aceptabilidad, y capacitación en la estrategia y supervisión. Estos dominios presentaron valores de alfa de Cronbach de 0,914, 0,868, 0,927 y 0,725, respectivamente, lo que indica una coherencia interna elevada. Además, todos los dominios mostraron una correlación adecuada con la escala Predisposición Organizacional a la Transferencia del Conocimiento para el Cambio de Práctica Clínica. Conclusión. La escala de impulsores de la implementación permite determinar de manera efectiva la adaptabilidad y la implementación de diversos componentes de los programas de salud mental, en particular de los que se centran en enfoques basados en la comunidad y en entornos de atención primaria. En este sentido, esta escala puede contribuir a una implementación más eficaz de las estrategias esbozadas en los marcos políticos locales y mundiales, con la consiguiente mejora de la atención de salud mental.

PACES: a primary care tool to detect mental health disorders in Indigenous Colombians.

INTRODUCTION: The aim of this research was to present the process of intercultural creation and validation, in addition to the analysis of the psychometric properties of the Parenting, Behavior, Emotions and Suicide risk scale. METHODS: A cross-sectional study, cultural adaptation and validation with an ethnic approach were carried out by expert judges in mental health; subsequently, the instrument was applied, and a factorial analysis was carried out, and it was established that there was agreement between the instrument results and two expert perspectives regarding spiritual disharmony. The sample consisted of 168 families of children and young people (54.8% women, 45.2% men), with a mean age of 11.2 years, in Colombia. Regarding the geographical location, 44% were from Guajira, 44.6% were from Nariño and 11.3% were from Vaupés, from the Wayuu, Awá and Emberá communities, respectively. RESULTS: The scale showed high reliability (Chronbach's α=0.911), and in the factorial analysis the following parenting domains were formed from the parents: involvement, monitoring and bond, from boys, girls and young people; suicidal risk perceived by caregivers and perceived by children and young people; in addition to a total mental health risk. The questions that inquired about hallucinations and seizures did not show grouping in any factor, and two questions were eliminated. Similarly, a high inter-rater concordance was shown, with a higher Cohen's κ coefficient for all domains. CONCLUSION: There are few intercultural and early detection studies of parenting and mental health problems in children and youth that have an ethnic approach. It is observed that the instrument serves as a means of monitoring mental health issues in children and adolescents, as well as the parenting practices employed in their socialization, from both the perspective of caregivers and the young individuals themselve. This study indicates that the scale is an adequate tool, quick and easy to administer in first-level care settings.

Mental Health Services in Colombia: A National Implementation Study.

Laws in Latin American countries are based on scientific evidence that calls for mental health services to move to the community. These care modalities have implementation problems. The objective of this article is to describe the implementation of the services proposed in Law 1616 of 2013 of Colombia (Mental Health Law): emergencies, hospitalization, community-based rehabilitation, pre-hospital care, day hospital for children and adults, Drug Addiction Care Center, groups support and mutual aid, telemedicine, and home and outpatient care. We used a mixed study, with a cross-sectional descriptive quantitative component, where an instrument was used to determine the level of implementation of these services, consisting of a scale that established the availability and use of these services, in addition to the climate of implementation of the services and community mental health strategies, in addition to a qualitative determination of barriers and facilitators of implementation. We found a low availability of all services in departments such as Amazonas, Vaupés, Putumayo, and Meta and an implementation of services in Bogotá and Caldas. The least implemented services are the community ones, and those with the greatest presence at the territorial level are emergencies and hospitalization. We conclude that low- and middle-income countries have few community models and invest a large part of their technical and economic effort in emergencies and hospitalization. There are difficulties in the implementation of most of the services proposed by Colombian legislation related to mental health.

Traducción y adaptación de la Escala de Continuidad de Servicios de Salud Mental de Alberta en un contexto latinoamericano

Introducción: La continuidad de atención es considerada como un proceso que involucra una atención ordenada, un movimiento ininterrumpido de personas entre los diversos elementos del sistema de prestación de servicios. No existe evidencia suficiente en cuanto a instrumentos de medición en Iberoamérica. Por lo anterior, el objetivo del presente estudio consiste en describir el proceso de traducción, adaptación cultural a un contexto latinoamericano, así como la consistencia interna y validez de constructo de la Escala de Continuidad de Servicios de Salud Mental de Alberta (ACSS-MH). Método: Este instrumento fue sometido a la evaluación de validez de contenido por expertos y este fue aplicado a una población rural en un contexto colombiano. Se realizaron pruebas de consistencia interna y validez de constructo para cada una de las partes de la escala. Resultados: Bajo el consenso del experto, se realizan cambios en algunos ítems, buscando una mejor adaptabilidad del instrumento a las características lingüísticas del español, sin perder de vista el objetivo de evaluación de cada uno de los ítems del cuestionario original. El resultado del análisis de la parte A convergió en 5 componentes que explican el 69,69% de la varianza con 24 ítems; de igual forma, el análisis de la parte B agrupó 13 ítems en cuatro componentes, los cuales explican el 72.02% de la varianza. Conclusiones: este instrumento podría ser implementado para mejorar la prestación de los servicios en salud mental en contextos latinoamericanos, donde la continuidad del cuidado ha presentado importantes dificultades.

Objective: Describe the process of translation, cultural adaptation to Colombia, as well as the internal consistency and construct validity of the Alberta Continuity of Services Scale for Mental Health (ACSS-MH). Methods: This instrument was subdued to the evaluation of validity of the content by experts and this was applied to a rural population in a Colombian context. Were performed tests of internal consistency and construct validity for each of the parts of the scale. Results: Under the consensus of the expert, it is made changes on some items, looking for a better adaptability of the instrument to the linguistic characteristics of Spanish, without losing sight of the evaluation objective of each one of the items on the original questionnaire. The result of the analysis of part A converged in 5 components that explain the 69.69% of the variance with 24 Items; Similarly, the analysis of part B grouped 13 items into four components, which explain the 72.02% of the variance. Discussion: This scale could be implemented to improve the provision of mental health services in Latin American contexts, where continuity of care has presented significant difficulties.

The best partner. School effect assessment of different interorganizational collaboration using Propensity Matching Score / El mejor colaborador. Evaluación del efecto escolar de diferentes colaboraciones interorganizacionales utilizando Propensity Matching Score

Abstract The Chilean Skill for Life (CSFL) is a school mental health program implemented by local agencies from the Education, Health, and Social Services public sectors. It represents an excellent opportunity to study inter-organizational collaboration and its advantages to public and state-subsidized schools. The propensity score matching technique was used to compare school performance in second grade (the most intensive treatment level) between schools participating in the program and those not participating and between schools with different types of sectoral collaboration to identify the best partner for the school. To select all Chilean schools' participant in CSFL and the comparative group of schools' non-participant, a sequential sampling was applied. The measures were obtained from government public data, considering annual school performance and other educational indicators. It was found that public schools that implement the CSFL obtain better school performance than those that do not implement it (ATT = .042; p < .05), for state-subsidized schools, the same was not found. It was also observed that when educational agencies implement the program, the gain is more significant (ATT = .046; p < .05). The importance of aligning program values and goals with local agencies and schools is discussed, analyzing the possibilities for better collaboration in school mental health.

Resumen Habilidades para la Vida (HPV) es un programa chileno de salud mental escolar multinivel que llega a millones de estudiantes en miles de territorios del país, y es considerado uno de los programas de salud mental escolar más grandes del mundo. Es implementado en el país por agencias locales de los sectores públicos de educación, salud y servicios sociales, lo que representa una excelente oportunidad para estudiar la colaboración interorganizacional y sus ventajas para las escuelas públicas y subvencionadas por el Estado. Este constructo ha recibido gran atención en los últimos años en el campo de la salud mental escolar, dado que destaca la importancia de generar procesos que permitan compartir una identidad colectiva, una agenda coordinada, tener una comunicación efectiva y una colaboración mutua entre los diversos dispositivos que buscan contribuir al logro de las metas de salud mental y a los objetivos educativos de las escuelas. A pesar de los grandes beneficios que traería la colaboración interorganizacional en la ejecución de programas de salud mental escolar, los estudios al respecto son más bien escasos y centrados en intervenciones que vinculan tan solo un tipo de agencia ejecutora con las escuelas. Por este motivo, el presente estudio pretende analizar el impacto de la colaboración interorganizacional en el rendimiento académico de aquellos estudiantes que reciben el programa HPV, teniendo dos hipótesis a la base: (1) que aquellos estudiantes que forman parte de las escuelas en las que se entrega el programa tendrán un mejor rendimiento académico que aquellos que no reciben la intervención; y (2) que el sector educación será el mejor partner o colaborador, puesto que comparte las metas educativas con la escuela, lo que impactaría en el rendimiento académico de aquellos estudiantes que reciben el programa. Para medir esto, se utilizó la técnica Propensity Matching Score, la cual sirvió para comparar el rendimiento escolar de los estudiantes en segundo grado (el nivel de tratamiento más intensivo) entre las escuelas participantes y no participantes del programa, y entre las escuelas con diferentes tipos de colaboración sectorial. Para seleccionar a los participantes de las escuelas chilenas en HPV y del grupo comparativo se aplicó un muestreo secuencial. Las medidas se obtuvieron de datos públicos del gobierno de Chile, y se consideró el rendimiento escolar anual, la vulnerabilidad social de las escuelas y otros indicadores educativos. Se encontró que las escuelas públicas que implementan el HPV obtienen un mejor rendimiento escolar que las que no lo implementan (ATT = .042; p < .05), resultados que no se repitieron en aquellas escuelas subsidiadas por el Estado. También se observó que cuando las agencias educativas implementan el programa, el aumento del rendimiento académico es mayor (ATT = .046; p < .05) respecto que aquellas que lo implementan mediante agencias locales de salud o de servicios sociales. Se discute la importancia de alinear los valores y las metas del programa con las agencias locales y las escuelas, analizando las posibilidades de una mejor colaboración en la salud mental escolar. Esto implica también considerar las metas educativas de cada centro en el cual se implementan estas intervenciones, ya que es posible encontrarse en ocasiones con modelos educacionales restrictivos y tradicionales, centrados por sobre todo en lo cognitivo. Por este motivo, experimentan dificultades al alinearse con programas de habilidades socioemocionales, lo que termina obstaculizando las posibilidades de colaboración interorganizacional con agencias interventoras de dispositivos orientados a esto. En este marco, se exponen una serie de consideraciones clave vinculadas a la importancia de preparar las condiciones y los recursos para el trabajo interorganizacional entre escuelas y entidades ejecutoras de programas de salud mental escolar.

Construcción y validación de una escala breve de capacidades de resiliencia en niños(as) respondida por madres, padres y cuidadores (ECR-P/9-12) / Construction and validation of a brief scale of resilience skills for children answered by mothers, fathers, and caregivers (ECR-P/9-12)

Resumen Introducción: La presente investigación tuvo como objetivo elaborar y analizar las propiedades psicométricas de una escala breve de Capacidades de Resiliencia para niños(as) contestada por madres, padres y cuidadores (ECR-P/9-12). Método: Se siguió un diseño instrumental de cuatro fases: (1) construcción de ítems, (2) Validez de contenido, (3) Entrevistas cognitivas y; (4) Análisis de propiedades psicométricas. Resultados: Inicialmente se construyeron 345 preguntas, las que fueron reducidas a ocho a partir de los resultados de las entrevistas cognitivas y la evaluación Inter-jueces. Los ítems fueron aplicados vía online a 267 apoderados de la Región Metropolitana. El análisis factorial mostró indicadores satisfactorios de bondad del ajuste para el modelo de un factor (RMSEA=0,071; CFI=0.980; TLI=974) y una consistencia interna adecuada (α=0,723), quedando la escala constituida finalmente por siete ítems. Conclusión: La ECR-P constituye una herramienta válida y confiable para la evaluación de capacidades de resiliencia en la infancia, constituyendo un aporte para la promoción, prevención e intervención en salud mental.

Introduction: The present research aimed to elaborate and analyze the psychometric properties of a brief scale of Resilience Capacities for children answered by mothers, fathers and caregivers (ECR-P / 9-12). Method: A four-phase instrumental design was followed: (1) item construction, (2) content validity, (3) cognitive interviews and; (4) analysis of psychometric properties. Results: 345 questions were initially constructed, reduced to eight thereafter from the results of the cognitive interviews and the Inter-judge evaluation. The items were applied online to 267 parents and caregivers in the Metropolitan Region. The factor analysis showed satisfactory indicators of goodness of fit for the one-factor model (RMSEA = 0.071; CFI = 0.980; TLI = 974) and adequate internal consistency (α = 0.723), leaving the scale finally made up of seven items. Conclusion: The ECR-P constitutes a valid and reliable tool for the evaluation of resilience capacities in childhood, constituting a contribution for the promotion, prevention and intervention in mental health.

Experiencias emocionales negativas durante el cierre de las escuelas por COVID-19 en una muestra de estudiantes en Chile / Negative emotional experiences during school closure by COVID-19 in a sample of students in Chile

Resumen Antecedentes: En el año 2019, las escuelas cerraron de forma presencial como medida de contención ante la pandemia del COVID-19, lo que implicó un cambio en los procesos tradicionales de educación y socialización entre los adolescentes. Objetivo: Identificar experiencias emocionales negativas en estudiantes de tres comunas vulnerables de Región Metropolitana de Chile durante este periodo. Método: 3.570 estudiantes de 10 a 18 años pertenecientes a 50 establecimientos educacionales públicos completaron un instrumento online de evaluación de condiciones socioemocionales. El promedio de edad fue de 12,65 (D.E=1,90) y el 52,5% se identificó con el género masculino. Se analizaron los datos a través de la prueba χ2 y Análisis de Clases Latentes. Resultados: Las emociones más experimentadas fueron la soledad y el miedo. La menos frecuente fue el aburrimiento. Se encontraron cuatro tipos de experiencias emocionales: (1) la experiencia de soledad (7%); (2) la experiencia combinada de preocupación, miedo y soledad (35,4%); (3) la experiencia generalizada de emociones negativas (9,6%) y (4) la experiencia de baja emocionalidad negativa (48,1%). Conclusiones: Los estudiantes presentan cuatro tipos de experiencias emocionales, tres de las cuales podrían alertar de un posible problema de salud mental. Estos datos deben tenerse en cuenta al planificar la respuesta sanitaria a corto y largo plazo.

Abstract Background: In 2019, schools closed face-to-face as a containment measure in the face of the COVID-19 pandemic, which implied a change in the traditional processes of education and socialization among adolescents. Objective: identify negative emotional experiences in students from three vulnerable communes of the Metropolitan Region of Chile during this period. Methods: 3,570 students between 10 and 18 years of age from 50 public educational establishments completed an evaluation instrument of socioemotional conditions through an online platform. The average age was 12.65 (D.S=1.90) and 52.5% identified with the male gender. Data were analyzed through the χ2 test and Latent Class Analysis. Results: the most experienced emotions were loneliness and fear, the least frequent was boredom. Four types of negative emotional experiences were found: (1) the experience of loneliness (7%); (2) the combined experience of worry, fear, and loneliness (35.4%); (3) the generalized experience of negative emotions (9.6%) and (4) the experience low frequency of negative emotions (48.1%). Conclusions: Students present four types of emotional experiences, three of which, could alert them of a possible mental health problem. These data should be considered when planning the short and long-term health response.

Impacto de la pandemia por COVID -19 en la salud mental de preescolares y escolares en Chile / Impact of the COVID-19 pandemic on the mental health of preschoolers and school children in Chile

INTRODUCCIÓN: El objetivo de esta investigación es describir el impacto de la pandemia por COVID-19 en la salud mental de una muestra de estudiantes pertenecientes a la Región Metropolitana de Chile desde prekínder a cuarto año de enseñanza básica. MATERIAL Y MÉTODOS: Apoderados de 4772 estudiantes de prekínder hasta cuarto básico de 46 establecimientos de educación pública pertenecientes a 3 comunas vulnerables de la Región Metropolitana de Chile, completaron el cuestionario en línea de condiciones socioemocionales, desarrollado por Acción Educar y la Dirección de Educación Pública, Ministerio de Educación, respecto de sus hijos. El 47,2% de los hijos de los encuestados fueron niñas. La edad mínima fue de 4 años y la máxima de 11 años. RESULTADOS: La pandemia aumentó significativamente todos los síntomas evaluados. El 20,6% de los estudiantes evolucionaron de no presentar síntomas a tener al menos uno. Los síntomas que más aumentaron fueron "Estar triste", "Falta de ganas, incluso para hacer actividades que le gustan" y "Cambios en el apetito (comer más o tener menos hambre)". Mostraron descenso sintomático: "Preocupación por las tareas escolares" y "Quejarse de dolor de cabeza o de guatita". Los síntomas más frecuentes fueron: "Irritabilidad, mal genio" , "No obedecer" y "Cambios en el apetito", sin embargo, la línea de base de estos síntomas antes de la pandemia ya era alta. CONCLUSIONES: Este estudio muestra el considerable impacto de la pandemia en la salud mental de los niños. Estos datos deben tenerse en cuenta al planificar la respuesta sanitaria a corto y largo plazo frente al COVID-19.

INTRODUCTION: The objective of this study is to describe the impact of the COVID-19 pandemic on mental health in a sample of students, between pre-kindergarten and fourth grade from Santiago, Chile. Material and METHOD: Parents of 4772 students from pre-kindergarten to fourth grade from 46 public schools belonging to 3 vulnerable communes of Santiago filled out an online questionnaire regarding their children on socio-emotional conditions, developed by Acción Educar y Educación Pública, Ministry of Education. 47.2 of the children sample were girls. The age range was between 4 and 11 years. RESULTS: there was a significant increase due to the pandemic for all symptoms. 20.6% of the students evolved from having no symptoms to having at least one. The symptoms that increased the most were "Being sad", "Lack of desire, even to do activities that you like" and "Changes in appetite (eating more or being less hungry)". A decline for "Preoccupation with schoolwork" and "Complaining of headache or pain in the throat" was observed. The most frequent symptoms were: "Irritability, bad temper", "Disobey" and "Changes in appetite", however, the baseline symptoms prior to the pandemic was already elevated. CONCLUSIONS: This study shows the substantial impact of the pandemic on children's mental health. These results must be considered when planning short-term and long-term health responses to COVID-19.

Identifying Adjustment Difficulties in Chilean Schools: Psychometric Properties of the Teacher Observation of Classroom / La detección de las dificultades de ajuste en las escuelas chilenas: propiedades psicométricas de la entrevista de observación de los profesores en clase

For preventive interventions in school mental health to be effective, it is essential to have valid and reliable screening instruments that can detect students in need of more support. In order to do this, the present study is aimed at assessing the psychometric properties of the Teacher Observation of Classroom Adaptation, an interview for teachers that measures school adjustment difficulties. The study evaluated 10,287 adolescents participating in a Chilean public program for improving mental health in schools. Of the total sample, 5,815 (56.5%) students were in 6th grade and were 12.91 years old on average (SD = 1.391). Exploratory factor analyses were used to identify four dimensions (behavioral, learning, social, and autonomyrelated difficulties), which were tested using structural equations. Reliability analyses show that all factors have high levels of internal consistency and differ according to age, grade, and extreme poverty. The article discusses the results obtained, their implications, and the importance of performing screening in schools through rigorously assessed psychometric instruments

Para que las intervenciones preventivas en salud mental escolar sean efectivas es esencial contar con instrumentos de detección válidos y confiables, que puedan identificar a los estudiantes que necesitan apoyo. Por ello, este estudio tuvo como objetivo evaluar las propiedades psicométricas del Teacher Observation of Classroom, entrevista para maestros que mide las dificultades de ajuste escolar. El estudio evaluó a 10,287 adolescentes que participaban en un programa público chileno para mejorar la salud mental en las escuelas. Del total de la muestra, 5,815 (56.5%) estudiantes estaban en sexto grado y tenían un promedio de 12.91 años (DE = 1.391). Se llevaron a cabo análisis factoriales exploratorios para identificar cuatro dimensiones (dificultades relacionadas con el comportamiento, el aprendizaje, las relaciones sociales y la autonomía), las cuales fueron confirmadas a través de ecuaciones estructurales. Los análisis de confiabilidad mostraron que todos los factores tenían un elevado nivel de consistencia interna y diferían según la edad, el grado y la pobreza extrema. El manuscrito analiza los resultados obtenidos, sus implicaciones y la importancia de realizar pruebas de detección en las escuelas a través de instrumentos psicométricos rigurosamente evaluados

Adaptación psicométrica de la Escala de Sentido de Comunidad (SCI-II) en escuelas públicas chilenas / Adaptação psicométrica da Escala de Sentido de Comunidade (SCI-II) em escolas públicas chilenas / Psychometric adaptation of the Sense of Community Index (SCI-II) in Chilean public schools

Resumen El presente estudio tuvo como objetivo adaptar la Escala de Sentido de Comunidad (SCI-II) a escuelas chilenas y analizar sus propiedades psicométricas. Se utilizó una muestra compuesta por 2871 estudiantes que cursaban entre 6. ° de enseñanza básica y 4. ° de enseñanza media de la comuna de Calama al norte de Chile. El 52.4 % (n = 1506) se identificó con el género femenino y la edad promedio de la muestra fue de 14.64 (DE = 2.046). Como resultados, el análisis factorial exploratorio indicó una solución de tres factores: conectividad escolar, pertenencia valorada y membresía-reciprocidad; la fiabilidad de la escala fue adecuada (α = .879 para conectividad escolar, α = .884 para pertenencia valorada y α = .716 para membresía reciprocidad); y los análisis confirmatorios indicaron índices de ajuste adecuados (CFI = .939; TLI = .933). Se concluye que el modelo propuesto de la versión adaptada es válido y es utilizable en futuros estudios sobre el sentido de comunidad en el contexto escolar. Al final se discute el valor de este instrumento para las políticas públicas y los procesos de innovación de la educación pública.

Resumo Este estudo teve como objetivo adaptar a Escala de Sentido de Comunidade (SCI-II) a escolas chilenas e analisar suas propriedades psicométricas. Participaram 2871 estudantes que cursavam entre o 6° do ensino básico e o 4° do ensino médio [nomenclatura usada no Chile] da comunidade de Calama, no norte do Chile. 52.4 % (n = 1506) foram identificados com o gênero feminino e idade média da amostra de 14.64 (DP = 2.046). A análise fatorial exploratória indicou uma solução de três fatores: conectividade escolar, pertencimento valorizado e filiação-reciprocidade. A confiabilidade da escala foi adequada (α = .879 para conectividade escolar, α = .884 para pertencimento valorizado e α = .716 para filiação-reciprocidade). As análises confirmatórias apresentaram índices de ajuste adequados (CFI = .939; TLI = .933). Conclui-se que o modelo proposto da versão adaptada é válido e é útil em futuros estudos sobre o sentido de comunidade no contexto escolar. Discute-se o valor desse instrumento para as políticas públicas para os processos de inovação da educação pública.

Abstract This study aimed to adapt the Sense of Community Index (SCI-II) in Chilean schools and to examine its psychometric properties. The validation process was conducted with 2871 students from 6th grade of elementary school to 4th grade of high school in a city of Northern Chile. A 52.4 % (n = 1506) of the sample identified with the female gender and the average age of the sample was 14.64 (SD = 2.046). An exploratory factor analysis indicated a three-factor solution: school connectivity, valued belongingness, and membership-reciprocity. The reliability of the scale was adequate (α = .879 for school connectivity, α = .884 for valued belongingness and α = .716 for membership-reciprocity), and confirmatory analyzes indicated adequate adjustment rates (CFI = .939; TLI = .933). It was concluded that the proposed model of the adapted version is valid and is appropriate to be used in future studies on the sense of community in the school context. Finally, the article discusses the value of this instrument for public policies and innovation processes of public education.

Effects of Psychosocial Adversity on School Maladjustment: A Follow-up of Primary School Students / El efecto de la adversidad psicosocial en la desadaptación escolar: un seguimiento de los alumnos de educación primaria

School maladjustment (SM) is understood as a set of behavioral, social, and emotional difficulties that prevent students from meeting the expectations of their school context. Its appearance during the first years of schooling is linked to school failure and dropout, violent behaviors, mental health problems, and maladaptive trajectories that persist for the rest of an individual’s life. The goal of this study was to identify psychosocial adversity variables capable of predicting the appearance of SM during the first three years of school. By collecting data on school maladjustment, adverse childhood experiences and psychosocial dysfunction, a longitudinal follow-up process was applied to a cohort of 26,108 Chilean students (50.7% female) from the start of their schooling (6.3 years of age in 1st grade) until two years later (8.4 year age mean in 3st grade). Through binary logistic regressions, the results obtained show that mother’s adolescent pregnancy, biological father's absence, mental pathology in a relative, psychosocial dysfunction, and teacher's negative perception of students’ academic and behavioral performance predict the appearance of SM after three years in the school system. The article discusses these results and their implications for the development of preventive programs aimed at reducing SM and mental health problems during childhood

La inadaptación escolar (IE) se entiende como un conjunto de dificultades de comportamiento, sociales y emocionales que impiden que los estudiantes cumplan con las expectativas de su contexto escolar. Su aparición durante los primeros años de escolaridad está relacionada con el fracaso y el abandono escolar, los comportamientos violentos, los problemas de salud mental y las trayectorias de mala adaptación que persisten durante el resto de la vida del individuo. El objetivo de este estudio fue identificar variables de adversidad psicosocial capaces de predecir la aparición de inadaptación escolar durante los primeros tres años de escolarización. Al recopilar datos sobre el desajuste escolar, las experiencias adversas en la infancia y la disfunción psicosocial, se aplicó un proceso de seguimiento longitudinal a una cohorte de 26,108 estudiantes chilenos (50.7% mujeres) desde el inicio de sus estudios (6.3 años de edad en primer grado) hasta dos años más tarde (8.4 años de edad en tercer grado). A través de regresiones logísticas binarias, los resultados obtenidos muestran que el embarazo adolescente de la madre, la ausencia biológica del padre, la patología mental en un familiar, la disfunción psicosocial y la percepción negativa del profesor del desempeño académico y del comportamiento de los estudiantes predicen la aparición de inadaptación escolar después de tres años en el sistema escolar. El artículo analiza estos resultados y sus implicaciones para el desarrollo de programas preventivos dirigidos a reducir los problemas de inadaptación escolar y de salud mental durante la infancia

Comparative study of adolescents with and without ADHD / Perfiles de personalidad: estudio comparativo de adolescentes con y sin TDAH

Abstract Introduction Although an association between attention deficit hyperactivity disorder (ADHD) and personality disorders has been observed in adult population, no descriptions in Chilean adolescents have been reported. Objective To explore personality profiles in Chilean adolescent patients diagnosed with ADHD. Method Non-experimental, comparative design, convenience sample with 61 adolescent patients (13-19 years old) diagnosed with ADHD who completed the Millon Adolescent Clinical Inventory (MACI) questionnaire. Results compared parameters for the Chilean adolescent population and patients in the study. Attending psychiatrists completed a medical history file (comorbidities, pharmacological treatment and factors associated with mental health). Multivariate statistics, cluster analyses, and means comparison analyses were performed. This project was approved by the Ethics Committee of the University of Chile. Results The personality profile of female adolescent patients with ADHD resembles that of the general female population, while the profile of the male patients is similar to that of the patient's parameter group. Cluster analysis identified two personality sub-profiles: 25% of the subjects belonged to cluster 1, which was characterized by higher scores for different personality traits, expressed concerns, and clinical syndromes, compared with subjects from cluster 2. There were no differences regarding gender, ADHD clinical presentation, use of medication, adverse childhood experiences (ACEs), type of school, grade retention, or, applicable only to the female group, comorbidities in belonging to cluster 1. Only the presence of comorbidity in male subjects was associated with cluster 1 membership. Discussion and conclusion Adolescent patients diagnosed with ADHD differed significantly in some personality traits when compared to Chilean parameters for the MACI. Of the adolescents studied, 25% have maladaptive personality characteristics.

Resumen Introducción Aún cuando en población adulta se ha observado una asociación entre el trastorno por déficit de atención con hiperactividad (TDAH) y el trastorno de personalidad, no se han reportado descripciones similares en población chilena. Objetivo Explorar perfiles de personalidad en adolescentes chilenos consultantes diagnosticados con TDAH. Método Diseño no experimental, comparativo y de muestra intencionada con 61 adolescentes consultantes diagnosticados con TDAH (13-19 años), que respondieron el inventario clínico de personalidad para adolescentes de Millon (MACI). Los resultados comparan los parámetros poblacionales de adolescentes no consultantes y consultantes chilenos con los resultados de los pacientes del estudio. Psiquiatras tratantes completaron las fichas de registro (comorbilidad, tratamiento farmacológico y determinantes asociados a salud mental). Se utilizaron estadísticos multivariados de aglomeración, análisis de clúster y análisis de diferencias de medias. Proyecto aprobado por el Comité de Ética de la Universidad de Chile. Resultados El perfil de personalidad de las mujeres consultantes con TDAH se asemeja al grupo de adolescentes chilenas no consultantes y el de los hombres, al perfil de consultantes. El análisis de clúster identificó dos subperfiles de personalidad. El 25% de los sujetos perteneció al clúster 1, que se caracteriza por puntajes más altos para diferentes rasgos de personalidad, preocupaciones expresadas y síndromes clínicos, comparado con los sujetos pertenecientes al clúster 2. Sólo la presencia de comorbilidad en hombres se asoció a la pertenencia al clúster 1, sin encontrarse diferencia por sexo, tipo de TDAH, uso de fármacos, experiencias adversas tempranas, tipo de colegio, repetición de grado escolar y diagnósticos comórbidos, sólo en el caso de las mujeres. Discusión y conclusión Los adolescentes consultantes con TDAH se diferencian significativamente en algunos rasgos de personalidad al compararlos con los parámetros poblacionales chilenos para el MACI. El 25% de los adolescentes estudiados tienen características desadaptativas de personalidad.

Validación de la escala de problemas emocionales y del comportamiento youth self report (YSR/11-18) en una muestra de adolescentes chilenos / Validation of the scale of emotional and behavioral problems youth self report (YSR / 11-18) in Chilean adolescents

El objetivo de este estudio fue realizar la validación y confiabilidad del Youth Self Report (YSR/11-18) en población adolescente chilena. La muestra estuvo conformada por 816 adolescentes, entre 11 y 18 años, provenientes de un colegio particular de la ciudad de Calama a quienes se les aplicó la versión latina del cuestionario. Se realizo un análisis factorial de componentes principales, para la derivación de los síndromes de primer y segundo orden, siguiendo los pasos descritos por Achenbach. Los resultados encontrados demuestran la alta consistencia y validez del instrumento, lo que sumado a los antecedentes reportados convierten al YSR/11-18 en un instrumento de probado valor predictivo en Chile, permitiendo no sólo evaluar competencias sociales y conductuales, sino que podría transformase en un instrumento que permitiese la detección precoz de riesgos en la población adolescente.

The aim of this study was to validate and determine the reliability of Youth Self Report (YSR/11-18) in Chilean adolescents. The sample consisted of 816 adolescents, aged 11 to 18 years, from a private school in the city of Calama, where we applied and the Latin version of the questionnaire. Following the steps outlined by Achenbach, was made a principal components analysis for the derivation of the syndromes of first and second order. The results show high consistency and validity of the instrument, which makes the YSR/11-18 a test of predictive value in Chile, allowing not only to assess social and behavioral skills, but could be transformed into an instrument that would allow the early identification of risks in the adolescent population.

Efectos de la fidelidad de la implementación sobre los resultados de una intervención preventiva en salud mental escolar: un análisis multinivel / Effects of implementation fidelity of the results of a preventive intervention in school mental health: A multilevel analysis

El propósito de esta investigación fue examinar los efectos de la fidelidad de la implementación sobre los resultados de una intervención en salud mental escolar. A través de un diseño de investigación pretest/postest se evaluó la desadaptación escolar a 1,414 estudiantes chilenos de 510 escuelas participantes de un taller preventivo selectivo realizado por 94 equipos psicosociales del programa Habilidades para la Vida. Por su parte, la fidelidad (dosis recibidas por los padres, profesores y estudiantes; pertinencia de la intervención, compromiso directivo, adherencia y satisfacción laboral) fue medida a través de los productos permanentes completados por los equipos durante el período de ejecución del taller y relacionada con los resultados mediante un análisis multinivel. Se encontró una alta fidelidad en los componentes implementados, a excepción de la adherencia (29.8%) y la dosis recibida por los padres (50.1%). Se logró evidenciar que los resultados varían principalmente a nivel del estudiante y que están relacionados con la cantidad de sesiones a las que asisten y con la pertinencia de la intervención para ellos. Se discute la importancia de considerar el contexto relacional en la implementación de intervenciones en el mundo real hispanoamericano

The purpose of this research was to examine the effects of implementation fidelity on the results of a school mental health intervention. Through a pre-test/post-test research design, school inadaptation was assessed on 1,414 Chilean students from 510 participating schools of a selective preventive workshop conducted by 94 psychosocial teams from the Skills for Life program. Fidelity (doses received by parents, teachers and students, intervention relevance, management commitment, adherence and job satisfaction) was measured through the permanent products completed by the teams during the workshop period and related to the results through multilevel regression analysis. A high fidelity was found in the implemented components, with the exception of adherence (29.8%) and the dose received by parents (50.1%). It was shown that the results vary mainly at the student level and are related to the number of sessions they attend and the relevance of the intervention for them. The importance of considering the relational context in the implementation of interventions in the Spanish-American real world is discussed