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.

Implementation strategies and outcomes of school-based programs for adolescent suicide prevention: A scoping review protocol.

OBJECTIVE: This scoping review aims to identify and map the empirical literature on the implementation strategies and outcomes of school-based programs for adolescent suicide prevention (SBASP). INTRODUCTION: School-based programs are preferred interventions for preventing suicide in adolescents, and their effectiveness has been well-systematized in several reviews. Implementation research is a growing field for prevention programs, making it possible to understand the nature of success or failure outcomes and maximize intervention benefits. However, there is a knowledge gap in the implementation research applied to adolescent suicide prevention in the educational context. We conduct a scoping review to provide the first overview of the scope of implementation research applied to adolescent suicide prevention programs in the school setting to know what implementation strategies and outcomes are reported by these programs and how they are evaluated. METHODS: The proposed scoping review will be conducted following six stages, including the definition of objectives. Studies must be empirical and address implementation strategies or implementation outcomes of school-based programs for adolescent suicide prevention. Studies that focused exclusively on clinical efficacy or effectiveness evaluation will be excluded. A preliminary search of PubMed was conducted to refine the initial search strings, followed by a final search of several other electronic databases. Finally, a gray literature search will identify unpublished literature and reduce location bias. There will be no limits to a specific date. Two independent reviewers will screen, select, and extract the retrieved records. The results will be presented using tabular forms and a narrative summary with attention to the review objectives and research questions and their implications for research and practice of school-based programs for adolescent suicide prevention.

[Disparities in the use of mental health services of adolescents in Chile]. / Disparidades en el uso de servicios de salud mental de adolescentes en Chile.

OBJECTIVE: To examine disparities in the use of mental health services (MHS) in adolescents according to sociodemographic factors. SUBJECTS AND METHOD: 2,022 adolescents aged 13-19 years in Santiago, Chile, participated in the study. Between April and May 2008, they answered a self-report survey that assessed lifetime (history of treatment for depression) and current (psychological or pharmacological treatment) use of MHS, sociodemographic variables, and psychopathology as symptoms of depression, symptoms of generalized anxiety disorder, and risk of problematic substance use. Data were analyzed using logistic regression. RESULTS: 16.5% of participants reported lifetime use of MHS due to depression, 9.7% were on current psychological treatment, and 2.7% were on current pharmacological treatment. Among those meeting criteria for a mental health problem, only 14.9% to 18.9% were currently on treatment. Males, younger participants, and those who had immigrants' parents reported lower lifetime use of MHS due to depression. Those with parents with 9 to 12 years of education and who had immigrants' parents reported lower current MHS use. Youth not living with both parents reported higher lifetime and current MHS use. CONCLUSIONS: We observe a high treatment gap in those with mental health needs as well as differences in MHS use based on socio-demographic variables. These results may be useful for planning interventions that favor access to and use of MHS, especially in the most disadvantaged groups of adolescents.

Public Policy Responses to Address the Mental Health Consequences of the COVID-19 Pandemic: Evidence From Chile.

Objectives: This paper reviews the mental health policies that have been implemented in Chile in response to the COVID-19 pandemic and the international context of countries' responses. Even before the start of the pandemic, there were significant barriers to access mental health services in Chile, coupled with a scenario of nationwide social unrest and protests that questioned the legitimacy of public institutions; now the rapidly worsening outbreaks of COVID-19 are exacerbating the pre-existing mental health crisis. Methods: We conducted a bibliometric and content analysis of the Chilean mental health public policies implemented during the COVID-19 pandemic and then compared these policies with international experiences and emerging scientific evidence on the mental health impact of pandemics. Results: Our analysis of the policies identifies five crucial points of action developed in Chile: (i) an established framework to address mental health in emergency and disaster situations; (ii) a timely COVID-19 Mental Health Action Plan; (iii) inclusion of mental health in the public health agenda; (iv) development of a presidential strategy during the pandemic for comprehensive mental health and well-being; and (v) emerging research assessing the mental health implications of COVID-19. Conclusions: In Chile, the public policy responses to address the mental health consequences of the COVID-19 pandemic has been characterized by the coordinated implementation of mental health plans, ranging from a health sectoral initiative to inter-agency and intersectoral efforts. However, it is imperative that increased funding is allocated to mental health, and efforts should be made to promote the participation of people with lived experiences and communities in the design and implementation of the proposed actions. This aspect could be of key importance to social peace and community recovery after the pandemic.

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

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