title: Evidence for the effectiveness of a national school-based mental health program in Chile.
abstract: OBJECTIVE
  Skills for Life (SFL) is the largest school-based mental health program in the world, screening and providing services to more than 1,000,000 students in Chile over the past decade. This is the first external evaluation of the program.
  
  
  METHODS
  Of the 8,372 primary schools in Chile in 2010 that received public funding, one-fifth (1,637) elected to participate in SFL. Each year, all first- and third-grade students in these schools are screened with validated teacher- and parent-completed measures of psychosocial functioning (the Teacher Observation of Classroom Adaptation-Re-Revised [TOCA-RR] and the Pediatric Symptom Checklist-Chile [PSC-CL]). Students identified as being at risk on the TOCA-RR in first grade are referred to a standardized 10-session preventive intervention in second grade. This article explores the relationships between workshop participation and changes in TOCA-RR and PSC-CL scores, attendance, and promotion from third to fourth grades.
  
  
  RESULTS
  In all, 16.4% of students were identified as being at-risk on the TOCA-RR. Statistically significant relationships were found between the number of workshop sessions attended and improvements in behavioral and academic outcomes after controlling for nonrandom selection into exposure and loss to follow-up. Effect sizes for the difference between attending most (7-10) versus fewer (0-6) sessions ranged from 0.08 to 0.16 standard deviations.
  
  
  CONCLUSIONS
  This study provides empirical evidence that a large-scale mental health intervention early in schooling is significantly associated with improved behavioral and academic outcomes. Future research is needed to implement more rigorous experimental evaluation of the program, to examine longer-term effects, and to investigate possible predictors of heterogeneity of treatment response.
authors.affiliation: Skills for Life Program of Junta Nacional de Auxilio Escolar y Becas (JUNAEB) Chile; Universidad del Desarrollo, Santiago, Chile, and Boston University School of Education, Boston.
authors.forename: Javier
authors.initials: J
authors.lastname: Guzmán
authors.affiliation: Harvard Medical School, Boston.
authors.forename: Ronald C
authors.initials: RC
authors.lastname: Kessler
authors.affiliation: Skills for Life Program of Junta Nacional de Auxilio Escolar y Becas (JUNAEB) Chile.
authors.forename: Ana Maria
authors.initials: AM
authors.lastname: Squicciarini
authors.affiliation: Universidad of Chile, Santiago.
authors.forename: Myriam
authors.initials: M
authors.lastname: George
authors.affiliation: Massachusetts General Hospital, Boston; Harvard Medical School, Boston.
authors.forename: Lee
authors.initials: L
authors.lastname: Baer
authors.affiliation: Massachusetts General Hospital, Boston; Harvard Medical School, Boston.
authors.forename: Katia M
authors.initials: KM
authors.lastname: Canenguez
authors.affiliation: Massachusetts General Hospital, Boston.
authors.forename: Madelaine R
authors.initials: MR
authors.lastname: Abel
authors.affiliation: Rutgers University, New Brunswick, NJ.
authors.forename: Alyssa
authors.initials: A
authors.lastname: McCarthy
authors.affiliation: Harvard Medical School, Boston.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Jellinek
authors.affiliation: Massachusetts General Hospital, Boston; Harvard Medical School, Boston. Electronic address: mmurphy6@partners.org.
authors.forename: J Michael
authors.initials: JM
authors.lastname: Murphy
mesh_terms: D000124:Achievement; D000067290:Behavior Rating Scale; D002648:Child; D002675:Child, Preschool; D002677:Chile; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis* / Q000517:prevention & control; D008605:Mental Health Services; D000066553:Problem Behavior; D015397:Program Evaluation; D011569:Psychiatric Status Rating Scales; D012572:School Health Services; D012574:Schools; D013334:Students
keywords: academic achievement; behavior problems; children’s mental health; school-based interventions