Chile’s Skills for Life (SFL) program, the largest school-based psychosocial intervention program in the world, has demonstrated improved behavioral and academic outcomes for elementary students identified as “at risk.” A team of Chilean and U.S. researchers assessed the SFL program and will publish their results in the October issue of the Journal of the American Academy of Child & Adolescent Psychiatry (JAACAP).
The authors claim that the study is the first “to provide empirical evidence that a large-scale preventative intervention for mental health has a significant positive association with improved student behavioral and academic outcomes.”
The paper is also accompanied by a lead editorial in JAACAP by Guilherme Polanczyk from the University of Sao Paulo in Brazil. “Most interventions are small-scale programs, targeting narrow populations or goals, with obscure theories of change, no integration with families or the community, inadequate implementation, tested with poor and heterogeneous methodologic approaches, and thus limiting the chances of generalization of different settings,” Polanczyk writes. “This study serves as an exemplar for the fruitful partnerships between academic and government institutions—and across distant international borders.”
Javier Guzmán of the Universidad del Desarrollo in Chile was the national coordinator of the SFL program and is now a doctoral student at Boston University. He explains that the program was developed by a multidisciplinary team of experts after the Chilean department of education made addressing mental health a priority for schools. Beginning in 2001, SFL has been running on a national scale, primarily in elementary schools that have been labeled high risk based on factors such as average family income or maternal education levels.
The SFL program has been implemented in 1,637 primary schools throughout Chile and 98% of these schools were included in the study. Within participating schools, all first-grade students are screened using parent and teacher surveys, and students whose scores indicate psychosocial risk are referred to SFL workshops that begin in second grade. The workshops consist of 15 sessions; 10 with students, 3 with parents, and 2 with the teacher. The student sessions consist of groups of 6-10 students and are led by a psychologist for 1.5-2 hours. The courses are modeled on cognitive-behavioral therapy and are designed to utilize discussions and physical activities that encourage self-esteem and concepts such as respect for self and others, autonomy, and honesty. These students are then posttested in third grade.
Guzmán and his team found that of the children deemed at risk in first grade and placed in SFL programs “there was a significant positive association between the number of workshop sessions in which the student participated and the magnitude of improvements in both teacher and parent-rated behavior.” In addition, the program was found to have a significant impact on school-related measures, such as end of year promotion and attendance, which “speaks directly to the relevance of the intervention- and mental health- to academic success.”
The positive results of the study have encouraged the Chilean government to add several hundred new schools to the program for the following year. The authors conclude: “By making a national commitment to improving the educational achievement of its most vulnerable students through an innovative mental health program using comprehensive and continuing evaluation, the government of Chile has set an international standard of excellence that should inspire other countries.”
Michael Murphy, a senior author of the paper and a researcher at Massachusetts General Hospital, writes: “These findings suggest that school-based mental health programs could play an important role in achieving better educational outcomes for whole countries as well as individual children. Our findings also provide evidence that non-pharmacological interventions can be effective.”
In a podcast for JAACAP, Murphy remarks that the SFL program is unique in that it involves a partnership between the national government and the local schools. The fact that the schools must opt-in to the program may ultimately lead to greater participation from parents, a problem that has arisen in similar programs in the US.
Guzmán, J., Kessler, R. C., Squicciarini, A. M., George, M., Baer, L., Canenguez, K., … & Murphy, J. M. (2015). Evidence for the Effectiveness of a National School-Based Mental Health Program in Chile. Journal of the American Academy of Child & Adolescent Psychiatry. (Abstract)