Universal Programs and Screening

Chile has a widespread universal intervention plan for mental health in its schools, called Skills for Life. It begins in first grade with:

• Screening using instruments like the TOCA-R and a clinical scale called the Pediatric Symptom Checklist.
• Students identified at risk in first grade receive an intervention in second grade in the form of workshops administered by trained bachelor’s-level psychologists.

Skills for Life:

• Is in 20% of Chilean schools
• Has screened over 1 million students in 10 years
• Identifies as at-risk, and provides support to, 16.4% of first-grade students

Students who complete the intervention workshops, compared with those who did not, are less likely to remain at risk, less likely to be held back after third grade and less likely to have poor attendance.³⁷

Many mental health studies of schoolchildren rely on broader teacher reports of behavior and functioning. One of these scales, the Teacher Observation of Classroom Adaptation–Revised (TOCA-R), is used to assess interventions addressing:

• Aggressive and disruptive behaviors
• Concentration problems
• Prosocial behaviors
• Emotion regulation³⁸

Studies have shown that TOCA-R scores may predict later poor outcomes like school dropout, unemployment and mental health disorders, alerting professionals that early intervention may be warranted. It must be noted that large-scale screening often results in “false positive” assessments of risk; effective programs must follow screening with more sensitive appraisals of an individual child.

³⁷ Guzmán, J., Kessler, R.C., Squicciarini, A.M., George, M., Baer, L., Canenguez, K.M., Abel, M.R., McCarthy, A., Jellinek, M.S., 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 and Adolescent Psychiatry, 54(10): 799-807. doi: 10.1016/j.jaac.2015.07.005.

³⁸ Bradshaw, C.P., Waasdorp, T.E., & Leaf, P.J. (2012). Effects of school-wide positive behavioral interventions and supports on child behavior problems. Pediatrics, 130(5). doi: 10.1542/peds.2012-0243