Mental Health Clinical Trial
Official title:
Mental Health Prevention Among Preschool Children: The Effectiveness of I Can Problem Solve (ICPS) Program in Chile Using a Cluster Randomized Controlled Trial
Mental health in Chilean children and families is an urgent public health problem. Prevalence
of psychiatric disorders among children between 4 and 11 years old is 27.8%, a higher
percentage than was found in adolescents between 12 and 18 years old, which is 16.5%. The
most frequent disorders in the population between 4 and 11 years old were disruptive
disorders (20.6%), followed by anxiety disorders (9.2%). Mental health problems generate a
high burden of disease on society in general; and there is an important treatment gap,
especially among economically vulnerable populations. Prevention strategies appear to be the
more recommendable options, mainly if these interventions can be implemented early in life
and at low cost. Few preventive interventions aiming to increase resilience in the face of
adversity, have been rigorously evaluated in Chile among preschoolers. There is substantial
international evidence that shows that strengthening basic psychological skills, such as
emotion regulation and social problem-solving, can reduce the incidence of mental pathology
and improve various academic indicators. The curriculum of the Interpersonal Cognitive
Problem Solving Program, also known as I Can Problem Solve (ICPS), is focused on the
development of the cognitive process and children's social problem-solving skills. ICPS has
been found to be effective in increasing pro-social behaviors and reducing aggressive
behavior among preschoolers. No previous studies in Spanish-speaking Latin American countries
have been conducted aiming to explore the acceptability and feasibility of ICPS to provide
information to evaluate later the effectiveness of this intervention at a larger scale.
The main objective of this study is the evaluation of the effectiveness of an adapted version
of ICPS, in the national context at educational institutions with high socio-economic
vulnerability, on increasing social-emotional competence and reducing emotional and
behavioral problems in preschoolers.
Background. Mental health in Chilean children and families is an urgent public health
problem. Several epidemiological studies have shown that a significant percentage of the
adult population has psychiatric disorders. For example, one recent study showed that 31.5%
of the population aged 15 and over has some type of psychiatric pathology in their lives and
that 22.2% suffered from a mental disorder during the last year. Today we know that many of
the present in the adult population begins in childhood and adolescence and that preventing
their onset can have a significant impact on the future functioning of the individual. The
few epidemiological studies on the Chilean child and adolescent populations show that the
prevalence of psychiatric disorders among children between 4 and 11 years old is 27.8%, a
higher percentage than was found in adolescents between 12 and 18 years old, which is 16.5%.
The most frequent disorders in the population between 4 and 11 years old were disruptive
disorders (20.6%), followed by anxiety disorders (9.2%). Mental health problems generate a
high burden of disease on society in general; and there is an important gap in the treatment
of these, especially in populations that are more economically vulnerable. Prevention
strategies appear to be the more recommendable options, mainly if these interventions can be
implemented early and at low cost. Few preventive interventions, or interventions that
increase resilience in the face of adversity, have been rigorously evaluated in Chile. There
is substantial evidence that shows that strengthening social and emotional learning skills
can reduce the incidence of mental pathology and improve various academic indicators. These
social-emotional skills include the ability to identify and express emotions, to be able to
adapt to social context, to regulate emotions, the ability to inhibit behavior, and
problem-solving skills. Deficits in these skills have been associated with the appearance of
both internalization problems (emotional problems such as depression and anxiety) and
externalization problems (such as disruptive behavioral problems), as well as peer rejection.
The curriculum of the Interpersonal Cognitive Problem Solving Program, also known as I Can
Problem Solve (ICPS), is focused on the development of the cognitive process and children's
social problem-solving skills. That is, it is a program that explicitly promotes cognitive
regulation (skills for listening and paying attention, sequencing and planning tasks) and
solving social problems (thinking up alternative solutions, causal thinking, means-to-an-end
thinking, and sequential planning). But it also includes the promotion and learning of
emotional processes (particularly emotional expression/knowledge, perspective, and empathy).
Several studies conducted among disadvantaged population have shown that students who
received ICPS had better results regarding increasing pro-social behaviors and reducing
aggressive behavior compared with students in the control group. ICPS is a universal
intervention designed to promote interpersonal cognitive processes and problem-solving skills
in children from preschool through 6th grade. This project will adapt the preschool program,
which has a total of 59 sessions. Each session lasts around 20 minutes, and the trained
facilitator follows a simple manual that guides their work with the students on ICPS
vocabulary and concepts and the development of problem-solving skills such as practicing
alternative solutions, consequences and the sequential thought (solutions-consequences). An
interactive technique and guided discussion strategies are used to solve problems.
Interactive methods include games, role-playing, and the use of stories, illustrations, and
puppets. These contents may also be used in other curricular activities for children, whether
they are working on Math, Reading or Science. Children learn how to think and not what to
think.
Aims. The general objective of this study is the evaluation of the effectiveness of an
adapted version of ICPS, in the national context at educational institutions with a high
socio-economic vulnerability, on increasing social-emotional competence and reducing
emotional and behavioral problems in preschoolers.
Methods. A cluster randomized controlled study will be conducted to asses the effectiveness
of the culturally adapted version of ICPS on increasing social-emotional skills and reducing
behavioral problems. There will be two arms: 1) Schools implementing the ICPS program
delivered by an early teacher hired and trained by the research team, who will work
collaboratively with the school early teacher; 2) A control group will consist of school
implementing their usual teaching activities.
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