Participatory Design and Feasibility of a Multicomponent Intervention to Improve the Well-being of Elementary School Children After the COVID-19 Pandemic
Phase: NA
Conditions: Child Mental Health
Sponsor: Universidad de Valparaiso

XVIII NATIONAL COMPETITION FOR RESEARCH AND
DEVELOPMENT PROJECTS IN HEALTH
FONIS 2021
PROJECT TITLE
"Participatory Construction and Feasibility of a Multicomponent Intervention to
Improve the Well-Being of Basic Education Children after the COVID-19 Pandemic"
(CONSTRUCCIÓN PARTICIPATIVA Y FACTIBILIDAD DE UNA INTERVENCIÓN
MULTICOMPONENTE PARA MEJORAR EL BIENESTAR DE NIÑOS DE EDUCACIÓN
BÁSICA DESPUÉS DE LA PANDEMIA )
FONIS SA21I0143
January 2022

SUMMARY
Child mental health (CMH) is essential to developing mental, physical, and social health in
adulthood. Preventing and intervening early in problems during this stage is a valuable strategy for
public health
1–4. Unfortunately, Chile has a high prevalence of MH problems in childhood and
adolescence, especially between ages 4 and 11 5.
The school system is an important place to investigate emotional and behavioral problems in
children and adolescents. However, the system has not always had a coordinated, functional
intersectional network to respond to the required demand. This project aims to improve the mental health
of children and the school community through a multicomponent intervention. This program is based on
a biopsychosocial mental health perspective that goes beyond the mere absence of disease, prioritizing
protective resources, especially those related to social support and networks that are necessary for human
well-being. The intervention includes two key components: 1) Participatory design and implementation
of an online CMH literacy program for teachers of Public Educational Establishments (PS) with basic
education. The program will be designed and implemented through a participatory process of
intersectional agents, with special emphasis on the needs expressed by teachers of the educational
establishments where it will be implemented. 2) Reactivation and coordination of the CMH network of
Valparaíso, including relevant actors of the community, the health system, and education in 2 sectors
(neighborhoods) of Valparaíso. This will be done by adapting the "ECO Barrio Solidario" program 6,7,
which was a model of good practices in health in 2019, to the new socio-sanitary context, in coordination
with the COMNSE 2.0 organized by the Municipal Health Corporation of Valparaíso. 8.
A two-year project is proposed, to be developed in four EEPs in Valparaíso. During the first 12
months, we will work on the construction of the literacy intervention with key actors of each
establishment defining objectives, methodology and scope of the program, and then build the online
platform with videotaped educational capsules. The network of children's MH or "ECO-Barrio
Network" will be articulated with the local agents of the network (Local Public Education Service,
National Service for Minors, Valparaíso-San Antonio Health Service, Municipality of Valparaíso and
Primary Health Care other sectors involved). In the following 12 months, the literacy intervention will be
applied in 4 of the 8 schools recruited, so that the other 4 schools will remain as a control. Finally, the
intervention will be applied in the four schools that did not previously participate in the program. The
results will be evaluated with indicators of acceptability, feasibility and effect in terms of achieving a
better knowledge of the faculty about CMH, a pertinent and timely investigation of mental health studies
at the school level and reduction of waiting times for care in the health and child protection system.
The results of this study will allow us to obtain the necessary information to design a larger study to
evaluate the effectiveness and external validity of this multicomponent intervention.
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1. RELEVANCE OF THE TOPIC AND CHARACTERIZATION OF THE PROBLEM
1.1.
RELEVANCE OF THE TOPIC
Children's mental health is the basis of comprehensive health as an adult, which is why prevention
and early intervention is relevant and has proven to be a valuable strategy in Public Health 1–4. 
According to the latest WHO Burden of Disease report of 2017, it is estimated that in Chile, Mental
Health (MH) problems are one of the main causes of years of healthy life lost9. In the child population,
psychiatric disorders also produce a burden of disease in children between 1 and 9 years (30.3%)
and adolescents between 10 and 19 years (38.3%) (MINSAL, 2007)10. The epidemiological study in MH
child and adolescent of Vicente, De la Barra et al (2012), investigated a total prevalence of 22.5 % of
mental disorders, higher in children between 4 and 11 years (27.8%) than in adolescents between 12 and
18 years (16.5%). The most frequent disorder up to the age of 11 was Attention Deficit Disorder
(ADHD), which can seriously hinder schooling (adaptation, performance and well-being at this vital
stage). In addition, they found an association between prevalence of affective disorders with history of
sexual abuse, family psychopathology, and living with only one parent, while poverty and school
dropout were related to higher prevalence of substance use disorders. The importance of preventing and
treating mental health illnesses in children and adolescents (CA) has been incorporated by the Ministry
of Health 11 through the National Mental Health Plans in recent decades12.
A worsening of the MH of children and adolescents in Chile is estimated in the last two years due
to factors associated with the social crisis and the SARS-CoV-2 pandemic13. On the one hand, the social
crisis began in October 2019 and manifested itself through collective action with massive participation
of the population, in response to decades of growing socioeconomic inequality and weakening of the
social safety net14. The social crisis led to violent repression by the security forces, which was
particularly brutal in the poorest neighborhoods of the country15. The modest evidence on the emotional
effects of community violence on children suggests that social unrest must have increased clinically
significant mental health problems in the child population 16,17. The study of the “Defensoría de la Niñez”
(DDN)18, in its qualitative component with 73 children, between 4 and 17 years old, investigates the
effects of the state of exception and after the social crisis, showing that symptoms of post-traumatic
stress were present, especially in children from territories exposed to high levels of violence. During the
period studied, 803 cases of violations of children’s rights were known, where 51% of children and
adolescents were in marches or demonstrations in contrast to 27% who were in everyday situations.
On the other hand, Chile is among the countries with the highest mortality in the world from
COVID-19 19. While children have been spared much of the direct health impacts of the pandemic, they
have seen their emotional and educational development disrupted, along with their social lives
drastically reduced due to forced or voluntary confinement19, social isolation, interruption of schooling,
overload of caregivers at home and risk of child abuse,
which entails effects not yet sufficiently
dimensioned in the mental health of children. Both international organizations and local leaders have
warned of the possibility of a so-called "fourth wave" in relation to the pandemic, that is, an increase in
mental illnesses in the population as a result of isolation, confinement, fear of contagion, over-exposure
to worrying or morbid news, and uncertainty or economic problems, adaptation to teleworking and
childcare without a support network, among 20 others.
Several researchers in the country have evaluated the impacts of the pandemic on the mental
health of the child and adolescent population. The study "Let's Take Care of Our Children", for example,
conducted 6149 online surveys of parents throughout Chile with children between 0 and 11 years old
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during the year 2020, and investigated an increase in sleep problems (43% of the sample) and
behavioral and emotional symptoms (61% were more emotionally reactive, 43% more disobedient, and
41% with increased appetite)21. In the study conducted by Larraguibel, Halpen and Montt (2020)22,
which includes an online survey of 4,772 parents of children between 4 and 11 years of age belonging
to public educational establishments, 20.6% of parents reported emergency mental health symptoms in
children who were asymptomatic prior to the pandemic; the most frequent symptoms were "irritability or
bad temper", "failure to obey" and "changes in appetite."18 In young people, the study by Carvacho,
Morán et al., which applied the same survey on mental health in 2016 and 2020 in equivalent samples of
university students between 18 and 25 years of age in the Valparaíso region, observed that in 2020 both
the group of men and women presented a significant increase in depressive symptoms23.
Although there is no evidence on the differential impact of the pandemic among children of different
socioeconomic backgrounds, it is likely that the mental health effects are even worse in sectors affected
by poverty and social precariousness24, either by direct effect or mediated by the greater impact of the
pandemic on their parents and communities. The study of Olhaberry et al. 25, who interviewed 1205
families with children from 0 to 5 years old, showed that parents of low Socioeconomic Level (SES)
increased their levels of sadness in relation to the pre-pandemic period, while those of high NSE
perceived greater support from their partners and did not change their levels of sadness. While the
researchers did not evaluate effects on children in the families studied, these data suggest an increased
risk of emotional problems in children of low SES.   
The pandemic has severely affected children's connection to community agencies that normally
provide emotional support (e.g., teachers and grandparents and another extended family) and to the
health system, whose ability to respond to health problems unrelated to COVID-19 has been
dramatically
reduced
(https://www.uchile.cl/noticias/166368/pandemia-e-infancia-como-ha-afectado-el-desarrollo-de-ninos-y-
ninas). Given the above, it is likely that much of this mental health problem has not been detected or if
it has been, it has not been adequately treated, further widening the gap in attention to mental health
needs.
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1.2.
PROBLEM STATEMENT
In consideration of the high prevalence of mental health problems of children and adolescents in
Chile and the increase already observed and even more expected in the context of the COVID-19
pandemic, it is imperative to address one of the many barriers that have been reported as maintaining the
gap between the need for care and the health system's response 5,26–28.
The literature reports several barriers such as: difficulty in recognizing or identifying their
children's MH problems by parents 29,30, parental beliefs about mental health services 31, perception of
availability of care services, waiting lists and satisfaction with previous experiences32 , among others. In
adolescents, less help-seeking is reported compared to a greater perception of difficulty of access to
specialized centers33 and greater requests when parents appear sensitive to the problems of their
children34. However, there are international figures that report only 17% of consultations from parents35
without data in Chile in this regard. In turn, international and national evidence shows that the highest
percentage of requests for mental health help derive from school teachers between 36% and 21.9%, with
the main problems being school-disruptive and emotional (50% and 17% respectively)35. In Chile, it
has been reported that only 41.6% of children and adolescents with psychiatric disorder associated with
social disability consulted in some type of service in the last year5, as well as, a large proportion did not
receive specialized care.
Given that the school environment, with its different actors, is the primary source of referral to
MH of children, it has been a privileged instance for the investigation of emotional and behavioral
problems. However, the school community does not always have the knowledge to differentiate which
problems can be addressed at the primary level and which require attention by trained specialists36, nor
does it have a coordinated and functional intersectoral network to respond to the required
demand. Precisely, I respect one of the ways in which the problem of referral of children and
adolescents to evaluation and treatment in CMH has been addressed.
In Valparaíso, an important part of the team of this project developed the “Eco Barrio Solidario"
Program between the years 2015 – 2019, based on the principles of the community approach of the
National Mental Health Plan in our country. The objective was to strengthen intersectoral links (Health,
National Service for Minors, Education and Community Organizations) to promote environments that
facilitate the well-being and MH of children in the Baron Territory, Placeres and Quebrada Verde. The
results were as follows: Regarding the problematization and through a participatory process, it was
concluded a dismantling of the intersectoral network that intervenes in the process of development of the
mental health of the child and youth population of Valparaíso in general and of each territory
corresponding to the CESFAM Baron, Quebrada Verde and Placers. Specifically, the representatives of
the education sector alluded to the difficulty in referral and access, the representatives of the
Primary Health Care (PHC) to the need for an ecological approach, SENAME to the presence of
different languages and logics, lack of space for communication with health and the Child and
Adolescent Unit of the Psychiatric Hospital of El Salvador to the need for comprehensive treatments and
support in early screening. Regarding referrals, through the ECO form, significantly higher figures are
reported to PHC than to specialized care service, in this case Child and Adolescent Outpatient Unit,
Salvador Hospital considering the years 2016, 2017 and 20186. In turn, in 2020, the Joint
Health-Education Commission (COMSE)8 of
Valparaíso reinforces the need for a rearticulation of
intersectionality to face the socio-health crisis in educational communities, collecting expectations of
constant and contextualized training to the territory, greater resolutivity and community participation,
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collecting elements of the aforementioned ECO Barrio Solidario program for children, which had good
valuation from its participants. 8
Therefore, at the end of the COVID-19 pandemic we will face an increase in mental health
problems in children, for which it is essential to improve the ability to identify them through their
teachers and parents, as well as the articulation of a community network and local services to meet these
needs, Both aspects being the components of the intervention that seeks to develop and evaluate in this
proposal.
1.3 ANALYSIS OF THE STATE OF THE ART
The concept of Mental Health Literacy (MHL). introduced in 199737, was defined as the set of
"knowledge and beliefs about mental disorders that help their recognition, management or prevention".
Consist in set of elements that includes aspects such as: a) ability to recognize the development of mental
disorders and thus facilitate the search for early help; (b) knowledge and beliefs about risk factors, the
causes of these disorders and how to prevent them; c) knowledge of effective treatments and self-help
strategies and available professional help; (d) attitudes that facilitate recognition and appropriate
help-seeking; and (e) knowledge and skills to provide initial mental health help to others. It is, therefore,
a question of training the general population on mental health38. Kutcher et al. 39 in 2013, proposed a
modification to the concept of MHL by identifying four components: a) The ability to understand how to
optimize and maintain good mental health, b) Understanding mental disorders and their treatment. c)
maintaining appropriate attitudes towards those living with mental disorders and developing actions to
reduce stigma. This last description can be considered more complete, since it emphasizes the
importance of fighting the stigma that mental health diseases produce.
40. There is considerable
agreement that one of the best places to carry out MHL strategies would be in educational
establishments. This is due to the fact that young people spend much of their time in the school, have
these places incorporated as centers to acquire knowledge, in addition to the fact that there is greater
ease of being able to execute MHL programs through the incorporation of these topics into the
curriculum and / or through recreational activities36, being a strategy that can also be developed by low-
and middle-income countries41 Although it has been considered that this process can begin in
adolescence, since this stage coincides with the onset of mental disorders 36, in our country, there is a
large number of children under 11 years of age with mental health disorders, therefore, it would be
justified to start interventions in primary school42. There are several systematic reviews of the literature
that have aimed to search for and describe the different mental health literacy programs in schools 43–45.
In these, it is highlighted that most of the MHL programs in schools are aimed at high school
students(92.3%), with only 7% of them destined to primary education 46 and that, although prevention
measures are considered cost-effective, most of these take place in developed countries46.
Among the programs described in the reviews, those with a higher level of evidence and that are
mainly aimed at health promotion in primary school students, are:
1) "The Mental Health and High School Curriculum Guide": Aims to increase awareness
of mental disorders and their treatments, as well as increase understanding of how to obtain and
maintain mental health, reduce stigma and improve the effectiveness of help-seeking47.
The Guide is
applied by regular classroom teachers who have been trained in its application, in regular classroom
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teaching, and has been designed to be integrated into a health promotion course that is already part of the
existing curriculum in the Canadian education system. Implementation takes about 10 to 12 hours of
class. Teachers participate in a 1-day training session to familiarize themselves with The Guide and
improve their own MHL before implementing it in their48 classrooms. It has been seen that the
application of "The Guide" in Canada, managed to increase the knowledge of students and staff, reduce
stigma and increase the search for help by students49. Reduced stigma, more adaptive coping, better
lifestyle choices and less perceived stress were also found for students who received "La Guía" in
Nicaragua
50. For example, when assessing mental health knowledge with an instrument designed
specifically for this intervention, it varied significantly from an initial score of 15.45 points (SD: 3.97;
range 0-28 points) to 19.5 points (SD: 3.39) post-test and 19.11 points (SD: 4.04) at two-month
follow-up (p<0.001). Regarding the attitude towards mental health diseases, this was evaluated with
an instrument that scored between 8 and 56, where a higher score indicates a better attitude, and
demonstrated a variation of 42.56 (SD: 6.08) points before the intervention to 46.42 (SD: 5.67) points at
the end of this (p<0.001)51 . We consider that the application of this program in our country would be
hindered since, although its results are statistically significant, they are clinically unattractive (modest
difference between baseline and post-test evaluation) and, on the other hand, Chile does not have a
defined subject within which this strategy could be incorporated, which would lead to increase the
existing curriculum or displace other topics considered relevant by the Current regulations. Another
aspect to consider is the one that has been preferably applied to adolescents, with an experience in
progress with children of 9 years 52.
2) "The Incredible Years - Teacher Classroom Management Training" (IY-TCM): Its
objectives are: a) Improve teachers' management skills and improve teacher-student relations b) Help
teachers develop effective individual and group behavior plans to enable proactive (rather than reactive)
management c) Encourage teachers to adopt and promote social and emotional regulation skills and, d)
Encourage teachers to strengthen positive relationships between teachers and parents. It uses a variety of
methods to impart the formation of these four principles and is mainly based on the theory of cognitive
social learning53. For its implementation, it requires six full-day sessions with teachers, separated by a
month between each one. A good summary of the evidence around this program is found in the report
of the randomized clinical trial STARS53, where it is reported that in previous studies, for example in that
of Murphy et al.
43 teachers and 1192 students were evaluated, demonstrating a high degree of teacher
satisfaction with the intervention, and a statistically significant effect on the "Positive Climate in the
classroom", improving it from 5.46 before the intervention to 5.77 post-intervention (b = 0.37, p = 0.02,
d = 0.45). This result did not show that it was maintained at one-year follow-up and no significant
changes were observed in the results that assessed pupils' behavior at a targeted level. In an experience
outside the United States, IY-TCM was applied to 1037 primary school students in the
United
Kingdom, comparing them with 1038 in the control group. The study found that IY-TCM improved
childhood mental health, according to the teacher-reported SDQ-TD score, by 1.0 point [95% confidence
interval (CI) 0.1 to 1.9; P = 0.03] at 9-month follow-up. However, there was little evidence of an effect
on follow-ups at 18 months (P = 0.85) and 30 months (P = 0.23). Interaction tests indicated that IY-TCM
led to greater reductions in teacher-reported SDQ-TD score at 9 months (interaction p<0.001) for
children who were classified as having mental health problems at baseline (mean difference -2.6, 95% CI
= –4.6 to –0.6) than for children who were not (mean difference –0.4, CI95%= –1.2 to 0.4)53. We believe
that the strengths of this program are given by being aimed at elementary school students, as well as the
7

ease of its implementation. However, its limitations include the inconsistency of results in the different
randomized clinical trials (RCTs). In addition, it is an intervention that primarily addresses behavioral
alterations, and in the population under 11 years of age, anxiety disorders are a group that has a high
prevalence42.
3) "Promoting Alternative Thinking Strategies" (PATHS): This program is aimed at reducing
violent behaviors as a main objective. The PATHS curriculum focuses on five major domains of
functioning, including self-control, emotional understanding, positive self-esteem, relationships, and
interpersonal problem-solving skills. An additional goal is the reduction of aggression and other
behavioral problems. Lesson activities include role-playing and storytelling54. In a study involving the
randomization of students from 14 schools (7 PATHS/7Control) from 3rd to 5th grade, it showed that, in
terms of the results that were rated by teachers, PATHS showed a slowdown in behavior problems (b
= -.111, t = -3.022, p = .023) and a tendency for a slowdown in aggression (b = -.137, t = -1.797, p =
.122) For outcomes that were rated by students, there were no significant intervention effects associated
with self-reported aggression, delinquency, or victimization in school. However, there were significant
effects associated with each of the social information processing variables, i.e., there was a linear trend
toward the importance of students' normative beliefs about aggression (b = -.464, t = -1.779, p = .126).
In addition, significant linear effects were found for aggressive social problem solving (b = -.023, t =
-2.606, p = .040), hostile attribution bias (b = -.041, t = -2. 811, p = .031) and aggressive interpersonal
negotiation strategies (b = -.038, t = -2.767, p = .033)55. On the other hand, Humphrey et al, could not
replicate these results, concluding that for the outcomes evaluated, Effect sizes were small in all cases.
suggesting that social and emotional learning interventions such as PATHS may not be as effective when
implemented outside their home country and evaluated in independent trials54. It is this irregularity, as
well as the low effect size of this intervention, which can be counted among its main limitations. 
4) In relation to this last program, it is important to highlight the strategy
"Social and
Emotional Learning" (SEL), given that its findings have been applied in a large number of different
interventions and, therefore, has a large amount of evidence that justifies its use, demonstrating
significant effects consistently, especially when the intervention was less Day by teachers. Durlak meta
analyzed 213 studies that used SEL as the axis of intervention in schools, reporting significant results at
the level of: Social-emotional skills: g=0.57 CI 95% (0.48-0.67); attitudes: g=0.24 CI 95% (0. 0-16-30);
positive social behaviors: g=0.24 CI 95% (0.16-0.32); behavioral problems: g=0.22 95% CI (0.16-0.29);
emotional distress: g=0.24 95% CI (0.14-0.35) and academic performance: g=0.27 95% CI (0.15-0.39).
These interventions, when mediated by teachers, show a slightly better performance in the areas of:
socio-emotional skills: g=0.62 95% CI (0.41-0.82); positive social behaviors: g=0.26 95% CI
(0.15-0.38); emotional distress: g=0.25 95% CI (0.08-0.43) and academic performance: g=0.34
95% CI (0.16-0.52) 56.
Lawson et al. 57 identified the core components of the various SEL-based
interventions: a) social skills, b) identification of one's own feelings, c) identification of the feelings of
others, d) behavioral coping and relaxation skills. This information facilitates the construction of local
literacy strategies, optimizing the process by focusing on these aspects. 
5) The "Life Skills" (“Habilidades para la Vida” HPV) program, developed and implemented
in
Chile, stands out worldwide as one of the strategies that has a very extensive and sustained
application over time43, with positive evidence in improving all the items evaluated with the TOCA-R
instrument, comparing the scores obtained pre and post intervention: attention span and concentration:
18.11 points (SD: 4.13) versus 15.39 (SD: 5.17); common achievements: 16.24 (SD: 4.49) versus 13.88
8

(SD: 5.37); acceptance of authority: 28.45 (SD: 9.18) versus 21.94 (SD: 10.06); activity level
(hyperactivity): 12.78 (SD: 4.33) versus 9.50 (SD: 4.43), social contact: 19.80 (SD: 5.79) versus 15.82
(SD: 6.47) and emotional maturity: 23.52 (SD: 5.21) versus 20.73 (SD: 6.06). It has also been shown to
achieve significant differences in reducing psychosocial dysfunction, decreasing the Pediatric Symptoms
Checklist (PSC) score from 46.79 (SD: 25.25) before the intervention to 40.95 (SD: 27.57)
post-intervention58. Guzman et al. demonstrated that the efficacy of this program varies according to
adherence to it, reporting that 41.6% of participants who attended 6 sessions or less remained in the risk
category measured by TOCA-R in the second evaluation, versus 36.1% of those who attended 7 or more
sessions (OR=0.84), for PSC the probability of staying at risk was 31.0% versus 22.2% (OR: 0.73); for
the risk of repeating the course in the PRIMER group the risk was 12.5% versus 7.9% of those who had
better adherence (OR: 0.68). It was also effective in measuring low school attendance (defined as
attendance less than 85%), with 25.8% versus 16.6% respectively (OR: 0.66)59. However, although there
is qualitative evidence on the contribution of the promotional approach to mental health of HPV within
the school community 60, it is an intervention mainly aimed at early detection and intervention in a
limited risk group. Among the main shortcomings of HPV, detected by the executors of the program, the
need to intervene in parents and teachers and to strengthen auxiliary actions such as articulation inside
and outside the school stand out.
61
In conclusion, the concept of MHL has been useful for the development of interventions that
allow increasing the level of MHL. While there are few MHL-based programs in schools, they show
some evidence of its effect, but this is not consistent.
One of the problems may be the lack of
participation in its construction by its recipients (teachers and parents), which reduces its adequacy and
affects its effectiveness. In our country there is the HPV program, which despite showing effectiveness
in the group of children where it is applied, its scope of action is focused and has had difficulties to
integrate within the establishments. Therefore, we believe it is necessary to develop an intervention that
is built in a participatory way with its recipients and based on their experiences and contexts of
application, which at the same time connects with local mental health services that will provide the
necessary support to meet the needs of these children, in a sustained way over time.
2. SOLUTION AND RESEARCH
2.1.
PROPOSED SOLUTION AND APPLICABILITY SCENARIOS
This proposal seeks to build "school communities" based on Public Schools (PS), aimed at promoting
MH in children and their families and detecting early MH problems in students, providing them with
initial support and subsequent coordinated referral to treatment.
To achieve this, it is proposed to construct a participatory multicomponent intervention aimed at
promoting the MH of children attending basic education in. The components of this grant are: 1) a
Child Mental Health (CMH) Literacy program for PS teachers, which will be built in a participatory
manner with them and other key actors; and, 2) the articulation of the local network of care in child and
adolescent mental health, including several levels of complexity (community, primary care and
specialized care) and, which occupies the strategy ECO-BARRIO SOLIDARIO with adaptations
according to the new socio-sanitary context. Given the nature of a pilot project that, in the first
instance, seeks to evaluate the feasibility of this intervention, its implementation is proposed in two
neighborhoods of Valparaíso, with a random selection of 8 PS with primary education in each of
9

these neighborhoods, after the implementation of the program, the initial effectiveness of the literacy
component in CMH will be evaluated with the teachers.
The process of participatory construction of the Literacy program in CMH will be developed during
the first 12 months of the project, for which we will work with representatives of the academic body of
these EEPs (teachers, parateachers, directors and others), parents, students, directors of the Local
Education Service (SLEP) of Valparaíso and representatives of the ECO-Barrio network.
Through working groups and individual interviews with key actors, a survey of objectives,
methodology and contents of the CMH Literacy program will be made. Due to the health situation
derived from the COVID-19 Pandemic and the current development of Information and Communication
Technologies (ICTs), an asynchronous and asynchronous online program is proposed, based on
recorded video educational capsules and discussion groups with CMH specialists respectively. There
will be an evaluation at the beginning and at the end of the course, to measure acquired knowledge
and level of satisfaction in terms of methodology and content, among others, in addition to evaluating
the application process in a qualitative way. The course will be free and certified by the Faculty of
Medicine of the University of Valparaíso. The certification will be automatic for those who complete all
the requirements on the online platform, which will be accessible from computers or mobile phones. The
total duration of the course should be between 3 to 4 months.
Parallel to the construction of the CMH Literacy program for teachers, the "ECO BARRIO
SOLIDARIO'' strategy will be implemented in one of the neighborhood with modifications
according to the new health and contextual scenario, which will be called "ECO-Barrio Network". The
strategy of the ECO-Barrio Network is feasible to replicate given that in Primary Health Care (PHC)
there are the Joint Commissions of Health-Education (COMSE), which aim to link CESFAM with the
Educational Establishments that converge in a territory, to develop strategies for prevention, participation
and health promotion in educational communities. Particularly in Valparaíso, since 2020 and in the face
of the socio-health crisis due to COVID-19, it is developing a COMSE 2.0 strategy 8, whose objectives
are: 1) to re-activate the COMSE meetings with the participation of Mental Health Managers of
each school, psychosocial duo of the PHC health team and in charge of participation and promotion of
CESFAM. 2) Develop a socio-educational process for COMSE participants to improve the referral and
follow-up of cases from the educational community to PHC, in addition to the development of
prevention and promotion strategies in MH and 3) Develop a containment, prevention and
promotion device in MH for the educational communities of the educational establishments of the
polygon associated with each
CESFAM. These new objectives of COMSE 2.0 are aligned with the
ECO-Barrio Network strategy and with this project. The contribution
of the ECO-Barrio Network
strategy will be to systematically convene potential participants of the COMSE, including all relevant
participants in the CMH of that neighborhood (Health from primary care with the CESFAM and
CECOF that correspond plus specialized care with the Outpatient Unit of Child and Adolescent
Psychiatry of the Psychiatric Hospital of Salvador (HDS), SENAME in its different programs and others
such as Life Skills (HPV). In addition, from the articulation with the Secondary level of Mental Health
and the link with the chair of Child Psychiatry of the University of Valparaíso, the ECO-neighborhood
Network will be able to organize and provide training, generate the case monitoring system on an online
platform and evaluate the implementation process in the two selected neighborhoods which will serve as
an input for a potential replication to other territories of Valparaíso.
10

This project promotes and strengthens the co-construction of responses and articulated strategies for
children, making visible the community role as the central axis of action. This multimodal intervention
can help to address the serious increase in CMH problems derived from the COVID-19 pandemic and
the social crisis, but it is also considered a useful model to function in a stable way throughout Chile,
since it considers interventions to increase the knowledge and resolutivity of the faculty in CMH, a
component not addressed in other instances of research or management known in our country.
The relevance and feasibility of scaling up to the rest of the country is ensured with the participatory
process of local key actors, in addition to the participation of SLEP, Health and I. Municipality of
Valparaíso. This proposal is aligned with the community approach contemplated in the National Plan for
MH and Psychiatry 2017-2025 and seeks to respond to the
increase in MH problems in the child
adolescent population and reduce social inequalities that remain in our country despite macroeconomic
growth.
2.2.
RESEARCH QUESTION
Is it feasible and effective a multi-component intervention, built in a participatory manner and with a
territorial perspective, to improve the level of mental health of children in public educational
establishments, identifying and treating those who need it?
2.3.
RESEARCH HYPOTHESES OR ASSUMPTIONS
1.
Teachers who participate in a Child Mental Health Literacy program are able to significantly
improve their knowledge regarding the identification of these problems and the delivery of
first aids.
2.
The establishments that participate in this training program significantly improve the detection
rate of children with mental health problems.
3.
The relevance of the diagnosis made by teachers when referring children with mental health
problems to the corresponding CESFAM is greater than 80%.
4.
The health-education networks where an intervention is carried out to articulate the referral of
girls and girls with mental health problems, reduce the waiting time that goes between the
referral and the first health care.
2.4.
OBJECTIVES
2.4.1. GENERAL OBJECTIVE
Evaluate the effectiveness and feasibility of a multicomponent intervention, built in a participatory
manner and with a territorial approach, to improve the level of mental health of children in public
educational establishments, identifying and treating those in need in a timely manner.
11

2.4.2. SPECIFIC OBJECTIVES
1.
Build in a participatory way the contents of a literacy program in Child Mental Health (CMH) with
teachers of Public Educational Establishments (PS) and key actors, from the commune of Valparaíso.
2.
Implement the strategy of articulation in a network of CMH (ECO-Neighborhood Network) between
schools, Primary and Secondary Health Care, Municipality, collaborating agencies of SENAME and
other relevant programs in 2 territories of the commune of Valparaíso.
3.
To evaluate whether the Child Mental Health Literacy program, aimed at teachers in public
educational establishments, manages to significantly improve their knowledge in this regard.
4.
To assess whether teachers participating in the CMH Literacy program significantly improve the
detection rate of these problems among their pupils.
5.
To evaluate whether the relevance of the research for referral from educational establishments to the
corresponding CESFAM is greater than 80%.
6.
To evaluate whether the health-education articulation strategy (ECO-Barrio Network) significantly
improves waiting times between referral and the first care received by a child with a possible mental
health problem.
7.
Evaluate indicators of feasibility of the multicomponent intervention, which are useful for a future
escalation (interest of teachers to participate, retention in the intervention, degree of satisfaction of
all participants, facilitators and perceived barriers).
12

3. METHODOLOGY, ETHICS AND PLANNING
3.1.
METHODOLOGY AND PROCEDURES
Research design. This project corresponds to an evaluation of the preliminary effectiveness and
feasibility of a multi-component pilot intervention. The program will be evaluated through a cluster
randomized controlled trial (RCT)
The project activities are organized around two clearly defined stages: one of participatory construction,
and another of evaluation of the effectiveness and feasibility of the pilot intervention.
They are
explained in detail below.
Effectiveness is studied through a mixed design (subtype DEXPLIS, explanatory design sequence) 62,
which begins with a quantitative study of quasi-experimental type (comparing equivalent intervention
and control facilities) and is followed by a qualitative study to analyze the implementation process and
results of the pilot to intervention(including its barriers and facilitators).
The reliability is studied through indicators
of participation of teachers in the intervention (initial
interest and retention over time), by
the satisfaction of teachers and those who participate in the
articulation of local health-education networks, and with the analysis of barriers and facilitators at all
levels.
Universe and sample. The universe to which the results of this study could be extended are public
educational establishments. For this study, two neighborhoods of the
commune of Valparaíso were
selected. Therefore, the selection of the territories is not random, but the selection of the 2 establishments
in each territory is. The inclusion criteria are that they are public schools and have 1st to 8th levels of
primary education. The list of establishments that exist in that sector and that meet the inclusion criteria
will be taken and will be selected using some random method, 2 schools of each neighborhood (4 in
total) will be initially assigned to the intervention and 2 will serve as a control (four in total). As
previously described, in a second moment the intervention will be carried out in the establishments that
served as control for ethical reasons.
To calculate the necessary sample size, the following parameters were considered: a prevalence of
mental disorders of 27.8% and an identification rate of 30% of these cases (9 cases per 100 children, per
year). This indicator (which corresponds to scenario 2 and specific objective 4) was taken as one of the
most important achievements and reflects the impact of the intervention as a whole. To accept the
fulfillment of our hypothesis, it will be necessary to double the identification rate to 60% of cases (18
cases per 100 children, per year). In this way, it is a comparison of proportions, where: p1 = 0.3, p2 =
0.6, a confidence level of 95% for a unilateral test and a power level of 90%, 56 children are needed in
each group. However, it is expected to work with a much larger sample: if it is considered that in each
establishment there are 30 children per grade and only one course per level (from 1st to 8th grade). This
would lead us to a potential sample of 240 children per establishment, which implies 480 in intervention
facilities and 480 in control facilities. 
Development of fieldwork. The development of the fieldwork has three fundamental stages: 1)
Implementation of the ECO-Neighborhood Network strategy in the 1 selected neighborhood, (months 1
13

to 18), 2) the participatory construction of the components of the intervention (months 12 months); and
3) pilot-level evaluation of this intervention (months 12-24).
1.
The first stage (months 1 to 18) The component of the intervention aimed at articulating
educational establishments with mental health devices (CESFAM teams and secondary level in
Health), within specific territories, whose purpose is to expedite the care of these children, will
be implemented. It is the so-called ECO-Barrio Network, for whose implementation a working
committee will be formed for each sector where the study is implemented, with representatives
of all these institutions, in addition to the I. Municipality of Valparaíso. This committee will
begin by analyzing the barriers that hinder the referral of children with mental health problems,
and then establish a specific work plan in each sector (with objectives, activities, goals and
deadlines). The activities of this plan will be implemented in parallel to the intervention with the
teachers, in the second part (months 7 to 18, so that the times are concordant). In addition,
follow-up meetings of referrals will be held with 1 representative of each CESFAM with ECO
BARRIO coordinator and the 4 schools intervened, in a modality that includes virtuous meetings
with bimonthly frequency. Finally, this stage of work will include at least one weekly meeting of
the FONIS team with advisors and coordinators of RED ECO and Literacy Program.
2.
The second stage (months 1 to 12) consists of the participatory construction of the contents of a
training program on children's mental health,
aimed at teachers of public educational
establishments, which will use e-learning (with asynchronous and synchronous activities) and
whose contents will be based on their experience with respect to
of the problems they
distinguish, the way they identify them, the obstacles they have in handling them, and the
opportunities for support they can provide (including the relationship with their parents). To
collect the experience of the teachers, a working group will be created in each establishment
participating in the project, which will collect the experience of the teachers on this subject. In
addition, in-depth individual interviews will be conducted. Then, one or two teachers from each
group (from each establishment) will be invited to participate in a team with psychologists and
psychiatrists from the project, to design the course together. The contents and methods of the
course will be made by the research team, under the
supervision of the team that includes
teachers, technical advisors and audiovisual equipment.
3.
The third part (months 12 to 24) consists of carrying out a pilot test taking 4 educational
establishments located in two different territories of the commune of Valparaíso, in which the
intervention will be carried out, and its results will be compared with 4 other equivalent
educational establishments, from those same territories, which serve as control. Pre- and
post-intervention assessments will be carried out, using a children's mental health knowledge
survey, while referrals from facilities to the corresponding CESFAM will be recorded. Results
will be compared between intervention and control results. Information is also collected to
assess the participation of teachers in the intervention (feasibility analysis).
At the end of the intervention in the establishments that were the object of it, the quantitative
indicators and results that were collected will be synthesized, and a qualitative analysis will be
carried out (DEXPLIS design), based on discussion groups that involve the interested parties
(teachers, mental health professionals and managers of both sectors).
in which the results and
achievements will be analyzed, barriers and facilitators of the process will be established, all of
which will allow to complete the evaluation in a participatory way and to improve the
components of the intervention, based on the empirical experience carried out.
14

After the end of the intervention, the intervention will also be carried out in its two components
(teachers and health-education network) in the 4 establishments that served as control. In this
way, an ethical requirement of not depriving the rest of the participants of a beneficial
intervention is met. (Months 18 to 24)
Indicators, instruments and analysis procedures. For the detailed description of this point, the
effectiveness analysis and the feasibility analysis of the pilot intervention are separated.
1) Evaluation of the effectiveness of the intervention. The effectiveness evaluation is based on
comparing the following indicators between intervention and control establishments.
a) Level of knowledge of the teachers, using an ad hoc questionnaire, which is built in the phase
prior to the intervention and validated by this team (which incorporates teachers).
The
conceptual framework of literacy in child and adolescent mental health will be used. This
questionnaire will include all the aspects that are part of the training program aimed at teachers
and will allow them to obtain scores for their different modules or dimensions. A test and
semantic adaptation will be carried out with teachers from establishments in other sectors of the
commune, which do not participate in the project, prior to its use within the project.
It is
expected that in the initial assessment (baseline), the results will be similar in the teachers of the
intervention and control establishments. At the end of the intervention it is expected that scores
have improved significantly in intervention facilities and have not changed in control facilities.
b) Rates of referral of mental health problems in children. In each project establishment
(intervention and control) a centralized register will be kept of the children indicated by their
teachers who require mental health care during the intervention. This will also allow for
centralized coordination for referral to the relevant CESFAM. In this way the detection rate can
be calculated.
c)
Waiting time between referral from the educational establishment to professional care at the
corresponding CESFAM. This indicator is obtained from the centralized register in each
educational establishment, which includes the date on which it coordinated with CESFAM for its
attention, and the registration of the first attention in the latter. The time elapsed between the two
is the waiting time that will be used as an indicator.
d)
Rate of accuracy for referral of children with suspected psychiatric disorders from the school to
health care. Each “case” referral will apply the Strength and Difficulties Questionnaire (SDQ).
25 items (scale 0-2).
2) Evaluation of the feasibility of the intervention. Feasibility assessment uses a combination of
quantitative (indicator) and qualitative methods, which are described below.
a) Level of interest of teachers in the intervention: It is estimated through the percentage of
teachers who agree to start the training course, out of the total number of teachers who were
invited (which would be the totality of each educational establishment).
(1)
𝑇𝑒𝑎𝑐ℎ𝑒𝑟𝑠 𝑤ℎ𝑜 𝑎𝑐𝑐𝑒𝑝𝑡
𝑇𝑜𝑡𝑎𝑙 𝑇𝑒𝑎𝑐ℎ𝑒𝑟𝑠
b) Level of retention of teachers in the intervention. It is estimated through the proportion of
teachers who complete the course of all those who started it. The retention rate for each phase
will be described.
i)
=> description for each phase
𝑇𝑒𝑎𝑐ℎ𝑒𝑟𝑠 𝑤ℎ𝑜 𝑐𝑜𝑚𝑝𝑙𝑒𝑡𝑒𝑠 𝑡ℎ𝑒 𝑐𝑜𝑢𝑟𝑠𝑒
𝑇𝑒𝑎𝑐ℎ𝑒𝑟𝑠 𝑤ℎ𝑜 𝑖𝑛𝑖𝑡𝑖𝑎𝑡𝑒 𝑡ℎ𝑒 𝑐𝑜𝑢𝑟𝑠𝑒
15

c)
Level of satisfaction of teachers with the intervention. An ad hoc survey will be used, with
Likert questions for each module or component of the training course, and differentiated for
each phase if necessary. The survey will also include open questions, which allow the opinions
of the participants to be collected, all with a view to improving them in subsequent versions.
i)
d) Level of satisfaction of the different participants in the intervention of articulation of the
health-education network. It will proceed in a similar way to the previous one, using an ad hoc
survey (with Likert type questions) and open questions, to collect opinions that seek subsequent
improvements.
e) Barrier analysis and facilitators. This analysis is qualitative and is obtained as part of the
DESPLIX design. It is obtained from discussion groups involving all stakeholders (teachers,
health and mental health professionals, and health and education managers), in which the
results and achievements will be analyzed (based on information from all previous indicators,
effectiveness and feasibility), identifying barriers and facilitators of the process.
3.2.
ANALYSIS OF ETHICAL IMPLICATIONS
This project has been formulated in response to both the international guidelines of the Council
for International Organizations of Medical Sciences (CIOMS), an entity founded by UNESCO and
WHO, whose great contribution has been the definition of guidelines for the application of ethical
principles in several key areas of Health, and we have been particularly concerned to consider Chilean
legislation and institutional frameworks.
All participation shall be preceded by the submission of information on: objectives,
participation, procedures, benefits and foreseeable risks of the study. All participation will be formalized
through the voluntary signing of an informed consent document by the participant. Throughout the
study, the criteria of research integrity will be taken into account (Singapore Declaration).
A process of recruitment and selection of participants will be carried out through dissemination
in educational establishments and through the ECO Network. In order to respect the autonomy of the
subjects,
participation will be completely voluntary and none of the instances of participation will
include the registration or consultation of personal data.
3.2.1. RISK-BENEFIT ANALYSIS
We believe there are no potential risks in this study, physical, emotional, or otherwise. On the
other hand, the results would allow for an intervention to improve CMH in children with PS, with its
initial evidence on effectiveness and feasibility indicators, for its possible scaling up to the national level.
Therefore, it is considered a study that has a favorable risk/benefit balance. 
3.2.2. SAFEGUARDING CONFIDENTIALITY
For the purpose of the analysis and maintenance of databases, during the research process any
information related to names, places or other data that could subsequently lead to the identification of the
participants will be modified from the written and virtual records.
16

The lists of names and telephone numbers of the participants in the three stages will be
maintained by the principal investigator in physical locations separate from the transcripts and audio and
video recordings. While the transcripts and audio and video recordings will be stored in a computer with
a key, which will be in a locked place and accessible only to researchers and therapists involved in the
processes. The protocol for the data backup chain will be explicitly established, which, together with the
informed consents, will be stored in a safe place, to which only the researchers in charge of the project
will have access. The criteria of the Singapore Declaration on Integrality in Research will be taken into
account. The project will take into account the criteria and recommendations of CONICYT and the
Institutional Ethics Committee of the University of Valparaíso.
All transcripts of committee meetings and focus groups will be made by researchers, who will
also participate in the data analysis process.
3.2.3. INFORMED CONSENT/ASSENT
In the design of this study, the free, informed and consented participation of all research
participants is contemplated . Each of these criteria is described below.
a) Free participation: All participants will be informed of the objectives of the study and will have the
freedom to agree to participate or not in the study, they will also be free to terminate their participation
in the study at any time, without this generating any consequences.
b) Informed participation: All participation will be preceded by the provision of information on
objectives, type of participation, possible benefits and foreseeable risks of the study. Participants will
also be informed about the characteristics of confidentiality and preservation of anonymity. They will
also be informed about the methods of custody of the registered information, the uses that will be given
to it and the treatment of said information for the purposes of publication of results.
c) Consented participation: After having been informed about the research process, the participation of
each person will be formalized through informed consent to participate, and to generate audiovisual
material as a graphic record.
CONSENTS: During the first stage a committee will be constituted with the representatives of all the
institutions, during the second stage the collection of the experience of the teachers and the invitation to
the participatory construction of the mental health training program will be carried out, and finally in the
final stage discussion groups will be made for the qualitative analysis DEXPLIS.
Participants
participating in any of the three stages must sign a prior informed consent. The consents will be applied
online, since that will be the modality of participation, and thus the CEC-UV will be requested to
approve the project.
In the event that any of the stages requires a graphic record of any activity, the express authorization of
the participants will be requested.
ASSENTS: This project does not provide for the application of assets when there is no participation of
underage subjects.
17

3.2.4. INSTITUTIONAL AUTHORIZATIONS REQUIRED
In case of being awarded, the project will be evaluated by the Institutional Ethical-Scientific
Committee of the University of Valparaíso CEC-UV, which is accredited (see payroll).
18

3.3.
WORK PLAN
Specific Objective
Activity
Months
1
2
3
4
5
6
7
8
9
1
0
1
1
1
2
1
3
1
4
1
5
1
6
1
7
1
8
1
9
2
0
2
1
2
2
2
3
2
4
1-Build in a
participatory way the
contents of a Literacy
program in CMH
1-Presentation of the Ethics Committee Project
x
2- Random selection of the 4 PS
x
3-Contact and invitation to working meetings of key informants of the
territories and PS
x
x
4- Establish work teams in each selected PS
x
6- Participatory design of the literacy program
X
X
X
X
2. Implement the
ECO-Barrio network
strategy
1- Contact with key agents of the CMH network
x
2-Form a committee in each sector with the representatives of the
institutions of the intersectoral ecosystem in CMH
x
3- Develop a participatory work plan with objectives, goals, activities,
deadlines and managers.
x
x
x
4-Bimonthly work and follow-up meetings.
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
3.Assess whether the
literacy program
significantly improves
knowledge in CMH
1- Recruitment of teachers to participate in the literacy intervention.
x
x
x
x
2- Development of knowledge instrument in CMH
x
3-Test of application of the instrument in PS of non-intervened sectors.
x
4-Semantic adaptation of the instrument.
x
5-Implementation of online literacy course (G1 and G2)
X
X
X
X
X
X
X
X
X
X
X
X
6 Evaluation of teachers intervened with instrument (pre and post
intervention)
X
x
X
4-
Evaluate
if
the
detection rate of CMH
problems is significantly
improved
1-Random selection of 2 PS similar to those selected in a neighborhood
where the intervention has not been implemented
x
2- Determine the detection rate in schools that received the literacy
program compared to control schools
X
X
5.Evaluate whether the
relevance of referral to
1- Determine how many of the referred children enter Mental Health
treatment (regardless of the device or level of complexity)
x
x
x
x
x
x
x
x
x
x
x
x
x
19

PHC
is
greater
than
80%.
6. Evaluate whether the
ECO-Neighborhood
Network strategy
significantly improves
waiting times for health
care.
1- Meetings with each territorial committee of MH children on a
bimonthly basis to execute and follow up on the proposed work plan
x
x
x
x
x
x
x
x
x
x
x
x
x
2-Weekly meeting of the FONIS team with advisors and coordinators of
the ECO-Barrio Network and the Literacy Program
x
x
x
x
x
x
x
x
x
x
x
x
x
3-Registration and monitoring of all derived cases and level of attention
from schools to APS (2 with ECO BARRIO network and control territory)
x
x
x
x
x
x
x
x
x
x
x
x
x
4. Evaluate waiting time based on referral form. To compare the date of
referral registered at school and the first care received at CESFAM.
x
x
x
x
x
x
x
x
x
x
x
x
x
7. Evaluate feasibility
indicators that are
useful for a future
scaling of the
intervention
1. Build a program satisfaction survey.
x
2. Determine the number of teachers who register in relation to the total
number of guests (recruitment rate) per group
x
x
x
x
3- Application of satisfaction survey to teachers and Red-Eco Barrio
x
X
5-Focus Group to analyze results and achievements, identifying barriers
and facilitators of the process.
x
X
6-Analysis of final descriptive, analytical and qualitative results and
preparation of report
x
x
x
x
x
x
20

4. RESULTS, IMPLEMENTATION AND DISSEMINATION
4.1.
IMPLEMENTATION OF EXPECTED PRODUCT(S)
4.1.1. EXPECTED RESULTS AND/OR OUTPUTS
Result/Product Name
Enter a brief description of the result/product
1) Child and Youth Mental Health Literacy
Program for teachers on an e-learning
platform
Free literacy program in Child and Adolescent Mental Health
based on videotaped educational capsules, feasible to be
modified according to contextual and local needs.
2). Technical recommendations to
implement a territorial Child and
Adolescent Mental Health Network
Implementation Manual of "Red-Eco Barrio" with description
of the methodology used, facilitators, obstacles and indicators
obtained
3) 2 scientific publications in indexed
journals (WOS or SCOPUS).
2 scientific publications will be made: the first with a
description of the multicomponent intervention and its
participatory construction, and the second with the results of
effectiveness and feasibility.
4) Presentations at scientific congresses in
the field of child mental health
There will be 2 presentations at scientific congresses, as
posters or free communication, related to specific products:
the child mental health literacy program for teachers and the
articulation of the local network (Eco Barrio program)
4.1.2. IMPLEMENTATION OF THE EXPECTED PRODUCT(S)
The direct beneficiaries will be PS teachers from the commune of Valparaíso who receive basic
education students and who voluntarily agree to participate in the child mental health literacy program.
To this end, an e-learning platform will be developed with audiovisual resources for training in CMH,
asynchronously, in addition to contemplating some synchronous meetings to resolve doubts with the
participants of the training.
Additionally, training activities and facilitation of intersectoral coordination will be programmed
for health, education, SENAME and other relevant actors, in order to support the process of identifying
students who require mental health care in an opportune and pertinent manner, through the
eco-neighborhood network that will be implemented in 2 sectors of Valparaíso. those that will be carried
out online, given the current global health context, and taking advantage of the familiarity that has been
given with these means that facilitate the meetings and reduce the expenditure of resources for their
participants.
In relation to the e-learning platform, the project will remain as an input for CORMUVAL and
the ECO-Barrio Network, so that they can continue using it in their activities.
21

Finally, the development of a critical nucleus and associativity of the University of Valparaíso
with specialized groups is expected, which promotes more research in this area and constitutes updated
and complementary information to what is currently available, in addition to contributing to the
technological development of science solutions applied to public health in the area of child mental
health. These expert groups have been described throughout the project. 
4.2.
DISSEMINATION ACTIVITIES
During the years of execution of the Project, it is expected that members of the team of researchers
will attend national and international congresses specialized in child psychiatry that will allow the
presentation of the partial and final results of the present research project on literacy in mental health.
The first year is planned to participate in the congress of the Chilean society of psychiatry and child
neurology, as well as the second year, a period in which the congress or international congress of the
American Society of Child Psychiatry will also be attended.
In turn, the results of this research will provide evidence that will be published in scientific journals.
It is planned to publish at least two collaborative articles in indexed journals (WOS or SCOPUS).
Additionally, during the first and second year of project execution, it is planned to hold two online
dissemination seminars for the city of Valparaíso. The aim of these seminars will be to present the
preliminary results of the study to the local community (mental health professionals, public school
teachers, educational community, Sename professionals, primary health professionals).
At the end of the second year, a closing event is planned. A training activity will be carried out aimed
at professionals, academics and students of health and social sciences careers with the aim of presenting
and training in the relevance of the implementation of a digital literacy strategy in mental health for key
actors of the intersectoral ecology of children in school, in order to positively influence their mental
health and thereby in the generation of well-treated environments and communities that contribute to
their integral development . In addition, to relieve the work in intersectoral mental health networks, in
order to develop an articulation device that we have called "ECO-Neighborhood Network", which serves
as a support for the implementation of the knowledge acquired by teachers, one of its purposes being to
impact on the early and pertinent investigation of mental health disorders that require to be attended in
mental health programs of both the primary health network and the secondary.
22

5. MANAGEMENT AND ASSOCIATIVITY CAPACITY
5.1.
MANAGEABILITY
NAME
INSTITUTION
PROFESSION
POSITION IN
THE PROJECT
Critical Functions
and Capabilities that
will contribute to the
project
% monthly
dedication
(calculated
based on 180
hrs. monthly)
$/HH
RESEARCH TEAM
Eva Madrid
University of
Valparaíso (UV)
Doctor
Director
Participation in the
Management and
Advisory Committee
of the intervention
25%
300.000
Fanny Leyton
UV and Hospital
Psiquiátrico del
Salvador (HDS)
Psychiatrist
Alternate
Director
Participation in the
Management and
Advisory Committee
of the intervention and
coordination of the
field work
48%
300.000
Marcelo Briceño UV and HDS
Child Psychiatrist
Researcher
Clinical Advisor of
the field work of the
intervention. Part of
the management
committee
11%
137.000
Karla Alvarez
UV and
Universidad de
Chile (UCH)
Child
Psychologist
Investigator
Clinical Advisor of
the Literacy program.
Part of the
management
committee
11%
137.000
Carolina Godoy
Peña
UV
Social Worker
Investigator
Fieldwork
ECO-Barrio Network
Coordinator.
Part of the
management
committee
30%
273.000
TECHNICAL SUPPORT STAFF
To be defined
UV
Teacher or
Educational
Psychologist
Support
Professional
Fieldwork in
Construction and
Implementation of
Literacy Program
50%
600.600
Sebastian
Alarcon
UV and UCH
Computer
Engineer and
Professor
Support
Professional
Construction, design
and technical support
to on-line platform
13%
163.800
Jorge Caro
UV and UCH
Computer
Engineer
Support
Professional
Construction, design
and technical support
to on-line platform
13%
163.800
Alex Ariel
Benavides Soto,
programmer
Technician
Construction, design
and technical support
to on-line platform
13%
163.800
23

To be defined
Audiovisual
technician
Technician
Recording and editing
educational capsules
13%
163.800
ADMINISTRATIVE STAFF
Percentage of monthly dedication in other projects
POSITION IN THE
PROJECT
NAME
2021
2022
2023
Director
Eva Madrid
20%
Dedication
20%
10%
Alternate
Director
Fanny Leyton
11%
11%
0
Researcher
Marcelo Briceño
0
0
0
Researcher
Karla Alvarez
0
0
0
Researcher
Carolina Godoy
0
0
0
24

5.2.
CURRICULAR BACKGROUND OF THE RESEARCH TEAM
-Eva Madrid Aris, Medical University of Chile (UCH), Doctorate in Medicine at University of
Granada. Postdoc at Harvard School of Public Health, with training in psychiatric epidemiology. Full
Professor at the UV School of Medicine Director of
the Cochrane UV Associated Center and
Interdisciplinary Center for Health Studies CIESAL, member of the UV Ethical-Scientific Committee
and Sustainable Health Care group of the Cochrane Collaboration.  He has numerous publications and
projects especially in the area of Evidence-Based Health and Mental Health.
-Fanny Leyton Alvarez, Psychiatrist UCH, Master in Psychotherapy and PhD candidate in
Psychotherapy P. Universidad Católica (PUC). Diploma in Community Psychiatry and Management of
Public Mental Health Services at the UCH. Professor of Child and Adolescent Psychiatry at the UV.
Psychiatrist of the Child and Juvenile Unit of the Psychiatric Hospital of El Salvador in Valparaíso
(HDS). Principal investigator in project FONIS SA11I2252 "Evaluation of Clinical and Social Factors of
Patients with Depression Resistant to Treatment in the Health Service Viña del Mar - Quillota year
2012." Member of the Millennium Institute for Research in Depression and Personality.
-Marcelo Briceño Araya, Child and Adolescent Psychiatrist from Universidad de Valparaíso, Master in
Clinical Epidemiology At Universidad de la Frontera. Professional experience in primary and secondary
care, head of the intensive care hospitalization unit in child and adolescent psychiatry of the HDS.
Member of the group that created the community psychiatry program "Eco Barrio Solidario''.
-Karla Álvarez Kozubová, PUC Psychologist, PhD candidate in Social Psychology at Charles
University of Prague and in PUC Psychotherapy. Assistant Professor of the Department of Psychiatry
and Mental Health UCH. Psychologist of the Child and Adolescent Psychiatry Unit at the University
Psychiatric Clinic of the UCH since 1999. Founder of the line of attention and prevention in child abuse,
of the Center of Violence of the I. Municipality of Santiago (1996). Research in SENAME residences
(2014) on the quality of family interactions and intervention strategies for video-feedback, mental health
and adolescent well-being.
- Carolina Godoy Peña, Social Worker (TS) UV. Master and Diploma in Family Intervention in Social
Work, PUCV. Diploma in Planning and Management Control at Instituto Les Hayes. He was in the Child
and Youth Unit of the HDS, when he created and coordinated the community mental health program for
children, "ECO Barrio solidario para la infancia", implemented from 2015 to 2019.
- Sharon A. Hoover Ph.D. , Doctor in Psychology, director of the National Center for School Mental
Health. National and international authority in the study, evaluation and implementation of mental health
programs in schools. Participate in Clinical Advisory Committee
- Hector Parada Valderrama, Child Psychiatrist at JLG RCIA Institute in Maryland. Professor at
Georgetown University and visiting professor at UV. Clinical Advisory Committee
- Marcela Horvitz Lennon,
Psychiatrist, Master of Public Health. "Senior Physician Scientist" at
RAND Corporation (Boston Massachusetts) and Associate Professor in the Department of Psychiatry at
Harvard University. She has some NIH projects and federal governments in the US and is an
evaluator of NIH projects. Participate in Management Committee and formulation of results
5.3.
PARTICIPATION OF RESEARCHERS IN TRAINING
In this work will participate two thesis students individualized below:
25

1.
First-year resident of child and adolescent psychiatry at the University of Valparaíso. Participate
in the process of collecting information for the construction of evaluation instruments, as well as
in the process of validating this. It will be supervised by the researcher Fanny Leyton for her
thesis work associated with her specialty
2.
Resident of child and adolescent psychiatry of second year of the University of Valparaíso. You
will participate in the process of collecting information for the construction of the mental health
literacy strategy, as well as in the discussion group process. For this, you will receive directed
classes within the subject of Research Methodology of your current study program. It will be
supervised by the researcher Fanny Leyton for her thesis work associated with her specialty
5.4.
ASSOCIATIVITY
The University of Valparaíso is the main beneficiary institution of this research project, and the
associated institution is the Salvador de Valparaíso Psychiatric Hospital, which for more than 50 years
has constituted its main clinical field in Psychiatry and Mental Health. This will allow a strong
commitment and teaching-care associativity, through the incorporation of thesis students and residents of
Child Psychiatry. Additionally, the incorporation of the
This will allow the collaboration between different Academic Units, which will allow the
contribution of undergraduate and postgraduate students of Medicine, the professionals of the Mental
Health teams of the CESFAM, as promised by the Director of the Municipal Corporation of Education in
his letter of commitment.
On the other hand, this project has the commitment of the Executive Director of the Local Public
Education Service of Valparaíso, who will facilitate the participation of those teachers of the teaching
staff of the public schools of Valparaiso who wish to participate (respecting the autonomy of the
teachers). In addition, this service undertook to hold periodic assemblies with key actors in its
community and the research team, to provide feedback on the relevance of the activities implemented in
the school and community environment.
On the other hand, from the academic point of view, the researchers involved have a permanent
collaboration relationship with teams from the University of Chile, McMaster University, University of
Maryland, Autonomous University of Barcelona and Harvard Medical School. This will contribute to
associativity in terms of information sharing, dissemination activities and generation of manuscripts of
the knowledge generated. 
26

TECHNICAL SPECIFICATION FORM FOR PROJECTS TO DEVELOP, USE OR
ADAPT MEASURING INSTRUMENTS
1.
TYPE OF INSTRUMENTS TO BE USED
The project contemplates the use of:
Instrument(s) previously used and validated in Chile, commonly used and in the
general population.
Instrument(s) previously used, which will be adapted or validated in Chile or focused
on new target populations.
X
New instrument to be created by the project.
In the case of using existing instruments:
Includes Copyrights
(If your answer is positive, indicate unit value
in Chilean pesos)
YES
NO
$
X
27

2.
INSTRUMENTS TO BE USED, QUANTITATIVE METHODOLOGY
TABLE GENERAL TECHNICAL INFORMATION ON QUANTITATIVE
INSTRUMENTS
NEW INSTRUMENTS TO BE CREATED BY THE PROJECT
Point out level of progress and stages in development.
Definition of constructs
General construct: Mental health literacy: defined as the set of
"knowledge and beliefs about mental disorders that help their recognition,
management or prevention"37
Specific constructs:
The constructs used will be based on the operationalization of mental
health literacy proposed by Kutcher, in which 4 dimensions are identified 39:
1. The ability to understand how to optimize and maintain good mental
health.
2. Understanding mental disorders and their treatment.
3. Appropriate attitudes towards those living with mental disorders and
decrease stigma.
4. Improving the ability to seek help from appropriate mental health care
services
Operationalization of constructs
The construct of the first dimension corresponds to general information
about factors promoting and protective mental health, as well as the main
risk factors.
The construct of the second dimension corresponds to the recognition of
the main symptomatic manifestations of the syndromic groups that
teachers consider most relevant from their own experience.
The construct of the third dimension corresponds to the myths and beliefs
in relation to children's mental health disorders and about the children
who suffer from it, about their parents, as well as about their treatment.
The construct of the fourth dimension corresponds to the general
knowledge of the health network in Chile, where and when to seek help.
Item Formulation
For the evaluation of constructs 1, 2 and 4, following the model of
Kutcher et al. 36, the items will be created for the specific evaluation of the
knowledge delivered. As these will be defined during the first stage of
the project, the formulation of items will be developed in parallel to this
process.  
Alternative or multiple choice responses will be used for knowledge
assessment (constructs 1, 2 and 4).
For the evaluation of stigma (construct 3), an adaptation of the Spanish
Stigma Scale for Health Care Providers(WHO-HC), which is
validated in Chile, will be used. This consists of 15 items (score
range 15-75), Likert type, with a score of 1 to 5. 63
Validity of constructs and
dimensions you would measure
In a first phase of content validity (apparent or façade), three groups of
experts will be formed (professors, experts by experience and clinicians),
28

(Dimensions/Variables and
Domain)
and the definitions of the constructs and the proposed items will be
analyzed with them.
In a second phase, a process of semantic validation will be carried out
through the application of a pilot test of the test to a group of 10
people (teachers from other schools, different from where the project will
be carried out), resulting in the linguistic and semantic adaptation of the
test.
In a third phase, the evaluation of the psychometric properties will be
carried out, differentiated according to each dimension. For dimensions
1, 2 and 4, which evaluates the level of knowledge, the items will be
studied in a specific way.
In the case of dimension 3 on stigma, a routine analysis will be performed
for the study of latent variables, with analysis of construct validity (using
exploratory factor analysis), internal consistency (with Cronbach's alpha)
and test-retest stability analysis in a subsample (of 50 people). For this, it
is estimated to apply the test to a sample of 200 teachers, who work in PS
different from where the project will be carried out.
References of uses of similar
instruments in the case of creation
Mental Health Knowledge and Attitudes Scale
(MHKAS) 39
Spanish Stigma Scale for Health Care Providers (WHO-HC) 63
Setting scores and rankings
Scores will be based on items. It will be studied what are the scores for
each domain when applied to the 200 teachers, according to the range of
answers obtained will determine the typical scores.
Piloting in population equivalent
to the target
It corresponds to the application to a sample of 200 teachers belonging to
the Municipal Corporation of Valparaíso, out of a total of 1,984 teachers
registered in 2019, except for those of the schools that are going to
intervene.
Standardization
(formulation/translation of
manuals and conditions of use)
The standardization and publication of the creation and validation process
will be carried out, as well as the results of the validation of this
instrument.
Include supplemental information that you want to add in this box. Incorporate the most
relevant bibliographic reference (no more than 3) on the construction of the instrument,
validation and / or study of psychometric properties in the population relevant to the study.
3. INSTRUMENTS TO BE USED, QUALITATIVE METHODOLOGY
29

TABLE GENERAL TECHNICAL INFORMATION ON QUALITATIVE
INSTRUMENTS Evaluation Satisfaction with Literacy Intervention
Level of application (individual/collective) and
structure of questions (open, thematic, in-depth, etc.)
Individual (teachers)
Technique to which you will respond (interview,
focus group, discussion group, etc.)
Survey
Standardization (Conditions of use as application
requirements by specially qualified personnel or
others)
Self-applied anonymous online surveys
Incorporate examples of the type of questions that the
instrument will include related to the objective of the
study (no more than 6)
The questions will be directed to evaluate the level of
satisfaction of the teachers with the intervention.
Likert questions will be used for each module or
component of the training course and differentiated for
each phase if necessary.
It will also include open questions, which allow to
collect the opinions of the participants oriented to its
improvement in later versions.
Include supplemental information that you want to add in this box. Incorporate the most
relevant bibliographic reference(no more than 3) on the construction of the instrument,
validation and / or study of psychometric properties in the population relevant to the study.
TABLE GENERAL TECHNICAL INFORMATION ON QUALITATIVE
INSTRUMENTS Satisfaction Evaluation with ECO-Neighborhood Network
component
Level of application (individual/collective) and
structure of questions (open, thematic, in-depth,
etc.)
Individual (participants of the articulation of the Health
Education Network)
Technique to which you will respond (interview,
focus group, discussion group,etc.)
Survey
Standardization (Conditions of use as application
requirements by specially qualified personnel or
others)
Self-applied anonymous online surveys
Incorporate examples of the type of questions that
the instrument will include related to the objective
of the study (no more than 6)
The questions will be directed to assess the level of
satisfaction with the intervention.
Likert-type questions and open-ended questions will be
used, which allow collecting the opinions of the
participants aimed at improving them in later versions.
30

TABLE OF GENERAL TECHNICAL INFORMATION ON QUALITATIVE
INSTRUMENTS. Implementation Process Evaluation
Level of application (individual/collective) and
structure of questions (open, thematic, in-depth, etc.)
Collective, open and thematic questions (based on
results obtained from quantitative data collection)
Technique to respond to (interview, focus group,
discussion group, etc.)
Discussion group that includes health professionals and
teachers, as well as directors of health centers and
schools.
Standardization (Conditions of use as application
requirements by specially qualified personnel or
others)
It requires to be carried out by personnel with training
in qualitative research and with knowledge of the
results obtained from the qualitative analysis
Incorporate examples of the type of questions that
the instrument will include related to the objective of
the study (no more than 6)
The questions will be designed: 1) based on the
qualitative results obtained 2) Aimed at evaluating
facilitators and facilitators of the process
DESPLIX, 62
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https://www.redalyc.org/articulo.oa?id=26424861003. Accessed April 6, 2021.
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61.
Rojas-Andrade RM, Leiva L. School mental health from the perspective of Chilean professionals.
Psychoperspectives. 2018;17(2). doi:10.5027/psychoperspectives-vol17-issue2-fulltext-1101
62.
Metodologia de la investigacion (6ta edicion) (9781456223960):
HERNANDEZ-SAMPIERI,ROBERTO: Books.
https://www.amazon.com/-/es/ROBERTO-HERNANDEZ-SAMPIERI/dp/1456223968. Accessed
April 7, 2021.
63.
Sapag JC, Klabunde R, Villarroel L, et al. Validation of the Opening Minds Scale and patterns of
stigma in Chilean primary health care. Guillen J, ed. PLoS One. 2019;14(9):E0221825.
doi:10.1371/journal.pone.0221825
36

 
 
 
CONSENTIMIENTO INFORMADO PARA PROFESORES y EDUCADORES PARTICIPANTES DEL 
ESTUDIO 
 
El propósito del presente documento es invitarlo a participar en el estudio titulado 
”Construcción Participativa y Factibilidad de una Intervención Multicomponente para 
mejorar el Bienestar de Niños de Educación Básica después de la Pandemia COVID-19”, cuyo 
investigador principal es la Dra. Eva Madrid Aris, en conjunto con los co investigadores; 
Fanny Leyton Alvarez, Marcelo Briceño Araya, Karla Álvarez Kozubová, Carolina Godoy 
Peña, Sharon A. Hoover Ph.D, Hector Parada Valderrama, Marcela Horvitz Lennon, 
patrocinada por Universidad de Valparaíso, para el desarrollo del proyecto de investigación 
y desarrollo en salud – FONIS 2021. 
 
Para que usted pueda tomar una decisión informada, le explicaremos cuáles serán los 
procedimientos involucrados en la ejecución de la investigación, así como en qué consistiría 
su colaboración: 
 
1. Esta investigación se realizará en Establecimientos Educacionales Públicos (EEP) con 
enseñanza básica de 2 sectores de Valparaíso, Mena y Reina Isabel II, durante el año 2023. 
 
2. Relevancia del estudio y beneficios: 
La salud mental infantil, es el fundamento sobre el cual se construye la salud mental, física 
y social en la vida adulta, la prevención e intervención precoz de los problemas pesquisados 
en esta etapa evolutiva es fundamental. Chile tiene una elevada prevalencia de problemas 
de SM en la etapa de la niñez y adolescencia. El sistema escolar, es una instancia privilegiada 
para la pesquisa de los problemas emocionales y comportamentales de los niños, niñas y 
adolescentes (NNA), pero no siempre ha contado con una red intersectorial coordinada y 
funcional para dar respuesta a la demanda requerida. Por ello, este proyecto busca 
contribuir a la salud mental de los NNA y de la comunidad escolar a través de una 
intervención multicomponente. Este programa se sustenta en una perspectiva de salud 
mental biopsicosocial que va más allá de la mera ausencia de enfermedad, relevando los 
recursos protectores, principalmente los referidos al soporte social y de redes necesarias 
para el bienestar humano. Por lo anterior, la presente investigación e intervenciones del 
proyecto apuntan a mejorar e instalar competencias en los profesores de educación básica, 
para identificar tempranamente dificultades de salud mental, que puedan presentarse en 
los niños y niñas con quienes mantienen una relación cotidiana en función de la labor 
docente, contribuyendo a generar un acceso oportuno y pertinente a los programas de 
salud mental de la red de salud territorial de los colegios que participarán en el proyecto, 
gracias a la articulación de redes intersectoriales que se fomentarán. 
 
 

 
 
 
3. Objetivo: 
El equipo de investigadores, espera conocer las posibilidades reales de la aplicación y 
efectividad, de una intervención que contempla capacitar a profesores en el área de salud 
mental en modalidad híbrida, mediante una capacitación co-construida con los profesores 
participantes de la presente investigación, con el fin de potenciar sus capacidades de 
pesquisa y derivación al sistema público de salud Chileno, para potenciar el acceso a una 
intervención oportuna y pertinente, contando con el soporte de una red de instituciones, 
de diferentes sectores, entre ellas; educación, salud, servicio nacional de menores, justicia, 
barriales, entre otras. 
 
4. Participación: 
Su participación en la presente investigación es totalmente voluntaria y no recibirá pago 
alguno para que acepte participar. Si acepta participar, deberá asistir a un programa de 
alfabetización en salud mental infantil (SMI),  que se llevará a cabo en formato híbrido 
(presencial y con la asistencia de una plataforma educativa en línea) y en caso de requerirse, 
de la aplicación de los siguientes cuestionarios: Al principio y al final de la capacitación se le 
solicitará contestar el cuestionario PHQ, el cuestionario de Burnout de Maslach y el 
Cuestionario para Educadores sobre Conocimiento en Salud Mental Infantil. Todos estos le 
tomarán alrededor de 20-30 minutos. Durante octubre se les pedirá completar el formulario 
SDQ, el cual toma 12 minutos por cada uno de sus alumnos. Al final de cada sesión se 
solicitará calificar brevemente (menos de 5 minutos) la calidad de la actividad. 
 
5. Riesgos; 
Explicitamos que no existen riesgos potenciales en este estudio, ni físicos, ni emocionales, 
ni de ningún tipo. Por otra parte, los resultados permitirían contar con una intervención 
para mejorar la SMI en niños y niñas de EEP, con su evidencia inicial sobre efectividad e 
indicadores de factibilidad, para su posible escalamiento hasta el nivel nacional. Por lo 
tanto, se considera un estudio que tiene un balance riesgo/beneficio favorable. 
 
6. Costos y pagos 
Si usted acepta participar en el proyecto de investigación, no recibirá dinero por concepto 
de pago de participación en el estudio. No obstante, el participante declara poseer los 
medios tecnológicos de acceso a internet para participar en las distintas actividades 
descritas en el presente consentimiento. 
 
7. Derechos del participante: 
Usted al participar en el presente estudio, tiene derecho a manifestar sus dudas al 
investigador en cualquier momento al correo eva.madrid@uv.cl, Además, puede retirarse 
del estudio en cualquier momento si lo considera necesario comunicándoselo a la Dra. Eva  
 

 
 
 
Madrid, investigadora principal; cabe señalar, que su retiro no lo perjudicará  en caso 
alguno. 
 
8. Reserva de la identidad del participante 
Para efecto del análisis y mantención de bases de datos, durante el proceso de investigación 
se modificará de los registros escritos y virtuales toda información relacionada con 
nombres, lugares u otros datos que posteriormente podría conducir a la identificación de 
los participantes, en su lugar se utilizará un código numérico. 
 
9. Confidencialidad de los datos 
Las listas de información obtenida de los participantes serán mantenidas por la 
investigadora principal en lugares físicos separados de las transcripciones y de las 
grabaciones en audio y video. Mientras que las transcripciones y grabaciones en audio y 
video serán almacenadas en un computador con clave, que estará en un lugar bajo llave y 
de acceso únicamente para investigadores y terapeutas que participan de los procesos. Se 
establecerá de forma explícita el protocolo para la cadena de resguardo de datos, los que 
junto con los consentimientos informados, serán almacenados en un lugar seguro, al cual 
solo tendrán acceso los investigadores a cargo del proyecto. Se tendrán en cuenta los 
criterios de la Declaración de Singapur sobre la integridad en la investigación. El proyecto 
tendrá presentes los criterios y recomendaciones de CONICYT y del Comité de Ética 
Institucional de la Universidad de Valparaíso. La totalidad de las transcripciones de las 
reuniones de comités y grupos de discusión serán realizadas por los investigadores, quienes 
también participarán en el proceso de análisis de los datos. 
 
10. Utilización y Publicación de los hallazgos 
Los resultados del presente estudio serán difundidos por diferentes canales públicos, ya sea 
en formato de publicaciones (artículos científicos) o presentaciones (exposición en jornadas 
y congresos). Además, esperamos que la tecnología que evaluaremos a través de esta 
investigación sea transferida a los servicios públicos posteriormente 
 
11. Evaluación Comité Bioética y contacto: 
Esta investigación ha sido evaluada y aceptada por el Comité Institucional de Bioética de 
Investigación en Seres Humanos de la Universidad de Valparaíso. Si usted lo requiriera, 
puede contactar a alguno de sus integrantes con su presidente, Dr. Héctor Arancibia al mail 
institucional cec.uv@uv.cl. 
 
12. En caso de aceptar participar, recibirá un ejemplar de este documento. 
Si los resultados de los instrumentos que miden salud en sus estudiantes tienen un puntaje 
de sospecha de problemas de salud mental se le informará a usted en persona y 

 
 
complementariamente se le entregará esta información al equipo biopsicosocial de su red 
de salud y de manera presencial al tutor del estudiante. 
 
 
Nombre:  
RUT: 
Fecha:  
 
Firma: 
Nombre investigador:  
RUT investigador:  
Fecha:  
 
Firma: 
 
 
Valparaíso, Marzo de 2023 
 
 
 
 
 

INFORMED CONSENT FOR TEACHERS AND EDUCATORS PARTICIPATING IN THE
STUDY
The purpose of this document is to invite you to participate in the study entitled
"Participatory Construction and Feasibility of a Multicomponent Intervention to improve
the Well-being of Basic Education Children after the COVID-19 Pandemic", whose main
investigator is Dr. Eva Madrid Aris , in conjunction with the co - investigators; Fanny Leyton
Alvarez , Marcelo Briceño Araya, Karla Álvarez Kozubová , Carolina Godoy Peña, n,
sponsored by the University of Valparaíso, for the development of the health research and
development project – FONIS 2021.
So that you can make an informed decision, we will explain the procedures involved in
carrying out the research, as well as what your collaboration would consist of:
1. This research will be carried out in Public Educational Establishments (EEP) with basic
education in 2 sectors of Valparaíso, Mena and Reina Isabel II, during the year 2023.
2. Relevance of the study and benefits:
Child mental health is the foundation on which mental, physical and social health is built in
adult life, prevention and early intervention of the problems investigated in this
evolutionary stage is essential. Chile has a high prevalence of MS problems in childhood
and adolescence. The school system is a privileged instance for the investigation of the
emotional and behavioral problems of children and adolescents (NNA), but it has not
always had a coordinated and functional intersectoral network to respond to the required
demand. Therefore, this project seeks to contribute to the mental health of children and
the school community through a multicomponent intervention. This program is based on a
biopsychosocial mental health perspective that goes beyond the mere absence of disease,
relieving protective resources, mainly those related to social support and networks
necessary for human well-being. Therefore, the present research and interventions of the
project aim to improve and install skills in basic education teachers, to early identify
mental health difficulties that may occur in children with whom they maintain a daily
relationship based on the teaching work, helping to generate timely and relevant access to
the mental health programs of the territorial health network of the schools that will
participate in the project, thanks to the articulation of intersectoral networks that will be
promoted.
3. Objective:
The team of researchers hopes to know the real possibilities of the application and
effectiveness, of an intervention that contemplates training teachers in the area of mental
health in a hybrid modality, through a program co -constructed with the teachers
participating in this research, in order to enhance their research capacities and referral to
the public system of Chilean health, to promote access to a timely and relevant
intervention, with the support of a network of institutions, from different sectors,

including; education, health, national service for minors, justice, neighborhoods among
others.
4. Participation:
Your participation in this research is completely voluntary and you will not receive any
payment for your agreement to participate. If you agree to participate, you must
participate in a child mental health (SMI) literacy program, which will be carried out in a
hybrid format (face-to-face and e-learning) and, if required, the application of the qualities
and difficulties questionnaire ( SDQ) that assesses emotional symptoms of the students
you are in charge of, responding to an online questionnaire before and after the
intervention on SMI and other mental health questionnaires, in addition, you may be
asked for in-depth interviews to learn about your experience regarding the problems and
facilitators that you identify in the implementation of the intervention.
5. Risks:
We make it clear that there are no potential risks in this study, neither physical, nor
emotional, nor of any kind. On the other hand, the results would make it possible to have
an intervention to improve SMI in EEP boys and girls, with its initial evidence on
effectiveness and feasibility indicators, for its possible scaling up to the national level.
Therefore, a study that has a favorable risk/benefit balance is considered.
6. Costs and payments:
If you agree to participate in the research project, you will not receive money as a
payment for participation in the study. However, the participant declares to have the
technological means of internet access to participate in the different activities described in
this consent.
7. Rights of the participant:
By participating in this study, you have the right to express your doubts to the researcher
at any time by email to eva.madrid@uv.cl . In addition, you can withdraw from the study at
any time if you consider it necessary by communicating it to Dr. Eva Madrid, principal
investigator; It should be noted that your withdrawal will not harm you in any way.
8. Confidentiality of the participant's identity
For the purpose of analysis and maintenance of databases, during the research process, all
information related to names, places or other data that could later lead to the
identification of the participants will be modified from the written and virtual records,
instead it will be used a numeric code.
9. Confidentiality of data
The lists of information obtained from the participants will be maintained by the principal
investigator in physical locations separate from the transcripts and the

audio and video recordings. While the transcriptions and audio and video recordings will
be stored in a password-protected computer, which will be in a locked place and accessible
only to researchers and therapists who participate in the processes. The protocol for the
data protection chain will be explicitly established, which together with the informed
consents will be stored in a safe place, to which only the researchers in charge of the
project will have access. The criteria of the Singapore Declaration on Research Integrity
will be taken into account. The project will take into account the criteria and
recommendations of CONICYT and the Institutional Ethics Committee of the University of
Valparaíso. All the transcripts of the committee meetings and focus groups will be made by
the researchers, who will also participate in the data analysis process.
10. Use and Publication of the findings
 The results of this study will be disseminated through different public channels, either in
the form of publications (scientific articles) or presentations (exhibition in conferences and
congresses). In addition, we hope that the technology that we will evaluate through this
research will be transferred to public services later.
11. Evaluation of the Bioethics Committee and contact:
This research has been evaluated and accepted by the Institutional Committee of Bioethics
of
Research in Human Beings from the University of Valparaíso. If you require it, you can
contact any of its members with its administrative secretary, Ms. Patricia Arancibia Pardo,
on the phone +56 32-2507909, or through the institutional email cec.uv@uv.cl .
12. If you agree to participate, you will receive a copy of this document.
If the results of the instruments that measure health have a score of suspicion of mental
health, you will be informed via mail or phone call and if you wish, this information will be
delivered to the biopsychosocial team of the health network
Name:
RUT:
Date:
Firm:
Researcher name: Eva Madrid Aris
Investigator RUT: 6.890.922-8
Date:
Firm:
Valparaiso, March 2023

 
                                                                 
 
 
 CONSENTIMIENTO INFORMADO PARA APODERADOS DE ESTUDIANTES  
 
 
Le estamos invitando a participar en la investigación “Construcción participativa y factibilidad de 
una intervención multicomponente para mejorar el bienestar de niños de educación básica después de la 
pandemia COVID-19”, adjudicada dentro de los proyectos de intervención en salud FONIS SA21I0143 2021.  
El equipo de investigación está liderado por la Dra. Eva Madrid A., profesora titular de la Escuela de 
Medicina de la Universidad de Valparaíso, y los coinvestigadores son los doctores Fanny Leyton A., Marcelo 
Briceño A., Karla Álvarez K., Sharon Hoover, Hector Parada V. y Marcela Horvitz L., además de Carolina 
Godoy P. y Sebastián Alarcón Ch.  
 
Para ayudarlo a tomar la decisión de participar o no en la presente investigación, a continuación le 
detallamos aspectos relevantes: 
 
¿De qué se trata la investigación a la que se lo invita a participar? 
Busca evaluar la aplicabilidad y efectividad de un programa de capacitación sobre la salud mental infantil 
dirigido a educadores de Establecimientos Educacionales Públicos (EEP) de Valparaíso. El objetivo de dicha 
capacitación es potenciar las capacidades de los educadores para reconocer los problemas de salud mental 
de sus estudiantes y realizar derivaciones oportunas y pertinentes a los programas de la red de salud 
territorial de los EEP. El mayor conocimiento sobre salud mental cobra aún mayor relevancia dado el 
aumento de problemas observados en los estudiantes después de un largo período de escolaridad en sus 
domicilios y confinamiento debida a la pandemia por COVID-19. La pesquisa temprana de problemas de 
salud mental infantil permite una intervención especializada oportuna, prevenir otros problemas de salud 
y favorecer el bienestar de los niños y niñas y sus familias.  
¿Cuál es el propósito concreto de su participación en esta investigación? 
Usted ha sido convocado a participar considerando que es padre, madre y/o apoderado de un/a estudiante. 
Su participación consiste en contestar un cuestionario sobre el estado de salud mental de su hijo/a (SDQ) , 
lo que le tomará máximo 15 minutos. e informar si recibe atención en salud mental. Los educadores 
contestarán el mismo cuestionario respecto de su hijo/a. Se le entregarán los resultados de los 
cuestionarios vía correo electrónico o llamada telefónica, en el caso de que su hijo/a presente, según el 
SDQ un puntaje de riesgo, se le entregarán los resultados en persona por un miembro del equipo 
investigador en dependencias del colegio.  
 
¿Qué beneficios puede obtener de su participación? 
Existen beneficios indirectos y directos derivados de su  participación en este estudio.  
Se espera que este proyecto reporte un beneficio para el progreso de las competencias en los profesores