6th UK and Ireland Implementation Science Research Conference 2023
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PRESENter
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Biography
Rodrigo Rojas-Andrade has his PhD in Psychology from the University of Chile, Master’s in Community Psychology from the University of Chile and a Master’s Educational Management from Andrés Bello University. He is an Associate Professor at the School of Psychology at the University of Santiago de Chile. Rodrigo is a specialist in School Mental Health and Implementation Sciences. National and international consultant for public and private bodies associated with public policies on mental health and education. Research Director of the Latin American nucleus of the Global Society Implementation.
Director of Project No. 11220112 (2022-2025) “Mixed study of psychological determinants of implementation fidelity in professionals linked to school mental health in public education.” (FONDECYT Initiation). Director of the project CP21-183 From your story. Mental Health Literacy Program for young people and adolescents (Public Science Fund). Responsible Researcher of the territorial intervention program in crisis and school coexistence MINEDUC. La Pintana Community. University of Santiago. Alternate Director of Project No. 0343 (2020-2022) “Comparative analysis of the impacts of the COVID-19 pandemic on comprehensive childcare systems in three countries: Chile, Uruguay and Colombia” (Covid Fund/Anid).
background
The global concern over mental health issues among children and youth arises from the detrimental consequences of not addressing them promptly, impacting personal and community development trajectories. Educational policies have acknowledged the strong link between emotional well-being and learning outcomes, recognizing the strategic role of educational environments in comprehensive school-based mental health interventions that integrate with local care networks through multi-level mental health support systems. As a result, school-based mental health services and programs have gained prominence in public agendas, leading to their adoption and legislation in many countries.
In Latin America, the Skills for Life (SFL) program by Junaeb has been at the forefront of school mental health for over twenty years. Although unrelated to the WHO program of the same name, the SFL-Junaeb program focuses on promoting essential competencies to cope with life challenges, particularly in vulnerable contexts. It is recognized as one of the world’s eight programs with the highest coverage. The program’s complexity lies in its national model, encompassing multiple levels, components, grades, mixed-prescriptive approaches, and shared administration.
Diverse studies have demonstrated its effectiveness and analyzed implementation outcomes, revealing that professionals generally achieve less than 70% adherence to the strategic components of school mental health programs and less than 50% adherence to the core components of the program itself. Furthermore, recent research indicates that the SFL-Junaeb took three times longer than reported in the literature to reach a sustainability phase. While some studies have attempted to address these implementation outcomes, most have focused solely on specific program components and the characteristics of implementing professionals, leaving gaps in knowledge about other dimensions potentially affecting the program and missed opportunities for improvement.
This study aimed to describe the barriers and facilitators of implementing the SFL-Junaeb program using the Consolidated Framework for Implementation Research (CFIR). Given the nascent state of implementation science in Latin America, it is crucial to explore the application of internationally accepted models to contribute to developing a global science.
MEthod
The study involved 16 participants, including four national coordinators, four regional coordinators, and eight local coordinators from the metropolitan region. All participants provided informed consent and participated in semi-structured interviews. The interviews, based on the five domains of the CFIR, lasted 60 to 90 minutes. Two team members conducted coding, validated in meetings with the principal investigator. 399 quotes were identified and coded, following the procedure suggested on the CFIR website (https://cfirguide.org/).
results
The study highlighted several facilitators. Firstly, the program’s characteristics, particularly its adaptability, allow adjustments to specific needs and contexts. Additionally, a high perception of program evidence supporting its effectiveness encouraged implementation. Effective communication and networks among professionals, teachers, and organization members played a fundamental role in exchanging strategies and providing mutual support within the internal organizational context. A well-established organizational structure with effective leadership facilitated coordination and efficient decision-making. Facilitators also included adaptability, flexibility, and support for employee well-being, increasing implementers’ motivation and commitment. Human resource development through training and education and appropriate planning, design, and alignment with objectives contributed to program success. Leadership and management were crucial for efficient and effective program implementation. Information and knowledge management facilitated the systematization and evaluation of implementers’ information, identifying areas for improvement and supporting informed decision-making. Finally, coordination and communication between programs and the regional level improved program implementation and adaptation to local needs.
However, the study also identified significant barriers to program implementation. Internally, a lack of coordination and clear communication between departments posed a critical barrier. Non-payment of teams had a negative impact on implementers’ motivation and commitment, creating an unfavorable organizational climate. At the organizational level, a new political team’s negative and distrustful attitude towards existing programs emerged as an extreme barrier to implementation. Additionally, the scarcity of human resources, training, and financing, including per diems, presented a critical barrier to ensuring the availability of necessary resources. The organizational structure also posed a significant barrier due to centralized management, hindering regional decentralization and decision-making processes.
Conclusion
This study emphasizes the importance of considering multiple factors for successfully implementing the SFL-Junaeb program in Latin America. The identified facilitators, such as program adaptability, effective communication and networks, well-established organizational structures, effective leadership, and support for employee well-being, align with existing literature on school-based mental health programs. However, significant barriers, including a lack of coordination, resource deficiency, and centralized management, must be addressed to enhance program implementation.
It is crucial to acknowledge the limitations of this study, including the limited sample size and qualitative approach. Future research should encompass larger-scale quantitative studies to provide a more comprehensive understanding of implementation outcomes. Exploring the perspectives of different stakeholders and delving into contextual and organizational factors will further contribute to the knowledge base in implementing school mental health programs in Latin America.
By advancing our understanding of the facilitators and barriers to implementing the SFL-Junaeb program, we can inform policy and practice to enhance the effectiveness and sustainability of school-based mental health interventions. This, in turn, can lead to improved mental health outcomes for children and youth, positively impacting their personal and community development trajectories.