Mental Health Prevention in Preschool Children: An Acceptability and Feasibility Study Protocol of the Implementation of the Culturally Adapted Version of the I Can Problem Solve (ICPS) Programme in Chile

Introduction

Mental health problems generate a high burden of disease in society in general. Early prevention strategies appear to be the more recommendable options. Few preventive interventions have been rigorously evaluated among Chilean preschoolers. The Cognitive Problem-Solving Program, also known as I Can Problem Solve (ICPS), is focused on the development of the cognitive process and children's social problem-solving skills, and it is effective at reducing aggressive behavior among preschoolers. Aims: (1) to develop a culturally appropriate version of the ICPS program and (2) to evaluate the acceptability and feasibility of the adapted version of ICPS among vulnerable schools in Santiago, Chile, conducting a pilot randomized controlled trial with three arms: (1) the ICPS program delivered by an internal early teacher (ICPS IT), part of the school staff, (2) the ICPS program delivered by an external early teacher (ICPS ET), part of the research team, and (3) a control group (CG), providing regular activities.

Method

The trial aimed to recruit 80 preschoolers attending four schools per arm. Children in both intervention groups received the ICPS program: 59 sessions of 20 minutes each delivered three times a week by trained internal or external early teachers over 5-6 months. Cognitive regulation, emotion recognition, social problem-solving skills, and psychological functioning was measured at baseline and will be assessed after the intervention.

Results

Each session was culturally adapted throughout an iterative process between the Chilean research team and the author and US trainer for six months. After this period, 100% of sessions suffered mild linguistic adaptation, 25.4% (15/59) medium-level linguistic and content adaptation (additional linguistic changes and mild changes in activities such as reducing extension or re-ordering the activities) and 3.4% (2/59) important adaptation (changing the whole activity), without compromising the core components of the program. Later, the training of trainer (TOT) was conducted before the implementation of the study. Twelve schools were initially recruited. One refused to participate just before the randomization process, one after the allocation, and one after the baseline assessment. A total of 264 out of 319 consented to participate, and 238 students completed the baseline assessment (attending ten schools): i) ICPS EF (n= 123), ii) ICPS IF (n= 109), and iii) CG (n= 87). 39.1% and 31.7% of students presented behavioral problems according to parents and teachers, respectively. From 59 sessions, in the ICPS EF group, 99.5% were completed, and 68.6% in the ICPS IF group. Acceptability was high among children (80% liked the program, 82.9% enjoyed the ICPS games) and early teachers was also high (76.6% rated the sessions as good or excellent). 40.2 % of parents reported that their children improved their behavior.

Conclusion. Results of acceptability and feasibility are promising. The impact of the intervention on cognitive regulation, emotion recognition, social problem-solving skills, and psychological functioning will be known after the follow-up assessments.