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The objective was to establish how stakeholders in low- and middle-income countries (LMIC) conceptualize child mental health impact. Semi-structured interviews were conducted with 18 stakeholders from disadvantaged urban communities in Kenya, South Africa, Turkey and Brazil. Participants represented education, welfare and health care agencies; as well as community and religious groups. Data were analysed through a thematic approach and three related themes were identified. Impact was defined as a process of change, with child-centred outcomes and measures that were broader than mental health symptoms improvement. Beneficiaries were identified at child, family, community and service level. Participants wished to see strategies that ensured sustainability of impact, namely child mental health policy, stakeholder engagement, interdisciplinary working, and capacity-building for all stakeholder groups. Child mental health service transformation in LMIC, especially in areas of deprivation, needs to build on existing resources and strengths by co-producing psychosocial outcomes with a range of professional and community stakeholders. Impact on children's mental wellbeing can be achieved through a co-ordinated strategy that involves designated policy, capacity-building, and interdisciplinary networks with meaningful community involvement.

The qualitative community embraces transparent dialogue through sharing knowledge to improve rigour and develop new initiatives. In this paper, we recognise there are many complexities within qualitative research, leading to important debates. We explore the benefits and challenges, as well as the practicalities and technicalities, of conducting research that 1) employs multiple methods within the qualitative paradigm, 2) is interdisciplinary, and 3) examines a sensitive research topic 4) with a vulnerable group of participants. Specifically, when research is also 5) cross-cultural and 6) utilises participatory techniques. Through our discussion, we draw upon an existing project and examine the complexity of designing and completing intra-paradigmatic mixed methods research with children from different sociocultural contexts, underpinned by interdisciplinary perspectives, in a complex area like mental health. [ABSTRACT FROM AUTHOR]

Several risk factors for children's mental health and wellness have been established. These are compounded by inequalities, especially in Majority World Countries (MWC). As evidence is largely based on adult reports, we aimed to capture children's experiences of risk across five MWC resource-constrained settings (Brazil, Pakistan, Turkey, Kenya, and South Africa) during the height of COVID-19 pandemic. Participants included 36 children aged 8–10 years and 37 young people aged 14–16 years. We employed a thematic design using a participatory methodological approach in collecting data through diary entries, drawings, posters, focus groups discussions, and child-led interviews with elders. Two researchers integrated and analysed the data set through a thematic codebook framework. Three identified themes related to exacerbation of existing risks, disruption or loss of protective factors, and lack of access to structural supports. Children linked risk factors along their socioecology. The findings have implications in actively involving children as social actors in determining and addressing risk for mental health and wellness through child-centred and multi-sectoral policy and interventions. [ABSTRACT FROM AUTHOR]

\nContributions to the intergenerational field There is limited evidence on how intergenerational trauma and resilience are perceived by children, especially in Majority World Countries (MWC). We established such perspectives among 73 children and youth in Brazil, Kenya, South Africa, Pakistan and Turkey. Children interviewed older adults, kept diary fieldnotes, and shared learning in focus groups. Data were integrated through a thematic codebook. Four themes reflected deprivation of safety needs and family challenges, especially for girls, which shaped older adults’ resilience. Children related accounts to their experiences, to generate intergenerational learning. Implications of the findings are considered in the context of intercultural shared trauma and resilience. Children can draw strength from intergenerational narratives to build their resilience in the face of future adversity. The emotional impact of intergenerational narratives can have more impact on children than conveying information or advice. A multi-method approach can be adapted for different age groups to elicit intergenerational perspectives. Children can make an important contribution as co-researchers in intergenerational research. Children can draw strength from intergenerational narratives to build their resilience in the face of future adversity.The emotional impact of intergenerational narratives can have more impact on children than conveying information or advice.A multi-method approach can be adapted for different age groups to elicit intergenerational perspectives.Children can make an important contribution as co-researchers in intergenerational research. [ABSTRACT FROM AUTHOR]

Drawing on integrated data from focus groups and diary entries, we explored the impact of the COVID‐19 pandemic on child well‐being for children from five Majority World Countries. We focus on the disruptions the pandemic caused, the adjustments made in response to these, and children's vision of a post‐pandemic world. Underlying children's experiences of loss, boredom and concerns about educational progress, was an awareness of systemic inequalities that disadvantaged them or others in their community. Findings have implications on capturing children's voices through introspective and dialogical approaches that transcend cultures and for the development of preventive and responsive interventions during crises. [ABSTRACT FROM AUTHOR]

Abstract Refugee young people have high rates of unmet mental health needs. Established barriers to accessing mental health care may be contextual to the host country and its support systems. The aim of this study was to establish the perspectives of refugee young people, parents, and service providers on service responses across one middle-income and one high-income country, Turkey and the UK, respectively. In Turkey, eight professionals (social work, psychology, and education), ten parents and ten young people took part. In the UK, stakeholders included four professionals (health, educational psychology, and non-statutory), seven parents and seven young people. Data were analyzed using a codebook thematic approach. Despite structural differences between the two systems, several commonalities were identified in responses. Conceptualization of mental health, stigma, shame, and parents’ language acquisition acted as barriers to help-seeking in both countries, whilst schools were viewed as central to the initiation of interventions. Contextual barriers in Turkey included child marriage and labor, whilst reliance on non-governmental organizations (NGOs) facilitated joint care pathways. In the UK, providers aimed to adapt and extend care pathways through primary health care. Recommendations included designated policy, joint working, schools acting as service hubs, awareness, and training professionals on contextual knowledge. [ABSTRACT FROM AUTHOR]

Digital technology offers opportunities for child mental health capacity building, which is a priority for Majority World Countries (MWC). The aim of this study was to explore the experiences and perspectives of professionals from different disciplines in Turkey (n =12) and Pakistan (n =15), who had completed a two-module digital trauma-informed programme on enhancing practice skills and instigating systemic changes. Interview data were analysed through a coding thematic approach. Participants especially valued the interdisciplinary and holistic approach of the training, and its proposed scaled service model. Digital training, particularly in blended format, can enhance reach and capacity in MWC low-resource settings. [ABSTRACT FROM AUTHOR]

Children in low- and middle-income countries (LMIC) have high levels of unmet mental health needs, especially in disadvantaged communities. To address this gap, we developed a child mental health service improvement programme. This was co-facilitated using interprofessional principles and values in four countries, South Africa, Kenya, Turkey and Brazil. Eighteen stakeholders from different professions were interviewed after six months on their perspectives on enabling factors and challenges they faced in implementing service plans. Participants valued the holistic case management approach and scaled service model that underpinned the service plans. Emerging themes on participants’ priorities related to service user participation, integrated care, and different levels of capacity-building. We propose that an integrated care model in LMIC contexts can maximize available resources, engage families and mobilize communities. Implementation requires concurrent actions at micro-, meso- and macro-level. [ABSTRACT FROM AUTHOR]

Despite the evidence on the role of parental factors, especially attachment relationships, in mediating complex trauma experienced by refugee children, there is limited evidence on the use of attachment‐based interventions. The aim of this study was to explore the feasibility of adapting such an intervention, group theraplay, for refugee children in Turkey. Fifteen child–parent dyads participated, and completed measures on attachment relationships, child mental health and parenting strategies. Children engaged with the intervention, whilst it proved more difficult to involve parents regularly. There was a significant improvement in children's post‐traumatic stress and other common mental health symptoms, as well as parent‐rated attachment relationship difficulties. Attachment‐based modalities using play, activities and games can be particularly useful for children and families with cultural and language challenges. Therapeutic interventions for refugee children and families should be integrated with other types of support within a multimodal service approach. [ABSTRACT FROM AUTHOR]

Although there has been increasing attention on the impact of risk and resilience factors on refugee children's mental health, there has been limited evidence on the role of parental factors to inform interventions, and this predominantly relies on adult reports. The aim was to investigate the relationship between perceived parenting styles and attachment relationships and child mental health, as reported by 322 Syrian refugee minors aged between 8 and 17 years in Turkey. Child-rated scales included the Children Revised Impact of Event Scale–8 (CRIES-8), Strengths and Difficulties Questionnaire (SDQ), Security Scale and Egna Minnen Betraffande Uppfostran for Children (EMBU-C), and were used as measures of post-traumatic stress disorder (PTSD), general mental health problems, attachment relationships and perceived parenting styles, respectively. Children with secure maternal and paternal attachment perceived their parents as less rejecting, while children with secure paternal attachment also reported their parents as emotionally warmer. Attachment relationships significantly contributed in predicting PTSD after controlling for age and gender, while conduct problems were predicted by lack of emotional warmth, rejection and over-protection by both parents, in addition to insecure attachment relationships. Refugee children's views are essential in establishing their needs and planning interventions. These should address both the impact of trauma and current family relationships. [ABSTRACT FROM AUTHOR]

Background: Child mental health services and related agencies are faced with an increasing challenge in responding to the influx of refugee children around the world. There is strong evidence on the prevalence and complexity of these children's mental health problems and broader needs. Aims: To review the research literature on risk and protective factors, and associated mental health interventions for refugee children. Methods: Peer‐reviewed studies were included for the period 2004–2017; if they included refugee, asylum‐seeking or internally displaced children under 18 years; and adopted a quantitative design. Vulnerability and protective factors for refugee children were considered in this context, followed by the respective types of interventions at pre‐, peri‐ and postmigration stage, and across high‐ and low‐/middle‐income countries. Eighty‐two peer‐reviewed studies fulfilled the selection criteria. Results: The existing body of literature is largely based on identifying risk factors among children with mental health problems and predominantly designing trauma‐focused interventions to reduce their symptomatic distress. Recent research and services have gradually shifted to a broader and dynamic resilience‐building approach based on ecological theory, that is at child, family, school, community and societal level. There is increasing evidence for the implementation and effectiveness of multimodal interventions targeting all these levels, despite the methodological constraints in their evaluation. Conclusions: In high‐income countries, child mental health services need to collaborate with all agencies in contact with refugee children, establish joint care pathways, and integrate trauma‐focused interventions with family and community approaches. In low‐ and middle‐income countries, where specialist resources are sparse, resilience‐building should aim at maximising and upskilling existing capacity. A six‐dimensional psychosocial model that applies to other children who experience complex trauma is proposed. [ABSTRACT FROM AUTHOR]

Despite growing evidence of the effects of social media on the mental health of adolescents, there is still a dearth of empirical research into how adolescents themselves perceive social media, especially as knowledge resource, or how they draw upon the wider social and media discourses to express a viewpoint. Accordingly, this article contributes to this scarce literature. Six focus groups took place over 3 months with 54 adolescents aged 11–18 years, recruited from schools in Leicester and London (UK). Thematic analysis suggested that adolescents perceived social media as a threat to mental wellbeing and three themes were identified: (1) it was believed to cause mood and anxiety disorders for some adolescents, (2) it was viewed as a platform for cyberbullying and (3) the use of social media itself was often framed as a kind of ‘addiction’. Future research should focus on targeting and utilising social media for promoting mental wellbeing among adolescents and educating youth to manage the possible deleterious effects. [ABSTRACT FROM AUTHOR]

Drawing on integrated data from focus groups and diary entries, we explored the impact of the COVID-19 pandemic on child well-being for children from five Majority World Countries. We focus on the disruptions the pandemic caused, the adjustments made in response to these, and children's vision of a post-pandemic world. Underlying children's experiences of loss, boredom and concerns about educational progress, was an awareness of systemic inequalities that disadvantaged them or others in their community. Findings have implications on capturing children's voices through introspective and dialogical approaches that transcend cultures and for the development of preventive and responsive interventions during crises., Competing Interests: No conflict of interest to declare., (© 2021 National Children's Bureau and John Wiley & Sons Ltd.)

Despite growing evidence of the effects of social media on the mental health of adolescents, there is still a dearth of empirical research into how adolescents themselves perceive social media, especially as knowledge resource, or how they draw upon the wider social and media discourses to express a viewpoint. Accordingly, this article contributes to this scarce literature. Six focus groups took place over 3 months with 54 adolescents aged 11-18 years, recruited from schools in Leicester and London (UK). Thematic analysis suggested that adolescents perceived social media as a threat to mental wellbeing and three themes were identified: (1) it was believed to cause mood and anxiety disorders for some adolescents, (2) it was viewed as a platform for cyberbullying and (3) the use of social media itself was often framed as a kind of 'addiction'. Future research should focus on targeting and utilising social media for promoting mental wellbeing among adolescents and educating youth to manage the possible deleterious effects.