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Background: Practitioners who support unaccompanied minors (UAMs) come from different professional backgrounds and often are not appropriately trained to address children's complex mental health needs. This gap informed a training programme across all accommodation centres in Greece. Methods: The aim of the Train-of-Trainer (ToT) national programme was to upskill trainers from 17 organisations to cascade knowledge. Training was interprofessional, trauma-informed and culturally sensitive. A pilot implementation involved 199 practitioners from all disciplines. A sub-sample of 33 practitioners, nine managers and six trainers shared their experiences in focus group discussions, which were analysed through a thematic framework. Results: Participants found that the programme was useful in generating knowledge relevant to children's needs and their roles, addressing the emotional impact of trauma on staff, sharing learning across professional disciplines and being interactive, but systemic support should be put in place for benefits to be sustained. Conclusions: Train-of-Trainer is a resource-effective approach to upskill mixed staff groups across many organisations. This should involve caregivers and staff with limited educational opportunities, while accommodating for different professional needs. Training should be integrated to service budgets, specifications and structures. Plain language summary: Staff who support refugee children without parents come from different backgrounds, and often have limited mental health knowledge and skills. To address this gap, a national programme was established for 17 organisations hosting accommodation centres across Greece. Selected professionals were upskilled as trainers to cascade knowledge to their staff group. Training was based on the understanding of the impact of trauma and children's cultural needs and was provided to interdisciplinary staff groups. In total, 199 staff attended pilot training. Experiences of the training were shared by a sub-group of 33 trained staff, nine managers and six trainers through focus group discussions. These were analysed through a qualitative thematic approach. Key findings included the relevance of new knowledge to children's needs and staff roles, training as a team, using learning methods based on real issues, and supports that should be put in place to ensure that benefits are maintained. Such a model of cascading knowledge and skills can be useful for large numbers of organisations and staff supporting refugee and other vulnerable children. Training should include staff such as caregivers, who may have had limited educational opportunities, while balancing between different staff roles. Training should be integral to all functions of accommodation centres. [ABSTRACT FROM AUTHOR]

Youth with mental health needs face barriers in seeking and accessing help, especially in resource-constrained settings in Majority World Countries. Community engagement is thus important for mental health promotion, particularly in addressing stigma. Engagement can be enhanced by involving peer educators and by relating to intergenerational experiences in the sociocultural context of the community. The aim of this study was to explore how intergenerational experiences and perspectives can inform the co-production of youth-led mental health promotion in a Majority World Country, Pakistan. We recruited 11 families (one grandmother, mother and granddaughter in each family) as advisers from two disadvantaged areas of Karachi, and 14 peer educators. Training for peer educators included seminars, experiential activities, three participatory workshops with family advisers and supervision. A sub-sample of family advisers and peer educators attended four focus groups, and peer educators completed reflective diaries following each activity. Data were integrated and subjected to thematic codebook analysis. The three themes related to enabling and hindering factors towards co-production of mental health promotion, incorporation of intergenerational resilience and cascading knowledge to communities. The findings highlighted potential benefits of youth-led mental health promotion that contextualizes intergenerational experiences for those communities. Peer educator roles should be supported by training, and mental health promotion should be integrated within local service systems. [ABSTRACT FROM AUTHOR]

The digital divide is especially pertinent in Majority World Countries (MWCs), and this was exacerbated greatly by the pandemic. Tackling the digital divide underpins the work of Human-- Computer Interaction for Development (HCI4D) and remains an important global endeavour. Our project aimed to understand how children and young people (CYP) in MWC coped during the pandemic and how technology played a role. Voices of CYP were complemented by those of their parents and professionals with whom CYP interacted regularly. Our empirical study involved 73 CYP and 76 adults from Brazil, Kenya, Pakistan, South Africa, and Turkey. Qualitative data from diaries, drawings and focus groups were analysed thematically. Four major themes were identified -- 'access', 'usage', 'risk', and 'future Among others, some intriguing findings were that CYP acutely felt the peer pressure on ICT ownership and tended to direct frustration at parents, who grappled with their untenable roles as gatekeepers to digital worlds. Implications for addressing the digital divide include long-term strategies to improve infrastructures and mobilise community-based collaborative efforts and enhance digital literacy. [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]

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]

There is limited evidence on the cultural appropriateness of first-stage psychosocial interventions for youth with mental health problems who experience conflict and disadvantage in low- and middle-income countries (LMIC). To evaluate the feasibility of such an intervention (Writing for Recovery – WfR) among youth with emerging emotional problems following internal displacement in Kenya. Fifty-four youth aged 14–17 years were randomly allocated to a six-session intervention or a waiting list control group. They completed measures of stressful life events; post-traumatic stress, depressive and anxiety symptoms; quality of life; and free text on their experience of the intervention. Young participants reported high levels of trauma exposure and emotional problems. The intervention was perceived as flexible and culturally acceptable, with reported short-term impact. This was found to have promising post-intervention effect in reducing post-traumatic stress, but not depressive or anxiety symptoms; and in enhancing quality of life scores. Similar psychosocial interventions that can be delivered by paraprofessionals are important for resource-constrained LMIC settings, but need to be integrated within a comprehensive scaled service model. [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]

• Child mental health interventions in Majority World Countries should be contextualized to local sociocultural needs. • Integration to existing psychosocial support can enhance uptake and maximize limited resources. • A Train-of-Trainer cascade approach has potential to widen reach and sustain impact. • Communities should be involved in the whole design and implementation process. This study evaluated the process of integrating child and youth mental health to existing psychosocial support in disadvantaged South African communities. Four child practitioners of the host organization attended a Train-of-Trainer programme. They subsequently co-produced an intervention informed by a service transformation framework along five service domains. Implementation involved 368 community participants. A sub-sample of 43 participants were engaged in focus groups on their experiences. Data were analysed through thematic analysis. Established themes were inter-linked and transcended the five intervention domains. Engagement and conceptualization of mental health through awareness were viewed as pre-requisites to application of new knowledge. This should be supported by systemic changes, predominantly community mobilization and integrated care. Knowledge transfer involving collaboration between services and communities would enable sustainability of impact. The findings led to the formulation of a Theory of Change. Integration of child and youth mental health through a cascade approach that actively involves communities in co-production and delivery can enhance service provision in resource-constrained Majority World contexts. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

To date, research on refugee mental health has mainly focused on understanding the absence of psychopathology rather than on their well-being and associated positive aspects. The aim of this study was to examine the role of resilience, hope, belongingness, and social support in predicting satisfaction with life and flourishing among 361 minority Syrian refugees living in Iraq (age range = 18–60 years, mean = 32.57, SD = 10.05). Participants completed the Brief Resilience Scale, Adult Hope Scale, Multidimensional Scale of Perceived Social Support Scale, General Belongingness Scale, Satisfaction With Life Scale, and Flourishing Scale. Males reported significantly higher levels of resilience, belongingness, and flourishing compared to females. Demographic variables (age, gender, and economic level), resilience, hope, belongingness, and social support were correlated with life satisfaction and flourishing scores. While controlling for sociodemographic characteristics, resilience and hope were associated with life satisfaction and flourishing scores. However, belongingness and social support were only associated with flourishing scores. The findings suggest that equipping refugees with positive psychological resources could promote increased levels of life satisfaction and flourishing and thus enhance preventive psychosocial programs. [ABSTRACT FROM AUTHOR]

• Youth mental health support in Global South Countries should be concurrently addressed at the inter-linked relational, systems and structural levels. • Forming meaningful connections are central to accessing such support. • Youth with mental health lived experience should be incorporated in the planning, implementation and evaluation of services. Youth mental health support and services vary across sociocultural contexts. It is important to capture the perspectives of youth with lived experiences for planning needs-led interventions and services, especially in Global South Countries (GSC), with limited specialist resources and representative literature. The aim was to establish how youth with lived experiences of anxiety and depression viewed external support in different countries, and how these views were juxtaposed with those of professionals. We involved 121 youth aged 14–24 years and 62 professionals from different disciplines in eight countries, predominantly from the Global South. Two youth and one professional focus group was facilitated in each country. The data were analysed through a codebook thematic approach. Youth across all countries largely valued informal support from family, peers and community, whilst those from GSC had limited access to structural support. They related lived experiences to therapeutic engagement and processes, in contrast with professionals who focused on outcomes and service delivery. Mental health awareness and integration of interventions with social support were considered essential by both youth and professionals, especially in disadvantaged communities. The mental health needs of youth in disadvantaged GSC communities can be best met through multi-modal interventions addressing these needs across their socioecology and positioned within a stepped care model. Youth with lived experiences should be involved in service planning, implementation and monitoring. [ABSTRACT FROM AUTHOR]

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]

Background: Although common mental health problems have been widely studied with self-stigma, few studies have focused on the mediating effect of self-stigma in the relationship between mental health problems and help-seeking behaviours of refugee adolescents. Therefore, the purpose of the present study was to examine whether self-stigma mitigates the adverse effects of stress, anxiety, and depression symptoms on the help-seeking behaviours of Syrian adolescents living in Turkey. Methods: The participants of this study included 488 Syrian refugee adolescents (boys, 63.73%; girls, 3627%) living in Turkey. Participants completed the Depression Anxiety Stress Scale and General Help-Seeking Scale and Self-Stigma of Seeking Psychology Help Scale. Results: The findings revealed that stress (β = 0.19, p < 0.01), anxiety (β = 0.12, p < 0.05), and depression (β = 0.17, p < 0.01) had significant and positive predictive effects on self-stigma, but not on help-seeking behaviours. Also, self-stigma (β = −0.12, p < 0.01) had a significant negative predictive effect on help-seeking behaviours. With regard to the indirect effects, the findings showed that self-stigma fully mediated the associations between stress – help-seeking [effect = −0.05, 95% confidence interval (CI) −0.11 to −0.01], anxiety – help-seeking (effect = −0.04, 95% CI −0.09 to −0.01)], and depression – help-seeking (effect = −0.05, 95% CI −0.12 to −0.01). Conclusions: Our findings highlight the potential negative effects of self-stigma on the help-seeking behaviours of Syrian refugee adolescents, both directly and indirectly. These results can be used to develop and implement effective and efficient interventions to address the unmet mental health needs of refugee adolescents. [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]

Children living in resource-constrained environments have high levels of unmet psychosocial needs. Through participatory focus groups, we juxtaposed the views of 55 children aged 7–10 years from resource-constrained settings in South Africa and Pakistan, with those of 96 service providers, focusing on available sources of psychosocial support. Children largely relied on individual and relational resources, with limited awareness of structural supports. Service providers focused less on children's capacity, instead viewing schools and community-based resources as essential sources for psychosocial support. Children's agency and capacity should be recognized and bolstered to inform service planning, community-based interventions, and systemic change. [ABSTRACT FROM AUTHOR]

There is little knowledge on how children perceive psychosocial supports and seek help in resource-constrained settings. The aim of this study was to establish these perspectives among 22 children aged 7–10 years living in a disadvantaged community in Kenya. Children discussed available resources in response to three scenarios of common life stressors. Focus group discussions were subjected to thematic analysis. Children regularly sought internal and relational (family and peers) rather than external structural resources when faced with adversities. Their unique knowledge of their needs, environment and required supports should inform the development of interventions and services through developmentally appropriate participatory methods. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to establish the perspectives of community providers on challenges and enablers in developing child mental health capacity in disadvantaged communities in South Africa. Design/methodology/approach: The authors involved 29 community providers operating in a large urban-deprived area in the Gauteng Province, east of Johannesburg. Community providers had educational, social and health care backgrounds. Their perspectives were captured through three focus groups, two participatory workshops and reflective diaries. Data were integrated and subjected to inductive thematic analysis. Findings: Three interlinked themes were identified. Community mobilization was viewed as pre-requisite through mental health awareness and strategies to engage children, youth and parents. Service provision should take into consideration contextual factors, predominantly inequalities, lack of basic needs and gender-based issues (domestic violence, teenage pregnancy and single motherhood). Participants referred to severe mental health needs, and related to physical health conditions, disabilities and impairments, rather than to common mental health problems or wellbeing. They proposed that capacity building should tap into existing resources and integrate with support systems through collaborative working. Practical implications: Child mental health policy and service design in Majority World Countries (MWCs), should involve all informal and structural support systems and stakeholders. Contextual factors require consideration, especially in disadvantaged communities and low-resource settings, and should be addressed through joined up working. Originality/value: Children's mental health needs are largely unmet in MWC-disadvantaged communities. These findings capture the experiences and perspectives of various community providers on how to enhance mental health provision by mobilizing communities and resources. [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]

Death of a parent has adverse effects on the child's well-being. The surviving parent is often the most important source of support for the child and a close witness of the child bereavement process. The aim of this study was to understand the perceived effects of paternal bereavement on children's mental health and coping strategies through their mothers' narratives. Adopting qualitative research methods, semi-structured interviews were conducted with nine mothers who had lost their spouses. Thematic analysis revealed three main themes: negative effects on mental health, posttraumatic growth, and coping strategies. The findings indicated that the consequences of paternal loss are not limited to negative effects on children's functioning, as they may also experience positive changes following the loss. Moreover, mothers noticed that their children overcame paternal death successfully by using coping strategies such as discovering new activities, religion, and social support. Consequently, these findings indicated that griefresponse and resilience-enhancing strategies should be tailored to the emotional needs of each family. [ABSTRACT FROM AUTHOR]

Locus of control (LOC) is a modifiable mediator of symptoms of posttraumatic stress disorder (PTSD) among traumatized individuals and a potential target of intervention. Compared with studies involving adults, the potential mediation effect of LOC on PTSD symptoms among trauma-exposed children and adolescents is relatively under-explored. This study, therefore, assessed the mediation effects of LOC on the association between lifetime cumulative trauma and PTSD symptoms among a large cohort of adolescents from different cultural background. Cross-sectional study. LOC was determined using the Multi-Dimension Locus of Control Scale; Posttraumatic stress symptoms using the UCLA PTSD Reaction Index; and other significant negative life events using the Life Events Checklist. Among 3826 adolescents who completed the study, external LOC explained 24% of variance (R2 =.24; F2,3823 = 619.01; p <.01) in PTSD symptoms and had significant indirect effect on the relationship between self-reported cumulative traumatic event exposure and PTSD symptoms (ß =.14; 95% BC CI [.10,.20]). Moderated mediation results showed significant potentiation of the moderation effects among older adolescents; boys; and those from more affluent families. The study further strengthened the hitherto limited evidence that external LOC partially mediate the relationship between cumulative trauma exposure and PTSD symptoms among adolescents. [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]