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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]

A critical analysis of the benefits and challenges of adopting a hybrid approach to conducting qualitative research in schools with children as co-researchers is presented. The study involved 18 children (10–11-years), working as co-researchers in pairs to interview each other with a goal of understanding their experiences online, particularly in terms of digital citizenship and mental wellbeing. Children participated in a pre-research lesson for the acquisition of interviewing skills. Analysis identified three key methodological lessons. First, the co-research approach with foundational learning enabled children to be active and responsible interviewers. Second, the adult researcher and school staff had a role in empowering children through empathy, reassurance, positive praise, and supporting them when upset. The final theme recognised the challenges of research being conducted remotely with implications for future research. [ABSTRACT FROM AUTHOR]

Child mental health assessments are complex and involve the analysis of data from multiple sources to inform treatment decisions. Question sequences are central to mental health assessments; however, little research has examined the functions of questions in child mental health interactions, particularly questions that aim to elicit information from children that might be used to inform diagnosis and treatment. In this study, we utilize a large corpus of video-recorded child mental health assessments to examine the use and function of a particular kind of wh-question—circular questions—that is, questions that seek clients' views on other family members' feelings, actions, and thoughts. Using conversation analysis, we identified three "broad" functions of circular questions in child mental health assessment. Our findings provide clinicians with clinically relevant examples for using circular questions to more fully involve children in the assessment process and acquire valuable information for diagnosis. [ABSTRACT FROM AUTHOR]

In mental health settings, before a child can be diagnosed with a mental health condition, they must initially be assessed. These assessments are characterised by question-answer sequences with the child and family members, and our objective is to explore the function of declarative questions. Video recordings of mental health assessments from 28 families were collected, each being approximately 90 min. Referred children were aged 6–17-years. Data were transcribed using the Jefferson approach and conversation analysis was used. Attention to question-answer sequences identified that one common type was the declarative question. We focus on three identifiable forms: clean language short declaratives, declaratives with extreme case formulations, and reformulation declaratives. The response to these three types of declaratives formed the basis for subsequent question-answer elaboration sequences. The question functioned both to engage the child directly and align with other family members. Implications for practitioners are that these types of declarative questions offer a resource to engage in fact-checking in a way that is non-face-threatening. Conversation analysis provides a methodological tool for practitioners to engage in reflective practice to enhance their clinical skills in relation to question design. • Question-answer sequences are the cornerstone of health communication practices. • Declarative questions are a useful part of the communication toolkit. • Different types of declarative questions perform different functions. • Practitioners benefit from paying attention to the form and function of declarative questions. • Attending to the child's knowledge domain through declaratives is child centred. [ABSTRACT FROM AUTHOR]

Background: Social media are integral in the lives of adolescents. Practitioners need to be able to assess risk, and social media are potentially a new dimension to consider. Adolescent voices and practitioner perspectives are central to understanding the relationship between social media and mental health, yet there is limited work that highlights their views. Aims: This paper aims to illuminate the perspectives of adolescents and practitioners about social media and mental health. Method: Eight focus groups, six with adolescents aged 11–18 years and two with mental health practitioners, were conducted. Ethical approval was provided. Discussions allowed for expression of experiences, views and opinions of the relationship between social media and mental health. Results: Participants discussed what might be thought of as the "good", the "bad" and the "ugly" side of social media, navigating the benefits of social media to well-being against possible negative impacts on adolescents. They differentiated personal use from third party attributions whereby they extolled the risk to adolescents outside of their personal group. Much of the negative rhetoric of social media was repeated by mental health practitioners, although there was some acknowledgement of potential benefit. Conclusions: Practitioners need to consider social media and its role in practice. When risk-assessing adolescents, it is arguably useful to include a social media dimension, without presuming the relationship will be negative. [ABSTRACT FROM AUTHOR]

Central to a contemporary understanding of childhood is the developmental and clinical‐medical construct of the 'normal' child. When judged to fall outside of culturally, socially and historically situated parameters of 'normality', children become labelled as 'deviant from the norm'; for instance, in mental health contexts where this may provide the basis for psychiatric diagnosis. However, judgements of a child's 'normality' are further complicated by the range of individuals who may have a stake in that construction, including parents/carers, professionals and the child themselves. Using discursive psychology, we analysed 28 video‐recorded UK child mental health assessments, to examine ways that parents presented concerns about their children's development. They did this by drawing on notions of 'ab/normal', in ways that functioned to legitimise their need for services and built a rhetorical case to demonstrate clinical need; often by contrasting the child with other 'typical' children and/or contrasting the same child's behaviour in different settings or contexts. We concluded that given the growing crisis in child mental health, initial assessments play a crucial clinical role in determining diagnosis and labelling, and therefore, a critical discussion of these concepts and processes is essential. [ABSTRACT FROM AUTHOR]

In everyday conversations, people put forward versions of events and provide supporting evidence to build a credible case. In environments where there are potentially competing versions, case-building may take a more systematic format. Specifically, we conducted a rhetorical analysis to consider how in child mental health settings, families work to present a credible 'doctorable' reason for attendance. Data consisted of video-recordings of 28 families undergoing mental health assessments. Our findings point to eight rhetorical devices utilised in this environment to build a case. The devices functioned rhetorically to add credibility and authenticate the case being built, which was relevant as the only resource available to families claiming the presence of a mental health difficulty in the child was their spoken words. In other words, the 'problem' was something constructed through talk and therefore the kinds of resources used were seminal in decision-making. [ABSTRACT FROM AUTHOR]

Purpose: The prevalence of mental disorders amongst children and adolescents is an increasing global problem. Schools have been positioned at the forefront of promoting positive mental health and well-being through implementing evidence-based interventions. The aim of this paper is to review current evidence-based research of mental health promotion interventions in schools and examine the reported effectiveness to identify those interventions that can support current policy and ensure that limited resources are appropriately used.Methods: The authors reviewed the current state of knowledge on school mental health promotion interventions globally. Two major databases, SCOPUS and ERIC were utilised to capture the social science, health, arts and humanities, and education literature.Results: Initial searches identified 25 articles reporting on mental health promotion interventions in schools. When mapped against the inclusion and exclusion criteria, 10 studies were included and explored. Three of these were qualitative and seven were quantitative.Conclusions: A range of interventions have been tested for mental health promotion in schools in the last decade with variable degrees of success. Our review demonstrates that there is still a need for a stronger and broader evidence base in the field of mental health promotion, which should focus on both universal work and targeted approaches to fully address mental health in our young populations. [ABSTRACT FROM AUTHOR]

Background: In child and adolescent mental health assessments, questions are integral to the process. There has been limited research focused on the assessment process, or on how questions are constructed within this clinical environment. Methods: We examined 28 naturally occurring initial assessments, with particular attention to how practitioners used questions in their communication with children and young people. We utilised conversation analysis to examine the data. Results: Analysis revealed a particular type of question preface used to reintroduce a prior topic. This was achieved through the use of ‘you said x’ as a foundation for asking a follow‐up question and demonstrated active listening. Conclusions: Arguably, this approach is a useful way of gathering assessment‐relevant information in a child‐centred way. [ABSTRACT FROM AUTHOR]

Objective Young children with congenital visual impairment (VI) are at increased risk of behavioral vulnerabilities. Studies on ‘at risk’ populations suggest that frontal EEG asymmetry may be associated with behavioral risk. We investigated frontal asymmetry at 1 year (Time 1), behavior at 2 years (Time 2) and their longitudinal associations within a sample of infants with VI. Frontal asymmetry in the VI sample at 1 year was also compared cross-sectionally to an age-matched typically sighted (TS) group. Methods At Time 1, 22 infants with VI and 10 TS infants underwent 128-channel EEG recording. Frontal asymmetry ratios were calculated from power spectral density values in the alpha frequency band. At Time 2, Achenbach Child Behavior Checklist data was obtained for the VI sample. Results 63.6% of the VI sample and 50% of the TS sample showed left frontal asymmetry; no significant difference in frontal asymmetry was found between the two groups. 22.7% of the VI sample had subclinical to clinical range ‘internalizing’ behavior difficulties. Greater left frontal asymmetry at one year was significantly associated with greater emotionally reactive scores at two years within the VI sample ( r = 0.50, p = 0.02). Conclusions Left frontal asymmetry correlates with later behavior risk within this vulnerable population. Significance These findings make an important first contribution regarding the utility of frontal EEG asymmetry as a method to investigate risk in infants with VI. [ABSTRACT FROM AUTHOR]

Integral to the diagnosis of autism spectrum disorder is the initial assessment through which the existence of a 'problem' is first ascertained. Despite this, there remains limited research on this early part of the diagnostic pathway. In this article, we utilised conversation analysis to examine relevant issues in relation to the practitioner-family interactions that take place within this initial assessment context. Our findings illustrated that parents typically first raised the possibility of the presence of an autism spectrum disorder diagnosis through 'building a case', which professionals were then able to ratify or negate. Furthermore, we found that the assessments unfolded sequentially and clinical decisions were typically reached through a distinctive pattern of interaction. These findings have important implications for clinical practice, including for the study of autism spectrum disorder assessments and diagnosis. [ABSTRACT FROM AUTHOR]

Systemic family therapy promotes a systemic reframing of individual problems to an understanding of the familial processes influencing family functioning. Parents often attend therapy identifying their child as the key problem, which raises issues of accountability and blame. In this article, we explored the discursive practices used by parents for constructing themselves as ‘good parents’. Using the basic principles of conversation analysis and discursive psychology, we analysed actual therapeutic sessions and found that parents used a range of strategies to display their good parenting. This included directly claiming to be a good parent, illustrating how they act in their child’s best interests, showing that they parent in appropriate ways and by making appeals to scientific rhetoric. It was concluded that family therapists have a challenging task in managing competing versions of events and we discussed implications for practice. [ABSTRACT FROM AUTHOR]

Background A comprehensive assessment is essential to contemporary practice in child and adolescent mental health. In addition to determining diagnosis and management, it is seen as important for clinical engagement and forming a therapeutic relationship. However, there has been little research on the processes which occur during this interaction, particularly in first assessments. Method Twenty-eight naturally occurring child mental health initial assessments were video recorded and subjected to the basic principles of the conversation analytic method. Results Several processes were identified in a typical child and adolescent mental health assessment. These included introductions, reasons for attendance, problem presentation, decision-making and session closure. Conclusions Initial assessments provide a platform for all future engagement with services and an understanding of the processes occurring within this setting is important for the eventual outcomes, particularly in respect to new ways of working such as the Choice and Partnership Approach ( CAPA). [ABSTRACT FROM AUTHOR]

Tackling the day-to-day challenges of family therapy can prove difficult for professionals. A particular issue arising in family therapy is the notion of what is appropriate for children. Families report events from their social world, out-there to the therapy in-here. There are occasions where the content is 'adult' in nature and this has to be managed in front of the children. On some occasions family members use derogatory or negative descriptions of their children while their children are present. Drawing upon naturally occurring family therapy sessions, we present a discourse analysis of how this is managed through a range of discursive resources. We show that adult family members construct what is inappropriate for children to be exposed to by positioning blame with others. This has implications for how family therapists deal with inappropriateness when children are present while maintaining the equilibrium of therapeutic alliances. [ABSTRACT FROM AUTHOR]

Background Recent policies recommend effective joint working between health and education; however, the views of service users are underrepresented, particularly opinions of young children. Method The project was operational from 2005-2008 when interviews were conducted with parents and children. The children were attending CAMHS for mental health and educational difficulties. Results Results indicated that they had a positive view of multiagency working. They consider that joint working is limited by a number of problems and make recommendations for improvement. Conclusions Findings indicate that more effective communication between agencies is needed and this should be provided for parents in an accessible language. This has implications for training professionals together. [ABSTRACT FROM AUTHOR]

Children's engagement and disengagement, adherence and non-adherence, compliance and non-compliance in healthcare have important implications for services. In family therapy mere attendance to the appointments is no guarantee of engaging in the treatment process and as children are not the main initiators of attendance engaging them through the process can be a complex activity for professionals. Through a conversation analysis of naturally occurring family therapy sessions we explore the main discursive strategies that children employ in this context to passively and actively disengage from the therapeutic process and investigate how the therapists manage and attend to this. We note that children competently remove themselves from therapy through passive resistance, active disengagement, and by expressing their autonomy. Analysis reveals that siblings of the constructed 'problem' child are given greater liberty in involvement. We conclude by demonstrating how therapists manage the delicate endeavour of including all family members in the process and how engagement and re-engagement are essential for meeting goals and discuss broader implications for healthcare and other settings where children may disengage. [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 considerable debate around the application of ethical principles and the notion of risk in qualitative research, and as such it is becoming increasingly important that we have empirical evidence to draw upon to contribute to these arguments. In this article, we use discourse analysis to look at what Child and Adolescent Mental Health Service users think about the role of anonymity in research. We consider the viewpoints of children and their parents to look at how necessary this ethic is and whether there is a possibility that a choice could or should be offered to those participating. Our findings demonstrate variability in perspectives and differences between parent and child views. Our findings highlight that a single approach to qualitative research ethics does not fit all people, and we consider the wider implications of offering choices in research contexts. [ABSTRACT FROM PUBLISHER]

Abstract: In this paper, I explore the ways in which family therapists interrupt their clients during the process of therapy. Family therapy involves multi-party talk and allows for the possibility of overlapping speech, side conversations and interruptions. I focus here on speech acts that occur in the middle of another speaker''s turn and can be treated as an interruption. The family therapist interrupts the clients in different ways. When interrupting an adult/parent client the interruption is accompanied by politeness or an apology. When interrupting the children in the family, though, the interruptions are different. The family therapist makes no apology and does not orient to the speech act as being interruptive. Here, I investigate, through a discursive analysis, how these interruptions are constructed and treated. [Copyright &y& Elsevier]

This work adds to the growing literature on children's talk and the extensive research on interruptions by combining the two. I investigate children in the institutional context of family therapy and their interactions with the parents and therapist. Drawing upon 22 hours of natural family therapy data and four families, I use a discursive approach. I note that children are not attended to when they try to interrupt unless they persist and then the acknowledgement is negative. I show that when the main topic is about extremes of behaviour the child's none relevant interruption is ignored. There are occasions however when the child interrupts with a topic relevant issue and these are usually attended to. This research has wider implications for therapeutic practice and children's role in therapy. There is a need for further study of children's interruptive discourse practice as research in this area is limited. [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]

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]

Recent changes to the law in England require all primary schools to teach Relationships Education and all secondary schools to teach Relationships and Sex Education (RSE). Our focus in this article is on the voices of teachers and other educational professionals in relation to this change. Discussion in three focus groups held with 16 educational professionals, indicated concerns regarding some of the challenges associated with the implementation of the new legal requirements, as well as recognising fresh opportunities afforded to teachers for engaging with children and young people. Through analysis, it was noted that participants considered how lessons on relationships and sex should cover LGBTQ+ (lesbian, gay, bisexual, transgender, queer/questioning, others) issues, with strategies advanced for building bridges between schools and parents/communities. Our research indicates a difference between the importance of Relationships Education/RSE and the perceptions of those charged with teaching it, as well as the view that the laudable aims underpinning the new provisions in England will only be realised if appropriate support and training is given to teachers. [ABSTRACT FROM AUTHOR]

In a recent contribution to this journal, Cummings (2023) reports findings from a preliminary qualitative study of practitioner viewpoints regarding digitally delivered mental health support to care-experienced young people. Cummings' study highlights the need to engage with professional experiences of using digital methods with this group, both during and outside of the COVID-19 pandemic. A response to - and commentary on – Cummings' contribution is provided, to advance discussion of issues identified by the research. We reflect on our experience as practitioners and researchers working in and alongside specialist child and adolescent mental health service teams serving care-experienced children and young people. We focus on workspaces in remote working, therapeutic technique in online and telephone-based care, and virtues and challenges of remote care delivery. [ABSTRACT FROM AUTHOR]

In England schools are increasingly responsible for supporting children with Social, Emotional and Mental Health (SEMH) difficulties yet their voices are rarely represented. Through semi-structured interviews, the views of 11 children aged 6–11 years with SEMH difficulties were sought. Using thematic analysis two themes were identified – (1) social relationships and interactions, and (2) emotional and behavioural reactions. The children demonstrated that they were articulate and reflective about the impact their difficulties have in the learning environment. For some, they reported building and maintaining close reciprocal friendships which they felt enriched their time at school. It was concluded that children with SEMH difficulties need to feel safe and supported by adults to flourish in school. This work demonstrates the importance of taking a child-centred approach, allowing children to feel heard, understood and valued. [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]

Aim: To investigate the effects of home-based early intervention in children with severe visual impairment (SVI) using the Developmental Journal for babies and young children with visual impairment (DJVI).Method: A longitudinal observational study was undertaken with a national cohort (OPTIMUM) of infants with congenital disorders of the peripheral visual system (CDPVS) and profound-SVI; and followed up after 12 months and 24 months. Intervention was categorized according to the practitioner diary records of their usual practice over 12 months from baseline comparing those receiving the DJVI and those receiving 'Other Support'. Outcome measures of cognition and language, behaviour difficulties, parenting stress, and satisfaction with parent-practitioner partnership were collected.Results: In the 54 children (26 males, 28 females, baseline mean age 13.5mo, SD 2.3mo, range 8-17mo) with 'total' CDPVS (including 16 'complex' and 38 'simple' with or without known brain disorder respectively), linear mixed effects pointed towards acceleration in sensorimotor understanding and expressive language especially in the 'simple' subsample (11.72 developmental quotient, 95% confidence interval -1.17 to 24.61, p>0.05) in those receiving the DJVI. Vision level also predicted outcomes (p<0.05). The DJVI group showed improvements in behavioural withdrawal (η2 =0.20, p=0.02, 'simple') and parenting stress (d=0.78, d=0.92, p=0.02 total and 'simple' respectively) and perceived practitioner-parent relationship (η2 =0.16, p=0.01).Interpretation: Infants and young children with visual impairment receiving home-based early intervention using the DJVI with a structured developmental approach had better outcomes than those receiving 'other' home-based early interventions. Moderate to large effect improvements were found in child cognition and language, behaviour and parenting stress and the perceived practitioner-parent relationship, although cognition did not reach 5% significance level.What This Paper Adds: Early intervention using the Developmental Journal for babies and young children with visual impairment was associated with enhanced developmental outcomes compared to other approaches. Improvements were also found in child behaviour, parenting stress, and perceived parent practitioner outcomes. Type and complexity of visual impairment also influenced outcomes. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to report findings from a service evaluation undertaken within a single specialist child and adolescent mental health service (CAMHS) team. The team works closely with local authority children's services to serve specific populations recognised as experiencing higher levels of mental health need, including children living in alternative care and with adoptive families. The evaluation sought to better understand the experience of this provision during the COVID-19 pandemic and concomitant increase in remote and digitally mediated care delivery. Design/methodology/approach: Analysis of the accounts of 38 parents, carers and professionals involved with the team gathered via telephone interviews and email and postal questionnaires. Findings: Similar views were expressed from participants involved with the team before and following the onset of the pandemic. Overall, satisfaction was high; however, changes in care appeared more challenging for those already involved with the team before the pandemic. Differences in experience between groups were also evident. Whereas foster carers' accounts were generally appreciative of the involvement of clinicians, particularly regarding clinician–patient relationships, amongst adoptive parents and members of children's birth families there were more mixed and negative impressions. Originality/value: Locally based service evaluations can help inform care pathway planning in specialist CAMHS provision as part of wider quality improvement initiatives. This is especially relevant considering the repercussions of the COVID-19 pandemic and as the longer-term acceptability of remote working practices is appraised. [ABSTRACT FROM AUTHOR]

In specialist child and adolescent mental health service (CAMHS) provision serving children living in local authority care (i.e. who are looked-after) and other vulnerable groups, consultation with social care professionals and carers is an important part of care delivery. It functions as both a pathway to direct assessment and treatment and an indirect intervention, via formulation, advice and support to the network surrounding a child. This article is concerned with consultation practice in a single multidisciplinary CAMHS team and incorporates two elements. First, it reports on an audit of basic data collected over a 26-month period for quality improvement purposes, and second, it provides practice-based reflections on facilitating consultations during the COVID-19 pandemic. The audit findings, notably that looked-after, adopted, and 13–15 year old children were most likely to be referred on for direct assessment, are discussed and contextualised in a description of local arrangements and working practices, as well as relevant research literature. The reflections involve consideration of changes in problems for which consultations were sought during the initial stages of the pandemic and challenges created by the turn to remote care delivery. In addressing these two tasks, an illustrative example is provided of the role that service audits and practice-based reflection on consultation work can play in helping to identify inequities in access to care in specialist CAMHS teams. [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]