Examining youth mental health promotion at scale: an exploration of the implementation of three initiatives in a national programme

IntroductionProtecting and promoting the mental health of youth under 30 years of age is a priority, globally. Yet investment in mental health promotion, which seeks to strengthen the determinants of positive mental health and wellbeing, remains limited relative to prevention, treatment, and recovery. The aim of this paper is to contribute empirical evidence to guide innovation in youth mental health promotion, detailing the early outcomes of Agenda Gap, an intervention centering youth-led policy advocacy to influence positive mental health for individuals, families, communities and society.MethodsLeveraging a convergent mixed methods design, this study draws on data from n = 18 youth (ages 15 to 17) in British Columbia, Canada, who contributed to pre- and post-intervention surveys and post-intervention qualitative interviews following their participation in Agenda Gap from 2020-2021. These data are supplemented by qualitative interviews with n = 4 policy and other adult allies. Quantitative and qualitative data were analyzed in parallel, using descriptive statistics and reflexive thematic analysis, and then merged for interpretation.ResultsQuantitative findings suggest Agenda Gap contributes to improvements in mental health promotion literacy as well as several core positive mental health constructs, such as peer and adult attachment and critical consciousness. However, these findings also point to the need for further scale development, as many of the available measures lack sensitivity to change and are unable to distinguish between higher and lower levels of the underlying construct. Qualitative findings provided nuanced insights into the shifts that resulted from Agenda Gap at the individual, family, and community level, including reconceptualization of mental health, expanded social awareness and agency, and increased capacity for influencing systems change to promote positive mental health and wellbeing.DiscussionTogether, these findings illustrate the promise and utility of mental health promotion for generating positive mental health impacts across socioecological domains. Using Agenda Gap as an exemplar, this study underscores that mental health promotion programming can contribute to gains in positive mental health for individual intervention participants whilst also enhancing collective capacity to advance mental health and equity, particularly through policy advocacy and responsive action on the social and structural determinants of mental health.

Physical Activity Intensity Measurement and Association With Adolescent Health: Chartering New Frontiers

Promoting youth mental health is a critical public health priority and merits robust policy and practice responses, inclusive of youth-centred and upstream interventions that address the root factors contributing to mental health outcomes. To that end, non-familial youth-adult relationships can powerfully impact youths’ healthy development, mental health and well-being, and capacities for enacting change within home, school, and policy contexts. Agenda Gap is a youth mental health promotion programme based on this principle, in which adult facilitators support youth (aged 15–24) in co-exploring activities focused on mental health promotion and policy advocacy, while fostering supportive, trusting intergenerational relationships. This study presents a realist evaluation of Agenda Gap, drawing on realist qualitative interviews with youth participants (n = 18) and adult collaborators (n = 4). We constructed 15 initial programme theories in four theoretical areas that we subsequently explored via analysis of the realist interview data. The analysis used the middle-range theories of ‘Third Space’ and ‘Third Place’ to conceptualize and articulate how causal mechanisms were produced from the non-familial youth-adult relationships that are foundational to the programme. Results are presented across 10 context-mechanism-outcome (CMO) configurations in three sections: (1) Agenda Gap Facilitation Activates ‘Third-Space/Third-Place’ Mechanisms; (2) Youth Enhance Personal Mental Health while also Supporting Mental Health of Friends and Family; (3) Youth Become Inspired and Informed to Act as Advocates and Policy Change Agents. Taken together, these findings provide insights into the important mechanisms of non-familial intergenerational trust building and demonstrate how a strengths-based conceptualization of youth mental health supports mental health maintenance, promotion, and advocacy for this population.

There is an unprecedented growth in the young population worldwide and especially in India and mental health of youth is an area of growing concern. The scope of convergence of the fields of positive youth development and mental health promotion among youth is becoming evident in the recent times. The paper aims to provide a brief overview of the field of PYD research in India and come up with implications for utilizing this framework for youth mental health promotion. A rapid review was carried out to examine Indian research on positive youth development and its relevance for mental health promotion through youth engagement. Two sets of key words, ‘Positive youth development’ and ‘India’ were jointly used as search words. The search was carried out in the month of April 2017, using EBSCO and ProQuest and MedIND as the electronic databases, with no restriction in the time-period of the published studies. A supplementary search of titles using Google search engine was done with eight Indian journals and one database for the period from 2010 till date. The search indicated significant paucity of Indian literature on positive youth development. A total of 24 articles were identified. Nine studies were retained of which six were non-intervention and three were intervention studies. The review suggests that PYD programs and PYD based mental health promotion programs are in a nascent stage in India with a dearth of published literature on the same. Implications for youth mental health promotion are highlighted.

This paper considers the priorities for policy to promote youth mental health in Australia. The Ottawa Charter is applied as a conceptual framework to determine current strengths and future priorities across the entire spectrum of interventions for mental health promotion. The five platforms of the Ottawa Charter are used to categorize some of the major initiatives that promote youth mental health. Areas of strength and major gaps within each platform are identified. Australia was shown to be at the forefront of many youth mental health promotion initiatives, particularly in the service reorientation and personal skills platforms of the Ottawa Charter. While significant progress has been made in some areas of youth mental health promotion, areas of critical need for policy focus were: oversight of all public policies for their impact on youth mental health; more supportive environments for youth and better interconnection with mental health care; community action to support the youth voice; investment in resources for parents and families; ensuring quality inreach and outreach to provide young people with positive mental health messages and improve mental health literacy; and embedding and expanding effective innovations in youth mental health services reorientation.

The youth mental health crisis is reaching epidemic proportions, stemming from both single and complex traumatic experiences. Because children and adolescents spend a considerable amount of time in schools, educational settings present both opportunities for and threats to youth mental health. This article outlines how the principles of equity-centered trauma-informed education can be applied in educational environments to enhance the mental health of students. The authors discuss policy recommendations aimed at prioritizing predictability, flexibility, empowerment, connection, and unconditional positive regard. Effectively implementing these policies can help protect young people from structural sources of trauma in the educational system and ensure that schools do not become additional sources of trauma for youths in the United States.

Background: Public policy across the world is increasingly focusing on the role of mental health promotion in whole of health strategies. There is a growing evidence-base that mental health promotion, delivered by trained facilitators, is effective in promoting self-awareness and self-care to prevent the damaging effects of ongoing stress in one’s life and to promote early detection of any possible emerging mental health problems. Within Australia, however, few clinicians or school staff are confident or trained in mental health promotion.Aims: This paper reports the results of a two-day training designed for facilitators of a mental health program for secondary-school students. The goal was to develop facilitators’ knowledge and understanding of best practice in youth mental health promotion and to increase their confidence in delivering the program.Design: A mixed methods evaluation assessed the impact that a solution-focused training program had on participating facilitators.Methods: A questionnaire was created and included eight quantitative items and one open ended, qualitative question. Twenty-seven nurses and guidance officers from central Queensland were recruited via convenience sampling and data were analysed using descriptive statistics and thematic analysis.Results: The evaluation revealed that participants’ perception of their ability to facilitate a youth mental health program significantly improved after completing the training. Qualitative data indicated that participants found the professional development experience to be valuable, provide useful and transferable skills, and believed it to be necessary for mental health promotion work.Conclusion: By providing detailed description of the program’s content and processes, other mental health professionals may be inspired to further develop effective learning experiences.

Refugee youth in Kampala, Uganda, face a unique sexual reproductive health and mental health risk environment requiring focused interventions. Resource limitations and access barriers complicate the provision of relevant supports. Few studies have engaged refugee youth's recommendations for satisfying their sexual and mental health needs. This cross-sectional, qualitative study aimed to identify urban refugee youth's sexual and mental health promotion preferences. We administered a structured survey to refugee youth in Kampala (n = 54) between July and November 2023 using the qualitative data collection platform, Sensemaker and analyzed survey responses using inductive thematic analysis (ITA). Two themes emerged: health promotion and youth empowerment. Participants proposed sexual and mental health promotion recommendations directed at distinct stakeholder groups including policymakers/service providers and peers. There were several points of overlap between the sexual and mental health promotion recommendations, including calls for counseling services, health education, and employment opportunities. Youth empowerment was a central theme underwriting both sexual and mental health recommendations. By differentiating between recommendations directed at distinct stakeholder groups, this study identified opportunities for non-governmental actors to contribute to promoting the sexual and mental health of refugee youth in Kampala. Participant insights show how engagement with urban refugee youth's health promotion recommendations can empower youth and ensure that service design and delivery is consistent with their knowledge, needs, and preferences.

BackgroundSystems transformation for health promotion, involving engagement from multiple disciplines and levels of influence, requires an investment in partnership development. Integrated youth service is a collaborative model that brings organisations together to provide holistic care for youth. Frayme is an international knowledge translation network designed to support the uptake and scaling of integrated youth service. Social network analysis (SNA) is the study of relationships among social units and is useful to better understand how partners collaborate within a network to achieve major objectives. The purpose of this paper is to apply SNA to the Frayme network in order to (1) examine the level and strength of partnerships, (2) identify the strategies being employed to promote the main objectives and (3) apply the findings to current research in youth mental health and system transformation.MethodsThe PARTNER tool includes a validated survey and analysis software designed to examine partner interconnections. This tool was used to perform the SNA and 51 of the 75 partners completed the survey (14 researchers, 2 advisory groups and 35 organisations). A network map was created and descriptive frequencies were calculated.ResultsThe overall network scores for the Frayme network were 20.6% for density, 81.5% for centralisation and 71.7% for overall trust. The Frayme secretariat received a 3.84 out of a possible 4 for value. In addition, the youth and family advisories each received a value score of 4 and all Leadership Team organisations received a score of 2.97 or above.ConclusionsThe Frayme secretariat links many partners who would otherwise be disconnected and acts as a significant conduit for novel information. Frayme may have the opportunity to enhance value perceptions among broader network members by profiling individual organisations and the potential leveraging opportunities that might exist through their work. These findings increase understanding with respect to the mechanisms of network development and will be helpful to inform partnership development in the future. In addition, they contribute to the literature with respect to knowledge translation practice as well as the scaling of collaborative interventions within youth mental health.

Background School-based youth mental health promotion is increasingly recognised as a useful tool to improve mental health knowledge and help-seeking among adolescents. Peer-led initiatives are emerging as a potentially viable mode of delivering this material. Yet, there is limited evidence on the effectiveness of these initiatives compared to more traditional, adult-led, forms of mental health promotion. Aims This study aimed to compare improvements in students’ mental health knowledge and help-seeking after attending either a peer- or adult-led youth mental health promotion workshop. It also sought to examine differential effects by gender. Method A within- and between-group comparative design was used to examine secondary school students’ (N = 536) mental health knowledge and help-seeking intentions before and after attending a school-based mental health promotion workshop. Results Students’ mental health knowledge and help-seeking intentions significantly improved in both peer- and adult-led groups. Outcomes did not differ across modes of delivery, although the impact of adult-led workshops on mental health knowledge was moderated by gender. Conclusions Peer-led youth mental health promotion appears to be as effective as traditional adult-led delivery, and seems to be particularly beneficial for male students who respond more favourably to content communicated through their peers.

INTRODUCTION: Mental health promotion apps can promote youth mental health but fail to engage young people. Fit to young people’s media preferences is known to mediate engagement.OBJECTIVES: To explore the fit of existing youth mental health apps with young people’s media preferences.METHODS: A workshop with 60 youth psychologists elicits designs of digital mental health interventions. A review of 29 youth mental health apps unpacks their modality strategies. We then compare modality strategies from literature on youth mental health, media preferences and engagement, and from the experts, with strategies in current mental health apps to identify potential fit problems.RESULTS: There is a mismatch between young people’s modality preferences and how youth mental health apps deliver their content.CONCLUSION: There is a need to make youth mental health promotion apps more interactive and tailorable, featuring dynamic visuals and social connectivity, to better engage youth.

Background Mental health conditions (MHCs) are becoming one of the most urgent public health issues in youth across Europe, especially among young women. These include depression, anxiety, substance use, and suicidal behaviour. Many of these conditions start already before the age of 24. However, many current approaches still focus too much on individual diagnoses and symptoms. We need a broader understanding that includes social, environmental, and systemic risk exposures. The EARLY project is addressing this gap by using a transdiagnostic and multi-level approach, with focus on prevention and early intervention through caring and proxy-caring strategies. Objectives The aim of this roundtable is to present new ways to understand and support youth mental health in Europe. Drawing on EARLY's mixed-methods, multi-country evidence base, we discuss how mental health is influenced by a wide range of factors beyond the individual level, and how multicomponent interventions-developed together with young people and communities-can improve outcomes. This includes support not only for the youth themselves, but also for their families, schools, and local environments. Structure After a short introduction by the chairs, six expert contributions will explore: 1. An overview of the transdiagnostic and exposure-based framework developed in EARLY. 2. Main findings from a recent umbrella review of mental health models. 3. An assessment of youth mental health and psychosocial care structures across Europe, including a first-hand local perspective from Helsinki, Finland. 4. Description of a multi-level and gender-sensitive intervention piloted in the EARLY project. 5. The role of the European Public Health Association (& public health networks) in dissemination of EARLY's project results for a sustainable impact. Local relevance The Roundtable entails an experience from Helsinki, Finland. A local report based on consultations with young people and service providers shows that mental health services are often fragmented. Many young adults with mental health problems fall between services. A recent participatory assessment involving young adults and professionals highlighted the need for integrated, relational approaches-such as the “pair method”-that build long-term trust with young adults “stuck at home” and bridges gaps in service chains. Audience engagement The second part of the session is a moderated discussion, inviting audience interaction and debate, supported by the Sli.do platform. Participants will be invited to share examples, raise questions, and reflect on how these approaches can be used in different local or national settings. Key messages • Youth mental health is a Public Mental Health challenge. • Interdisciplinary and intersectoral collaboration is needed to better respond to youth mental health needs. Speakers/Panellists Jutta Lindert Hochschule Emden-Leer, Emden, Germany Giuseppe La Torre Sapienza University of Rome, Rome, Italy Erika Valtonen Ukraine Henrique Barros ASPHER, Porto, Portugal

Smart use of new federal funding for youth mental health initiatives in the wake of the pandemic, as well as effective allocation of state opioid settlement funds, can and should be used to shore up the infrastructure needed for a comprehensive approach to preventing youth substance use and mental health problems.

Asian American youth experienced high levels of discrimination during COVID-19, which negatively impacted their mental health. To address discrimination and promote youth mental health, we developed a novel and culturally sensitive virtual intervention involving both Chinese American parents and youth through collaboration with local Chinese language schools and community organizations. The parent component was based on Parent-Child Connect, a culturally sensitive parenting program for Chinese American parents. The youth program was culturally adapted based on the Strong Kids curriculum. Ninety-one Chinese immigrant parents (Mage = 47.64; SDage = 5.51) and 62 Chinese American youth (Mage = 12.71; SDage = 1.65) participated in the intervention between 2021 and 2023. Retention rates were high: about 82% of parents and youth completed the intervention and post surveys. Results suggest the intervention was effective in promoting positive parenting behaviors (autonomy granting, parental warmth), reducing negative parenting behaviors (verbal hostility, punitive parenting, shaming, directiveness), and improving parental sense of competence, parent-child communication, and parent self-efficacy to support youth during discrimination. Youth also reported significantly greater social and emotional learning knowledge and resilience, increased positive coping, emotional regulation, and mental health. Findings contribute to the limited literature on culturally adapting interventions for Chinese American youth and parents. Impact Statement This is one of the first culturally responsive mental health program involving both Chinese American parents and youth to address discrimination and youth mental health challenges. Findings contribute to the limited literature on how to collaborate with schools and communities to culturally adapt interventions for Chinese American youth and their parents.

Background Adolescence is a period of transition in which young people undergo physical, psychological and social changes. While most move through this transition with few problems, others experience greater difficulties, which may lead to an increased risk of becoming vulnerable to mental health issues. Social media use amongst young people is high; an abundance of literature identifies the deleterious impact of its use on mental health. However, its positive influence on youth well-being is also reported. Ireland’s mental health policy recommends harnessing the positive role social media can play in the promotion of youth mental health. However, an evidence gap exists as to how this can be implemented. This scoping review aims to identify the barriers and enablers to the use of social media as a youth mental health promotion tool, to inform the implementation of policy recommendations. Methods The search strategy, screening, extraction and synthesis will be informed by the JBI guidelines. The Consolidated Framework for Implementation Research will guide the identification and mapping of implementation determinants. The review outcomes will be reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews guidelines. Primary studies focused on young people and key stakeholders, such as teachers and parents, identifying barriers and enablers to the use of social media for youth mental health promotion will be included. A librarian-developed search strategy will be applied to the Web of Science Core Collection, Medline (EBSCO), Embase, PsycINFO and CINAHL databases. A narrative synthesis of the results guided by CFIR framework will be presented. Conclusion The review extends the work of previous reviews by adopting an Implementation Science approach focusing on the identification and mapping of implementation barriers and enablers to the use of social media as a youth mental health promotion tool. Registration Open Science Framework (https://doi.org/10.17605/OSF.IO/T5YF7M)