A child mental health service transformation framework in the Global South.

Global South countries are typically faced with multiple socioeconomic and resource challenges that predispose rising child mental health needs, which remain largely unmet. Collectivist societies, however, provide protective mechanisms for child mental health and opportunities for interventions through existing informal support systems. We provide an empirically grounded framework for child mental health service transformation, accounting for the complexities of resource burdens and the need for culturally sensitive adaptations. In presenting this framework, we utilise data from projects in South Africa and Pakistan which engaged participants from disadvantaged urban areas. These involved a total of 10 psychosocial interventions, 504 end-users (youth, parents and professionals) and a sub-sample of 76 focus group participants, to describe the design, refinement, cascade training, implementation and process evaluation of the framework. The secondary thematic analysis illustrates four layers of knowledge generation, translation and transfer, transformation through community engagement and mobilisation, and impact through service integration and systemic changes. The framework and supporting findings informed a provisional Theory of Change. This highlights the principles of stigma prevention, co-production with communities, contextualisation of psychosocial interventions, integration with informal and structural support systems, knowledge cascade, and involvement of youth and parents with lived experience.