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Equality in Implementation

Equity, Implementation and Use of Evidence-Informed Interventions to Promote Mental Health and Wellbeing of Children and Youth in Scotland

Increasing the availability of evidence based mental health and wellbeing interventions for children and young people is a priority for Scotland. Early prevention and intervention for children at risk of or experiencing emerging mental health and wellbeing difficulties is critical to maximising both treatment benefits and broader wellbeing outcomes. Inequities and inequalities in the delivery of early intervention and prevention programmes for mental health and wellbeing between populations can relate to differences in the access, use, quality and outcomes of care. Inequalities and inequities in access and participation in mental health and wellbeing interventions are associated with several wider social determinants of health, including race and ethnicity, immigration status, socio-economic circumstances, sexual orientation and identity, disability, and being care experienced. Yet these are also the same factors found among populations at increased risk of experiencing poorer mental health and wellbeing. Children and young people are more likely to experience mental health and wellbeing difficulties if they are:

  • from an ethnic minority group
  • a refugee or asylum seeker
  • have a disability
  • care experienced
  • lesbian, gay, bisexual or transgender
  • living in greater socio-economic deprivation and disadvantage

Therefore, it is imperative that addressing these inequities and inequalities is prioritised.

Equitable implementation of evidence-based interventions occurs when strong equity components, including explicit attention to the culture, history, values, assets, and needs of the community, are integrated into the selection and implementation of interventions to improve outcomes for children, young people and their families, and the communities in which they live. The Early Intervention Framework considers several aspects of contextual fit when assessing, describing, and rating interventions to promote the mental health and wellbeing of children and young people living in Scotland.  Considering contextual fit aligns with the goals of equitable implementation to select interventions that meet the needs of specific populations, are a good fit with the culture and values of the community, can reach all children and young people who can benefit from the intervention, and can be adapted to meet the specific needs of diverse sub-groups.  

The selection and implementation of interventions with a strong contextual fit can help reduce the service inequities which these populations have historically experienced. The following elements should be considered when selecting and implementing interventions to promote mental health and wellbeing:

Implement what works for children, young people and families

  • Understand what the research evidence demonstrates in terms of what interventions and approaches have been shown to work, for which populations and, under what conditions. As far as possible, the data used to assess need and evidence should be disaggregated by race/ethnicity where appropriate, as well as by sub-population characteristics (e.g. gender, socioeconomic status, geography).
  • Select implementation strategies and approaches that will produce the best implementation and population-level outcomes

Focus on reach from the very beginning

  • Consider how many children, young people and their families can access and benefit from potential interventions
  • Identify challenges to access for selected interventions and develop strategies to increase access, especially for those populations for whom it is known that there are inequities related to access. Involve stakeholders in developing these strategies; families from the focus population and community partners.

Design and select interventions with implementation in mind

  • Involve stakeholders, including the families from the focus population and community partners, in the selection of interventions to improve relevance and social validity
  • Examine the specific local context from the beginning of intervention selection and implementation. Involve families from the local area and community partners in determining the broad need, as members of the discussion team and in the selection of interventions to be considered
  • Select interventions that match this local context and local need
  • Involve local stakeholders in building the infrastructure needed to sustain the intervention in practice with equitable outcomes

Identify and develop adaptations of interventions

  • Assess adaptability of early interventions to meet the needs of diverse children, young people and families, to address family processes, and to fit within the implementation context.
  • Co-create with programme developers and other key stakeholders – specifying the proposed adaption and accompanying implementation strategy, test assumptions of both adaptation and implementation strategy, support continuous improvement of the adaptation and implementation strategy