Profiles

Mental health conditions affect about 1 in 7 adolescents globally. In the context of COVID-19, the importance of mental health and psychosocial support for all has been undoubtedly confirmed. Despite the increased attention to mental health issues, there is a dearth of evidence on what determines child and adolescent mental health, who is most at risk, and what works to foster mental health across contexts, cultures and distinct population groups. This conceptual framework aims to inform research on child and adolescent mental health. It incorporates children’s developmental stages and the dynamic environment in which they live and grow. Informed by a review of existing theoretical frameworks on mental health and child development, this framework integrates elements of the socio-ecological model; the life course approach; the social determinants of health approach; and Innocenti Report Card’s Worlds of Influence Framework. Combining diverse aspects of these frameworks and approaches, we propose an integrated model to guide UNICEF’s research in this area.

COVID-19 is a crisis like no other in modern times. It has reached every population and community. While the evidence base is still nascent, this report looks at the impacts of disasters and past epidemics – such as Ebola, HIV, SARS/MERS and Zika – on child and adolescent mental health and psychosocial wellbeing, and examines how these insights can guide policies and progammes to support children, their families and communities during the current pandemic.

The impact of COVID-19 on the mental health of children and youth has been near ubiquitous. Resilience factors are significant in enhancing and supporting mental health in the COVID-19 era. Our first COVID-19 Quarterly Thematic Digest presents research highlights from our growing Children and COVID-19 Research library. In this inaugural digest we spotlight 11 studies on mental health that were all generated in the first half of 2021. These research papers address an array of subjects related to the impact of COVID-19 on child and youth mental that include disorders such as anxiety, depression, suicide ideation and compulsive internet gaming, as well as risk factors such as HIV or refugee status, and responses such as art therapy and parenting and caregiver programmes. These studies have been undertaken in a range of countries and regions and include several multi-country analyses.

The initial impression that paediatric SARS-CoV-2 infection is uncommon and generally mild has been replaced by a more nuanced understanding of infectious manifestations in children and adolescents across low-, middle-, and high-income countries, with recognition of a widening disease spectrum. Critical knowledge gaps, especially in low- and middle-income countries, remain that have significant public policy and programme implications. Insufficient data disaggregated by age, geography and race/ethnicity continue to hinder efforts to fully assess prevalence of infection and disease manifestations in children and adolescents and their role in transmission. Potential biologic differences in susceptibility to infection and transmissibility between children, adolescents and adults need to be assessed. Determination of mother-to-child SARS-CoV-2 transmission during pregnancy, the peripartum period, or through breastfeeding requires appropriate samples obtained with proper timing, lacking in most studies. Finally, predictors of disease progression, morbidity and mortality in children need to be determined and whether these predictors vary by geographic location and in settings where poor nutritional and health conditions and other vulnerabilities are more frequent. Countries, UN agencies, public health communities, donors and academia need to coordinate the efforts and work collectively to close the data and knowledge gaps in all countries (high-, middle- and low-income) for better evidence to guide policy and programme decision-making for children and COVID-19 disease.

(19 November 2020) From health to education, every child in the world has been affected by the COVID-19 pandemic, with many impacted in multiple ways. As the crisis rages on, further entrenching pre-existing inequalities, there is an urgent need for scalable and cost-effective solutions for children. Such solutions require more evidence on COVID-19, which is not yet available. A new report by the UNICEF Office of Research—Innocenti, Beyond Masks: Societal impacts of COVID-19 and accelerated solutions for children and adolescents, examines past health crises (such as HIV/AIDS, SARS, and Ebola) to provide insights into COVID-19, and proposes proven and promising solutions.

It is commonly accepted, at least for now, that children and adolescents (0-19 years) have been largely spared the direct epidemiological effects of the COVID-19 crisis on their own health and survival. This narrative is based predominantly on early data from the first affected countries of the virus, notably from China (Wuhan Province) and Italy in early 2020, and also other high-income countries including the United States and some European nations. This narrative has conditioned subsequent screening and testing of COVID-19 cases in children and adolescents, which have been notably lower than for other age cohorts. But demographic dynamics differs widely among countries, and assumptions and narrative made on evidence taken from ageing societies and mainly from high income countries may not hold for more youthful and growing populations (Figure 1). For this reason, we began to investigate the burden of COVID-19 cases for children and adolescents globally. And what we have found so far, despite major data limitations, suggest that children worldwide may be more affected by COVID-19 than the dominant narrative so far suggests. The narrative [that children have been spared] is based predominantly on early data from the first affected countries of the virus, notably China and Italy and other high-income countries including the United States and some European nations.Italy source: https://www.statista.com/statistics/1103023/coronavirus-cases-distribution-by-age-group-italy/ Kenya source: https://www.health.go.ke/wp-content/uploads/2020/06/Kenya-SITREP-090-15-Jun-2020.pdfThe dataset we have compiled from websites of 42 countries with available disaggregated data shows that the average of COVID-19 reported cases among children and adolescents under 20 years as a percentage of total cases is 8.1 per cent. There is an incredibly broad spread among the proportions, ranging from Paraguay, where under-20s account for about 23 per cent of the national COVID case load on 14 June 2020, to Spain, where they represented just 0.82 per cent by 4 June 2020. (Figure 2). A pattern of the child and adolescent burden of reported COVID-19 cases emerges when countries are aggregated along income levels and geographic locations. Using the World Bank income categorization, the share of COVID-19 cases among under-20s in the total reported burden is around 10 per cent for low- and middle-income countries (LMICS) including China compared to 7 per cent for high-income countries (Figure 1). When China is excluded, the share of COVID-19 cases among under-20s in the total national burden is around 11 percent. What is perhaps more disturbing, however, is that for some of the high-burden child and adolescent mortality countries – including Brazil, India and Nigeria – the proportion of cases among under 20s to the total national COVID-19 cases is in double digits. One reason that children may be neglected as sufferers from COVID-19 derives from the way the virus affects them. Children confirmed with COVID-19 generally have fewer symptoms than adults, including fever and cough, and much less dyspnoea (shortness of breath) than adults. Consistent with less severe disease, laboratory findings in children with COVID-19 are less abnormal than in adults, and they are less likely to require ICU or significant treatments. However, the emerging multi-system inflammatory syndrome (MISS or MIS-C) in children reported in Western countries is of great concern and calls for increased vigilance. Early detection is key to prevent unintended consequences for children. Much of the difficulty of drawing definitive conclusions from the available data is related to the fact that there is just too little of child specific data. From our search of diverse sources, we were only able to draw on data by age from 42 countries out of the 188 countries and territories that have confirmed cases of COVID-19, which represents about 20 per cent of these countries. It is even harder to obtain disaggregated data to evaluate proportional representation by age among children and adolescents with COVID-19. This omission requires rapid rectification if the full direct effects of the virus on children and adolescents – and indeed other stratifiers such as gender and race/ethnicity -- are to be better understood. While understanding the additional burden the accurate age reporting may place on already overstretched health systems, particularly in countries with weak health system capacity, experience from some low-and-middle-income countries proved that it is possible for much more age disaggregated data to be made available in a readily accessible format. This will not only benefit children and adolescents but the wider understanding of the impact of COVID-19 on all age cohorts. The same argument can and is being made for disaggregation by sex. A medical worker applies a flu vaccine to a girl in Asuncion, Paraguay amid the COVID-19 pandemic. Health authorities in Paraguay are encouraging people over 60 and children to be vaccinated against the flu.It is imperative to have standardized age data to enable a comprehensive and timely understanding of the patterns of vulnerability across ages, geography, co-morbidities and vulnerabilities, thus enabling better programme strategies and policy adoption that are context specific. At the end of the day, the pandemic is about people in different parts of the world, so invoking the SDG principle of leaving no one behind, and universal health coverage, we need to pay attention to everyone including children and adolescents, who are often the silent victims. Children are without a voice or platform and are among the most vulnerable. It is the responsibility of all governments and parties to make sure they are not left behind in this epidemic due to lack of data, research and testing. The pandemic has currently appeared to hit men and the elderly hardest, particularly in high income countries. But data emerging from the US and elsewhere points alarmingly to COVID-19 disease becoming an equity issue, with certain ethnicities and income groups much more likely to die from it than othersIn addition, a further call by the authors is for the continuous monitoring of age- and sex-disaggregated data for COVID-19 by governments and major international agencies. The pandemic has currently appeared to hit men and the elderly hardest, particularly in high income countries. But data emerging from the US and elsewhere points alarmingly to COVID-19 disease becoming an equity issue, with certain ethnicities and income groups much more likely to die from it than others, even when controlling for pre-existing health conditions, age, and other socio-demographic factors. Like polio before it, unless we continue to monitor its socio-demographic spread, COVID-19 may start out being a disease that first affects more affluent communities and countries but could end up lasting longest and deepest among the world’s poorest countries and communities. In the HIV crisis, age-disaggregated data appeared long after the aggregate numbers or even the sex-disaggregated, leaving child prevention, detection and treatment lagging well behind that of adults. Until it did, children were assumed to be affected largely by its secondary effects on their parents, caregivers and family members. The disaggregated figures showed that children were also primary victims of the crisis, as well as secondary ones, but by the time this happened, it was too late to stop this momentum. We must not make the same mistakes with the COVID-19 crisis. See a complete list of country level COVID-19 data sources.   Priscilla Idele is Deputy Director of UNICEF Innocenti. David Anthony is Chief of Strategic Planning  and Convening at UNICEF Innocenti. Kaku Attah Damoah, is a Research Consultant at UNICEF Innocenti working on poverty reduction. Danzhen You is Sr. Advisor, Statistics and Monitoring at UNICEF.             

  This post is the first in a series of articles focused on helping children continue to learn at home during the COVID-19 global pandemic, emphasizing the need for multiple remote learning platforms to meet the needs of all students.   While some countries are now moving to reopen schools, nearly 1.3 billion children are still out of school and dependent on remote learning, due to nationwide shutdowns. As national educational systems strive to meet this challenge, Multiple Indicator Cluster Survey (MICS) data offer some important insights into how we can ensure every child has an equal opportunity to learn remotely.  Among other key insights, the MICS data highlights that many children and youth still do not have internet access at home, and household wealth is the biggest determinant of home internet access.  This underscores the importance of providing different learning tools, at the same time as we accelerate access to the internet for every school and every child, including through UNICEF's GIGA initiative. IT-enabled learning will be a critical part of the remote learning toolbox, including offline options. UNICEF will continue to advocate for innovative solutions to provide connectivity for every school and every student. Meanwhile, governments must also continue to invest in other distance learning technologies, such as the use of television and radio broadcasts, and 'take-home' printed materials, in order to reach all school-age students. This has been summarized in UNICEF's Remote Learning COVID-19 Response Decision Tree.   Providing the world's disadvantaged and marginalized children with equitable access to learning opportunities is foundational to creating a sustainable future and must be a priority for the global education sector.  Many of the world's children do not have internet access at home   There are wide disparities in wealth and corresponding differences in access to digital technology, both between and within countries. Globally, many schools lack the resources to invest in digital learning, and many children from poorer households do not have internet access. MICS6 data show that in countries like Bangladesh, Lesotho, Madagascar, Mongolia, Pakistan (Punjab), Sierra Leone, Togo, Tunisia, and Zimbabwe, more than half of children aged between 5-17 who are attending school do not have internet access at home. In Democratic Republic of Congo and Lao PDR, fewer than two per cent of children attending school have internet access at home. Of the 18 countries examined, only Georgia, Kyrgyzstan, and Montenegro had internet access in more than 70 per cent of households.   Household wealth is the biggest determinant of internet access    Household wealth and internet access are strongly linked. Students from the richest 20 per cent of households are the most likely to be able to continue learning via the internet. In some countries, internet access among the poorest 20 per cent of households is almost non-existent. Countries with low levels of internet access overall also have the highest levels of inequality of internet access between rich and poor. In Madagascar, Togo and Sierra Leone, less than 30 per cent of the population has internet access, and this access is distributed unequally across wealth levels. In all the three countries, the wealthiest 20 per cent of households comprise more than 60 percent of those with internet access. These data illustrate why, in the short term, the internet alone is not enough to ensure inclusive, equitable education, particularly in countries that were already experiencing a learning crisis before the COVID-19 pandemic. It is essential that education sector responses be carefully designed to meet the learning needs of poor and disadvantaged children, so this crisis doesn't leave them even further behind.   The link between internet learning solutions and reading skills   A key insight provided by MICS6 data is that children with internet access at home also have substantially higher foundational reading skills. Well-designed digital learning platforms have the potential to provide interactive and engaging remote education, which could greatly benefit disadvantaged students, if they had access. This again shows why investment in connectivity in disadvantaged areas must be a priority. Information like this can help education stakeholders in all countries develop strategies and solutions targeted at helping children from poor households continue to learn in today's challenging environment.   Strategies for successful remote learning: internet, television, radio and 'take-home' printed materials Governments, schools and teachers around the world are looking for the best immediate solutions to provide remote learning opportunities during school closures. Afghanistan is broadcasting programmes that cover the national curriculum via television and radio. Argentina, Iran, Morocco and Viet Nam have all adopted hybrid approaches that rely on a mix of online learning for those who have internet access, and educational programming offered via television or radio for those who do not. Some countries are also delivering printed learning materials to households to reach those children who do not have access to the internet, television or radio. In the long run, the global education community needs to develop and implement comprehensive remote learning plans and modalities, including accessible digital and media content, to provide quality learning during pandemics and other crises. The consequences of the COVID-19 pandemic have only begun to manifest and will persist long after social isolation has ended. Remote learning programmes, using various modalities, should be designed to meet the needs of all children and ensure that existing learning gaps are not further widened. Providing the world's disadvantaged and marginalized children with equitable access to learning opportunities is critical to creating a sustainable future and must be a priority for the global education sector. We can overcome the digital divide by accelerating access and finding the most innovative ways to provide online learning. And we can leverage this crisis to help bring about that change even more quickly. We must work together to seize the moment, so that education systems are stronger and more inclusive after this pandemic.

A total of 835,401 children and adolescents were out of school in Nepal in 2017, equivalent to 11.3 per cent of the primary and secondary school aged population (UNESCO – UIS, 2020).[1] This rate varies across the country and population, as barriers related to poverty, social exclusion linked to caste and ethnicity, disability, social norms and gender biases, migration, child labor, mother tongue, and geographical location disproportionately keep children out of school (Nepal Ministry of Education School Sector Development Plan, 2016). Access to education, however, does not guarantee learning. Around 53 per cent of children in low- and middle-income countries cannot read and understand a simple story by the end of primary school (World Bank, 2019). In Nepal, one survey found that of the children assessed, over 50 per cent of third graders were unable to understand half of what they were reading, and most were reading only at a grade 1 level. The same study found that 19 per cent of grade 3 students and 37 per cent of grade 2 students could not read a single word (RTI, 2014, as cited in Ministry of Education, 2016). barriers related to poverty, social exclusion, caste and ethnicity, disability, gender biases, migration, child labor, mother tongue, and geographical location disproportionately keep children out of schoolIn response to these challenges in education, UNICEF has been supporting the Government of Nepal to prepare and implement a Consolidated Equity Strategy for the School Education Sector. UNICEF is also working with local municipalities and civil society partners in deprived regions to implement two contextualized approaches to helping the most marginalized out-of-school children access education. The long-standing Girls Access to Education (GATE) programme focuses on helping out-of-school girls return or enroll in the formal education system, while Kheldai Sikne Kendra (KSK), which means ‘Center for Learning by Playing’ provides a more flexible learning model well-suited to reaching out-of-school boys and girls in urban areas. Young learners attend a UNICEF-supported Girls’ Access to Education (GATE) small group activity in Mithila Municipality in Dhanusha District in Nepal’s south.The GATE programme, which receives financial support from Let Us Learn[2], provides full-time non-formal education for a period of nine months, teaching disadvantaged girls the basic literacy, numeracy, and life skills they need to successfully transition into the formal school system. In partnership with 30 local governments, UNICEF supported 300 GATE classes reaching 7,394 girls in Nepal’s Province 2 during the 2018-2019 programme year. Approximately 89 per cent of participants successfully enrolled into formal school upon completion of the programme, exceeding the programme’s original target of 80 per cent. KSK is a newer non-formal education model in Nepal, first conceptualized with stakeholders in 2014, piloted in 2015, and progressively scaled up in partnership with the NGO Samunnat Nepal and local municipalities. There are currently 10 centres present in three provinces, and the programme’s learning modality has also been taken up by 47 alternative learning centers in the same region. KSK provides a child-friendly, flexible-time learning space to meet the needs of the most disadvantaged urban out-of-school boys and girls aged 10 to 19 who may have responsibilities and challenges that do not allow them to regularly attend school. KSK learning centres are open 250 days a year for 6 days a week. Utilizing a multi-grade, multi-level methodology, facilitators closely support and monitor each individual child or adolescent’s learning progress. Through linkages with formal schools, the programme has helped 65% of its 10-13-year-old participants enroll in formal schooling. Through GATE and KSK, UNICEF and its partners are providing an opportunity for groups that would otherwise not have had access to education. This includes ethnic minorities who often face discrimination, such as Dalit castes, which constituted 32 per cent of GATE participants and 40 per cent of KSK programme beneficiaries in 2018. A recent report on out of school children in Nepal found that, strikingly, more than half of children in the primary and lower secondary age school groups of Dom (58.4 per cent) and Mushahar (51.3 per cent) - both Dalit castes - were out of school (UNICEF, 2016). Children from migrant families coming from India, who face constraints in access to education, have also particularly benefited from the KSK programme. Both GATE and KSK are measuring child learning outcomes to understand progress in this area, as access and learning are key goals of non-formal education. In 2018, GATE participants improved their average score on a pre- and post- test by 53 percentage points from the start to the end of the nine-month programme. For KSK, meanwhile, a leveled assessment framework has been piloted to measure progress and map learner achievement to the grade levels of the formal education system.  In addition to learning, positive behavior change in participants – which includes social skills and hygiene and sanitation practices - has been documented as an important outcome of the KSK intervention. if children are not provided with the flexibility to learn on their own terms, they often will not participate in educational opportunities, particularly when their families’ livelihoods depend on their work.KSK’s flexibility has allowed children who work to support their families to visit the centres for learning when their schedule allows them to do so. Children and adolescents often feel a strong responsibility towards their families and may be the designated income earners of their households. In 2018, 62 per cent of KSK participants reported they were engaged in household chores: 63 per cent of all boys reported engaging in household chores while the corresponding figure for girls was 60 per cent.  The remaining 38 per cent of KSK participants reported that they worked in various forms of labor outside of the home to help their family. Labor outside the home was mostly performed by boys; girls were only engaged as street vendors. In contrast, boys were found to work in restaurants, transportation, shops and as factory workers. In a recent site visit to a KSK center in Chitwan, one adolescent participant mentioned that his mother and siblings were in India and that he was working in Nepal to support them. While aiming to return or enroll children and adolescents into formal schooling, the KSK model acknowledges this dilemma: if children are not provided with the flexibility to learn on their own terms, they often will not participate in educational opportunities, particularly when their families’ livelihoods depend on their work. In recent site visits, children from both programmes showed great enthusiasm about their learning experiences and all spoke of their career aspirations. They enjoyed learning and were particularly aware of the benefits of learning English. “If we speak English, we can have a job,” one KSK female student shared. A large share of KSK beneficiaries at one center wanted to be policemen[3]; others wanted to be teachers. Many former and current GATE participants (all girls) also shared that they wanted to be teachers; one girl mentioned that she would grow up to be a rail engineer, defying stereotypes in what is still a society with entrenched gender norms. Despite the accomplishments of these non-formal education programmes, important challenges remain for the achievement of inclusive education in Nepal. According to local government leaders, most children complete up to grade 5, but they start to drop out later. Some GATE graduates interviewed mentioned that, while the non-formal education programmes are free of cost, once enrolled into formal school, they face important financial constraints. For example, while formal education is nominally free, they are still required to pay examination fees (between 50 and 500 NPR, roughly between 0.44 and 4.41 USD) or bear the cost of school supplies and uniforms. In addition, according to World Education, GATE graduates are often discriminated against when they attend formal schools. Due to social biases related to ethnicity or caste, GATE graduates are thought to ‘bring down’ the level of public schools, although a recent internal assessment by World Education revealed that they actually outperformed their formal school student counterparts (World Education, unpublished). When speaking with local leaders about common causes for drop out, important challenges, such as child marriage and parents not caring for their children continuing their studies were raised. For girls, menstruation was cited as leading to missing 3 to 5 days of school every month, leading them eventually to drop out of school. Lastly, the high unemployment rate amongst young people in Nepal makes parents question whether the investment of time and resources yields returns. Indeed, a recent UNICEF report found that lack of parents’ interest (26.1 per cent) was the major reason cited amongst children who had never attended school (Ministry of Education, UNICEF and UNESCO, 2016). GATE and KSK provide strong examples of contextualized approaches to expanding access to education and learning to marginalized out-of-school children in Nepal.  Going forward questions remain as to the replicability and scalability of these programmes in different contexts within the country, which further evidence generation will attempt to help answer. In the meantime, local government leadership in implementing, scaling, and providing financial support to both programmes suggest they currently have a lot to contribute on the pathway towards SDG 4, ensuring that every child in Nepal has access to quality learning. [1] 770 thousand children were not attending school, equivalent to 14.3% of primary and lower secondary school aged children in the country according to the 2011 census (Ministry of Education, UNICEF and UNESCO, 2106). MICS 2014 data places this figure slightly higher - around 16.1 per cent of children were out of school in 2014.[2] Dedicated to bringing the most marginalized children in five countries - Afghanistan, Bangladesh, Liberia, Madagascar and Nepal - back into school.[3] This is largely attributed to the local implementing partner supporting that particular KSK center being founded by ex-police.  Robert Jenkins is the Associate Director of the Education Section in the Programme Division at UNICEF Headquarters, New York, USA. Priscilla Idele is Deputy Director of the UNICEF Office of Research - Innocenti in Florence, Italy.

In some way, mental ill health has touched everyone. The statistics are alarming, and by some accounts constitute a public health emergency. Today, around 10-20 per cent of all children and adolescents suffer from some type of mental health disorder and mental health conditions account for around 16 per cent of the global burden of disease and injury among adolescents. Worldwide depression is among the leading causes of disability among young people and suicides are the third leading cause of death among adolescents worldwide, and the second among 15-19-year-old adolescent girls. Fifty percent of mental health conditions arise before the age of 14, and 75 per cent by the mid-20s. Given the age-sensitive nature of predictors, early life investment makes good sense. However, globally relatively small sums have been allocated, with an estimate of less than 1 per cent of national health budgets in low-income countries being devoted to mental health. Yet the economic cost of mental health is enormous, amounting to around 4 per cent of GDP. Evidence supports early investment -- if left untreated, it is estimated that mental health disorders which emerge before adulthood can impose a health cost 10 times higher than those that emerge later in life. mental health disorders which emerge before adulthood can impose a health cost 10 times higher than those that emerge later in life.Emerging evidence indicates that the prevalence of mental ill-health is growing. Issues such as climate change, environmental degradation, unplanned and rapid urbanization, migration, demographic transition, youth unemployment, and technological leaps are implicated. These may have profound impacts on the minds of children and young people. Yet we know very little today about how to manage or harness these changes to improve the mental wellbeing of children. The 2018 Lancet Commission report compellingly illustrated the value of addressing mental health to advance a number of sustainable development goals. This suggests that effective mental health interventions may be potential development accelerators – with provisions that lead to progress across multiple SDGs. In the context of shrinking fiscal space, this makes it a highly desirable area of investment. Rafeya Akhter Moni, 14, plays a game with friends at a UNICEF-supported Adolescent Club near her home in Dhaka’s Duaripara slum. Twice each week Moni and 35-40 other young people have the opportunity to get together and be ordinary teenagers in a safe space.More work is needed to examine the state-of-the-art evidence, and the corresponding programmatic and policy responses on children’s mental health in the first decade of life, beginning in utero, through the first five years, and then into middle childhood (5-9 years). The evidence agenda is clear: we need to look at the latest findings from neuroscience; the overall prevalence and spread of mental ill health across ages and geographies; causes and contributing factors; and methods of preventing and treating mental ill health. These are all important parts of the puzzle, and critical to the response effort. Adolescence is a critically important stage of life when many of the mental health conditions prevalent in adulthood first manifest, and also the most challenging time for those entrusted with the care and protection of young people to reach them with solutions. Addressing the mental health of our children is imperative. Greater leadership and political commitment on policy, research and implementation is needed to turn the tide and advance healthy minds and healthy bodies of children and young people. A dedicated global plan or alliance through a shared value partnership for the mental health of children and young people is long overdue. On November 7 – 9 2019, UNICEF and WHO will convene a conference co-chaired by UNICEF’s Executive Director Henrietta H. Fore and WHO’s Director General Tedros Adhanom Ghebreyesus. The Inaugural Leading Minds for Children and Young People conference will focus on advancing the global agenda on mental health in children. This first year will bring together a broad array of the world’s thought leaders and decison makers – from academia, business, civil society, government, international development, philanthropy and of course, children and young people – to accelerate global progress to respond to this neglected issue. This will be the start of a critical conversation about what is needed to ensure children grow up with ‘healthy minds and healthy bodies.’ Throughout, the focus will be on the scale of the challenge and the proven and promising solutions to meet it. The conference’s final session will conclude with a deep dive into the pathways that global actors can take to tackle the issue of child and youth mental health. Crucially the voices of children living in challenging situations will be central. Sessions will be co-designed and run with and by the Youth Leaders of the conference. We need to understand and listen to them: their emotions, fears, coping strategies, and hopes. We need to engage with how they cope, what they do to support others, and what must be done for young people themselves to feel supported and thrive in a complex world.   Priscilla Idele is Director of the UNICEF Office of Research – Innocenti; Prerna Banati is former Deputy Director at UNICEF Innocenti and currently UNICEF Regional Advisor on Adolescent Development and Gender; David Anthony is Chief of Strategy and Policy at UNICEF Innocenti.