An adaptive, youth-centred co-design methodology: place-based co-design centring youth and community participation

BACKGROUND: Co-design approaches are increasingly used in efforts to address complex challenges, such as adolescent mental health. Benefits of these approaches are multifaceted and include strategies that better reflect local perspectives and needs, as well as the potential for improved outcomes for those involved. However, the literature has highlighted challenges and unintended consequences of co-design, such as issues with inclusivity and undue burden being placed on participants. This paper examines the methods used in the ‘Deeper Discovery and Co-design phase’ of Kailo, a place-based research and design initiative aimed at tackling the social determinants of children’s and young people’s (CYP) mental health in their local communities. METHODS: Over approximately nine months, a co-design approach was used across two pilot sites. This involved more than 69 workshops and several ad hoc engagements with CYP and other community members. The goal was to explore structural challenges and develop strategies to address CYP mental health and wellbeing in their local context. The co-design work also aimed to bring together community knowledge and expertise, systems mapping and academic evidence. RESULTS: Over 300 local CYP, community members, professionals and practitioners participated or contributed to Kailo’s Deeper Discovery phase across the two pilot sites, via group sessions, individual feedback or surveys. The study identified key barriers (e.g. logistical constraints, limitations in accessibility of processes and participation, safeguarding and participant wellbeing concerns) and enablers (e.g. flexible and accessible participation, inclusive and adaptive facilitation, and participation and influence) that shaped conditions for implementation. Moreover, it explored the requirements and tensions for methodological implementation whilst maintaining a flexible and adaptive approach, centring CYP needs and voices, and integrating different methods into the co-design process. CONCLUSIONS: The Kailo programme prioritised the contributions of CYP and their communities, aiming to foster inclusive and diverse engagement through a distinctive, adaptive, youth-centred approach. This paper outlines the co-design methodology used to support the development of locally relevant strategies addressing the social determinants of mental health. However, balancing flexibility and adaptability and centring CYP needs, voices and agency, whilst maintaining a focus on broader structural issues, remains a challenge.