Adaptation of an intervention for psychological distress in children and adolescents living in urban areas of Sweden - UNITE.

BACKGROUND: Sweden has faced an increase in community violence over the past few years. The integration of potentially scalable psychological interventions into mental health responses in affected communites can contribute to addressing the psychological consequences. The World Health Organization's Early Adolescence Skills for Emotions (EASE) was originally developed as a task-sharing, group-based intervention for low- and middle-income countries. To address urgent needs in a high-income context, EASE was pragmatically adapted into a shorter, low-intensity intervention named UNITE, suitable for rapid implementation within civil society settings. METHODS: UNITE was developed through a structured but pragmatic adaptation process, including contextual needs assessment, stakeholder consultation, cultural and linguistic modifications, and adjustments to format, intensity, and delivery structure. The intervention was shortened and modified to fit the operational realities of community-based delivery and to enable implementation by non-mental health specialists within the framework of Save the Children Sweden's regular activities in areas affected by community violence. RESULTS: The adaptation process resulted in a more brief, scalable group intervention tailored to high-income urban contexts experiencing chronic community violence. Key adaptations included reduced session length, streamlined content, and alignment with existing organizational infrastructure to facilitate feasibility and sustainability. UNITE was successfully implemented within routine programming, demonstrating the practicality of adapting task-sharing psychological interventions across economic contexts. Lessons learned highlight the importance of balancing fidelity to core therapeutic components with contextual responsiveness. CONCLUSION: This study provides a real-world example of adapting a WHO-developed task-sharing intervention from a low- and middle-income setting to a high-income context. The findings underscore the potential of scalable, low-intensity interventions delivered by non-specialists in these contexts and offer guidance for civil society organizations seeking to implement rapid, evidence-informed mental health responses in similar settings.