Hedges, E., Roberts,A., Wohi,G., Fitzsimmons-Craft, E., Schleider, J., & Salhi,L.

The early Kooth Theory of System Change outlines the predicted long-term change as a result of the Kooth whole-school approach to mental health and well-being. The framework describes sequential events within the Kooth service (inputs, activities, outputs, and outcomes) and theorises the potential impacts on wider systems. By providing the Kooth service and enabling mechanisms of change, Kooth can contribute to improved literacy and agency; social, emotional, and mental wellbeing; downstream service access; school and economic outcomes. Therefore, it is theorised that Kooth meaningfully impacts wider systems in Pennsylvania, such as the education, healthcare, government, judicial, and economic systems, leading to positive systemic change.