ATTUNE project: Impact of ACEs on young people
Research type
Research Study
Full title
Understanding mechanisms and mental health impacts of adverse childhood experiences to co-design preventive arts and digital interventions (ATTUNE) project
IRAS ID
312815
Contact name
Kamaldeep Bhui
Contact email
Sponsor organisation
University of Oxford / Research Governance, Ethics and Assurance /
Duration of Study in the UK
2 years, 2 months, 2 days
Research summary
Research Summary
The ATTUNE project investigates how adverse childhood experiences (ACEs) unfold to affect adolescents' mental health and coproduces novel prevention approaches. ACEs refer to harsh, unsafe, abusive and/ distressing events or living conditions during childhood. Three in four adolescents exposed to multiple ACEs develop significant distress and mental health disorders as young adults, including anxiety and depression. We do not know what makes an adolescent vulnerable to or protected from mental health problems facing ACEs nor how best to protect and support affected young people. This project will include six work packages that explore the lived experience of young people exposed to ACEs, how they define and explain their mental health and co-design new resources to support young people. Young people will be engaged via creative arts, and writing, performance, film, music and state of the art games technology and examine if these help young people express and share their experiences. This will enable care approached to be identified for ACE related mental health problems that are considered useful and acceptable. WP1 will identify care approaches for ACE-related mental health problems through creative methods with young people. WP2 will extend our understanding of ACEs and mental health via analysis of existing large datasets. WP3 co-produces public mental health resources to support adolescent mental health following ACEs. WP4 involves young people in co-design of a digital game exploring ACEs. WP4 examines if the new approach is feasible, acceptable and helpful to young people of diverse identities and to clinicians. WP5 will deliver preliminary cost-effectiveness information on distinct approaches. WP6 runs across the project to share learning with young people, clinicians, communities, policymakers and other relevant stakeholders. This application focuses on WP1, 3 and 4 which involve collection of new data with young people and stakeholders.Summary of results
The ATTUNE project explored how difficult or traumatic experiences during childhood can affect young people’s mental health, and how creative arts, supportive relationships and digital technologies might help. A key principle of the project was that young people should not simply be studied: their experiences and ideas should help shape the research and the solutions developed.The research showed that young people’s mental health following adversity is influenced by more than what happened to them in the past. Their current relationships, environments and experiences of services also matter. Feeling safe, listened to, believed and valued can support wellbeing and recovery, while feeling dismissed or invalidated can make difficulties worse. The research also highlighted the importance of belonging, trust, supportive relationships and opportunities for creative expression.
ATTUNE involved young people from a wide range of backgrounds and communities, including young people who were neurodivergent, LGBTQ+, refugees, from Gypsy and Traveller communities, and young people with learning disabilities. Creative approaches such as photography, animation, drama, dance and film enabled young people to communicate experiences that can be difficult to capture through conventional interviews.
The project also used existing research data to examine why some young people experiencing adversity develop emotional difficulties while others cope better. This work examined factors such as family and peer support, as well as differences associated with young people's identities and where they live. The findings reinforce the importance of considering the different and overlapping circumstances that shape young people's experiences of adversity and mental health.
Young people and professionals worked together to turn these findings into practical resources. One major outcome was **Validating Voices**, a resource designed to help professionals and young people create more supportive and validating environments. It uses realistic scenarios, role-play, films and training materials to help professionals understand the effects of invalidation and have more helpful conversations with young people. It has been evaluated in public-sector settings and has already been adopted by several organisations.
Another major outcome was **Ace of Hearts**, a digital game co-designed with young people who had experience of adversity. The game uses four mini-games to explore different experiences associated with adverse childhood experiences. An initial study examined whether it was practical and acceptable to deliver the game to young people. Recruitment and downloading the game proved challenging, so further work is needed before its effectiveness can be tested on a larger scale.
ATTUNE also examined the economic consequences of adverse childhood experiences and reviewed evidence about the costs and value of digital mental-health interventions for young people. The team developed an economic model that can be used to explore both the economic impact of childhood adversity and whether interventions could provide good value for money.
Young people were central to the project throughout. More than 50 young people participated through advisory groups, and over 210 contributed directly to research activities across the programme. They helped design research materials and the Ace of Hearts game, advised on ethics, co-authored research, organised and chaired conferences, and presented findings to policymakers. Their input helped make the research more relevant, inclusive and grounded in young people's lived experiences.
Overall, ATTUNE showed the value of combining young people's lived experience with arts, psychology, public health, digital technology and economic research. It produced practical resources as well as academic evidence, including Validating Voices, Ace of Hearts, films, podcasts and new approaches for conducting arts-based mental-health research. Findings have also been shared with Parliament, policymakers, schools, health professionals and community organisations.
The project provides a foundation for the next stage of research rather than a final answer about which interventions work. Further funding has been secured to develop the work and prepare for larger studies, including exploring whether it is feasible to recruit young people nationally for a future randomised controlled trial. The longer-term aim is to develop and rigorously test approaches that are shaped by young people's experiences and can improve support for young people affected by childhood adversity.
REC name
West Midlands - Solihull Research Ethics Committee
REC reference
23/WM/0105
Date of REC Opinion
9 Jun 2023
REC opinion
Further Information Favourable Opinion