ATTUNE : Understanding mechanisms and mental health impacts of Adverse Childhood Experiences to co-design preventive arts and digital interventions.

这项研究调查了不良童年经历(ACE)如何影响青少年的心理健康，并共同制定新的预防方法。Ace指的是儿童时期发生的恶劣的、不安全的、虐待的和/或令人痛苦的事件或生活条件。暴露在多个A级的青少年中，有四分之三在年轻时会出现严重的痛苦和心理健康障碍，包括焦虑、抑郁和创伤后应激障碍。我们不完全了解是什么使青少年容易受到ACES后的精神健康问题的影响或受到保护，也不知道如何最好地保护和支持受影响的年轻人，他们中的许多人很难找到并参与护理服务。这项研究旨在通过将年轻人的生活经验放在我们学习和行动规划的中心来解决这些知识和支持方面的差距。青年将在六个工作包(WPS)的设计、交付、治理、评估、传播和影响方面发挥关键作用。所有WPS都涉及来自不同地点(农村、城市、沿海)的不同年轻人(年龄、性别、种族、LGBTQ、神经多样性/自闭症)，因为地点影响当地的资产、机会和获得护理服务的机会。年轻人将制作一部电影，以确保从研究的各个部分进行良好的沟通和学习，并对研究进行评估。道德问题和保护贯穿始终。WP1探讨了接触ACEs的年轻人的生活经历，他们如何定义和解释他们的心理健康，以及ACEs如何以及为什么对人们产生不同的影响。我们强调在ACE研究中代表性不足的年轻人的需求，以及不同身份和地点的年轻人的需求。我们将通过创意艺术和写作、表演、电影、音乐和最先进的游戏技术来吸引年轻人，并研究这些技术是否有助于年轻人表达和分享他们的经历。WP1将确定被认为有用和可接受的ACE相关精神健康问题的护理方法。WP2将通过分析从30,000多名个人收集的现有大型数据集来扩展我们的理解，以了解哪些个人或背景因素最能解释ACES后的心理健康结果。WP3将WP1和W2的学习和产出转化为行动。我们将与年轻人和主要利益攸关方密切合作，共同为中学、第三部门和社会服务编制公共精神卫生资源，帮助他们了解和更好地支持ACES后的青少年心理健康。WP4让年轻人参与一种有前途的疗法(叙述性暴露疗法，Net)的数字版本的共同设计。许多年轻人积极避免谈论他们最不利的经历，尽管这有助于他们的心理健康。我们想测试一个共同设计的Net版本，它利用WP1&2直接提供的严肃游戏或混合现实技术，是否有助于年轻人参与并受益于Net。网络与技术的融合是新颖的，需要多个阶段的原型改进。年轻人将在农村、沿海和城市环境中塑造实施和测试。WP4审查新方法对不同身份的年轻人和临床医生是否可行、可接受和有帮助；在继续进行更大规模的有效性研究之前，我们将了解它的工作原理和需要改进的地方。WP5将提供关于不同方法的初步成本效益信息。WP6贯穿整个项目，与年轻人、临床医生、社区、政策制定者和决策者分享学习，他们将为ACES后的年轻人提供护理指南。我们的团队包括不同的艺术、数字和健康专家、研究人员和临床医生、护理人员、志愿者和社区团体、地方政府、专员和提供者。这项研究将使人们关注ACE和年轻人的心理健康，并促进对受影响年轻人的风险、复原力和康复的了解。

This research investigates how adverse childhood experiences (ACEs) unfold to affect adolescents' mental health and co-produces novel prevention approaches. ACEs refer to harsh, unsafe, abusive and/or 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, depression, and post-traumatic stress disorder. We do not fully understand what makes an adolescent vulnerable to, or protected from, mental health problems following ACEs nor how to best to protect and support affected young people, many of whom struggle to find and engage with care services. This research aims to address these gaps in knowledge and support by placing young people's lived experience at the centre of our learning and action planning. Young people will be key actors in the design, delivery, governance, evaluation, dissemination and impact of six work packages (WPs). All WPs involve diverse young people (age, gender, ethnicity, LGBTQ, neurodiversity/autism) from different locations (rural, urban, coastal) because place affects local assets, opportunities, and access to care services. Young people will produce a film to ensure good communication and learning from all parts of the research and to evaluate the research. Ethical issues and safeguarding are addressed throughout. WP1 explores the lived experience of young people exposed to ACEs, how they define and explain their mental health, and how and why ACEs impact people differently. We highlight the needs of young people who are under-represented in ACE research, and of diverse identities and places. We will engage young people 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. WP1 will identify care approaches for ACE-related mental health problems that are considered useful and acceptable. WP2 will extend our understanding via analysis of existing large data sets collected from over 30,000 individuals to learn which personal or context factors best explain mental health outcomes following ACEs. WP3 turns WP1 and 2 learning and outputs into action. We will work intensively with young people and key stakeholders to co-produce public mental health resources for secondary schools, the third sector and social services to help them understand and better support adolescent mental health following ACEs. WP4 involves young people in co-design of a digital version of a promising therapy (Narrative Exposure Therapy, NET). Many young people actively avoid talking about their most adverse experiences even though this can help their mental health. We want to test if a co-designed version of NET that makes use of serious games or mixed reality technology, directly informed by WP1&2, helps young people engage and benefit from NET. Merging NET with technology is novel and requires multiple stages of prototype refinement. Young people will shape implementation and testing in rural, coastal and urban settings. WP4 examines if the new approach is feasible, acceptable and helpful to young people of diverse identities and to clinicians; we will understand how it works and what improvements are needed before proceeding to larger studies of effectiveness. WP5 will deliver preliminary cost-effectiveness information on distinct approaches. WP6 runs across the project to share learning with young people, clinicians, communities, policy and decision-makers, who will produce guidance on care for young people following ACEs. Our team includes diverse arts, digital and health experts, researchers and clinicians, carers, voluntary and community groups, local government, commissioners and providers. The research will bring a spotlight to ACEs and young people's mental health, and advance understanding of risk, resilience, and recovery for affected young people.