The ATTUNE Project

The ATTUNE project (attuneproject.com) seeks to understand the mechanisms and mental health impacts of adverse childhood experiences (ACEs) and co-design preventive arts and digital interventions together with young people. This project is led by a national consortium of clinicians, academics, and service providers at Oxford, Falmouth, Leeds, Kent, and London universities and organisations.

In ATTUNE, we primarily use arts-based methods to engage young people in the research process. Creative arts methods—such as writing, performance, filmmaking, music, and state-of-the-art games technology—allow us to uncover experiences that verbal methods alone might not be able to capture. This approach not only deepens our understanding but also reduces the resource and emotional burden on young participants, particularly those facing multiple levels of disadvantages in their lives.

Why ACEs?

Adverse childhood experiences (ACEs) are unpleasant events in childhood that can have lasting detrimental effects on health and psychological wellbeing. These events include but are not limited to; neglect, physical, mental, or sexual abuse, household issues such as violence or substance abuse, and community risks such as poverty and peer victimisation.

There is growing scientific and policy attention to these potentially preventable adversities and their links to complex trauma, serious health problems, and increased mortality rates later in life. There is still uncertainty of what makes young people vulnerable to or protects them from health and psychological issues following ACEs.

Two years into the ATTUNE project, young people working with the team have produced animations, play, poetry, dance, and songs reflecting their lived experiences with ACEs, demonstrating creativity and resilience. Check out the ATTUNE project film "Just Surviving", which has been nominated for the Lived Perspectives Film Festival 2024. Young people's insights have also been crucial in co-designing a public health resource and a serious game intervention with the ATTUNE team. We are currently in the evaluation phase of the public resource and testing the game's acceptability and feasibility before planning further trials and rollout.

Why serious games?

According to a report by the Children’s Commissioner for England, an estimated 89 percent of young people in the UK aged 3 to 17 had played video games in the last year. For many, gaming is an extension of ‘play’ within the digital landscape, offering a way to learn new skills, socialise with friends, and ward off boredom.

Serious games, as the name suggests, are designed with a specific purpose beyond entertainment. They aim to educate, train, or change behaviour while still engaging players. In the healthcare industry, serious games are increasingly used to meet various needs, from patient education (e.g., simulating health conditions and providing interactive learning) to professional training (e.g., using realistic VR environments to practice procedures). Notably, the National Institute for Health and Care Excellence (NICE) in the UK has included serious game interventions that were designed based on CBT principles in its recommendations for adolescents with mild depression.

The ATTUNE team is co-developing and testing a serious game intervention focused on ACEs with young people. The intervention includes a series of mini games focusing on specific challenges and different clusters of ACEs, such as coping with bereavement, poverty, gender dysphoria, and challenges of being a young carer. Each game adopts a unique format to engage players effectively, for example offering a virtual space where players can explore narratives and develop resilience to meet real-life challenges, or using a 2D side-scrolling format to navigate a dark forest, symbolising the journey of a young carer. The games integrate metaphors to address sensitive issues with both subtlety and empathy.

Our feasibility and acceptability study aims to determine if these co-designed games can effectively promote mental health wellbeing, compassion, help-seeking, and resilience to ACEs in young players. Psychological outcomes are measured before and after the intervention using questionnaires such as the Short Warwick-Edinburgh Mental Wellbeing Scale, and participants are interviewed afterward to share their experiences with the game.

The journey ahead

We hope the ATTUNE project will begin to answer some crucial questions: How do young people themselves define mental health wellbeing and ACEs? What are the lived experiences that shape how ACEs impact or protect the mental health of diverse young people? Can serious games and other creative arts approaches generate new and transformative data to improve understanding and inform prevention and care interventions?

To date, an increasing number of digital health interventions have been developed to engage people with mental health conditions and teach psychological principles and techniques. However, few studies have explored the effects of co-designed, youth-informed arts and digital interventions in the context of ACEs. The outcomes from the ATTUNE project will pave the way for using creative arts to enhance prevention and intervention strategies, foster awareness of young people’s experiences, promote agency and self-advocacy, and ultimately improve long-term outcomes for young people affected by ACEs.

More information

For more information, please visit the website (attuneproject.com) or follow the project on Twitter: @AttuneProject.

Funding

The ATTUNE project is funded by the UKRI Medical Research Council (MR/ W002183/1).