King's College London

1. To explore the lived experiences of service users disclosing adverse childhood experiences, and of mental health practitioners asking about and listening to disclosures of adverse childhood experiences in community mental health settings

2. To co-design and refine a complex intervention for community mental health practitioners to improve the experience and impact of disclosing adverse childhood experiences.

This study follows the Medical Research Council framework for developing complex interventions (Skivington, 2021) and will focus on the development phases of complex intervention research. A combination approach of experience-based co-design and behaviour change theory will be used to guide the intervention development in three phases:

Phase one:

An experience-based co-design multi-method qualitative study of the disclosure journey in a community mental health setting will be undertaken. This will involve individual interviews with service users and staff and detailed observations of the clinical environment. The findings from the study will be used to co-produce an animated film of service users' experiences.

Phase two:

The co-design phase will involve staff and service users coming together to view the film, explore the findings and work in small groups (co-design teams) to identify areas for improvement and potential solutions. Behaviour change theory will be used to consider the context and mechanisms of change. Co-design teams will develop an intervention prototype.

Phase three:

Once a final prototype of the intervention has been developed it will be delivered to mental health practitioners. 12 practitioners will be using the intervention for 6 months to guide conversations about adverse childhood and evaluate its feasibility and acceptability The prototype will be refined based on findings from the early testing.

The findings from phase one highlight that disclosures of adverse childhood experiences (ACEs) are a relational process. Trust and psychological safety are essential to reduce fear and enable people to share difficult experiences. Many people reported that their childhood experiences were overlooked, with too much focus placed on diagnosis and medication rather than underlying trauma.

When clinicians genuinely acknowledge and bear witness to people’s suffering, it can have a powerful and meaningful impact, supporting recovery. Although recovery is complex and challenging, people demonstrate hope and resilience.

From the clinician perspective, facilitating these conversations requires skill, sensitivity, and clinical judgement. However, organisational barriers—such as limited time, heavy workloads, and insufficient training—can make this work difficult. While engaging with trauma can be deeply rewarding, clinicians are also at risk of burnout and vicarious trauma without adequate support and resources.