Associate Professor Anna Mankee-Williams So,   thanks for inviting us to present here  today. My name’s Anna Mankee-Williams.   I’m an Associate Professor for Arts and Health  at Falmouth University, and Professor Eunice Ma,   who will introduce herself more fully in a  moment. We’re going to share this presentation. I will introduce the project to you and  Eunice will be presenting the serious   game developments to you. So, the Attune  Project is a 3.9 million UKRI project,   surfacing the unseen and the unheard impact  of adverse childhood experiences on adolescent   mental health through arts-based research.  We are exploring people’s – young people’s   lived experiences, their thoughts and voices,  captured through art, dance, music, animation,   photography, film and creative writing. Through  this, and alongside a framework analysis of their   narratives, and a quantitative analysis of  three large datasets that include OxWell,   Reach and HeadStart, which is about 30,000  datapoints, the project has sought to understand   not only the impact of ACEs as they are perceived  by young people today, but also the mechanisms by   which young people seek, are supported to hold,  mitigate impact, or improve their mental health. The final two pieces of our project are  what you’re going to hear about today. Well,   you’re going to hear about the serious  game, so that’s the co-designing of the   serious game and the co-designing of the  public health and educational resource. So,   we’re going to share some early insight  that has informed the game development. However, before we go any further, we need to  recognise that the siting of young people at   the heart of this project has been really, really  interesting. We have a young person as the Project   Manager, working on her apprenticeship, and we  also had a young person as the Comms Officer, who   gained a distinction in her apprenticeship, and  is now at university with an internship at Disney   under her belt, and a role behind the scenes  of a recent show, “The Assembly,” some of you   may have seen it, about a group of neurodivergent  and disabled young people who interviewed Michael   Sheen. So, amongst other – an awful lot of other  young person present, they are absolutely at the   core of this project, and everything that  we are doing is co-designed with them. So, our research questions are, “What are  the psychological and geo-socioeconomic   contextual mechanisms by which ACEs unfold  to affect or safeguard the mental health   and lives of young people?” And “Are  co-designed, youth-informed public   mental health technological and clinical  actions acceptable, feasible, beneficial   for young people, and potentially cost effective  for Commissioners and providers and communities?” So, within the project, we have six work  packages. This is very academic language,   I do appreciate that, and they all inform each  other. And the insight that is informing the   game development and the educational resource has  come from work package one, which is the creative   arts-based research lens, and I have led that,  and work package two, which is the large dataset   analysis. And we’re now fully in the depths of  our work packages three, four, five and six. So, the early insight which has been surfaced  for us – just moving you again there,   is that – and this is probably not a surprise  to people, but it is the response of others to   the young person becomes a relived trauma,  repeated invalidation becomes an adverse   childhood experience in and of itself. It  is the first thing they talk to you about,   repeatedly, prior to them telling you about  physical abuse, sexual abuse or anything else. Neurodivergence is poorly understood,  and neurodivergence and mental ill health   together is extremely poorly understood and  overwhelmingly, not catered for in terms of   support provision. Addressing mental ill health  is not classness. When you’re just surviving, it   is a luxury to think about your mental health, and  they feel unsafe in an awful lot of places. There   are some really good experiences for them that  are carefully curated and framed, but actually,   school does tend to feel very unsafe for some of  the young people that we have been working with.  Young people seem, through this project, to be  intuitively seeking out nature. They are clearly   saying that trusted relationships are crucial and  that includes with pets. Interestingly, they’re   saying that support workers close in age and/or  experience are more important than professionals,   and this came out extremely strongly when  we were working with refugee groups and   those groups who were more marginalised,  for example, gypsy traveller children. Trauma informed training is crucial, but they  are very, very clear, and they have developed   a policy ask that trauma informed training as an  add-on is not good enough, and they want to see   trauma informed training as an embedded part  of any professional development and training,   for example, Teachers, GPs, School Nurses, rather  than it being a bit of CPD on the side. And,   also, neurodiversity training is crucial  amongst all practitioners who are frontline,   and place may have an impact and  we need to further explore it. The following three slides are a very brief look  at some of the work created by the young people.   These are unfiltered, they are their choices  of photographs that we have permission to show,   and the narratives that they have  developed with the photographs. So,   for this particular creative practice, they  were taught how to use an Instax camera,   and they were asked to take photos that  represented how they felt and what they saw   as part of their daily lives. And they were then  asked to put their own narrative to the photos,   so that we were not putting our own  translation and interpretation onto it. Many of the pictures represent  feeling trapped, isolated,   invisible and afraid. These were common  themes, and the exhaustion of masking and   frustration and hopelessness at being not  believed or invalidated on a micro or macro   daily level, this was very common. So, I will put  the pictures up, and then just pause slightly,   so you have a chance to look at them.  This young person was being sent back   to the house which was the cause of her extremely  adverse childhood experience and trauma [pause].   And what came out very strongly  is how invisible they feel and   how alone they feel and how hopeless they feel. So, I’m now going to show you a short film, it’s  90 seconds. We worked with Aardman Animation,   and so, this is the young people worked with  Aardman to develop this particular film. The   narrative is their narrative and they are  their voices on the film. We compacted hours   and months of work into these 90 seconds,  please do tell me if you can’t hear it. [Video starts] Speaker 1 I remember being like a little ninja,  running around, trying not to be seen [background   shouting]. I got used to saying and doing  as little as possible [background shouting]. Speaker 2 Sometimes I’d try to eat so little,   I hoped I would disappear. When I tried to get  help, I was put on a waiting list for months,   then turned away because my case wasn’t  urgent enough, whatever that means. Speaker 3 I don’t feel safe anywhere,   not at home and definitely not online [buzzer].  The only place I like being is the staffroom,   away from the other kids. That’s  probably why I keep getting in trouble. Speaker 4 I kept getting called  a ‘neek’ for covering myself up,   but nobody knew what he was doing to  me, and I didn’t want them to find out. Speaker 5 Our generation is experiencing adverse  childhood experiences in ways that are different   from before. Without help from people and services  that really understand this, we can get stuck. All We want to do more than just survive. [Video ends] Associate Professor Anna Mankee-Williams And just  to balance out the findings and to bring it back   into the digital space, we worked with a group of  young carers in North Wall, called North Wall, in   Oxford, who really wanted to make a film about how  a curated app can help them. These are all young   people between the ages of ten and 18. They’re  all young carers, and they are all having issues   at school because of their caring responsibilities  affecting their mental health, and are therefore,   referred into the actual voluntary community  sector group to try and help them to stay in   school. So, I’m just going to play this one.  Again, please tell me if you can’t hear it. [Video starts] Speaker 1 [Music]   Your grades have come back and they’re not high  enough. You will need to work harder or we’ll get   budget cuts, and we will not be able to continue  providing you with the high level of education   that we currently offer. There are students that  go home and revise for five hours every day.   Your school grades are extremely important. Also,   we have been told that we have  to show you this short video. Speaker 2 If you’ve been feeling  under pressure or struggling with   your mental health, please download Healthy Minds,   an app to offer you support and our services. For  example, setting up with new compatible friends,   access to classes and clubs in your area and  online therapy sessions, if wanted, and more. Speaker 3 [Music]   In my room, I have a bin full of  rude notes from my classmates.   I’ve been struggling at school and  they’re not being kind about it. Speaker 4 [Music] In my bedroom, I can’t see the  floor from all the mock exams I’ve printed out.   My printer’s ran out of ink. My order for  more ink is processing as I type this. Speaker 5 [Music] In my bedroom,  I have piles of extra workbooks   that my parents have bought me. Most of  them I haven’t even had time to open,   ‘cause there are so many. My parents really want  me to practise for tests every second of my life,   but I told them that school isn’t the only  thing that I want my life to revolve around. Speaker 6 [Music] In my bedroom, I have  a set of shelves, shelf one at the top,   my books and CD player on display.  Shelf two is for my schoolwork,   piles of paper everywhere and late homework  hidden away. Shelf three is for my mum’s stuff,   just pills and equipment and forms. I’ll do it  in a minute, all organised in boxes and folders. Speaker 3 In my room, I have  a bin full of rude notes… Speaker 4 In my bedroom… Speaker 3 …from my classmates. Speaker 4 …I can’t see the floor… Speaker 5 I have piles of… Speaker 4 My printer’s run out of ink. [Voices merge] Speaker 5 …I haven’t had time to   open because there are so many [music]. [Video ends] Associate Professor Anna Mankee-Williams   Okay, so I am now going to hand over to Eunice,   but I am in charge of the slides,  so I will do my best, Eunice. Professor Minhua Eunice Ma Thank  you. Thank you, Anna. Good evening,   everyone. My name’s Eunice Ma. I’m a Professor of  Games Technology at the University of Oxford. I’m   excited to share with you a serious game from  our Attune Project, focusing on adolescents’   mental health. The game is entitled “Ace  of Heart,” and ACE, also, is the acronym   of Adverse Childhood Experience. The serious  game is designed around playable, fictional   narrative that depict a diversity and struggle,  exploring various adverse childhood experience. And it features a cluster of four mini-games,  which are housed within a central hub,   known as The Cosy Den, and the place is not only  a place to relax and customised by the player,   but also, serves as a launch point for all the  stories. And player have the option to play music,   explore the environment, import  their own images or soundtrack,   and dive deep into the narrative surrounding  ACEs. And I look forward to delve into this   how Ace of Heart leverage games  technology to foster understanding   and support for mental health among adolescents,  and let’s have a close look at how it works. Next slide, please. So, the game  consist of – apart from Cosy Den,   it’s four mini-games called Horse & Foal,  which covering young carer and bereavement,   Hard Time, it’s a poverty game with the  element of family breakdown, Dial it Back   embedded the concept of narrative exposure  therapy, and Out of Shell about gender dysphoria. Next slide, please. So, in the Ace of Heart,  players are introduced to a cast of characters,   each dealing with their own adverse  childhood experience, and this connection   is deepened as players can interact with these  character through text messages, empathise   with their stories, and really dive into  their experience, to understand the depths   of their challenges. And the journey begins  in The Cosy Den. It’s a safe and welcome hub,   from which all adventures start, and here player  receive initial text message from their friend,   setting the stage for the interactive  experience. And responding to these messages,   player are drawn into each mini-game, they reveal  a character story in each game, and upon complete   those mini-games, the player return to The Cosy  Den, where new items and features are unlocked,   for example, new toys freshly appeared  on the bookshelf, and new pages of comic   books are unlocked. These are rewarding  player for their progress in the game. And resolution of those stories are also delivered  to the player’s phone in The Cosy Den. That’s not   their real phone. It’s the phone within the game,  adding another layer of personal connection and   continuity. And for those who wanted to  have more content and create more depth,   The Cosy Den also is a place to explore comic  books, which is on the table in the room,   and additional resources that provide further  insight into ACEs and the broader issue that they   address. And, moreover, Ace of Heart also serves  as a educational purpose. It offers research   resources about the issue covered in the game,  allow players to learn more about the real-world   implications of ACEs. And this blend of game  play, narrative depths and educational content   create a rich, immersive experience that not  only entertains but, also, informs and educates. Next slide, please. Now we made significant  progress on our game series designed to address   complex issue through engaging narratives and  interactive gameplay. So far, we have completed   two of our mini-games, Horse & Foal and Hard  Times, while the remaining two are currently   under development. The Horse & Foal is a 2D narra  – [inaudible – 1900] narrative, set amongst the   wilds of nature. It tells a poignant story of  a young carer wrestling with the heavy burdens   of responsibility, bereavement and the processing  of loss. The game invites player to step into the   shoes of someone facing life’s harsh reality at a  young age and enhancing empathy and understanding. Hard Times offers a completely different  contrasting gameplay experience,   with its 3D first person perspective, where  players can freely explore a household setting,   that simulates the stress of poverty, the rising  cost of living, and the constant juggling of   conflicting demands. The game aims to immerse  player in scenario that many people face daily,   encouraging a deeper understanding of  these challenges. And moving forward,   we are developing Dial it Back, a game that  integrates gameplay elements with a narrative   focused on exploring past memories and traumatic  events, through the lens of narrative exposure   therapy, and this approach provides insights  into how we process and recover from trauma. And lastly, Out of Shell is set to be a 2D  narrative game that incorporate tower defence   type of game mechanics. The game addresses  challenges and pressure of gender dysphoria   and coming out as a transgender. It’s designed  to foster awareness and support for transgender   community by providing players a glimpse into the  complexity of gender identity issues. And each of   these game is designed not just to entertain,  but to inspire and provoke thought, reflecting   our commitment to leveraging games technology as  a powerful tool for young people’s mental health. Next slide, please. And let me now give you  a visual glimpse into the world that we have   created, and here are some screenshots from  the games we’ve completed, which will help   you get a feel of the diverse and immersive  environment our game offer. And each screenshot   capture the unique aesthetic and mood of the  pers – respective game, providing insight into   how we designed this interactive experience to  both engage and educate players. As you can see,   we focused on ensuring that each game  is not only tell an ACE story, but also,   visually communicate the theme and  emotions central to its narrative. Next slide, please. In our game Hard Times,  we also call it “Poverty Game,” which players   step into a 3D first person simulation set in a  household where every decision impact the family   survival. The player takes the role of Nina, the  elder daughter of a single mum with two children,   navigating through a series of daily challenge  in a rundown council flat in London. Over the   course of three days, the player will  manage finance, time and mental health,   while juggling the demand of family  responsibility and her own study. The game delves into the theme of poverty, family  breakdown and the pressure of the cost of living,   and player experience the conflicting emotions  of a family struggling to stay afloat amidst   all these challenges. As Nina, the player, is  tasked with competing – completing home chores   with – for her mum and little brother, and making  tough decisions, to ensure the family’s survival,   like, paying, you know, utility bills, rent, etc.  And the game is designed to not only entertain   but also, educate players about the real-world  issues that many facing, encouraging empathy and   understanding through interactive storytelling. Next slide, please. Dial it Back, which is the  game we’re currently developing. We conceptualised   a game grounded in the principle of narrative  exposure therapy, or NET. For those of you who are   unfamiliar with NET, NET is a treatment that helps  individual construct a coherent life narrative,   integrating both traumatic experience and a  positive memory, to address and contextualise   trauma. Narrative exposure therapy typically  involve four to ten therapy session, where a   patient is guided by a Therapist, chronologically  organise their life events, focusing predominantly   on the traumatic experience, but  also, acknowledging positive moments. And this process aid in contextualising  the cognitive, affective and sensory   memories associate with trauma, and patients  articulate their narrative, filling in details,   and develop a coherent autobiography story, which  is therapeutical in itself. And the first session   of narrative exposure therapy usually involve  creating a lifeline, a physical representation of   one’s life story, using symbols like flowers and  stones, where flower symbolise positive events and   the stone represent negative ones. The size, shape  and colour of those flower, stone, are – symbolise   the barriers, to reflect the intensity of those  events, whether it’s positive or negative. As you can see, narrative exposure therapy itself  or – is already gamified, and in our game Dial it   Back, the players experience a timeline of  a young person, Ollie, his name is Ollie,   his life over ten years period. And the  player can explore Ollie’s memories,   where the narrative gradually unfolds. And  again, touches on themes like life after trauma,   neurodiversity, social isolation and invalidation,  and one of the finding Anna mentioned in the early   part of our presentation, reflecting the challenge  of multiple adverse childhood experiences. And   through this interactive format, we aim to engage  and, also, educate players, offering insights into   overcoming adversity through structured narrative  therapy. So, this picture on the right is a, kind   of like – give you an idea of what our symbolised,  kind of, lifeline is look like. Next slide. Associate Professor Anna Mankee-Williams Just to  let you know, you’ve got a couple of minutes left. Professor Minhua Eunice Ma Okay, next  slide, please. So, this is a full story   plan of Ollie’s memory and his lifeline, which  consist a list of stones and flower memories,   like – flower memories, like baking  with mum when in his childhood,   and traumatic experience, like the car accident  and social isolation in school, invalidation.  Next slides. So, to give you some example of  some flower memories in Ollie’s lifeline from   Dial it Back, and these are – you know, one of  the memory is about a pet. You know, it’s, “I   always wanted a dog. It was love at first sight.  I’d just have about anything to keep the little   guy smiling,” and the player can choose a name  from a list of name or have their own name. And,   also, a moment in Ollie’s memory, when he spent  time with mum cooking chocolate-encrusted imp. And another example is imagine that in a scene  where Ollie and his best friend, Anya, are   camping under a star-lit sky, in this part of the  game, player not only witness this scene, moment,   but also, actively participating by tracing  constellation in the sky to this interaction.   To – not only about recreating the stars, but  also, connecting with Ollie’s happy memories,   deepening the player’s understanding of his  life’s positive moments, amidst the challenges. Next slide, please. So, these are some examples  of negative memories, and bear in mind these   are – this game is in – still in the development  stage, so that’s just a concepted design. So,   one of those traumatic moments is the car  accident, another one is the trying to – Ollie   trying to break social bubbles, ‘cause he’s feel  isolated and feel excluded in school. Trying   to fit in all the – any of these bubbles. Next  slide, please. We don’t have time to look at game   playthroughs, but I have included some links. If  you’re interested, you might have a look offline   of the three games that we have – two games,  including Cosy Den, we have already completed. And my final slide, please. This is about  co-design process of our game development. As   Anna mentioned earlier, everything we do in Attune  Project, we do together with young people. So,   our game design, development process  pretty much co-designed with young   people as stakeholders. In Game Sprint, we  run co-design workshop every six weeks. So,   we present game in Attune with the  iterative version of game development,   and discuss and let the player have – the young  people have a go with the game and their idea,   suggestions, are implemented in iterative  way. And these stories are informed by young   people’s lived experience, and we also run  experiments – experience-based co-design. So,   we put a stakeholder, like healthcare  providers, professionals and young people,   in the same room to balance the stakeholder  power dynamics in the co-design session. Associate Professor Anna  Mankee-Williams Thank you.