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19/01 Improving health and wellbeing for people who are at risk of or exposed to Adverse Childhood Experiences (ACEs)

 

Contents

Please note: The Public Health Research (PHR) Programme would like to draw researchers’ attention to the commissioning brief below, which was first advertised in Spring 2019 as a commissioned funding opportunity. We are still interested in receiving applications in this research area, as it remains a priority in our portfolio. However, please note that the commissioning brief, along with the underpinning literature searches, has not been updated since originally written.

Research question(s)

  • What interventions are effective* in reducing the impacts of ACEs across the life course?
  • What impact do these interventions have on health, wellbeing and health inequalities?

Adverse Childhood Experiences (ACEs) are stressful and potentially traumatic events and situations that occur during childhood and adolescence. They include child abuse and neglect and also adverse family circumstances, such as parental loss due to death, divorce or separation, or incarceration. Evidence suggests that one form of adverse experience often co-exists with other forms of adverse experiences and that a key risk factor for children is adverse socioeconomic conditions. Research shows that these experiences are linked to health-harming behaviours and the development of non-communicable diseases later in adult life that can have negative, long-lasting effects on physical and mental health and wellbeing. These effects represent a major health, social and economic burden across communities.

The Public Health Research Programme wishes to commission research on the effectiveness of interventions to prevent ACEs, reduce the impact of ACEs and/or bolster resilience across the life course in those affected by ACEs or at risk of ACEs. The programme is interested in research that takes a broad view of the concept of ACEs, rather than the consideration of individual types of ACE. We are interested in interventions that act at a population, community or group level, rather than those that act at an individual level. Studies may evaluate multi-component interventions that can be delivered in different settings. Relevant target groups to be studied may include those defined by age, disability, gender, ethnicity or other relevant characteristic. Researchers should provide evidence that there is a clear gap in knowledge, providing a strong scientific rationale for their proposed study design, along with a clear health or health inequalities outcome.

Research areas of interest may include

  1. Evaluation of interventions that aim to improve the wellbeing of young people aged 12 to 17 who have experienced abuse or neglect, including those who are now in temporary or permanent alternative care placements or living independently.
  2. Evaluation of population level, community-wide interventions specifically targeting ACEs. This can include interventions across a whole community or particular communities at risk or already facing discernible adversity (as measured by relevant ACE indicators).
  3. Evaluation of population level, community-wide interventions with a broader focus (i.e. not exclusively about ACEs) to understand the impact on ACEs. This could include, for example, secondary data analysis.
  4. Qualitative research that evaluates the social and cultural changes caused by the relevant interventions on the impact of ACEs.
  5. Evaluation of interventions to prevent or reduce the impact of ACEs that are aimed at particular population groups across the life course.
  6. Effectiveness of different interventions to bolster and support resilience of populations at risk of or affected by ACEs. This could include evaluation of the differential impact that ACEs can have on different population groups, with a view to isolating potentially important protective factors.
  7. Effectiveness of interventions that are focused on preventing and reducing the risk of intergenerational transmission of ACEs.
  8. Context and timing specific evaluations which investigate how interventions interact with the experiences of children, families and adults at risk of or affected by ACEs.
  9. Evaluations of multi-agency or integrated interventions (this can include knowledge-based, educational approaches/programmes) for children and families.
  10. Evaluations of ACE- and/or trauma-informed approaches to commissioning, service provision and ACE-based interventions within local systems. For example, the evaluation of the effectiveness of interventions to ask people about ACEs as part of routine enquiry in front-line services in different settings. This could include evaluations of the validity, reliability and acceptability of using ACEs tools with children, families and adults.
  11. Investigations of potential unintended harms of ACE interventions (including ACE- and/or trauma-informed approaches to commissioning and service provision as per (9) above).

Researchers should demonstrate the relevance of their proposed research to policy makers and other evidence users. Researchers are encouraged to consider economic impacts across whole systems.

Studies should generate evidence to inform the implementation of single or multi-component interventions. Studies may include evidence syntheses, studies evaluating interventions, including trials, quasi- and natural experimental evaluations, and feasibility and pilot studies for these. We welcome applications for linked studies (e.g. pilot + main evaluation). Secondary analyses of existing epidemiological data and/or impact modelling studies may also be funded. We encourage the adoption of a systems perspective where appropriate to the study context. In all cases a strong justification for the chosen design and methods must be made.

The primary outcome measure of the research, if not necessarily the intervention itself, must be health-related. The positive or negative impacts of the intervention, including inequitable outcomes should be considered.  Researchers are asked to indicate how long-term impacts will be assessed. All applications should identify underlying theory and include a logic model (or equivalent) to help explain underlying context, theory and mechanisms. Proposals should ensure adequate public involvement in the research.

The impacts of public health interventions are often complex and wide-reaching. Studies should acknowledge this by adopting a broad perspective, taking account of costs and benefits to all relevant sectors of society. An appropriate health economic analysis to inform cost effectiveness, affordability or return on investment should be included where appropriate. Sustainability - health, economic and environmental - are also of interest. 

For all proposals, applicants should clearly state the public health utility of the outcomes and the mechanisms by which they will inform future public health policy and practice. Details about the potential pathway to impact and scalability of interventions, if shown to have an effect, should be provided, including an indication of which organisation(s) might fund the relevant intervention(s) if widely implemented.

Remit of call

All proposals submitted under this call must fall within the remit of the NIHR Public Health Research (PHR) programme. Please go to the PHR pages for details. For the evaluation of time sensitive, policy driven, interventions applicants may wish to consider the fast-track work stream.

General notes

The PHR Programme funds research to generate evidence to inform the delivery of non-NHS interventions intended to improve the health of the public and reduce inequalities in health. Our scope is multi-disciplinary and broad, covering a wide range of interventions that improve public health.
The primary aim of the programme is the evaluation of practical interventions. We will fund both primary research (mainly evaluative, but also some preparatory research) and secondary research (evidence synthesis); precise methods will need to be appropriate to the question being asked and the feasibility of the research.

Our research serves a variety of key stakeholders including: decision-makers in local government; primary care organisations and other local public services; third sector organisations; relevant national agencies (e.g. NICE) concerned with improving public health and reducing health inequalities; researchers; public health practitioners and the public.

Applicants should consider how their findings will impact upon decision making in public health practice, whether results are generalisable to other populations and affordable, setting out a clear pathway to impact. The NIHR PHR programme recognises that there is a need for an evidence base for disinvestment and that the removal of an intervention from a population can be worthy of evaluation.

The affordability of the intervention, and at least an indication of the stakeholder(s) willing to fund the intervention, should be referenced within the stage 1 application. At the stage 2 application point, statements of support confirming stakeholder commitments to funding will be required. Applicants should be aware that the NIHR PHR programme is unable to fund intervention costs.

The NIHR PHR programme is open to the joint funding of research projects with other organisations such as those in the third sector. If you would like to explore the potential for joint funding, please contact us at phr@nihr.ac.uk with details of your proposal and the other funder prior to submission.

All of our funded projects are eligible for publication in the NIHR Journals Library. This open access resource is freely available online, and provides a full and permanent record of NIHR-funded research.

Notes to applicants

The NIHR PHR programme is funded by the NIHR, with contributions from the CSO in Scotland, Health and Care Research Wales, and HSC R&D, Public Health Agency, Northern Ireland. Researchers in England, Scotland, Wales and Northern Ireland are eligible to apply for funding under this programme.

Applicants are recommended to seek advice from suitable methodological support services, at an early stage in the development of their research idea and application. The NIHR Research Design Service can advise on appropriate NIHR programme choice, and developing and designing high quality research grant applications.

The NIHR Clinical Research Network (CRN) supports health and social care research taking place in NHS and non-NHS settings. The CRN provides expert advice and support to plan, set up and deliver research efficiently.
Clinical Trials Units are regarded as an important component of many trial applications however, they are not essential for all types of studies to the PHR programme. The CTUs can advise and participate throughout the process from initial idea development through to project delivery and reporting. NIHR CTU Support Funding provides information on units receiving funding from the NIHR to collaborate on research applications to NIHR programmes and funded projects. In addition, the UKCRC CTU Network provides a searchable information resource on all registered units in the UK, and lists key interest areas and contact information.

Transparency agenda

In line with the government’s transparency agenda, any contract resulting from this tender may be published in its entirety to the general public. Further information on the transparency agenda is at:
http://transparency.number10.gov.uk/
http://www.ogc.gov.uk/policy_and_standards_framework_transparency.asp

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