The ACE of Hearts Serious Game for Young People With Adverse Childhood Experiences

The ACE of Hearts project establishes a novel methodological framework for developing trauma-informed digital health interventions by integrating Experience-Based Co-Design with agile software development. This approach prioritizes the agency of young people aged 12 to 24 who possess lived experience with adverse childhood experiences. By facilitating iterative design sprints and maintaining an auditable decision log, the development process successfully balances youth-led creative input with clinical safety requirements and technical feasibility. This collaborative model effectively mitigates power asymmetries between researchers and vulnerable participants, ensuring that the resulting digital tools remain both emotionally authentic and ethically sound.

The resulting serious game prototype utilizes symbolic narratives and metaphorical gameplay to explore complex themes such as bereavement, financial hardship, and social stigma without risking retraumatization. Central to the design is a customizable "cozy den" hub that provides a safe, controlled environment for self-reflection. By embedding therapeutic techniques, such as elements of Narrative Exposure Therapy, directly into the game mechanics, the project offers a non-clinical, accessible platform for youth to engage with their experiences. The inclusion of continuous stakeholder feedback and embedded ethics sessions ensures that safeguarding remains a primary component of the user experience.

While the project demonstrates that meaningful participation can produce highly relevant and engaging digital interventions, the long-term therapeutic value and clinical efficacy of the game remain subjects for future controlled evaluation. Nevertheless, the integration of EBCD and agile methodologies provides a scalable and transferable blueprint for the broader digital mental health industry. By prioritizing emotional realism and user agency, this framework serves as a robust foundation for creating future digital tools designed to support vulnerable populations through trauma-informed, interactive media.