Validating Adapted Screening Tools for Adverse and Benevolent Childhood Experiences in Military-Connected Children and Young People: A Feasibility Pilot

The primary purpose of this study is to establish the psychometric validity and feasibility of the MCCYP-adapted ACEs and BCEs screening tools for use with Military-Connected Children and Young People (MCCYP). We use the term military-connected children and young people to include anyone whose lives are linked to the Armed Forces through a parent or carer who is serving or a veteran, being adopted into a military family, or through step- or blended family connection.

Psychometric validation is an essential and non-negotiable prerequisite before any adapted screening tool can be used with confidence in research or practice settings. Without evidence that a tool reliably and validly measures what it intends to measure within a specific population, findings derived from that tool cannot be interpreted with confidence. This is particularly important when adapting existing tools for a new population, as is the case here.

This study has 4 aims:

Aim 1: To validate the psychometric properties of both the MCCYP-adapted ACEs screening tool and the MCCYP-adapted BCEs screening tool, including assessment of internal consistency, item performance, and criterion validity for each measure. Internal consistency will be assessed using Cronbach's alpha for both tools, which provides an estimate of the extent to which items within each scale measure a coherent underlying construct. Item performance will be examined through item-total correlations for each tool, which identify whether individual items contribute appropriately to the overall scale score. Criterion validity will be assessed by examining correlations between both ACEs scores and BCEs scores with RCADS scores; based on extensive prior research, we expect ACEs to be positively associated with RCADS scores (greater adverse experiences associated with higher anxiety and depression symptoms) and BCEs to be negatively associated with RCADS scores (greater positive experiences associated with lower anxiety and depression symptoms).

Aim 2: To assess the feasibility of the research methodology, including recruitment rates, completion rates, time to complete measures, item non-response patterns, and safeguarding referral rates. Feasibility assessment is a critical component of pilot research, as it identifies practical challenges that must be addressed before scaling to a larger study. Recruitment rates will indicate whether the planned approach to participant identification and engagement is viable. Completion rates will reveal whether the survey battery is acceptable to participants in terms of length and burden. Item non-response patterns will identify any specific questions on either the ACEs or BCEs tools that participants find difficult or are unwilling to answer, which may indicate a need for further refinement. Time to complete will inform logistical planning for the larger study. Safeguarding referral rates are particularly important given the sensitive nature of ACEs questions, as they will indicate the level of support resources required when scaling up.

Aim 3: To generate descriptive data on the distribution of ACEs, BCEs, and emotional wellbeing in the MCCYP population. While robust prevalence estimates require larger samples, this pilot will provide preliminary data on the distribution of scores across all three measures within this population. This includes the proportion of MCCYP reporting different levels of ACE exposure (0, 1, 2, 3, and 4 or more ACEs), the distribution of BCE scores, and the distribution of SRCADS scores. These descriptive data will contribute to the limited existing evidence base on MCCYP experiences and will inform the design of the subsequent definitive study.

Aim 4: To explore preliminary bivariate associations between ACEs, BCEs, and SRCADS scores to generate effect size estimates for power calculations. The correlations observed in this pilot study will provide the variance and effect size parameters needed to calculate the sample size required for a definitive study with adequate statistical power to test moderation hypotheses. These analyses are explicitly exploratory and hypothesis-generating rather than confirmatory; the pilot is not designed or powered to provide definitive tests of relationships between variables.

The study will use an exploratory sequential mixed methods design. Phase 1 will consist of a scoping review of pertinent literature to inform phase 2 of the study. Phase 2 will consist of a qualitative (narrative) exploratory study in the form of co-design with up to 15 MCCYP. The participants in this phase will amend the presentation of the ACEs nad BCEs screening tool so it is child or young person appropriate for self-reporting ACEs and BCEs. The final design of the adjusted ACEs BCEs screening tool will be tested by up to 10 MCCYP. On completion of Phase 2, Phase 3 will use the adjusted preference-based ACEs BCEs screening tool and be administered to a wider selected population of MCCYP in conjunction with the Revised Children's Anxiety and Depression Scale (RCADS).

Is it feasible to validate adapted screening tools for adverse and benevolent childhood experiences in military-connected children and young people through a pilot study?

The sample will be drawn from across the four devolved nations of the UK and will purposively recruit 50-60 MCCYP aged between 14 and 17 years who have a currently serving parent. Purposive sampling with maximum variation will be employed, which is a non-probability-based sampling approach where researchers use a deliberate strategy to select participants who vary from each other in relation to relevant characteristics. The maximum variation sample will include participants selected based on their characteristics and those of their military parent or guardian, including age (within the limits of the inclusion criteria), gender, parental service branch (Army, Royal Navy, Royal Air Force), and geographical location. This approach ensures that the pilot sample reflects the diversity of the MCCYP population, which strengthens the generalisability of validity findings for both adapted tools.