A school-based trauma-informed care and social-emotional learning intervention for adolescents with adverse childhood experiences in India: Protocol for a sequential mixed-methods study with a single-arm quasi-experimental evaluation

Background Adverse childhood experiences are major determinants of mental disorders, health-risk behaviours and non-communicable diseases across the life course, but evidence from India remains limited. This study aims to estimate the prevalence and patterns of adverse childhood experiences among Indian adolescents, examine their associations with mental health and non-communicable disease risk factors, and evaluate a culturally adapted school-based intervention integrating trauma-informed care and social-emotional learning. Methods A sequential mixed-methods study will be conducted among approximately 1,632 adolescents in 16 public and private schools in Chandigarh and Mohali, India. Phase I is a cross-sectional survey of adverse childhood experiences, mental health, perceived stress, sleep, screen time and behavioural and biological risk factors for non-communicable diseases. Phase II comprises focus group discussions and key informant interviews with students, parents, teachers, counsellors and mental health professionals to inform intervention development. In Phase III, findings from both phases will guide development of the intervention using the ADDIE (Analysis, Design, Development, Implementation and Evaluation) instructional design framework. In Phase IV, adolescents reporting ACE exposure will participate in a school-based intervention delivered over 8-12 weeks by trained psychologists, comprising trauma-informed social-emotional learning sessions, individual counselling sessions for high-risk adolescents (at least six sessions), school-wide awareness activities and parental sensitization. Effectiveness will be evaluated using a quasi-experimental pre-post design. The primary outcome will be change in emotional and behavioural difficulties measured by the Strengths and Difficulties Questionnaire (SDQ). Secondary outcomes will include changes in depressive symptoms (Patient Health Questionnaire-9), perceived stress, sleep quality, school functioning, and behavioural risk factors for NCDs. Recruitment began in April 2026 and is ongoing; data collection is expected to be complete by June 2028, and no results have yet been generated.