Child Study Center Grand Rounds 05.25.2021

June 08, 2021

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A Game Changer: Using Videogames as Interventions to Improve Adolescent Health and Well-being

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00:00Before I introduce her superb
00:02speaker for today, I want to tell
00:04you about our speaker for next week.
00:07We're coming close to the
00:09end of the academic year,
00:10but we have some really very good
00:13things lined up next Tuesday.
00:15We're going to have our very own
00:17alumna from the CHILD Study Center.
00:19Lisa Akbar is going to be giving
00:22us grand rounds and talking about
00:24some of the very important.
00:27Anti racism interventions that
00:28she and others are taking a lead
00:32in at the American Psychological
00:34Association and it's really a
00:37feather in every every one of
00:39the Child Study Center's captive.
00:41That metaphor works to know that my
00:43son is now the Chief Diversity officer
00:46of the American Psychological Association,
00:49including all of its I think 100,000 members.
00:53So that is really remarkable.
00:55And she's doing that from.
00:57Here from New Haven CT.
00:59Actually.
01:00From Westville she lives not far from me,
01:03so that's that's in some way.
01:05The prodigal daughter come back,
01:07although if you have some left,
01:10so that's next week.
01:12My son Akbar.
01:14Today I'm really delighted about
01:16this grand rounds.
01:17I've been looking forward to.
01:20It's in some ways the second.
01:22I wouldn't say that it's a series,
01:25but it's two grand rounds on
01:27an area and a topic that is new
01:30and exciting to many of us,
01:32and yet something that I for
01:34one know very little about.
01:36You may remember that about a month
01:39or six weeks ago we have Kim we had
01:42Kim Hatchet from the play to prevent lab.
01:45She talked about gaming and some of
01:48the games that she has developed and.
01:51And today we have this
01:53related presentation by Lynn.
01:59Lean philein we tried this
02:01in the pre final Celine.
02:04I was very generous, among other things,
02:07and tell me how to pronounce her name,
02:10which of course already screwed up.
02:12So Lynn, as you can use a professor
02:15of medicine and public health.
02:17She's also a professor at
02:19the Yale Child Study Center,
02:21so that tells you that she has any
02:23number of collaborations with us
02:25with colleagues in the department.
02:27She is the director of this
02:30plate to prevent lab at the.
02:33At Yale and maybe a year ago,
02:37I didn't even know.
02:39That we have such a thing as,
02:42you know, play in gaming journals
02:45in health and mental health.
02:47It's a whole area that we
02:50know very little about, so.
02:53Lynn is the director of
02:56that play to prevent Lab.
02:58She and her team focus on developing
03:01and evaluating videogame interventions
03:02in this in the form of serious
03:05claims to impact the health
03:07and well being of adolescence,
03:09including around smoking,
03:10vaping, HIV prevention,
03:12HIV counseling and testing,
03:13sexual mental health in adolescents.
03:15We heard some of that with Kim
03:18and mental health in general,
03:20an opioid, abuse in particular.
03:23So she and her lab are internationally
03:26renowned for their novel work.
03:28She has all sorts of interesting
03:30and extensive funding,
03:31and we were just talking about dear friends
03:34who we know from various study sections.
03:37So when we're delighted to have you here.
03:41Take it away and we're
03:42going to meet everyone.
03:44Just remember Lynn after we mute
03:46everyone to please unmute yourself.
03:48So Lynn, welcome to the Child Study Center.
04:08Glenn, you're on mute still.
04:13Alright, so should I
04:14start that all over again?
04:16I just been talking myself.
04:18Gotta love technology.
04:19OK I will start from the beginning
04:22so thank you Andras for that
04:24for that introduction and to you
04:26and Linda for having me here,
04:28it's good to see everybody.
04:29Please tell me if I'm muted again.
04:33So, so I'm very pleased to talk
04:35with you about the work that we've
04:37been doing at the play play to
04:39prevent Lab for the last 12 years.
04:41Using video games as interventions to
04:43improve adolescent health and well being.
04:45As you'll see from some of my sides,
04:48this is really a team effort.
04:49This is work that cannot be
04:51done by any one of us alone.
04:53I want to give a shout out to Linda Mays,
04:57who actually helped me write
04:58my first grant in this area,
05:00so it's really wonderful to come
05:02back now to be able to share
05:04where we have gone from there.
05:09Up OK, given technology is let's see.
05:16OK, so just a quick disclosure.
05:18I am co-founder and equity holder of
05:20a new spin out company from my lab
05:23which is called label that focuses
05:25on the marketing and distribution
05:26of our video game interventions.
05:31And since I spent the last decade
05:33becoming a big fan of play,
05:35I just wanted to share this quote,
05:38which I really like as I love
05:40playing and I'm also getting older.
05:42It seemed very appropriate.
05:46So this is just a brief outline of
05:48what I'm going to talk about with you.
05:51So first is how did we get here?
05:55Really involved building a program
05:57and a team, building a platform,
05:59and then what we're looking at
06:01in terms of our next steps.
06:02This seems to be on autopilot,
06:04so how did we get here?
06:06So this is my was my still is my son Liam,
06:10who at the time was.
06:1310 years old and he loved
06:15playing video games.
06:16In fact, everyone in our House love playing
06:18video games between my husband, my.
06:21We had five kids between the ages
06:23of nine and 19 and everyone was
06:26playing something on a device
06:29on a phone on a console,
06:31on a computer,
06:32and it really struck me that this was
06:35a way to engage engaged teenagers in
06:37in something healthy that we might be
06:40able to use this delivery vehicle,
06:42specifically a video games to deliver
06:46something that would be good for them.
06:49And so about 12 years ago I submitted
06:51a grant in response to this RFA
06:54from the National Institute of
06:56Child Health and Human Development,
06:58proposing to develop and evaluate a
07:00video game intervention specifically
07:02around HIV prevention and at
07:03risk adolescents.
07:06And sort of amazingly,
07:08the NIH jumped out of their comfort
07:10zone and funded this first grant,
07:13which really allowed me to do a stab
07:16lish the play to prevent lab and
07:19start this large five year project
07:21that was focused on developing
07:23a game around risk reduction in
07:26HIV prevention in younger teens.
07:31So as I said, this allowed
07:33me to establish the play to
07:34prevent lab subsequently done.
07:36The Yale Center for Health Learning games.
07:38And as you've heard,
07:40we really focus on developing and
07:42evaluating video games using constructs
07:44from social and emotional learning,
07:46character development to impact
07:48health outcomes in adolescents.
07:53And once I established my lab,
07:55really, the key was to establish a
07:57team and as I started out this talk,
08:00you know this is very much of a
08:02team effort and this became what
08:04I claimed our collective brain.
08:06And again, not any single one
08:08of us could do this work alone.
08:11It really has been a huge
08:13collaborative effort and not only
08:15sort of in terms of within, you know,
08:17sort of different disciplines.
08:18But really, as you can see from here.
08:22You know four different sides.
08:24If you will of this team,
08:27so there's the science side.
08:29You know folks with expertise and Pediatrics,
08:33adolescent medicine, addiction,
08:34social and community psychology statistics.
08:38Very importantly, the Community side.
08:39This is just a small sample of the
08:42schools that we've worked with.
08:44We've now worked with many,
08:46many schools,
08:47school based health centers after school
08:49programs in Connecticut now nationally,
08:51and they, their students,
08:52their teachers.
08:53Their parents had been absolutely
08:55fundamental and doing this work.
08:58The game side includes folks with expertise
09:00both in serious games and commercial games,
09:03and serious games is what we're
09:05talking about here today,
09:06so serious games are games that are
09:08for purpose beyond just entertainment,
09:11so they hope to accomplish something.
09:13And so these are some of the serious end
09:16commercial game developers we work with,
09:18most notably,
09:19Shell Games has been our game development
09:22partner for the past 12 years.
09:23They're based in Pittsburgh
09:25affiliated with Carnegie Mellon,
09:26and had been a fabulous partner.
09:29And then some of our institutional partners.
09:31And these are folks who have
09:34helped with funding.
09:35These projects,
09:36as well as just offering
09:38support and you know,
09:39and promotion and you know really
09:41their own sort of areas of expertise
09:44to help get this work done.
09:46So again,
09:47this collective brain is fundamental
09:49to all of these projects.
09:53The other thing was to build a
09:56platform to start thinking about.
09:58You know where we were going
10:00to build our stories from.
10:02The from the go into these games,
10:05how were we going to use those stories?
10:08The artwork, the voice,
10:10and really think about creating
10:13something that could be. You know?
10:16Retooled sort of reinvented
10:18with each new game project.
10:20These projects take an extraordinary
10:22extraordinary amount of time,
10:23effort, and funding,
10:24and so to think about building a
10:27platform that might be sustainable
10:29that we could then subsequently
10:32build other games off of.
10:33And you'll see how we ended
10:36up being able to do that.
10:41And then really starting
10:43each of our game projects.
10:45And I'm disgusting really.
10:46The first game project that
10:48came from that first NIH grant.
10:50We start with doing a lot of formative work,
10:54and that is really going
10:55out into the community.
10:57We've built amazing community partnerships.
10:59Specifically tityra pendergrass.
11:00Boomer, who's been with my lab,
11:02last eight or nine years now,
11:04has become sort of our community.
11:08Whisperer she builds relationships that
11:10are longstanding and incredibly valuable.
11:13I hope from you know, from both sides,
11:16and so we really work.
11:19Start by working with the kids.
11:23And running focus groups,
11:24talking with them, getting,
11:26you know their input and their stories,
11:28which really serve as a foundation
11:30for for each of our games.
11:32And that's really the the place
11:34that we first start is with
11:36those focus groups talking with
11:38really what now has come down to
11:41hundreds and hundreds of teenagers.
11:45And for those of you,
11:46many of you who work with teenagers,
11:49you know that getting them to talk
11:51about themselves or the things in their
11:53life is not always the easiest thing.
11:55I've raised three teenagers, and, you know,
11:57have spent years with asking them.
11:59How was your day and then saying fine?
12:01Or what did you do nothing?
12:04So we really had to come up with some
12:07creative methods to engage teenagers and
12:09have them share some of these stories.
12:12Their stories with us.
12:14So this is an example of actually a
12:17drawing that we commissioned from now.
12:19A very famous artist.
12:21That we wanted,
12:23we asked him to create an image
12:25of teenagers in a party setting,
12:26but without anything overtly risky going on,
12:29and this is the image we ended up with,
12:31which I have grown to love and what
12:34we did is we brought together a
12:36group of about 10 or 12 kids in a
12:39focus group and we gave them each
12:41a copy of this and all we said was
12:44what do you think is going on here?
12:47And the stories that that came
12:49from these kids,
12:51the things they talked about, the.
12:55I know what the different parts of this
12:57picture invoked in them was really amazing.
13:00So for example,
13:01in one small group,
13:02if you look back down to
13:04the center in the very back,
13:06the little girl who looks like she's
13:08looking at her watch about 80% of
13:11the teen girl said that she had
13:13just found out she was pregnant.
13:16Which was pretty astonishing to sort
13:18of see that that was sort of what if
13:22you will what they read into this
13:24picture and what they could talk about,
13:27and then expand on and so using a
13:29method like this helped us to really
13:32build the stories that went into
13:34the first game that we developed.
13:36And it's a it's a method we've
13:40used going forward.
13:41This is another method that we
13:43used which was essentially to help
13:45inform the artwork of the game,
13:47and so we gave a group of about
13:4910 teens disposable cameras and
13:50we asked him to go out into their
13:53community and take pictures of
13:55everything that was important to them.
13:57The things that they saw every day,
14:00what they wanted to capture.
14:02And so they did.
14:03And they came back and brought the cameras.
14:06And we developed the the photographs.
14:08And we talked with him about the photographs.
14:10And then all of those images were
14:12sent down to Shell games to then
14:15be translated into the artwork.
14:17And so this was one way again,
14:19since our goal has been to create
14:21games that are authentic and real
14:23to our target audience.
14:25This allows us to really take the
14:27images right from kids eyes and
14:29build it into the artwork as opposed
14:31to us being translators of that.
14:33It really came from what they saw
14:35and what they felt was important
14:36and wanted to be captured in the
14:39images of this game.
14:42And from there you know endless input
14:44from them again through focus groups
14:46on different design elements you know,
14:48did they like the the clothes?
14:50This is all you know, artwork that.
14:52That Shell games had had drawn,
14:55you know the characters look too old.
14:57You know one thing about teams that
14:59I've learned is that you know they
15:02will tell you what they think.
15:03And so this allowed us to again bring
15:06the artwork back to them and say,
15:08did we do OK did we?
15:10Did we do it right and have them give that
15:13feedback so that it could then be changed?
15:16And what all of this ended up in
15:19involving in with every game that we do?
15:22It's a highly iterative process.
15:24It goes back and forth and back and
15:26forth between you know our team partners,
15:28our game development partners and
15:30you can see from here the upper left
15:33hand corner is where we started with
15:35one of our many games for this game,
15:37this first game.
15:38And by the end had gone down to the
15:41the right lower hand corner to where
15:43we landed and what that game that
15:47minigame ultimately looked like.
15:48So a lot of back and forth,
15:51which is absolutely critical so that
15:53we at each step we can incorporate
15:56our adolescent partners voices.
15:59So this was the first game we
16:00developed with that funding from
16:02the National Institute,
16:03Child Health and Human Development
16:05called play for Dallas City stories.
16:07The origins of that name play forward
16:10is really sort of carried through to
16:12all of our games or games focused very
16:15much on developing future orientation.
16:17Helping kids recognize that decisions
16:19they make now have an impact now
16:22and in their future,
16:23and sort of how to think forward.
16:26And in this case play forward so that
16:29they can develop better decision
16:32making skills. Elm City stories.
16:34You know,
16:35New Haven is the Elm City and
16:36these were the stories of kids in
16:38New Haven and so it was really.
16:40It's a real really.
16:41A shout out to New Haven for all of
16:43their time and efforts that they put
16:45in helping us to build this game.
16:49So this is just the home screen
16:51of the game again, which is,
16:54you know, served as kind of a.
16:57You know part of the platform
16:59where we you know we end up using
17:02or adapting parts of each game to
17:05build new games for new populations.
17:08New outcomes.
17:08You can see these games are highly narrative.
17:12The 12 stories at the top going from
17:157th to 12th grade are all you know,
17:18narrative based.
17:19What we called challenge decks as they.
17:23Present challenges throughout the
17:25different stories that the player
17:27has to navigate through and then the.
17:29In this case the five mini games at
17:31the bottom you can see are really where
17:34the kids build skills and are kind of
17:38interfacing with the different stories.
17:40Games tend to be very short,
17:42graphic novel style.
17:44And you can see with the mini games you
17:47know they are focused on different skills.
17:50They are highly sort of repetitive so that
17:53they get to practice these skills alot.
17:56Refusal power focuses on helping kids go
17:58through the sort of science based steps
18:01of how to negotiate risky situations,
18:03how to refuse in a way that helps him still
18:07preserve their place in their social circle.
18:11People sense focuses on
18:12how to build your network.
18:14You know your peer network so that you
18:16can keep the people who are really,
18:18you know, sort of.
18:19You know,
18:20maybe the best influence for you or the
18:22the best friends for you close to you.
18:25And maybe folks were a little bit more
18:27risky farther away on the no sense,
18:29for example,
18:30is really just teaching them information.
18:32You know accurate information
18:33on different topic areas.
18:35And then you can see in the right lower
18:37hand corner is a Fast forward button.
18:39And at anytime during the game,
18:41the player can Fast forward to their
18:43epilogue and their epilog is essentially
18:46where their character is in the game.
18:48At age 30,
18:49based on all the decisions that
18:52they've made so far in the game,
18:54and so they can sort of see this
18:57collage if you will, of where.
18:59How did decisions that their player has
19:01made in the game has impacted their future?
19:04They can then go back in the game and
19:07make different decisions or change.
19:10The actions they take and if you
19:12Fast forward again,
19:13that will now be reflected in a new epilogue.
19:17So it's a very dynamic sort of
19:19situation where you can see the
19:21relationship between decisions
19:22and their impact now and later,
19:24and we've carried that through.
19:26Also,
19:27in some of our other games.
19:32So that game took about 18 months.
19:34That first game played forwards on
19:36city stories, 18 months to develop.
19:38We then conducted a randomized
19:40control trial working with after
19:42school in school based programs
19:43in New Haven and Bridgeport.
19:45We enrolled 333 teens between the ages
19:48of 11 and 14 and we randomize them
19:50either to play forward or to a set of
19:53control games games that were sort
19:55of entertaining and skill building,
19:57but had no relevant content.
19:59And we followed those kids for
20:02two years and collected data.
20:04Different time points on a large
20:08array of outcomes.
20:10I also collected a lot of game gameplay data,
20:13which is essentially data collected
20:14through the game software,
20:16which tells us a lot about what what
20:18the player is done in the game and
20:21the actions they took or how long
20:23it took them to learn something.
20:25So that's that's also very rich
20:26data and we were able to demonstrate
20:28we've thus far looked at the 12
20:30month outcomes we started looking
20:32at the 24 month outcomes we've
20:34been able to demonstrate.
20:37Statistically significant and
20:38sustained impact in areas such
20:40as attitudes and knowledge and
20:42are hoping to also be able to
20:44demonstrate that with behaviors.
20:49And so going from there again,
20:51you can hear that you know that
20:54process of development takes an
20:56extraordinary amount of time, effort,
20:58input and so to figure out a system.
21:01Again to build this platform where
21:03we could then create other games
21:06using the assets from a game that
21:08we've created to create what we
21:11call these Playford spinoffs.
21:13Which is really to take again the
21:16framework and build out from there so.
21:19The first one we did that with
21:22is our gameplay test,
21:23which focuses on more on health advocacy,
21:27helping older teens really learn how
21:29to advocate for their own health care,
21:32engage in the health care system,
21:35and also specifically promoting
21:37HIV and sexually transmitted
21:39infection testing and counseling.
21:41In partnership with school
21:43based health centers.
21:44So this game was created with funding
21:46again from the National Institute of
21:49Child Health and Human Development
21:51through a phase one anaphase.
21:54Two small small business technology
21:56transfer research grants and
21:58this allowed us again to take the
22:01platform of play forward and now
22:04build it out to have a new target
22:06outcome with in this case an older
22:09older group of adolescents.
22:11Subsequently,
22:12we did similar with our smoke
22:14screen game which focuses on
22:16vaping and smoking prevention,
22:18again in adolescence,
22:19and this game was funding both
22:22through the FDA and the NIH,
22:24and then subsequently,
22:25the CVS Health Foundation allowed us
22:28to take components of our other games
22:31and build it out for this new focus
22:34on vaping and smoking prevention.
22:36Again,
22:36with each of these,
22:38starting with focus groups with
22:40teens with collecting their stories.
22:42That information new our new
22:44voice and then obviously the
22:46behavioral scientists building
22:48out what needed to be sort of the
22:52scientific backbone of the new game.
22:54And then finally our play smart game,
22:57which we just finished development on.
23:00This game focuses on both mental health
23:03promotion and opioid misuse prevention
23:05in teens in school based health centers.
23:08Again,
23:09this is part of the national.
23:12NIH Hnyda heal initiative,
23:14which is the helping to end addiction
23:16long term initiative and for this
23:18program we have developed a very
23:20substantial partnership with the
23:22National School based Health Alliance,
23:24which has been very fruitful in terms
23:26of all the different phases of that
23:29project which I will talk about.
23:31But this gives you sort of an overview
23:33of how these games can sort of build
23:36off each other and creating new
23:39assets in a new new focus in terms
23:41of the health outcome that were.
23:44Targeting
23:47so briefly, this is play test and you
23:51can see that we again using the same
23:54kind of framework and structure have
23:57a home screen which now has its an
24:00older age group that we're targeting.
24:03So this is now 9 through 12th
24:05graders were focused more on health
24:08promotion than risk prevention.
24:10So instead of having a refusal minigame,
24:13we have a persuasion minigame.
24:15In other words, developing skills how to.
24:18Persuade your peers to do healthy things
24:21and in turn kind of reflect that back on
24:25yourself in terms of learning skills on
24:28how to advocate for your own good health,
24:32creating new artwork,
24:33news stories again to build this new game
24:37playtest has gone through pilot testing,
24:39which was very successful in
24:42terms of demonstrating sort of
24:44the general usability of the game.
24:46We also we.
24:48Had enrolled 26 teenagers in the pilot
24:51study and followed them for about 6
24:54weeks and within that six weeks actually
24:57two teens who had not been tested
25:00for HIV went and got tested for HIV.
25:04So obviously very small numbers,
25:06but sort of preliminary impact.
25:08We then subsequently just completed
25:10a randomized control trial with
25:13about 300 teenagers in school based
25:16health centers in Connecticut to
25:18test the efficacy of play test.
25:20And remarkably,
25:22despite the pandemic actually
25:24were able to complete.
25:27Six month outcomes,
25:28which was our target outcome period
25:31and 92% of our participants,
25:33so that was that was a challenge, but.
25:37But we met it.
25:40And then smokescreen as I mentioned,
25:42is the game that we developed with
25:45support from the NIH and from the
25:48CVS Health Foundation that focuses
25:50on vaping and smoking prevention.
25:53All of our games are available on the web.
25:56Smoke screen is also available on both
25:58of the app stores and in part because
26:01of our partnership with CVS Health and also,
26:04I think because of the game
26:06being on the app stores,
26:08we have to date reached about 250,000 teams.
26:12With smokescreen.
26:15And smokescreen is part of CVS Health.
26:19Be the first tobacco free generation.
26:21Their focus on really providing
26:24education and prevention
26:25interventions around smoking and
26:27then subsequently vaping this game.
26:30You know,
26:31went through a number of different
26:34iterations really just to keep up with
26:37the evolving epidemic that E cigarettes
26:40and vaping became so we had to continually,
26:44you know.
26:44Seemed content an update things
26:46to just keep keep with what was
26:49happening in the world around us.
26:54And I focus a lot about,
26:56you know on on the development process,
26:59which is obviously key
27:01and very labor intensive.
27:02But we also do evaluate
27:04these games rigorously.
27:06We've now conducted two large scale
27:08randomized control trials as well
27:10as a large field study and with the
27:13upcoming play Smart Game we will
27:15also conduct a randomized control
27:17trial so to be able to demonstrate
27:20the impact in the areas of attitudes,
27:23knowledge, behaviors, intentions.
27:24Self efficacy is absolutely critical.
27:27Again, the focus of serious games is not
27:30only that they are fun and engaging,
27:32but that they actually accomplished
27:34something, and so we we focus on,
27:37you know,
27:38evaluating those in you know those
27:40outcomes and doing it for a long
27:43enough period of time that we can
27:45actually capture that impact.
27:50The other part of this though,
27:52as I mentioned, you know the these.
27:54These digital tools need to be
27:56engaging and they need to be fun.
27:58Is that we also collect a lot of
28:00data on the gameplay experience.
28:02We want to make sure that kids in
28:05these studies are playing games
28:06and also find out just what they,
28:09what their experience has been.
28:10So this is data we we pretty much
28:13collect this data on each of our games.
28:15This is data from the first
28:18play forward game.
28:19And you can see they played.
28:21This is over a course of about six weeks,
28:24paid on average,
28:25about 10 hours over 10 sessions.
28:27So about an hour per session an when
28:29we talked to the kids who were in the
28:32play forward arm about their experience.
28:34The majority of them talked with
28:36their friends about the game.
28:38The vast majority of of them,
28:40like the way the game look,
28:42enjoy playing the game and thought
28:44it was challenging reported that
28:46they felt responsible for the
28:47choices they made in the game,
28:49which is really critical in
28:51terms of trying to make.
28:53That translation between kind of the
28:55virtual experience and their real world.
28:58And similarly close to 80% reported
28:59that they would make decisions in real
29:02life as they had made them in the game.
29:04Again with this focus on.
29:06We want to see their healthy decision
29:10making move from the game too.
29:12Go to the real world.
29:17We further just looked and this is
29:19this is an area that I think deserves
29:21a huge amount of exploration just to
29:24sort of really drill down a little bit
29:26more on how to tailor these games in
29:28a way that they'll be most effective.
29:30So we looked at some gender differences
29:32and again this was really just sort
29:34of a first pass and again with the
29:36Playford game we found that girls
29:38were more likely to report that
29:39they would play the game again.
29:41This is girls versus boys were more
29:43likely report that they like the game.
29:45And were more likely to report that
29:47they tell their friends about the game.
29:49Interestingly,
29:50boys reported that they felt more
29:51connected to the character characters
29:53in the game and also reported
29:55there were more likely to report
29:57being frustrated with the game.
29:58So I think it's it's an interesting.
30:01There's a.
30:02There's a whole area in game design that
30:05focuses on games being challenging enough
30:09and frustrating enough in a good way.
30:12So that but not not too much so,
30:14so that they're not too easy,
30:16and they're not too hard,
30:18so some of this feedback was
30:19really interesting,
30:20and I I found particularly that it was
30:22interesting to see that that the boys felt
30:25more connected with their characters.
30:27And something to potentially
30:29build on in future interventions.
30:32So notably, we as I mentioned,
30:34we, you know,
30:35we really do focus on getting our work
30:38out there and not only the outcomes,
30:40but also the process.
30:42So we have published extensively
30:43on our process and extensively
30:45on our outcomes to really,
30:47you know,
30:48be able to describe some of the
30:50models that we've created on how
30:52to design and develop these games,
30:55as well as how to evaluate them.
30:57And I feel like that has made a very
31:00important contribution to the to the field.
31:03That is,
31:03you know really been expanding and becoming,
31:06you know,
31:07much more prominent in the area
31:10of serious games.
31:12So I'm going to talk a little bit
31:15specifically about our most recent game,
31:17which is play smart,
31:18which is funded by night I,
31:20which I mentioned before with
31:21because we were deep in the
31:23throes of this specific game.
31:25I also have to say that you know
31:27I before I started working.
31:2912 years ago,
31:31really focusing my my research on
31:33prevention with a younger population I spent.
31:36A number of years doing
31:39clinical research with adults.
31:41More ranch treatment models and
31:44specifically treatment models
31:45regarding substance use disorders
31:47and very specifically opioid use
31:49disorder and so to be able to
31:51do this work as part of the heel
31:53initiative was really quite frankly,
31:55a dream come true for me because
31:58this is an area that I really wanted
32:01to focus on for many, many years.
32:04In terms of designing and developing
32:06an intervention around preventing
32:08opioid misuse in a younger population.
32:10So this is play smart.
32:12This is our most recent game,
32:15again funded through the National Institute
32:17on Drug Abuse and their Heal initiative,
32:20and this is a five year grant looking
32:22at preventing initiation of opioid
32:24misuse in adolescence in conjunction
32:26with school based health centers.
32:28And as you'll see,
32:30it's sort of a multi phase fairly complex.
32:34Proposal and has been going along
32:37actually pretty well to date,
32:39so this is this is play smart and the
32:43game we finished development of the game.
32:47In April and so we are now
32:49moving into the next phase,
32:51which I will discuss,
32:53but again, as I talked about,
32:55we started with the formative work
32:57and this game was no different,
33:00so we had the joy of starting our
33:03formative work in the you know,
33:05at the beginning and through the height or
33:08one of the heights of the COVID-19 pandemic.
33:12So this work began in February of 2020.
33:16And we ultimately ended up conducting
33:18all of the most, if not all,
33:21of this work virtually, which is a real.
33:25You know a real kudo to my team for being
33:28able to complete so much work under
33:31obviously such challenging circumstances
33:33that we all had to function under.
33:36So this formative work was completed
33:38between February and June 2,
33:402020.
33:41We conducted 16 focus groups
33:43with a total of 84 participants.
33:46That included seven focus groups
33:48with adolescents who reported
33:49not having tried opioids before.
33:511 focus group with prevention specialists
33:53who are folks who were now working in
33:56the prevention field but also many of
33:59them were in recovery by Focus Group
34:01with school based health alliance.
34:03Our national partner,
34:04adult affiliates and three with.
34:07School based Health Alliance youth leaders.
34:10And then we also conducted 6
34:12interviews with providers who were
34:14working with patients who were in
34:17treatment for opioid use disorder.
34:20And you know this ended up being a
34:24very compelling and rich experience.
34:27The idea of sort of talking with
34:29adolescents who had not tried
34:31opioids and could sort of be looking
34:34forward and thinking somewhat.
34:36Sort of theoretically about
34:38what struggles there might be.
34:40But then speaking with prevention
34:42specialists who were, you know now,
34:44young adults and adults who really,
34:46you know where they you know
34:49they contributed,
34:50was to be able to share with us.
34:53You know,
34:54their stories an what they had gone through,
34:57an what they might.
34:58Say to their their former 16 year old
35:02self so that we were really sort of
35:05able to capture stories going forward.
35:08Stories going back,
35:09talking to younger folks,
35:11older folks, and so this.
35:13This provided incredibly
35:14valuable formative work,
35:15and I'm I'm very grateful to those folks,
35:18for you know, for participating
35:21and sharing their stories with us.
35:24This allowed us to identify
35:26these nine salient themes,
35:28which included things such as,
35:30you know, really helping you know.
35:34Kids to be able to identify
35:36opioids and what they were
35:38what their risk of harm was.
35:40What kids believe their
35:41risk of harm was a specific
35:43focus on prescription opioids.
35:45Different modes of learning that might be.
35:48You know, most important for for this.
35:51For this game the accessibility of opioids.
35:53Reasons to miss you to music misuse,
35:56opioids issues around mental health and
35:58support systems and in place and then.
36:01Sort of general ideas around how
36:03a video game might address and
36:06capture all these different themes.
36:11And so where we landed was obviously
36:13on a on a, you know a dedicated focus
36:16on addiction and and also a very
36:19substantial focus on mental health.
36:21You know as we know these these travel
36:24together and it did not feel like we
36:27could address issues around substance
36:29misuse and an addiction and not have a
36:32heavy focus on mental health as well.
36:34And so play smart again is focused
36:37on preventing opioid misuse in
36:39adolescence and is grounded in.
36:41Theory of planned behavior,
36:43social learning theory,
36:44self efficacy and message framing,
36:47and these were the stories and many
36:50games that we ended up with based
36:53on all of that formative work based
36:56on the literature science to date,
36:59and the stories.
37:00Again, as with all of our games,
37:03make up the narrative content,
37:05we have a story on sort of discussions
37:09with the dentist about paying.
37:11Management and wisdom tooth extraction,
37:14which is a very common way that
37:17kids are introduced to opioids.
37:19After a dental procedure.
37:21Story on peer to peer relationships and
37:25dealing with a friend who is struggling
37:28with a possible problem with addiction.
37:32Substance use in the setting of a
37:35party scene concerns about substance
37:36use in a more intimate relationship.
37:39A love relationship.
37:41Concerns about misuse and overdose
37:44specifically around family members,
37:46who you know are taking medications
37:50for medical reasons.
37:52And then a focus on mental health
37:55specifically around helping.
37:57Uh, sort of helping.
37:59Advocating for yourself when you
38:01when you need to have some have
38:03some mental health help and so
38:06those are stories are mini games,
38:08which typically are based
38:10in powers and senses.
38:11Focus on skill development and so we
38:14have one that focuses on assessing
38:16risk and perception of a risk of harm.
38:19One on managing stress,
38:21one on knowledge and sort of
38:23factual information and interactive
38:25game using social media to.
38:27Sort of.
38:28Help kids learn how to ask and
38:30answer questions and also how to do
38:33that in a non stigmatising manner.
38:36Future sense,
38:37which again helps build this sort
38:39of sense of future orientation
38:41and then refusal power.
38:43Again,
38:43sort of how to negotiate or
38:47refuse risky situations.
38:49And so this is play smart was went
38:52through development between April 2020.
38:54In March 2021.
38:55Again a huge shout out to my team
38:58who kind of lived and breathed
39:00us for 24/7 for that time period
39:03and and you can see the stories
39:05that circle the character that you
39:07know that the player can create.
39:09And then the skill based mini games.
39:14And so this is sort of the
39:17home screen of play smart.
39:20So this is where we go from here.
39:23As I mentioned,
39:25this is a complex and comprehensive project.
39:28We finished game development.
39:29We conducted a pilot study in April,
39:33so last month with 33 adolescents
39:35this was actually done nationally,
39:37all virtually and we had those
39:40in groups pilot test the game,
39:43provide feedback.
39:43There were nine playtesting
39:45groups that were conducted,
39:47and rate range in length from.
39:50Hour and a half to 4 1/2 hours.
39:53So we will then take that
39:55feedback from the pilot study.
39:57We've also received very solid
39:59feedback from partners at
40:00the night of Science Policy.
40:02Branch Ann will package it out.
40:04That feedback to give to Shell
40:07games will modify the game.
40:09Provide us with a final game by July.
40:13And then we'll begin to randomized
40:15control trial in September of this
40:18year where we will enroll 532
40:20adolescents from 10 Connecticut High
40:22School School based health centers to
40:25evaluate the efficacy over two years
40:27through a randomized control trial.
40:29At the same time,
40:31we are in the process of
40:33recruiting 15 high school school
40:36based health centers nationally.
40:38So and diversely in terms of
40:40different from different geographical
40:42locations with different populations.
40:45Areas that have a different
40:47experience around the opioid,
40:49epidemic and will work with those
40:53partners around implementation strategies
40:55for implementing the game in their sites.
40:58Collecting specifically using an
41:00implementation science framework
41:02to collect data around successful
41:05implementation strategies and at the
41:07same time will also be collecting cost.
41:10Data to do an economic evaluation.
41:12This is all in conduct conjunction with
41:15the other nine prevention research projects.
41:17Anna Coordinating Center that is
41:19coordinating all of these projects
41:22so we will have a lot of overlapping
41:24data with the other nine programs
41:26and harmonize that data so it
41:28should be a very rich data set.
41:33So this is kind of where we've landed with.
41:37Again with this building.
41:39This play forward prevention platform and.
41:42Creating these games,
41:43building 1 after an off of the one
41:46before with different outcomes,
41:48different age groups and has,
41:50you know, allowed us to do this
41:53somewhat economically and stealthily,
41:55but also really taking the assets
41:57from each game and building
42:00off to create the next.
42:02And, you know,
42:03even better game intervention.
42:07So just to conclude,
42:08so I think we have found that video games
42:11are engaging in delivering risk prevention.
42:13Health promotion meeting teams where
42:15they are and where they want to be,
42:17which really has felt like 9/10 of the
42:20battle is to just meet them where they are.
42:23The play forward prevention platforms
42:25terms is an effective and sustainable
42:27program for developing new game
42:29interventions to target new outcomes.
42:31New populations in new settings.
42:34And I think our games uniquely
42:36target some of the most critical
42:38health outcomes in adolescence.
42:39There's obviously many other places to go,
42:41which I will also share with you
42:43quickly and lend themselves to further
42:45modification to address the issues,
42:47these issues and others in adolescence
42:49in different parts of the country
42:52in different parts of the world.
42:54And so some of the next steps and
42:57again thinking about different areas.
42:59So we're looking at focusing on
43:01substance use and mental health
43:03promotion and specifically around
43:05suicide prevention and adolescence.
43:07We were looking at the impact
43:09of family connectedness,
43:10race,
43:11ethnicity on adolescent substance use
43:12and also sort of interesting Lee.
43:15The use of digital biomarkers
43:17potentially derived from the gameplay
43:19data we collect as a predictive
43:21tool for adolescent substance use.
43:23We are looking to create a video
43:25game intervention around race,
43:26ethnicity and the impact
43:28on health disparities.
43:30And also looking at the impact of board
43:32games and specifically the most recent
43:35one play smart on stigma around mental
43:37health and addiction in adolescents.
43:40And could these games be really used
43:42as a way to destigmatize some of this
43:45content and these topics with adolescents
43:48an with adults who work with adolescents?
43:51And then finally we are looking to
43:54adopt and implement our smokescreen
43:57game for tobacco use in Kenyon
43:59High School adolescence.
44:01So let's do and not enough hours in the day,
44:05but just wanted to say thank
44:07you to all of our partners.
44:09Again,
44:10this is a major team effort,
44:12could not be done without,
44:14and it's been incredibly rewarding
44:16and an and fun to do this so.
44:19And thank you to all of you for listening.
44:27Thank you so much.
44:33Would you mind?
44:36Would you mind Lynn just stopping
44:38your share so that people come?
44:41Come on line, if they want I
44:43see at least one of your many,
44:46many collaborators on the screen.
44:48So maybe that collaborator wants to speak.
44:53Gucci I'm looking at you.
44:59Thank you for putting
45:00me on the spot.
45:07It's been an incredible year, I think.
45:10Working with Lin and trying to
45:13develop research interests and just.
45:15I'm using games as a platform
45:17of meeting kids where they are.
45:23And thinking about this whole
45:25potential of what we can do
45:27with the with the game data,
45:29how can we incorporate the
45:31things that we know are useful in
45:34terms of family relationships?
45:37And how can we understand how those
45:39can help us with engaging youths and
45:41also addressing some of the risk
45:44that exists at the family level?
45:46So those are some of the things that I
45:49will be looking to understand with Lin.
45:52Mentoring the other thing that
45:54we're thinking about is that you
45:56know we get a lot of information.
45:59From the way from from kids
46:01playing their games and.
46:03Can we use that information to think about?
46:07When we might be able to like
46:09catch kids early and develop
46:11and deliver early intervention.
46:13So Lynn was talking about the
46:15idea of digital biomarkers.
46:17And how what kids do on
46:20their games might represent?
46:24Cognitive deficits, for example.
46:27And how that might help us to
46:29identify kids who are immediate
46:30risk and deliver intervention.
46:32So it's very exciting and I'm
46:34looking forward to all the things
46:36that we might be able to like.
46:38Learn from this process.
46:43Thank you Jay, and I mean I think one of
46:45the best parts of this work is learning
46:48like Blue Jays taught me so much.
46:50So you know, you gotta keep learning
46:52and it's it's just great to be able to
46:55work with folks that that teach you.
46:57Things that are not your area of expertise
47:00on that is a constant experience,
47:02which is wonderful.
47:06When I I see on the screen,
47:08dear friend of the Child Study Center,
47:10who we don't see often.
47:11She's in the library very studiously.
47:14So Hillary, do you want to say
47:16something and so great to see you?
47:20Well, thanks for the call out.
47:24But but that was a great presentation.
47:27Len, and it's been really exciting to
47:29start to work with you and Claudia around
47:32some of the suicide prevention work.
47:34That's something I've you know,
47:36collaborated with Andreas and others
47:37in the Child Study Center on as well.
47:40I don't know if you wanted to
47:42say a word about that or.
47:46Yeah, I mean I think it's it's.
47:48And again I think the the what I found so
47:51rewarding about this work is is really,
47:54you know, is creating this space
47:56where people can bring their areas of
47:59expertise and interest so you know Uche,
48:01you know, bringing sort of her expertise
48:04around family you know and you know.
48:06And then digital biomarkers which
48:08I had not even known about.
48:10You know to to to use this platform to
48:13explore those things or Claudia, you know.
48:16Claudia Fernandez,
48:17who's in my lab for the last
48:20almost four years now,
48:21who is very focused on mental health
48:24and suicide prevention and again to
48:27bring her expertise to this platform
48:29to think about building a game
48:31that could really help you know,
48:34provide you know information and skill
48:36building for younger teens around, you know,
48:39you know around suicide prevention,
48:41how to you know?
48:42You know how to help peers or how to
48:46advocate for yourself so so it's really,
48:48you know.
48:49Sort of feels limitless in terms of
48:52where the applications can come from,
48:55but having people who have their
48:57own interests and expertise
48:58is absolutely invaluable,
48:59because with Claudia you know a shout out.
49:02I don't know if she's she's on this call,
49:06but her her experience in education.
49:09It is really I found, really,
49:11you know, remarkably helpful and
49:13informative and really valued in this.
49:16Right, right and again that you know
49:19it comes back to that collective brain.
49:21As you know, I I,
49:23I think I've ended up seeing myself
49:25as a really fabulous organizer.
49:27You know, like I'm really good at
49:29nagging and organizing people,
49:31but everybody else brings in these,
49:33you know these assets that.
49:35You know that just make it,
49:37you know, make it happen.
49:39Honestly, you know,
49:40make it happen and happen well so
49:42it's been great to be a part of it.
49:47Thank you.
49:50Other questions. Doctor
49:53Cardona you had texted me a question. Do you
49:56want to share it? Sure, Lynn.
49:59It's just so inspiring to see your
50:01work evolve in just this astronomical,
50:04impactful manner.
50:05In such a short period of time,
50:07it might feel for you like,
50:10well over a decade.
50:12But it feels like a blink
50:14from where where you began,
50:16an and the tremendous mental health
50:18and health impact that you're having,
50:21and particularly impact in terms of health.
50:24Equity, so I want to also let the group
50:28know that your Co director Kim safety,
50:32you know she.
50:33She's also a wonderful,
50:35wonderful partner and collaborator and Xi'an.
50:38I an address an Rebecca Kennedy
50:41are in the very baby steps of
50:44creating a prototype for a
50:46game to teach little children,
50:49DBT skills and as you might know,
50:53DBT is a very inaccessible.
50:55Form of treatment.
50:56It's a very effective form of treatment,
50:59but it's a high intensity,
51:01high requirement form of
51:03treatment has barriers to access,
51:05and so by exploring the gaming
51:07format we hope we can really tackle
51:09this problem of dissemination,
51:11and particularly for little children,
51:13DBT was developed for adolescents
51:15an as adults.
51:16As you well know,
51:18and so we're looking to adapt DBT for
51:21little children within our settings,
51:23we're going to try with the most.
51:26Challenging populations that we
51:27hope to pilot on Winnie one and
51:30also our Children's Day hospital.
51:32So we're going to start with the most
51:35challenging children we can imagine,
51:37and we're really excited to partner
51:40with you and Kimberly on this project.
51:43And also a shout out to the Yale
51:45Child Study Center Faculty Development
51:47Fund that has provided some seed
51:50money for this project as well.
51:52So all good stuff is coming to you,
51:56Lyn falleen
51:58well and and Full disclosure Laurie
52:00and I have been best friends forever,
52:02but but no I I agree with you and I think
52:06that I mean that is so exciting right?
52:09To think about that application.
52:11I mean there there really is no limit
52:13and and I think the notion of really
52:16reaching kids that you know are are
52:18really challenged and hard to reach.
52:21You know, is I mean,
52:22that's that's what we're here for, right?
52:25So that is just that's fabulous.
52:27And the application is just.
52:30Is so important and I think
52:33has such potential so.
52:35Now think teaching self
52:37regulation through gaming.
52:40Exactly exactly exactly. Hi
52:44Lynn, I want to make a comment and then
52:47I'm on on the batters mount is Ravi Anand
52:50who just wrote a question but he'll turn
52:53his camera on and he'll ask it himself.
52:56But let me just make a comment
52:59following up on what Lori said,
53:01we're doing a lot of work in simulation,
53:04not game simulation but patient human
53:06simulation kind of work and we've
53:09started also dreaming together with.
53:11Kim and we were talking before we started
53:13with Bernice Escolhido in Indiana,
53:15who's a major player in the area of
53:17stigma and with other colleagues
53:19about how to bring the work that
53:21we're doing in simulation and large
53:24randomized control trials.
53:25Together with gamification,
53:26I haven't quite figured the equation,
53:28but I know that there's a lot there
53:31because we know that kids get so into
53:34these games and the way that we can make it.
53:37And if I had time,
53:39I would ask you, but I'll just.
53:42Plug it in your in your ear.
53:44You know I was delighted to
53:46see your partnership with CVS.
53:47I've always wondered about what about
53:50partnering with the guys who really
53:52have the big bucks to do games.
53:53What about with?
53:54You know,
53:55I'm not hip enough to know what's
53:57the game right now,
53:58but what about those guys who
54:00have infinite money and then bring
54:02this mental health component so
54:04it might be my little question
54:06if I may? Yeah, no. And I I may. I may,
54:09I may shift you to a slightly different.
54:12Approach to that and it's it's.
54:14It's funny 'cause I actually was speaking
54:16to her, a writer from The Washington
54:19Post this morning about all of this
54:21and he asked the question which I've
54:23been asked a number of times before.
54:25Which is, you know,
54:27could you just take this content
54:29and this approach to sort of health?
54:32An you know health,
54:34education and and build it to one
54:37of these wildly popular games.
54:39You know, like Fortnite, or you know.
54:44Grand Theft Auto or whatever,
54:46so actually sort of take, you know,
54:48take the vehicle of a very popular game and.
54:52You know, embedded it almost subliminally.
54:54Some of these you know,
54:55positive health components,
54:56and so you know.
54:57I actually got off that call
54:58with him this morning,
55:00and I was saying my nephew
55:01works for Epic Games,
55:02which is a one of those big
55:04game companies thinking, well,
55:05maybe I could get.
55:06Maybe I can get him to do that,
55:09but I think what you're saying is sort of
55:11so that's one way where you'd actually
55:13take their game is kind of a delivery
55:15vehicle for what you want to get out there,
55:17but the flip side is sort of,
55:19you know,
55:20with those with those types of companies.
55:22Be interested in and putting funding
55:25and effort towards actually some
55:27of this game development work.
55:29And it's you know,
55:30it's hard to know.
55:31I think part one of the challenges is that
55:34those games really do take can take years
55:36and years and years to develop and cost,
55:38you know,
55:3910s of 20s of millions of dollars.
55:41But I think there is, you know,
55:43I think there's room for
55:45that type of collaboration.
55:47So more to come.
55:48Thank you I.
55:49I think that our final
55:51question comes from Ravi and,
55:52and so Robbie take it away.
55:54Thank you so much
55:55for that. That was such a great
55:57presentation and it's an area
55:59that I'm going for
56:00then I it. Seems like
56:01you guys have really succeeded at
56:03making these games fun to
56:04play, which I think that's incredible,
56:06because if I
56:07think back to my adolescence,
56:08in teen years, I would be automatically
56:10suspect of anything that was.
56:13Love me by authority, figures,
56:15and especially that you know,
56:16dealt with anything that you know we're
56:18trying to teach me a lesson about how to
56:20live differently that would, you know.
56:22I wouldn't want to have anything
56:24to do with it, so obviously you
56:26guys have really succeeded there,
56:27and I, you
56:28know, I think we've
56:29we've had good insight into all you've
56:31done with the aesthetics, etc. You know,
56:33to kind of appeal to that group,
56:35but I wonder if kind of
56:37like you alluded to the.
56:39Frustration to ease ratio like
56:40what other things have you done
56:42to make these like fun for
56:44kids to just engage with in
56:46the moment you know?
56:48Yeah, yeah, and so that's that's a great
56:51question and I think that that is why
56:54you know we really have partnered with,
56:57you know, a company like Shell Games who
56:59is a commercial game developer who's
57:02developed games for Microsoft for Disney.
57:05And because I I sort of defer to them
57:08for those those parts of things right is
57:12really the game design and so that they.
57:16They do know the the strategies to
57:18make it fun and engaging an and
57:20bringing kids you know kids want to
57:22keep playing and want to come back and
57:25that's that's really a major role that
57:27they play is the mechanics you know.
57:29And they they have crafted mechanics
57:31that accomplished just that.
57:33So that's sort of I think,
57:35the most you know and in part
57:37also you know along the way.
57:39Playtesting with kids and have
57:41having kids give that feedback to
57:44sort of be able to say Oh well.
57:46You know this doesn't really work.
57:47They really are. Co designers,
57:49so between Shell games and input from teams.
57:52I think they sort of are the ones
57:56who really keep that covered so.
57:58Does that answer?
58:00Question, yeah, it's.
58:01It's just really it is.
58:03It is challenging to figure
58:04out how to marry those things,
58:07especially when they're serious.
58:08You know, somewhat sobering, so to speak.
58:10Topics you know that.
58:12I mean, in our current game,
58:14we have an overdose scene.
58:17And you have to figure out how to make
58:19that you know it can't be gratuitous.
58:22It can't be over the top.
58:23It has to be sensitive,
58:25but it also has to drive home the message.
58:28So it's it's a very.
58:29It's a very fine balance, so.
58:31Uhm,
58:32and to disclose if anyone wants
58:35to play any other games just.
58:39Just reach out 'cause we can.
58:41We can give access very easily,
58:43you know through logins and are happy to
58:46share that so very proud of our gains.
58:49As
58:50you should be, thank you so
58:52much Linda. In a pleasure.