1. Coaching emotion regulation skills with The SIMS™: Design and development of a computer game based intervention for young people in residential care
Áine Aventin1, Tom Teggart2, Geraldine Macdonald1, Stan Houston1
1School of Sociology, Social Policy & Social Work
2Southern Health & Social Care Trust
ICL Conference
21st February 2014

2. Overview Background & Aims Intervention design process
The intervention
Key Findings
Future Directions

3. Background Mental illness among young people in care
Reluctance to engage in traditional therapy
A call for engaging interventions delivered in community settings
Therapeutic approaches to social work in children’s homes across Northern Ireland
Computer games under-explored

4. Aims
To design and develop a therapeutic intervention incorporating a computer game suitable for use by social workers and young people in residential children’s homes;
To explore its acceptability and potential therapeutic impact; and
To explore the factors which acted as facilitators of and barriers to engagement and successful implementation.

5. Research Design Medical Research Council (2008)
II. Feasibility/piloting
1 Testing Procedures
2 Determining sample size
3 Estimating recruitment/retention
III. Evaluation
1 Assessing effectiveness
2 Understanding change process
3 Assessing cost-effectiveness
IV. Implementation
1 Dissemination
2 Surveillance and monitoring
3 Long term follow-up
I. Development
1 Identifying the evidence base
2 Identifying/developing theory
3 Modelling process and outcomes
Medical Research Council (2008)

6. Intervention Design Process
Pragmatic, Systematic & Iterative
Involving:
- Literature reviews
- Consultation with key stakeholders
- Preliminary logic modelling
- Exploratory research in 3 children’s homes
Resulting in:
- The SIMS intervention & preliminary indications of acceptability
- Model of potential barriers and facilitators of implementation effectiveness
- Intervention design & implementation logic models

7. Emotion Regulation Skills Coaching
The Intervention
Computer Game
played by young person alongside a residential social worker
Emotion Regulation Skills Coaching
offered by the social worker to the young person while playing the game
Identification of emotions
Modulation of emotions
Expression of emotions

9. The Intervention Riley looks frustrated!
Why do you think he got so angry?
How do you think Mike is feeling?
What might she do to calm down?
How would you feel if that happened to you?
What would you do in that situation?

10. The Intervention

11. Key Findings A word of caution Acceptability Potential uses
The challenges to introducing therapeutic innovations in residential child care contexts

12. Acceptability
“good” (YP); “really good” (YP); “something different”, “interesting” (RSW); “fun” (RSW)
“[The game] was a load of shite” (YP); “It’s nearly too complicated” (RSW); “There was a lot of preparation” (RSW)

13. Acceptability
He was very keen. [Andy] would be very open to new experiences, meeting new people and trying new things. He likes computers as well. He likes computer games. So there’s an interest there too. (RSW) I identified some concerns about Oliver and his participation before [implementation] and thought that it wouldn’t be right for Oliver’s particular needs. Some aspects of that were wrong and some were right. Oliver did engage with it for a prolonged period, but completely at his own determination. He would only do it on his own and wouldn’t engage in the dialogue that would be associated with a sort of more therapeutic response. (RSW)

14. Potential Uses
It sort of gave me an insight to what I needed to actually do and whatever, whenever I go out into the world. (YP)
R: What did you like most about it?
Sam: The game just. It gave me something to do.
R: It gave you something to do of an evening type of thing. Is that what you mean?
Sam: Yeah.
R: What would you normally be doing if you weren’t playing the game?
Sam: Sitting around probably. (YP)

15. Potential Uses
I mean he’s a high risk taker, major high risk taker. There’d be a lot of concern about his behaviours and potential for misadventure or, you know, even disability or fatality in terms of his behaviours. So at least when he was engaging on a regular basis with the game that did reduce his high risk behaviours. (RSW)
When that game was being played he’d be very very focused on it and he was very calm. He wasn’t agitated in any way when he was playing the game. (RSW)

16. Challenges to engagement & successful implementation
If I’m honest it wouldn’t have been a huge priority. We would have played as much as we could but there was a lot going on for him the last six months. (RSW) [Oliver] is very different from a lot of kids. He’s a real individual when it comes to it. He’s very self-determined. He’s very headstrong. He doesn’t like authority. He doesn’t like therapeutic approaches. I can sort of understand, maybe, where he’s coming from because he’s had therapy to it’s coming out of his ears. (RSW)

17. Challenges to engagement & successful implementation
I suppose in general there would be staff here who would be into more therapeutic approaches than others and others would have a more practical outlook on residential so there might be some resistance to that. (RSW) You know you’re living with the young person so in one way you’re the person whose imposing sanctions and discipline, you’re sort of a parental figure, so they mightn’t be able to sit down and open up. (RSW)

18. Model of Implementation Effectiveness
Successful Implementation (Enabling Forces)
Intervention
Research Process
Researcher
Residential Social Worker
Young Person
Context
CONSIDERING IMPLEMENTATION
Research Process
Residential Social Worker
Intervention
Researcher
Young Person
Context
Implementation Failure (Constraining Forces)

19. Implementation Logic Model
1: Inputs
Collaborative partnerships with key stakeholders in children's homes
Participants for consultation
Participants for implementation
Laptop computers or games consoles
Game software
Identify evidence base and theory through literature reviews
2: Activities
Design research, intervention & implementation protocol in consultation with stakeholders
Identify intervention 'champion' in the children's homes
Recruit participants willing to implement the intervention
Design and deliver training course to residential social workers
Secure laptops/consoles and games
Residential social workers implement intervention
Conduct pilot study
Conduct single-subject evaluation & process evaluation
3: Outputs
Pilot study data indicating the feasibility and acceptability of the intervention in context
Single-subject evaluation study data indicating efficacy of intervention
Process evaluation data indicating implementation effectiveness
Intervention theory of change model
Therapeutic tool suitable for use with young people in residential care
Implementation protocol
User manual
Training protocol
4: Outcomes
Increased engagement of young people in therapeutic work
Increased involvement of residential care staff in delivery of therapeutic work
Increase in emotion regulation skills among young people
5: Impact
Improved mental health outcomes and coping for young people in residential care

20. Future Directions Further development work
Further exploratory research to examine its potential uses
Evaluation research to examine therapeutic impact

21. Conclusion
You can discover more about a person in an hour of play than in a year of conversation. – Plato, c. 400 BCE

22. Aventin, Á. (2013). The Challenges of Introducing Computer Games for Therapeutic Use in Residential Child Care: An Exploratory Case Study. PhD Thesis. Queen’s University Belfast.