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
Overview
• Background & Aims
• Intervention design process
• The intervention
• Key Findings
• Future Directions
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
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.
Research Design
II. Feasibility/piloting
1 Testing Procedures
2 Determining sample size
3 Estimating recruitment/retention
I. Development
1 Identifying the evidence base
2 Identifying/developing theory
3 Modelling process and outcomes
IV. Implementation
1 Dissemination
2 Surveillance and monitoring
3 Long term follow-up
III. Evaluation
1 Assessing effectiveness
2 Understanding change process
3 Assessing cost-effectiveness
Medical Research
Council (2008)
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
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
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?
The Intervention
What is “Emotion Regulation”?
• It’s about understanding
and managing our emotions
• Everyone does it...
• We have to learn to do it
(just like we learn to talk,
write or tie or drive)
• Some people are not taught
how to do it properly when
they are children
The Therapeutic Use of Computer Games in Residential Child Care
Version 1 10.01.10
Key Findings
• A word of caution
• Acceptability
• Potential uses
• The challenges to introducing therapeutic
innovations in residential child care contexts
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)
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)
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)
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)
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)
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)
Model of Implementation Effectiveness
Successful Implementation (Enabling Forces)
Intervention
Research
Process
Researcher
Residential
Social
Worker
Young
Person
Context
CONSIDERING IMPLEMENTATION
Intervention
Research
Process
Researcher
Implementation Failure (Constraining Forces)
Residential
Social
Worker
Young
Person
Context
Implementation Logic Model
1: Inputs
2: Activities
3: Outputs
• 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
•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 singlesubject evaluation &
process evaluation
•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
Future Directions
• Further development work
• Further exploratory research to examine its
potential uses
• Evaluation research to examine therapeutic
impact
Conclusion
You can discover more about a person in an hour
of play than in a year of conversation.
– Plato, c. 400 BCE
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.
a.aventin@qub.ac.uk