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Coping Coach

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Dr. Nancy Kassam-Adams describes her current serious game aimed at children following stressful events (such as a medical or traumatic emergency)

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Coping Coach

  1. 1. Coping Coach: Online intervention to prevent traumatic stress after acute child trauma Core team: Nancy Kassam-Adams, PhD Meghan Marsac, PhD Flaura Winston, MD, PhD Kristen Kohser, MSW Children’s Hospital of Philadelphia & University of Pennsylvania Collaborators: Justin Kenardy, PhD; Univ. of Queensland Sonja March, PhD; Univ. of Southern Queensland
  2. 2. Developing innovative prevention tools: Coping Coach Purpose: Prevent traumatic stress, promote health-related quality of life in school-age children after acute traumatic events Why a web-based intervention? • Millions of kids experience acute medical events, violence, disasters, etc • Need for accessible delivery, wide reach • Interactive activities: Engaging and powerful What are we trying to change? (evidence-based targets) • Cognitive appraisals • Connections between thoughts & feelings • Helpful “self-talk” (reframe unhelpful thoughts) • Coping strategies • Discourage avoidance-based coping • Seek social support
  3. 3. Coping Coach Development process (2010 – 2012) Child feedback at each step: - Look & feel - Engagement Built prototype - Usability testing Re-design = game - Usability + - Engagement + - New modules
  4. 4. Meet coach Choose avatar
  5. 5. Plot / story line
  6. 6. 4 character stories:  Asthma  House fire  Car crash  Community violence
  7. 7. ID reactions during / after event
  8. 8. ID trauma- related thoughts (appraisals)
  9. 9. Practice re-appraisal skills
  10. 10. Identify problematic avoidance coping Model approaching fears & seeking social support
  11. 11. Pilot RCT: Initial test of effectiveness, estimate effect size  N=72; age 8 to 12  Enroll at hospital within 2 weeks of acute medical event  Excluded: Severe head injury, Event = family violence  Randomize to Coping Coach (36) vs Wait list control (36)  Weekly email / text / phone reminders to child & parent  Incentive to finish whole game  Track all interactions with the game  97% Coping Coach group / 64% Wait list group used the game  58% Coping Coach group / 57% Wait list group completed at least once  Mean = 52 minutes playing game  Baseline, 6 wk, 12 wk, 18 wk assessments of key outcomes  PTSD symptoms – promising pilot results  Health-related quality of life – no intervention effect
  12. 12. RCT results: PTSD symptom reduction 0 5 10 15 20 25 30 Baseline 6 wks 12 wks 18 wks PTSD (CPSS total) Wait List Coping Coach
  13. 13. RCT results: By initial risk status 0 5 10 15 20 25 30 Baseline 6 wks 12 wks 18 wks PTSD (CPSS total) At risk Wait List At risk Coping Coach Not at risk Wait List Not at risk Coping Coach
  14. 14. • What did we learn? • Pilot RCT results suggest: • Feasible, acceptable • Reduction in PTSD symptoms • Intervention time frame may be flexible • Most useful for higher-risk group … but did not harm low-risk group • Next steps • Testing now in children with violence-related injuries • Increase “stickiness” – promote more & repeated use • Propose a larger trial – target higher-risk group • Continue development of new components • Platform as springboard for other purposes – e.g. screening system Summary
  15. 15. Acknowledgements  Funding  Pennsylvania Department of Transportation  National Institutes of Child Health and Human Development (NICHD)  Design - UPenn Digital Media Program students  Marley Gilb, Elliot Kaplan  Design – Radiant Creative  Jeffery McLaughlin: Creative Director  David Williams: Software Developer  Omar Esquivel: Production Artist  Music  Paul Weinstein
  16. 16. Related publications  Marsac, ML, Kohser, K, Winston, F, Kenardy, JA, March S, & Kassam-Adams, N. (2013). Using a web-based game to prevent posttraumatic stress in children following medical events: Design of a randomized controlled trial. European Journal of Psychotraumatology, 4: 21311. doi: 10.3402/ejpt.v4i0.21311  Marsac, ML, Winston, F, Hildenbrand, A, Kohser, K, March, S, Kenardy, J, & Kassam- Adams, N. (2015). Systematic, theoretically-grounded development and feasibility testing of an innovative, preventive web-based game for children exposed to acute trauma. Clinical Practice in Pediatric Psychology 3 (1); 12-24. doi: 10.1037/cpp0000080 PMID: 25844276  Kassam-Adams, N. Marsac, ML, Kohser, KL, Kenardy, JA, March, S, & Winston, FK. (2015). A new method for assessing content validity in model-based creation and iteration of eHealth interventions. Journal of Medical Internet Research 17 (4): e95. doi:10.2196/jmir.3811 URL: www.jmir.org/2015/4/e95 PMCID: PMC4414959 PMID: PMID: 25881584  Kassam-Adams, N., Marsac, ML, Kohser, K, Kenardy, J, March, S, & Winston, F. (epub June 2015). Pilot randomized controlled trial of a novel web-based intervention to prevent posttraumatic stress in children following medical events. Journal of Pediatric Psychology. doi: 10.1093/jpepsy/jsv057 PMID: 26089554

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