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

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. 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. 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. Meet
coach
Choose
avatar

5. Plot /
story line

6. 4 character
stories:
 Asthma
 House fire
 Car crash
 Community
violence

7. ID
reactions
during /
after
event

8. ID trauma-
related
thoughts
(appraisals)

9. Practice
re-appraisal
skills

10. Identify
problematic
avoidance
coping
Model
approaching
fears &
seeking
social
support

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. 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. 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. • 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. 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. 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