This document describes the development of a video game called Coping Coach to help children ages 8-12 recover from acute trauma. It discusses conducting user testing on early prototypes to improve engagement and usability. The game incorporates evidence-based techniques like understanding thoughts and feelings, decreasing avoidance, and increasing social support. Further evaluation through a randomized controlled trial is planned to systematically assess the game's ability to prevent or reduce psychological symptoms and promote emotional recovery in children experiencing acute trauma.

1. Promoting recovery in children following acute trauma via a
video game (“Coping Coach”)
Meghan L. Marsac, PhD
Kristen L. Kohser, MSW
Flaura K. Winston, MD/PhD
Sonja March, PhD
Justin Kenardy, PhD
Nancy Kassam-Adams, PhD

2. WHAT WE ARE PLAYING NOW
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3. CHILDREN AND ACUTE TRAUMA
High impact / high profile events
∼ e.g., natural or manmade disasters, mass
violence, terrorism
∼ affect large numbers of children and families all
at once
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4. CHILDREN AND ACUTE TRAUMA
Lower profile “everyday” events
∼ e.g., traffic crash, house fire, injury, sudden
serious illness, witnessing violence in street or at
home
∼ affect children and families one at a time, out of
the public eye
∼ very frequent – thus MANY children are affected
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5. CHILDREN AND PARENTS’ EXPERIENCES
“I thought I was going to die. I
thought I must really be hurt. I
was so scared because my
mom was not there.”
“I saw my son lying in the street.
Bleeding, crying, the ambulance,
everybody around him. It was a
horrible scene. I thought I was
dreaming.”
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6. WHAT IS TRAUMATIC STRESS?
Re-experiencing Increased arousal
“It pops into my mind.” “I am always afraid something
bad will happen.”
“Feels like it’s happening
again.” “I jump at any loud noise.”
“I get upset when something “I can’t concentrate, can’t
reminds me of it.” sleep.”
Avoidance Dissociation
“I block it out - try not to think “It felt unreal -- like I was
about it.” dreaming.”
“I try to stay away from things “I can’t even remember parts
that remind me of it.” of it.”
*Also, anxiety, depression, acting out behaviors
**Related to functional outcomes
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7. CREATING EFFECTIVE WEB-BASED RESOURCES
1. Clearly define specific goals & “program theory”
∼ How will website help with secondary prevention?
∼ Build site with this in mind
2. User-centered design process
∼ Involve users at every stage of development
3. Test usability / engagement & effectiveness
∼ “Usability” – can they use it as we intend?
∼ Engagement – do they like it and want to use it?
∼ Does it achieve specific secondary prevention goals?
4. Consider Dissemination
∼ How best to reach the intended audience?
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8. COPING COACH: SPECIFIC GOALS
• Overarching Goals:
∼ Prevent or reduce psychological symptoms
∼Promote emotional recovery
• Target Audience:
∼ Children ages 8-12 years old exposed to acute trauma
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9. COPING COACH: PROGRAM THEORY
EVIDENCE-BASED ACTIVE INGREDIENTS
Understand appraisals (thoughts & feelings)
• Understand normal reactions (thoughts & feelings) after a trauma
• Helpful & unhelpful ways of thinking
• Practice by helping game characters
Decrease avoidance
• Pros & cons of avoidance
• How to approach trauma-related fears / situations
• Practice by helping game characters
Increase social support
• Recognize people available for support
• Practice giving and seeking support with game characters
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10. COPING COACH DEVELOPMENT: USER-CENTERED
DESIGN/TESTING USABILITY & ENGAGEMENT
Build Pilot test
Develop a prototype prototype Refine
conceptual with 2-3 for based on
design for high- usability pilot
intervention priority and data
modules feasibility
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11. FIRST PROTOTYPE
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12. PILOT RESULTS
• Children ages 6-12 years old & parents
• Hospitalized for injury or illness
• Played game and provided feedback
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13. CONCLUSIONS FROM PROTOTYPE 1 TESTING
• Children and parents interested in a web-based
resource & found information trustworthy
• SUGGESTED IMPROVEMENTS
 Increase interactivity and functionality
 Add audio and reduce amount of text
 Incorporate a system of tracking progress/
accomplishments throughout the activities
 Develop an overall concept or platform for the activities
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14. CHANGES FOR SECOND PROTOTYPE
 Game-based, including storyline
 Tracks progress, includes storyline and adventure
log
 Uses points and trophies for reinforcement
 Traditional functionality via flash-based platform
 3 levels: Tree world (Feelings), Airship
(Appraisals), Cloud (Avoidance/Approach)
 Social support woven throughout
 Adds music
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15. 2ND PROTOTYPE: PENN DIGITAL MEDIA
STUDENTS & RADIANT CREATIVE
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17. PROTOTYPE 2: PILOT TESTING
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18. PROTOTYPE 2: PILOT TESTING ENGAGEMENT
Sample Comments
Caregivers Children
 “l liked it… [my child] got to help
 “I learned that everybody
some of the other kids…and [the
has accidents and you can get
game] helped him figure out how
help by telling someone.”
he felt.”
 “[The activities were]  “I think [Coping Coach] was
interactive... that's what kept her fun, it was cool… I liked
attention.” getting to help everybody.”
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19. CONCLUSIONS FROM PROTOTYPE 2 TESTING
• Prototype 2 demonstrates better usability and
acceptability
• SUGGESTED IMPROVEMENTS
Improve directions for parents
 Add audio option
• Move forward with a systematic evaluation
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20. FUTURE DIRECTIONS FOR COPING COACH
• Conduct Pilot RCT
∼ NICHD-funded R21
• Evaluate program theory
• Dissemination
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21. MODEL FOR DISSEMINATION:
AFTERTHEINJURY.ORG
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22. MODEL FOR DISSEMINATION:
DIRECT TO PARENTS
Online news Wikipedia
“Mommy bloggers”
Sponsored search
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23. MODEL FOR DISSEMINATION:
DIRECT TO PARENTS
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24. ACKNOWLEDGEMENTS
∼ Jeffery McLaughlin: Creative Director
∼ David Williams: Software Developer
∼ Omar Esquivel: Production Artist
• UPenn Digital Media Program
∼ Marley Gilb, Elliot Kaplan
• Music
∼ Paul Weinstein
• Research Assistants
∼ Mona Abughaida, Anne Baker, Kathleen Clawson, Aimee Hildenbrand, Dan
Huber, Dan Nessenson, Olivia Klingbeil
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25. THANK YOU!
• Meghan Marsac, PhD
∼ marsac@email.chop.edu
• Nancy Kassam-Adams, PhD
∼ nlkaphd@mail.med.upenn.edu
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