1. “The Adventures of Florence the LadyBird”
A Multimedia Pre-intervention for Hospitalisation
Draft Proposal
A CHERI initiative
Simple Description and Design Considerations: The focus of this project is the development of a multimedia pre-admission intervention
that sets out to improve children’s coping strategies and in alleviating the family’s stress of the experience of hospitalisation.
Long Description
A multimedia pre-admission hospital intervention (distributed on CD-Rom) that utilises Microsoft Agent Technologies to create transitional
characters that allows a child to have a virtual experience of hospitalisation. It is hoped that these animated characters (agents) and other
media rich resources (such as video vignettes) will allow children to observe and perhaps model the range of coping strategies embedded
within these resources. In designing this resource we will acknowledge the three different coping approaches that we all use when faced
with stressful situations, those being seeking information, developing social support and finally avoidance or denial.
The courseware by its design will at various stages encourage both the parent and child to simultaneous participation through the journey of
hospitalisation, allowing the parent to become aware of the areas of concern for their child. At the same time we are intending to distribute

2. materials such as fact sheets and small videos to inform parents of the issues they may encounter during their child’s hospital experience,
with suggested strategies to deal with them.
The authoring platform for this resource will be web based which facilitates the use of a variety of media rich contents, such as Microsoft
Agents, photographic panoramas, Macromedia Flash and MPEG movies. It will also provide interactivity for the user and allow for many
paths of navigation depending upon the coping preference and age of the viewer. At the same time we will be utilising the venue of the
hospital in an innovative way as a multimedia backdrop to draw in our wonderful architecture, artwork and other facilities such the Chinese
garden.
The courseware will be in the form of a magazine format (like Sesame Street) allowing for variations in character, content, style and mood,
aimed at holding onto the attention of the child viewer. As a sub-theme we will also have an allegory quest that utilises visual imagery
(photographic panoramas) of The Children’s Hospital and reinforces the content of this resource in fun way for the children. The allegory will
be along the lines of a child having to come reluctantly to hospital in the form of an animated ladybird character “Florence the Ladybird” that
is transported to the hospital and becomes fascinated with the world she encounters. Florence’s family came recently from China as puma
on the rocks that make up the Chinese Garden at The Children’s Hospital, she now lives in the garden but ventures in the hospital to find
out where she is.
The storyline is loosely based on “The Wizard of Oz” with “Florence the Ladybird” taking on the role of Dorothy, someone is transported to a
foreign land and has to work out the strange world that she encounters. Florence mirrors the experience of children coming to terms with
the strange land of hospital where most experiences are foreign in regards to what they have lived outside of hospital. The character of
Florence will embed the character traits of our target audience child that of a child who is fearful of hospital and needs to seek support to
feel comfortable about being in hospital. Florence throughout her quest comes across other animated characters which present varying
perspective’s of the hospital experience, with the child able to make choices to role-play these character to virtually live the consequences
of their different strategies.
Florence has special powers in that she can bring to life objects and images by landing on them, whilst at the same time casting a spell to
freeze reality so that nobody knows that the characters have come alive. It is intended that this alternate reality reflects the role of
“Transitional Objects” such as teddy bears in the imaged and psychological life of children. The rationale is that this myriad of transitional
objects around The Children’s Hospital will bring new focus to their use for children whilst at hospital.
Florence talks to a variety of characters originating from toys, sculptures and images (paintings and photography) within the hospital. Her
trusty companion is a “Toto” like a dog/cat like creature which gives Florence objective facts about the world of being in hospital. Toto has a
variety of abilities similar to K9 in the television series “Doctor Who” such a being able to project video/computer data and of course talk.

3. Design of Characters
We are proposing at the moment to use a range of Microsoft Agents that have different roles. We will develop these characters making
them appealing to children by the scripting situations that we create and by embedding within them a variety of distinctive, reliable
personalities.
I keeping with our goal of representing different coping styles we have proposed the use of at least 3 characters in this regard.
The above characters will be used in our prototyping stage of this resource whilst we are in the alpha phase of the resource development.

4. In this stage Peedy the Parrot (Florence the Ladybird) will focus upon being the social networker whilst Karabus or Max Dog (Toto) will
encapsulate the analytical, self-sufficient, positive personality. The third character that uses denial as a coping strategy will initially be in the
form that could be represented by the Genie or the Witch as they rely of their magic or imagination to escape from the realities of the world
around them.
Therefore we would like to see the development of three new characters, Florence the Ladybird, Toto and The Good Witch. Of these
new characters Florence the Ladybird is in early development (as seem below) and will cater for the traits of cautiousness, needing to
source information before being comfortable with her surroundings. This ladybird character will be used in a number of roles and offers the
flexibility of being able to access of variety of functionalities, that of flying and being small enough to go anywhere within the hospital.
The staff and students of the Silicon Graphics Centre are developing a series on new characters to be incorporated into the ongoing
development of this resource. It is intended to build a bridge of mutual opportunities between TAFE and the CHW to develop innovative
projects that bring the best from both partners.

5. Methodology
The use of thought bubbles to reveal different worlds of both children and adults, whilst at the same time giving legitimacy to the child’s
point of view. For example the fears that young children have of machines arise as they have the capability to bring inanimate object to life
which is encouraged in everyday situations. For example the use of transitional objects such as teddy bears where the child to is
encourage to bring the teddy bear to life, little wonder when the child is faced with a CAT scan machine that they feel fearful of the
encounter with it as if it may swallow them whole.
With this in mind the idea of predicting the common fears that children have of the procedure of a CAT scan or MRI could be taken into
consideration, with the hope of allying that fear by suggesting an alternative reality. For example the guide may present an alternate view
that the MRI might be like going into a time machine or spaceship where one can use your imagination to visit your favorite place.
At the same time we have the capability to use children’s voices eventually as the speech output of the characters, with this hopefully
leading to the development of child generated journals that reflect their hospital experience in terms of both a worldview and style of
presentation. We may also use the children’s artwork as navigation and background resources within the design of the courseware
therefore embed a child’s worldview and a sense of ownership of this resource.

6. This will be brought about by the use of the software application “Mash” which allows children to easily script Microsoft Agents within a web
page environment. The use of this technology also allows children to use their own voices as the audio component of a lip-synchronised
animated Microsoft agent. It may also be possible in the future to further personalise this character by tagging it with a signature tune.
Producing a Virtual Hospital Experience
We have already produced photographic panoramas of the procedural rooms such as the ones which follow which we hope will give the
children an opportunity to experience these environments virtual so as to prepare them for the actual experience.
The Galleria – The Children’s Hospital at Westmead 
Third Floor looking towards the Galleria – The Children’s Hospital at Westmead 

7. Circus 2000 by Beth Norling – A preparation room of Nuclear Medicine at The Children’s Hospital at Westmead. 
Dreaming 2000 by Beth Norling – A preparation room of Nuclear Medicine at The Children’s Hospital at Westmead. 

8. The Gammacamera room by Rodney Monk – A procedure room of Nuclear Medicine at The Children’s Hospital at Westmead. 
Distractions
As part of the coping strategy of avoidance/denial we are proposing to present an opportunity for the children to escape from the hospital
“virtually” by navigating through outside environments such as The Powerhouse Museum. With this in mind we are intending to use a
Powerhouse Museum Quicktime VR tour presented to us, which we will integrate into a quest to find clues to answer a riddle allowing the
child to continue the quest.

9. Macromedia Flash
We intend to create interactive games of content that is of concern to children, for example to issue of how blood clots. The image below is
a frame taken from an example of a Flash movie that explains how red blood cells distribute oxygen throughout the body.
Social Scripting
The strategy of providing scripts that allows children to navigate through social situations, i.e. dealing with a person in authority, wanting to
have your opinions hear, creating some personal space without offending other people. This will take the form of presenting vignettes that
role-play the above common social situations.
An Children’s Visual Medical Dictionary
The development of a resource that shows and explains at an appropriate developmental level the roles of health professionals with the
objects and terms that a child will come across whilst at hospital.

10. Partnerships
The Children’s Hospital School
The Children's Hospital School is part of the NSW Department of Education and Training. It is the largest hospital school in the state and is
located within The Children's Hospital at Westmead.
It provides educational services for up to 75 Kindergarten to Year 12 students each day. These students are from government and non-
government schools throughout NSW and other states. Overseas students may also be eligible to attend.
At CHERI we have been working with the school to develop their school website by offering staff training in the field of Instructional Design
and web page creation.
http://snowy.kids/kids/school/class/primary.htm

11. The Silicon Graphics Centre
The Silicon Graphics Centre (SGC) offers full-time and part-time programs in 3D Animation, Game Development and Digital Media, as well
as short courses in 3D Studio Max, Character Studio and Combustion. It is the largest educational Silicon Graphics Centre in South East
Asia, and is based at the Enmore Design Centre, TAFE NSW Sydney Institute. The training rooms have a large purpose-built network of
computers ideally suited for producing and rendering showreel animations.
http://www.tafensw.edu.au/sites/artsprize/1999/tafecourses/silicon.htm
The Children’s Hospital at Westmead
Naturally we have being involving as many hospital staff as possible in the development of this resource and have through that process
being able to bring a rich array of ideas and resource to this project. For example we have wonderful collection of imaging content ranging
from archive photographs from the Camperdown hospital site to the latest high technology of animated MRI movies.

12. Additional Resources
We also have a wonderful collection of artwork that graces our innovative architecture which we intend to use as a backdrop for a virtual
and real life discovery game. We have also been offers images from Taronga Zoo which will act a destinations from clicking on the picture
portals such as the on below of the giraffes.

13. Finally as part of the hospitals ongoing commitment to community education and health promotion we has access to a resources
that we will distribute by both our parent and child audiences such as the following fact sheet.
Sculpture
Painting

14. Fact sheets catalogued in Abode Acrobat

15. Background/Literature Review:
CHERI1.
states that “With an estimated 90,000 children in Sydney aged between 4 and 14 having some form of chronic illness”, there is
ample need to develop an integrated approach to the issue of hospitalisation interventions.
Melamed & Siegel (1975)9.
states that “Several authors have suggested that preoperative anxiety is a significant factor in impeding recovery
from surgery (Dumas, 1963; Giller, 1963; Janis, 1958). Backing this point up, Kane (2000) states that “ About 50 percent of all children
undergoing routine outpatient surgery present at two weeks with new-onset anxiety, night-time crying, enuresis, separation anxiety, temper
tantrums and sleep or eating disturbances. Twenty percent of these children continue to demonstrate negative behaviors six months
postoperatively”.
Melamed & Siegel (1975)9.
cites earlier research that suggests that the major purpose of preoperative preparation is to (a) provide
information to the child (b) encourage emotional expression, and (c) establish a trusting relationship with the hospital staff.
Melamed & Siegal further states that “While a number of different procedures have been used to impart information to the child about the
hospital and his operation, they are similar in that they attempt to correct any misinformation that he might have and to help him master the
experience by enabling him to anticipate events and procedures and to understand their meaning and purpose”.
These strategies appear to support the mechanism of coping and should be incorporated into the design of preoperative interventions.
Whelan & Kirkby (1998) state that “ Outcome studies to compare the effectiveness of different preparation approaches have been
inconclusive. This is largely to the tendency of practitioners to combine preparation strategies, making it difficult to isolate the effective
components. Nevertheless, a range of benefits from psychological preparation have been reported, including decreased child and parent
anxiety, fewer problem behaviours, shorter hospital stays, and the need for less medication. Added to this, it has been found that
preparations reduces the cost of hospitalisation”.
Throughout the literature in this field there is an emphasis of the efficacy of the intervention and at the same time comparative studies of the
various modalities. This approach has been beneficial in defining the key issues of consideration in designing these interventions which I
believe are the following:
• Healthy children should be exposed to pre-admission resources (Nelson (1995)4.
, Peterson et al. (1984)12.13.14.
,
• The importance of the children’s understanding of illness and medical concepts taking into account the developmental
conceptualisation of the child (Redpath et al. (1984)25.
, Rasnake & Lischeid (1989)26.
• Children’s reactions to hospitalisation (Melamed & Siegal (1975)9.
, Nelson (1995)4.
• The comparison of different modalities aimed at reducing anxiety in children facing hospitalisation and surgery (Peterson et al
(1984)12. 13. 14.
, Elkins et al (1983)15.
,

16. • The correlation between the timing of the pre-admission experiences, the age of the child and the length of stay in the hospital
LaMontagne et al. (1996)16.
, Atkins (1987)17.
• The type and number of the pre-admission resources (Peterson et al. (1984)12. 13. 14.
• The use of novel new approaches to pre-admission resources (Bers et al (1997)18.
, Sheldon et al (1999)19.
, Demaso (2000)20.
• The issues of the parents and siblings stress and negative behaviours impacting upon the child (Atkins (1987)17.
, Utah State
University (2000)11.
• The hospital as a learning environment and the culture of hospitals (Bers et al (1997)18.
• What is the effect of these strategies with children who have had previous experiences of hospital (Nelson (1995)4.
, Melamed &
Siegal (1975)9.
CHERI - Children’s Hospital Education Research Institute
Name: Prof. Jeff Bailey Title/Position: Director of CHERI and the James Packer Professor of Educational Research
Telephone: 02 98450415 Fax: 02 98450421 Email address: JeffB@chw.edu.au
Name: Ken McCullagh Title/Position: Senior Research Officer
Telephone Number: 02 98450418 Fax: 02 98450421 Email address: kennetm2@chw.edu.au