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The Challenges of Creating Mobile Games for Regulated Health Situations
Pear Therapeutics is a leader in developing FDA-regulated digital therapeutics, aiming to treat serious mental health disorders through prescription digital therapies like Reset®, which has shown improvement in abstinence rates for substance use disorder. The company addresses significant unmet needs in brain health treatment, with a focus on providing effective, accessible, and scalable digital health solutions to combat the high economic burden and prevalence of mental illnesses. Additionally, the document outlines the challenges faced in the integration of serious games and apps within regulated healthcare environments, emphasizing the need for clinical evidence and reimbursement models.
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The Challenges of Creating Mobile Games for Regulated Health Situations
- 1. Serious Games ina Regulated Environment: Games and Apps as Digital Medicine Beth Rogozinski, Chief Content Officer Serious Play Conference 2017
- 2. Confidential - DoNot Distribute 2 Agenda and Objectives Play and Games for Serious Health Issues Pear Therapeutics and Digital Medicine Agile Dev Meets Regulatory: reSET Case Study Enhancing within the Boundaries Brining Game Best Practice and Design to Healthcare
- 3. PEAR Therapeutics –the leader in digital therapeutics PEAR is a fully integrated digital therapeutics company, developing regulated, reimbursed, prescription digital therapeutics We are a venture-backed company with a 40-person team in Boston and SF with expertise in software design & engineering, clinical development, regulatory affairs, and product commercialization and reimbursement We have developed a modular, cloud-based platform to deliver eFormulationsTM and our lead product, reSETTM, significantly improved abstinence in 6 randomized controlled trials in Substance Use Disorder, paving the way for it to be the first FDA- approved digital therapy in 1H 2017. We also have programs treating Opiate Dependence, Schizophrenia, and PTSD and other serious disorders. Confiden'al – Do Not Distribute 3 Our mission is to commercially develop and distribute clinically validated, FDA regulated, digital therapeutics to treat diseases of the brain in order to improve clinical outcomes and lower overall treatment costs
- 4. Agile Game andApp Development for Mental and Behavioral Health with Medical Regulatory Oversight Confidential- do not distribute 4 Clinical Product Design Process
- 5. Confidential- do notdistribute 5
- 6. 9 148Alzheimer’s disease 123Obesity Addiction 366 Multiplesclerosis Parkinson’s disease 10 Spinal cord injury 15 Epilepsy 16 Schizophrenia 33 Anxiety 47 Hearing loss 50 Vision 52 Traumatic brain injury 56 Stroke 57 Sleep disorders 75 Attention disorders 77 Depressive disorders 83 Chronic pain 95 1. 2012 values; Includes both direct and indirect cost of disease Source: NeuroInsights, Office of Nat’l Drug Policy, American Psych. Assoc., Cost of Brain Disorders Europe 0.4 2.0 0 1 2 un- served under- served Total pts 0.7 served 0.9 U.S. Economic Burden1 for CNS disease, 2012 $ Billion Global patient pop. for CNS disease Billion patients CNS: Huge Unmet Need Estimated U.S. economic burden of common brain-related illnesses exceeds $1.3 trillion per year and worldwide burden exceeds $2 trillion per year Approximately 80% of the world market for brain related treatments is currently either unserved or underserved Confidential- do not distribute 6
- 7. Costs and Consequences:Mental Illness and Addiction
- 8. Digital health isbecoming the most effective means of delivering behavioral treatment programs Confidential- do not distribute 8 “Of the 26 trials, 23 demonstrated some evidence of effectiveness relative to controls… Conclusion: Internet interventions for depression and anxiety disorders offer promise.” “In adolescents with mild to moderate depression, the remission rate for those using SPARX greater than that of the usual face-to-face therapy.” “Video game- based training resulted in performance benefits with enhanced sustained attention and working memory...and preservation of multitasking improvement 6 months later.”
- 9. Confidential- do notdistribute 9 Experience- dependent cognitive and rehab programs Chemical agent (i.e. supplement or medication) =+ Neuroplasticity: Chemistry + Cognitive Training Current standard of care
- 10. Confidential - DoNot Distribute 10 Digital therapies create medical value in areas of high patient need – Mental and Behavioral Health The US spends ~ $1.3 Trillion per year on CNS illnesses (psychiatry, neurology, and pain) with 80% of the world market currently unserved or underserved High Unmet Need Few new drug therapies are set to come to market for CNS diseases, and the pipeline is particularly thin for mental health and addiction conditions Few New Therapies The Affordable Care Act and the Mental Health Parity and Addiction Equity Act are driving reimbursement of care for brain related diseases including new devices and drugs Favorable Reimbursement Software-based therapies have shown efficacy in treating brain related diseases and also in enhancing the efficacy of approved CNS medications Clinical Proof of Concept
- 11. Healthcare Psychographic Segments BalanceSeekers (18%) • Open to many ideas and options, as long as they make sense for me • Need context to understand ideas and recommendations Strong Survivors (27%) • There are more important things in my life to focus on than improving my health • Live in the “here and now” Self Achievers (24%) • Take ownership of my health and actively take steps to be healthy • Focus on achieving my goals and objectives • Disease is another challenge to overcome Active Listeners (13%) • Look to physician and other healthcare professionals for guidance and direction on what to do to address my disease C2B Solutions Proactive Reactive Priority Jugglers (18%) • Worry about my family’s health more than my own • Constantly on the go, juggling many responsibilities so getting sick is not an option
- 12. Proactive Target Audience Motivators:INTRINSIC efficiencies CONTROL social COMMUNICATIONS Who are they? • 60% are female • Primarily “Achievers” and “Belongers” goal oriented – successful -‐ Driven • Between the age of 35-‐65 (Sweet Spot – mid 45-‐54) • Married/aKached professionals with families and very busy lives • Above average educaMon level – managers, execuMves, professionals • Higher than average disposable income levels and spending tendencies • They are connected via tech, socially connected and integrated What do they look for in health/wellness • Professional and friendly communicaMons and style • Value, reliability – relaMonship and trust come first • Simple, easy to use system that fits their busy schedule • One stop place to hold medical records and other data – can be shared with docs • Price is not primary – will pay more at first – but demands quality • Transparent, open easy communicaMons and informaMon • Technical and mulM-‐plaWorm access Business Indicators: • Heavy user of technology • Connected across social networks, LI, FB, Tw • Involved in group events and community – K Factor • Fastest growing segments of casual gamers • Price not a top issue, but efficiency is • Willing to pay for Premium Services/Supplements Women, middle aged, healthy lifestyles, well educated, higher income, ac6ve and fit http://www.aafp.org/media-center/releases-statements/all/kits/052908.html
- 13. Proactive Identity Customer • Professional working manager/executive, professional • Married with kids – lives in Bay Area – travels around the bay for meetings and events. Partner has good job at tech firm • Health focused – bikes, runs, hikes, does yoga – passionate about fitness, food and wellbeing • Competent and DIY focused – but smart enough to ask for help when needed • Passionate about SERVICE and QUALITY • Connected and involved in her community – volunteers and gets out to contribute from self and company • Is honest and expects honesty and open communications Self-motivated Can be directly monetized Seeks help and connections Intrinsic rewards are enough
- 14. Reactive Target Audience Motivators:EXTRINSIC Needs Driven REWARDS SOCIAL RECOGNITION Who are they? • 55% are female • Needs Driven and Emulators – can cross all categories • Between the age of 40-‐59 • Divorced, unemployed/under employed • Average or below educaMon level • Uninsured, underinsured or government insured • They are less connected via tech, and not socially connected or integrated What do they look for in health/wellness • Access and availability – cost and access paramount • RelaMonship with doctor/caregiver – may be transferred • Simple, easy to use system – easily frustrated • One stop place to hold medical records and other data – can be shared with docs • Price is a primary – may exchange ads/acMviMes for free access • Transparent, open easy communicaMons and informaMon • May have single point of access – oden phone or computer only Business Indicators: • They trust the doctor, but not medicaMons • May not be digitally inclined • Compliance requires reminders and rewards • Easily bored and frustrated • Ads in exchange for payment/Price is an issue • MoneMzaMon would be via external sources Women, middle aged, lifestyle issues and concerns, less educated/lower socio-‐economic status, o;en mul6ple health concerns/symptoms
- 15. Reactive Identity Customer • Working single mom • Lives in suburban areas and takes public transit to work • Family and socially focused - not health focused - but may be focused on looks and beauty products • Competent and capable - Seeks outside help as a last resort for fear of seaming incompetent • Demands and requires equal access and treatment • Connected and involved in her family, church and local circles • Works hard and desires recognition for work and achievements Situational motivations May be directly monetized – though exchange of ads/actions may be preferred Will seek help locally – church, family Extrinsic and recognition rewards may be more compelling
- 16. Confidential - DoNot Distribute 16 Games and Apps as Medicine Traditional Emotional Motivation Game/App Approach Apprehension, uncertainty, wai6ng, expecta6on, fear of surprise do a pa6ent more harm than any exer6on. Florence Nightengale Notes on Nursing 1859
- 17. Confidential - DoNot Distribute 17 Games and Apps as Medicine
- 18. Confidential - DoNot Distribute 18 Serious Issues Limit the Impact of Digital Therapeutics • Focus on health and wellness use cases • Limited clinical evidence for efficacy; small longitudinal studies relying on patient reported data • Due to regulatory limitations, unable to promote disease treatment claims or modify drug dosing • Unclear distribution channels with physician confusion regarding path to patients • Lack of third-party payer reimbursement without clear means for coding and payment Traditional business model • Focus on diseases with high unmet need • Efficacy evaluated via RCTs versus current standard of care utilizing existing approvable endpoints • Filing for FDA approval with claims to assess/treat disease and integrate with medication • Marketed directly to physicians as a prescription product with access codes conferring patient access • Medical device with product codes and reimbursement supported by health economic analyses PEAR’s approach
- 19. The FDA andRegulated Healthcare • Formed in 1906 by Pres. Roosevelt to protect citizens against worthless “cures” and adulterated foods and pharmaceuticals • Continuously updated to reflect modern times • Focus – safety and efficacy Confidential- do not distribute 19 FTC fines for: Lumosity, Carrot Neurotech, AcneApp
- 20. Confidential- do notdistribute 20 Data Driven
- 21. Subclinical Apps andPlatform Live in 2015 Confidential- do not distribute 21
- 22. Confidential - DoNot Distribute 22 Indication Content Partner Prototype Pilot study Pivotal studies FDA submission FDA approval We have developed a pipeline of eFormulationsTM treating areas of high unmet medical need Stage In-licensed Internal Product FDA PreSub Opiate Dependence Schizophrenia Substance Use Disorder reSET-OTM reSETTM ThriveTM Combat-PTSD reCALLTM Insomnia PEAR-006 General Anxiety Disorder reVIVETM Traumatic Brain Injury PEAR-007 ADHD PEAR-008 Major Depressive Disorder Acute & Chronic Pain PEAR-010 PEAR-009
- 23. A Common Struggle– SUD and OUD a Nationwide Epidemic • In 2015 only 11% of the estimated 22.7 million Americans in need of treatment for SUD received any formal treatment • Over $740B in annual costs from healthcare, productivity and crime • Addiction and overdose have surpassed car accidents as a leading cause of death in young men • 91 people a day are overdosing and deaths > 2 jets a week crash landing • Health impacts are profound and include abscesses, cellulitis, pneumonia, heart failure, HIV and Hep C • High rates of comorbidities – causative or reflective directionality Confidential- do not distribute 23
- 24. Why Digital Therapiesare Needed Current State of Care • Diagnosis occur too late – Jail, hospital, death • Stigma and shame • Expensive, not available and not scalable – Desserts of care for all mental health • High friction for patients – Removed from home, work, stressors and triggers • Inconsistent treatment Pear Tx Digital Treatment • Digital can allow exploration and early intervention • Private – apps are all HIPAA secure and CFR-42 compliant • Effective, available and scalable – BYOD – patients already online • Always on and always available – 168 hours in the week • Consistent approach that is gamified and engaging and can be personalized Confidential- do not distribute 24
- 25. Addiction: Enslaved • Learningdisorder – double edge sword of neuroplasticity • Often have no positive feedback or affirmations in their lives – or the drug/substance confused with rewards • Success requires overcoming shame and focusing on the moment (MBSR) and learning new life skills • Risk taking patients particularly tied to rewards Confidential- do not distribute 25
- 26. PROJECT 28 DAYS– PEAR-001 Persona 1 Anthony Addict DETAILS • Over 30-‐40, Anglo • Lives in a urban center • Unemployed, on welfare • Owns older smartphone • Psychologically and Physiologically addicted • Uses opioids 1/day • Uses opioids habitually to stave off withdrawal • Difficulty controlling drug-‐taking behavior • Post rehab and going through city clinics • Post-‐detox GOALS • Hit rock boYom with an arrest and going through the long process of recovering from dependence • Wants to stay out of jail via mee'ng terms of proba'on including treatment, counseling, and tes'ng
- 27. PROJECT 28 DAYS / PEAR-‐001 -‐ PEARTX ADDICTION TREATMENT APP V1 -‐ AGILE VISION BOARD A SMARTPHONE APP THAT, PAIRED WITH MEDICAL TREATMENT, IMPROVES OUTCOMES FOR RECOVERING SUD/OUD PATIENTS Needs • Rewards you for par'cipa'ng in your own treatment • Teaches you the proven skills and behaviors to overcome addic'on • Gives you the tools for a beYer life • Enhances the effec'veness of your treatments • By tracking progress, gives you and your doctor beYer info to help you Target Group Primary • 80% Male • Anglo • 28-‐46, median 37 • English speaking • Own a smartphone Secondary • Physicians, Clinicians & Assistants • Medical Researchers Business Goals • Creates reoccurring revenue stream from city, county & state clinics • Provides strategic value as our first FDA approved product • Bellweather for poten'al pharma partners • Validates IP and thus provides business proof to addi'onal investment and /or poten'al acquirers Product • A smartphone app • App that presents and test cogni've behavioral therapy • App presents and tests fluency training • App gives mo'va'onal incen'ves • Server can push and app can display self tracking data to user
- 28. reSET®, is ontrack to be the first FDA-approved digital therapy with efficacy claims for the treatment of substance use disorder (SUD) Introducing reSET® for treatment of SUD • reSET® is a prescription digital therapy for treating SUD by delivering addiction-specific Cognitive Behavioral Therapy (CBT), Fluency Training, and Contingency Management • The concept product was developed at Dartmouth’s Geisel School of Medicine by Lisa Marsch, PhD • reSET® and reSET-OTM have been evaluated in 5 published randomized clinical studies involving over 1500 patients, and has attracted more than $45M in National Institute of Health (NIH) funding1-4 • In a multi-center randomized trial consisting of 507 patients seeking treatment for SUD, reSET® enhanced abstinence versus in-office treatment (p = 0.003)5 • reSET® is projected for approval in 1H 2017 as a class II medical device with claims for treatment of SUD to and enhance abstinence and retention in treatment 1 Experimental &Clinical Psychopharmacology. 2008. 16(2):132-143. 2 Substance Use and Misuse. 2011. 46(1):46-56. 3 American Journal of Psychiatry. 2014. 171(6):683-690. 4 Journal of Substance Abuse Treatment. 2014. 46: 43-51. 5 Campbell et al. Am J Psychiatry. 2014. Confiden'al – Do Not Distribute 28
- 29. In the pivotalclinical trial, reSET doubled rates of abstinence versus treatment as usual (TAU) 507 patients with Substance Use Disorder at 10 nationwide treatment centers were randomized to 12 weeks of typical outpatient treatment (TAU) vs Product X with limited clinician exposure and abstinence was measured through urine analysis and self reports TAU Product X Week 4 6 7 8 9 10 1153210 12 10 20 30 40 50 0 %Abstinent Week 9-12 29.7% (n=255) 16.0% (n=252) 2.22 (1.24, 3.99) 0.0076 Time PointPopulation All comers Week 9-12 10.1% (n=113 ) 3.0% (n=119) 3.59 (1.36, 9.48) 0.0099 Non-abstinent at start Product X TAU Odds Ratio (95% CI) P-value*
- 30. reSET enhanced retentionin treatment relative to treatment as usual (TAU) Treatment Retention Patients receiving reSET were significantly more likely to be retained in treatment vs those receiving treatment as usual TAU Product X P-value Patients remaining in treatment 63.5% (n=252) 72.2% (n=255) 0.0316 Time (weeks) PercentageRemaininginTreatment 2 4 6 8 10 12 60 70 80 90 100 0 0
- 31. Treatment Retention ModuleCompletion Time (weeks) Average#modules completedperweek Module Retention Averagetimespenton modules(inminutes) Time (weeks) TAU reSET® P = All- Comers 36.5% (n=252) 27.8% (n=255) 0.0316 Time (weeks) PercentageRemaininginTreatment Abstinent Non-Abstinent 0 1 2 3 4 5 6 7 8 9 10 11 12 20 40 60 Abstinent Non-Abstinent 1 2 3 4 5 6 7 8 9 10 11 12 Abstinent Non-Abstinent 0 1 2 3 4 5 0 2 4 6 8 10 12 60 70 80 90 100 reSET® enhanced retention in treatment relative to TAU, and patients showed strong rates of engagement reSET™ Treatment as usual (TAU) Patients receiving reSET® were significantly more likely to be retained in treatment Patients remained engaged with reSET® throughout the duration of the clinical trial Confiden'al – Do Not Distribute 31
- 32. Confiden'al-‐ do not distribute 32
- 33. reSET includes includesboth a patient-facing intervention and clinician-facing dashboards Health Care Professional Concept Proficiency Abstinence and Appointments Module Use Cravings and Triggers Patient Mobile Dashboard CBT Modules Contingency Management Craving & Trigger Assessment Fluency Training
- 34. Cognitive Behavioral Therapy(CBT) Modules for reSETTM Confidential- do not distribute 34 Core Modules Optional Modules 1. Training Module 2. What is Functional Analysis? 3. Conducting a Functional Analysis 4. Self-Management Planning 5. Introduction to Problem Solving 6. Effective Problem Solving 7. Drug Refusal Skills Training 8. Seemingly Irrelevant Decisions 9. Coping with Thoughts about Using 10. Awareness of Negative Thinking 11. Managing Negative Thinking 12. Managing Thoughts about Using 13. Managing Negative Moods and Depression 14. Decision-Making Skills 15. Increasing Self-Confidence in Decision-Making 16. Introduction to Assertiveness 17. How to Express Oneself in an Assertive Manner 18. Introduction to Giving Criticism 19. Steps for Giving Constructive Criticism 20. Receiving Criticism 21. Giving and Receiving Compliments 22. Communication Skills 23. Nonverbal Communication 24. Social Recreational Counseling 25. Attentive Listening 26. Sharing Feelings 27. HIV and AIDS 28. Sexually Transmitted Infections (STIs) 29. Sexual Transmission of HIV and STIs 30. Drug Use, HIV and Hepatitis 31. Identifying/Managing Triggers for Risky Sex 32. Identifying/Managing Triggers for Risky Drug Use 1. Vocational Counseling 2. Financial Management 3. Insomnia 4. Time Management 5. Introduction to Relaxation Training 6. Progressive Muscle Relaxation Training 7. Progressive Muscle Relaxation Generalization 8. Introduction to Anger Management 9. How to Become More Aware of the Feeling of Anger 10. Coping with Anger 11. Relationship Counseling – Part 1 12. Relationship Counseling – Part 2 13. Relationship Counseling – Part 3 14. Hepatitis 15. Alcohol Use and risk for HIV, STIs and Hepatitis 16. Getting Tested for HIV, STI and Hepatitis 17. Finding More HIV, STI and Hepatitis Information 18. The Female Condom 19. Negotiating Safer Sex 20. Taking Responsibility for Choices 21. Birth Control Use and HIV and STIs 22. Living with HIV: Communication Skills for Disclosing HIV Status 23. Living with HIV: Drug Use and Immune System 24. Living with HIV: Managing Treatment and Medications 25. Living with HIV: Daily Routines to Promote Health 26. Living with Hepatitis C: Coping Skills 27. Living with Hepatitis C: Managing Treatment, Promoting Health 28. Naltrexone 29. Limited Alcohol Use 30. Alcohol and Disulfiram • 32 core modules and 30 optional modules • Each module intended to last ~20-30 minutes with real-world use suggesting average completion time of ~10 minutes • Content presented as a mix of video, audio, and still images reSETTM and reSET-OTM are not available for sale in the USA
- 35. Tracking feature forself-report usage, cravings and triggers
- 36. Rewards for completinglessons and answering questions (Contingency Management) All rewards are of nominal value with average monthly reward of ~$30 Behaviors are rewarded with opportunity to win monetary prizes in two ways: 1) by completing a set of proficiency questions, and 2) a clinician-entered clean urine drug screen result The patient receives the ability to spin the prize wheel to determine whether digital badges or monetary rewards will be awarded Monetary rewards are automatically added to a rewards card the patient receives during enrollment
- 37. Clinician-facing dashboards features:Lesson progress
- 38. Clinician-facing dashboards features:Cravings and Triggers
- 39. Clinician-facing dashboards features:Abstinence and appointment compliance
- 40. reSETTM: Patient-facing features Confidential-do not distribute 40 Cravings & Trigger Assessments Mobile Dashboard Fluency Training CBT Modules Contingency Management Patient reSETTM and reSET-OTM are not available for sale in the USA
- 41. Overview of FDASubmission Process Pre-submission filing and meetings Acknowledgment of receipt QMS Established SOPs Written and Authorized SOP/QMS Training Administrative information document Introduction & Summary of Regulatory History Regulatory History: responses to FDA feedback Proposed Indications for Use Device Information and Summary - SRS – Software Requirements Specification (82) - SDD – Software Design Description Change Summary Between PreSub and De Novo device description Classification Summary Classification Recommendation Proposed Special Controls (for Class II devices ONLY) Supporting Protocols and Data (9 additional documents with 31 Appendices) Summary of Benefits Summary of known and potential risks to health Risk and mitigation information (5 with FMEA and DFUs for clinicians and patients) Benefit/Risk Considerations Device Labeling – 3 levels of labeling negotiations V&V – Validation and Verification (all content and aspects meticulously tested and retested with every new build) 41
- 42. Confidential- do notdistribute 42
- 43. Dose Response Curve Confidential-do not distribute 43
- 44. Multiple choice andfill in the blank questions are asked at the end of each lesson to ensure understanding Multiple Choice Example Fill in the Blank Example Which of the following is not a goal of attentive listening? a. letting a person know you are listening to them b. letting a person feel like you are listening c. making a person hurry to finish what they are saying d. building trust with the person who is talking “I must do this task perfectly without making ANY mistakes”, is an example of which type of negative thinking? a. black-and-white thinking b. positive thinking c. self-putdown d. perfectionism All of the following are goals of attentive listening except _________________. a. showing a person you are listening to them b. gathering information c. talking only about things that interest you d. building trust with the person speaking Avoiding eye contact when a person is talking to you is an example of poor_____________. a. verbal skills b. active listening skills c. inactive listening d. distraction • Approximately 5-10 questions follow each CBT module • Repetitive nature of questions developed from Fluency Training techniques • Patient must answer all questions correctly in order to advance to the next module • Missed questions are recycled back into the queue and asked again
- 45. Reframing One’s Storywith CRAFT Confidential- do not distribute 45
- 46. Neurologists have Proventhat Humans are Wired for Story Research shows that STORY: • Provides superior retention (memory and recall) • Provides improved understanding • Creates context and relevance • Creates empathy • Makes readers/listeners pay attention • Enhances the creation of meaning Story and Your Brain
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- 48. 1. CHARACTER 2. CHARACTERTRAITS 3. GOAL 4. MOTIVE 5. CONFLICTS/PROBLEMS 6. RISK & DANGER 7. STRUGGLES 8. DETAILS Order ResoluMon Chaos Disruption Conflict/Struggle Hero’s Journey The Eight Essential Elements
- 49. PROJECT 28 DAYS UIUX/ Story world Aesthetic 90s action movies / GTA III illustrations
- 50. Grand Theft Automeets the SIMS Confidential- do not distribute 50
- 51. Characters, Goals, Motives,Conflicts, Struggles…. Confidential- do not distribute 51 r the right or wrong answer is selected. When the pl priate response to enhance in the moment learning. B C
- 52. Details = Engagement Confidential-do not distribute 52 ed. When the player choses incorrectly, the oment learning. C
- 53. Options and Opportunities Confidential-do not distribute 53 scrolled from side-to-side to show the 3D city and its locations. Once a location has been selected, a character will deliver module content with voice and animated movements. The "!" symbol shown in Figure 3B indicates that the character can be tapped to present the next content sequence in the module. O&O will also utilize fluency training following most modules with characters presenting questions about the lesson content (Figure 3C). Tapping the "?" symbol will prompt the character to ask the next question. The list of multiple choice question answers on the bottom of the screen will be selected by tapping the screen, prompting a specific reaction from the character based on whether the right or wrong answer is selected. When the player choses incorrectly, the character will explain the appropriate response to enhance in the moment learning. Figure 5. A comparison of reSET (left) and O&O(right). A. The home screen. Modules can be accessed in the different “locations” within O&O. B. Example of module content delivery. The “!” symbol indicates that the character can be tapped to present the next sequence of module content. C. Fluency training sample question. Tapping the "?" symbol prompts the character to ask the next question while tapping an answer from the list below prompts a reaction from the character showing a right or wrong answer. O&O will be played by exploring the city locations, learning the lessons presented at each location by the characters there and successfully completing the fluency training tied to each location. Gameplay will follow a linear progression and successful completion of prescribed modules will be required to advance to new locations and modules. Like reSET, O&O modules will be designed to take 20-30 minutes to complete. Players will earn virtual reward items such as keys, badges, and prize wheel spins, using the contingency management system developed for reSET. Rewards will be provided for making good choices, module completion, prefect proficiency A B C • Story and progress • Balanced rewards and realistic/understandable outcomes • Social and meaningful interaction
- 54. Serious Games ina Regulated Environment • Bring best practices to new worlds • Work with existing structures and mores • Enlist the early input of experts – both domain experts and systems experts • Push the envelope • Build great Games for Good Confidential- do not distribute 54