SBIR-STTR Award

Recent research on the treatment of first-episode psychosis has documented positive results and hope for better long-term outcomes for consumers and their families. In particular, the NIMH-funded RISE study (Recovery after an Initial Schizophrenia Episode) developed an innovative early intervention. Building on the RAISE project, the Center for Social Innovation, LLC (C4) has partnered with the Research Foundation for Mental Hygiene, Inc. (RFMH) at the New York State Psychiatric Institute and Columbia University to develop and evaluate On Track>An Online Role-Playing Game (On Track>The Game). The goal of the game is to give consumers, family members, and provider's knowledge and skills to improve access to care. After playing the game, young people will be more likely to engage in and follow through with treatment; participate more actively as collaborators in their own care; and become more hopeful about their futures. Designed in the style of an animated, interactive comic book, On Track>The Game includes four main components: 1) role playing scenarios, 2) mini-games to promote self-advocacy skills, 3) practical tips, and 4) stories of hope (video testimonials from consumers about their recovery journeys). Additionally, the game will include an online Family Resource Center that provides concrete information and links to resources for consumers, family members, and other support people. During Phase 1 of this project, we will conduct a small-scale pilot study. Using a convergent parallel mixed methods design, we will use qualitative and quantitative methods to evaluate the product/intervention in order to provide proof of concept for a larger Phase 2 effectiveness study. Quantitative and qualitative data will be gathered and analyzed concurrently, then synthesized into findings that will inform Phase 2. We will recruit a sample of consumers (n=20), family members (n=10), and providers (n=10) from two New York RAISE sites providing care for people who have experienced first-episode psychosis. Quantitative data will be collected through baseline and follow up surveys that utilize instruments with good psychometric properties to measure knowledge and attitudes about recovery, perceptions of stigma, feelings of empowerment, sense of hopefulness, and engagement in treatment. Qualitative data will be collected through 3 focus groups with a subset of participants (6 consumers, 6 parents, and 6 providers); open-ended questions will explore experiences with the game and suggestions for Phase 2 development.

Thesaurus Terms:
Adolescence;Advocacy;Attitude;Behavioral Health;Books;Caring;Data;Design;Development;Early Intervention;Effectiveness;Empowerment;Ensure;Evaluation Studies;Experience;Family;Family Member;Feeling;First Episode Psychosis;Focus Groups;Follow-Up;Foundations;Funding;Future;Goals;Health Services Accessibility;Improve Access;Improved;Innovation;Institutes;Instrument;Intervention;Knowledge;Link;Measures;Mental Health;Methods;Modeling;National Institute Of Mental Health (U.S.);New York;Novel Strategies;Outcome;Outcome Forecast;Parents;Participant;Perception;Persons;Phase;Phase 1 Study;Pilot Projects;Play;Population;Programs;Property;Prototype;Provider;Psychometrics;Psychotic Disorders;Public Health Medicine (Field);Public Health Relevance;Randomized Controlled Trials;Recovery;Recruitment Activity;Reporting;Research;Research Support;Resources;Response;Role;Role Playing Therapy;Sampling;Schizophrenia;Site;Skills;Small Business Innovation Research Grant;Social;Social Stigma;Societies;Staging;Suggestion;Surveys;Testing;Timeline;Tool;Translating;Trust;Universities;User-Friendly;Willingness;Work;

First episode psychosis is a serious mental health condition that affects youth and young adults, often between the ages of 15 and 30. The illness is marked by hallucinations, delusions, withdrawal, poor organization skills, and diminished cognitive and social functioning. Recent research has demonstrated that programs designed to treat people experiencing early psychosis can reduce hospitalization, decrease psychiatric symptoms, improve quality of life, and result in better social and occupational functioning. Despite this promising picture, few tools have been developed to support optimal engagement and participation in care. In response to this need, the Center for Social Innovation (C4) has partnered with researchers at the Research Foundation for Mental Hygiene, Inc. (RFMH); Columbia University; and the University of Maryland School of Medicine (UMSOM) to develop and test OnTrack>An Online Role-Playing Game (OnTrack>The Game, or OTG). Based on cutting- edge practices in serious gaming, OnTrack>The Game offers players the opportunity to experience a community that includes the player's apartment, treatment provider's office, school, work, gym, parks, and a movie theater that shows videos of hope and recovery from real people who have experienced first episode psychosis. Interactions with family, friends, co-workers, and treatment providers allow players to simulate and rehearse real-life situations in a safe, non-threatening environment. To evaluate the impact of the game, this Phase II study involves a mixed-methods randomized controlled trial in which we will recruit 200 young people from first-episode programs in New York State. Participants will be randomized into 1 of 2 conditions: (1) OnTrack>The Game or (2) Recovery Videos (RV), a website that includes information and videos about first episode psychosis (FEP). We will use standardized measures and semi-structured qualitative interviews to achieve the following aims: 1. Refine, expand, and finalize OnTrack>The Game. Building on the Phase I prototype, we will improve functionality, expand the play spaces and levels, add interaction with non-player characters, include more resources on FEP, and expand the library of videos on hope and recovery. 2. Evaluate the effectiveness of a role-playing game (OnTrack>The Game or OTG) in increasing empowerment, decreasing stigma concerns, and improving treatment engagement. 3. Determine if changes in empowerment and stigma concerns mediate the effect of OnTrack>The Game on treatment engagement. Early intervention for psychosis has emerged as an effective way to improve outcomes for young people, yet few tools exist to connect them with supporting treatment providers and to build confidence in their recovery. OnTrack>The Game has the potential to fill this void and to help improve outcomes for young people with psychosis as they strive to build meaningful lives in community.

Public Health Relevance Statement:
Project Narrative OnTrack>An Online Role-Playing Game is an interactive game designed for people who have experienced first episode psychosis. The game provides players with knowledge and skills to address stigma, understand psychosis, and engage in treatment. Through the game's levels, zones, and interactions with friends, family, treatment providers, and the broader community, players develop a greater sense of hope and the possibility of recovery.

Project Terms:
Address; Adolescent and Young Adult; Affect; Aftercare; Age; Antipsychotic Agents; Attention; Attitude; base; Behavioral; Caring; Chronic; cognitive function; Communities; Comorbidity; cost; Delusions; design; Development; Diagnosis; Disease; Disease remission; early experience; Early Intervention; Effectiveness; empowerment; Environment; expectation; experience; Family; first episode psychosis; follow-up; Foundations; Friends; functional disability; Game Theory; Hallucinations; Health Personnel; Hospitalization; improved; improved functioning; improved outcome; indexing; Individual; innovation; intervention program; Interview; Knowledge; Learning; Libraries; Life; Maryland; Measures; Mediating; Medical; medical schools; medical specialties; Mental Health; Methods; Modeling; Morbidity - disease rate; Motivation; movie; National Institute of Mental Health; Neurobehavioral Manifestations; New York; Occupational; optimism; Participant; Pharmaceutical Preparations; Phase; phase 2 study; Play; post intervention; Principal Investigator; Productivity; programs; prototype; Provider; psychiatric symptom; psychosocial; Psychotic Disorders; psychotic symptoms; Quality of life; Questionnaires; Randomized; Randomized Controlled Trials; Recovery; Recruitment Activity; Recurrence; rehearsal; Reporting; Research; Research Personnel; Residual state; Resources; response; Risk; Role; Role playing therapy; Schizophrenia; Schools; Self Efficacy; skills; Small Business Innovation Research Grant; social; Social Functioning; social stigma; standardize measure; Stress; Structure; Symptoms; Technology; Testing; Therapeutic; tool; Unemployment; United States; Universities; web site; Withdrawal; Work; young adult; Youth