Pioneering Ideas

A Model for Equity in Specialty Care, Part IV

The Pacific Vision Foundation, with support from the Pioneer portfolio, is piloting a new clinic in Northern California that will provide the same level of specialty care and other services to all patients regardless of ability to pay, while maintaining sustainable profit margins. Over the last week, David Green and David Roe, two of the project’s leaders, joined Pioneering Ideas to discuss the inspiration and behind their work and the challenges and implications. Below, find out why they believe the Pacific Vision Foundation might serve as a valuable model as the national health reform dialogue plays out.

 

What do you see as some potential long-term implications for health care?

David Roe: One of our marching orders was make this work within the existing system, not assuming or banking on any change from health care reform.  Within the existing system, the implication of success in ophthalmology would be that the same approach could work in other medical specialties – particularly ones that use repetitive procedures that take lots of expensive equipment – so that the more patients you put through, the higher the efficiency you can get. Cardiology, for example, certainly comes to mind. And of course, if health care reform does increase support for low-income patients, the economics of this approach will only get better.

 

A Model for Equity in Specialty Care: Part III

Last week, in Part I and Part II of our series, David Green and David Roe discussed the business model for the Pacific Vision Foundation, a self-supporting eye care center in San Francisco that will provide equal service to paying and non-paying patients. Today, they join us to discuss some of the challenges they face let us know when they expect this operation to be up and running.

What have been some of the major challenges in moving this forward?

David Green: In India, there are many procedure-oriented specialties or subspecialties in medicine that have a self-financing model, where it’s basically the same procedure performed over and over again, where you have para-medicals trained to do just a few things rather than many, and that helps bring the cost down. So how do you have the right clinical and business model combined with more affordable consumables in a procedure? It all adds up to how you source your goods, how you train your people, how you acquire and organize your patients.

David Roe: Given the legal differences and the very different regulatory structure for medicine between the United States and places where this has worked before, as well as the very different income expectations, it was natural to question whether this can work here in the U.S. The answer is, while there are some serious challenges, nothing in the law, business structure, or medical regulations stands squarely in the way. The big obstacle is the notion that since it’s never been done here, it can’t be – the intellectual inertia, or gut inertia. You can’t point to this city or that city and say, “There’s your example.” A lot of our work is to help overcome that inertia. Once you’ve done one, then it’s much easier to recognize that it’s doable.

A Model for Equity in Specialty Care: Part II

Yesterday, David Green and David Roe discussed the inspiration and history behind their work to create a self-supporting eye care center in San Francisco that will provide equal service to paying and non-paying patients. Today, they join us to discuss the business model of this project. Visit Pioneering Ideas again on Tuesday to learn about some of the challenges they face and when they expect this operation to be up and running

 

What is the business model for the new clinic you are creating?

David Green: The notion that this kind of specialty care can be provided in a self-sufficient business model is very attractive and compelling, but also sounds impossible. I think the main obstacle is that by serving low-income people, doctors initially think that somehow they’re going to make less money. What actually happens in practice is that they make more money as the practice becomes more like a hybrid model, where the volumes are higher, costs are lower, and margin is greater per surgery. I’ve seen many instances where the work to reach lower-income strata helps to bolster overall profitability and also the amount of money going into the pocket of those involved. It’s quite counterintuitive to think that if you serve low-income people that somehow you’re going to make more money, but that’s in fact what’s been going on. 

Debra Lieberman on Health Games Research’s new Call for Proposals

Today, Health Games Research released their second Call for Proposals: Health Games Research: Advancing Effectiveness of Interactive Games for Health. We will wrap up our week-long conversation with Debra Lieberman, Ph.D., director of Health Games Research, with a discussion about this new funding opportunity.

Debra, can you tell us about the types of grants that will be available through this Call for Proposals?

The focus of the Call for Proposals (CFP), both during the first round of funding and now, is on research that will discover principles of health game design. This year the funding limit is higher: $300,000.  The money must be used primarily for research and only a small percentage of the grant – no more than 25 percent of the funding – is permitted to be used for developing game software or technology that will be used in the study   Also, like last year, the research must focus on a physical activity game that motivates people to get up and move, and/or on a self-care game that motivates people to engage in prevention, lifestyle improvement, self-management of chronic conditions or adherence to their treatment plan.  As we saw last year, these guidelines keep the program focused, yet they are not so restrictive that we don’t see a wide range of research issues addressed, game platforms used, game genres, research questions or study populations in the funded projects.

Are there specific things that you’re looking in this round of grantees?

We are looking for projects that focus on physical activity games and self-care games. The games may appear on any platform, with any genre, but they must be well designed and have theory or evidence demonstrating the game’s effectiveness.   

How can people learn more about this funding opportunity?

The complete Health Games Research Call for Proposals is available at http://www.healthgamesresearch.org  Additionally, there will be two optional web conference calls for potential applicants on February 11, 2009 (3 p.m. ET) and February 19, 2009 (4 p.m. ET).  Proposals are due by 3 p.m. ET on April 8, 2009. The conference calls are great opportunities for potential applicants to learn more about the program and to ask questions about the CFP requirements.

 Are there any tips you want to share with potential applicants?

The best tip I can give is to encourage applicants to read the Call for Proposals carefully and make sure that all the criteria and requirements have been met. Make sure your research team has the skills required to carry out the proposed project and that you are realistic about the budget and time line. Be sure to provide a good theory-based justification for your research plan, too. What are your hypotheses? Are they based on any theoretical knowledge and findings that already exist, and how are you taking your study to the next level? And be sure to include a dissemination plan for your work and explain how your findings will help us improve health games in the future

Thanks so much to Debra for taking the time to talk with us.  Health Games Research is taking on some really exciting work and we look forward to following the progress of the project's grantees. 

More from our conversation with Debra Lieberman

Today, we continue our discussion with Debra Lieberman to learn more about the Health Games Research national program and the work of the program's twelve grantees.

Debra, can you give us an update on the first round of grants?

We selected 12 grantees in the first round of funding for Health Games Research last May. The 12 grantees, awarded up to $200,000 each, are leading one- to two-year studies of games that engage players – ranging in age from eight to 98 – in physical activity games or games that motivate them to improve their self-care.  For example, our grantees at the University of Southern California are testing the role of social support and coaching, delivered on line, in improving and maintaining a healthy lifestyle. They have developed a game that uses players’ friends and family as coaches.

A team at the University of South Carolina is looking at physical activity games, such as Dance Dance Revolution and Wii Fit, as therapy interventions for people who have had a stroke. Many patients receive physical therapy for a set period of time after a stroke, but there is a need for continuing physical therapy after the initial therapy sessions are done. Perhaps there is a game-based solution for ensuring ongoing therapy for stroke patients.

A team from the Maine Medical Center is investigating family interactions around the popular dance pad game Dance Dance Revolution with families that have at least one overweight child. The grantees are asking the questions, how do family interactions affect the child’s physical activity and what effects does the child have on the family’s activity? 

What has surprised you about the first round of grantees?

I’m not surprised, but I’ve been very pleased at the diversity of grantees’ areas of expertise and populations of focus. Many of our grantee research teams include medical experts, game designers and researchers so they are well equipped to develop powerful, effective health games.  The populations they are studying range from children to seniors, from people dealing with addictions and substance abuse to those dealing with chronic conditions. One of our grantees is studying seniors’ responses to stationery bikes that enable them to bike through virtual worlds. Another grantee is developing a game to motivate Cystic Fibrosis patients to engage in respiratory exercises and to inhale their medications.  So, I’m very pleased with the variety and scope of these projects and I should add that we are learning a lot from all twelve grantees.

How will Health Games Research impact health and health care in the short term, and in the long term?

At Health Games Research, we are working in the short term to help build the field by supporting high-quality research that will lead to the creation of impactful games. We want to build interest in the creation and use of health games, and we want people to see how much learning, understanding and behavior change can be stimulated by a fun, exciting, well-designed game.

In the long term, we will provide research findings and resources that will enable many more people and organizations to design and produce effective health games – especially on some of the newer game technologies.  For example, games can now receive input from sensors and monitors, such as GPS devices that identify players’ geographic location, accelerometers that record how much walking they have done that day and heart rate monitors that report aerobic activity.  What fun to integrate these kinds of data into the state of a game, with an eye toward health promotion and behavior change! 

I also expect to see our research influence the design of mobile health games and games delivered on electronic toys or robots. Almost any interactive technology could provide a health game if designed with a little creative ingenuity and a solid foundation of theory, evidence, and understanding of the way people respond to games cognitively, emotionally, socially and physically. I believe that our research will lead to better game design and by engaging the health care community, policy-makers and game designers in this effort, our program will potentially lead increase the uses and effects of games for health behavior change.

Tomorrow, we will post the last part of our interview with Debra in addition to the new Call for Proposals being released by the Health Games Research program.

Talking with Debra Lieberman: Building the research on how games improve health

Today, we continue our discussion with Debra Lieberman to learn more about how Health Games Research is working to advance the research and design of health games and is contributing to building the health games field.

Debra, yesterday you introduced us to Health Games Research and its efforts to build the research for the health games field. Today, can you share any examples of games that highlight the potential for games to improve health?

Two games, both that I helped design, come to mind.  The first is Packy & Marlon.  Made for the Super Nintendo platform in the mid-1990’s, Packy & Marlon is a diabetes self-management game that was designed to reduce the stigma of diabetes among children and teens, increase their diabetes knowledge and self-care skills, foster communication with family and friends and improve self-efficacy for diabetes self-management.  The game centers on two diabetic elephants, Packy and Marlon, who arrive at diabetes summer camp and discover that rats and mice have marauded the camp and scattered all the food and diabetes supplies.  Players, taking the role of the two elephants, must search through the mountains, rivers, forests, playgrounds and haunted cabins to find these items, select a balanced diet of three meals and three snacks a day, measure their blood glucose and take insulin. 

We conducted a clinical trial with diabetes outpatients, ages 8 to 16. Participants were given a Super Nintendo console and were randomly assigned to receive Packy & Marlon or an entertainment video game that had no health content.  After six months of having the game at home, there was no change in number of annual diabetes-related urgent care and emergency room visits among the group that received the entertainment game. We found that the treatment group that received Packy & Marlon reduced their urgent care and emergency room visits by 77 percent.

 The second Nintendo game I helped design is the asthma self-management game, Bronkie the Bronchiasaurus.  In this game, players take on the role of Bronkie, a male dinosaur, or Trakie, a female dinosaur,  who are trying to save their planet and recover a mighty wind machine that keeps away deadly dust. The characters have asthma and the player must guide them through the game where they have to avoid asthma triggers, such as dust, pollen, smoke, furry animals, and sneezer characters who intermittently sneeze out cold viruses.  Players must check their character’s peak flow (breath strength) and take medications if they have bumped into too many triggers.  The asthma-related activities in the game provide almost unlimited opportunity to rehearse asthma self-management skills. The game was tested in clinical trials and found reductions in player's asthma-related urgent care and emergency visits of about 40 percent. The game also reduced children’s missed school days and parents’ missed workdays due to their child’s asthma by about 40 percent as well.

Another well known and well-researched health game is the cancer education game, Re-Mission. Designed to explore the inside of various cancer patients’ bodies, the player takes the role of a nanobot named Roxxi, who blasts away cancer cells with chemotherapy and delivers other treatments to the patient. Clinical trials found that the game increased cancer patients’ cancer knowledge, self-efficacy for cancer self-care, and adherence to one’s treatment plan.

How are you hoping to engage health care providers and game developers in the work of Health Games Research and its grantees?

Health Games Research aims to improve the quality and impact – and of course, the quantity – of basic research that will help us understand how people respond to specific features of health games cognitively, emotionally, socially and physically. This will help us discover principles of health game design to use in developing future games. We want this research to stimulate more interest and involvement in the field, and to set high standards of quality for research and for health games.      

We know that health care providers want evidence that treatments they recommend to their patients are efficacious—that they work. If a health care provider is going to prescribe a game to their patients, or implement games in their clinics, they’re going to want to know if those games work, include current medical information and were designed with state-of-the-art techniques. They need data in order to take a game seriously.  To engage health care providers, we must be able to respond to their requirements for data and evidence regarding a particular game’s effectiveness and, more generally, we must be able to show them the wide variety of health games and their benefits and clinical outcomes as evidenced in research so far.

This type of research is essential in the health care industry, but it is usually not required in the game publishing industry, so it is our job to demonstrate the benefits of applying research toward the design and production of games meant to change health behaviors.   We want to encourage game developers to invite researchers and behavioral health specialists to be part of the design team, even at the earliest stages of game design, to help determine the goals of the game and to use theory and research findings as the basis for health-related design decisions. Without dampening a game’s creative spirit and uniqueness, the goal is to integrate game design elements that are known to improve health.

Check back tomorrow for part three of our interview with Debra Lieberman and an update on the work of the current round of Health Games Research grantees.

Conversation with Pioneers: Debra Lieberman

This week, as part of our Conversations with Pioneers series, we talk with Debra Lieberman, Ph.D., Director of Pioneer’s Health Games Research national program.  Debra is a lecturer in the Department of Communication at the University of California, Santa Barbara, and also a researcher in the university’s Institute for Social, Behavioral, and Economic Research (ISBER).  Her research focuses on process es of learning with interactive media, especially in the areas of health communication, interactive games for learning, and children’s media.

This Thursday, January 15, Health Games Research will release its 2009 Call for Proposals. The CFP will provide an opportunity for universities, government agencies, medical centers and nonprofit organizations to submit proposals for research projects that will investigate how health games can be designed and used to improve players’ health behaviors and health outcomes.

We thought this would be the perfect time to check in with Debra to learn more about the program, the first round of grantees and her expectations for Health Games Research’s new grant solicitation. We will feature our conversation with Debra here on the blog over the next few days.

Debra, can you tell us a little bit about the background and mission of Health Games Research?

Health Games Research is a national program of the Pioneer Portfolio aimed at advancing the research and design of digital games intended to improve people’s health. About $2 million was awarded to 12 grantees in the first round of funding in 2008, and our second round of funding – awarding roughly another $2 million – will be announced this Thursday.

Our mission is to improve the quality and impact of interactive games that are designed or used to improve players’ health-related behaviors and outcomes.  To reach this goal, we support research that will identify evidence-based principles of health game design, which can then be implemented in future health games.  Our current grantees are investigating a variety of design principles involving, for example, (1) how best to provide performance feedback, from a game and from other people, to players who are trying to improve their eating habits; (2) methods for engaging players in interactions with fictional characters and immersing players in a compelling story, to motivate them to get more physical activity; and (3) strategies for using an “exergame” such as Wii Fit or the dance pad game Dance Dance Revolution to help stroke victims develop better balance and range of motion.  In addition to awarding and supporting grants, Health Games Research provides information and resources related to health games, and serves as a champion for and builder of the field.

How did you become involved in the health games field?

I have always been passionate about the use of media for learning and behavior change. I have worked in this area for 35 years, beginning with educational television, when I worked and trained with the Sesame Street researchers and producers while studying at the Harvard Graduate School of Education in the early 1970s. There, I learned about the Sesame Street approach to designing educational media, which integrates researchers into the design process. In this approach, there is respect for both the art and the science of media design. The creative team is free to be creative and the research team contributes its expertise about the capabilities and interests of the audience, and how they learn, and it conducts research during the formative stages of design to make sure the audience is learning.  Together the team develops a product that is not only entertaining and fun, but also evidence-based, field tested, and educationally effective.

I worked in educational television in the ‘70s, and in the ‘80s I worked in educational software and got my Ph.D. in communication research at Stanford.  After a short time teaching at Indiana University, my life circumstances brought me back to Silicon Valley where, in the early ‘90s, I became involved in health games, joining a company as their VP of research to help them figure out how to design Nintendo games that would improve players’ prevention and self-care behaviors in areas such as diabetes, asthma, and   smoking prevention. This work brought together so many of my interests in learning, behavior change and interactive media in ways that could potentially make a difference in people’s lives.  And our games were successful!  Our diabetes self-management game, Packy & Marlon, reduced players’ diabetes-related urgent care and emergency visits by 77 percent. 

Why Games?

As I see it, games are the most interactive form of media we have today. A good game gives players a great deal of control, more than many other forms of interactive media, and feeds back information to players about all the actions they have taken and choices they have made. Games engage players by offering a challenge to reach a goal, and players often get hooked on that challenge, striving to get a better score, trying to get their character to the next level, or developing strategies to beat their opponent or whatever it is that really gets them involved…it’s that challenge! Interactive games are popular because they are deeply engaging.  These days, we spend more money on games than we do on movies. And people willingly spend a lot of their leisure time playing them. This is where many people live, and it is in an incredibly interactive and rich environment for learning, skill development, skill rehearsal, and other activities that, when well-designed – remember the Sesame Street approach – can motivate and support significant health behavior change.

Check back tomorrow for the second part of our interview with Debra.

About Debra Lieberman

Debra Lieberman, Ph.D., is a communication researcher at the Institute for Social, Behavioral, and Economic Research at the University of California, Santa Barbara (UCSB).  Her research focuses on processes of learning and behavior change with interactive media, with special interests in interactive games, health media, and children's media.  At UCSB, Debra directs the Health Games Research national program funded by the Robert Wood Johnson Foundation’s Pioneer Portfolio to advance the design and effectiveness of interactive games intended to improve health.  Debra has published widely and she consults for health organizations, education agencies, and media and technology companies to help design and evaluate interactive media for entertainment, learning, and health.

Wrapping up with Candice Kane

Today, we wrap up our conversation with Candice Kane of CeaseFire with a look at how workers are responding to trainings in Second Life and some thoughts on the potential for virtual worlds to help advance the violence prevention field in addition to other community health interventions.

 

How has your staff responded to these new trainings in Second Life?

The workers have responded very well. The beginning was a bit bumpy. We brought in a small group of workers that really didn’t know anything about computers and had no concept of virtual worlds. So the initial response was a little bit skeptical, I think they were concerned that they wouldn’t be able to do it, and we had a couple folks who struggled early on. By the end of the first training, they all said, “This is really cool. I really want to learn this. I want to do this.” And for those that had any computer sophistication at all, they were off and running in an hour’s time. They were doing all kinds of things with their avatars -- changing body shapes, outfitting their virtual selves. Some even went a bit overboard with their virtual bling. We had to remind them that you can’t be out on the streets, real or virtual, with all that flashy jewelry. So for them it’s fun. It’s entertaining. And it is giving them the opportunity to develop not only the violence prevention and mitigation skills they need for the job, but also computer skills and problem solving skills.  It has also empowered the staff to take ownership of the training. In fact, one of our violence interrupters has volunteered to take the lead on training other workers. So, we are excited to see the peer-to-peer training that virtual world enables.

 

 

An image of a violence interrupter practicing in Second Life.

 

Where do you hope to go with Second Life? 

Right now we are just using Second Life for training with our Chicago team, but we are looking to get Baltimore and other cities up and running soon.But more than that, we see enormous possibility for how we can use Second Life to empower individuals and to prevent violence.

Elena Quintana, who heads our evaluation unit, has her doctorate is in psychology. As a clinical psychologist she talks a lot about social distance, and the social distance that both our workers and our clients have to cover to become part of mainstream society, even to reach just the fringe of mainstream society. I think Second Life really offers us some potential there, because there are a lot of things that our workers and clients don’t have experience doing – things that are unfamiliar to them. And when you’re 25, 30, 35, you’ve been in prison for 15 years, you’re just coming back, and you don’t know how to get your own apartment, you don’t know even how to take public transportation, you don’t know how to do things that an 8 or a 10-year-old kid can do, there’s a reluctance to admit it. We’ve talked about doing things in Second Life that are self guided, so that someone can go in and practice certain skills without needing a supervisor or co-worker to be present. And if we can get to that point, then that really opens some doors for people, where they don’t have to admit that they don’t know how to do things. I’m also exploring to see if there are ways we can do more literacy training and job training – like having our workers practice doing job applications on line. We really see Second Life as a portal to so many skill development opportunities.

Is there anyone else in your field that is already or considering using Second Life?

I’m not aware of anybody. We did a presentation at the Second Life conference last summer, when we were just getting into this. We had some still images and a two-minute video to share.  There were a lot of folks that came up to us and said, “Wow, this is really cool. Keep us posted.” But there were not too many social service types. As I’ve been out and about, I’ve been talking about it with other groups, and there is a lot of interest out there. We have seen interest from some organizations that are exploring how to use virtual worlds to provide counseling to people who are sexually assaulted. I think that there are some real opportunities for victim services and other areas. It’s just a question of helping them understand the technology and then overcoming some financial hurdles, which are really not as substantial as they would’ve been some years ago.

Thanks so much to Candice for taking the time to talk with us.  It is clear that CeaseFire is out in front of leveraging the use of virtual worlds to drive social change and we are so excited about the work they are doing and the results they are achieving.

More on Second Life from Candice Kane of CeaseFire

Today we continue our discussion with Candice Kane of CeaseFire to learn more about how their organization is using Second Life to train outreach workers and violence interrupters as part of a national effort to prevent violence.

 

How did you make the connection between your training efforts and Second Life?

A couple years ago, we were tossing around the idea of doing some type of CeaseFire game.  A couple of us had the opportunity to participate in a regional Games for Health meet-up in California where we learned a little bit more about how games were being used to promote health.  We talked with Ben Sawyer about our interest in using games to prevent violence; he was excited that we were thinking about games, but encouraged us to think more about what were going to do with the game, what we wanted to accomplish and what would be the potential challenges. We brought these ideas and questions back to our colleagues at the Center for the Advancement of Distance Education (CADE) here at the University of Chicago and someone said, “Have you thought about Second Life?” Given our interest in using games or interactive technology for training, a number of folks felt it would be a good fit.  

 

The first time I got a look at Second Life, I thought, wow, this is a great opportunity for us to create a forum where people can practice violence interruption. Conducting CeaseFire training sessions around the country is really cost prohibitive for us, but we saw quickly that Second Life would enable us to reach a broader audience and train workers in a safe and engaging environment.

What went into the development of your space in Second Life?

At this point, we have two islands in Second Life. CeaseFire Island was our first project. The initial challenge was to develop an environment that replicated the look and feel of the Chicago neighborhoods where CeaseFire was focused. Working with the developers at CADE, we went into our neighborhoods and took pictures of the houses, buildings and streetscapes.  The developers we worked with were terrific, but I remember seeing the first designs and saying, “This is too clean. This is too neat. We’ve got to mess this up. We need litter. I want graffiti. I want to board up some of the buildings.” The creative team looked at me like, “You want to mess up my building?” “Yes!” It was very important to me that the Island look like the neighborhoods where we spend our time, and our neighborhoods are messy.  So we spent a lot of time to get the look right, and now we even have a backdrop of the Chicago skyline. Our second island, CeaseFire Isla is adjacent to CeaseFire Island and is largely Latino in look and feel.

 

The pictures below show how the CADE developers and CeaseFire team used neighborhood photos to develop sketches that eventually led to a realistic virtual world.

 

 

 

Check back tomorrow for the last part of our conversation with Candice. And to learn more, be sure to visit the CeaseFire website at www.ceasefirechicago.org.

Conversation with Pioneers: An interview with Candice Kane

This month we continue our Conversation with Pioneer Series with Candice Kane, the chief operating officer of the Chicago Project for Violence Prevention and the organization’s CeaseFire initiative. CeaseFire, which is funded through the RWJF’s Vulnerable Populations Portfolio, works with community-based organizations and focuses on street-level outreach, conflict mediation, and the changing of community norms to reduce violence, particularly shootings. Launched in 2000, CeaseFire treats violence like a public health epidemic that can be prevented.  The program engages the community to work with people at high risk of being involved in violence to provide on-the-spot alternatives to shooting and change social norms about gun violence. A recent evaluation of the program has demonstrated its effectiveness in reducing the size and intensity of shooting hot spots in targeted Chicago neighborhoods.

Susan Promislo blogged about CeaseFire over the summer and highlighted the organization’s use of virtual world tools and techniques to advance their anti-violence mission. We were fortunate to have the opportunity to talk with Candice Kane further about their use of Second Life and their innovative approach to training outreach workers and violence interrupters.

What role does Second Life play in your anti-violence efforts?

Perhaps the most vital component of CeaseFire are the violence interrupters and outreach workers. These are street-smart individuals, many of whom are former gang members, who give back to their neighborhoods by mediating high-risk conflicts and reducing violence – specifically shootings. There are three areas that our outreach workers and violence interrupters need to master to be successful in their work. They have to be able to identify and engage clients; they have to be able to relate to the community; and they have to be able to mediate and resolve conflicts, anticipate retaliatory action and intervene before something happens.

When we started training our outreach workers and violence interrupters, we were using a lot of role playing to simulate the situations they would need to mitigate. It was clear that for some people, approaching and talking to strangers was difficult and intimidating, understandably. Our outreach workers are very effective with people they already know and most of our workers know many of the people in their community. However, there are going to be occasions when our outreach workers and violence interrupters need to approach people they don’t know or need to approach people in threatening situations, and we wanted to help them build their confidence for these types of interventions.

We’re trying to make Second Life a core component of our training for violence interrupters and outreach workers. It is a safe environment that lets the workers navigate these types of interactions and practice approaching strangers or threatening situations.

What has been the value of moving to a virtual world for training?

Most of our violence interrupters and outreach workers are former gang members. Most of them have been in prison for violent crimes and some have served more than 20 years in jail. As you might expect, many of them don’t have formal employment experience. Their reading and comprehension skills vary from the 6th-8th grade level to college level; most they don’t write a lot and, since they don’t work with computers on a regular basis, are not computer literate.

So, it is no surprise that it is not practical for us to use written materials in our trainings. It means that our trainings need to focus on learning through doing, not reading or even through oral presentations. Our outreach workers have to observe, they have to do it own their own, they have to practice and get feedback on how to improve. Second Life has given us the space for that practice and that doing. And more importantly, it is fun for people, especially if you give them a few Linden Dollars so they can go out and buy their own outfit.

Can you share some examples of what happens on CeaseFire Island?

Second Life gives the workers a chance to practice different scenarios. Their worker’s avatar might need to approach a young guy, played by a CeaseFire staff member, who is on the streets dealing drugs, waiting for his next buyer to come by. The worker might have to deal with a hostile response if the client feels the worker is interfering with a potential sale. The interaction gives the worker the opportunity to think about the whole process of approaching someone. What signals do you look for? What do you have to be aware of, in terms of what’s going on around you? What if there are three people standing together and they seem to be in a conversation? Or if it’s a heated conversation, would you even walk up to them? Why would you walk up to them? Why wouldn’t you walk up to them?

We have a scenario where we actually have done some filming and we show somebody taking the brochure, and then throwing it on the ground and going, “I don’t need this shit.” How do you handle that? What do you say? What do you do? How do you know when you may be threatened? So Second Life gives us the opportunity to play out those scenarios and then debrief on what worked and what didn’t.

We also put a lot of effort into helping our clients rethink their life and their behaviors so there are structural and cognitive behavioral changes that we’re looking for, things like getting a job or seeking help to kick a drug habit. It is important for our workers to think about how they help others solve problems. There’s a temptation with our workers, and probably most of us, to immediately go to solutions. Someone says, “I need a job,” and so the inclination is to say, “Well, I know they’re hiring over at the store on the corner, why don’t you go over there tomorrow and put in an application?” Well that’s not what we want the workers to do. We want them to be a coach, an advocate who will help the client understand why they want a job, what type of job and help them acquire the skills they will need to be successful at a job.

Check back tomorrow to hear more about how the outreach workers and violence interrupters are using CeaseFire Island and have responded to trainings in Second Life.

About Candice Kane: Candice M. Kane, Ph.D., J.D., is the Chief Operating Officer of the Chicago Project for Violence Prevention, a strategic public health initiative to support community-based and city-wide violence prevention. Her responsibilities with the Chicago Project include day-to-day oversight of all program activities, including those related to CeaseFire, the campaign to stop shootings and killings, and evaluation. In addition to her management duties, Dr. Kane is actively involved in the framing and implementation of policy, program development, drafting of program-related materials including training curricula and brief performance reports, and budget projections. Prior to joining the staff of the Project, Dr. Kane was director of a state planning and research agency and part of the University of Chicago team that developed, implemented and tested the Office of Juvenile Justice and Delinquency Prevention Comprehensive Gang Model.