Web-based Game Teaches Coping Strategies After Traumatic Event

Millions of children will likely experience some kind of unexpected traumatic event, from car crashes to natural disasters to medical emergencies. Many will struggle with psychological challenges during recovery, and parents and physicians may not know how to help them cope emotionally after such frightening episodes.

Researchers at The Children’s Hospital of Philadelphia have developed a web-based intervention called Coping Coach that aims to prevent post-traumatic stress in school-aged children by using game-like activities that they can complete independently or with parent supervision. The study team tested its feasibility in a randomized controlled trial of 72 children ages 8 to 12 who had been admitted to the hospital for an acute medical event. The investigators reported positive results in the Journal of Pediatric Psychology.

“It’s a different way of engaging kids,” said Nancy Kassam-Adams, PhD, a CHOP psychologist and associate director of Behavioral Research at the Center for Injury Research and Prevention (CIRP). “We’ve worked hard to build in items that are useful and therapeutic while keeping it fun. It doesn’t substitute for full-blown mental health treatment. This is for the early days after they’ve been through something difficult, and it teaches kids skills to recover well.”

The online tool starts with a short symptom assessment each time a child logs on. Then the child has the opportunity to interact with different characters, including a misunderstood squirrel named General Malaise. “Mwa-ha-ha-haaaa!” he laughs, and then zaps the town, leaving the townspeople without any feelings. The child must identify different emotions in order to advance to the next module.

The other modules also focus on areas that CIRP researchers and others have shown to be important in intervening early to lower the severity of pediatric post-traumatic stress. These include teaching children to recognize helpful or unhelpful thoughts and behaviors and how not to rely on avoidance as a coping response. An underlying theme that emphasizes the value of social support is embedded throughout the game.

“Each module includes carefully selected intervention targets based in empirical evidence on how post-traumatic stress develops in children,” said Meghan Marsac, PhD, a CHOP psychologist at CIRP, who has co-led the development and evaluation of Coping Coach. “We have applied what we know about the treatment of post-traumatic stress to prevention.”

A group of University of Pennsylvania digital media students created an early version of the game as a summer project five-years-ago and gave it a retro, pixelated vibe. A web design firm in Houston then came on board as collaborators and helped to expand the story and make the tool more robust and interactive. The CHOP Youth Advisory Council shared its feedback at various stages of the game’s development.

The latest version of Coping Coach includes a girl who experiences a scary asthma flare-up, a girl who has been in a car crash, a boy who survived a house fire, and a boy who saw his brother beaten up by other neighborhood kids. The game can be expanded to include other characters to address other sudden, distressing situations.

“Children who use Coping Coach may not see their exact experience, but they get a sense of the range of common traumatic scenarios that kids are exposed to,” Dr. Kassam-Adams said.

For the study, the researchers invited one group of children to log in and play the game within six weeks after being admitted to the hospital. A second group was assigned to a wait list and given the same instructions to complete the online intervention activities following a 12-week research assessment. Both groups completed research assessments over the phone at 6, 12, and 18 weeks so that the researchers could track their symptoms and coping skills over time. They concluded that both groups benefited from Coping Coach participation, which suggests its recommended timing can be flexible.

“Depending on the nature of the event, and the child’s physical/medical condition, some children may not be ready or able to engage in an online intervention immediately post-event,” the authors wrote in their analysis.

The next step is to test Coping Coach in a bigger trial, Dr. Kassam-Adams said. In the meantime, the research team is looking at ways to incorporate new features into the game to encourage children to play it longer and return again and again, perhaps reinforcing the coping strategies. About 60 percent of the children who participated in the study finished the game at least once, and they used it for an average of 52 minutes.

Coping Coach also received a pilot research grant from The Children’s Hospital of Philadelphia’s Violence Prevention Initiative to see how well it works for a group of 20 children who experienced a community-violence related injury.

“In our previous evaluation, we have focused on children exposed to unintentional traumatic events,” Dr. Marsac said. “We know that many children also have to deal with trauma resulting from violence, which can bring up unique feelings and challenges. This new research will allow us to examine whether or not the elements of Coping Coach can also be helpful for children experiencing injuries due to violence.”

Once the researchers have enough data to validate Coping Coach’s effectiveness, Dr. Kassam-Adams anticipates that it could be publicly available within the next five years. Since the number of school-aged children who could benefit from a low-cost, web-based post-traumatic stress intervention is enormous, she envisions Coping Coach as a way to fill the gap in resources available to support them during their recovery.

“It could have a huge public health impact on kids exposed to trauma,” Dr. Kassam-Adams said. “They can’t all get in — and not all need to get in — to see a mental health professional. Coping Coach is designed to be preventive. It has the potential to reach so many more kids that even if it helps a little, it will be an important tool.”