Child Study Center Grand Rounds 04.13.21

June 08, 2021

Extended Reality (XR) in Health and Medicine: What is the Reality?

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00:00Welcome everyone. Rebecca Kennedy
00:03and I are delighted to welcome into
00:05today's grand rounds and we'll get into
00:08introducing our speaker in a second.
00:09But I just want to tell you.
00:13Some of the coming events.
00:16How 2 weeks from today?
00:19Very home Wendy Silverman,
00:21who hopefully all of you have met and
00:24then so you happen you will become.
00:27When the who's your friend Mr Professor here?
00:29The Child Study Center is
00:32World world renowned?
00:33Expert in anxiety disorders in
00:35childhood and we're going to hear
00:38from her latest and greatest.
00:40So that's two weeks from today.
00:42One week from today,
00:44we're going to have the 13th annual.
00:47Sam and Lucille Ritvo lecture.
00:50So you saw the whole series of events,
00:54so that's going to be posted.
00:56It goes from Tuesday,
00:58Wednesday, and Friday,
00:59an on Tuesday for grand rounds were
01:01going to have actually right before grand
01:04rounds next week from 11:30 to 12:30.
01:06Our trainees in psychology and
01:08psychiatry are going to be meeting
01:11with our speaker and then the lecture
01:14is going to be from one to two.
01:16As always,
01:17our speaker is Donna Harris.
01:19She is a social work.
01:21Social worker who we met once earlier as
01:25she talked to us about race relations,
01:29racism, anti racism.
01:30And her grand rounds is an important
01:34title and an important topic.
01:36Healing from racial trauma.
01:38So that will be next week,
01:41and then there's going to be more
01:43that evening at the New England
01:46Institute for Psychoanalysis.
01:47She will be talking about racialized,
01:50enactments in the clinical
01:51setting on Wednesday,
01:52again at the New England she will
01:55talk about the impact of racism and
01:57internalized racism on clinical training,
02:00and finally on Friday from three to four
02:03again at the New England Institute.
02:06We'll be talking about racial identity
02:09development in psychodynamic treatment,
02:10and although all of these are between here
02:13and the CHILD Study Center, guess what?
02:15It's pandemic time,
02:16so it's all unzoom.
02:18So if people are interested in joining,
02:20we will make that information available.
02:22And we're very grateful to the Ritvo
02:25siblings we have been supporting us for.
02:2813th year in the memory of their their
02:31parents and are very dear salmon Lucille,
02:33who many of us knew.
02:35So that's the next coming two weeks today.
02:38Rebecca Kennedy didn't know it,
02:40but she's gonna be my.
02:45Something as we introduce today's speaker
02:47and I'm really very excited about the
02:50grounds that we have a plan for today.
02:52Kim Heath check.
02:53Did I pronounce it right, Kim?
02:56Keep she hit yeah he yeah he pia coast
02:59yeah we're working on it Kim hit yeah
03:02and that is the Belgian pronunciation.
03:04His chair is a Dutch pronunciation.
03:07We were talking about this Kim.
03:09I'm just going to call her Kim
03:11and Kim is a colleague who I
03:13have not known for centuries and
03:16decades like many of my friends.
03:18But just for a couple of months.
03:21And we serendipitously met through
03:23the work that we both do in simulation
03:26and she was introduced to me.
03:28By the director of the Pediatric
03:30Simulation Lab a couple of months
03:32ago and that was really the
03:34beginning of a beautiful friendship
03:36and in a wonderful collaboration,
03:38Kim will be telling us today about
03:41the work that she's such a pioneer,
03:44an important person and which
03:46is in games gaming,
03:47bringing games to health in general,
03:49and certainly psychiatry and
03:51Chelsea country in particular today.
03:54And before I let Rebecca say some nice
03:57things about our collaborator and friend,
03:59Kim,
04:00I want to also put another emphasis here.
04:03You know,
04:03we're all child mental health providers,
04:06psychiatrist, psychologist,
04:06social workers.
04:07We know that games play are what
04:10make children children.
04:11You know that is their job description.
04:13They play, they do games.
04:16And it took me to get to this old
04:19age to know that there is such
04:21a thing as gaming for health.
04:24In fact,
04:25if you didn't know that if you
04:27were just as naive and I as I was,
04:29you probably also did know that there
04:31is a journal called Games for Health.
04:34You didn't know that?
04:35Well,
04:35let me tell you what you're in good company,
04:38because the editor in chief of that
04:40journal is with us today and that is Kim.
04:43So before we let we unleash Kim to teach
04:45us and share exciting stuff with us.
04:47Rebecca Committee,
04:48I know I've given you lots of time
04:50to prepare your prepared comments.
04:52OK for Kim, so please take it away.
04:55Thank you Andres and it actually probably
04:57appropriate to be put on the spot
05:00'cause I only have the most wonderful
05:02things to say about Kim knowing her,
05:04even though shorter while.
05:05Then Andre says that was introduced
05:07to Kim recently by Doctor Martin
05:09and in some collaborative efforts
05:11with Lori Cardone as well,
05:12and thinking about building
05:14on our systems of care here.
05:15And I think I've I've learned so much
05:18in such a short period of time with
05:20Kim's work and thinking about how we can
05:23really kind of take this incredible.
05:25Advance work that she's doing in
05:27gaming and apply with a lot of
05:29our evidence based treatments.
05:30An interesting Lee,
05:31and kind of putting a plug.
05:33Thinking about using it with DBT with
05:34some very exciting things forthcoming.
05:36And I think what Doctor Martin had on,
05:38was it as a bit of radical acceptance
05:40on my part of my lack of knowledge in
05:43this area and accepting that this is
05:45where our patients that how we reach
05:47our patients and really thinking about?
05:49How do we reach the populations that
05:51we're working with and so I am could
05:53not be more excited to learn more.
05:55About Kim's working and look forward
05:57to all of our future collaborations.
06:00Thank you, Rebecca Kim.
06:02It's all you know. Alright,
06:04well I hope I can hold up to that.
06:08OK, let me share my screen.
06:24Sorry I gotta get it to the beginning.
06:28Wow, sneak preview. It already looks great.
06:31I'm so sorry. OK, here we are.
06:36So, uh, the talk I'm going to
06:38focus on today is XR in health,
06:40so this is kind of I'm going
06:42to talk a bit about gaming,
06:44but I'm also going to talk about extended
06:46reality in health and kind of like
06:48what is this and what is the reality?
06:50What is the state of XR
06:52in health and medicine?
06:55Just a quick background on me.
06:57I have been here for about
06:59going on 12 1/2 years now.
07:02I'm a research scientist
07:03at the ice cold medicine.
07:05Most recently I'm the director
07:06of our play for Real XR Lab,
07:09which is at the Yale Center
07:11for Health and Learning Games,
07:12and I'm also Deputy director of
07:14the play to Prevent Lab within
07:17the Center and then another hat
07:19I have is that I'm a K12 scholar
07:21at Yale Center for Implementation
07:23Science through the NHS BI,
07:24which has been great.
07:26In terms of thinking about game
07:28based interventions about how?
07:30What are some of those factors
07:32to implementation?
07:33Successfully implementing games within
07:34schools and clinic based settings
07:36and and community settings settings.
07:38So and then most recently this
07:40year I became editor in Chief for
07:43the Games for Health Journal,
07:45which has been just wonderful.
07:47Kim, we're not seeing your
07:49slides. If you want to
07:50share not see my sites.
07:53Let me try again.
07:55Can you see them now, Yep.
07:59OK, so sorry about that.
08:01OK, so so yeah, so I'm going to
08:03give you a little bit background of
08:05some of the games I've worked on.
08:07I'm going to talk a little bit,
08:10give an introduction to what
08:11XR extended reality is and what
08:13it can do in terms of health.
08:15I'm going to give you some examples
08:17of XR in health and medicine
08:19broadly and then talk about two
08:21specific projects that we've
08:23been working on in our lab and
08:25then kind of wrap it up with.
08:27Kind of my my bigger thoughts about kind of.
08:30What is the optimism with games Annex
08:32our technology and then of course
08:35kind of the caution moving forward.
08:42So for the past like I said for the past,
08:46you know over a decade a porch on what a
08:50lot of of game based interventions and
08:53projects as both as a PIN does copii.
08:56So we focused on games around
08:59tobacco use and vaping.
09:01E cigarettes, marijuana use,
09:02alcohol, harm reductions,
09:03HIV STI prevention in minority use,
09:06HIV testing and counseling and teens.
09:09Empowering black teen girls
09:10around sexual health decisions,
09:12bystander intervention and sexual
09:13assault and LGBTQ bullying.
09:15So why games like why?
09:16Why so much effort an interesting games?
09:19Well, in terms of interventions,
09:21and when we think about kids right?
09:23Especially 'cause our games have always
09:25focused on on youth and young adults,
09:28is you know this is?
09:29This is where kids are so.
09:32So let's let's meet them where they are.
09:34Let's let's put our energy into something
09:37we know that they're interested
09:39in and that's that's, you know,
09:41digital health and technology and games.
09:43But beyond that,
09:44it's beyond like the engagement factor,
09:46right?
09:47You know, games can be tailored.
09:49They can be adapted.
09:50Is this wonderful environment in
09:52place for kids to practice skills?
09:54You know when they're in there,
09:56doing it in a safe space, right?
09:58So they can practice again and
10:00again and again.
10:01And if they mess up, it's not a big deal.
10:05We just try something else.
10:06You can practice decision making.
10:08See that what kind of outcomes?
10:10No, you get from making
10:12certain decisions and games.
10:13And again these outcomes are not
10:15going to affect your real life.
10:17You know health outcomes, right?
10:18So we can we can see what happens
10:20if we don't use condoms.
10:22You know, in a relationship, right?
10:24And then and see how that affects
10:27our future so. It's a great.
10:30It's a great platform for role modeling,
10:33you know. And it's less idea.
10:35Kind of, you know,
10:36exploring options kind of
10:38like the old adventure books.
10:40You know, adventure games.
10:42And finally two there.
10:43There is a lot of interest.
10:45There has been a lot of interest
10:47for a long time in in this idea of
10:49collection in collecting in game data
10:51and kind of also thinking about Fidelity,
10:54right?
10:54So when we we think about
10:56interventions that come into schools,
10:57oftentimes you have to have
10:59a teacher that is trained to,
11:01you know,
11:01implement that intervention.
11:02And when you think of something
11:04like sexual health,
11:05you know teachers sometimes maybe
11:06things out that they you know.
11:08Maybe they don't want to talk about
11:10or don't feel comfortable talking
11:12about or don't know enough about.
11:14You know,
11:15with games that kids are
11:16playing the same way every time,
11:18so there's a.
11:19There's a high,
11:20you know high fidelity to them.
11:22Which is another reason that they're
11:24great and in game data we can.
11:25We can see how kids are making choices
11:27in the game and then compare that to
11:29perhaps assessments outside of the
11:31game or behaviors outside of the game.
11:33And we can see real connections
11:35to where kids are
11:36actually learning in the game.
11:38So I mentioned I am the director of the.
11:43Play for real X. Our lab.
11:45Our mission is really to kind of not
11:48just develop these interventions,
11:50but also to rigorously evaluate
11:52them and that could be in,
11:54you know, Kayla studies, RCT's,
11:55whatever kind of you know, rigorous study.
11:58We want to think of.
12:00But those games are also going to be
12:02based on theory and evidence, right?
12:05And the literature.
12:07We both focus on XR and gaming technology.
12:11This started back in 2000.
12:1517 Yes 2017 we started the
12:17lab with funding from Oculus,
12:19which is one of the IT is,
12:21you know,
12:22one of the top VR headsets that
12:24you can buy the Oculus Quest.
12:29So taking a step back So what is XR?
12:32I keep using this term, but you know,
12:35a lot of people aren't really
12:37familiar with what it means,
12:38so XR means extended reality.
12:40And really what it means is it's a
12:42blanket term for immersive technology,
12:44so that can be, you know,
12:46augmented reality virtual reality
12:48and this mixture merged reality,
12:49so I'll take it even a step further and
12:52describe some of these so augmented reality.
12:55So AR is where you're creating an overlay
12:57of virtual content onto the real world.
13:00But you can't necessarily interact
13:01with that environment, right?
13:03So you will most likely see a lot of AR
13:06applications on your phone and in some
13:08headsets to headsets are quite expensive,
13:11but you're probably most likely
13:13interested or Reno augmented reality
13:14from some popular apps like Pokémon
13:16Go is augmented reality, right?
13:18You can't necessarily interact
13:19with those Pokémon.
13:20They're not going to recognize
13:22if they're on top of the table,
13:25or you know under a bed.
13:28But they're they're going to,
13:29you know you can still see the digital
13:31objects, and you can capture them,
13:33right?
13:33Which it's not really interacting
13:34with your environment.
13:35Another example of augmented reality.
13:36I don't know if you guys saw this.
13:38You know about the lawyer that had his
13:40cat filter on and couldn't figure out how
13:43to turn it off during the court meeting.
13:45And another kind of example
13:47of augmented reality.
13:48But we can we think of health and medicine.
13:50We can take this even further, right?
13:52So we can we can think about,
13:54you know,
13:55a projections of holograms and
13:57other ideas that are projected in
13:58front of you and you can see them.
14:00You can.
14:01You can skip more of like a,
14:03you know a 3D models.
14:04You can walk around and and maybe
14:06remove layers and dig deeper right?
14:08We can we can do a lot of brain scans.
14:11We can let you know there's a lot that
14:13we can do with augmented reality.
14:15Come this way.
14:18And then to you know more and more
14:21augmented reality is being used
14:22to assist in surgical procedures.
14:24By superimposing patient information
14:26in reality. So for surgeons, do it.
14:28You know they're not having to
14:30maybe look up an over there,
14:32you know,
14:33to the side to look at a monitor
14:35that that this kind of information
14:37page patient information can be
14:39projected directly down onto the
14:41patient and where they're working.
14:43And they can also get real real time
14:45feedback from from others on their team.
14:51A second we have virtual reality,
14:53so virtual reality it actually.
14:54On the other hand, is where you're
14:56fully immersed in a digital environment,
14:58so most of you might know this right?
15:01It's like examples might be like
15:03being able to tour the Anne Frank
15:06House to really kind of step in.
15:08When and what it meant must have felt
15:10like for Anne Frank to be, you know,
15:12hidden away what her environment was like.
15:14You can get a feeling of this size an
15:16an objects that would have been in
15:18her room and you can actually interact
15:20with them and interact with her story.
15:22Another example is you know being
15:24able to be trained for Black Friday,
15:27Walmart as this is an inexpensive
15:30way to train, you know,
15:32temporary employees and how
15:34to prepare for Black Friday.
15:36But even further,
15:38we can think about,
15:39you know virtual reality being used
15:42in treating phobias or exposure therapy,
15:44right so, crowded spaces,
15:46or being out in public or
15:48social interactions.
15:49We can create environments that simulate
15:52these kind of these situations and and put
15:56people in them and help them with exposure.
15:59And then even further a,
16:01you know a colleague of mine in
16:04Pediatrics has been working with.
16:07You know he's an oncologist.
16:09Pediatric oncologist has been
16:10working with kids with brain cancer,
16:13and,
16:13you know,
16:14be he's created these wonderful
16:17environments where kids can meet
16:19for social support with the goal
16:21of being able to, you know,
16:23increase socialisation,
16:24where if there in chemo,
16:26or their isolated from others,
16:29they can't necessarily be.
16:30Are in the room, you know,
16:32oftentimes are going to be
16:34teenagers or young adults,
16:36and they may,
16:37you know,
16:37might be anxious about meeting others
16:39or just might not physically possible,
16:42so creating these kind of social
16:44spaces for therapy.
16:45Group therapy to happen is really
16:47can really interesting.
16:48An markets market are Asher Marks is
16:52doing some amazing work with that.
16:55So this is an article I wanted to share
16:57'cause this is something that I I just.
17:00I fell into this and I couldn't
17:02put this paper down.
17:04I was so excited to see it.
17:06It's from the Journal of Medical
17:08Internet Research.
17:08It's just released this last making
17:10month or two.
17:11It's a bibliometric report of the
17:13uses of XR in health and medicine,
17:16and those words are based on author
17:18and abstract keywords.
17:19So there is about 8400 papers and
17:21original original articles that
17:22about 63% of that literature.
17:24And but what's really cool is you can
17:27really see from this heat map where
17:29the work you know in XR is being done,
17:32so you know,
17:33even for you know in your own careers,
17:35perhaps looking at some of these keywords
17:37and seeing where your interests lie,
17:39an where you know where
17:42you might fit on this map.
17:44So these can range from anything from,
17:47you know,
17:48we see the you know I mentioned
17:51improving surgical skills and
17:53reducing surgical procedure errors,
17:55acute pain Management VR is often
17:57used as a distraction technique,
18:00chronic pain management,
18:01even beyond distraction,
18:03physical rehabilitation and we think of
18:05mirror therapy for stroke patients or TBI.
18:08Improving cognitive abilities
18:10of patients with stroke or TBI,
18:12including speech and attention and memory.
18:16And then we are, you know,
18:18we can also knows it benefits patients with
18:20mental health conditions such as anxiety,
18:22depression,
18:23substance abuse and eating disorders.
18:24And it's used.
18:26Like I mentioned it,
18:27in therapy for a number of fodio
18:30phobias and traumatic stress disorder.
18:32So in this article went on to kind
18:35of show where the publications
18:37are being are happening,
18:39so the most are happening.
18:41You know, in pain, pain,
18:43distraction, pain reduction, a lot,
18:44a lot of VR is wonderful for distraction.
18:49Especially for kids that are going through,
18:52you know, dressings or.
18:55And simple procedures that can cause
18:56a lot of stress and anxiety for them.
18:59You know,
18:59putting them in a VR headset can help
19:02to keep them calm and distracted from
19:04things that are happening to them.
19:06Uh, and it, you know,
19:08if you go down then there's stroke
19:10anxiety of Parkinson's depression again,
19:12fearing those phobias, cancer,
19:13Alzheimer's, dementia, PTSD.
19:15So the list really kind of goes on,
19:17but you can see here where the a lot
19:21of the work has been done already.
19:24Uhm?
19:25And if you see here and This is why
19:28I think it's such an exciting time,
19:30you know to be a pioneer in this field.
19:33There is this.
19:34This area is really exploded, you know.
19:36Just in this last five to 10 years,
19:39more and more work is being done.
19:41There spends a lot of exciting applications
19:43and more and more publications,
19:45so you know it is.
19:46If it's just an exciting time to
19:49be a part of this. So moving on.
19:53So what I wanted to share with you today.
19:56You know we're working on
19:57several projects in our lab,
19:59but I wanted to share two of those
20:01projects I wanted to share a game based
20:04intervention multiplayer intervention
20:05and then a VR based intervention.
20:07So you kind of get a taste of two
20:10different types of ways to use digital
20:13health technology for digital health.
20:15So I'm going to talk to
20:16you about one night stand.
20:18This is a video game for HIV
20:20prevention and black teen girls,
20:22funded by the an ICE HD and then
20:24invite only VR vaping prevention games.
20:26This is funded by Oculus
20:28Education Anas in VR.
20:31So one night stands.
20:33This is a a game has been near and
20:35dear to my heart for many many years.
20:38This started as a card game and we had
20:41received funding from the Women's Health
20:43research at Yale and we created a,
20:45you know, a paper based card game to
20:47to to kind of get our ideas on on
20:50paper and try some simple prototyping.
20:52Cheap simple prototyping to come
20:54up with a game.
20:55And then from that from that pilot data
20:57that we received from the card game,
21:00we extended that into an R21 and got.
21:02I need to create this into an multiplayer
21:04web based video game intervention,
21:06so this has been just so so fun
21:08and it's always wonderful to see.
21:11Like you know,
21:12your ideas and projects come come to life,
21:14even if it takes several years,
21:16you know, just keep pushing forward
21:18if you believe in something,
21:20I think that's the message from this game.
21:23So HIV prevention in black teen girls?
21:26So why did we focus here?
21:28Well, one in 32 black women will receive
21:31an HIV diagnosis in their lifetime.
21:33Black women are often diagnosed
21:35late in the disease process,
21:37which means they're infected intestines.
21:39A lot of this has to do with,
21:42you know,
21:43their experience with racism and and
21:46mistrust of the medical field so.
21:49Black teen girls between the ages
21:50of 14 and 19 or are diagnosed
21:53with an STI at over two times.
21:55The rate of white girls and we know
21:57that STI's are associated with,
21:59you know,
22:00a five time increase in the risk of HIV,
22:02so that is kind of coming out at two ways,
22:06HIV and STI's.
22:06So the goal of this game was can
22:09we create an early intervention,
22:11specifically terror tailored for
22:12black teen girls to decrease their
22:14risk for HIV and STI infection?
22:16But the most important piece
22:17of this right is like the.
22:19What does this all mean within the context
22:22of being a black teen girl in dating?
22:25And that was kind of really why?
22:27Again like why I mentioned like
22:29the importance of being able to
22:31tailor games and and make them,
22:33you know specific to certain
22:36topics or populations.
22:37There were a lot of things I know talking,
22:39you know talking with.
22:41With with teen girls through focus
22:43groups that we just learned and that
22:45really guided the way our game came out.
22:52So yeah, this is very long list here,
22:55but of our aims for a research project,
22:57but we're really looking at that
22:59preliminary impact of the game right?
23:01We wanted to look at knowledge, intentions,
23:03social perceptions, self efficacy,
23:04and then this this idea of behaviors so.
23:07But but even a step further,
23:09you know before those behaviors.
23:10What are some of those smaller
23:12behaviors that you engage in
23:14before the big behaviors happen?
23:15So we were interested in the big primary
23:18aim of can we increase HIV STI testing?
23:20Partner testing and condom use.
23:22But we also wanted to see if
23:24we could get girls you know,
23:26to engage in the behavior of talking
23:27to their partner right about condoms,
23:29talking to their partner
23:30about getting tested?
23:31You know, maybe looking,
23:32getting on the Internet and
23:34find out where they can go.
23:35Maybe talking to their doctors about
23:37what what it means to you know,
23:39is prep right for them.
23:40So we're really interested in,
23:42you know,
23:42kind of seeing what this game could
23:44do and then we were also interested
23:46in the acceptability of the game.
23:48You know, games and interventions
23:49are all great and wonderful,
23:51but if they're not an engaging
23:53or you know I'm not.
23:54I'm always cautious.
23:55Use word fun, but if they're not,
23:57you know engaging and fun to use,
24:00then then teens won't play them or
24:02they won't be paying attention so.
24:04We want to make sure that
24:07the game is enjoyable.
24:08So like I mentioned, we did one of them.
24:11You know,
24:12an important part of developing
24:13any type of intervention like
24:15this is as we really spend a lot
24:17of times in the formative work,
24:19so we did a lot of focus groups
24:22with with black teen girls and it
24:24was really kind of interesting.
24:26Interesting time,
24:26because if you see the dates here,
24:29this is when you know kind of COVID
24:31happened and everything moved
24:32on line and we could no longer
24:35ask access teens in schools to
24:37have in person focus groups.
24:39So we open this up.
24:40We put a,
24:41you know,
24:41a call out on on Facebook and
24:43Instagram had to see you know if
24:45we could bring some teens in to
24:47do some zoom focus groups and I
24:49was really nervous about doing
24:51this because I thought you know,
24:52these girls aren't going to know each other.
24:55They're really not going to make it
24:57just going to sit and not say much.
24:59Maybe they're going to be quiet
25:01or not engaged to get,
25:02you know in a conversation,
25:03but it was actually quite
25:05the opposite that teens.
25:06This is.
25:06Also, you know during the riots
25:08and Black Lives Matter when.
25:10This movement was really big and important,
25:12and George Floyd,
25:13you know it's a really important time,
25:15so these conversations with girls
25:17really took a life on their,
25:19you know, life of their own.
25:21It was,
25:22we learned so much just by listening to
25:24them engage with each other about you.
25:27Know what it means to date as
25:30a black teen girl. And it was.
25:33It was just so so amazing
25:35and such an eye opener.
25:37So a lot of that you know in terms
25:40of and what I mean by that in terms
25:42of navigating as a black teen girl,
25:45you know, just like any team,
25:46they're there.
25:47They're navigating the world
25:48of what it means.
25:49You know today to be in a relationship.
25:52And how do you vet guys and determine
25:54what are some red flags stating?
25:56But within that to be a black teen
25:57girl also means you're you're
25:59dealing with colorism and racism.
26:01And men saying I only date light
26:03skin black girls and you're getting
26:04you know you're you know you're
26:06not necessarily getting support.
26:08Your family and and you know?
26:10And so there was.
26:11It was just really powerful about
26:13hearing these girls talk about what
26:15it means to data as a black girl.
26:17So so we use that formative work
26:20to to move forward in our game.
26:22And again,
26:23another point to bring this up about.
26:25You know,
26:26making a game relatable to your audience.
26:28You know when that one of the girls
26:30that we talked with in our focus
26:32girls had mentioned you should
26:34hire a black female artists to
26:36do this artwork for your game.
26:38Graphic novelists were like
26:39of course we should.
26:41That makes absolute sense.
26:42'cause you know, this is what that's just.
26:44It was a common sense thing.
26:45I don't know why we hadn't thought of it,
26:48so we sought out.
26:50A woman that did a black woman
26:52that did some amazing artwork
26:54that we really enjoyed and vetted
26:56that with the teams Ann and she
26:58did all the artwork for the game.
27:02I'm here is just another example, but.
27:05In the game,
27:06it's a multiplayer game and I
27:08can give you an example here.
27:10It's kind of.
27:11I don't know if you've played Jackbox,
27:14but it's like a jackbox games
27:16where you have a shared screen.
27:19Then everybody is on their phone making
27:21decisions and doing things on their phone,
27:23and then those responses are
27:25actually on the main screen.
27:26So we what we really wanted
27:28to see from this game.
27:29It was it we wanted it to be about all
27:32the things that teens told us about, right?
27:35Like you know, dating is happening.
27:37You know, navigating through social media.
27:39That's how girls do that.
27:40If they want to learn about the guy there,
27:43they're getting on Instagram.
27:44I'm gonna snap traffic.
27:45Getting on Twitter.
27:47They're doing Google searches.
27:49And often,
27:49most early conversations can
27:51happen through text.
27:52When you're getting to know
27:53somebody and then even more so,
27:55you know a lot of conversations around
27:57Saxon condoms and all those things
27:59are actually happening in text.
28:01So we wanted to make this a game about,
28:04you know.
28:05So how are you?
28:06How girls are not navigating social media
28:08and romantic relationships and dating?
28:10So the game is sex is really sex positive?
28:13We really try to keep this idea of and
28:16keeping humor in the game in the sense of.
28:19You know 'cause stating is fun
28:21and sex of course should be.
28:23You know if done well and safely,
28:25it's it should be fun and not something
28:28that you should feel bad about so we can.
28:30We really wanted to see the game
28:33anchor conversations with girls.
28:34So this is a multiplayer game.
28:36This means girls are playing together
28:38on a planet shared screen and they're
28:40doing a lot of fun activities together.
28:42So yeah, the goal is is like can we use
28:45the game to anchor these conversations?
28:47Make some of these topics,
28:49normalize them, maybe you know.
28:50Girls themselves are going the conversations
28:53between them or really is going to
28:56be what's driving this intervention.
28:58So that's I should just say next
29:00steps for for for this is that we
29:02are going to do a pilot randomized
29:04control trial with 80 black teen girls.
29:07We've kind of had to put that
29:09on hold because of kobid.
29:11We've been hoping to get into schools,
29:13but that may not happen.
29:15And so where we've?
29:16We've been considering moving this
29:18to on line and doing it through
29:20zoom and having girls use the shared
29:22screen on zoom and using their
29:24phones to play so that we do believe
29:26that's going to be our next steps.
29:29Here in the fall.
29:31So the second game that I want
29:34to talk about is invite only VR,
29:36so this is our vaping prevention game.
29:40The game that is focused again
29:42on E cigarette prevention,
29:43but with a real focus on
29:46skill based learning.
29:47This is the game we partnered with
29:49twenty with Oculus and 2017 to
29:52develop and evaluate the game versus
29:54a pie small pilot study with 48
29:56teens and then with a larger pilot.
30:00Non randomized control trial
30:03with about 290 teens.
30:07So vaping was the problem with baby.
30:09I don't probably don't need
30:11to tell you guys this,
30:13so I want to spend too much there,
30:16but I think you know the big concern
30:19that we have is that you know
30:22ecigarettes exposure to nicotine.
30:24Nicotine, specifically 3 cigarettes,
30:25can increase susceptibility to
30:27future nicotine addiction, including,
30:29you know, combustible cigarettes.
30:30Adolescent nicotine exposure can
30:32affect attention and cognition.
30:33You know.
30:34We also know that E cigarettes are
30:36known to cause breathing difficulties and
30:39inflammatory reactions and lung diseases.
30:42So you said you know in in a
30:44word or not good it's you know,
30:47we really don't want kids to start vaping.
30:50We do that know that you know kids
30:52that have been introduced to nicotine
30:54early earlier in are more likely to
30:57be addicted to nicotine as adults.
30:59So I don't know if you've ever
31:02heard that city.
31:03I think it's like 90 some percent of
31:06adults 9095% of adults all started,
31:08you know?
31:11I'm sorry, secondary cigarette
31:12users smoking adults that are
31:14smoking 90 to 95% of them actually
31:16started as an under the age of 18.
31:19So we really want to try to
31:21get to kids before you know
31:23addiction becomes a problem.
31:27And more so for the last,
31:28you know the last couple of years here
31:30we've seen an alarming increase in high
31:33school students that have reported
31:34using E cigarettes, so this in this,
31:37you know, we look at 27.5%.
31:38Have reported that they have used any
31:40cigarette **** in the last 30 days,
31:43whereas you know we have about
31:44when we think that leaving.
31:46Look at the middle school,
31:47we have like 10 and a half
31:49percent reported having used one.
31:51So you know with this our goal
31:53really with invite only was.
31:55So really think about how can we get our
31:57kids before they're starting debates,
31:59so we really focused on this, you know,
32:02idea looking into middle schools,
32:03middle schoolers, 7th and 8th graders.
32:06So the the the primary aims aims of our
32:09research project we wanted again look
32:11at this preliminary impact of invite
32:14only VR again a knowledge perceived
32:16likelihood of using E cigarettes
32:19there harm perceptions the perception speak,
32:21addictiveness,
32:21social perceptions,
32:22self efficacy to refuse and those you know.
32:25Again looking at the big picture of their
32:29behaviors related to E cigarette news.
32:31And again, acceptability the kids,
32:33find it fun.
32:34Are they engaged with they played again?
32:37What they tell others play that game
32:39play experience was really important.
32:41And then, because this was a VR game,
32:44we were really interested in
32:46exploring their VR experience.
32:47How did that you know?
32:49How did that kind of fit
32:51into this intervention?
32:52What were some of the benefits
32:54of using VR over a traditional
32:57like web based or 2D game?
32:59And then did this perceived responsibility
33:01decisions they made in the game?
33:04The things they do in the game kind
33:06of extend outside of the game did
33:08they feel like the things they were
33:10doing in the game they were in control
33:13of and it feel kind of relatable
33:15to things outside of their game.
33:17In real life.
33:20So again,
33:20you know kind of that same approach they
33:22talked about with with one night stand,
33:25you know?
33:25An invite only VR was developed
33:27with input from over 100 teams.
33:29Then I'm going to talk about
33:31this more at the end of my talk,
33:33but it was the first developed for,
33:36you know,
33:36the headset where you provide
33:38your phone in and you know it was
33:41run as an app that's run on your
33:43phone and it was really clunky and
33:45and it overheated and it was.
33:47It was not that great of a headset,
33:49even when Oculus first funded us for
33:52this I was like sure I'm on board,
33:54let's do this but.
33:55Part of me was saying,
33:57but is this going to get into
34:00schools because it was so clunky
34:02and difficult to use.
34:03And then within a year and development
34:05we immediately got Lesgo came out,
34:07which is a standalone VR headset.
34:10Very user friendly and we were
34:12able to move the game into that
34:14and then now you know,
34:16even if we got to a point in 2020 last
34:19year, being last year where Oculus
34:21GO is now been discontinued and
34:24we were trying to look for funds.
34:26To see how to port it into other headsets.
34:28So technology moves really fast,
34:29which is a concern that we do have,
34:32which I'm going to talk about later.
34:34So this is a narrative based game,
34:35so you're a kid.
34:36You're a teenager freshman in high
34:38school and you're trying to get an
34:40invitation to this older students party.
34:42That's happening that night and your
34:43friends are really putting a lot of
34:45pressure on you to get this invite.
34:47And then of course you have
34:49like the guy that's in,
34:50you know in front of you in health class,
34:52but is taking with the teachers and paying
34:54attention because that really happens.
34:56This is the thing that kids told us.
34:58That happens that kids smoke vape in class,
35:00so so yeah,
35:01that that you're trying to get to
35:03this party and so you have to put
35:05yourself in these really awkward
35:06situations of trying to navigate vaping.
35:09And how do you get out of that vaping
35:11and do it in a way that you still feel
35:14in control and kind of cool, right?
35:16Because we know that just say
35:18no doesn't work,
35:19but if you can make a joke or it kind
35:21of changed topics or make excuses,
35:23anything that gets you out of a situation,
35:25then that's that's OK as long
35:27as you get out of it,
35:29right?
35:29So we want to try to give those kids
35:32these kind of tools to be able to use
35:34to get out of these risk situations.
35:36And another cool thing that we
35:38did in this game was we used
35:40voice recognition software,
35:41so this meant that kids were not only
35:43just refusing peers in the game,
35:45but they were also able to use their
35:47real voice to practice refusing.
35:48So you know,
35:49as a character would say something to them,
35:51you know they've been engaged looking
35:53him in the eyes and then kids with
35:56their own voices had to choose a
35:58couple of different ways to say no,
35:59whichever when they wanted.
36:00Or get out of a situation and then
36:03they would speak it and then the
36:05characters you know the game would
36:06recognize it in the characters
36:08would reply back,
36:08so it was really this idea of of can
36:11we push this idea of skill practice
36:12a little further so we're not just
36:15clicking on different responses,
36:16but we're actually using our
36:17voices to practice his responses.
36:19The whole goal was to try to make this
36:21game a little stick here in the practice,
36:23the skill practice listed here.
36:26We worked, we had a room eising
36:29artist that we worked with.
36:30We went.
36:31We worked with a local school in
36:33New Haven and we they were let
36:35they let us into their classrooms
36:37and talk to their teachers and
36:39talk to the kids and we we took a
36:42bunch of pictures for the artist
36:44and the artists were able to render
36:46that into a virtual environment that was
36:49very similar in a lot of conversations
36:51happen in in hallways and the bathroom.
36:54'cause you know that's where
36:55baking happens in schools so.
36:57Uh, we had a bathroom that we
36:59took from from the school.
37:01And another thing we did too.
37:03That's really important when we
37:04think of VR and extended reality.
37:06Is this audio component.
37:08When you're fully immersed
37:09when you think about VR,
37:10is really kind of capture a
37:12lot of your senses, right?
37:13And a big part of that is the is the audio.
37:17So we really thought a lot about like
37:19this binaural audio like having sounds
37:21come from different XYZ coordinates
37:22and making you really feel like
37:24you're in the game and the voice in
37:26the sounds are aligning with that.
37:28So we had, you know,
37:29a colleague of ours that came in and did.
37:33Didn't recorded a ton of
37:34sounds within the schools,
37:36so that meant what it sounds like in
37:38the hallway between class periods
37:39that you know the locker slamming and
37:42kids screaming and talking loud and
37:43laughing and then into the classroom.
37:45All the things you hear,
37:47like the buzzing of the lights and chair,
37:49scooting and phones going off
37:51and people coughing and the car
37:53outside the window going by.
37:54So we incorporated a lot of
37:56that to make sure that it.
37:58It also felt like you were
38:00in the real environment.
38:02And then we engage teams.
38:04We had a lot of teens locally that
38:06came in most of them not having
38:08any experience at all with voice,
38:10that voice acting but came in and
38:13did the the voice acting for us.
38:15They also bettered our scripts and
38:17helped us write the the content in
38:19any time that the conversation was
38:21lame or didn't sound right that we
38:23gave them the liberty to change it to
38:26make it sound the way that teams talk.
38:29So this was really a game for teens by teens.
38:32Not every sense of the word.
38:35And then we took the game
38:37into Milford School District.
38:38We partnered with the middle schools,
38:41so we worked with three middle
38:43schools and we enrolled about.
38:45I want to say let's see wait,
38:47we rolled 290 and but our N by
38:50the end of it was 279 and did
38:54have a couple kids drop out.
38:57But we would come in and
38:58kids would play the head.
39:00The game's about an hour and
39:0250 minutes to two hours long.
39:04When they come in about 3-4 gameplay
39:06sessions and we had a control group
39:08and everybody took assessments before
39:10the game play after gameplay three
39:12months and six months we did do a
39:15longer term follow up tonight to see
39:17if there was some retention of a lot of this.
39:21These indicators of behavior change.
39:24This is a lot of fun.
39:26We had.
39:26Kids were completely engaged.
39:27It was just wonderful.
39:28We didn't have any kids actually drop
39:30out because of any sort of VR sickness.
39:33Or, you know, I think that's a
39:35concern that most people have that
39:36all VR is going to make me sick.
39:38We actually didn't have any kids that
39:40that dropped out because of that.
39:42We did have a couple kids drop out,
39:44mostly because we were pulling them
39:46out of physical education class.
39:47So kids were not.
39:48How is this kind of a lesson learn
39:50kids don't mess with their gym class.
39:53Don't take them out of gym because.
39:55You know that kids just fast,
39:57they enjoy that time.
39:58Even if you're bringing in
40:00something cool like VR headsets,
40:02they don't want to miss out on,
40:04you know,
40:05going outside or playing games in the gym,
40:08so that's definitely a lesson learned
40:10that we had to figure out the hard way.
40:13So here's our N,
40:15you know we had kind of pretty much
40:17across the pretty even eight 7th and
40:208th grade 279 kids in total between
40:23the ages 11 and 1465% were were white.
40:26That does definitely reflect
40:27Milford School District,
40:29but we also know that Peiping
40:31is is a problem.
40:33Bigger problem in suburban communities
40:35and schools as opposed to urban schools.
40:38So the we felt that the you know
40:41we had a good population here.
40:45And like I mentioned that I
40:47think this is one of the things
40:49that I would like to highlight,
40:51just as it was so exciting
40:53to me to see that we had.
40:56You know, we had 149 in that.
40:58Receive the intervention and nearly
41:00all of them finished the game.
41:03It tells us, I mean that this tells us a lot,
41:06right?
41:06Like the kids played the game and
41:08they enjoyed playing the game and
41:10they enjoyed it so much that they
41:12finished the game so that in terms of
41:14engagement you know this we had kids,
41:16we had them,
41:16we had them,
41:17they were,
41:18they were locked in and that was great in
41:21terms of yeah delivering an intervention.
41:23Assess the changes and are dependent
41:26variables across those four time points
41:28that I mentioned and we were looking
41:30really looking at effect sizes so
41:32I can just go through these quickly
41:35so I have enough time for questions,
41:37but we did see some great, you know,
41:40greater improvements compared to
41:42the control group in terms of E,
41:44cigarette knowledge,
41:45nicotine addiction, knowledge,
41:46perceptions of E,
41:47cigarette harm,
41:48nicotine addiction perceptions
41:49and these social perceptions
41:50around the cigarette news right?
41:52This idea that everybody is using it?
41:55Ann,
41:55you're cooler if you use it and
41:57all my friends are doing it,
41:59we were able to kind of shift
42:02those perceptions alot so are in
42:04somewhat here in a small small
42:06effect size but still significant.
42:08We didn't see significant changes in
42:10their perceived likelihood of using E
42:12cigarettes or self efficacy to refuse.
42:14However, because these are 7th
42:15and 8th graders going into this,
42:17they were already,
42:18you know,
42:19had these these kind of attitudes
42:20or this idea that I'm not going
42:23to use E cigarettes,
42:24so there mean was pretty low already.
42:26We hit a ceiling effect with both
42:28that and their self efficacy,
42:30'cause kids before they've actually
42:31tried something or been in a
42:33situation they actually their self.
42:35Efficacy is actually pretty high.
42:36Like of course I can say no.
42:39Somebody offers me that,
42:40but a lot of times they just
42:42haven't been in that situation.
42:44To know you know that it's actually
42:45harder once you once you've
42:47been in those situations, so,
42:49but it was still indicative of
42:51a successful primary prevention.
42:53And then our persistent experience.
42:54We had really great scores around
42:56their gameplay satisfaction,
42:57their VR experience,
42:58and this idea of feeling responsible for
43:01the decisions they made in the game.
43:03So we were really happy to see that.
43:06So the big question then,
43:07I'll leave you with this so you know
43:10I talked a lot about XR and can it,
43:13you know,
43:14is this idea of candies kind
43:15of interventions fundamentally
43:17transformed health? Well, maybe right.
43:19Maybe we just don't know yet.
43:21We're so early into exploring this field,
43:23especially around extended reality
43:25that we do.
43:26We just have to do a lot more,
43:28more research and more larger style.
43:30You know,
43:31effectiveness trials and implementation
43:32trials to really understand this
43:34better is shiny and it's new,
43:36and that draws a lot of people in.
43:38So we we need to wait.
43:40We just need to do more work.
43:44So my optimism about all of this is right.
43:47We had an excellent experience with
43:49invite only and some really prominent,
43:52promising preliminary results.
43:53There's a lot of excitement
43:55about Exar right in VR and AR,
43:57talking to teachers and schools.
43:59They were.
44:00They were really excited about
44:02what we were doing.
44:04There are a lot of XR apps and
44:07interventions that do exist
44:09for health promotion and.
44:11And an health behavior change.
44:13Technology that is moving faster
44:14and faster is becoming more and
44:16more user friendly and intuitive.
44:18You can just see that in the change of the X,
44:22the headsets that have been coming
44:24out over the last several years.
44:27I do believe that XR can provide
44:29some opportunities for greater
44:30immersion and skill practice.
44:32You know these headsets now we have,
44:34like you know,
44:35hand tracking and and you know, I tracking.
44:37There's so many things now that we can
44:39do where your actual physical body is doing.
44:42Some of the work and that is
44:44a lot different than clicking
44:45through things on a computer.
44:47So when we have ability to
44:49use our hands in the game,
44:51recognizing our hands in the game or
44:53where we're gazing or who were making
44:55eye contact with that says a lot and then.
44:58I do think that we can think about is time
45:01to start thinking about beyond schools,
45:03where those opportunities to reach kids
45:05are in terms of implementing these.
45:07These health based interventions.
45:08We have them,
45:09you know if we have kids waiting in
45:11clinics or they're in community based
45:13settings or after school programs,
45:15or even the emergency department right
45:16where you have opportunities in hospitals,
45:18we have kids there.
45:19Maybe we can kind of give some of
45:22that use this technology to engage
45:25them or they're already there.
45:27Just my caution.
45:28Stakeholders are still nervous implement,
45:30you know it is you that those that don't
45:32necessarily understand XR extended reality.
45:34It could be.
45:35Sometimes it takes a little bit
45:37of self because you know a lot of
45:40people just don't understand it.
45:42So it does take some getting comfortable
45:44getting people comfortable with technology
45:46and recognizing that it's actually
45:47you know is actually quite simple.
45:49You know to use in a lot of cases you
45:52gotta have buy in from the schools
45:54in the clinics and other programs.
45:57Or when you leave because you can't
45:59keep coming in and and you know setting
46:02up the equipment and which also means
46:04you often need a champion to run that.
46:07So again,
46:08technology moves really fast and research
46:10move slow as it should in many ways,
46:12but as soon as you've got
46:14something figured out,
46:15that headset may be discontinued
46:17and you have to, you know,
46:19think about how you're going
46:20to keep up with technology and
46:22support for that new technology.
46:24Like I mentioned,
46:25researchers greatly still needed,
46:27especially in the field of implementation.
46:29Science creating cool stuff is awesome
46:31and even when it can show that under
46:33controlled situations that works,
46:35what about in the real world?
46:37And another big point that I
46:39want to bring process this idea.
46:41Ensuring access to all.
46:42Not all kids are going to or
46:45or adults for that matter.
46:46Wanna be in VR?
46:48Not all can use that because of
46:50this some sort of disability or
46:52learning disability or vision
46:53and hearing issues right?
46:55Or physical disability?
46:56So what can what ways can
46:58we ensure access to?
47:00All outside of the technology
47:01and that can be sent.
47:02That something is simple it is.
47:06Casting this game from a headset
47:07onto a monitor where others
47:09can see are playing in groups,
47:11right or or in.
47:12You know,
47:13translating games to two web based
47:15or two D games on the computer and
47:17rigorous trials are still needed,
47:19and they there is a need for
47:22them to be higher powered.
47:24So other projects that were working
47:28on a extended reality model of here
47:31were talk about ** our models to to
47:35teach medical residents and students
47:38had improved diagnosis of neurofibromatosis.
47:42We we another project we're
47:43working on is skill based,
47:45augmented reality based intervention
47:47focused on alcohol use,
47:49prevention and harm reduction.
47:54A game based application to enhance
47:57outpatient cardiac rehabilitation for
47:59women who just had a heart attack.
48:02An then again, thinking about how we're
48:04going to take invite only an adapt that to
48:07other risk behaviors such as marijuana,
48:09use marijuana vaping in other
48:11populations that may be at high risk for
48:14negative outcomes related to vaping,
48:16and then I do have this really keen interest
48:18in development and evaluation of projects.
48:21Those focused on patient advocacy,
48:23especially like when you think about kids,
48:25teenagers and young adults that are
48:28trans transitioning into young adulthood
48:29and maybe leaving their insurance
48:31may be moving to another state.
48:33And if they have some, you know,
48:36congenital heart disease or mental health
48:37issues or concerns that they're able.
48:39They learn how to advocate for themselves.
48:42So maybe VR is a wonderful way to
48:44practice those interaction skills
48:45with a doctor or your peers or others
48:48to to really kind of say, hey,
48:50this is what I've got going on and
48:53and I need to advocate for myself
48:55and my health so and then again,
48:57let's use of AR an artificial intelligence.
48:59How can we think about that?
49:01Technology can be used as a way
49:04for skill development.
49:05I'm I'm really interested,
49:06been super excited and interested in an
49:09artificial intelligence so, so that's me.
49:11So thank you.
49:12You know,
49:13Doctor Martin for inviting me to do this,
49:15and I've just been super excited about
49:18this all week so I will stop my slides.
49:21And if anybody has any questions
49:24for me I'm happy to answer them.
49:26And we do have some some interesting
49:30questions and I'm going to let
49:33Faye had the first question.
49:37Thanks Andres and I apologize,
49:39Kimberly for not mentioning
49:40your name in my in my question
49:43that I wrote. This is how the brain works
49:46sometimes I could have. I just knew
49:48I didn't know your name but I could
49:51have just looked at the screen and
49:53and see that your name is Kimberly.
49:56So I I refer to you in my notice
49:59in my chat as a speaker so I
50:01apologize for that, but nonetheless,
50:03as I listened to you though,
50:05I request two questions popped into.
50:07My head the the name of
50:10the game for the black teens.
50:13That's called one night
50:14stand. When I heard that something
50:17in my stomach reacted to that name.
50:21Uhm yeah, be 'cause of the the whole
50:24term of one night stands and the
50:27negative connotation of one night
50:30stand just hearing that as it was
50:33linked to black young people I my my
50:37I had a visceral reaction to to the
50:40name. So I thought that it could
50:43suggest a bit of a negative connotation
50:47when one hears that. So that's
50:49the first thing. And so with that.
50:53I wondered if when you were developing
50:55the game you mentioned, how dear it
50:58is to your heart on if you also have
51:01some black folks on your team who
51:04who listen to something like this
51:06and thought about what it meant.
51:08An gave some some suggestions and
51:11some feedback as still the the
51:13different ways of looking at that.
51:15So that's what
51:16popped into my head as I as I listen to you,
51:20so I appreciate that so much.
51:23We thought of the name the name one night
51:26stand because there was a character in the
51:28game that he's he's kind of the trickster.
51:30He's the guy that is going.
51:32He's kind of looking for a one night stand.
51:34So how do you recognize this?
51:36Diane? Avoid him.
51:37So that's kind of where that.
51:39And then it's it has evolved.
51:40So if that gave you a visceral reaction
51:42and you know that's something we should
51:44consider changing the name, absolutely.
51:46I think it's just something
51:47we've hung on to forever.
51:49And it was a main character in this game.
51:51The early versions of the game,
51:53and it's.
51:53Not so much now,
51:55so it I think changing name is still we're
51:58totally fine to do that in terms of the team.
52:01We the very first thing we did
52:03when we started this project
52:05was we brought on ijoma apara.
52:07She actually is going to be moving
52:10coming to Yale at the school.
52:12Public health here.
52:13In the summer she's a black female
52:15that focuses on specifically empowering
52:17black teen girls around risk behaviors.
52:20You know,
52:20avoiding risk behaviors and
52:22taking pride in their ethnicity.
52:24So she has been involved from day
52:26one and helping us to do all of this.
52:29So she's been fighting this with us
52:32and helping us look through focus
52:34groups and analyzing those through her
52:36lens and her expertise is definitely,
52:38I think that's one of the main
52:41things I'm not a black teen girl.
52:43I have no idea what that means
52:45to to be a black teen girl.
52:47So another thing that we did
52:48too is from our focus groups.
52:50We created an advisory group of
52:52Teen Black Teen Girls from that was
52:54I think we had eight that every
52:55step of the way we're like.
52:57So what do you think about this?
52:59What do you think about this?
53:00What do you think about this?
53:02So in every step it has to go through
53:04our Advisory Board and they have
53:06to either in promote, you know,
53:07say, give us thumbs up,
53:09or tell us how to change it or
53:11tell us to get rid of it so.
53:14For sure,
53:14we've been really trying hard
53:16to put that in place.
53:17You can guess the wonderful part about
53:20working with teams is that yeah, yeah.
53:22I acknowledge very quickly that I don't.
53:24I'm not an expert in what it
53:26means to live that experience,
53:28so the teams tell us.
53:30And then you know, like Joma tells us,
53:33and that's I'm just.
53:34I just try to look at like the
53:37vessel to try to create this
53:39things that others are telling
53:41me how to correctly create.
53:43And
53:44Kimberly, thank you Kim and and just to
53:46add that I I'm I'm very excited about
53:48the mixed methods approach right that
53:50he start with hearing the voices of the
53:52kids in these focus groups to inform you.
53:54And then you do the fancy statistics
53:56as you roll them out and also that
53:58your artist was a black artist.
54:00I mean that that art was wonderful,
54:02but I think that's a great question.
54:04Feyen mix jamming out on that.
54:06I see another riffing off of that.
54:08I also see a great question
54:09from Maggie Maggie.
54:10Do you want to and if you could turn
54:13your camera that would be great.
54:15And Natasha, you're on next.
54:16Also, turn your camera on so Maggie, please.
54:22Hi. Thank you, I don't get it.
54:26Yeah, I was wondering about your control
54:29group of whether you're comparing
54:31to conventional methods of social.
54:34About the second one of getting
54:37the information about breaking out,
54:39or if you're comparing to no intervention.
54:43Touch it, yeah.
54:44So what we did and we did a couple of
54:47things and I think when we do these
54:49talks it's hard to get it all in there.
54:52But the entire school had a right
54:53before we did our intervention in
54:55the entire school had their own
54:57intervention where somebody came in
54:59and talk to them about vaping and
55:01that's what the school that was,
55:03how the school focused on beat that
55:04was their vaping prevention methods.
55:06So we we use that like the all
55:08the kids got that and then we had
55:11kids and then we had kids that.
55:13Play the game so like on top of
55:15it so it would kind of be like
55:17an adjunct to what they already
55:18received through the school.
55:20So so the control group got their
55:22normal stuff that they would
55:23have gotten from the school.
55:26Thank you Maggie. Thank you Kim Natasha.
55:33Yeah, we lost, you know Tasha. They are.
55:39I'm sorry I have to hold the
55:41camera because of the setup,
55:43but I'm just curious as to have any of
55:46these simulations been triggers for any
55:48of the teams and what is your follow
55:51up response to any of those triggers?
55:54Feel like a lot of times there are probing
55:57questions or things that trigger response,
55:59but the follow up it's lacking,
56:02so there's no. How do I word it?
56:06There is no follow up to
56:08what they were feeling,
56:10what they were experiencing.
56:11It's kind of just like, OK,
56:13we've triggered this and now
56:15you're on your own to figure out
56:17and process your feelings and deal
56:20with that separate and apart.
56:22This is a great question.
56:23This is been why I've been hesitant
56:25to move the intervention to do on line
56:27because when we work with schools
56:29we can have those debriefings with
56:31kids and teens and say hey if any
56:33of this was triggering or to you
56:35or you want to talk to somebody,
56:37let us know.
56:38We have a clinical psychologist
56:40on our team that was the first
56:42point of contact but when we work
56:44in schools we can also engage the
56:46school and the school counselors and
56:48an ensure that that supports there.
56:50So that is been one of the main
56:52reasons I've been super super
56:53hesitant and holding off on doing.
56:55Moving intervention to do
56:56online through zoom is I.
56:58I was specifically worried about that
57:00follow up because you know what?
57:02If we do have a girl that was
57:04sexually assaulted and got any,
57:06you know an STI from that or or
57:08do you never know?
57:09You just never know what this could
57:11trigger an usually when we're within
57:13a community in a school community especially,
57:16we can.
57:16We can help to safeguard that
57:18and provide resources.
57:19So we've been working with that on our
57:21team of trying to come up with a plan.
57:24If we do move this on line.
57:26How can we be supportive?
57:28We do have a follow up a four
57:31month follow up with these girls,
57:33so we'll be doing baseline one
57:35month for months.
57:36We have several opportunities
57:37to engage with them.
57:38But yeah,
57:39kind of having a broad like
57:41link to resources is.
57:42It's just not as nice as being
57:45able to to connect them locally.
57:48And sort of to follow up
57:50on that question as well,
57:51like what is the parental
57:54involvement in this meaning.
57:56What is the parental involvement with the
57:58child having access to this programming?
58:00But secondarily,
58:01if there is a trigger annerys the response.
58:04What is the family involvement then you know,
58:07that might not have been there.
58:10Prior to engaging them for this purpose,
58:12so I feel like as a person of mixed heritage,
58:15I find that in my community it's kind
58:17of like we're going to come in here.
58:19We're going to.
58:20We're going to prove you were
58:22going to do all these things,
58:24and then there's these massive
58:25repercussions when it comes to
58:27finding therapy.
58:27Finding follow up for the children is
58:29kind of like you guys figure this out.
58:32Yeah, we we might have started
58:33it and triggered it,
58:35but now you figure it out on your own.
58:37I'm just wondering what supports
58:39are there for families that.
58:40May have had some type of response
58:43or or things of that nature.
58:45Yeah, I mean, these are great questions.
58:48Maybe I'll reach out to you making help
58:51me brainstorm this because you know,
58:54currently we just have the
58:55helping helping kids connect.
58:57We do apparently, do, you know,
58:59require parent permission to be
59:01in to be involved in the study,
59:04obviously, but we don't.
59:05Only unless there's like
59:07concerns of apparmor,
59:08self harm or obviously something
59:10like sexual assault, this happened.
59:12Then we are obligated to tell
59:14parents about that stuff.
59:15But you're right, I.
59:16I would love to talk to you more about
59:19if you have some ideas about how to
59:22to ensure that safety or the you
59:24know those this access to resources.
59:28That said,
59:28thank you for bringing that up.
59:31We have one final question.
59:33We want to be mindful of of time.
59:36Walter, you go ahead.
59:41Well, I was. I was curious there.
59:42I know Kimberly and by the
59:44way great to see you again.
59:48It's there's been some research
59:49in the past and I'm thinking maybe
59:52four or five years ago that I was
59:55looking at and in some sense then
59:57looking at VR as a way to be able to
01:00:00increase empathy or groups that have
01:00:02been authorized by the person who's
01:00:04actually participating in the VR.
01:00:06So, like, you know,
01:00:08spending some time walking in
01:00:09the shoes of a refugee family,
01:00:11spending some time visualizing
01:00:13yourself as a black man in a car
01:00:15being pulled over by the police.
01:00:18And then doing attitudinal measures
01:00:19about people's thoughts about
01:00:21these individuals before and
01:00:22after having experienced certain
01:00:24circumstances in their shoes.
01:00:25And I'm wondering what your thoughts
01:00:28are about that kind of research.
01:00:30As well as applications for for,
01:00:32for, for the medical profession.
01:00:34Because I'm concerned about you know,
01:00:36what can we do to be able to help children
01:00:39be able to view other children better,
01:00:41but I find myself increasingly
01:00:43more interested in what can we do
01:00:45to help adults be able
01:00:46to view children better.
01:00:49I'm really, I'm really curious
01:00:51what your thoughts are about this.
01:00:53Yeah, I think we're moving more and
01:00:55more towards greater embodiment with VR.
01:00:57Like I'd mentioned now,
01:00:59like before when you would look
01:01:01down at your body if you're in VR,
01:01:03you have controllers and you look down.
01:01:06You see controllers.
01:01:07Now we can look down and hands
01:01:09of art become our body right?
01:01:11And our brain is very easily
01:01:13tricked into into that.
01:01:15And there's some great amazing
01:01:16work being done out of Stanford
01:01:18around embodiment and changing.
01:01:20Uhm, views around all kinds of
01:01:22things like you're talking about
01:01:24one of the one of the cool ones too
01:01:27are for adults to be able to look
01:01:29into mirror and see themselves but
01:01:31see themselves aged and then people
01:01:33that can see themselves aged are
01:01:35able to kind of be able to think
01:01:37forward more about decision making
01:01:39and you no longer term impacts
01:01:41on their health and stuff.
01:01:43But that thing of empathy.
01:01:44You're right and I you've hit
01:01:46something that I don't know if it's
01:01:49been done about about helping adults.
01:01:51Look through the eyes of what
01:01:52it's like to be a child.
01:01:54Maybe that's maybe that would be
01:01:56an amazing project to think about,
01:01:58doesn't it doesn't?
01:01:59I think you could do a lot of just
01:02:02really preliminary work on that,
01:02:03just to see.
01:02:04'cause immediately when you think
01:02:06perspective and embodiment you've
01:02:07gone from high level right.
01:02:09Like if I put on a VR headset and
01:02:11I'm usually talking directly to
01:02:12a character to now I'm down here
01:02:15and I'm having to look up you
01:02:17immediately just changed even just
01:02:18the perspective of how a child sees
01:02:20an adult or somebody in power.
01:02:22So you could do just there so I
01:02:24could imagine there's just simple
01:02:26things you can do to try to get this concept.
01:02:29My subliminal messaging worked.
01:02:34So this is a fantastic idea. Yeah,
01:02:38so with this subliminal message
01:02:39brought to you by Walter Gilliam,
01:02:41we really thank you.
01:02:43It's very exciting and I
01:02:44know that Rebecca, Lori,
01:02:46and I are thrilled about our
01:02:48collaboration and I'm sure that
01:02:50you give ideas to many others.
01:02:51So stay tuned for more.