Final Post: Learning Experiences

Well, the quarter is coming to a close, and all the projects and papers have been handed in. Looking back at the progress we all made, I'm impressed by how much we accomplished in such a short amount of time, and how much thinking and learning we did surrounding the issue of underprivileged and marginalized populations. It was very rewarding to create a project from the ground up, and it's even more rewarding to do so for a worthwhile cause.

One of the things that impressed me the most was the incredible variety of projects my classmates put together. From the starting point of serving underprivileged populations, people came up with a whole slew of different ideas, from preserving languages to helping schoolchildren in India to providing first aid for people on the border. I wonder if our class had been twice as big, or four times as big, how many fascinating ideas would have emerged.

At the expo, I met several different people who had incredibly useful things to say about my project; I spoke with a woman who works with emotionally disturbed children, and a cognitive scientist who works with depressed patients, for example. It was great to get their real-life expertise on a subjects I'm just beginning to learn about. They gave me constructive feedback on things I hadn't even considered (What if they can't figure out how to play the game? How to deal with children who are pre-literate? Can you save your progress? What happens if the player just sits there without pushing any buttons?)

Since many of our projects are still in the early stages, I'm curious to see whether these endeavors will continue, and if so, in what form. I haven't decided yet how I plan to carry on my ideas, but based on the feedback I got from the people who visited my poster, it sounds like a game for childhood depression is a good idea, and with enough work and research, it could turn into something truly valuable.

It was very eye-opening to see the many different options out there in the field of online learning. It seems like the web is a great way to transmit education to the masses, and I hope to participate as these initiatives become even more prevalent in the near future.

Presentations: Digital Artifact #2

Class presentations

Last week we presented our digital artifacts to the class. There were some terrific ideas put forward, in various stages of resolution, and it's amazing how such a wide variety of concepts came from a single prompt. If so many ideas could emerge from a class of twenty students or so, it's pretty staggering how many ideas must be percolating with all the nonprofits, corporations, volunteer organizations, and individuals out there trying to make a difference. Maybe we do have a shot at making the world a better place...

Like last time, I thought I would post a few screenshots and an overview of my process. I had a really good time putting together this artifact, and I'm looking forward to making further progress soon.

Here's the splash page:



...and setting the scene:



...and a map of places to go (this one's my favorite):



I started with line drawings, which I scanned into the computer:



...then I used Illustrator to clean up the lines and add color:



Next steps

Before the big presentation in December, there are plenty of things I could do to beef up my artifact. Practically speaking, here are some steps I could probably take between now and the presentation:

1. Interface wireframes: I talked about game examples for the different animals; to make this idea even clearer, I'd like to sketch out a basic drawing of what I had in mind. Nothing too detailed, just something to bring the ideas to life a bit more.

2. Flash functionality: I've been meaning to brush up on some Flash, and this seems like a good opportunity. Although I don't want to create a fully-functional game at this point (I'd like to leave room for growth before setting things in stone), it may be helpful to show some active examples of how the game would operate.

3. Web structure: In order to make my game accessible to the public, it will eventually need to be presented on a webpage. I'd like to go ahead and build the structure of the page (and add some additional information for people who have never seen it before).

4. Other stuff: Some ideas I've been tossing around...it would be cool to prepare some family-friendly printouts that might come with the game, or some printed color screenshots to give the presentation some added flare. At some point, I'd also like to show a demo to a child psychologist here at Stanford and get some feedback / suggestions from somebody who knows a lot about this issue.

Coping strategies for kids

Child psychology

Last week in class, we heard from two different project in the education arena: a new video system for online lectures, and a research project about disseminating valuable information to schoolchildren in the Chicago area. There are so many details involved in these projects, so I'm glad they took the time to visit our class and hear our thoughts. It's helpful to have an outside perspective when you're designing or researching something brand new.

With that in mind, I've turned to some more outside sources for planning my zoo game. I'm looking for specific ways that kids can reduce their chances of depression, and/or alleviate the depression they are currently experiencing. There's a lot of vague stuff in the literature about "coping strategies," many of which are abstract and cognitive in nature. I'm searching for concrete examples, specific behaviors I can encourage kids to perform.

I was lucky to find several valuable child psychology sources with just this sort of information. I can use some of their recommended activities to build the small exercises within the game. I was especially interested in the concept of play therapy, which seems consistent with the warm, whimsical attitude I want to communicate in my game. The tool kit presented at playtherapy.org is so thought-provoking, because I think an online game could provide kids with many of those useful behaviors, like creative visualization, therapeutic story telling, drama role-play, and art/drawing.

If I can encourage children to play more (especially unstructured, active outdoor play, as emphasized in this article), I think I will be in a good place.

So here's what I found: some specific strategies I'd like to incorporate.

• substituting reasonable thoughts for unreasonable ones (polar bear exercise)
• self-monitoring mood (crocodile exercise)
• increasing positive activities such as unstructured childhood play (monkey activities)
• social skills: initiating conversations, responding, refusing / making requests (turtle game)
• self-control and monitoring (what animal could this be?)
• getting better sleep (koala exercise) as discussed here.

Flash games

Shifting gears a bit: I also checked out some fun Flash games for kids! Casual games are really big right now (I scoped this article for some tips about sustainability for casual games online). Here's a fascinating blog post that breaks down a popular game into all of its usability components, like this:



Pretty overwhelming. To see for myself what these game experiences are like, I tested out Diner Dash by Playfirst...



...and another one of their popular kids' games, Avenue Flo:



Unlike websites, these games don't have consistent navigation throughout. They are fullscreen experiences, with minimal references to previous screens or the outside world. They have their own specialized UI elements, rather than a list of web links. Since I'd prefer to make a web-based game rather than an executable right now, I think I can strike a middle ground between those two extremes.

Now, in terms of feasibility, I don't think I can realistically expect to have a fully functional game for my second digital artifact. So I'll have to scale my project down to its key elements:

1. Opening page with navigation
2. Choose a character
3. Story page (time to cheer up)
4. Zoo map
5. 7 introductions (zoo fades to background)
6. 7 game screenshots
7. About page
8. Extras page
9. Credits page

I can always add some more functionality over the break, or later down the road as I continue to feel inspired about this topic.

Sample art

And now your regularly scheduled update of "stuff I did."




The rest is a surprise ;)

A peek at zoo graphic design

Now the fun part: building the artifact! I've got plenty of work ahead of me, from drawing the characters to making the game to building the website, not to mention all that extra research. Before I jump in too deep, I thought I'd whip together a quick post with some of my ideas and early-stage work so far. I especially want to keep my eyes open for neat sources of inspiration.

The zoo aesthetic

I'd like to pattern my web design after your typical zoo homepage. Kids are already familiar with those bright colors, big photographs, and welcoming pages full of fun facts. Zoos are about both fun and education, which seems appropriate for my project, which deals with difficult issues but hopes to do so in a friendly, enjoyable way. You'll see that many zoo websites have a lot in common: similar colors, similar layouts, animals featured prominently on the homepage, emphasis on adventure, and enticing the visitor to come see for themselves:













This last one is a little different, and I love the concept. The visitor can click on different sections of land to go to that space. I'd like to incorporate something similar into my artifact (perhaps not as fancy as this one) to make the navigation more interactive.



Flowcharts

Here's a chart of what I'm envisioning for the opening steps:



...and a summary of what I'm planning to include in the website:



Character designs

Each character will be a cartoon-style animal, with a personality and a back story. They each have a positive feature (the parrot is friendly, the fox is smart, the flamingo is beautiful...) but they all have moments when they feel sad and upset. Since kids are used to seeing animals and relating to their stories, this could be a way of introducing ideas like sadness, depression, and anxiety. Here are some line drawings of what the characters might look like:



So that's it for now...I'll keep posting more drawings and design steps as they come along!

Reviewing an online therapy program

Notes on learning theories

In class last week, we discussed key learning theories and how to address them in practice. These theories turned out to be a useful tools for examining learning programs and evaluating how effective they might be. From our assessments in class (my team looked at Vyew.com) to the experiences all around us, concepts like cognitive load, meta-cognition, and interactivity can shape how we interpret and improve education.

For cognitive behavioral therapy (CBT), there are a handful of theories that seem especially relevant. Vertical transfer is a big one: people have to learn important skills from their online CBT session and translate them to real life, which may involve a leap from a computer desk (or therapist's office) into the contexts and pressures of the world. Set effect is also crucial, since the literature on depression emphasizes how habit-forming negative thoughts can be. The way people think becomes completely automatic over the years, so in order to be effective, a CBT program needs to overcome these automatic habits, replacing unconscious harmful thinking patterns with conscious helpful ones.

I tried to keep a handful of learning theories in mind as I reviewed a site called MoodGYM this week, to see which areas were working and which areas could use some changes.

What it is

MoodGYM is an online CBT program for people struggling with depression. The program is geared towards young adults, not children, but many of the therapy principles are the same. I went through the core structure of the site, including making a profile and going through some of the modules.

The program starts with a neat ABCD-like approach, describing its specific goals and the behavioral changes involved:



The user begins with a lengthy questionnaire, which appears to include standard depression-related questions. The results were a bit simplistic for my taste (they are only divided into low, medium, and high amounts of depression, which is not terribly helpful), but the personalization is a good idea, and the questions can make people think about what's going on in their heads.


Each module goes through different characters and situations, and the user selects ways to respond to adversity, ways to counter negative thoughts, and so on.

Seeing a CBT website in action was very useful, and it would be a good idea to pattern my own digital artifact after this type of system, since the methods are already tested and seem to work. Here are a few factors I noticed:

Strengths

Sympathetic characters: Even though some of the characters were a little cheesy (there's actually a guy named "Noproblemos"), it can be helpful to have characters to relate to, so people can recognize similar thoughts in themselves.


Everyday language: The words are casual and colloquial. Since the website is based in Australia, there are plenty of amusing Australia-isms ("typical bloody me, I stuffed everything up"). It seems important for my own project to use language kids are familiar with, perhaps the sort of language they might hear in a children's book.


Relatable situations: The exercises go through specific experiences and how different characters might react to them. This strategy helps people apply valuable coping mechanisms to the real world. For kids, I would have to change my examples: instead of wrecking a car, hooking up with wrong person, botching a job interview, I might include things like fighting with a brother or sister, a bad report card, or a bully at school.

Weaknesses

Too much text: The lessons and modules have far too much of a preamble for kids to sit through. In fact, I suspect that even most adults would skip through the text. In particular, people suffering from depression, or people who are unsure whether they want to use the system, may be discouraged by reading too much before getting to the actual therapy. I would need to design a system that didn't rely too much on text.

Not enough feedback: It would be useful to include feedback about where you are in the module, how far you've come, and what's coming next. This would be more consistent with the learning theories of interactive media, and also more suitable for childrens' short attention spans.

Easy to forget the lessons: I would like to see an easy way to pull up summaries of what was previously taught. This would be especially helpful for kids who would have a hard time remembering all these new things. For my own project, it would be nice to have some handy printouts or summaries that kids can refer to later on.

My current idea

I'll be making adjustments and changes as I go along, but I'd like to try making a CBT tool geared towards kids. It can be a story that takes place in the zoo, and each animal will represent a different symptom (a crocodile who's always angry, a turtle who isolates himself from friends, a koala who is sleepy all the time). Based on the personalization principle we learned in class, kids will be able to choose their avatar based on positive characteristics about themselves. Then they will go through a small series of games / exercises to teach kids how to respond to different tough situations they might encounter.

Next steps

I'll definitely continue researching childhood depression, with a special focus on which coping mechanisms are most helpful for kids. I would also love to talk with a child psychologist or some kind of therapist who specializes in depression in young people, to get some insights on what elements would make my game most effective. And meanwhile, I'll start making character sketches and drawings to fully realize my idea.

Cognitive Behavioral Therapy for Children

It was really inspiring to hear from the Edison Learning team about their program. They developed an entire online learning system from the ground up, and they are still planning and implementing new ideas. With my own project for the class, I'm inspired to move beyond the summaries and readings, and take the next step into developing a solution.

To help clinically depressed children, I could focus on prevention by promoting activities like healthy eating and lots of outdoor exercise. Or I could develop a system for treating existing depression, based on established therapy techniques. In order to focus my project specifically on the marginalized population (children with depression), I'd like to tackle treatment options first, and see what I can find.

I wanted to take a look at cognitive behavioral therapy, or CBT, which is one of the most widely used treatment methods for clinical depression. In fact, CBT has been used successfully with children, and it is often recommended for various mental health disorders in young kids and adolescents. Although there is no specific protocol for CBT (it refers to a wide umbrella of treatments), it tends to rely on several key principles:

• Systematic and goal-oriented
• Time-limited treatments
• Focus on here and now
• Focus on alleviating symptoms

If you think about it, many of these characteristics make CBT a natural choice for mobile or web-based interfaces. Its goal-oriented nature can be channeled into games or directed puzzles, much as Edison's goal-oriented modules direct students toward understanding of a particular concept. Time limits are easily placed on computer-based activities, and many computer programs have a here-and-now focus. Plus, with an emphasis on alleviating symptoms, progress can be concrete and measurable.

In terms of the ABCD approach we learned in class, I found an interesting set of specific behavioral goals from the American Institute for Cognitive Therapy. After completing therapy, children should be able to:

• Recognize and modify irrational and self-deprecating thoughts.
• Adopt more appropriate and/or positive responses to their own and others’ thoughts and feelings.
• Improve listening, social, and problem-solving skills.
• Plan positive/pleasant individual and social activities.

Here are a few techniques used in CBT that could be easily translated to the web:

- Keeping a diary of events and feelings: The web is already a useful tool for journaling and recording thoughts, and it would be an interesting challenge to develop an online journaling system specifically for managing childhood depression.

- Questioning assumptions and beliefs: People learn many cognitive skills from the Internet, including critical thinking and questioning what they see. I could imagine a game based on rejecting beliefs that don't make sense, and accepting ones that do.

- Gradually facing avoided activities: People often use their mobile devices to set reminders for themselves or plan activities. Perhaps an application could be designed to systematically propose new activities (such as exercise or social interaction), gradually encouraging the child to try them for a reward.

- Relaxation, mindfulness, distraction: Stress management is a big part of both prevention and treatment for depression. There are hundreds of stress management programs online, and along with soothing video and audio collections designed to enhance relaxation. I wonder if I could design a web-based relaxation system especially for children.

As it turns out, there are already a few computer-based therapy programs, collectively referred to as Computerized Cognitive Behavioral Therapy (CCBT). These programs have the advantage of being less intimidating than talking to a therapist, less expensive than paying for sessions, and more accessible for people who would have trouble getting to a doctor's office. Children often fit these criteria very well, having little to no disposable income and not much personal freedom without their parents. The National Institute for Health and Clinical Excellence (NICE) has described a set of guidelines for using CCBT, and preliminary studies have suggested that it can be a successful supplement to existing treatment programs.

Computerized therapy initiatives have been developed for a number of mental disorders. Specifically for depression, NICE recommends a program known as "Beating the Blues," which consists of 8 sessions of self-help treatments. The program is described as follows:

"They work through cognitive modules which focus on the identification and challenge of automatic thoughts, thinking errors, distractions, core beliefs and attributional styles. Interwoven with these cognitive elements are problem directed behavioural components where patients can work on any two of activity scheduling, problem solving, graded exposure, task breakdown or sleep management according to their specific problems. The final module looks at action planning and relapse prevention."

Although I can't access Beating the Blues without making a payment and performing a screening over the phone, I might send an email to request access for my project, because I'm curious as to how the program works. There's also a free program called Mood Gym, which I'd like to check out as well.

To develop my next artifact, I'd like to take advantage of the principles of cognitive behavioral therapy to reach out to children, especially those who want help but aren't seeing a therapist yet. I'd like for my web-based system to emphasize education: teaching kids the skills they need to manage depression. Hopefully I can pull inspiration from Edison Learning and other online educational programs to make an effective treatment tool.

Digital Artifact Debrief

Class Presentations

Last week, we presented our first digital artifacts for marginalized and underprivileged populations. I was impressed to see such a wide variety of topics, and so many ways to discuss them: videos, Powerpoints, websites, posters...I enjoyed seeing the circumstances and populations people are passionate about. The presentations came from all over the place, from rural America to the far reaches of Africa and India. Seeing so many situations in which getting a good education can be difficult or impossible, I realized that our own niche in the system is the exception, not the norm. Only a few people have the chance to grow up in upper-middle-class America and attend fancy universities. It's nice to see that despite our mostly privileged backgrounds (and certainly privileged in terms of education), we still have the desire to reach out to those who don't share these opportunities. I'm curious to see how all this information will be translated into a second digital artifact.

I chose to explore childhood depression in schools, and I used a mind map as a presentation tool. It seemed to go pretty well, and I think people got most of the points I wanted to express. To find out everything I could about childhood depression, I looked through lots of different resources and articles. I was surprised at how little we still know about depression in general, and especially how it affects children. Given the devastating effect it can have on a child's education, it's certainly an area that could use more research.

Drawings / Process

I want to share a little bit about how I put together my artifact. I had a good time constructing the diagram and the website, since I enjoy visual thinking, and my past few blog entries have been focused on how people lay out information. I started with some drawings, and built them into a map and webpage framework:

Lots of icons to go into the map:



What the full map looks like:



Website screenshots:





A lot of little details go into the actual implementation, like the Flash plugin for the images and little Javascript goodies for the mouseover effects. These are always some of my favorite parts, because they offer a tricky set of little challenges, but they really give that something extra to a webpage.

Ideas for Digital Artifact #2

So now what? Now that I've gotten a decent overview of childhood depression, naturally I want to keep finding more resources, but ultimately turn this information into something that can help people. There are lots of organizations out there designed to spread awareness about mental health, but I wonder if there's something more active I can do? In the spirit of the presentations I heard last week, I'm optimistic that technology can be used to make a real difference to people who are suffering.

I had a few ideas of what I could do about the problem of depression in schools. It seems impractical to tackle the whole thing at once, so perhaps I could focus on a few elements that seem manageable. For example, I found that depression is often ameliorated by healthy food and exercise, especially for children who are prone to obesity. I'd like to develop a game that would encourage kids to play outside and eat healthy food. My current idea is based on what my siblings and I used to play when we were little: set up outdoor "restaurants" with snacks, and ride our bicycles between each one. If I could place this kind of game in some sort of framework where lots of kids could use it (such as a website or application), it might help kids go outside and eat healthy snacks...two for one.

Still shuffling through some ideas, but I hope that in the next few weeks I come up with something exciting and concrete.