Simulations Train Veterans’ Families to Recognize, Respond to PTSD Symptoms

by U.S. Medicine

December 14, 2010

NEW YORK CITY, NY—The student sitting across from you is withdrawn, a little hostile, and tired all the time. He has missed assignments, been repeatedly absent, and when he does show up for class, he sometimes falls asleep mid-lecture. If you begin the conversation from a place of compassion and concern, you will eventually be able to convince him to go see someone at the counseling center on campus. If you aggressively confront him about his grades, he will shut down and the session will end with the student no better off.

This scenario is part of a training simulation called At-Risk®, designed by Kognito Interactive, and it is played out on a computer using avatars. In the simulation, you play the part of the professor, with the goal of recognizing students who are suffering from psychological distress and directing the simulated conversation in such a way that they agree to seek help. The technology has been in use for the last couple of years, training educators to recognize college and high-school students at risk for depression and suicide.

Beginning early next year, the same technology will be used to help veterans and the families of veterans in recognizing the symptoms of PTSD and will teach them the most beneficial ways of responding to veterans exhibiting those symptoms.

At-Risk Avatars

Kognito has been in business for five years, and has specialized in health and behavioral health for the last two. They develop their simulations using a tool called the Human Interaction Simulation Platform—a proprietary authoring system that allows designers to capture what works best in terms of social and emotional learning simulations. The goal is to create the most realistic simulation possible, since the people using the simulation will immediately begin using what they learned in real-world environments.

“The At-Risk simulation allows you to enter a virtual environment where you will assume a role—doctor, veteran, family member of a veteran—and engage in challenging conversation with emotionally responsive avatars,” explained Kognito CEO Ron Goldman. “You learn useful tactics in managing that conversation. The simulation goes through body language and voice [and] every choice you make limits what you can do with the avatar. For a teacher talking to a student who is having thoughts of suicide, if you are being aggressive, [you are] obviously not using very effective tactics. The student will shut down and leave the room. If you use better tactics, [you’re] more likely to have the student avatar open up.”

The technology is in use in 50 universities nationwide, and the state of Texas recently signed a contract with Kognito to use the simulations in training high school educators.

For the past year, Kognito has been adapting its technology specifically for veterans and their families in a pilot project set to roll out in VISN 3—the New York and New Jersey area—in 2011. “The family members of returning veterans are utterly overwhelmed. They don’t know what to say. They’re scared of saying the wrong thing,” said Dr Glenn Albright, Kognito director of applied research. This new simulation will allow them to explore options in a consequence-free environment that can prepare them for the real thing.

“In this simulation, parents and family members interact with a veteran who is experiencing PTSD. He may have depression or suicidal ideation. The avatar is going to respond like a real person will respond,” Albright explained. “In this simulation, they’re taught how to pick up the signs of PTSD, depression, suicidal ideation, and [some symptoms of] TBI. Once they know what the signs are, they are given different strategies. How do you de-escalate an argument? How do you approach them with their responsibilities they need to meet as being a father with children?”

Armed with this information and some familiarity with different strategies, the family member is asked to put those best practices to work by communicating with the avatar. The information includes practical advice; including how to register with VA and what obstacles—socially and bureaucratically—the veteran will face in getting treatment. “What are the barriers a veteran experiences in seeking treatment? What are the stereotypes? How do you tackle them?” Albright asked.

Simulated Healthcare

Kognito designers have been working with VA experts in PTSD and suicide in an attempt to make the simulation as realistic as possible. They conducted a comprehensive needs analysis with help from VA experts, veterans suffering from PTSD, and with families of returning veterans. “We want to be sure we have all our bases covered,” Albright said.

VISN 3 administrators are planning to make the simulation freely available online to everyone. “Each family member who wants can go online and take this training free of charge,” Goldman explained. “We’re going to make it easy for them to do that.”

Goldman said that the company would be happy to work with other VISNs if the project is successful. “We would want to make sure the simulation fits to each VISN’s need. We can modify scenarios and characters,” he noted.

An assessment plan for the pilot project is still being finalized, but Goldman said Kognito will pay close attention to how VA sees the technology working. “It’s important for us, as we introduce this technology that has never been used in this area before, to know that it’s working.”

The next few years will see the simulations take a step further into the healthcare setting, Goldman added. Currently Kognito is designing programs to teach health providers how to successfully manage challenging conversations with patients. “There’s a tremendous need for that type of training,” he declared.

That includes teaching physicians how to best get patients to adhere to treatment after they leave the hospital. “There’s a huge need, especially around diabetic patients. Research shows that a major part of whether a patient adheres to the guidelines is how the doctor or nurse communicates those guidelines.”

Other simulations will look into teaching ER personnel how to identify symptoms of depression and suicidality and how to provide bad news to patients. Kognito will also focus on veterans in the workplace. These simulations will teach employers the benefits of hiring a veteran—including disabled veterans—as well as teaching them how to recognize if an employee is experiencing distress and how to handle it properly.

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