SickKids VR De-Escalation Training

About

In a Virtual Reality (VR) simulation, care providers are immersed in a fictional scenario centered around Caden, a non-binary youth brought into the Emergency Department due to suicidal risk and self-injury. The program guides learner's through four escalation levels, facilitating practice in critical decision-making, collaborative problem-solving, and emotional regulation at each stage of escalation.

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The Problem

Care providers face challenging situations during de-escalation scenarios. It is essential to ensure healthcare providers feel equipped to put theory into practice and effectively navigate rising challenges and emotions.

"When there's a mental health crisis, it's a very high stakes, complex situation. We need to practice, but historically there hasn't been a great way to do this" — Dr. Sasha Litwin, Emergency Department Physician

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The Goal

Provide healthcare professionals with a safe environment to practice communication and de-escalation skills, particularly focusing on pediatric care, by offering feedback and suggestions based on their simulation experience.

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The Impact

The VR training will start being used in 2024, starting with staff who are Crisis Prevention Institute (CPI) certified, and later integrated into a larger de-escalation program offered through the SickKids Learning Institute. The training is scheduled to occur in SickKids' newly constructed facility, Project Horizon. These fresh spaces are designed to facilitate the incorporation of emerging healthcare technologies and much more. Read the SickKids Article.

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The Process

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01 Understanding the User

Narrative Branching

Collaboratively, we recognized that de-escalation scenarios exhibit unique characteristics in each situation, leading us to embrace a branching choose-your-own-story format. One effective strategy for weaving storytelling and plot into gameplay involves implementing branching narratives, where the player's choices substantially impact both the storyline and its ultimate outcome.

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Stakeholder Interviews

Collaboration with hospital project managers and stakeholders to find out what they want and why. Discussing the scope and vision of the project almost always openly reveals the feasibility of a product. These discussions played a pivotal role in shaping the project's direction.

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Storyline Scenario Mapping

During our stakeholder interviews, we decided to used the escalation cycle to lay a foundation for the simulation storyline. We leveraged existing health training materials and common conflicts/triggers that give learners an opportunity to practice realistic scenarios. We were mindful of accessibility, inclusion, diversity, and triggering trauma in learners.

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Persona

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02 Starting the Design

User Flow

I decided to use Figma as the primary tool for communicating the branching script to stakeholders, developers, and animators. This served as the foundational and go-to resource throughout the entire process, spanning from design to launch. Designing a branching simulation, which involved a lot of moving parts, presented a welcomed challenge.

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Low-fidelity Storyboard

Created 113 low-fidelity storyboards for stakeholders, developers, and animators to understand the flow before moving forward to 3D animation and motion capture.

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Motion Capture & 3D

On mocap day, organizing the composition/flow of each scene and refining the script were imperative given our tight schedule. As I prioritize user experience in the VR simulation, I personally selected the best takes and communicated them to animators. Additionally, I introduced ID codes early on to each scene for efficient communication.

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03 Refining the Design

Usability Test Parameters

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Usability Test Findings

All participants were experienced healthcare professionals. These were the main findings uncovered by the usability study:

• Verbal Learning Opportunities: (VLO): Users would speak before clicking the Next button, making the voice transcription unusable. Based on the finding, we removed any extra interaction points.
• Training Coach (TC): Experienced users didn't need guidance from the training coach, instead preferred to go through the simulation as a review. We gave users the choice to turn TC off.
• 3D Asset Items: Users said some 3D items were potential risks to youth.

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04 Going Forward

Impact

The VR training will start being used in 2024, starting with staff who are Crisis Prevention Institute (CPI) certified, and later integrated into a larger de-escalation program offered through the SickKids Learning Institute. The training is scheduled to occur in SickKids' newly constructed facility, Project Horizon. These fresh spaces are designed to facilitate the incorporation of emerging healthcare technologies and much more. Read the SickKids Article.

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What I Learned

I've discovered that crafting a training simulation involves numerous moving parts. Navigating the feasibility of various design choices with the perspectives of stakeholders, developers, and animators, all within the project's time constraints, can be quite challenging (e.g., hosting platform, diversity in healthcare professionals, navigating triggers, measuring training efficacy, animation). However, despite these challenges, I found enjoyment in the process and ensured effective communication and negotiations throughout.

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