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(figs 2 and 3)
Egon Brunswik left, and hislens model describing ecological validity below.
(fig 1)
Dr Lisa Reynolds.
1. Reynolds LM, Jones LM, Davies JC, Freeth J, Heyman B. Playing the game: service users' management of risk status in a UK medium secure forensic mental health service. Health, Risk & Society 16(3) 2014; 199-209.
2. Godin, P., Davies, J., Heyman, B., Reynolds, L., Simpson, A. & Floyd, M. (2007) Opening communicative space: A Habermasian understanding of a user led participatory research project, Forensic Psychiatry & Psychology. 18 (4), 452 - 469.
3. Abuhamdeh S, and Csikszentmihalyi M. Attentional involvement and intrinsic motivation. Motivation and Emotion 36(3) 2012; 257-267.
4. Ermi L, Mäyrä F. Fundamental components of the gameplay experience: analysing immersion, worlds in play. International Perspectives on Digital Games Research 37 2005; e14.
Dr Lisa Reynolds led the research (fig 01). Lisa, like other team members, has a wealth of experience in forensic mental health research. The research consistently underlines a requirement for ecological valid systems of assessment within secure settings [1,2]. Ecological validity as originally defined by Egon Brunswik (fig 2 and 3) was a narrow property of stimuli in perceptual experiments (fig 3), nowadays the popular use, broadly equivalent to 'realism', has overtaken this. A realistic game environment and game-play imperatives can be expected to yield a degree of ecological validity - realism engendering player immersion and therefore intuitive, uncompromised, responses [3,4]. In a user-centred process, Streetwise was developed with input from secure forensic mental health service users to capture realistic and credible characters, environments, scenarios and motivations.
The need for tools with a higher degree of ecological validity in secure forensic mental health settings is an established and defined challenge. Press ‘2’ below to read more.
StreetWise is a prototype serious game. It was developed as part of an initial phase of research to test the feasibility and acceptance of a serious game in a secure forensic metal health domain. The development and evaluation of the game required NHS approval to access the secure facilities and work alongside service users. The ultimate goal of the research is the creation of a serious game that supports and enhances the rehabilitation of secure forensic mental health service users.
UK Forensic Mental Health services are tasked with ensuring public safety while facilitating service user recovery and integration into wider society. Due to dangerous and antisocial behaviour service users can find themselves detained under the Mental Health Act. Restricted community access makes risk assessment and the development of skills for independent living problematic. Therefore, the primary requirement on StreetWise was to enable service users to explore and reflect on their responses to community-based situations, such as peer pressure to offend, within a safe context.
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Professor Neil Maiden, an expert in Requirements Engineering and Creativity, oversaw the user-centred design process (fig 1). Generating the realism required to create a valid ecology for StreetWise was perceived as a hurdle, especially with incarcerated service users. We took inspiration from various sources including reported requirements discovery practices with other user groups [1,2,3], and good co-design practices such as providing food in workshops and producing memorabilia, to help elevate service user sense of ownership. The materials that can be brought in to the secure facilities is understandably limited. However, by prior arrangement a basic range of creativity tools including pens, paper and printed matter was permitted. The generous assistance of service providers in facilitating efficient access to service users in a high security environment was also essential.
All of the service users constructively participated in the workshops and expressed positive attitudes about their involvement. The workshops spawned numerous pertinent and exciting suggestions for game features and the potential therapeutic and educational context of StreetWise.
1. Wilson S, Roper A, Marshall J, Galliers J, Devane N, Booth T, Woolf C. Codesign for people with aphasia through tangible design languages. CoDesign: International J of CoCreation in Design and the Arts 11(1) 2015; 21-34.
2. McKeown M, Jones F, Wright K, Spandler H, Wright J, Fletcher H, Duxbury J, McVittie J, Turton W. It's the talk: A study of involvement initiatives in secure mental health settings. Health Expectations 2014; e10.
3. Cook MR. Creative requirements conversations. IEEE Software 27( 2) 2010, 90-91
Working with secure forensic mental health service users to design a serious game was a novel and largely uncharted process. Press ‘2’ below to discover more.
Implementing a user-centred process, all the stakeholders were carefully consulted throughout the development of the StreetWise prototype. Most notably we worked in situ with pre-discharge secure forensic mental health service users.
A series of 3 workshops took place over the summer of 2014 in secure facilities. Each workshop was attended by 4-5 service users from a pool of 8 volunteers. All were males between 20 and 45 years of age preparing for discharge. 2-3 service providers also attended each workshop and 2-3 researchers who facilitated each workshop. A further 2 meetings were held by 2 researchers with a single service user, also in a secure setting. One of the researcher-facilitators who was also the game developer attended all the workshops and meetings to acquire a first-hand understanding of the domain and requirements.
The workshops were used to capture and hone credible characters, environments, scenarios and gameplay motivators such as punishments and rewards. The prototype focused on alcohol and drug use, recognised as initiating negative cycles that can result in institutionalisation.
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The Scenario Engine also introduces a level of randomness to each game by seeding from a bank of different stories and characters. It also reacts to how well the player was doing by following weighted paths to provide easier or harder gameplay. Snippets of dialogue from StreetWise in panel above describe how a player doing well is confronted by a more powerful negative scenarios (left), and a neutral option replaced by a Trojan-horse, higher-risk, scenario (right).
The Senario Engine.
As demonstrated in the panel-images to the right, the Scenario Engine reacts to how easy or hard the player is finding the game. In addition to ramping-up or dampening-down the difficulty of scenario choices, the engine also generates play-appropriate game character prompts aimed at the player. Unlike the main scenario choices, the prompts are initiated by the game-characters independent of direct player-interaction. They are short comments used to reinforce game-play protocols, encourage slow players to speedup/make a choice, and, again based on how well a player is doing, promote a good or poor response.
The 'Scenario Engine', click the numbers to find out more.
Using abbreviated snippets of spoken dialogue from StreetWise, the panel above demonstrates how a story path with one specific character may develop over 3 rounds depending on the choices the player makes and random seeding from the bank of possible options using the Scenario Engine.
The Scenario Engine.
The engine incorporates authentic stories and dialogue based the service users’ experience of drug and alcohol use. The process of elicitation pushed the service provider’s knowledge of the service user’s world, for example the extent to which drugs are used by dealers to entrap users, and the degree of separation between personal and street personas. There was also a belief among the service users that drug dealing was both easy and profitable, and that being institutionalised was relatively desirable. Additionally, some scenarios involved extravagant rewards and violent punishments - consequently these scenarios required some moderation to meet the needs of rehabilitation.
The 'Scenario Engine', click the numbers to find out more.
As a player explores the game location from the first-person-perspective, characters encountered present choices for the player to select or disregard. Some choices are deemed to be of lower risk to the player than others, and the game evaluates the player accordingly. Using abbreviated snippets of spoken dialogue from StreetWise, the panel above shows possible first round choice scenarios of, high-risk, low-risk, and medium-risk (left to right).
The Scenario Engine.
The Scenario Engine is at the fist level of development in the prototype, providing some limited variations on scenarios that evolve in reaction to player choices and consequent random seeding. Currently the Scenario Engine has enough assets to generate 250-plus unique game-play experiences. The intention is that the scenario engine will eventually provide personalised, immersive and emergent-like game play, allowing service users and service providers to customise the game in order to address individual therapy requirements.
The 'Scenario Engine', click the numbers to find out more.
Each successive round is populated by characters who react and provide further choices that are consistent with the choices made in previous rounds so that an engaging and coherent story emerges, StreetWise also reacts to how well the player was doing by following weighted paths for easier or harder gameplay, this behaviour is provided by the ‘Scenario Engine’
The delivery of StreetWise is via the Unity game engine for web browser. It does not rely on expensive or intrusive equipment because of the restrictions imposed in a secure forensic mental health setting. Moreover, stakeholder consensus was for a simple pick-up-and-play game on a desktop computer or tablet.
The game loop of StreetWise is based on the scenarios elicited from the service users at part of the user-centred design process. As a player explores the game location the characters encountered present choices for the player to select or disregard. Some of these choices are deemed to be of lower risk to the player than others. For example, choosing to visit the Job Centre was of less risk to the player than choosing to smoke crack. In the current version of the game each player goes through 3 rounds.
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Above, an edited 3-round play-through of StreetWise.
Use the number-buttons below to update the text to the left.
Following feedback from the evaluation, future development of StreetWise will look to quantifiably improve service user’s self-management. The prevention of risky behaviour and an increase in esteem and confidence is a priority. StreetWise also needs be fun to play, feedback from the service users was positive in respect to the direction of the game and it’s the realism afforded, however it was clear that Streetwise needs more content. Fortunately the initial phase of research captured over a hundred discrete stakeholder ideas to be mined for future features.
Future development will address the service provider’s request for a serious game to reinforce intended outcomes outside of scheduled therapy sessions. Service providers also remain concerned about ecological validity, therefore the game will need to demonstrably safeguard against potential subversion by service users. The generation of an appropriate level of ecological validity remains key to delivering clinical value from StreetWise. Methodologies will be pursued that can grow and measure a valid game ecology, to deliver life-like imperatives and accurate and actionable diagnostics. To this end, new research is planned to test a set of documented strategies for measuring player engagement using the StreetWise prototype, progress will reported here on this website.
While there was already good evidence for feasibility and acceptance for StreetWise from the development process, we also undertook a first summative evaluation with service users. A new group of 6 volunteers, who had not been involved in the game development, were observed playing StreetWise before participating in a group debrief. The observations allowed the researchers to informally access the participant’s engagement with the game. The group debrief ascertained how accurately the prototype depicted the service user experience and matched their expectations.
Feedback confirmed that StreetWise has a credible game ecology, and all the participants were keen to see the adoption of a serious game as part of their rehabilitation.
To investigate the depth of acceptance of a serious game in the forensic mental health domain, 8 clinical and administrative professionals were also interviewed. After being shown the StreetWise prototype, the service providers were encouraged to express their thoughts about it. Like the 6 service users, the 8 service providers saw strong potential in the game as a therapeutic tool.
The conclusion is that a serious game in the secure forensic mental health domain is both feasible and acceptable.
The StreetWise team wish to give special mention to,
Richard Sinnett (additional character customisation artwork)
Matthew Attenborough-Warren (voice art)
Jordan Clarke (voice art)
Thea Gojic (voice art)
Becki Newell (voice art)
Bongo Sokude (voice art)
Further Resources
http://dx.doi.org/10.1016/j.procs.2015.08.341 (paper: StreetWise: a valid ecology for a serious game in a secure forensic mental health setting)
The reserch was funded and involved staff and students from City University London. Visit the City University London website by
clicking here.
Paul Hodge developed the StreetWise prototype game. Paul has 20 years experience as an artist and user-interface designer in the games industry. Mail for further information by clicking here.
The important work initiated by the StreetWise prototype serious game project is currently looking for revenue to secure future development. For more information about the project mail Lisa by clicking here.
A prototype game for change in secure forensic mental health.