Improving capacity to identify, assess, and manage adolescents engaging in non-suicidal self-injury using patient avatars

Abstract

Purpose

We developed and evaluated a training comprising a didactic and virtual practice session with human-guided patient avatars to increase pediatric residents’ competence to identify and assess non-suicidal self-injury (NSSI) and suicide risk.

Methods

Thirty pediatric residents at three children’s hospitals in Florida participated in the training and completed pre-, one-month post-, and three-months post-training surveys. One-way repeated measures ANOVA with post-hoc comparisons determined changes in confidence, comfort, behavioral intentions, attitudes, knowledge, and behavior over time. Qualitative responses provided feedback on the training, especially the novel practice session with adolescent patient avatars.

Results

Three-months post-training residents expressed significantly greater confidence in talking to adolescents who self-injure, applying the SOARS method to assess self-injury, and assessing functions/reasons for self-injury; reported feeling significantly more comfortable asking about self-injury, well-equipped to handle the emotional aspects of self-injury, and comfortable treating adolescents who self-injure; reported greater behavioral intentions to talk to adolescents about self-injury, assess an adolescent’s stage of change for stopping self-injury, and provide brief interventions for adolescents who self-injure; and used SOARS to evaluate current NSSI with a greater proportion of adolescent patients. Qualitative feedback expressed positive perceptions, especially related to the virtual-reality role-play session.

Conclusions

Incorporating an interactive, human-guided virtual experience using role-playing and feedback with patient avatars represents a viable option comparable to using typical standardized patients to expand the scalability of NSSI trainings for pediatric residents, especially when they occur virtually.

Keywords:

• NSSI
• virtual
• avatar

Acknowledgments

All phases of this study were supported by internal funding from the UCF College of Medicine to Dr. Lindsay Taliaferro. We thank the pediatric residency programs who participated in this study.

Author contributions

LT, NW, and JM conceptualized and designed the study and data collection instruments.

CH and KI created the patient avatars, including nonverbal body language movements, and their environment. KI also served as an Interactor during some training sessions and trained other Interactors.

NW created the adolescent patient scenarios residents used in role-plays with the avatars and created the SOARS assessment method.

LT developed and delivered the didactic lecture, facilitated the role-playing virtual simulation with the patient avatars, and drafted the initial manuscript.

BM managed data collection and performed data analyses.

All authors edited and commented on the versions for this article.

Disclosure statement

The author reports no conflicts of interest. The author alone is responsible for the content and writing of the article.

Additional information

Funding

This work was supported by the University of Central Florida, College of Medicine.

Notes on contributors

Lindsay A. Taliaferro

Dr. Lindsay A. Taliaferro, MPH, PhD, is an Assistant Professor in the Department of Population Health Sciences, College of Medicine, University of Central Florida, USA.

Nicholas J. Westers

Dr. Nicholas J. Westers, PsyD, ABPP, is a Clinical Psychologist in the Department of Psychiatry at Children’s Health Systems of Texas and Associate Professor at UT Southwestern Medical Center, USA.

Brandon Matsumiya

Dr. Brandon Matsumiya, PhD, is a Postdoctoral Fellow in the behavioral health primary care program at Swedish Hospital in Seattle, WA, USA.

Kate Ingraham

Dr. Kate Ingraham, PhD, is Program Director for the Center for Research in Education Simulation Technology at the University of Central Florida, USA.

Jennifer J. Muehlenkamp

Dr. Jennifer J. Muehlenkamp, PhD, is a Professor in the Department of Psychology at the University of Wisconsin-Eau Claire, USA.

Charles E. Hughes

Dr. Charles E. Hughes, PhD, is a Pegasus Professor in the Department of Computer Science at the University of Central Florida, USA.