Klein Schaarsberg Renée E, Ribberink Amber Z, Osinga Babette, van Dam Levi, Lindauer Ramón J L, Popma Arne
Child and Adolescent Psychiatry & Psychosocial Care, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, Netherlands.
Garage2020, Dutch innovation network for societal youth challenges, Amsterdam, Netherlands.
JMIR Form Res. 2023 Nov 28;7:e46592. doi: 10.2196/46592.
We developed Street Temptations (ST) as an add-on intervention to increase the treatment responsivity of adolescents with disruptive behavior problems. ST's primary aim is to improve adolescents' mentalizing abilities in order to help them engage in and benefit from psychotherapy. Additionally, virtual reality (VR) is used to work in a more visual, less verbal, fashion.
By recapping the lessons learned while developing ST so far, we aim to design the following study on ST. Furthermore, we aim to enhance the development and study of new health care interventions in clinical practice, together with adolescents as their end users.
We followed an iterative co-creation process to develop a prototype of ST, in collaboration with adolescents and professionals from a secured residential facility in Amsterdam, the Netherlands. The prototype was tested during a pilot phase, involving 2 test runs, in which 4 adolescents and 4 professionals participated. Qualitative data were collected through interviews with the adolescents and by conducting a group interview with the professionals, in order to gain first insights into ST's usability, feasibility, and its added value to clinical practice. In between the first and second test runs, the prototype was enhanced. On the basis of the complete pilot phase, we reflected on the future development and implementation of ST to design a subsequent study.
Over the course of 6 months, ST's first prototype was developed during multiple creative sessions. Included was the development of a short 360° VR video, to serve as a base for the mentalization exercises. The final version of ST consisted of 7 individual therapy sessions, incorporating both the VR video and a VR StreetView app. On the basis of the qualitative data collected during the pilot phase, we found preliminary signs of ST's potential to support adolescents' perspective-taking abilities specifically. Additionally, using VR to focus on real-life situations that adolescents encounter in their daily lives possibly helps to facilitate communication. However, several challenges and requests concerning the VR hardware and software and the implementation of ST emerged, pointing toward further development of ST as an add-on intervention. These challenges currently limit large-scale implementation, resulting in specific requirements regarding a subsequent study.
In order to gather more extensive information to shape further development and study treatment effects, a small-scale and individually oriented research design seems currently more suitable than a more standard between-subjects design. Using the reflection on the lessons learned described in this report, a research protocol for a forthcoming study on ST has been developed. By presenting our co-creation journey thus far, we hope to be of inspiration for a more co-creative mindset and in that way contribute to the mutual reinforcement of science and clinical practice.
我们开发了“街头诱惑”（ST）作为一种附加干预措施，以提高有破坏性行为问题的青少年对治疗的反应性。ST的主要目标是提高青少年的心理化能力，以帮助他们参与心理治疗并从中受益。此外，虚拟现实（VR）被用于以一种更具视觉性、更少言语性的方式开展工作。
通过回顾迄今为止在开发ST过程中吸取的经验教训，我们旨在设计关于ST的后续研究。此外，我们旨在加强临床实践中针对青少年这一最终用户的新型医疗保健干预措施的开发和研究。
我们与荷兰阿姆斯特丹一家安全住宿机构的青少年和专业人员合作，遵循迭代共创过程来开发ST的原型。该原型在试点阶段进行了测试，包括2次试运行，有4名青少年和4名专业人员参与。通过与青少年进行访谈以及对专业人员进行小组访谈来收集定性数据，以便初步了解ST的可用性、可行性及其对临床实践的附加价值。在第一次和第二次试运行之间，对原型进行了改进。基于整个试点阶段，我们对ST的未来发展和实施进行了反思，以设计后续研究。
在6个月的时间里，ST的第一个原型在多次创意会议期间得以开发。其中包括制作一个简短的360°VR视频，作为心理化练习的基础。ST的最终版本包括7次个体治疗课程，融合了VR视频和VR街景应用程序。根据试点阶段收集的定性数据，我们发现了ST尤其有潜力支持青少年观点采择能力的初步迹象。此外，使用VR聚焦青少年在日常生活中遇到的现实生活情境可能有助于促进交流。然而，出现了一些关于VR硬件和软件以及ST实施方面的挑战和要求，这表明需要进一步将ST开发为一种附加干预措施。这些挑战目前限制了大规模实施，从而对后续研究提出了特定要求。
为了收集更广泛的信息以塑造进一步的发展并研究治疗效果，目前一个小规模且针对个体的研究设计似乎比更标准的组间设计更合适。利用对本报告中吸取的经验教训的反思，我们制定了一份关于ST未来研究的研究方案。通过展示我们迄今为止的共创历程，我们希望能激发更具共创性的思维方式，从而为科学与临床实践的相互促进做出贡献。
