‘At-Risk’ – Concerns About Its Effectiveness

Judith_McDaniel2_80By Judith McDaniel
Editor, Web-based Course Design

[Note: Judith McDaniel originally posted this as a comment to Carrie Heeter’s “Review of ‘At-Risk’: A Simulation Training Program for College Staff.” We’ve decided to publish it as an article to stimulate further discussion on this and similar simulation programs. -js]

Carrie – thanks for the interesting summary and analysis of At Risk. I had several responses myself after trying out the same “free” sample interaction that you did. Let me see if I can summarize some of my discomfort with this product.

First, I don’t think I have had a class at the university level with only 20 students in it since the 1980s. So for me, one necessary assumption is that most instructors are going to be dealing with far larger classes than the one represented here – at least double, probably triple or more. That makes this entire process problematic for me since it assumes that I will be talking to these students about their work outside of class – and in very large classes that seldom happens.

I am concerned too that my role as an instructor, not a therapist or counselor, not be confused – by me or by my students.

a frontal lecture where all the students are using laptops

Further, the self-reporting of changed attitudes is interesting. I did not have the same experience that you did with feeling more comfortable. But that aside, self-reporting, no matter how well-meaning, is not evidence that the program works. Changed behavior in terms of frequency of reporting would be more relevant, but of course that takes years and $ investment.

I also found the “flags” for what we should notice in our students to border on the ludicrous. Does a student come to class looking tired and with messy hair? Yes, that describes about half of a freshman class in early November. Is a student anxious or withdrawn or sullen or non-participative? Yes, inevitably when there are 100 or more students in a class, that describes some of them. I have never found that to correlate to a need for referral . . . that I would have known.

And, finally, that is my last discomfort. I did have a student who disappeared last semester two-thirds of the way through class. She had been doing really well. Emails did not get a response. Finally, the last week of the class, she reappeared. She had been hospitalized after a suicide attempt and was back. I am still working with her to finish her Incomplete. But could I have referred her sooner? I honestly can’t imagine how. Would having taken this training have let me identify her? Not from what I have seen of it.

Review of ‘At-Risk’: A Simulation Training Program for College Staff

heeter80By Carrie Heeter
Editor, Games Development

I vividly remember the day I received email from a graduate student who had gone missing from my online class, announcing that he had “just gotten back from the loony bin.” He wrote that he had checked himself in to a mental hospital and was now back and ready to start making up late assignments (with one week left in the semester). Over the years as professors each of us comes to realize our students are enrolled in classes other than just the ones we are teaching, and beyond that they have real lives, jobs, and families. Our official job is to teach well, to inspire, and to grade fairly while juggling our own impossible to meet demands of work and life. Unofficially, the unfolding joys and concerns experienced by everyone’s whole self may enrich or undermine teaching and learning.

At-Risk is a simulation training program designed to addresses one specific, potentially lifesaving dimension of this complex milieu.

At-Risk was created by Kognito, in partnership with the Mental Health Association of New York City (MHA-NYC). MHA-NYC programs help raise awareness about mental health problems and encourage people to seek treatment. The At-Risk training simulation teaches college faculty to identify mental health problems among their students and to refer mentally distressed students to the college counseling office for assistance.

poster with 3 small people in front of 1 taller person and the words: at-risk - identify students in mental distress - refer them to the campus counselling center

In the simulated 20 person class, 6 students have been flagged as potentially experiencing mental distress. As the instructor, your goal is to talk with each of those students and, if appropriate, refer them to the counseling center. You can review each student’s grades, behavior in the class, and appearance. You are told at the beginning that three of the six are at-risk, but you are not told which three. The training simulation lasts approximately 45 minutes. It is 2D web based and includes many lengthy narrated explanations before and after the interactivity.

At-Risk uses “conversation menus” organized by category to offer choices of what to say next. The animated student responds, choices of what the instructor says next are presented, and the simulation offers encouragement or criticism about the conversation choices.

I played through the free online demo of one of the six students. Wendy’s problems were exaggerated and extreme. She is a 4.0 student who is so nervous she comes in to talk about every assignment. Heart palpitations caused her to go to the health clinic, causing her to skip the class presentation. As I played through the simulation, I argued with myself about whether it is reasonable for professors to call a meeting with 4.0 students who are nervous about speaking in class, even if the student is very nervous. I made a note to myself to check whether my university counseling center still exists, after the latest round of budget cuts, and what services they offer.

I also found that experiencing the simulated conversation was helpful and informative, even though I was trying to figure out what the simulation expected me to choose. It was useful to choose and hear spoken exactly how to bring up the counseling center. If sending students there has a chance of helping them cope better with life and with school, that’s something I would be willing to do. And now I have a better sense of how it’s done. The simulation was more useful in convincing me of the importance of identifying mental health problems and in showing me how to refer people than reading a brochure would have been.

clip-art-like image of a class where students at risk are marked by a white triangle above their heads

I also naively expect socially useful serious games to be free. At-Risk is definitely not free. Licensing fees are way beyond what any individual faculty member would consider paying. I am not familiar with how universities prioritize nontrivial expenses like this for 45 minutes of online simulation, especially in times of deep budget cuts. The online free demo for one of the six students was informative and useful. Playing the other five conversations would not add five times more value — just playing one was enough to get the most important message: referring students is not hard to do and could help them a lot.

Serious game design needs to be accompanied by research to determine whether the serious goals have been met. Kognito has taken this important step. They are studying their own product and using the findings in marketing. And yet, product specific efficacy studies are not an expected domain for academic scientific research. The research findings offer a window onto desired and achieved impacts of the At-Risk simulation. I contacted the company for details about the sample size that I didn’t see online. They responded that 42 colleges and universities (who were not paying customers) were invited to use a trial subscription. The first 35 individuals who completed the training at each institution were automatically invited to complete an anonymous online survey. Respondents who were full time practicing psychologists were excluded from study results which, instead, focus on faculty and staff reactions. A total of 375 respondents are represented in the results. No response rate percentage is known.

Key findings from the Kognito.com online research report:

  • Over 80% reported that At-Risk increased their awareness that identifying and referring students is part of their job role and that At-Risk made them more likely to engage in identifying and referring at-risk students.
  • 87% of respondents indicated they were better prepared to identify, refer, and approach at-risk students, and 82% felt better prepared to help a suicidal student.
  • 99% of respondents said the simulated conversations were realistic representations of conversations they were likely to have with at-risk students.

If I had been a respondent, I would have answered the way the majority of respondents did, based only upon playing the demo.

For more information about the simulation see http://www.kognito.com/atrisk/