Bridging simulation technology with positive behavioral supports to promote student engagement and behavior.

Simulation technology provides opportunities for teachers to engage in extended practice using positive behavioral supports to promote student engagement and behavior. These training models are rapidly emerging and if effective, create an infrastructure for scaling up positive behavioral supports in classrooms and schools. However, there is limited research examining teacher skill transfer or student outcomes. This study examined the incremental benefits of Interactive Virtual Training for Teachers (IVT-T) in combination with professional learning communities (PLCs) in one high poverty school district. Using a quasi-experimental design, teachers (N = 90; n = 52 IVT-T + PLC condition; n = 38 PLC condition) and students (N = 100; n = 60 IVT-T + PLC condition; n = 40 PLC only) participated across six K-8 schools. Both training conditions were rated as moderately acceptable. One and two-level generalized linear models indicated teachers who used IVT-T increased their use of praise (b = 0.75, p = .03) and decreased their use of behavioral corrective feedback (b = -0.32, p = .02). Their students were also more passively engaged (b = 0.42, p = .05) and showed fewer inappropriate physical behaviors (b = -0.87, p = .002). IVT-T hours predicted increases in praise statements (b = 0.07, p < .001) and decreases in vague directives (b = -0.07, p = .006) whereas PLC hours predicted increases in teachers' use of vague directives (b = 0.07, p = .05). There was a significant positive effect of IVT-T hours on student passive engagement (b = 0.04, p = .01) and a negative effect of PLC hours on rates of inappropriate physical behaviors (b = 0.1, p = .04). Study limitations and future directions for research and practice are discussed.

Development, Feasibility, Acceptability, and Utility of an Expressive Speech-Enabled Digital Health Agent to Deliver Online, Brief Motivational Interviewing for Alcohol Misuse: Descriptive Study.

BACKGROUND: Digital health agents - embodied conversational agents designed specifically for health interventions - provide a promising alternative or supplement to behavioral health services by reducing barriers to access to care. OBJECTIVE: Our goals were to (1) develop an expressive, speech-enabled digital health agent operating in a 3-dimensional virtual environment to deliver a brief behavioral health intervention over the internet to reduce alcohol use and to (2) understand its acceptability, feasibility, and utility with its end users. METHODS: We developed an expressive, speech-enabled digital health agent with facial expressions and body gestures operating in a 3-dimensional virtual office and able to deliver a brief behavioral health intervention over the internet to reduce alcohol use. We then asked 51 alcohol users to report on the digital health agent acceptability, feasibility, and utility. RESULTS: The developed digital health agent uses speech recognition and a model of empathetic verbal and nonverbal behaviors to engage the user, and its performance enabled it to successfully deliver a brief behavioral health intervention over the internet to reduce alcohol use. Descriptive statistics indicated that participants had overwhelmingly positive experiences with the digital health agent, including engagement with the technology, acceptance, perceived utility, and intent to use the technology. Illustrative qualitative quotes provided further insight about the potential reach and impact of digital health agents in behavioral health care. CONCLUSIONS: Web-delivered interventions delivered by expressive, speech-enabled digital health agents may provide an exciting complement or alternative to traditional one-on-one treatment. They may be especially helpful for hard-to-reach communities with behavioral workforce shortages.

Engaging adolescents in a computer-based weight management program: avatars and virtual coaches could help.

OBJECTIVE: This research focuses on the potential ability of animated avatars (a digital representation of the user) and virtual agents (a digital representation of a coach, buddy, or teacher) to deliver computer-based interventions for adolescents' chronic weight management. An exploration of the acceptance and desire of teens to interact with avatars and virtual agents for self-management and behavioral modification was undertaken. MATERIALS AND METHODS: The utilized approach was inspired by community-based participatory research. Data was collected from 2 phases: Phase 1) focus groups with teens, provider interviews, parent interviews; and Phase 2) mid-range prototype assessment by teens and providers. RESULTS: Data from all stakeholder groups expressed great interest in avatars and virtual agents assisting self-management efforts. Adolescents felt the avatars and virtual agents could: 1) reinforce guidance and support, 2) fit within their lifestyle, and 3) help set future goals, particularly after witnessing the effect of their current behavior(s) on the projected physical appearance (external and internal organs) of avatars. Teens wanted 2 virtual characters: a virtual agent to act as a coach or teacher and an avatar (extension of themselves) to serve as a "buddy" for empathic support and guidance and as a surrogate for rewards. Preferred modalities for use include both mobile devices to accommodate access and desktop to accommodate preferences for maximum screen real estate to support virtualization of functions that are more contemplative and complex (e.g., goal setting). Adolescents expressed a desire for limited co-user access, which they could regulate. Data revealed certain barriers and facilitators that could affect adoption and use. DISCUSSION: The current study extends the support of teens, parents, and providers for adding avatars or virtual agents to traditional computer-based interactions. Data supports the desire for a personal relationship with a virtual character in support of previous studies. The study provides a foundation for further work in the area of avatar-driven motivational interviewing. CONCLUSIONS: This study provides evidence supporting the use of avatars and virtual agents, designed using participatory approaches, to be included in the continuum of care. Increased probability of engagement and long-term retention of overweight, obese adolescent users and suggests expanding current chronic care models toward more comprehensive, socio-technical representations.

Guest editorial. Special section on affective and pervasive computing for healthcare.

This special section is focused on the novel and practical ways, and solid contributions, to improve affective computing and pervasive technologies. There are 19 papers in this special section.

Features for culturally appropriate avatars for behavior-change promotion in at-risk populations.

We explore how avatars can be used as social orthotics defined as therapeutic computer-based social companions aimed at promoting healthy behaviors. We review some of the health interventions deployed in helping at-risk populations along with some of the unique advantages that computer-based interventions can add to face-to-face interventions. We posit that artificial intelligence has rendered possible the creation of culturally appropriate dialog-agents for interventions and we identify specific features for social avatars that are important - if not necessary - when applied to the domain of social orthotic systems for health promotion.

Second life, bio-sensors, and exposure therapy for anxiety disorders.

We give an overview of the Second Life (SL) virtual world, explaining what objects can be manipulated to implement user-defined scenari in SL, and give an example of a work-in-progress scenario of exposure therapy for anxiety disorders, coupled with automatic processing of bio-sensed emotional signals. Both e-Health and emotion recognition researchers can benefit from such experiments.