OnTrack>An Online Role-Playing Game for Young People With First Episode Psychosis
Condition: Psychosis; Schizoaffective Disorder; Schizophrenia
MeSH terms: Schizophrenia; Psychotic Disorders; Mental Disorders
Study type: Interventional

Summary: 
      The research team will develop and test a prototype version of OnTrack>An Online Role-Playing
      Game (OnTrack>The Game or OTG), an online role-playing game designed for youth and young
      adults experiencing First Episode Psychosis (FEP). Phase I showed positive changes in
      quantitative measures of hope and recovery, as well as an enthusiastic response to the
      prototype as evidenced by qualitative interviews. In Phase II, the research team will refine,
      expand and finalize OTG and evaluate the effectiveness of OTG.
    

Detailed description: 
      The proposed mixed-methods Phase II study will use standardized measures and semi-structured
      qualitative interviews to achieve the following aims:

        1. Product aim: To refine, expand, and finalize OnTrack>The Game. Building on the Phase I
           prototype, the investigators will improve functionality, expand the play spaces and
           levels, add interaction with non-player characters, include more resources on FEP, and
           expand the library of videos on hope and recovery.

        2. Primary research aim: To evaluate the effectiveness of a role-playing game (OTG) in
           increasing empowerment, decreasing stigma concerns, and improving treatment engagement.

           Hypothesis 1: Compared to control condition (Recovery Videos, or RV), participants in
           OTG will report significantly increased empowerment at 2 months post-intervention
           compared to baseline.

           Hypothesis 2: Compared to the control condition (RV), participants randomized to the OTG
           condition will report significantly increased empowerment, decreased stigma concerns,
           and greater treatment engagement at the 5-month follow-up compared to baseline.

        3. Secondary research aim: To determine if changes in empowerment and stigma concerns
           mediate the effect of OnTrack>The Game on treatment engagement.

      Hypothesis 3: Increases in hope, attitudes toward treatment, and self-efficacy and decreases
      in stigma concerns at post treatment will partially mediate the improvement in treatment
      engagement at follow-up.

      Approach

      Overview and Rationalization of Study Design: Phase II is a randomized controlled trial (RCT)
      enrolling 200 clients randomized to OTG or a control condition of RVs in a 1:1 ratio. The
      investigators will recruit these participants from OnTrackNY's Early Intervention for
      Psychosis (EIP) clinical centers after screening for eligibility. After consent and Baseline
      data collection, participants will be randomly assigned to either OTG or RV, which will be
      available to them for two months. Following an intent-to-treat framework, the investigators
      will then assess each client participant at 2 additional time points regardless of
      participation in their assigned condition: post-intervention (immediately after the 2 month
      intervention has completed), then follow-up at 3 months post-intervention.

      Ten clinicians working with these clients will also be recruited for semi-structured key
      informant qualitative interviews. Twenty client interviews will also be conducted, 10 from
      each condition. The investigators' rationale for selecting a randomized controlled design
      stems from Phase I findings, which suggest that the game may be effective in addressing young
      people's hopefulness, stigma, and understanding around first episode psychosis. An RCT design
      will allow the research team to examine how specific aspects of the game impact outcomes in
      these areas, as compared to more static, passive online resource.

      Study Setting: OnTrackNY is New York State's coordinated specialty care (CSC) program. Funded
      by state dollars, a SAMHSA Health Transitions Grant, and Mental Health Block Grant funds, the
      state currently supports 13 teams throughout the state. Eight additional programs are
      expected to come on line within the next 6 months. The program serves young adults ages 16 to
      30. To date, a total of 290 individuals have been enrolled. Across the sites, clients are 69%
      male; mean age of 21; 19% are under the age of 18; racial/ethnic breakdown is as follows: 42%
      White, 39% Black, 10% Asian, 9% Other, and 23% Hispanic.
    

Intervention name(s): OnTrack>TheGame (OTG); Recovery Videos (RV)
Intervention type(s): Behavioral; Behavioral
Intervention description(s): OTG clients will be informed that the game can be played on a computer or a tablet and the time estimate for completing the game is approximately 5-8 hours. OnTrack>The Game offers players the opportunity to immerse in a fictional neighborhood that centers around four domains for supportive recovery as defined by SAMHSA: health, home, purpose and community. The player interacts with other game characters including new acquaintances, friends/peers, a family member, and a treatment team, allowing the player to practice social and communication skills, while fostering personal relationships and building a support network. Additionally, the game provides players with helpful resources including psychoeducation materials and videos of real people who have experienced a first episode of psychosis, sharing their stories of hope and recovery. As a whole, the game provides a safe environment to promote goal attainment and recovery.; As described, RV clients will have access to a website that includes recovery videos and static psychoeducation materials. In this condition, mental health providers will also ask about possible reactions to viewing the recovery videos and information on the website.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Investigator, Outcomes Assessor)
Primary purpose: Other