Developing videogames and play for hospitalised children

Lead Research Organisation: University of Sheffield
Department Name: Education

Abstract

In exploratory network meetings, we identified a lack of videogames that meet the specific needs of hospitalised children. Hospital play tends to be based on 'traditional' toys and games, with limited innovation in digital play, such as children using tablets/ smart phones brought in by family visitors to access video games. We have identified apps designed for children to communicate pain levels and other symptoms to doctors (e.g. Small Talk Intensive Care, SmallTalk Pain Scale, Answers: YesNo, Speak Aid, Easy Speak, AutoVerbal Talking Soundboard PRO). However, there is considerable scope for development in the videogames industry that could use expertise from humanities and the arts to co-create digital play opportunities that respond to the specific needs of hospitalised children, to stimulate their play experiences, imaginations and creativity when confined to medical and recovery spaces. There is potential for significant impact from scoping the challenges to research and innovation in the videogames sector.
The network integrates three strands of membership to promote interdisciplinarity and combine academic and industry expertise:

Strand 1: Academic researchers in the arts and humanities Specialists in children's play and graphic representation of medical conditions and emotions across cultures and visual media:
Elizabeth Wood specialises in researching traditional and digital forms of play, with a focus on children's choices and agency in free play activities (Wood, 2013; 2008; Wood and Hall, 2011). Dylan Yamada-Rice specialises in researching children's understanding and use of images, their changing multi-modal communication practices, and the expression of emotions in the visual mode (Yamada-Rice 2013; 2012; 2011). Matthew Cheeseman (http://eine.tumblr.com/page/2) will build on knowledge from The Phoenix Art Project (funded by NESTA and Sheffield Crucible theatre), which uses graphic forms to facilitate literary tropes such as humour, metanarrative, ambiguity and metaphor in order to address psychological, taboo and medical problems in imaginative, affecting, complex and contradictory ways (Cheeseman et al, 2013). Richard Finn is a PhD student in the School of English, researching the conceptual structure and reader experience of mental health graphic narratives.

Strand 2: Children's videogames designers: Industry experts in the design and production of videogames for children age 3-18: Nigel Little, Distinctive Games http://www.distinctivegames.com/; Emma O'Kelly De Conejera, and Steve Taylor, Stripy Designs http://www.stripeydesign.com/.

Strand 3: Hospital play specialists: Christina Lloyd and Kevin Hartshorn, Sheffield Children's Hospital.

Digital play is a significant area for creative development, and has strategic importance to the NHS Trusts that manage the five children's hospitals in England: Alder Hey, Liverpool; Children's Hospital, Sheffield; Great OrOrmond Street, London; Royal Manchester Children's Hospital; Birmingham Children's Hospital. For videogames designers this is a complex but new niche market, which requires considerable knowledge about children's play choices and preferences and about hospital play contexts and practices, including ethics. Hospital play specialists and videogames designers will benefit from methodological innovations developed by the academic members of the network, including emotional representation in graphic form, linked to spaces and places (Cheeseman & Finn); emotional representations in environmental images and their appeal to children (Yamada-Rice) and children's multimodal communication practices in traditional and digital play forms (Wood). In order to co-produce these kinds of videogame(s), knowledge exchange amongst the network members (and invited workshop participants) is crucial. Important strategic and creative areas need to be explored in order to inform future developments, and build on existing practice (e.g Create Explore Learn).

Planned Impact

This project includes considerable commitment, including in-kind contributions, by the network contributors from Sheffield Children's Hospital (Lloyd and Hartshorn), and the industry experts videogames designers (Little, Conejera, Taylor). Further in-kind commitments will be secured as the project develops to include wider collaborations on proposals for research and development funding.
The significance of the collaboration is the longer-term potential for co-production and co-creation of commercially viable ideas for developing videogames for children in hospital. This is an under-developed area, and presents numerous challenges to videogames designers, who need knowledge about ethics, age of children, nature of the illness [including treatments and therapies], length of stay in hospital, degree of mobility and access to play activities. Videogames designers wil also benefit from understanding multi-professional relationships and professional cultures in hospital contexts, as well as parents' and children's experiences.
The immediate beneficiaries will be the members of the three strands, specifically developing university-industry collaborations and accelerating the potential for innovations in hospital play. The exchange of professional knowledge, cultures, and practices will specify the research challenges in hospital play (including ethical protocols and creative ways of approaching future research with children and play specialists).Hospital play and therapeutic specialists will benefit from communicating the ways in which functional and free play activities can be integrated into children's experiences in ways that enhance their well-being. Children and families will also benefit from their involvement in Workshop Four, and from subsequent development of any commercial outputs of videogames.
Targets for the NHS Trusts include improving children's experiences of preparing for, and being in hospital, particularly for repeated treatment and therapies. The Workshop activities will inform the development of playful/functional apps, which will be of direct benefit to NHS targets, and to the multi-professional communities of practitioners who work with young people. The project will contribute to enhancing the work of hospital play specialists in educating medical professionals about how to relate to young children in playful and age-appropriate ways.
The wider beneficiaries will be the invited contributors to the four workshops, and the organisations that they represent in the videogames industry, arts, media, hospital play and therapeutic professions, as well as academics and students. Impact will emerge will arise from knowledge exchange activities, workshop summaries on the project website, and plans for future research and funding applications (Workshop 4). There will be scope for scaling-up the outcomes by linking to other research sites in hospital play (such as Professor Joce Nuttall's networks with hospitals in Auckland, Melbourne and London. Prof Nuttall has already expressed interest in developing research collaborations). Future collaborations will afford further potential for improving strategies for sustaining children's development in holistic ways during hospitalization.
In academia, the project will contribute to the University of Sheffield's trans-disciplinary research agenda, specifically linking the arts and humanities with medicine, medical humanities, arts therapies, and developing innovative ethical approaches to trans-disciplinary research methods. The network activities will inform research-led teaching, notably in undergraduate programmes (Dr Cheeseman - Graphic Novels and the Love of Superpower), as well as advanced methodologies and research ethics with M and D level students.
There is considerable potential for opportunities for scaling up and transferable learning to the wider videogames sector, and innovative high quality cross-disciplinary research projects.

Publications

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Title Hospital Heights - a three-dimensional sculptural cal card game 
Description Hospital Heights was developed during the four workshops in our project. First, it represents the design processes in the project, drawing inspiration from the work of Eames - House of Cards, and focusing on images and emotional representations. Second, it drew on the rules from 'Top Trump', with subsequent developments to take account of the new game design. Hospital Heights is a three-dimensional card game that can be played to engage the public and professionals with issues around play for children in hospital, specifically missed play opportunities from their homes and communities, emotions and isolation. The cards are printed with photographs that represent aspects of life in hospital, and images of play and the outdoor environment. These images are designed to encourage discussion about children's hospital experiences, and to communicate their emotions about those experiences. 
Type Of Art Artefact (including digital) 
Year Produced 2014 
Impact We have used Hospital Heights to engage with the public, professional organisations, hospital play specialists and digital games designers. The impact has been to engage digital games designers with key design issues when designing for young children, specifically addressing misconceptions about young children's capabilities and play repertoires. In addition, the impact has been to encourage them to consider specific issues about designing for children in hospital, such as restricted spaces, restricted movement, isolation, and the role of hospital play specialists. http://iedgameresearch.wordpress.com/ www.shef.ac.uk 
 
Description Knowledge and understanding about the needs of children in hospital for physical and digital play
The role of hospital play specialists in supporting physical and digital play

Key outcomes that emerged to inform the videogames industry experts included:
Understanding the different purposes for play.
Knowing how children blend digital and traditional forms of play. This issue was most vividly exemplified by Stripey Design, whose work begins with an understanding of young children and their play. This understanding enables children to create their own content and add this to games.
Understanding play from children's perspectives - i.e. not assuming that children are content with simpler versions of adult videogames.
Understanding the nature and challenges of the hospital environment - for example, what digital tools can be made available within the constraints of space and daily routines. Some young people can have no access to digital technology because of conditions such as depression and eating disorders that can be exacerbated via social media.
Knowledge exchange between different participants, particularly the situated insights shared by the hospital play specialists on the specific demands and nature of their work.
Exploitation Route Develop ways of visualising design processes for the game and game equipment, that promote co-production across academics, artists, game designers and information experience designers.
Engage the general public in playful ways to consider play for children in hospital and recovery spaces.
Extend the reach of the findings to include Special Schools and Children's Hospices.
Inform NHS targets: how hospital play specialists can work with medical staff to understand how digital tools can be used in playful ways for children (and families) to

• Learn about and prepare for their stay in hospital.
• Learn about their conditions and treatments.
• Provide feedback to staff on their emotions, discomfort/pain levels.
• Manage their treatment after discharge or between hospital stays (for chronic conditions).
Sectors Creative Economy,Digital/Communication/Information Technologies (including Software),Education,Healthcare,Leisure Activities, including Sports, Recreation and Tourism

URL http://iedgameresearch.wordpress.com/
 
Description Economic and Social Research Council Festival of Social Sciences, November 2014, Sheffield Museum. Members of the general public and museum educators engaged with the Hospital Heights game, and were encouraged to represent and discuss their emotions associated with illness, recovery, childhood. They talked about their own and their families' experiences in hospital and suggested ways of improving the game design. An outcome of this day was an 'Emoji quilt' - a three-dimensional sculptural quilt. We extended our research and development collaborations with a range of partner organisations, such as Children's BBC; the Children's Media Conference; Stripey Design; Distinctive Games; Medikidz. We have disseminated the outcomes to a range of videogames developers, artists and specialists in different media platforms, specifically understanding of the range of ways in which videogames can blend play and the creative arts for emotional expression, therapeutic and educational purposes, communication and representations, and connecting children's play across real and virtual spaces. Local games designers are using the findings to consider - how children to create their own content and add this to games. - understanding play from children's perspectives - i.e. not assuming that children are content with simpler versions of adult videogames. - understanding the nature and challenges of the hospital environment - for example, what digital tools can be made available within the constraints of space and daily routines. Some young people can have no access to digital technology because of conditions such as depression and eating disorders that can be exacerbated via social media. - how videogames can help meet NHS targets for improving patient experiences and outcomes.
First Year Of Impact 2014
Sector Creative Economy,Digital/Communication/Information Technologies (including Software),Education,Healthcare
Impact Types Societal,Economic

 
Title Project blog 
Description The project has been fully documented on a blog http://iedgameresearch.wordpress.com/ 
Type Of Material Database/Collection of data 
Year Produced 2014 
Provided To Others? Yes  
Impact Engagement with the project's methods and outcomes. Visual representation of the project through images. 
 
Description Industry, NHS and academic partners 
Organisation Birmingham Children's Hospital
Country United Kingdom 
Sector Hospitals 
PI Contribution The PI and Co-I organised three workshops, each of which focused on a key theme, and each was led by one of the partners: hospital play specialists, academics, industry games designers (Stripey Design and Distinctive Games). Workshop four brought together all the partners to explore physical and digital space, tactile and imagined play, friendship and isolation, ethics and emerging themes from the previous workshops. These themes were discussed as key outcomes from the project, focusing on design principles for children in hospital and recovery spaces. We have since met with some of the team members to develop a proposal for follow-on funding, focusing on the realisation of the physical game, Hospital Heights, in digital form. Two MA students form the Royal College of Art made significant contributions to the design and development of the workshops, and were subsequently involved in an ESRC Festival of SS event in Sheffield, as well as exhibitions in the RCA.
Collaborator Contribution Contribution of knowledge and expertise, culminating in the co-production of the project outcomes. Leading one of the three workshops, and contributing to all four workshops. Knowledge exchange across the partner organisations including: how videogames can be used to support children's play and communication across different contexts; shared understanding of the complex ways in which children are blending traditional and digital play, across different sites (homes, schools, communities); how videogames can help meet NHS targets for improving patient experiences and outcomes; understanding the working practices of games industry designers - making prototypes and pitching to audiences
Impact Design principles specifically designing for children in hospital and recovery spaces New knowledge and understanding of hospital play, and the potential for crossovers between physical and digital play Multi-disciplinary knowledge exchange - University of Sheffield, Sheffield Hallam University, Royal College of Art: Education, English, Medicine, Medical Humanities, Information Experience Design.
Start Year 2014
 
Description Industry, NHS and academic partners 
Organisation Royal College of Art
Country United Kingdom 
Sector Academic/University 
PI Contribution The PI and Co-I organised three workshops, each of which focused on a key theme, and each was led by one of the partners: hospital play specialists, academics, industry games designers (Stripey Design and Distinctive Games). Workshop four brought together all the partners to explore physical and digital space, tactile and imagined play, friendship and isolation, ethics and emerging themes from the previous workshops. These themes were discussed as key outcomes from the project, focusing on design principles for children in hospital and recovery spaces. We have since met with some of the team members to develop a proposal for follow-on funding, focusing on the realisation of the physical game, Hospital Heights, in digital form. Two MA students form the Royal College of Art made significant contributions to the design and development of the workshops, and were subsequently involved in an ESRC Festival of SS event in Sheffield, as well as exhibitions in the RCA.
Collaborator Contribution Contribution of knowledge and expertise, culminating in the co-production of the project outcomes. Leading one of the three workshops, and contributing to all four workshops. Knowledge exchange across the partner organisations including: how videogames can be used to support children's play and communication across different contexts; shared understanding of the complex ways in which children are blending traditional and digital play, across different sites (homes, schools, communities); how videogames can help meet NHS targets for improving patient experiences and outcomes; understanding the working practices of games industry designers - making prototypes and pitching to audiences
Impact Design principles specifically designing for children in hospital and recovery spaces New knowledge and understanding of hospital play, and the potential for crossovers between physical and digital play Multi-disciplinary knowledge exchange - University of Sheffield, Sheffield Hallam University, Royal College of Art: Education, English, Medicine, Medical Humanities, Information Experience Design.
Start Year 2014
 
Description Industry, NHS and academic partners 
Organisation Sheffield Children's Hospital
Country United Kingdom 
Sector Hospitals 
PI Contribution The PI and Co-I organised three workshops, each of which focused on a key theme, and each was led by one of the partners: hospital play specialists, academics, industry games designers (Stripey Design and Distinctive Games). Workshop four brought together all the partners to explore physical and digital space, tactile and imagined play, friendship and isolation, ethics and emerging themes from the previous workshops. These themes were discussed as key outcomes from the project, focusing on design principles for children in hospital and recovery spaces. We have since met with some of the team members to develop a proposal for follow-on funding, focusing on the realisation of the physical game, Hospital Heights, in digital form. Two MA students form the Royal College of Art made significant contributions to the design and development of the workshops, and were subsequently involved in an ESRC Festival of SS event in Sheffield, as well as exhibitions in the RCA.
Collaborator Contribution Contribution of knowledge and expertise, culminating in the co-production of the project outcomes. Leading one of the three workshops, and contributing to all four workshops. Knowledge exchange across the partner organisations including: how videogames can be used to support children's play and communication across different contexts; shared understanding of the complex ways in which children are blending traditional and digital play, across different sites (homes, schools, communities); how videogames can help meet NHS targets for improving patient experiences and outcomes; understanding the working practices of games industry designers - making prototypes and pitching to audiences
Impact Design principles specifically designing for children in hospital and recovery spaces New knowledge and understanding of hospital play, and the potential for crossovers between physical and digital play Multi-disciplinary knowledge exchange - University of Sheffield, Sheffield Hallam University, Royal College of Art: Education, English, Medicine, Medical Humanities, Information Experience Design.
Start Year 2014
 
Description British Educational Research Association Conference 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Other audiences
Results and Impact Innovation session at BERA, exploring visual methods, drawing on the outcomes of the project. Discussion of the project methods and outcomes.
Year(s) Of Engagement Activity 2015
 
Description Copenhagen Play festival - Talk and presentation of Hospital Heights Game 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Industry/Business
Results and Impact We presented a talk and the game, Hospital Heights, at the Copenhagen Play Festival in May 2014. We first presented a talk about the AHRC project, focusing on the co-production of the design processes and their physical manifestation through the design of the game - Hospital heights. We then presented the game as part of the Festival. Around 300 people attended the Festival, and around 50 people engaged with the game as co-players. They contributed to the development of the game - setting the rules, developing the reach of the game, and suggesting design features for the crossover between the physical and potential digital game design. These activities have been documented at

http://Website link: http://iedgameresearch.wordpress.com/
http://www.shef.ac.uk/
Year(s) Of Engagement Activity 2014
 
Description Creative Economy Showcase (AHRC-funded and organised) 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Industry/Business
Results and Impact Creative Economy Showcase - keynote lectures on Creative Economy, showcase of projects in this network. We presented the early stages of the Videogames and Play for Hospitalised Children, engaged with participants from academia, business and industry and the media.
Year(s) Of Engagement Activity 2014
 
Description Digital literacies for Hospital Spaces: Everyday Language, Everyday Literacy Conference, University of Sheffield. 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Conference presentation showcasing the Project's methods, partners and outcomes
Year(s) Of Engagement Activity 2014
 
Description ESRC Festival of Social Sciences 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Public/other audiences
Results and Impact 'Emoji Quilt' workshop, hosted by Museums Sheffield. Public engagement event, building on the findings of the project Videogames and Play for Hospitalised Children. Participants (parents and children; museum educators) engaged in creating a three-dimension sculptural quilt, focusing on memories and emotions of childhood illness and hospitalisation. This activity inked with the project themes of physical and digital spaces for play, tactile and imaginary play, friendship and isolation. They also engaged with the sculptural card game 'Hospital Heights', both as game and as a representation of play in hospital and recovery spaces, including emotional representations in environmental images and their appeal to children. See http:// iedgameresearch.wordpress.com/
Year(s) Of Engagement Activity 2014
 
Description European Educational Research Association Summer School 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Research Methods Summer School, prevention and workshop on Visual Methods, using the findings and outcomes of the project.
Year(s) Of Engagement Activity 2015
 
Description Faculty of Social Sciences Inter-disciplinary Research Conference: Digital Play for children in hospital and recovery spaces 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Professional Practitioners
Results and Impact Conference presentation at Sheffield University, reaching academics across Social Sciences disciplines.
Year(s) Of Engagement Activity 2014
 
Description Research seminars - academic audiences 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Professional Practitioners
Results and Impact Research seminars held at the University of Sheffield's Centre for the Study of Childhood and Youth, School of Education and Medical Humanities Research Centre have engaged students and academics across disciplines, and are informing the development of trans-disciplinary connections.
Year(s) Of Engagement Activity 2014,2015
 
Description School Visit (Special Educational Needs School, Nottingham) 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Schools
Results and Impact Presentation on the research project with a view to developing a research partnership with the organisation for follow-on funding. The headteacher wants the school to be involved in the next project, with potential for related SEN Schools in the UK to become partners, or sites for engagement and impact.
Year(s) Of Engagement Activity 2016
 
Description University of Sheffield, Faculty of Social Sciences launch of MOOC 'Exploring Play' 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Professional Practitioners
Results and Impact The University of Sheffield MOOC on Exploring Play includes a section on our Project. Two members of the core team from Sheffield Children's Hospital participate in the MOOC, talking about play in hospital and recovery spaces, and the role of play workers. The MOOC also includes a discussion of our project between the PI and Co-I, and shows the Game 'Hospital Heights'.
The MOOC ran in 2014-15 (17,000 learners) and 2015-16 (8000 learners)
Year(s) Of Engagement Activity 2014
 
Description Videoconference workshop, Melbourne and Auckland 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Videoconference organised during sabbatical leave of PI. Based in Melbourne. the workshop included academics and hospital play specialists in Australia and New Zealand. Dissemination of project and findings, discussion of play on hospital spaces. Participants reported that they rarely had opportunities to talk about their work, and that play in hospitals is an under-researched area.
Year(s) Of Engagement Activity 2015
 
Description Visit to Bluebell Wood Children's Hospice 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Professional Practitioners
Results and Impact Discussion about future research projects with the organisation's research team leader. Identification of need for reviewing opportunities for digital play in hospices for young people and their carers, particularly with young people age 11-18.
Year(s) Of Engagement Activity 2016
 
Description Visit to Eureka Children's Museum 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Professional Practitioners
Results and Impact Presentation to staff at Eureka! Children's Museum (Halifax) on the research, followed by discussion of their involvement as partners in follow-on funding applications.
Year(s) Of Engagement Activity 2016
 
Description • Workshop presentation to CBeebies team at Children's BBC, Salford, 6.6.14 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Industry/Business
Results and Impact Workshop on the Project with BBC staff working on CBeebies programmes, including commissioning editors and designers. Dissemination and discussion of project outcomes, designing for young children, and the crossovers between physical and digital play.
Year(s) Of Engagement Activity 2014