Using a Digital Application to
Refresh Knowledge of Abuse for
Individuals with Intellectual/Developmental Disabilities

Thomas Howard
University of Rhode Island
Krishna Venkatasubramanian,
Noah Daniels, William Kinnersley,
Kunal Mankodiya

Outline

  1. Introduction
  2. Collaborative Design
  3. Usability Evaluation Study
  4. Discussion
  5. Conclusions & Future Works

Introduction

Abuse is a Problem

Abuse is a Problem

Regarding individuals with I/DD

  • 9/10 abused at least once 1
  • 50% experience 10+ instances 1
  • Often abused by known persons 2
  • Abuse is severely under reported 1
  • Trouble recognizing abuse 2
  • How can we increase reporting?
[1] D. Valenti-Hein and L. Schwartz, The Sexual Abuse Interview for Those with Developmental Disabilities. James Stanfield Company, 1995
[2] K. Venkatasubramanian et. al, “Exploring abuse reporting for people with intellectual and developmental disabilities,” in ACM CHI Conference on Human Factors in Computing Systems (In Review), 2021.

Education as a Solution

Education as a Solution

Man peeking over wall with books
  • If you don't know, how can you report?
  • Abuse prevention training is effective 1
  • Shown to increase confidence 1
  • Awareness and Action training
[1] K. Venkatasubramanian et. al, “Exploring abuse reporting for people with intellectual and developmental disabilities,” in ACM CHI Conference on Human Factors in Computing Systems (In Review), 2021.
[2] K. Ayres and D. Cihak, “Computer- and video-based instruction of food-preparation skills: Acquisition, generalization, and maintenance,” vol. 48,6 no. 3
[3] E. Buehler et. al, “Accessibility barriers to online education for young adults with intellectual disabilities,” in Proceedings of the 13th Web for All Conference, ser. W4A ’16. ACM

Awareness and Action (A&A) Training

Awareness and Action (A&A) Training

  • By individuals with I/DD
  • For individuals with I/DD
  • Self Advocates
  • Frequency is important to continued understanding 2
  • Logistics of attending in-person training
  • Taking home the training?

Digitizing the A&A training

Digitizing the A&A training

Welcome screenshot from final application
  • Autonomous learning
  • Refreshing A&A content vs teaching it
  • Emotionally Difficult Material
  • Intrinsic Motivation

Key Questions

  • Can we apply elements of gamification 2 to the application?
  • Can we prevent individuals from becoming triggered?
  • Can an application effectively 1 refresh knowledge from the A&A training?
[1] Within this work "effectiveness" is measured by users willingness to use the application regularly and recommend others do the same.
[2] Gamification is the application of game elements to educational contexts

Related Works

Related Works

  • Individuals with I/DD and MOOCs [1]
  • Barriers to learning autonomously [2]
  • Gamification for basic skills [3]
  • Frameworks for applying gamification for Individuals with I/DD [4]
  • No research uncovered on preventing triggering individuals with I/DD
Concept Description Behavior
Acknowledgement Feedback that praises a players' actions Engagement
Imposed Choice Decisions the player is obligated to make for the game to advance Engagement / Motivation
Social Pressure Pressure through interactions with other players (real or NPC) Engagement / Motivation
[1] R. Laiola Guimaraes and A. Britto Mattos, “Exploring the use of massive open online courses for teaching students with intellectual disability,” in Proceedings of the 17th International ACM SIG ACCESS Conference on Computers & Accessibility, ser. ASSETS ’15.
[2] E. Buehler et. al, “Accessibility barriers to online education for young adults with intellectual disabilities,” in Proceedings of the 13th Web for All Conference, ser. W4A ’16. ACM
[3] L. M. Morales-Villaverde et. al,“Online learning system to help people with developmental disabilities reinforce basic skills,” inProceedings of the 18th International ACM SIG ACCESS Conference on Computers and Accessibility, ser. ASSETS ’16.
[4] A. Shaban and E. Pearson, “A learning design framework to support children with learning disabilities incorporating gamification techniques,” in Extended Abstracts of the 2019 CHI Conference on Human Factors inComputing Systems - CHI EA ’19.

Collaborative Design

Gathering Requirements

Gathering Requirements

  1. Personas 1
  2. Scenarios 2
  3. Use-Cases 2
  4. Requirements 2
  5. Low-Fidelity Prototypes
[1] A. Cooper,The Inmates Are Running the Asylum, C. Hall, Ed. Boger, Paul,1999.
[2] H. Sharp, Interaction Design: Beyond Human-Computer Interaction, Fifth Edition. Wiley and Sons Canada, Limited, John, 2019

Medium-Fidelity Prototypes

Medium-Fidelity Prototypes

Emotional Reinforcement
Grounding Activities
Quizzes
Interactive Elements
Skills Activities

Collaborative Design Session

Collaborative Design Session

  • Six co-designers
  • Four self-advocates, two coordinators
  • Five prototypes to be presented
  • Prototype projected and distributed
  • Feedback gathered throughout session
ID Self-Advocate
C1 check
C2 check
C3 check
C4 check
C5 close
C6 close

Feedback: Emotional Reinforcement

"[the application should] never take anything away from somebody." - C5
  • Generally negative
  • Taking away happiness
  • Avoid negative reinforcement

Feedback: Grounding Activities

C1: "I wanted to put some grounding games in, because that will-"
C2: "That'll keep people more engaged"
C1: "The training can be a little hard for people"
C2: "This is a tough subject."
  • Very positive
  • All participants valued this element
  • Avoid mandatory fun
  • Add a time limit

Feedback: Interactive Elements

"Can you see the smoke coming out of my ears yet?" - C5
"I like the concept, I like the idea and everything like that" - C4
  • Generally positive
  • Confusing interface
  • Overly complicated
  • Move to discrete clips

Feedback: Quizzes

"[it] should either, you know, talk about physical abuse or show the video" - C4
  • Very positive
  • Would benefit users
  • Not enough on its own
  • Make it optional

Feedback: Skills Activities

"I have incidents of people borrowing money, or taking it and, 'here I paid you back' and it's, you know, someone takes a dollar for twenty." - C5
  • Generally positive
  • Money Counting
  • No Touch Zones
  • Identifying Emotions was challenging

High-Fidelity Prototypes

Version A
Version B
Version C
Xylophone game Grounding Activity
Acknowledgement Reward

Usability Evaluations

Study Methodology

Study Methodology

  • Remote Synchronous Trials
  • Six participants with I/DD
  • Zoom Video Call
  • Shared virtual emulator
  • Remote control ceded where possible
  • Interview Questions + Verbal Feedback

Study Participants

Study Participants

ID Age Gender Disability Had Control A&A Trainer
P1 34 M ASD close check
P2 46 F IDD - Hearing Loss check close check
P3 29 M Seizure Disorder, ASD check check
P4 43 M Acquired Brain Injury - IDD check history
P5 27 M William Syndrome, PTSD,
Chronic Anxiety		 close history
P6 N/P M N/P check close

Study Procedure

Study Procedure

  • One hour per session
  • Recorded in its entirety + researcher notes

Data Analysis

Data Analysis

  • Thematic analysis over all sessions
  • Iteratively developed code
Theme Example
Positive Reaction "This is good"
Negative Reaction "This is bad"
Intervention Required "I need help"
Incorrect Response "Oops"
Enhancements "Add feature X"
A&A Connection "This reminds me of x from A\&A"

Results: Participants Favorites

Results: Participants Favorites

Participant Favorite Middle Least Favorite
P1 B C A
P2 C A B
P3 B C A
P4 C B A
P5 C B A
P6 B A C

Version B and C tie with 3 votes each!

Results: Impact of Interaction

Results: Impact of Interaction

"The skills game make[s] it easier to identify what is." - P5
  • Video quizzes were engaging
  • Skills Activities were informative
  • Lack of engagement with Slides
  • Acknowledgement via Emojis

Results: Grounding Activities

Results: Grounding Activities

Where is there to go? Where is there to feel safe if you're technically supposed to already be in the safe spot?" - P5
  • Extremely important
  • Xylophone has potential (5/6)

Results: Effectiveness

Results: Effectiveness

  • Recommending others download and use the final application
  • Willingness to download and use
"if you do it less, then you're not gaining the strength to tell somebody, if you use it more then you're gonna be like okay, now I know I really need to say something. Cause' a lot of people just shut down, they get shocked, they don't know what to say, they don't know what to do, and I think that if it was more that it would definitely be a better thing to have." - P4

Discussion

Recommendations for Future Applications

Recommendations for Future Applications

  • Combine the three presented prototypes
  • Slides, Grounding, Video/Skills, Reward

Reporting Abuse

Reporting Abuse

  • Brought up during usability evaluation
  • Showing people what happened
  • Calling DPPC using the buttons

Limitations

Limitations

  • Accessibility was not in scope
  • Population bias
  • User device control

Conclusions & Future Work

Conclusions

  • An effective application can be made.
  • Remote synchronous evaluations are viable
  • Individuals with I/DD need an application like the one presented here

Future Works: Large Scale Evaluations

  • Focus on accessibility
  • Large sample size
  • Remote asynchronous

End

Etcetera

Emotional Reinforcement

  • Virtual pet
  • Happiness increases with training
  • Happiness decays over time
  • Maintaining happiness
  • Intrinsic motivation

Grounding Activities

  • Programmatic breaks
  • Extremely difficult content
  • Emotionally triggering
  • First-hand experience

Interactive Elements

  • Constant interaction
  • Increased engagement
  • Flagging abuse / not abuse

Quizzes

  • Presented a traditional quiz
  • Prompting users to think
  • Only quizzes

Skills Activities

  • Tangential skills
  • Variety of activities
  • No Touch Zones: Sexual Abuse
  • Money Counting: Financial Abuse
  • Identifying Emotions: More General