Product Details

Author Information

Corresponding Author
Wendy Stanyon
University of Ontario Institute of Technology
2000 Simcoe Street North
Oshawa, ON L1H 7K4
Canada
p: 905-7218668 ex 2250
wendy.stanyon@uoit.ca

Authors (listed in order of authorship):
Marjory Whitehouse
Ontario Shores Mental Health Sciences

Bruce Townley
Durham Regional Police Services

Product Description and Application Narrative Submitted by Corresponding Author

What general topics does your product address?

Educational Technology; Mental Health Awarenesss; First Responders

What specific topics does your product address?

Mental health

Does your product focus on a specific population(s)?

First Responders; Individuals Challenged by Mental Illness

What methodological approaches were used in the development of your product, or are discussed in your product?

Community needs assessment, Community-academic partnership

What resource type(s) best describe(s) your product?

Simulation, Training material

Application Narrative

1. Please provide a 1600 character abstract describing your product, its intended use and the audiences for which it would be appropriate.*

The simulations, developed from an Inukshuk grant,are a product of a collaborative initiative between Durham
Regional Police Services (DRPS), Ontario Shores Centre for Mental Health Sciences (formerly Whitby Mental Health
Centre), Durham College Innovation Centre, and the University of Ontario Institute of Technology (UOIT). DRPS officers, staff nurses from Ontario Shores and a UOIT nursing professor actively participated in all phases of the simulation development, from the initial script writing to the video shooting and designing of the learning activities. The simulations, depicting critical incidents involving mentally ill persons, were created to promote frontline officers’ understanding of some of the challenges individuals with a mental illness experience, and to facilitate their ability to respond effectively in interactions with mentally ill individuals in our community. Four priority critical incidents were selected by frontline officers from their on-the-job experiences: 1) young man exhibiting suicidal behaviour, 2) adult male demonstrating delusional thinking, 3) adult male experiencing hallucinations, and 4) young woman exhibiting
self-harming behaviour. Each of the four simulations includes interactive video clips with response options, learning activities, detailed feedback provided on both the response choice and the answers for the learning activities, as well as a library containing additional learning resources. The knowledge and skills targeted by the simulations have broad applicability that extends beyond policing to include other first responders and members of helping professions,(e.g. nursing, paramedics, human service counseling, social services),staff working in mental health facilities, as well as faculty and students in related programs in postsecondary educational institutions.

2. What are the goals of the product?

The primary goal of the simulations is to improve the quality of life for mentally ill individuals living in our
communities by providing frontline police officers (and other first responders, members of helping professions) with an interactive educational resource to help them better understand mental illness and facilitate their ability to respond effectively in their interactions with individuals who are exhibiting behaviours associated with a mental health challenge. The simulations focus on: 1) recognizing behaviours that may be indicative of mental illness, 2) developing strategies to de-escalate situations involving mentally ill individuals, 3) principles of therapeutic communication, 4) responding effectively to an individual exhibiting psychotic behaviour, 5) responding effectively to an individual who is demonstrating suicidal behaviour, 6) responding effectively to an individual who is engaging in self harming behaviours, and 7) increasing awareness of the unique challenges facing individuals with mental illness. The simulations also provide additional opportunities for relationship building and developing a greater shared understanding between police officers, mental health providers and mental health educators.

3. Who are the intended audiences or expected users of the product?

The simulations are currently being used by several police services. Part of the mandatory training for over 8,000
frontline police officers in Ontario, the simulations are also being used by other police services and crisis teams across Canada including: the Calgary police; an RCMP attachment in Edmonton; PACT (police and crisis team), which is part of the Alberta Health Services; the Police Services Division of the BC Ministry of Public Safety & Solicitor General; and the Nova Scotia Department of Justice. There has also been international interest; content from the simulations has been included in education sessions provided by the Mental Health Foundation of New Zealand for the Auckland police, and recently colleagues in the United Kingdom have contacted us and expressed an interest in developing an international collaboration for future work in this area.

4. Please provide any special instructions for successful use of the product, if necessary. If your product has been previously published, please provide the appropriate citation below.

Ideally, each participant has access to a computer so that they can complete the simulations independently, on their
own time and at their own pace. This can be done in a classroom setting or on an individual basis. However, e-learning is not a substitute for hands-on training in real-life settings. Therefore it is recommended that the simulations be incorporated in the context of a wider curriculum and that after completing the simulations, individuals be able to participate in a debriefing session in which the key concepts and learning activities are reviewed and discussed and there are opportunities to ask questions and share learning.

5. Please describe how your product or the project that resulted in the product builds on a relevant field, discipline or prior work. You may cite the literature and provide a bibliography in the next question if appropriate.

The following brief review of the literature provides the rationale for the development of the police simulations and
the multimedia/instructional design decisions that were made as well as support for the community engagement
process that was followed. Police officers are often the first responders to situations in the community involving mentally ill persons. First responders are interacting more often with individuals who have a mental illness largely because of the impact of deinstitutionalization without adequate community supports being in place, below poverty-level social and disability assistance rates, reduced psychiatric hospital facilities, and homelessness (1). In turn, police services are recognizing the inadequacy of the current constable training programs in terms of awareness and understanding of mental illness
and knowing how best to respond to individuals who appear to be experiencing a mental illness (2). Current literature
indicates that the best practice models for police response involve specialized and ongoing education for all frontline
officers (3; 4; 5).
E-learning is an increasingly popular method of education for adults and professionals. The educational benefits of
simulations and other modes of e-learning are well documented and include: improved psychomotor skills, enhanced retention of knowledge as well as enhanced decision-making skills, interactive learning, options for immediate feedback, the opportunity for repetition and ongoing reinforcement of skills, and the ability to ‘restart’ or ‘reset’, so users can learn from their mistakes without risk (6; 7; 8; 9). However, not all e-learning efforts are equally effective. The effect of a well-designed module will depend not only on the content but also the presentation, including technical aspects such as graphics, ease of use, and the overall ‘fidelity’ or ‘realism’ of the program (10). Research has indicated that end-users’ perspective is essential to the development of effective computer-based learning tools, as users’ perceptions influence the acceptability and use of such tools (11). Tailoring an e-learning tool to the intended
audience ensures the materials meet the specific learning needs of the users (12), as well as the reality of users’ busy schedules and unique ingrained habits and perceptions (13; 14). Users report greater satisfaction and engagement where simulations and other e-learning resources closely resemble the situations in which the learned skills will have to be used, (15; 16; 17).

6. Please provide a bibliography for work cited above or in other parts of this application. Provide full references, in the order sited in the text (i.e. according to number order). .

1 Watson AC, Corrigan PW, & Ottati V. Police responses to persons with mental illness: Does the label matter? Journal
of the American Academy of Psychiatry and the Law Online 2004; vol. 32, no. 4, pp. 378-385.
2 Hanafi S, Bahora M, Demir BN, & Compton MT. Incorporating crisis intervention team (CIT) knowledge and skills into
the daily work of police officers: A focus group study. Community Ment Health J 2008; vol. 44, no. 6, pp. 427-432.
3 Weaver CM, Joseph D, Dongon SN, Fairweather A, & Ruzek JI. Enhancing services response to crisis incidents involving veterans: A role for law enforcement and mental health collaboration. Psychol Serv 2013; vol. 10, no. 1, pp. 66-72.
4 Watson AC, Ottati VC, Draine J, & Morabito M. CIT in context: The impact of mental health resource availability and district saturation on call dispositions. Int J Law Psychiatry 2011; vol. 34, no. 4, pp. 287–294.
5 Coleman TG, & Cotton DH. Reducing risk and improving outcomes of police interactions with people with mental
illness. J Police Crisis Negot 2010; vol. 10, no. 1, pp. 39-57.
6 Rentroia-Bonito MA, Jorge JA, & Ghaoui C. Motivation to e-learn within organizational settings: An exploratory factor structure. International Journal of Distance Education Technologies 2006; vol. 4, no. 3, pp. 24–35.
7 Lanzilotti R, Ardito C, Costabile MF, & De Angeli A. eLSE methodology: a systematic approach to the e-learning
systems evaluation. Journal of Education Technology and Society 2006; vol. 9, no. 4, pp. 42-53.
8 Perkins GD, Fullerton JN, Davis-Gomez N, Davies RP, Baldock C, Stevens H, & Lockey AS. The effect of pre-course elearning prior to advanced life support training: A randomised controlled trial. Resuscitation 2010; vol. 81, no. 7, pp. 877-881.
9 Dror I. ‘A novel approach to minimize error in the medical domain: Cognitive neuroscientific insights into training. Med Teach 2011; vol. 33, no. 1, pp. 34-38.
10 Trapp P. Engaging the body and mind with the spirit of learning to promote critical thinking. J Contin Educ Nurs
2005; vol. 36, no. 2, pp. 73-76.
11 Moisio A, Markkula ML, & Smeds R. E-learning lessons learnt from a student perspective: a cross-case comparison
between public and private organizations. pp. 22-24, referred paper from the 7th International Workshop on
Experimental Learning in Industrial Management, 22-24 May, Aalborg, Denmark, Aalborg University, Department of
Production, Center for Industrial Production.
12 Blake H. Computer-based learning objects in healthcare: The student experience. Int J Nurs Educ Scholarsh 2010;
vol. 7, no. 1, pp. 1-15.
13 Adler MD, Vozenilek JA, Trainor JL, Eppich WJ, Wang EE, Beaumont JL, & McGaghie WC. Development and evaluation of a simulation-based pediatric emergency medicine curriculum. Acad Med 2009; vol. 84, no. 7, pp. 935-941.
14 Blake H. Staff perceptions of e-learning for teaching delivery in healthcare. Learning in Health and Social Care
2009; vol. 8, no. 3, pp. 223-234.
15 Kovacs E, & Toms W. Scenario-based learning improves trooper performance. Public Manager 2010; vol. 39, no. 2,
pp. 34-37.
16 Tashiro JS, & Dunlap D. The impact of realism on learning engagement in educational games. pp. 113-120, referred paper from the 2007 Conference on Future Play, 15-17 November, Toronto, Canada, ACM, New York.
17 Schuwirth LWT, & van der Vleuten CPM. The use of clinical simulations in assessment. Medical Education 2003; vol. 37, no. 1, pp. 65-71.

7. Please describe the project or body of work from which the submitted product developed. Describe the ways that community and academic/institutional expertise contributed to the project. Pay particular attention to demonstrating the quality or rigor of the work:

• For research-related work, describe (if relevant) study aims, design, sample, measurement instruments, and analysis and interpretation. Discuss how you verified the accuracy of your data.
• For education-related work, describe (if relevant) any needs assessment conducted, learning objectives, educational strategies incorporated, and evaluation of learning.
• For other types of work, discuss how the project was developed and reasons for the methodological choices made.

The first phase of the simulation development involved discussions with frontline officers about the types of mental health scenarios they commonly encounter in the community and what they considered to be their priority learning needs. Four scenarios were identified from officers’ actual on-the-job experiences: 1) young man exhibiting suicidal behaviour, 2) adult male demonstrating delusional thinking, 3) adult male experiencing hallucinations, and 4) young woman exhibiting self-harming behaviour. These scenarios provided the basis for developing the simulations. The following learning outcomes were identified, based on the four priority scenarios: 1) to identify behaviours that may be indicative of a mental illness, 2) to implement strategies to deescalate situations involving individuals challenged by mental illness, 3) to respond effectively to an individual exhibiting psychotic behavior, 4) to respond effectively to an individual who is threatening suicide, 5) to respond effectively to an individual who engages in self-harming
behaviours, and 6) to describe available mental health resources.
During the script writing of each of the scenarios, which involved direct input from both frontline police officers and mental health professionals, additional learning outcomes were identified that would address the identified learning needs and facilitate an officer’s ability to respond effectively to the communication and behavior challenges they experienced in the interaction. All of the educational components of the simulations (the video clips, response options, feedback boxes, learning activities, summaries, and library of resources) were designed to achieve the learning outcomes. Special attention was paid to ensuring the simulations were interactive and required the learner to actively engage in the learning activities. For example, the video clips and accompanying response options are based on the previous clip and the learner’s selected response at that time. In addition, emphasis was placed on providing learners with frequent and timely feedback, as well as opportunities to learn from their mistakes. At the end of each simulation, there is a summary of the key concepts that were covered in the scenario and a library of resources has also been included, which provides learners with opportunities for further learning. Multimedia and instructional design expertise was also provided for the project.
Feedback was solicited throughout the development of the simulations and modifications were made accordingly. In
addition, a formal evaluation of the simulations was conducted with research funding provided by the Canadian
Council on Learning. DRPS and other police services are also continuing to collect data that can be used in the ongoing evaluation of the simulations (e. g. the number of calls identified by police officers as being mental health related, the number of individuals taken to hospital for a mental health assessment and the number of individuals who are subsequently admitted to hospital).

8. Please describe the process of developing the product, including the ways that community and academic/institutional expertise were integrated in the development of this product.

Following the fatal shooting of a mentally ill individual in 2006, an Inspector with Durham Regional Police Service
(DRPS) contacted a nursing professor in the Faculty of Health Sciences at the University of Ontario Institute of
Technology (UOIT) to explore possible educational opportunities for frontline officers to gain a better understanding of mental illness, some of the challenges facing individuals who are living with a mental illness, strategies to facilitate more effective interactions and the mental health resources available in the community. This initial contact led to the development of a unique partnership between DRPS, Ontario Shores Centre for Mental Health Sciences, Durham College’s Innovation Centre, and UOIT. Over the past few years, this partnership has successfully implemented several educational initiatives, and in 2007 the partnership applied for and received a grant to develop the online computer-based simulations. The first phase of development involved discussions with frontline officers about the types of mental health scenarios they encounter in the community and what they considered to be the most critical incidents. From these discussions, four scenarios were identified from officers’ actual on-the-job experiences: 1) young man exhibiting suicidal behaviour, 2) adult male demonstrating delusional thinking, 3) adult male experiencing hallucinations, and 4) young woman exhibiting self-harming behaviour. The next stage was writing the scripts for each of the scenarios, planning the video clips, determining the response options for each video clip and the feedback to be provided, as well as the content and format for the learning activities and the resources to be included in the library. This was a collective effort that included frontline officers, mental health nurses from Ontario Shores, and the nursing professor from UOIT. All decisions were made
collaboratively and particular attention was paid to the police officers’ perspectives and what they believed was necessary to ensure the credibility of the simulations as an educational resource for police services. Next was the multimedia phase. Once again, frontline officers, staff nurses from Ontario Shores and the UOIT nursing professor worked closely together. The police officers depicted in the video clips in the simulation scenarios and in the feedback boxes are actual members of the Durham Regional Police Service and the mentally ill individuals in the scenarios are role played by mental health nurses from Ontario Shores, who are very familiar with the challenges experienced by individuals living with a mental illness and the different types of behaviours. The same collaborative efforts occurred during the shooting and editing of the video clips and the feedback boxes in the simulations. Throughout the entire process all participants were encouraged to provide feedback and modifications were made based on this input. Each of the four simulations (including the video clips, response options, feedback boxes, learning activities and library of resources) were also shown to frontline officers and mental health nurses who had not been directly involved in the development of the resource, and their feedback was elicited as well on both the content and the simulations’ usability, including the interface design and navigation system. Again,
modifications were made based on their comments. Only after all of the individuals who participated in the
development of the simulations, as well as the frontline officers and staff nurses who reviewed the simulations, were
satisfied with the results did we consider the simulations to have been completed.

9. Please discuss the significance and impact of your product. In your response, discuss ways your product has added to existing knowledge and benefited the community; ways others may have utilized your product; and any relevant evaluation data about impact, if available. If the impact of the product is not yet known, discuss its potential significance.

The simulations are currently part of mandatory training for over 7,000 police officers in Ontario and they are also
being used by several other police services in the province and across Canada. As well, there has been international
interest. Most recently, a mental health facility in the United Kingdom, charged with the task of developing
educational resources for local police services, expressed interest in collaborating with us on future work in this area. Based on the success of the original simulations, the Ontario Provincial Police, the largest police service in the
province, recently volunteered their multimedia expertise to develop another simulation. This new e-learning resource
focuses on elder abuse and was developed in collaboration with several other local police services, community
organizations, UOIT, and the elder abuse advisor for the Region of Durham. The partnership is also continuing to
expand; currently, another police service in Ontario is considering volunteering their multimedia expertise to develop a fifth simulation. The original simulations and the OPP elder abuse simulation are available to police services free of charge and there is general agreement among the current partners that any future simulations will also be made freely available.
Also, representatives from each of the partners have attended local, provincial, national, and international
conferences together to showcase the simulations, discuss their effectiveness as an educational resource, share the
findings from the research study, and highlight the benefits and challenges of maintaining and expanding the
partnership. The partners are also collaborating on articles for submission to professional magazines and academic journals.
Durham Regional Police Service is also collecting data related to the effectiveness of the simulations as an educational resource for their frontline officers. To date the data indicates officers are better able to identify which calls are related to mental health and to decide whether or not an individual needs to go to the hospital for a mental health assessment. Officers are also becoming better at referring individuals to the mental health resources that are available in communities.

10. Please describe why you chose the presentation format you did.

We wanted to develop a creative and interactive educational mental health awareness resource to educate police
services and other first responder groups. Online computer-based simulations are both economic and easily accessible and therefore can be used to teach large numbers of learners. Using actual mental health scenarios from on-the-job experiences of frontline police officers, having officers participate in all phases of the simulation development and actually be the police officers in the video clips, and providing feedback on the video response options was critically important and certainly one of the main factors in police services’ willingness to use this educational resource as part of their officer training. Understanding that effective e-learning focuses on engaging with the learner, the simulations were designed to be highly interactive and require the learner to take an active role in the learning process. Also, the importance of providing frequent and timely feedback was addressed by including explanations for each of the video clip response options, and for the answers to the learning activities. The summary provided at the end of each simulation reemphasizes the main concepts and communication strategies covered in the scenario and the library of resources is an effective way of including additional educational opportunities, without overwhelming the learner. By using different multimedia formats and including a variety of learning activities, the simulations are also able to
address diverse learning styles and provide a level of realism that effectively engages the learners.

11. Please reflect on the strengths and limitations of your product. In what ways did community and academic/institutional collaborators provide feedback and how was such feedback used? Include relevant evaluation data about strengths and limitations if available.

Feedback was solicited from all of the participants at every stage of development and also by individuals who did not participate in the development of the simulations but who had a vested interest in ensuring the quality of the final product. Modifications were made to the simulations in response to all of the input.
The simulations were also formally evaluated with funding from the Canadian Council on Learning. A research study
was conducted to determine the effectiveness of the simulations as an educational resource for frontline officers. The study was a mixed methods design involving both qualitative and quantitative data collection. Officers were assigned to one of three groups: simulation, face-to-face, and control. Pre-post-tests were conducted to determine officers’ knowledge and understanding of mental illness and how to engage effectively with mentally ill persons. In addition, focus groups provided data about police officers’ perceptions of the impact, if any, the educational session (simulation, face-to-face) would have on their confidence level and the extent to which they found the simulations to be easy to use and reflective of reality.
The findings of this study indicated that simulations are an effective tool for educating officers about mental illness. When compared with face-to-face education, the simulations were considered to be as effective. Police participants showed a high level of engagement and appreciation for the simulations. They made positive comments about being able to progress at their own pace, receive immediate feedback and even go back and redo a scenario. The library of resources contained in the simulations was also seen as a benefit. Officers found the simulations to be both realistic and easy to use and several of the participants suggested that this type of education should be mandatory for all frontline officers as well as members of the police leadership. However, rooted in a strong oral culture, the majority of the police officers did indicate a preference for face-to-face education sessions, citing the ability to dialogue, share
ideas and stories, as well as seek clarification when necessary as key components of the learning process. They did see the simulations as providing a good foundation for their learning; they also believed a follow up discussion group or seminar would further add to the benefits of the simulations as educational resource. This would suggest that a hybrid teaching methodology (online and face-to-face) would be the most effective.

12. Please describe ways that the project resulting in the product involved collaboration that embodied principles of mutual respect, shared work and shared credit. If different, describe ways that the product itself involved collaboration that embodied principles of mutual respect, shared work and shared credit. Have all collaborators on the product been notified of and approved submission of the product to CES4Health.info? If not, why not? Please indicate whether the project resulting in the product was approved by an Institutional Review Board (IRB) and/or community-based review mechanism, if applicable, and provide the name(s) of the IRB/mechanism.

Both the process and the product (computer-based simulations) involved collaboration that embodied the principles of mutual respect, shared work, and shared credit. Representatives from each of the partners (DRPS, Ontario Shores, and UOIT) actively participated in every phase of the simulation development, in the evaluation of their effectiveness as an educational resource for frontline police officers, and in the dissemination activities. Feedback was regularly solicited during the development of the simulations and any ideas or suggestions were given thoughtful consideration and modifications were made in response to this input. Each partner is always consulted before any invitation to talk about the simulations or the partnership is accepted, and there is at least one representative from each of the partners at every conference presentation. Also, there is a credit section of the simulations that clearly acknowledges the contributions of all of the individuals who were involved in the development of the simulations.
The use of force expert for DRPS reviewed and approved the simulations in terms of the Use of Force Policy and the
UOIT’s Research Ethics Board (REB) approved the research study that was funded by the Canadian Council on Learning
and designed to evaluate the educational effectiveness of the simulations. All of the partners are aware of and have
approved the submission of the simulations to CES4Health.info.