FORTERRA

SYSTEMS INC

Troubled Kids & Computer Games:

Using Virtual Worlds for Successful
Behavioral Therapy
Teens with severe learning and psychiatric disorders such as
attention deficit disorder, oppositional defiant disorder, and the
effects of psychological trauma face numerous challenges,
including the need to positively change their social behavior, break
bad habits, and establish meaningful and supportive relationships.
Often circumstances are complicated by substance abuse and/or
low self esteem. Many of these teens face the complex challenges of
the world with little or no social support structure to help. Sadly, the
result is often poor school performance; difficulty building strong and
lasting bonds; strained family relations; a loss of hope in the future;
and even incarceration. In addition to the human toll, society loses a
potentially productive citizen and faces the steep costs of long-term
attendant care.

The Company
Greenleaf Medical, based in Palo Alto, CA, is a leader in the application of traditional VR to tele-rehabilitation and the challenges of
behavioral health. The company is tapping the potential for a new genre of virtual environments to offer therapists and health care
providers a powerful new medium in which clinicians, patients, therapists and families can meet and be an integrated part of the
care process; not just for a single therapy session, but as a way to practice and sustain new skills and behaviors. Greenleaf
Medical is a medical product development company and consulting group that has been successfully creating medical devices
and software for nearly 20 years. Dr. Walter Greenleaf, CEO of Greenleaf Medical, is recognized internationally as a pioneer in the
use of advanced computer technology in medical applications. A research scientist trained in neuro- and bio-behavioral sciences
at Stanford University, Dr. Greenleaf has focused his lifes work on the use of simulation technology to improve physical medicine,
neuro- and cognitive rehabilitation.

The Challenge
While there are many therapeutic interventions to treat at-risk teens that can be effective for many, such techniques are inherently
flawed for many children and adolescents with attention, memory, and communication difficulties, let alone the typical teen
resistance to engage in one-on-one discussion with adults. Additionally, there few tools for capturing insights into the inner world
of a patient, or ways for the patient to explore and understand themselves better; such approaches can be slow, complex, and
require expert skills not always available.
But, what if troubled teens could use a virtual world as a meeting place, in which the therapist, a peer group and even family
members, might work together and learn those essential transition skills for a successful rehabilitation? And, what if a virtual world
could serve as a persistent place to meet providing an environment for sustaining these new life skills in an environment that is
familiar and is as engaging as the popular video games and on-line social networks, which are so much a part of the life of todays
young people?

The Solution
Using Forterra Systems OLIVE (On-Line Interactive Virtual Environment) platform, Greenleaf is developing a computer-based
approach for treating teen behavioral disorders using a multiplayer immersive environment called SECTER the Simulated
Environment for Counseling, Training, Evaluation, and Rehabilitation. SECTER is intended to magnify and leverage the skills and
experience of clinicians, not replace them. Through the use of computer-generated virtual environments, children and adolescents
can be treated for a wide range of behavioral disorders.

info@forterrainc.com
www.forterrainc.com
tel: (650) 433-4000
fax: (650) 433-4099

Forterra Systems, Inc.

2207 Bridgepoint Pkwy
Suite 200
San Mateo, CA 94404

Forterra Systems, Inc.

48 Wall Street
11th Floor
New York, NY 10005

Forterra Systems, Inc.

3501 Quadrangle Blvd
Suite 355
Orlando, FL 32817

FORTERRA

SYSTEMS INC

Child and adolescent mental health therapy through this medium is conducted with realistic 3D avatars that mimic natural human
interaction, creating a powerful, immersive virtual environment. The focus of SECTER is to facilitate interactive role-play, practice
of interpersonal skills, exploration of past behavior, and drug and alcohol refusal skills. In addition to the real-time capabilities for
clinicians to interact with their client, SECTER includes 3D playback capabilities, a built-in OLIVE feature that allows for the
examination of sessions from multiple perspectives, including the capability to see events through the eyes of other participants.
The replay capabilities enable discussion and exploration with patients that can lead to a faster and deeper understanding of what
the antecedents to the patients problem behaviors are.
Greenleaf Medical has partnered with CFG Health Systems, a New Jersey-based organization committed to treatment of mentally
ill children, to develop new techniques and technologies for therapists and clients, leveraging the Forterra OLIVE platform as a new
modality to enhance their existing products and services. More importantly the partnership focused on using this new technology
as a way to bring better care at a lower cost to their customers.

The Result
Greenleaf Medical, in partnership with CFG Health Systems, has been developing new therapeutic products for mental health
treatment with Forterras OLIVE at the core. The first phase of research and development has focused on treating boys with
oppositional defiant disorder in a residential treatment facility in New Jersey. Recently, the scope has been expanded to include
coed residential programs treating a broad range of psychiatric disorders, with a focus on trauma.
While this project is on-going, positive trends appear to be emerging with OLIVE-use, such as improved data collection,
relationships between counselors and the teens, and patient communication about their inner lives. While this work is still in its
early stages, it has become clear that the use of session playback can be quite valuable. Not only does the playback reduce
the cognitive and communicative load of session review (the staff and patients no longer must rely on a joint memory of what
has happened), but allowing the students to review their sessions in VR helps in the refinement process of strategies patients
are expected to use in the real world. Additionally, such practice can result in reduced anxiety that can exist around employing
new skills beyond the therapeutic setting. This capability suggests that adding VR to traditional in-person drug and alcohol
educational programs may lead to faster and more complete integration of the life skills being taught.
Once the boys are pulled into the computer world, they become disarmed very quickly and respond to the various scenarios
more naturally and authentically, said Hollis Evans, MSW, LSW. Afterwards, I use playback as a basis for discussion in traditional
individual therapy sessions. The potential demand for these kinds of programs is enormous, said Les Paschall, CEO of CFG
Health Systems. Every single school, group home, residential program, childrens psych unit, and juvenile prison facility in America
is looking for and already has a budget for clinical materials that will reach out and grab their kids and engage them in
treatment and do it without boring them to death!

About Forterra Systems

Forterra Systems is the leader in providing private, virtual world technology for the corporate, healthcare, government, education,
and entertainment industries. Forterra's software and services enable organizations to train, plan, rehearse, and collaborate using
new media technologies integrated into a compelling 3D virtual world. Using the OLIVE (On-Line Interactive Virtual Environment)
Platform and industry standard PC hardware, customers can rapidly generate realistic, collaborative, 3D Internet solutions that
easily scale from single user applications to large scale simulated environments supporting many thousands of concurrent users.
Forterra can be found on the Web at: http://www.forterrainc.com
OLIVE is a trademark of Forterra Systems Inc.

info@forterrainc.com
www.forterrainc.com
tel: (650) 433-4000
fax: (650) 433-4099

Forterra Systems, Inc.

2207 Bridgepoint Pkwy
Suite 200
San Mateo, CA 94404

Forterra Systems, Inc.

48 Wall Street
11th Floor
New York, NY 10005

Forterra Systems, Inc.

3501 Quadrangle Blvd
Suite 355
Orlando, FL 32817