Early Draft Important Basic Considerations for Programs Using Role-Playing Games with At-risk Populations

This is a not quite final draft, and all of the formal citations are pending. It will be cleaned up over time before released to the public. Your review and feedback (keeping in mind this is not a final draft) is welcomed!

This article provides a very brief list of just a few of some basic, but critical, considerations that we (author and program associates)  frequently come across that can help make role-playing gaming (RPGing)  more effective for at-risk populations. 


This document assumes you are already familiar with the potential benefits and caveats of using role-playing games (RPGs) in your practice or facility to help various populations achieve recreational, entertainment, educational, and therapeutic goals. If you are not already familiar with the research, see the website www.rpgresearch.com for a comprehensive literature review on the topic.

While primarily covering cooperative intragroup interaction pattern ( citation avedon ) versions of the tabletop role-playing game (TRPG) format, most of this information is applicable for similar interaction patterned electronic role-playing game (ERPG), and live-action role-play (LARP) formats, and in some adaptations of the solo adventure books/modules (SABM) RPG format. ( rpg formats citation )

The following may be very obvious to experienced program designers & facilitators, but we have run into many practitioners from a wide range of disciplines, and various facilities, that have attempted to integrate role-playing games (RPGs) into their programs, but had to cancel their programs because of a lack of experience and nuanced understanding about the adaptive considerations a program designer should make when using a role-playing game (RPG) as an intervention modality for at-risk populations and related populations.

Related populations include: at-risk youth & adults, incarcerated youth & adults, in-patient and out-patient mental health clients, in-patient substance dependency transition programming, Autism Spectrum (ASD/PDD), ADHD, various learning disabilities, physical disabilities, Deaf and Hard of Hearing (HoH), visually impaired, developmental delays or impairments, and others that have factors putting them “at risk”. ( citation definition of at risk )

This article addresses some of the more common issues consistently observed with a whole range of at-risk population programs. These RPG-based programs readily address issues related to executive function (EF) impairment ( cite adhd ef  for youth, and one for adults ), learned helplessness, anger management, locus of control, turn-taking & impulse control, social skills development, and many others. This article draws upon decades of experience, research, program development & implementation, and assessments. We have been involved with RPGs since the late 1970s, researching the effects of RPGs since 1983, implementing RPGs in educational settings since 1985, and in therapeutic settings since 2004.

These results have been evaluated by combinations of various assessment tools related to each program’s goals, especially those assessment tools with higher scoring reliability & validity scores (.6 to .8+). ( citation red book ) An excellent resource for a starting point reference of such assessment tools useful for evaluating the effectiveness of RPGs includes the book “Assessment Tools for Recreational Therapy and Related Fields” by Burlingame & Blaschko.

In rehabilitation and rehabilitation transition programs, including those facilities and practitioners we have helped, implementing RPGs as an intervention modality, we have found that using in-game abstracted metaphorical approaches to the appropriately adaptive thoughts and behaviors was more effective at keeping players experiencing a higher level of immersion and potential experiences of flow state. ( citation flow state milhalyi ) This was compared to programs that were more obvious about the educational and therapeutic goals of the game.

The participants knew they were participating in an educational or therapeutic setting, but program facilitators did not overly stress these factors, instead letting the participants focus on “just having fun”. When combined with “processing”, the more embedded the learning is in the game experience, rather than overtly “in their face”, the more effective the programs, by not interfering with the suspension of disbelief ( citation milhalyi suspension ) necessary to maximize enjoyment and immersion in the game mode.

While in-game transparency of the desired learning materials is important, another critical consideration is pre-and-post-game-session processing discussions. Processing discussions typically only need to be about 5 minutes per participant (either in the group setting or privately), covering how the metaphorical experiences within the game session were analogous to their own challenges and goals.

Post game session processing discusses what happened in the most recent game. Especially for younger populations or lower cognitive functioning, it is best to do so immediately after the game experience, because of the stronger associative learning when stimuli are temporally paired more closely. While just 5 minutes per player is sufficient, longer processing is of course acceptable depending on the needs of the participant(s) and the programs established goals. ( tr citation on processing ) 

Participants are also usually given a “weekly challenge”, which asks them to keep their eyes open for opportunities in their real lives to apply the adaptive thoughts and behaviors learned in-game, to out-of-game experiences. Of course with the caveat of not always literally applying some of those actions. For example, if the participant learned an important concept that happened to involve an in-game physical combat situation, the facilitator should explicitly stress that of course they are not going to use a physical combat approach in real-life. While not usually needed for other populations, some at-risk participants need clear, explicit phrasing that the combat situation was a metaphorical representation of other types of conflict in the real-world. The combat is an exaggeration of what they may experience in conflict with other individuals or objects.

As an example, when working with a participant that struggles with lack of confidence, learned helplessness, ( citation learned helplessness ) and a lack of of a balanced locus of control perspective, ( citation locus of control ) or anger management issues, the confidence they showed through their character in-game overcoming a seemingly impossible foe (building learned optimism) ( citation learned optimism ), they can then express in-real-life (IRL), using non-combat behavior. This may be as siple as verbally standing up for themselves, rather than passively remaining silent. Rather than suppressing and exploding in anger, by calmly asserting their concerns they address anger management issues ( CFT, citation ) . Their responses could be as simple as just an assertive “no” rather than passive “yes” when asked by peers to engage in undesired behaviors. “What would your character do?”

Pre-game processing asks about the participants experiences between sessions. “How was your week?”, “Did you have any experiences that reminded you of any previous game sessions?”, “Were you able to apply what you learned in previous games to your real-life situation?”, etc.

Explicitly stating these considerations may not be necessary for those clients that have developed strong introspective and analytical skills. Walking through the potential lessons (and skills) learned from the session is especially important for those of any age or population that have not developed strong introspective, analytical, and self-awareness skills, aka mindfulness. ( citation mindfulness CFT? ) 

An explicit explanation approach can also be helpful for those needing to work on empathetic development skills. Research shows that RPGs can be highly effective in empathy development ( multiple citations list ) but some approaches are potentially more effective than others. Empathy development can often be more effectively handled through in-game modeling and in-game rules systems that emphasize simulation of empathic behaviors. These considerations are especially important for at-risk populations and those that are younger or have cognitive or other developmental impairments that might not have picked up on the direct relationships in the RPG session stories relevant to their own personal challenges and goals.

Especially for juveniles and other at-risk populations, we find that resistance to compliance is higher if the message is too "in their face" about the game being therapy or teaching them something. They are less likely to be able to maintain the critical suspension of disbelief necessary to maximize enjoyment and immersion in the game, which increases likelihood of maximal flow state opportunities to optimize learning. ( learning & flow optimize ) If the lessons are intelligently embedded in the game play, then resistance is often negligible.

While highly variable based on your audience, repeatedly we find the following important items related to optimizing RPG sessions. 

1. No more than 6 players per table in tabletop RPG (TRPG) sessions. Sweet spot is around 3-5 players. You want enough players for more complex social interaction, but each additional player means longer delays between each participant getting a turn to be active, since TRPGs are not usually real-time and so typically take turns. In more real-time, rather than turn-based variants, notably ERPG and LARP settings, number of participants may be larger, but typically more than 8-12 participants tends to create more separate sub-groups and less likely same-group bonding. Larger groups also typically require more facilitators to be manageable. ( forming citation )

2. Optimal game session duration and frequency is typically around 3-4 hours (short break mid-session) weekly, though they can be as short as 30-45 minutes, especially with very young or significantly developmentally delayed participants (typical ages 5 to 10 years old or equivalent functioning. 3-4 hours allows the best opportunities for immersion and sustained flow state experience. It is possible to experience this in as little as 15 minutes, but requires extremely ideal environmental variables for such quick immersion. If meeting more than once per week, then well-disciplined 15-60 minute sessions can be effective. ( citation rpg optimization )

3. Electronic devices (audio devices, flashing lights, laptops, tablets, flat screen battle mats, projectors, phones, mobile devices, electronic dice rollers, virtual tabletop software (Fantasy Grounds, rolld20), etc.) and other technology, while may add a “wow factor”, tend to actually reduce satisfaction and immersion scores compared to groups just using non-electronic aides. However, some of these technologies may be necessary adaptive equipment for different disabilities and have the reverse effects for those participants. For those not needing adaptive technologies, often even just one player using their cell phone or tablet, even if just for looking up game rules, tends to not only interfere with that participants immersion and satisfaction scores, but also impacts the rest of the players as well. Scores can be anywhere from just 5% to as much as 50% lower. ( citation rpg optimization )

4. Tactile and visual aides such as physical dice, white board, maps, battle mats, miniatures or other tangible visual aides are helpful. In complex tactical situations the “battle mat” or a white board is especially important. These visual aides are critically helpful for anyone that tests high for Aphantasia-related impairment. ( aphantasia citation ) Such aides are also especially important for at-risk populations to help reduce debate and potential conflict about where their character was located at a crucial moment in the game. “Nuh-uh, my character was 50’ away from the exploding trap, not 10’!” 

Also critical for transition programs is setting up supervised day passes to attend regular gaming groups out-of-facility. This is to prepare them to have a new (gaming) peer group they are already comfortable with prior to discharge. This should be implemented before discharge as early as possible. This potentially reduces the risk of going back to the same drug, gang, or other maladaptive peer group they associated with previously. You can't just tell them "stay away from your old friends they're bad for you", without offering something to replace that critical social void.

An important consideration is that some game settings provide built-in behavior modification rules. Some even include metaphorical equivalents to substance abuse, through game system rules consequences for overusing/abusing magic or other special abilities, and the risk of it becoming addictive and/or other dangerous consequences including: corruption, sanity (SAN), losing control and being overpowered by “the source”, detection by "the enemy" (broadcast/residue), etc. ( multiple citations: corruption (Thieves World?), Cthulhu, wheel of time, MERP ) 

We've also found RPGs that have built-in behavior modification make it much easier to address in-game-session social conflict between players, compared to exerting your own rules to curb them. Though we always include printed codes of conduct, especially if using games that don't spell out appropriate game etiquette well, at risk participants have less resistance to in-book published game rules than rules & restrictions that are added externally.

There are many games excellent for achieving these goals. A few example TRPG systems follow, though similar options can be found in LARP settings as well, and some modified ERPGs.

Cubicle 7’s The One Ring RPG (TOR) & Adventures in Middle-earth (AiMe) include “Shadow Points” ( TOR, AiMe pp ) as a consequence to non-heroic game play. Too many Shadow Points causes the player character (PC) to have increasing penalties and runs the risk of losing control of the character, “pulling a Boromir”. Also TOR's “Fellowship Focus” ( tor cite ) creates an in-game partner player character. This creates simulated empathy because consequences to the Fellowship Focus (FF) PC impact their own PC’s functioning. If their FF PC is in danger, injured, or dies, then their own PC experiences in-game penalties to functioning to represent emotional impact. If their FF PC is saved by them, they may experienced benefits and boots to their own PC. FF is not included in AiMe, but because it is so effective we created house rules to “port” over this TOR rule to AiMe ( url cite ), and have been increasingly adding it to other game systems/settings in both TRPG & LARP. PDFs of all our house rules are freely available on the RPG Research website.

TODO: Explain pros and cons of Inspiration vs. Hope/Story/Plot points, and considerations for learning real consequences......

Another excellent example of an RPG with built-in behaviors modification is the Doctor Who Role-playing game. This system includes rules encourages players to try to take the least violent approach to any situation. The level of violence intended impacts initiative ( who cite ) (who goes first in taking action) & story points ( who cite ), which are necessary to game play and character development.

One of the strongest pre-game “session 0” rules for building camaraderie is “A Song of Ice & Fire” (Game of Thrones) ( SoIF cite ) RPG and the “House Building” rules. The House Building rules require a setting that has strong affiliations with “houses” or other affiliate types of organizations. The participants form their own customized “team” and are bonded before they even begin to create their own individual characters. This typically takes anywhere from 30 minutes to 2 hours depending on the group. We have successfully adapted the House Rules system to other settings such as D&D’s Greyhawk, Dune, and other settings.

Fantasy Flight Games’ Warhammer FRP, has been nicknamed by our staff as “the nanny RPG”, because it has so many visual aides for the character sheet for game play that it helps reduce cheating issues by having so many things visible on the table through sliders, tokens, etc. ( WFRPG cite char sheet ) 

No thank You Evil (NTYE) by Monte Cook Games is excellent for younger players (as young as 5 years old, even younger with help from older players for reading-level considerations). The game is high in both token economy and physical token trackers good for both a feeling of tangible cause-and-effect, and cheating tracking. ( NTYE cite char sheet pp ) This RPG is also enjoyable for all ages for just a few sessions, for example getting adults to not take themselves quite so seriously and teaching them to loosen up and use their imaginations more freely. This game can be unappealing to some adolescents and at-risk participants for lack of perceived “coolness” factor and not wanting to let their guard down, but if initial resistance can be overcome can be very enjoyable even for these groups. While NTYE can be played as long as desired, most adventures resolve in 30-45 minutes. For younger players we recommend physical breaks between each adventure and no more than 3 adventures in a single game session. Also to help with the “wiggle bottom” factor, we incorporate semi-LARP aspects to having the players get up and walk around in-game exploring while the narrator describes the scene. This is a very family-friendly game accessible to all ages, and provides various levels of complexity to adapt to different cognitive functioning levels.

Another consideration regarding curtailing players’ desire for combat is that more “deadly” game systems over time teach the players how dangerous combat is to their PC, and they increasingly prefer to find non-combat solutions to challenges. For example systems like Iron Crown Enterprises (ICE) Rolemaster (RM) that have detailed critical hit charts, rather than just abstracted points, that are considered “deadly systems”, and that over time can cut off bits and pieces of the PC and can lead to sudden PC death. Once the players start to understand these risks to their PC, the players become much more combat averse in their problem solving approaches.

Yet another useful consideration is systems that explicitly provide rules covering current or temporary versus potential statistics. For example the aforementioned ICE RM has a clearly defined system showing the PC’s current temporary stats which can be higher or lower over time due to events or efforts (and representation of effort shown by “development points”), and the maximal potential of that character. Most PCs will not start out with any of their primary stats at potential. So in addition to skills (and levels in those systems that use levels), the players see how their attributes can evolve over time. RM uses a percentage scale from 0 to 100 (with a little room above 100 for super beings), with 25 to 75 being average range. The PC may start with Strength and Memory attributes of 50, but have potentials of 90 and 95 respectively, as something clearly to strive for over time. This is a tangible that they understand and can be reflected on the player sown goals for growth in different areas.

The key is that if the behavior modification rules are built into the game, at-risk participants are much more willing to go along with those published rules modifying their behavior, than anything made by the program designers. Now, they may have an innate preference for systems with fewer behavior restrictions, and may be resistant to systems that clearly curtail “misbehavior”, so it is best when describing each game to focus on the setting and fun aspect of the game offering rather than the behavior modification aspects if offering them a choice between games. For example D&D versus AiMe, or Doctor Who versus Warhammer FRP, etc.

Another consideration for at-risk populations is that we recommend avoiding overly abstracted RPG systems that reduce or eliminate many of the typical token economy, causality, and progress tracking benefits of most RPGs.

For example Margaret Weiss Productions revised Cortex System in the Firefly RPG drastically abstracted most equipment items rather than well-defined material goods. ( firefly citation ) The earlier version of the system in their previously published Serenity RPG had an equipment list and pricing. ( serenity citation ) This was abstracted out in the Firefly RPG. Most participants strongly disliked this lack of tangible goods and value, and fairly consistently prefer the older system over the new system.

The One Ring RPG only provided “Treasure Points”, this is far less satisfying for players than “100 gold pieces, a silver ring with a ruby, and a dark amethyst” as treasure reward. ( citation TOR ) 

For all populations, an accurate assessment of participant functioning is extremely helpful to matching game system, setting, and modifications necessary to maximize the benefit of the RPG sessions for the participants to achieve their goals. A useful resource directly related is the "Red book" for assessment tools, combined with the  book Recreational Therapy Handbook of Practice, ICF-Based Diagnosis and Treatment by Porter & Burlingame, to cross reference ICF codes and recommended adaptations. There is an updated offshoot based on the latter book in draft form on the RPG Research website and scheduled for publication in late 2019.

There are many other considerations that need to be addressed when working with at-risk populations. We freely publish many articles on these recommendations for this, and for other populations, including: brain injury, PTSD, depression, social skills development, panic disorder, agoraphobia, and many others. Also organizations such as RPG Therapeutics LLC and others can provide paid professional services to develop and/or run programs for you, or consulting services to help you develop your own program effectively. (citation of other resources page on rpg research dotcom )


Learning and Behavior, Russell A Powell, P. Lynne Honey, Diange G. Symallik, 2017, Cengage Learning. Boston MA

Abnormal Psychology, David H. Barlow, V. Mark Durand. 7th edition, Cengage Learning, Boston MA

Teaching Teens with ADD, ADHD, & Executive Function Deficits. Chris A. Zeigler Dendy, M.S.   2nd Edition. Woodbine House. Bethesda, MD.

Psychology of Adjustmennt. John Moritsugu. Elizabeth M. Vera.  Jane Harmon Jacobs. Melissa Kennedy. 2017. SAGE Publications. Thousand Oaks, California.

Forming, Storming, Norming, Performing. Donald B. Egolf, Ph.D.  Sondra L. Chester, PhD.  3rd Ed. iUniverse. 2013. Bloomington, IN.

Middle-earth Role-Playing 2nd Edition.  Iron Crown Enterprises. Charlottesville, VA. 1993. pp 214-217 & 264.

Avedon Interaction patterns book

Hawke’s summary of Avedon interaction parts 1 page pdf


Suspension of Disbelief


Flow state

flow state optimizing learning

group size

interaction patterns

“At Risk” definition citation

Red Book 

TR “processing” source

“learned optimism” source

“learned helplessness” source

“locus of control” source

CFT anger management source prof 

Mindfulness other source

effective group size forming source

aphantasia source

The "Blue Book" Recreational Therapy Handbook of Practice , ICF-Based Diagnosis and Treatment. Heather R. Porter. Joan Burlingame. Idyll Arbor. 2010 2nd Printing. Enumclaw, WA.

The "Red Book". Assessment Tools for Recreational Therapy and Related Fields. Fourth Edition. Idull Arbor. Joan Burlingame, HTR, ABDA. Thomas M. Blaschko, MA.

The "Cook Book". Therapeutic Recreation Program Design, Principles & Procedures. Norma J. Stumbo. Carol Ann Peterson.  4th ed. 2009. Pearson Education. San Francisco, CA.

Therapeutic Recreation Service, and Applied Behavioral Science Approach. Elliot M. Avedon. Prentice-Hall, Englewood Cliffs. NJ.

Facilitation Techniques in Therapeutic Recreation. John Dattilo, Ph.D. Alexis McKenney, Ed.D. 3rd Ed. Venture Publishing. PA.

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