April 21, 2017

Podcast: How HopeLab Creates Games for Good

Transformative change rarely occurs in any one field of endeavor, but rather at the intersection where different fields meet. HopeLab lives at one of those crossroads, where health, technology, neuroscience, design, and philanthropy come together to improve the health and well-being of kids and young adults.

As Margaret Laws, the nonprofit’s CEO, recounts in this edition of the Business of Giving, HopeLab evolved out on an idea by philanthropist Pam Omidyar, a biologist and avid gamer, to develop a video game that would spur kids with cancer to take their medications despite unpleasant side effects. The result was Re-Mission, a "first-person shooter" game that helps players see their chemotherapy drugs as a weapon to blast away the disease.

From there HopeLab moved on to Zamzee — a game designed not just for but in part by children to promote physical activity and reduce obesity and diabetes — and into broader research and development of digital tools that aim to change behavior for the good, underpinned by what Ms. Laws calls "the psychology of resilience."

"We all actually naturally have a state of resilience; it isn’t something that has to be created. It’s within us, and it can be tapped into, and it can be ignited," she says. "We need to create experiences and opportunities for people to ignite it and to connect with it."

Listen to the full interview on the player below and/or scroll down to read a transcript provided by the Business of Giving.


Denver: We frequently discuss on the show how transformative change rarely occurs in any one field of endeavor, but rather at the intersection of where different fields meet. And at one of those crossroads where health, technology, neuroscience, and philanthropy come together, you’ll find a nonprofit organization by the name of HopeLab. And it is indeed a pleasure to have with us this evening their President and CEO, Margaret Laws. Good evening, Margaret, and welcome to The Business of Giving!

Margaret: Good evening and thanks for having me!

Denver: Tell us the founding story of HopeLab, Margaret, and the mission and goals of the organization. 

Margaret: It’s actually a terrific founding story. So Pam Omidyar, wife of eBay founder, Pierre Omidyar, was working in a lab. She was working on some research and some challenges faced by kids with cancer. And what she was seeing and what they were seeing in the lab was that these kids with cancer… who were supposed to take chemotherapy for two years… were not taking all their meds. They weren’t taking all of their chemo meds, and they weren’t taking all their antibiotics, and they weren’t having the outcomes that we would hope they would have.

She was into video games – she was a gamer – and she thought maybe video games could play a role in helping get these kids to take their drugs, to take their full course of chemo. So she had this crazy idea, which is:  “Could a video game cure cancer?” And HopeLab was formed actually to create “the game” that would help kids take their cancer meds at the frequency they were supposed to take them… and ideally have optimal outcomes through their cancer treatment. 

Denver: And now your  expanded mission would be?

Margaret: Now, our expanded mission is to combine science, design, and technology to improve the health and well-being of kids and young adults. 

Denver: Fantastic! Now, before we get into more details and some of your specific programs and projects, why don’t you give us an overview of the state of health and wellness of young people in our country today. I think most people know it isn’t probably what it should be, but may not know much more than that. Tell us what it looks like. 

Margaret: It doesn’t look great. We’ve got significant problems with childhood obesity… with type 2 diabetes…at epidemic proportions.  And one of the things that we’re really focused on now that’s been a real challenge is mental and emotional health and wellness of kids. We’re really seeing challenges in the teen years, but all the way down into childhood. So there are a lot of things that are creating adversity for kids in our environment, and a lot of opportunities to engage kids and young people in helping to create better pathways for health and well-being.

So, we thought a lot about health and well-being of kids and young adults… what contributes to it, what’s detracting from it.  And our unique contribution is really to engage those young people in helping to create the solutions. 

Denver: Why don’t you walk us through the original game that Pam Omidyar helped create. It was called Re-Mission. How do you play that game?


Margaret: Remember, we’re going back about 10 years now, and video games were new. It’s hard as technology progresses to remember what things were like back then. But this is what we call a first-person shooter video game. It was a game that actually has a female protagonist. Her name is Roxxi, and you, as the player, actually go through the body. You both learn about your condition– your cancer– and what’s causing it.  You basically, with Roxxi, go through and blast away the villains.

What was really interesting about it was the psychology of it.  What we were really trying to do with the game was to get kids to see the chemotherapy… to see the drugs… as their power and their weapons, as opposed to being their enemy.  

Denver: I guess rigorous research has been one of the hallmarks of HopeLab, and it really started at a very beginning with that game. What impact did it have in getting children to take their medication as prescribed? 

Margaret: Dr. Steve Cole, who is the Vice President of Research & Development and really created all of the science platform for HopeLab, worked on this and got several studies in place. And basically what the study showed was a couple of things:  that kids were much more likely to take their medications, to take their full course of chemo and the antibiotics, and have better outcomes. And so while you can’t specifically attribute lives saved, you can extrapolate out and show that this game actually saved lives. Getting kids through their full course of chemo and antibiotics resulted in them having much better outcomes through cancer.

The other thing that they did, which was very unique, was to do fMRI studies– brain imaging studies– that actually showed that while playing the game, motivational centers were triggered and fired in these kids.  We could show that this game was doing what we had hoped it would do, which is to really get these kids activated and motivated and really working too against their disease.  

Denver: Oh, wow. So there’s actually psychological, physiological, and neurological changes taking place as a result of playing this game. 

Margaret: Yes. We saw those correlations during the game play. 

Denver: Well, HopeLab went on into a considerably larger cohort in Step 2 than children with cancer.  That was focused on the young people who don’t get enough physical activity and all those associated problems you alluded to just a moment ago. That game was called Zamzee. Tell us about Zamzee.

Margaret: Zamzee, as you point out, was an effort to try to take the learnings from Re-Mission. And when I say that, I think the way I would describe it is: in Re-Mission, what HopeLab sought to do was to understand the psychology of behavior change– so what was going on psychologically with these kids that was keeping them from doing what we wanted them do, from taking the medications?  And once we understood that psychology, then an experience could be engineered to help reverse that, or create a different opportunity for them.

And to this idea, this recipe that HopeLab was using– what we called sort of reverse engineering health. So, it’s first understanding the psychology, and then thinking about an experience that would act in the way that we wanted it to, and then creating a technology or an experience that would help people have that… make that change.

So in Zamzee, the idea was really around physical activity. It started with a desire to work on obesity, type 2 diabetes, that whole big area of need. Physical activity was seen as one of the real keys that we could potentially impact. So with physical activity, there was a long process of engaging kids… trying to understand what got them excited about physical activity. With teen girls, it was dancing.  With different groups, it was different things. It wasn’t a team sport for everybody. It wasn’t soccer for everybody. So we really needed to think about ways to capture activity among lots of kinds of kids. And then basically, a game was created. Think of it as like a Fitbit or a tracker for kids, combined with what we call an experience or a gaming layer. So they’d have an avatar; their avatar would be given challenges, and they would get points and badges and a variety of things once they had accomplished different things within the game.

So Zamzee, like Re-Mission, was developed with young people… heavy engagement from young people. We call it “young people as the co-designers,” and then we tested it.

Denver: Very smart!

Margaret: They definitely had a lot to teach us, and they continue to.  And then, we took that through randomized control trials as well. And again, in randomized control trials, the kids who were using the Zamzee were shown to have a 57% increase in exercise and physical activity. And so Zamzee basically was working in these randomized control trials, and then the effort for HopeLab was really to think about: how could we get Zamzee out into the market. 

Denver: Absolutely! I really admire how thoughtful you’ve been about your core competency that you uphold, and then seeking partners who have complementary competencies – like distribution – to achieve that optimal impact. And perhaps there  is no better example of that than the relationship you forged with Welltok. How did that partnership work?  And how did it come about?

Margaret: That’s a great question. It’s a real challenge. You talked at the beginning of this interview about combining these disparate worlds of philanthropy and business and technology – not an easy set of things to do. When I got to HopeLab, Zamzee had been in the nonprofit form.  There had been an attempt to spin it out as a business; there had been some challenges in getting it into the market. You might argue that the market wasn’t quite ready for it yet, or that it wasn’t meeting–

Denver: It was before Fitbit, right?

Margaret: Yes, it was before Fitbit. It was early. And I’ll get to this theme several times during this discussion – kids are not the expensive part of the healthcare market. So when you’re thinking about new innovations coming into the market, it’s often difficult to get them in with kids first unless it’s something that is unique to kids, because the cost that the system sees is much more in adults than kids.

And so with Zamzee, we looked for a partner. At the time that we were looking, there were a few platforms that you might call wellness platforms out there – Welltok is one of them. And these platforms where smoking cessation, diet and exercise, mental and behavioral health interventions can all be offered to employees or to people in insurance plan. And Welltok was one that we thought was particularly interesting, and it was interested actually in bringing on a physical activity solution for young people. One of their interests was they had physical activity opportunities for adults and for parents, but having a solution that could work for the whole family was something that was appealing. 

Denver: That’s what they want. They want to reach the family.

Margaret: So we sold Zamzee to Welltok. Zamzee has now been incorporated as part of Welltok’s CaféWell platform. It’s actually, just as we’re speaking, going out to market as part of  a set of solutions that Welltok is taking out in the employee benefit and wellness space. And so, we’re looking forward to seeing how that partnership plays out, but we have been really excited about finding a place where Zamzee could sit as part of a broader wellness solution for kids and families. 

Denver: Well, that’s great!  Because sometimes when you create something… and you own something, it’s hard to give it up. But if you have your eye on the prize– getting kids to get more physically active– you really don’t care whether it’s under your umbrella or somebody else is doing it.  You want it used, and you want that end result. After these first two– Re-Mission and Zamzee–  and the organization seemed really focused with a laser focus around one project at a time– you’ve kind of become a catalyst or a launch pad.  You’re now doing a bunch of things simultaneously. Would that be correct?

Margaret: I think it’s a good way to describe it. The strategy that evolved afterZamzee–and this is still before my time, but it’s something that has carried forward into my tenure–was to take one more step back. So we took a step back from Re-Mission to create Zamzee. We took one step back from Zamzee and Re-Mission to look at: what do they have in common? What are the things that these solutions are doing that is helping people with positive behavior change?  And the commonality was the concept of resilience.

And so, HopeLab developed a resilience framework, looking at resilience as sort of three-pronged – as purpose, connection, and control. And so, there are elements under each of those: purpose, a sense of something bigger than yourself; connection, really deep connections to others – one or more other people; and control, really a sense of self-efficacy, a sense that you have some power to create positive behavior change over your life and your future. Those elements really played out in Re-Mission and Zamzee.

And so what HopeLab has been trying to do is to take those resilience elements and the psychology of resilience, and really use that as the foundation for technology solutions and interventions. And so, there was an effort to look at a number of different ways that these concepts of resilience could play out in interventions or solutions that would be helpful to kids and young adults.

Denver: And one of the products you’ve introduced to deal with that issue directly is something called The Mood Meter. Tell us about that.

Margaret: The Mood Meter was a really interesting experiment. It was a collaboration with Marc Brackett, Director at the Yale Center for Emotional Intelligence. And it was taking a program that Marc had been using really successfully with students in schools– that really helped them identify their mood and their feelings– and shift to a more positive state. Sounds simple, but actually isn’t that simple. 

And what HopeLab did with Marc Brackett was take The Mood Meter from a paper-based form to an app, and that app is now available on the app store and is in use by tens of thousands of students around the country. It was a really interesting collaboration — taking an evidence-based and paper-based program and trying to make it much more scalable and available to more people by putting it into app format… making it more usable but more engaging for students.

Denver: And bringing it to the 21st century.

Margaret: Exactly.

Denver: How did you get involved in this? Because we’ve had a lot of people on this show talking about how fragile today’s young people are, how they can’t bounce back from any kind of adversarial news, and people don’t pay much attention to it. It’s kind of overlooked. How did you capture that? Where did you see that?

Margaret: What’s interesting about that is the purpose, connection, control – the resilience framework that HopeLab developed – and I think one of the keys of it is building on the positive and building on aspiration. I think one of the things that HopeLab learned from the early work with Re-Mission and with Zamzee is that if you think about solutions that build on positive aspirations rather than punish for negative behaviors– particularly with young people– you’ll have much better outcomes. So all of this work around resilience is really designed to build on the positive things that exist in all of us.

So the theory and the perspective that HopeLab has taken on it is that we all actually naturally have a state of resilience;  it isn’t something that has to be created. It’s within us, and it can be tapped into, and it can be ignited. And so rather than start with a deficit– that we don’t have it and we need to get it, start with the concept that we have it, but that we need to create experiences and opportunities for people to ignite it and to connect with it. 

Denver: Great way of looking at it. The resources and the answers are all inside of us; we just have to find out where they are. You’ve really done this in a very activist way. You’re not an organization that sits around trying to figure out what’s next. You’ve been out pounding the pavement with children’s hospitals and schools and the commercial marketplace and Medicaid plans to find out what’s happening and what’s needed. What else are you hearing and seeing out there?

Margaret: It’s great. It’s been a really interesting experience because as I said earlier, one of the challenges traditionally in the healthcare market– where I’ve spent 25 years working– is that kids… because they are generally healthy, are not usually the burning platform. It’s not where a healthcare system really needs to focus its efforts or feels that it’s going to save a lot of costs. And yet, working with kids is an incredible opportunity and down payment on a future healthcare system that doesn’t have some of the problems that we have. So for me, it’s an incredibly exciting opportunity to try to work with… but maybe redirect a little bit… what we see in healthcare.

So, what we did was go out and talk with a range of people in the market of, as you noted, Medicaid plans, of commercial plans, schools, pediatric hospitals to look at where they’re interested in innovating around the health and well-being of kids. We didn’t do an exhaustive search. I think we’ll be going out again, as I’ve had a little bit more time at HopeLab, and do something maybe a little more scientific. But the early responses that we got were fairly consistent. And one of them was the time around birth– lots of opportunity for prevention in the future, and it’s a costly time. When you think about the cost of kids in the healthcare system, a lot of it happens around birth and leading up to birth.

And then a second area which emerged frequently was this area of adolescent and young adult mental and emotional health and wellness. It’s a real challenge for the system right now. As you know in society, we’re seeing big challenges with depression and anxiety among young people, and really not a lot of great solutions in the system or in the market to meet it. So these seemed like a couple of important areas.

As we talk to pediatric hospitals, transitions from pediatric care to adult care broadly are big challenges. And an area that HopeLab holds near and dear– and we’ve worked long on– is cancer. And so we’re doing work in adolescent and young adult cancer, really trying to get at this challenge, which is that adolescents and young adults with cancer haven’t had increases in outcomes the way that children and adults have. And so, we’re really trying to work hard with that population to understand mostly the psycho-social factors that keep them from being able to complete their course of treatment in as effective a way as they can. 

Denver: A very interesting portfolio, and if I may, I’d like to pick up on one of those. I know in your previous life at the California HealthCare Foundation, you were really focused on underserved communities. You were talking about the time of birth just a moment ago, and that probably led to your partnership with the Nurse Family Partnership. Tell us how that works.

Margaret: It did. A really interesting project that we’ve been working on is a collaboration and a partnership with Nurse Family Partnership. Nurse Family Partnership works with low-income, high-risk, first-time moms. It started as teen moms; now, it’s teens and young moms. And what we’re doing with them, it’s a really interesting program– 40 years old– very strongly evidence-based. They’ve got huge improvements in… they’ve reduced preterm birth significantly, lots of reductions in child abuse, improvements in school performance. So really, a hugely beneficial program.

One of the things that was interesting to us about it, or to me as I reached out to them for a potential partnership, was that while their focus is on teens and young adults, they weren’t using technology at all. It was a program that really, really was based on the personal human connection between a mom and a nurse, and everything that took place between them took place one-on-one, face-to-face, in the home. But 40 years ago, that was the program that was started, and it had a lot of success. Why mess with things that are successful?

But as we know, today’s young moms are digital natives. They’ve grown up in a digital world, and much of what they do in the rest of their lives, they do using their cellphones and connecting digitally, consuming information and media digitally. And so one of the things that we wanted to do was see if we could team up with Nurse Family Partnership that was already serving more than 30,000 moms at any given time…so there’s a real platform for scale there. And if we could actually bring our assets and our benefits to them, how might we partner with them to bring the psychology and the technology that could help that program potentially be more engaging, more impactful, and reach greater scale?

Denver: It sure sounds like it’s going to be a great marriage.

Margaret: I hope so.

Denver: What have you done?

Margaret: It’s actually been a fantastic experience so far. We’ve teamed up with Nurse Family Partnership and have taken them through the process of human-centered designs. So we basically–our team went out and interviewed and spent time with lots and lots of young moms in the program and really asked them:  where are they in their lives, what are their aspirations, what are their hopes and dreams, what’s working for them in the program, what are the challenges of the program. We did the same thing with the nurses. There’s a huge amount of innovation and drive–latent innovation in these nurses.  They were really interested also in talking about how the program might benefit from some changes and from the things that technology might bring to it.

So, a lot of time with moms, a lot of time with nurses, out in the field, seeing how they work and what they do, and then development of a series of different potential prototypes of projects, things we might do together – technologies, service models that might be brought to bear. And now we’re at a point where we’ve actually developed one project that we’re moving forward with with Nurse Family Partnership. It’s actually an app that the moms and the nurses will use together, and that is currently in development.  We hope to have it out in pilot tests by the beginning of 2018. 

Denver: Very interesting and fantastic!  And what a wonderful way to amplify one of the best programs we have here in America!  People who follow your organization, Margaret, know that you have a culture of risk-taking and experimentation, which is not all that common in the nonprofit sector, I dare say. Tell us how you create such an environment, and more about the corporate culture of HopeLab that makes it such a distinctive and special place to work.

Margaret: So, I go back to the Omidyars. I really think that the founding of this organization and the work that they do broadly celebrates risks and celebrates the opportunity for a philanthropic organization in this space to do things that are riskier than a purely research organization might do… than a business might do. Some of it is about risk, but some of it is actually about time. A lot of times we talked about patient capital, and I think one of the things that’s been really interesting about being a philanthropic research and development organization is that we’ve had the time and the patience to actually bring the rigor of research to the product development cycle. And again, I think that part of it has been really an important distinguishing feature of HopeLab.

It’s interesting. We sit in Silicon Valley, so we need to move at the pace of Silicon Valley, but we have what I consider the luxury to be able to take a little bit more time and have the rigor of the research drive, the iterations in the product development that we do. So I really give huge credit to the Omidyars for supporting an organization like this and for having a vision for a research and product development organization that can work in a little bit of a different way.

I also would say the culture of risk taking–I can tell you from  25 plus years in this field–it’s really hard. It’s difficult to get people– particularly when they’re working in areas where they deeply, passionately care about solutions working for people– to work on things that might fail. And so one of the things we are challenged constantly with is to really keep the spirit up among people to be willing to take risks and to not necessarily always take the path that feels the most certain. And when you’ve got people working with young moms and babies, and they really want to do the best by them, and they want to make sure that whatever they do works, taking risks can be hard. So it’s a constant tension, but I think a really exciting tension to manage. And we try to maintain a balance and to be working in areas where we think we really do have some chance of being successful. We picked an evidence-based program to work with!

But we also want to hold some space, at least a little bit of what we do, that really pushes the envelope. One of the other things we do at HopeLab that I think really helps this is we have a discovery science portfolio. One of the things we do is fund basic research and discovery science that can feed the work that we do. So we may look at things like the psychology of giving, and how giving and being compassionate in doing good work can actually help people, both psychologically and even physiologically, and try to feed that research into the work that we do. And that’s another way of being a little bit out on the frontier, trying to push the envelope, and then trying to translate that research into the work that we do day to day. 

Denver: You’ve got a lot of things going on. Let me close with this: what is the biggest challenge that you currently face with this work?  And what’s the biggest opportunity that just excites you no end?

Margaret: Great question. The biggest challenge we face I think is always the challenge of scale. In this world in which we work, in the world of social innovation, we’re really trying to do things that can reach a lot of people, and I think the mechanisms for getting things out to lots of people can be really challenging. Some things go viral. Look at Pokémon GO. It sometimes happens, but you can’t predict it, and you can’t necessarily engineer for it. And so being strategic about how to get the best relationships and the best potential for scale via distribution partnerships, via partnerships from the beginning of projects, I think, is one of the biggest challenges.

In the work that I’ve done in healthcare, one of the biggest challenges for a startup company who has got something really fantastic that can get out to the world and help lots of people is: how do you actually get it out to people?  How do you get things out through physicians?  How do you get things out in the hands of consumers?  And I think as we think about young people, one of the biggest challenges we have is keeping up with channels of communication to young people. It’s one of the reasons why engaging young people as co-designers is such an important part of what we do because if we don’t keep up with how and where young people get their information– who’s influencing them, how they’re finding out about things– we’re not going to be able to be successful in scaling solutions to them. 

Denver: You’re designing something for something which was so yesterday. And the opportunity?

Margaret: Exactly. I really feel like this opportunity of doing something in the space of mental and emotional wellness for teens is a huge one. It’s such a big issue in society. And I think one of the things that’s so exciting about this opportunity is that I believe that it’s young people who are going to tell us and teach us what’s going to work for them.

I’ve spent a lot of time recently talking with people who are experts in mental and behavioral health, mental and emotional health, and who are experts in technology, and one of the things that we all concur on– and that we consistently learn in these discussions– is that the old ways of doing things, particularly in this domain, are not going to work for these kids. It’s not what they want. It’s not what they’re looking for. Things that engage peers much more effectively, things that do engage technology as a way of communicating, connecting, are going to be much more likely to be a way that we see success.

And I think one of the other really exciting opportunities in working in this field is I’ve spent a lot of time over the past few years thinking about how we combine a human experience with technology in a way that really works effectively in health and well-being. And that’s I think one of our biggest challenges – biggest in the world of healthcare, biggest challenges in the world of social innovation. We’ve got this incredibly powerful human connection that helps us move forward, important social goals and social needs, and we have the power of technology. I think we haven’t always done a great job over the past several years thinking about how we combine those things most powerfully and how we have the human touch when we need it, and we have the efficiency of technology when we need that. I think getting that formula right and having an opportunity, in some ways to have a laboratory where we experiment with that, is an incredibly exciting opportunity. I’m hoping that with young people engaged– helping us figure out how to do it– we can really achieve some powerful things.

Denver: Whatever the field of endeavor, I would actually say that is the question of our time. Well, Margaret Laws, the President and CEO of HopeLab, I want to thank you for being on the program this evening. Tell us about your website, the kind of information people will find if they go visit, and how they can become involved with the organization.

Margaret: Terrific! Please visit us. We’re at If you go to our website, you can learn about the projects we have in the field.  You can learn about the research that we’ve done and are continuing to do, and you can sign up to be part of our various social media and mailing lists.

We’re also very actively engaged right now in a project, as I’ve said, with adolescents and young adults with cancer, so we’re forming a council there. Several other places where we’re actively seeking to engage adolescents and young adults who want to be co-creators of exciting health and wellness solutions. So please reach out to us via our website or social media channels if you’re interested in getting involved. 

Denver: Fantastic! Well, Margaret, it was a real pleasure to have you on the program.

Margaret: Thanks so much! I loved talking with you and appreciate the opportunity.