Tech-Driven Transformation: Revolutionizing Early Childhood Mental Health
CfD Conversation Fall 2023–2 | October 27, 2023
Written by Aashita Jain. Edited by Julie Farkas.
This conversation focused on a project that is funded through a fellowship with the Center for Design. It aims to develop and pilot a smartphone-based application to enhance the family partner model for early childhood mental health services in the Boston Healthy Start Initiative (BHSI). The purpose of this project is to improve effective communication between families and their family partners, to support guided experiential learning, and decrease the gap in screenings, referrals and services for economically-disadvantaged children with social, emotional and behavioral difficulties.
What is TEAM Health?
Beth Molnar started the conversation by talking about her research lab, where they have worked for nearly 12 years to revolutionize services for children exhibiting social, emotional, and behavioral difficulties before the age of eight. In collaboration with the Massachusetts Department of Public Health and the Boston Public Health Commission, they developed a program focused on enhancing early intervention services. This program is called Technology-Enhanced Approaches to Mental Health Navigation in Families with Young Children, otherwise known as TEAM Health.
“How can we enhance those services in a way that gets the attention that they need sooner and more effectively?” — Beth Molnar
This initiative involved integrating individuals with firsthand experience in special healthcare needs of their children into the system as family partners, alongside early childhood mental health clinicians. These teams were introduced into community health centers and pediatric practices, adopting a holistic approach that encompassed therapy, case management, and family-centered care.
The program, known as LAUNCH, operated within a medical home model. Pediatricians referred vulnerable children to this multidisciplinary team, leading to regular, year-long engagements with families. Rigorous data collection and evaluation formed the cornerstone of their assessment.
The outcomes were impressive. Across age groups, there were substantial decreases in clinically concerning behaviors and emotional issues among children. Additionally, parents exhibited significant reductions in stress and depressive symptoms. These results propelled the program into the realm of evidence-based interventions, gaining recognition and acknowledgment within the Maternal and Child Health Bureau’s database with an award in 2020.
The program was recognized as the best new practice of the year and made its materials available online for wider adoption. It expanded across Massachusetts and ventured into the child welfare system, securing funding for future extensions to home visiting programs. However, as the program grew, challenges emerged in replicating initial successes.
“As we expanded, it was harder to reach everybody. We didn’t see as, you know, clean results as we did the first round when it was more tightly controlled, which is often the case when you’re doing prevention science, as you get bigger and expand to more diverse kinds of settings.” — Beth Molnar
To address this issue, the team is exploring innovative solutions like a smartphone app to bolster communication, access to information, and community building — dubbed as a “family partner in your pocket.” Collaborating with experts, they are strategizing data collection methods for designing impactful enhancements. This marks an exciting phase as the program aims to refine and elevate its impact on early childhood mental health services.
The two phases: Information gathering and pilot testing
Michael Arnold Mages described the participatory, user-centered research process for gathering the preliminary data for the development of the app. The research approach is divided into two phases: an information-gathering phase and the subsequent development and evaluation of a complete prototype.
The current phase, which is the information-gathering phase, involves conducting qualitative face-to-face interviews with 20 dyads comprising a family partner and a caregiver. Through in-depth, open-ended interviews, the team aims to identify challenges and opportunities related to communication, adherence to therapy, and emotional well-being for parents, children, and caregivers. This stage will culminate in a document of requirements that will outline the app’s set of features.
Following this, a prototype will be created using common prototyping software, showcasing the app’s functionalities in real practice scenarios. The team plans to return to the community for usability and acceptability evaluations. Users will engage with the prototype, providing valuable feedback on its practicality in their daily lives.
“We’re looking forward to getting hard data on whether this will be acceptable to the community to help them in these kind of difficult and challenging moments.” — Michael Arnold Mages
The collected data will serve as foundational information for a broader funding proposal to support the complete development of the app and the implementation of a robust testing protocol in the upcoming years. This phase marks an important step in gauging community acceptance and the app’s potential.
TEAM Health application development
As a faculty member of the Khoury College of Computer Science, Herman Saksono took the lead on describing the development of the TEAM Health app. The research team has brainstormed several potential features for the app designed to support parents with tracking their children’s development and fostering deeper conversations with family partners. These features include incorporating videos created by other caregivers to encourage shared learning, enabling the exchange of information through group chats, and integrating interactive social activities to engage families.
While these features are still in the conceptual phase, the team is using the NIMHD Framework from the National Institute of Minority Health and Health Disparities as a guide. This framework emphasizes intervening at multiple levels: individual, interpersonal, community, and societal. Notably, the team is excited about addressing intervention at various levels to create a comprehensive impact.
They envision the note-keeping feature for parents as an intervention at the personal level, facilitating dialogue with family partners to support family functioning. On the other hand, features like caregiver videos, group chats, and social activities aim to intervene at the community level, fostering a health-oriented community where members support each other and identify potential concerns early on.
“The reason why we are doing this is that we want to reduce the risk of intervention-generated inequality. It’s a concern in tech, but it’s actually a longstanding concern in health.” — Herman Saksono
The team aims to mitigate the risks of intervention-generated inequality by prioritizing user-centered design and a multi-level intervention approach that involves community members and family partners in collective health efforts. Overall, they seek to continuously develop innovative ideas to support social interactions that facilitate healthy behaviors, ultimately creating an inclusive and impactful platform for families.
Using the app in the real world
The app’s potential impact on real families and their unique situations is an exciting aspect to discuss. Christy Moulin detailed some hypothetical scenarios depicting how the app could significantly benefit imaginary individuals like Sally, Reggie, Claire, and the Green sisters:
- Sally, a single mother working at a childcare center, faces challenges in understanding her daughter Sarah’s special medical needs despite her expertise in child development. The app’s note-keeping feature could assist Sally in documenting Sarah’s strengths, fostering a more positive perspective during challenging moments.
- Reggie, a single father raising his active 22-month-old son, Ron, could greatly benefit from community videos. Seeing other parents handle similar situations would help normalize Ron’s behavior and provide Reggie with reassurance in his parenting journey.
- Claire, a family partner, assists multiple parents facing feeding issues. The app’s group chat feature could facilitate discussions among those parents, allowing them to share experiences, build social networks, and gain confidence in parenting decisions.
- The Green sisters are raised by their grandmother. The app offers interactive learning and knowledge-testing features that could aid her in adapting to current parenting practices. It could serve as a reliable resource to confirm or update her parenting methods for children with diverse age ranges.
These examples demonstrate many situations in which the app could be instrumental in supporting families, regardless of their cultural backgrounds or unique family dynamics. By addressing various parenting challenges through interactive tools and community support, the app aims to offer a valuable resource for families navigating different aspects of child-rearing.
What’s next?
The TEAM Health app is an ongoing project. The research team is still working on gathering information and developing the app. This conversation ended with a question and answer session that brought forth some interesting and valuable suggestions and concerns from the audience. Thoughts on ensuring cultural sensitivity, data security, anonymity and more were some highlights of the discussion. The research team is open to receiving questions and feedback for further development of the app at their project email, ECMHresearch@northeastern.edu.
Interested in learning more? Watch the event recording:
CAMD Moderator
Estefania Ciliotta: Associate Director of the Center for Design at Northeastern University.
Panelists
Michael Arnold Mages: Interim Director, Center for Design; Assistant Professor, Art + Design, College of Arts, Media and Design
Beth E. Molnar: Professor, Department of Health Sciences, Bouvé College of Health Sciences; Director, PhD Program in Population Health
Herman Saksono: Assistant Professor, Khoury College of Computer Science; Assistant Professor, Department of Health Sciences, Bouvé College of Health Sciences
Christy Moulin: IMH-E® Director, Center for Early Childhood, The Home for Little Wanderers
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