EmBRACE: Empower NICU – A Bridge to Resources for Adjusting and Coping with Emotions

Annually, 15% of U.S. births result in a Neonatal Intensive Care Unit (NICU) hospitalization.  The extreme emotional strain of parenting an infant in the fast-paced medicalized NICU settings can be detrimental to mental health and functioning, with up to 70% of NICU parents experiencing depression and severe anxiety. Moreover, parents experience chronic stress and trauma from the day-to-day threats in the NICU, putting them at risk for posttraumatic stress disorder. Addressing parental mental health and sequelae is critical given the potentially devastating consequences for parents and children, such as significantly impaired parent-infant interactions and attachment, infant development, and parent-provider interactions. Despite the clear need, many NICUs do not address parent mental health needs as a universal standard of care. Approximately 70% of NICU parents are not routinely screened or identified for mental health symptoms and thus do not receive the mental health services they need, creating notable health disparities. Experts and emerging research recommend a Standards of Care embedded in the NICU that includes universal screening, ongoing mental health monitoring, psychoeducation, and a stepped-care approach to best serve NICU parents that optimizes and tailors services based on the unique needs of the parent. Unfortunately, widespread implementation of a clinically practical system based on expert recommendations has not been achieved. We propose to develop a mHealth app entitled Empower NICU – A Bridge to Resources for Adjusting and Coping with Emotions (EmBRACE) to provide: 1. Universal mental health screening while giving NICU parents control over when and where assessments are completed; 2. Ongoing mental health monitoring using a set of quick, daily assessments (via ecological momentary assessment) and weekly screenings; 3. Customized microlearning education (e.g., 1-3 minute videos) tailored to assessment results and referrals in a stepped-care approach; and 4. A sustainable contingency management approach to increase parent compliance with assessments, microlearning, and referral follow-up.

PRECARE: Platform to Recognize and Evaluate Children for Age-Appropriate Response and Early Detection of Delays

Developmental screening is crucial for early identification and intervention of developmental delays (DD), yet over 63% of babies in the US do not receive developmental screening, and less than 10% of those with DD receive appropriate intervention. Furthermore, evidence suggests only 50% of pediatricians use a formal developmental screening tool, with most prompting parents for concerns. Pediatricians have limited data points (e.g., limited information on a baby’s developmental history) with a small window to complete comprehensive risk assessment during “well-baby” visits. Finally, relying on parents for identifying DD is also a challenge. Parents face multiple barriers such as lack of general knowledge about child development, recall bias, and lack of tools for longitudinal tracking of developmental milestones, leaving them ill-equipped to properly observe and raise concerns. These challenges have contributed to underdetection of DD. We propose to fully design, develop, and pilot test a multi-purpose baby monitoring system and a mobile app to educate parents about child development, flag potential motor, speech, and social indicators of DD, and facilitate clinical data sharing between parents and pediatricians. The mHealth platform, called Platform to Recognize and Evaluate Children for Age-Appropriate Response and Early Detection of Delays (PRECARE), will be designed as an attachment to baby gyms and mobiles for continuous and ubiquitous baby monitoring while serving as a diagnostic aid for pediatricians during well-child visits.

Expanding Research and Recruitment by Engaging Adults through Community Health Workers (eREACH)

The African American/Black (AA/B) older adult population is projected to triple and will account for 12.8% of older adults by 2060. Additionally, they are disproportionately affected by chronic conditions such as dementia (up to twice), hypertension (75% versus between 40-55% for White men and women), and diabetes (13.2% versus 7.6% Whites in one study). Risk factors such as lack of access to healthcare, education, transportation, and living in distressed neighborhoods in minority communities (i.e., social determinants of health) have led to poor health outcomes and health inequities. One approach using community health workers (CHWs) shows effectiveness across multiple settings and chronic conditions for bridging the gaps in health disparities by building trust, improving screening and referral processes, and expanding communication and health information delivery to AA/B older adults. However, scaling effective CHW programs through continuous enrollment and engagement of AA/B older adults needs to be improved to address the increasing caseloads and limited funding. We propose an innovative platform called Expanding Research and Recruitment by Engaging Adults through Community Health Workers (eREACH) that supports CHWs in the process of screening and referral and engages AA/B older adults in local health services, clinical trials, and health events. Innovative features of eREACH include an electronic screening process, an integrated patient dashboard, microlearning education, and enhanced communication via a virtual agent named “Reggie”. We have successfully developed the first iteration of high-fidelity wireframes of eREACH for AA/B older adults. To take our design to the next level, we are looking to collaborate with SpringBoard designers to leverage our recent findings from focus groups with the target users to (1) enhance and finalize high-fidelity wireframes and (2) transform them into interactive wireframes for user testing and development.

Expanding Research and Recruitment by Engaging Adults through Community Health Workers (eREACH)

The African American/Black (AA/B) older adult population is projected to triple and will account for 12.8% of older adults by 2060. Additionally, they are disproportionately affected by chronic conditions such as dementia (up to twice), hypertension (75% versus between 40-55% for White men and women), and diabetes (13.2% versus 7.6% Whites in one study). Risk factors such as lack of access to healthcare, education, transportation, and living in distressed neighborhoods (i.e., social determinants of health) have led to poor health outcomes and health inequities. One approach using community health workers (CHWs) shows effectiveness across multiple settings and conditions for bridging the gaps in health disparities by building trust, improving screening and referral processes, and expanding communication and health information delivery to AA/B older adults. However, scaling effective CHW programs through continuous enrollment and engagement needs to be improved to address the increasing caseloads and limited funding. Benten Technologies is developing an innovative platform called Expanding Research and Recruitment by Engaging Adults through Community Health Workers (eREACH) that supports CHWs in the process of screening and referral and in engaging AA/B older adults in local health services, clinical trials, and health events. Innovative features of eREACH include electronic screening, an integrated patient dashboard, microlearning education, and enhanced communication via a virtual agent named “Reggie”.