Our goal is to propagate a low-cost but effective intervention to increase parental behaviors that promote children's development.
Updates: How has your idea changed or evolved throughout the Prize? What updates have you made to this submission? (1500 characters)
The Gary Community Investments Early Childhood Innovation Prize spurred our team to re-name our innovative endeavor. We realized through this iterative process that, although our project is well underway, our name did not describe the project at all. We changed the name of our project from the Bright By Three Mobile App Study to Engage.Develop.Learn.
At all levels, our project endeavors to nurture the engagement, development, mutual learning that happens between parents and young children when they communicate. The new name describes our goal to expand and increase child development (and school readiness), and to spark engagement and learning in young children… and in their parents.
We learn a tremendous amount from the families we’ve encountered during this project, and continue to refine the mobile app based on every conversation and interaction with have with families. As described in the question regarding human-centered design, our target audience (socioeconomically vulnerable parents of children approximately 1 year old) has provided input during every step of our design, implementation, and evaluation phases.
Additionally, we have received feedback from our community of pediatricians, scientists and researchers, and from the foundations who have funded Engage.Develop.Learn so far.
This project has been reviewed at many levels:
• The team has several well-trained and thoughtful investigators with Masters in Public Health (MPH) degrees and/or PhDs in biostatistics and social science, as well as MDs; all of the investigators have played a role in ensuring that the study design is appropriate and rigorous;
• Dr. Mandy Allison has presented this project at several ‘Works in Progress’ or WIP meetings at the Adult and Child Consortium for Outcomes Research and Delivery Science (ACCORDS) on the Anschutz Medical Campus in Aurora, Colorado that include other investigators with PhDs, MDs, and/or MPH degrees and experience in conducting health services research—these investigators include well-respected investigators including Des Runyan, Russ Glasgow, and Allison Kempe;
• The project has been reviewed by the Colorado Multiple Institutional Review Board; this review board is responsible for ensuring the safety of human subjects but they also review the appropriateness of the study design, power calculation, and statistics, with very positive reviews; and
• The project was reviewed by an NIH panel as part of an application for an R21 pilot grant. The NIH reviewers did not have concerns about the study design. We are happy to share the entirety of the reviewers’ feedback.
Name or Organization
Children's Hospital Colorado Foundation, Inc
We are located in Aurora, Colorado, influencing all of Colorado and the western region.
What is your stage of development?
Advanced Innovator with 3 to 10+ years of experience in ECD
What is the stage of your proposal?
Piloting: I have started to implement my solution as a whole with a first set of real users.
Describe how your solution could be a game-changer for your selected Opportunity Area (600 characters)
If the Engage.Develop.Learn intervention (app, home visit, and written materials) is effective, our partner, Bright By Three, is poised to help us disseminate this intervention across the county and target low-income families. A low-cost effective intervention to reduce the ’30 million word gap’ among low-income children would be a game changer because it could help reduce disparities in school readiness and school performance that result in persistent disparities in wellness in adulthood.
Select an Innovation Target
Service: A new or enhanced service that creates value for end beneficiaries.
Tell us more about your innovation (1500 characters)
We have a multilayered approach to promoting positive parenting; namely, increasing Talking, Reading, Playing, and Praise (TRPP) to ensure ALL children are on equal footing and ready to enter kindergarten. Our research is looking at how much our app and home visit makes a difference to parent/child interaction and subsequent language development. If we know what works, we can promote our intervention, both the lowest-cost intervention (the app) and the more intensive intervention (the app and written materials plus a home visit from a community health worker or CHW).
To that end, we draw upon the rich body of research on child development (much of which was developed by one of our researchers on this project and his colleagues at Children’s Hospital Colorado, over many years) and employing a mobile app, written positive parenting materials, and a home visit to test whether we can offer these tools to parents to strengthen parent-child interactions in the earliest years.
To our knowledge, this approach to promoting early childhood development through increasing parents’ TRPP behaviors has not previously been tested. A recent study conducted at Stanford found that messaging promoted reading in older children but we know of no information for children younger than three, a critical age of brain development.
What problem are you aiming to solve? (3 sentences)
A large body of data has established that early life experiences are critical determinants of brain development, which can have enduring influence on a person throughout life: their socio-emotional and intellectual development. By the time they enter kindergarten, children with lower incomes have lower reading and general knowledge scores and poorer social skills compared to higher income children. Fortunately, we know that interventions to increase children’s exposure to TRPP.
Explain your idea (5000 characters)
We, in fact, developed a low-cost, high-reach intervention (an app) and are engaging families to use and report back to us on how the intervention works for them. At the same time, we are gathering data about how, when, and how much families use the app, hoping to engage families more frequently at a place and time that is convenient for them without significantly increasing cost.
And in addition, we have a more intensive intervention (the app plus a home visit and written positive parenting materials) that uses proven positive parenting messages and provides support through a community health worker. Our research study will offer the most in-depth data on what works, and how well each way of connecting with parents works, to promote development in the earliest years.
The project began in March 2015; we are now in Year 3 of the project (March 1, 2017-February 28, 2018) and have developed the app and are beginning the research study
A gift from Gary Community Investments would provide funding to allow our team of researchers to talk more and gather nuanced qualitative data from parents/caregivers who have and haven’t engaged with the Engage.Develop.Learn app to understand why they are or aren’t using it, what they suggest for future versions or innovations outside of the app. This will inform our use of the app and our intervention.
A portion of the prize would also ensure that we can collect follow up data when from the parents/caregivers when the children turn 2 years old so that we can understand how app use relates to behavior and child development outcomes. This is our ultimate aim: to gather quantitative and qualitative data about actual behavior change, and to contribute to the larger body of work in the early childhood development field. We want to make a unique contribution to this field!
Who benefits? (1500 characters)
All young children, and families with young children, can benefit from the BB3 intervention. We are most keenly interested, however, in giving low-income children a leg up by providing their caregivers with easy-to-access, easy-to-use tools to encourage Talking, Reading, Playing and Praise (TRPP). These are all qualities that help young children develop their language skills and enter kindergarten ready to learn. Socioeconomically vulnerable children often do not receive as high a “dosage” of TRPP. In fact, a dose-response relationship exists—the lower the income, the less prepared a child is when he or she enters kindergarten. We have simple tools that give parents ideas about how to increase these behaviors.
Parenting is hard, and all parents and children will benefit from the BB3 intervention. Our research study aims to show that the intervention is effective with our target population, however: low-income children.
What kind of impact will your idea have? (1500 characters)
Engage.Develop.Learn has captured, and will capture rich data no other organization has captured about TRPP: now that we have the app and the administrative database capturing how the families who download the app use it (which will endure), we have information unique in the field and which no one else has, and which can be studied and disseminated.
Children and families, at every socioeconomic level, will benefit from the positive parenting messages communicated through the app and through the more substantial intervention (app, written materials on positive parenting, and home visit from an Infant Development Advocate or IDA).
How does or how could your idea impact low-income children? (1500 characters)
The app and intervention were intentionally designed for low-income children to close the language gap that develops between birth and age 5, when a child enters kindergarten. We are piloting our intervention and research study with children and families from Children’s Colorado’s primary care clinic, serving a high-need, low-income population ( of approximately 2,500 children aged 12 to 15 months for well-child checks annually, and a total population of more than 11,000 children and adolescents).
More than 85% of the families at our clinic are low-income/working poor; approximately 65% are covered by the Medicaid program, 20% have a state of Colorado health program or supplement, 10% are uninsured, and only 5% have private insurance.
Our goal is to use the app and intervention to close this language gap, support parents, and offer a level playing field for ALL children to thrive.
Innovation: What makes your concept innovative? (5000 characters)
While other apps to promote early childhood development exist, our approach is disruptive to the status quo.
First, we actively target parents/caregivers who stand to benefit most with the Engage.Develop.Learn app. Specifically we’re using Infant Development Advocates, or IDAs, trained community members to introduce parents/caregivers to the app and help engage them with using it. We think the child development advocates are important because we suspect (though data are scarce) that non-English speaking parents/caregivers and those with less education are less likely to download and engage with apps. In addition, we know from data sources such as the Pew Research Center that most apps that get downloaded are rarely used. Therefore, for an app to promote ECD to be successful at the community level, we need to do more than just make it available—we need to actively engage community members who will benefit.
Second, we have developed the infrastructure and measurement tools to record and analyze how much and in what ways parents/caregivers are using the Engage.Develop.Learn app and relate these findings to their children’s language and social development. Often the sole evaluation of mobile technology is the number of downloads or the ‘click through’ rate for text messages. This doesn’t tell us whether the mobile technology is reaching the people who need it most or whether the technology is changing behaviors and child development outcomes. The real value of our Engage.Develop.Learn app is whether it improves child development and reduce disparities.
Scale: Describe how your idea could reach a significant number of end-users. (1500 characters)
The less intensive part of our innovation; our app, can be disseminated widely; there is no limit to the number of end-users we can reach with the app. Our messages have already been developed through the body of research and used by Children’s Colorado and Bright By Three, based on proven child development research, and already disseminated throughout one region (Colorado) by Bright By Three.
With regard to the more time- and resource-intensive aspect of our intervention, home visits by Infant Development Advocates (IDAs), we are researching the impact of these interventions. While there are many programs in Colorado and throughout the country that target early literacy and 0-3 child development, all are primarily based on the same evidence (Hart and Risely, the Abecedarian project, and Whitehurst dialogic reading). These programs vary with respect to the type of visit (home or group visits), the level of training of the person making the visit (nurse, developmental specialist, or unpaid volunteer) and the frequency of the encounters (yearly to weekly). We believe that a blended approach with home visits, phone interactions, mobile reminders, and virtual networking on Facebook will be more productive and cost effective than programs having only limited in-person encounters.
Feasibility: Where are you with understanding the feasibility of your idea? Describe what you’ve done so far and your plans. (3000 characters)
We have developed the app, hosted it on Children’s Colorado’s server, and hired the staff to implement the project. Threats to feasibility include our ability to adapt to major changes in platform use with mobile devices that may require reprogramming our app or adding functionality. Of course with any randomized clinical trial there is a risk that the intervention will not yield the expected positive result. This is the reason we are doing this study; to try to document the impact of this program. Having developed an app and started to test it reassures us that the project is feasible!
Additionally, we have done the following:
Our team recruits 10-to 15-month-old children are recruited at our academic pediatric clinic serving vulnerable families. Enrollment criteria are owning a smartphone, English or Spanish-speaking, parent education less than a college degree, and child uninsured or insured by Medicaid or CHIP. Enrolled parents receive the Engage.Develop.Learn intervention, including the app, at a home visit where the app is downloaded and demonstrated. The app includes messages and videos about talking, playing, and reading; goal setting and logging of minutes read to child; and opportunities to earn points for completing language-promoting activities. Parental demographic characteristics and access to technology are measured by surveys and app use data are collected by the app and stored in a database.
• To date, 17 parents have completed the Engage.Develop.Learn intervention visit and downloaded the app.
We have seen a tremendous amount of variability to date regarding how parents use the app and how much they use the app. We have also seen variability in how enrolled parents engage with our Facebook page. Our data is so rich, and we are able to record so much information, that our next steps are to dive deep into the data and explore the more qualitative aspects of the data.
In addition to touching families with a “low touch” measure (the app) and a “high touch” measure (the intervention with the IDA), we have learned so much about how to think about solutions involving technology, and how to create infrastructure to gather valuable, usable data on early childhood development. We have a hunger to share what we’ve learned with others in the field, based on our successes and challenges, and to learn from others.
Business Viability: How viable is your business model? (5000 characters)
While it was expensive to develop the mobile app for Engage.Develop.Learn, now that it is developed and hosted on the Children’s Hospital Colorado server, we believe we have a valuable product to offer that moves beyond even early childhood development. Our mobile app is simple and easy to use, and the early childhood development messages are backed by decades of research by the top experts in the field. It is inexpensive and can be widely disseminated.
Additionally we have expertise we can offer to organizations, companies and individuals on systems logic and development of a tool to effect behavior change, and we have a working tool we are using to nurture child development at the family level. While many people believe mobile apps are a “magic solution” to problems, our view is there is more nuance to it, an app can be a complementary tool. We feel we have a lot to offer any organization using technology to promote behavior change.
We are also filling a needed gap with the complexity and sophistication of our evaluation tools, and we believe we can market our evaluation tools and learnings to others looking to promote behavior change and understand true impact through validated research measures and the deep analysis of quantitiative, and qualitative, data.
HCD: How have you used human centered design to build or refine your concept? (5000 characters)
We did not conceive of the idea to create a mobile app and use it to build TRPP between parents and children to increase child readiness. We simply had an idea and embarked on the project.
Almost from the beginning, we realized that input of potential users was the crux of the development of the entire project. It would simply be a waste of time to develop an app and intervention without knowing the ways in which our audience—parents of young children, and particularly, traditionally marginalized groups—would actually want to use an app.
We quickly mobilized an English- and a Spanish-speaking Parent Advisory Board (PAB). In fact, we split the PABS into two groups (English- and Spanish-speaking) based on the consensus of these groups. Having one group was just too big. The Parent Advisory Board (PAB) engages English and Spanish speaking parents, who utilize Medicaid/CHP+ with children ages nine months to four years old, as a focus group to garner feedback to help us understand what is working, what is not working, and to identify negative or unintended consequences. We provide free child care during these meetings.
We met ongoingly with these groups as we developed the app and intervention, and used their feedback directly in app development. Our app developer created user experience maps and we shared these with our parents, and asked for feedback.
Now, we ask our PAB parents to advise us on aspects of BB3 program evaluation including recruitment and consent of families, data collection procedures, interpretation of data, and dissemination of our findings to community stakeholders.
The success of the BB3 study relies on parent feedback. We have set out to create interventions that will not improve outcomes “in theory”, but will be proven to be user-friendly and useful for families.
Tell us more about you (3000 characters)
Mandy Allison, MD, the principal investigator for the BB3 app, shared her own perspective on the questions above:
Prior to attending medical school, I was a 9th grade teacher in rural Mississippi for two years. This formative experience led me to pursue a career as a pediatrician and taught me, in a very deep way, the importance of ensuring that children are mentally and physically healthy so that they can perform well in school. My parents had already raised me with a very strong sense of social justice and my teaching experience deepened my desire to commit myself to work to reduce disparities in wellness and success among low-income populations in my community and in the U.S. As a clinician, I strive to reduce disparities by providing the highest quality healthcare for my low-income patients and their families. As an academician, I conduct research to identify ways to address disparities in wellness and improve youths’ school performance and help inform policy to support youths’ wellness at school.
As I’ve worked as a general pediatrician over the past 15 years and in the area of school health over the past 10 years, I’ve become increasingly passionate about the need to intervene in early childhood, or even during a mother’s pregnancy, to ensure that children enter school in Kindergarten healthy and prepared to excel. In my clinical practice, I see the difference between infants and toddlers whose mothers have the well-being, knowledge, and resources to nurture, talk to, read to, sing to, play with, and praise their children and the infants and toddlers whose mothers don’t provide those experiences. I see many one and two year olds who smile when I hand them a book, bring it to their parent, open the book and start pointing and vocalizing. Their parents appear delighted and immediately begin smiling, talking, and interacting positively with their child. Unfortunately, I also see one and two year olds who appear to be dysregulated as demonstrated by their lack of engagement with me, frantic behavior, and lack of interest in the book that I bring them. Their parents are often talking on the phone or yelling at their children when I walk in. It breaks my heart to see these types of parent-child interactions when I know it could be so much better for both the parent and the child and that the lack of positive interaction is laying the groundwork for poorer health and school performance years down the road.
Engage.Develop.Learn provides an opportunity to get things right for children and their families during the most critical time of development during early childhood. I am excited about the opportunity to determine the best way to provide parents with the knowledge and resources to enable them to nurture and practice positive interactions with their children. I am passionate about ensuring that resources to promote positive early childhood development, such as Bright By Three, reach families who could benefit most.
Do you have the people and partners you need to do what you’ve described? (600 characters)
Our team of researchers and clinicians at the University of Colorado and Children’s Hospital Colorado has a longstanding partnership with the amazing people at Bright By Three. Dr. Steve Berman was one of the founders of the Bright By Three program, since the beginning of the program more than 20 years ago. In addition, our roles as clinicians and researchers provide us with the partnerships and resources to reach families in need of the Bright By Three intervention and evaluate the effect of the intervention. That said, we would love to work with those doing this same work!
As you consider your next steps, what kinds of help could you use? Is there a type of expertise that would be most helpful? (1800 characters)
There are so many non-profit organizations, practitioners, and researchers working in the early childhood space in Colorado and nationwide. While rare, sometimes there is a sense of competition for scarce money and other resources to support everyone’s work. Our team would benefit from having a ‘neutral’ organization bring together all of the interested stakeholders in our area to share lessons learned and ideas, and, ideally, develop next steps to help use reached our shared goals. We could particularly use expertise in convening diverse groups of stakeholders and facilitating meaningful discussion about how we can find synergy in our work.
Would you like mentoring support?
If so, what type of mentoring support do you think you need? (1200 characters)
Our team could use mentorship surrounding the best way to disseminate our program evaluation findings to stakeholders in early childhood development outside of the medical field. Similarly, we could use mentorship surrounding the best way to disseminate Engage.Develop.Learn more broadly if we find that it is effective in our evaluation.
Are you willing to share your email contact information submitted on OpenIDEO with Gary Community Investments?
Yes, share my contact information
[Optional] Biography: Upload your biography. Please include links to relevant information (portfolio, LinkedIn profile, organization website, etc).
Mandy A. Allison, MEd, MD, MSPH (Co-Principal Investigator): Dr. Allison is an Assistant Professor of Pediatrics at the University of Colorado Denver (UCD) and an investigator in the Children’s Outcomes Research Program (COR), Children’s Colorado. She continues a clinical practice with a focus on early childhood development among low-income and minority families. She is also an NIH-defined New Investigator and Early Stage Investigator.
Mentorship: How was your idea supported? (5000 characters)
We did not have mentorship support during this process, but are so interested in finding mentors as we look at the potential to disseminate the app and put our learnings out into communities. We have learned so much from the opportunities, challenges, and process of this project, and would like to know how to communicate with other individuals and organizations from a systems design perspective.