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Movement Matters: Leveraging Technology to Detect Social Isolation among Low-Income Mothers and Trigger Offline Social Connectedness

An app's GPS coordinates will prompt offline supports and treatment if necessary for low-income women experiencing social isolation.

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Updates: How has your idea changed or evolved throughout the Prize? What updates have you made to this submission? (1500 characters)

We have added additional information on content of the app and emphasized the gaps in knowledge and technology that our app would fill. All of the changes were based on the feedback our mentor provided in a mentoring session. We have also added on a component of voice pattern recognition and talked about how we would balance in-person and online content and connections.

Name or Organization

Dr. Megan Smith. The existing MoMba™ app was created and is provided by the MOMS Partnership out of the Yale School of Medicine in collaboration with partners including Stop and Shop grocery stores, City of New Haven, The Diaper Bank, New Haven Healthy Start, the Department of Children and Families, and the New Haven Public School System. These partners stand ready to support the piloting of an enhanced MoMba™ app in New Haven.

Geography

New Haven, CT and other communities currently being selected

What is your stage of development?

  • Advanced Innovator with 3 to 10+ years of experience in ECD

Type

  • Individual

What is the stage of your proposal?

  • Research & Early Testing: I am exploring my idea, gathering the inspiration and information I need to test it with real users.

Describe how your solution could be a game-changer for your selected Opportunity Area (600 characters)

When parents are depressed, they may be at their least motivated to reach out for help. This enhanced MoMba™ app will lift that burden. With GPS coordinates automatically registering and flagging limited mobility, it will galvanize a Community Mental Health Ambassador to proactively engage with the mom and provide treatment or connection to other services. No longer will access to mental health depend upon the already-compromised ability of a person suffering to secure the resources they need. A depressed mom’s very experience of struggle will be enough to activate a support system.

Select an Innovation Target

  • Platform: Creating a community or market that facilitates interaction between users and resources.

Tell us more about your innovation (1500 characters)

The enhanced MoMba™ app will harness complex concepts, including the antecedents of depression and geospatial sensoring, to meet moms struggling with depression where they are, thus manifesting a population-level, scalable intervention. The enhanced MoMba™ app will retain and build upon the existing MoMba™ app features. These include a carbon monoxide sensor to detect tobacco smoking and supports for quitting; the ability to chat with other moms on the app; and a token economy that allows moms to earn points for activities and redeem them for gift cards. Moms who use the MoMba™ app have been provided access through the MOMS Partnership, which provides mental health services and ancillary supports in grocery stores, laundromats, and other neighborhood locations, to moms with low incomes and experiencing depressive symptoms. This prize would support a breakthrough enhancement for the app and integrate it into the existing apparatus: the development and implementation of a feature that registers the GPS coordinates of the mom’s cell phone and automatically flags if the cell phone has not traveled greater than five miles over 48 hours. The flag is electronically and instantly delivered to a CMHA, one of whom is available 24/7, who will reach out to the mom to connect in a culturally-appropriate and time-sensitive manner that yields a dialogue that illuminates the nature of the potential contraction of mobility and any experiences of social isolation it may reflect.

What problem are you aiming to solve? (3 sentences)

Social isolation is both a driver and symptom of depression – and, most cruelly, can stand in the way of mothers getting the help they need. The ramifications for families can be severe: for example, a mom may be too depressed to leave the house to apply for a job or to get out of bed and get her child on the school bus. We aim to bring down the barriers to mental health treatment by inverting the burden of outreach so it falls on a support system, not on the parent struggling.

Explain your idea (5000 characters)

Movement matters. Pilot data from MoMba™ suggest that women with high levels of depressive symptoms have lower frequency of movement as compared to those women with low or no depressive symptoms. We have piloted a feature of the MoMba™ app that collects GPS coordinate data but does not flag a certain pattern indicative of social isolation as we propose here, nor do we currently provide the offline supports based off that flag that we propose here. Additional features we propose to add to MoMba™ include voice pattern recognition to detect a mother’s depressive symptoms via recorded interactions she has with her child and uploads to the app.) As noted above, our idea is to build out the MoMba™ app to provide a support system with instant electronic notification if a mother’s cell phone doesn’t move outside a customized, pre-determined radius over 48 hours. Electronic notification would prompt a supportive interaction initiated by a Community Mental Health Ambassador (CMHA) that can lead to detection of depression, brief screening for other issues (including suicidality assessment and safety assessment of mom and children), brief intervention (such as motivational interviewing and behavioral activation), and referral (through warm hand-off) to effective treatment services. We plan to also incorporate a voice-activated depression screening into the enhanced MoMba™ app. Research has shown that this technology has over a 90% success rate at detecting depression from a two-sentence voice sample. Upon receiving a GPS-based flag, a CMHA would ask the mother through MoMba™ to say two sentences into her phone’s voice recorder and upload to the app. (The mother would then receive tokens in her MoMba™ bank, where she can redeem points for a gift card.) The system would interpret the voice recording for the CMHA, indicating whether a mother is experiencing depressive symptoms. Note that we see this feature as insufficient alone, as a person can experience social isolation as a precursor and contributor to depression. Focusing on the GPS coordinates for early detection of social isolation will better help address a root cause, and the additional data from the voice-activated detection technology can help a CMHA make better sense of a social isolation flag triggered by the app. CMHAs are perfectly positioned to “staff” this enhanced MoMba™ app. As integral members of a team delivering services through the MOMS Partnership, they are already deeply trained professionals who often have already developed relationships with moms who would use the enhanced MoMba™ app. CMHAs are moms from the local community – often the same low-income areas where MoMba™ users live. Some are former MOMS Partnership participants, having struggled themselves with depressive symptoms. They are all committed to providing the cultural and emotional empathy that has proven crucial for the success of the MOMS Partnership. CMHAs are overseen by a clinical supervisor. We are confident in the promise of this proposal. Of course, moms may not experience any social isolation when their cell phones do not travel beyond a certain radius; their social connection may take the form of chatting with neighbor next door on her stoop, for example. But conversation between moms and CMHAs sparked by the automatic flag can shed light on whether the mom herself believes she is experiencing social isolation, the data point from which can be fed back into the system such that the next automatic flag may generate a nuanced response from a CMHA that accounts for this information. Other moms may experience social connection virtually. However, some research indicates that connection via social media may challenge mental health on net and that connection in person may confer unique benefits. CMHAs can make referrals for mothers to community “hubs” or meeting points that the MOMS Partnership (the creator of MoMba™) has established. These hubs are located in community settings such as supermarkets and community colleges and provide a space for mothers to gather, talk with CMHAs, receive mental health services, and meet up with other mothers. Finally, our experience indicates that our target population, like the public, does not often leave home without their cell phones, rendering it unlikely that a social isolation flag would register on the basis that a mom forgot her phone for days in a row at home. We are also prepared to ensure that low-income moms can consistently use the MoMba™ app. The partnerships we seek to create (as detailed below) to target the enhanced MoMba™ app and its offline support to low-income moms currently serviced by free or reduced-cost cell phone plans represent a prioritized component of our plan. We also have limited our reliance on the app itself, having designed an approach that can connect moms quickly with offline supports in the form of a CMHA and the services to which she can attach a mom.

Who benefits? (1500 characters)

The primary beneficiaries are low-income moms struggling with social isolation and depressive symptoms. They will benefit because they will no longer bear the sole burden of activating supports when they are isolated from others. Instead, their lack of physical movement will trigger a trained professional to reach out to them and connect them with effective services like cognitive behavioral therapy (CBT) as needed. The MOMS Partnership has extensive experience engaging with these primary beneficiaries to improve their outcomes as well as those of their children. Created in 2011, the MOMS Partnership has engaged over 4,000 low-income women in New Haven in a Needs Assessment, findings from which have informed the programmatic direction of the MOMS Partnership including the development of the MoMba™ app, which has been based on focus groups with over 160 New Haven mothers. We have also enrolled over 600 low-income women with depressive symptoms in our Stress Management course that delivers group-based CBT. We solicit monthly feedback from participants to refine the program, and some of these moms have even become staff as CMHAs, helping to deliver services and guide strategic decisions as the program evolves. Thus we believe not just in providing for but also providing with. We are pleased to see positive effects of this approach on their children, who attend six more days of school per year on average and who benefit from higher levels of maternal sensitivity.

What kind of impact will your idea have? (1500 characters)

There are currently many apps available to mothers that provide content on pregnancy, parenting and child development. Yet few of these apps provide motivation for the user to engage with the app; few utilize sensor-based technology to detect depression, and to our knowledge, there is no app that either harnesses the power of sensor-based technologies to trigger an in situ, real-time response from a person, or connects mothers to in-person meeting points for additional intervention and social connection. The enhanced MoMba™ will fill these gaps and improve women’s lives in lasting ways. Evaluations of our group CBT, co-delivered by CMHAs, show positive effects on depression outcomes (48% reduction in symptoms) that not only persist but actually increase over time (six and 12 month marks). Informed by that success, our team believes that – as a result of this proposal if funded – social capital will increase, depressive symptoms will abate, attachment between mom and child will strengthen, children will show lower levels of internalizing symptoms of mental illness, and families will have greater economic mobility. Culturally, we also believe stigma will decrease locally at the neighborhood level and, with scale, population level. The need for these changes is deep: depressive and anxiety disorders affect women twice as frequently as men. Women are at highest risk during childbearing years and low-income women are at the highest risk.

How does or how could your idea impact low-income children? (1500 characters)

Children of low-income moms struggling with social isolation and depressive symptoms using the enhanced MoMba™ app will benefit from their moms growing more socially connected and developing stronger mental health. We base this belief on evidence, having studied outcomes of moms using MoMba™ and their infants (up to 18 months of age). The evaluation revealed clinically and statistically significant improvements in attachment and bonding between mother and child (as measured through key concepts such as maternal sensitivity and attachment quality) as compared to the control group. These findings are consistent with a robust literature demonstrating that social ties are extremely important for maternal mental health and maternal interactions with their children. We also know from research that mothers who feel a strong sense of community and have established support networks have better mental health than those without such resources. In other words, healthy moms help make for healthy children.

Innovation: What makes your concept innovative? (5000 characters)

A key to engaging underserved populations in depression care could lie in digital health interventions offered through modern smartphones and their sensors. Smartphones can provide important context information and inference on a patient’s depression symptom severity to allow for adequate in-situ support. We propose to utilize the most valid and innovative technologies to assess depression and include them on an app to trigger support for mothers with depression by mothers. For example, physical activity, shown by numerous studies to be related to depression, can be approximated by GPS coordinates. Another innovative aspect of our proposal is to use voice pattern recognition to detect depression. Few attempts have been made to link data that can be derived from these sensors to in-person outreach and engagement in care, and to our knowledge none have focused on underserved and overburdened populations such as low-income, racial and ethnic minority mothers—the very population we propose to serve. This app will use two of the most promising sensor-based technologies to detect depressive symptoms and connect mothers to in person supports: (1) activity and location data and (2) voice pattern recognition data. Specific to activity and location, changes in travel patterns (eg, distance travelled per day, location changes), which can be gathered through GPS, Bluetooth (via detection of other wireless devices) and WiFi, may provide information about mood states. Studies have documented that people in a depressive phase travel and stay outside less often. Finally, voice pattern recognition is another promising approach to detect depressive symptoms that has not yet been incorporated into a comprehensive app. Analysis of speech and voice features appears to be a useful approach in predicting mood state in depressive disorders end will be incorporated into our app via our partnership with engineering collaborators across the University and in the private sector.

Scale: Describe how your idea could reach a significant number of end-users. (1500 characters)

We will actively seek cross-sector solutions to ensure the level of exposure and financial support necessary for sustainable scale, starting with several city/county-level markets. For access, we envision communities where doctors prescribe MoMba™ for moms leaving the hospital with a newborn baby. For financial support, a modest part of long-term financial sustainability will come from philanthropy. However, we believe a greater part can and must come from public coffers. We are currently establishing a Policy Lab at Yale that will provide technical assistance to government partners across the U.S. to advance family mental health as a pathway to social and economic mobility. That work will include securing government funding to support this app as part of replicating the MOMS Partnership – work that is already ongoing. We also can work towards future regulations that allow Medicaid dollars to reimburse for CMHA mental health outreach prompted by the MoMba™ app. And there’s hope – the MOMS Partnership has successfully tapped Medicaid funding to reimburse for its clinician delivery (distinct from CMHA delivery) of our Stress Management course. We will also seek partnerships with government agencies to offer the enhanced MoMba™ app and its offline supports to mothers who are currently serviced by the agencies’ existing free or reduced cost cell phone coverage plans (e.g., the FCC’s Lifeline program) to help address concerns of inconsistent access to cell phone service.

Feasibility: Where are you with understanding the feasibility of your idea? Describe what you’ve done so far and your plans. (3000 characters)

Our extensive piloting and testing of the MoMba™ app provides a strong foundation to turn this idea into reality. Most basically but importantly, the app exists, so we do not need to undertake the complex and expensive task of first creating an app to house the features proposed here. Second, we have already developed sound privacy practices that can envelop this proposal. For example, for privacy reasons, the app has been hosted on a secured private server through HTTPS, rather than piggy-backing off existing networks (e.g. Facebook API). (However, the MoMba™ app has been developed with these interfaces in mind to facilitate future scale.) The master access list containing mappings between the MoMba™ app credentials and the actual person will be stored in hardcopy under lock and stored digitally only on HIPAA-compliant (encrypted) computers belonging to CMHAs, mirroring a similar practice in place. Third, our testing of MoMba™ has been person-centered such that low-income mothers have provided iterative feedback in focus groups that rely on principles of human-centered design to deconstruct and reconstruct the app. The end product of this testing has been an app that is meeting the needs and goals of the majority of mothers interviewed with high levels of satisfaction (over 92%) and usage (most mothers with MoMba™ log on an average of 4.7 times a week). Further, we already have the staff as part of the MOMS Partnership, including CMHAs, who comprise a ready infrastructure to easily implement and evaluate the enhanced MoMba™ app and its offline supports. The Policy Lab that we are establishing at Yale (and for which we have already received philanthropic support) will house additional staff to work with government agencies on (1) the implementation and evaluation of the enhanced MoMba™ app and its offline supports in jurisdictions outside New Haven and (2) the policy supports for financial sustainability of this effort. The Policy Lab has access to Yale Information Technology Services such that we can use their mobile device management program and has access to the current developer of MoMba™ such that we can readily develop a GPS coordinate feature that triggers a flag prompting offline action. Finally, we have worked with a voice recognition software company to pilot voice recognition software for depression in outpatient clinical settings at Yale for parents. Thus, this technology is ready to implement in an app like MoMba™. In addition, we have collected data through the existing MoMba™ app (n=8,210 data points) that suggests that women with high levels of depressive symptoms have lower frequency of movement as compared to those women with low or no depressive symptoms and, when they do move, move closer to their residential address and in the same movement pattern for two weeks. These kind of preliminary data prepare us to tap predictive analytics to model what a movement pattern of a depressed mother might look like.

Business Viability: How viable is your business model? (5000 characters)

We have focused on diversifying our funding and strategically planning for our long-term revenue streams to mitigate the risk of diminished support from government partners. Market segmentation will be one of the key pieces for our business viability. For example, we focus om developing specific strategic partnerships for pregnant MoMba™ users vs. users who are newly postpartum, and those who are parenting young children. Although we will begin our focus on low-income women, part of our business viability is to expand to serve women from broad socioeconomic backgrounds (assuming the addition of targeted content). Several commercial insurers have expressed interest in the MoMba™ app for use specifically with perinatal populations. Department stores that provide baby supplies and clothing and hospital and healthcare systems have also expressed an interest in partnering for the newly postpartum population, with hospitals suggesting prescriptions for the app. From prior experience, we have more of a difficult time receiving buy-in from mobile phone carriers or makers of smartphone devices. However, we anticipate this and as detailed, above, would instead partner with free or reduced mobile phone service programs and government funding streams through social services block grants to provide some of these cost offsets. We will continue to measure our return on investment for women who use the app around areas such as mental health care service utilization and hospitalization as a way to continue to market ourselves to commercial insurers.

HCD: How have you used human centered design to build or refine your concept? (5000 characters)

Community Mental Health Ambassadors (CMHAs) are the key to our human centered design approach. Trained mothers from the local community who focus on target population outreach, retention, and treatment (alongside traditional licensed, skilled, and local mental health clinicians). These ambassadors are highly valued given both their understanding of the unique struggles faced by these mothers and their unparalleled ability to develop authentic partnerships. CMHAS have assisted in each step of the initial design of MoMba™ and led focus groups of additional mothers (a total of 63). Each focus group uses best practices from human-centered design approaches such as using a proven design process and a tailored approach to design. The key best practice in human-centered design that CMHAs reflect is “leading with real people.” In this principle, we use consumers of our app (mothers and CMHAs) to truly understand how consumers will use and react to the solution design. Through the use of CMHAs and CMHA-led focus groups, we invite real mothers to share their experiences so that our leadership and design team can not only appreciate their experience, but can also pivot to make necessary changes if necessary. These discussions serve as both inspiration and a reality check for our team.

Tell us more about you (3000 characters)

I’m pleased to serve as the Principal Investigator of the MoMba™ app and the project lead. I am an Associate Professor in the Departments of Psychiatry and in the Child Study Center in the Yale School of Medicine and in the Division of Chronic Disease Epidemiology in the Yale School of Public Health. I also founded and direct the MOMS Partnership. My current focus is working to transform systems of mental health care for low-income mothers and other female caregivers of children with a particular focus on reducing mental health inequities related to race, ethnicity and poverty. The idea for MoMba™ emanated from what I view as my own failure as a clinician and researcher in the area of mental health for low-income mothers. I was working to create mental health systems and screening tools that, although highly utilized in clinical settings, failed to change outcomes for mothers and did not improve the well-being of families. Screening for maternal depression is now required by law in over 10 states in the U.S., but, while screening detects mothers with depression, it does not ensure that mothers with depression will engage with needed mental health services. Additionally, providing one-on-one psychotherapy to mothers with depression (if mothers do engage in mental health services) is costly, and not scalable on a community-wide level, and as a population approach. My training in public health taught me the importance of harnessing the power of community, increasing social capital, and promoting collective efficacy as mechanisms to promote mental health. I strongly believe that the limited effectiveness of current public health approaches to address the mental health of mothers means that new strategies must be developed to address depression in women. Depression constitutes one of the largest public health problems facing women of reproductive age. This fact, and the need for new public health approaches, necessitates the development of communitywide public health promotion efforts to reduce the burden of depression in mothers such as proposed here through an enhanced MoMba™ app.

Do you have the people and partners you need to do what you’ve described? (600 characters)

As noted above, we will need to cultivate existing partnerships with our app developer, Yale Information Technology Services, and a voice recognition software firm to turn this idea into a reality. We also look to establish partnerships with those government-sponsored programs that provide free or reduced-cost access to cell phone plans to low-income individuals. Finally, we are talking with other potential funders who could support evaluations of this project or fund the MOMS Partnership and Policy Lab, which will provide critical infrastructure for this effort.

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)

We would welcome technical expertise that is well-versed in geospatial tracking via smartphones as well as expertise on privacy issues relevant to geospatial tracking. While we believe we have access to partners who will provide sufficient coverage, we would be all the more delighted and grateful should this network be able and willing to help share those valuable perspectives to help guide our work to be technically, legally, and culturally sound.

Would you like mentoring support?

  • Yes

If so, what type of mentoring support do you think you need? (1200 characters)

We would be most grateful for mentoring through this next stage of the application process to help us better understand how we can optimally articulate the alignment between the promise of this project and the goals of OpenIDEO and Gary Community Investments for this initiative. If we had the honor of a prize award, we would deeply appreciate the opportunity to be mentored by experts who can speak to the potential pitfalls and their corresponding solutions during the phases of piloting, testing, refining, and scaling an innovation within an existing infrastructure.

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).

Dr. Megan Smith is an Associate Professor in the Departments of Psychiatry and in the Child Study Center in the Yale School of Medicine and in the Division of Chronic Disease Epidemiology in the Yale School of Public Health. Smith is the Founder and Director of the nationally acclaimed Mental health Outreach for MotherS (MOMS) Partnership, a community-academic partnership to improve maternal mental health among low-income women through a community-driven, place-based approach.

Are you willing to share your email contact information submitted on OpenIDEO with Gary Community Investments?

  • Yes, share my contact information

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