Answering the Cry
Supporting newborns who are exposed to substances and their mothers through early intervention services from hospital to home and community.
Updates: How has your idea changed or evolved throughout the Prize? What updates have you made to this submission? (1500 characters)
Our team's idea started with a simple premise, which was to make sure families of infants in Virginia born exposed to substances had the best chance for getting off to a positive start. In 2017, Virginia developed a Plan of Safe Care toolkit to address the care needs of substance-exposed newborns, which includes infants that test positive for drug exposure, those experiencing withdrawal, and those with documented exposed to substances, including alcohol, during pregnancy. The kit included an algorithm that defines key responsibilities of those involved in the infant’s care, such as hospital staff, early intervention providers, Child Protective Services, and home visitors. The toolkit had not been fully operationalized and the resources were not in a useful format. At its genesis, the idea we started with was to meet the needs of all of the provider groups identified in the toolkit and to add missing components, including better supports for families about attachment.
The team grew to include different partnerships to help inform and develop the idea. The team reached out to faculty and students at VCU's da Vinci Center for Innovation who had extensive expertise in human centered design and had participated in past OpenIDEO challenges. The most useful refinements came through working with end users and learning more about important design elements and key components to include in the tool. The team learned more about current processes early intervention providers use to gather information from families and how they find out about resources and services (i.e., how do they use their phones and what a typical visit with a family looks like). To help develop the IT prototype, open-ended questions were included about ways to help them do their jobs better.
The da Vinci Center students then developed a prototype of the platform based on the information learned from end users.
Name or Organization
Virginia Commonwealth University, Partnership for People with Disabilities
Virginia Commonwealth University, da Vinci Center for Innovation
Virginia Department of Health
Virginia Treatment Center for Children, Attachment Clinic
Virginia Department of Behavioral Health and Developmental Services
Local early intervention systems in the greater Richmond Virginia area
Virginia Early Childhood Mental Health Initiative
USA- the core group lives and works in Richmond, Virginia.
What is your stage of development?
Advanced Innovator with 3 to 10+ years of experience in ECD
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.
Tremors and crying in an infant exposed to substances
Why is this idea so important? Listen to Bonnie Grifa, Early Childhood Mental Health Coordinator, describe why meeting the needs of infants who are exposed to substances and their mothers is so important to foster positive attachment, bonding, and a relationship between mothers and babies who are born exposed to substances.
The team thinking through the design process - the human centered design in action.
Team members Bethany Geldmaker, Deana Buck, VCU da Vinci Center for Innovation students and Aaron Forrester, Professor, developing a story map of the idea to support the transition from hospital discharge to receipt in the community by the early intervention provider - the "helpers" at the community level.
Team members Bethany Geldmaker, Deana Buck, and VCU da Vinci Center for Innovation students developing a user experience map of early intervention providers, based on the discussion the week before and on the interviews with end-users (early intervention providers).
Describe how your solution could be a game-changer for your selected Opportunity Area (600 characters)
Infants exposed prenatally to substances and their families need intervention sooner than later, long before problems present as social or behavioral issues. Focusing on development, mental health, and attachment behaviors at birth can change a child's developmental trajectory. Virginia’s new Plan of Safe Care will be put into action so that all newborns exposed to substances are referred to Early Intervention at discharge. Providers will have access to hospital plans and community resources/services through the "Answering the Cry" app/web platform to link families once they come home.
Select an Innovation Target
Channel: A new way to deliver existing products or services to customers or end users.
Tell us more about your innovation (1500 characters)
Babies going through opioid withdrawal have a distinct way of crying: a short, anguished, high-pitched wail, repeated over and over. They shake, sweat, vomit, and hold their bodies stiff; they often eat and sleep fitfully. While in the hospital, staff teach mothers how to swaddle the newborns and meet their unique needs such as using dim lights and hushed conversations because the babies need calm and quiet. Many also need methadone or other medication to relieve their symptoms; they are weaned from it over days or weeks. When babies transition home, we plan to address gaps that exist in picking up and continuing the hospital plan of care and providing ongoing support to the infant and family. Because the baby is diagnosed with substance exposure, they are eligible for early intervention services in Virginia.
The team aims to pilot an app/web platform for early intervention providers to use to support and build social-emotional supports to parents in caring for their infants and themselves following hospital discharge. This prototype resource will be used by early intervention staff to access Virginia's Plan of Safe Care tool kit, the family's care plan, and a range of resources including videos, social services, mental health help, peer support, and education about infant care. Each family's needs are different, so the application will enable early intervention staff to be responsive to family priorities, child needs, and local community resources and services
What problem are you aiming to solve? (3 sentences)
The opioid epidemic is a public health crisis in the US. In 2012, nearly 22,000 babies were born drug dependent, one every 25 minutes. Hospital staff begin teaching mothers how to care for their infant's unique needs. These babies are eligible for early intervention services but providers need help. We aim to support families as they build attachment and healthy relationships with their babies by equipping providers with information they need that is unique to child needs.
Explain your idea (5000 characters)
The opioid epidemic is the emerging public health crisis which directly impacts young children and families; 100,000 babies are born annually in Virginia and, according to national estimates, over 20,000 are substance exposed in utero. Treatment for the babies goes hand in hand with compassionate, comprehensive care for their mothers. Rather than transfer babies to a specialty unit, hospitals are keeping infants with their moms throughout their stay focusing on eating, sleeping, and how to be consoled. Staff encourage the women to breastfeed and clutch their babies skin to skin. Following discharge, the babies are referred to early intervention services so that the families get help caring for the babies once they go home. The perinatal period presents unique risks for those who are substance dependent and their babies but it is also a time when there are unique opportunities for positive intervention. The early intervention workforce has been challenged to meet the needs of this population, from the number of referrals of infants referred, to the issues related to drug withdrawal treatment for babies and mothers, and intervention strategies for babies who have been exposed to substances. The supports each baby and family needs are also unique, and need to be individualized to work, and providers need to have access to current information about services in the community and the most current information about intervention strategies for this population.
We took Virginia's Plan of Safe Care toolkit and developed a prototype app and web platform for early intervention providers to use to help them in their work with families with substance-exposed infants. The kit includes information about prenatal and maternal mental health and attachment and relationship building for mothers and infants. We targeted early intervention providers as the end user for the idea, due to the fact that the babies are eligible for services based on their substance exposure and the likelihood that they will need help. It also makes them eligible for reimbursement for service delivery. The app will be a user-friendly resource for early intervention providers to have, at their fingertips, information to assist families in navigating service delivery systems, finding child care, and solving problems their infants face, like difficulty soothing, sleeping, and eating.
As clinicians, mental health, and community health care providers, it is imperative that we understand the nature of perinatal substance use disorders and provide interventions and care that preserve the parent-infant dyad, promote parenting potential, and support the baby’s health and development.
For families with infants that have been exposed to substances, the range of needs and supports varies greatly, but we know that access to needed information and to needed services is vitally important -- particularly in the infant period. In the Richmond area, we will work with local early intervention providers, families, substance abuse experts, and treatment providers to implement the new community tool kit for young children exposed to substances. This wonderful information, however, is not in a format that can be easily used by families and providers to be responsive to include family priorities, updates about the child's medical and developmental needs, and practice guidelines and professional resources to guide intervention. There is also no means for the family to determine how those involved in the child's care can access the same information in a time-sensitive manner. The next step for the app will be to consider expanding the audience for use by hospital discharge personnel, local substance-abuse treatment personnel, and other intervention professionals and by families. The challenges of supporting infants who are exposed to substances are real and, at present, communities in Virginia are challenged to meet the demands of this population. Partnering with early intervention systems in the area, health care providers, and service providers with expertise with this population will give us the best opportunity to pilot the app/web platform so that it is useful in supporting this population of infants, toddlers and families. We also think the app will also be useful in collecting information on unmet needs in the community, services that were found to be most helpful, and potentially data on child change.
After testing and bringing the app to scale with early intervention providers, we plan to expand its use by reaching out to discharge planning staff at hospitals, substance abuse treatment providers, child care providers, pediatricians, home visiting staff, and other community-level providers involved in the family's care.
The Henrico early intervention program supervisor reported that this week alone, she has done 7 intakes and 5 were for substance-exposed infants.
The video walks the viewer through the app prototype pointing out proposed key features such as resources, Virginia Plan of Safe Care, infant information, mother information, and proposed videos for working with the family. We plan to finish building the app and then test with our end users.
Students on our team used the interview guide developed for end user interviews. Here is a photo of one of the interviews with Early Intervention supervisor, Toni Peace, from Richmond City. She did a great job helping them understand the process she follows, including paperwork and tools (computer, phone) which she takes with her on visits with families.
Who benefits? (1500 characters)
The initial beneficiaries of this idea will be early intervention providers who will use the app in their work with families of substance-exposed infants to access information to community resources and services. The benefit to this group is to have a means to access real time information and/or local resources based on the needs of the families during home visits. It is more valuable to families to take care of the need in the moment and to have resources during the visit as opposed to the provider playing catch-up once they leave to go look things up. Another benefit is in improved service delivery and referral systems, with better-coordinated transitions from hospital to home for this population. This benefits both recipients of the service and providers within systems such as early intervention, medical care, hospitals, and mental health from implementation of this idea. A third beneficiary are the families of infants exposed to substances. The biggest benefit for families is uninterrupted transition in care from hospital to home. In addition to families receiving ongoing care for their substance and mental health needs, it is also important to experience being a new mother with an infant. The focus of this space is for families to have real time information to meet both needs. For example, helping the mother learn ways to feed and soothe an irritable baby will support her to feel more confident in caring for her newborn and in turn attach and get off to a better start.
What kind of impact will your idea have? (1500 characters)
The needs of infants exposed to substances are complicated and require significant early coordination of care from diverse service delivery systems. The catalyst for change is proposed at the community level, during the initial transition from hospital to home. Long-lasting impact is expected to emerge from the collective synergy from the intentional efforts of teams of people aligned to a common mission and goals of connecting the mother and infant, prior to hospital discharge, to the existing service delivery system, to ensure they have early ongoing needed supports and services. The importance of synergy in effectively protecting the health and promoting well-being of substance exposed infants and mothers ensures the only chance of getting off to a positive start.
For early intervention providers, the impact will be most significant. Early intervention staffs are receiving referrals for substance exposed infants and mothers and have shared how they are struggling to find resources. The prototype to assist the staff is an application that is user-friendly to include the tool kit and resources such as video on soothing, attachment, social and emotional supportive techniques for this population. The prototype could lead to systemic positive change. The women need to work and find childcare as irritable infants need continuity of care or risk expulsion.
How does or how could your idea impact low-income children? (1500 characters)
Children living in poverty have multiple challenges. The added impact on substance exposed newborns, who experience the physical symptoms of withdrawal upon birth, are behaviors making them difficult to handle by their mothers, placing them at even higher risk for abuse and neglect. For mothers in recovery from opioid addiction, newborns may be on methadone, then weaned from it. When they gain weight, sleep well, and are ready to go home, support in the community needs to begin. The team plans to address this need and risk by eliminating the gap between hospital discharge and community follow-up. Children who screen positive are identified in the nursery. The links to services will occur at discharge with early intervention providers in receipt of the referral and the first appointment scheduled prior to leaving the hospital.
The impact of the idea on low-income children is to: 1. provide a direct connection with early intervention at discharge and effectively shorten referral and receipt of services by early intervention, 2. immediate intervention and the provision of parent support before the family is in crisis, and 3. ongoing support for mental health and health care (e.g., early intervention links family to a home visitor program). The long term plan is for 100% enrollment of positive newborns in early intervention services upon hospital discharge with initial visits scheduled. The platform will support early intervention staff to track and monitor referrals.
Innovation: What makes your concept innovative? (5000 characters)
Early intervention providers who serve infants with developmental concerns need tools to do their work that are effective, efficient, and well designed. Through a human centered design process, we are cross-walking tools and resources from Virginia’s Plan of Safe Care tool kit onto an app/web platform that will put the information, resources, and tools in the hands of early intervention providers so that they can support families who have substance-exposed infants. Early intervention providers will use the app’s resources to assist with transition from discharge from the hospital to home. Critical to the family’s success is early needed supports and services based on the home plan of care linked to the community’s early intervention system and additional identified resources and services.
For this population of babies and families, transitions can be a challenge. Issues such as treatment, drug withdrawal, changes in living arrangements, and childcare can add to the complexity of care. Having access to current, real-time, and accurate information about community resources and services will support a more seamless transition period. The app prototype is designed to equip early intervention staff with information for mothers based on identified needs, such as phone numbers for agencies, accurate information about how to access needed community services (e.g., specific eligibility information, forms required to apply for services, income levels required to receive help, etc.). It will also help with navigating service systems, while valuable for all families, is particularly important for families who have additional challenges of maternal drug treatment, potential drug withdrawal for the baby, and the long-term impact of drug exposure on the infant.
Using technology in their work is not new to early intervention providers, as the great majority report accessing their smart phones or computers/iPads in their work with families. End user interviews with providers demonstrated strong interest and support in having an app or platform that contained key information and resources related to babies with substance exposure accessible for immediate use and in one place. The app will include information about common intervention strategies for this population, including strategies for feeding, sleep, comfort, and overall infant care. In addition, the app will have information about local substance abuse treatment services and family supports, like counseling and addiction support groups.
The other component of the app that is innovative is the capacity for updates in real time, as information changes. A link can be added to the app to reflect the individualized care. For example, new resources may be added that a mother finds helpful, like a new video on breastfeeding strategies for babies with high muscle tone (a common complication for some babies born exposed to substances). In addition, the app will have the ability for mothers and providers to take video clips of the baby’s intervention strategies and upload them to the app to show progress and change over time. For mothers who need video reminders of intervention activities, the video clips will be helpful guides. For early intervention providers, this may be a way to track progress.
The market for use of this app is strong, both within Virginia and across the US. The reach and penetration of early intervention providers includes all 50 states and the territories; all states currently participate in the Individuals with Disabilities Education Act (Part C), Early Intervention Program.
Early intervention providers are one component of the planned scaling for the app platform provider system for infants born exposed to substances. The platform has the agility to be updated and built out to bring in additional providers working with these families (i.e., substance-abuse treatment providers, childcare providers, home visitors, hospital staff, etc.).
The design process and collaboration between students in VCU's da Vinci Center for Innovation and the Innovation Prize team is another example of innovation demonstrated in this idea. The students supported the Prize proposal through their intense academic focus on human centered design and IT design expertise. Their collaboration and novice, unbiased views brought a unique insight and addressed a significant IT need; the collaborative process has been remarkable. Specifically, the students applied their knowledge to this real-world problem, and the ability to see the human centered design process in action has resulted in a much more robust, refined, and streamlined MVP (minimum viable product).
Scale: Describe how your idea could reach a significant number of end-users. (1500 characters)
Service providers are in place across the state and the responsibility for populating the process is available through existing resources. There are over 3,000 early intervention providers providing services in the community. The applicability of this idea and prototype for hospital/birthing centers is even larger; infants exposed to substances initially enter the pipeline through delivery in hospitals with initiation of plans of care but limited knowledge of community referral processes. Early intervention is aware of the Plan of Safe Care Tool kit and the requirement for referral to early intervention staff with a positive infant drug test. The addition of an app prototype is seen as supporting clarity around roles and responsibilities and in providing a valuable resource for work with families. The team plans to start with a central site with high rates of SEI, testing the process and prototype with end users. Once the idea and prototype are ready to bring to scale, the team will work through the medical society, Behavioral Health Community Service Boards, and early intervention networks. In addition, plans for long-term financial sustainability include the inclusion of third party insurers to be part of the conversation for care and reimbursement. Barriers to scaling include addressing the mechanism of adding in locally specific and accurate information with the biggest challenge seen as the constant change in information based on type of drug and associated care.
Feasibility: Where are you with understanding the feasibility of your idea? Describe what you’ve done so far and your plans. (3000 characters)
The system and infrastructure is in place to move forward technically and operationally as well as with financial reimbursement. Service providers exist across the state; the responsibility for populating the process is available through existing resources. With the overwhelming rise in substance-exposed infants, the gap that emerges is in the need for targeted technical assistance and outreach to OB practices and pediatric practices to educate and reinforce understanding of their responsibilities as outlined in the Plan of Safe Care toolkit. While plans of care and treatment are developed during the stay in the hospital, there is no clear process for hand off to community providers. The how and where Early Intervention and Community Service Board services fit into hospital referral processes, is the starting point of the transition or hand-off into the community to early intervention providers. The team has been working with early childhood health, mental health and early intervention systems on a number of infrastructure building projects. These projects have included work with our state Medicaid agency to strengthen policy around reimbursement services linked to early childhood mental health. In addition, policies for developmental screening have tightened to support a parent administered developmental screening instrument for child development, social, emotional and behavioral health, and autism screening.
Based on these past successes, we have the experience and capacity to engage early intervention systems in the Greater Richmond area with hospital systems, including the largest newborn nursery in the area, at the VCU Health System. The pathway to implementation and support stems from the algorithm that is included in the Plan of Safe Care tool kit outlining referral processes. The kit includes details and templates for each step of the process of referral from hospital to the community. While these efforts have improved the infrastructure for service delivery, it does not bring together end users to address designing solutions to meet the challenge of caring for substance exposed infants and their families. Rather than attempting to fit interventions for substance exposed infants into early intervention processes for non-exposed infants, human centered design will offer the end user the opportunity to develop a different approach to problem solving and trying a unique approach to the addressing the growing need in this early childhood space. Developing indicators are grounded in fidelity to the tool kit algorithm as well as success in the development of the innovation. Measurements of success will be integrated throughout the initial transition from hospital to home, including processes of referral, acceptance by the mother of transfer of care, receipt of early intervention services, community support, and completion of prototype development.
Business Viability: How viable is your business model? (5000 characters)
The birth of substance-exposed infants has soared over the past decade. Average hospital charges for infants born with Neonatal Abstinence Syndrome (NAS), a group of conditions caused when a baby withdraws from certain drugs he’s exposed to prenatally, are five times higher than those for non-NAS hospital births, and the total hospital charges associated with caring for these babies has nearly doubled from $732 million in 2009 to $1.5 billion in 2012, with 80 percent of charges paid by Medicaid. Even after being released from the hospital, some children may still require treatment with medication and therapy. It can cost upwards of $60,000 to treat one baby. In Virginia in 2014, there were 10 substance exposed infant births per 1000 live births. In the targeted area for the Innovation Prize, Richmond has the highest rates (70 Richmond SEI/1099 state SEI/100,000 VA live births) at slightly over 7%. The challenges of supporting infants exposed to substances are real and, at present, communities in Virginia are challenged to meet the demands of this population.
The end user experience map and storyboard served as strong resources and assisted us in rethinking our primary customer. Specifically, we found there were a number of processes that needed to be in place to reach families. The mapping process showed that hospital partners were key in the identification and initiation of care for substance exposed infants. As our team probed and asked more questions, a pre-structure business model canvas emerged for our idea.
Our customers are early interventions providers. Having identified our customer, the next step was to map out a plan on how to reach early intervention staffs. In Virginia, infants born exposed to substances are automatically eligible for early intervention services, based on presumed developmental needs; this requirement automatically enables direct billing for services delivered to this population through early intervention services (tied to a physician plan of care). Service providers exist across the state and the responsibility for bringing the project to scale can potentially be met by existing resources; it is anticipated that costs should be minimal. The process of expansion will need to address the mechanism of adding locally specific information.
The primary costs for this idea and prototype will be tied to the development of an IT platform. The goal is to provide an app-based prototype to assist early intervention staff in working with families in the community. The prototype could lead to systemic positive change outside the early intervention world (e.g., child care, home visiting).
Distribution channels are directly aligned to steps in the algorithm of the Plan for Safe Care. The algorithm assisted in outlining the team’s plan to partner with early intervention, health care providers, and service providers with expertise with this population systems in the geographical area of interest. This will provide us the best opportunity to reach to reach our targeted beneficiaries and customers who support this population of infants and families.
Motivation for the partnerships is directly tied to delivery of steps in the algorithm of the Plan for Safe Care Toolkit. The team will reach proposed partners through VCU's Partnership for People with Disabilities who has active relationships with early intervention systems in the area and with service providers with expertise to serve infants exposed to substances through the Community Service Boards.
The key activities in the value proposition of the Business Model Canvas for this idea are the bundle of activities that creates value for the team’s idea and prototype. The value proposition for this idea includes support during the infant's transition from hospital to home, coordination of care during transition into the community, and response to needs of the infant and family as they are identified.
The success of the business model is supported based on the identified needs by early intervention staff to address capacity to meet increased demand. This was reinforced through interviews with the early intervention staff.
The foreseen barriers are related to the voluntary nature of providers when making referrals that is tied to the culture of the hospital, the presence or absence of hospital discharge planning and role confusion as to hand off of the hospital treatment plan to community providers. The primary plan to work through these early barriers is to develop and provide education, outreach, and technical support through local early intervention staffs to health and mental health providers in their geographic areas. In addition, as other barriers arise, we plan to continue to engage providers to assist with solutions through human centered design
HCD: How have you used human centered design to build or refine your concept? (5000 characters)
Human centered design was a new concept to some members of our team. We used two approaches to become more familiar with the design process. One team member enrolled to take the online course through Acumen. We also collaborated with the da Vinci Center for Innovation at Virginia Commonwealth University (VCU) to receive technical support and mentoring by the faculty and students. Through the collaboration with VCU, ten students joined our idea team to assist in building and refining elements of the design process.
In conducting the research to initially design and subsequently refine the proposal, we engaged in a series of Human Centered Design exercises. The exercises enabled us to: 1. Learn from end users and subject matter experts (e.g., interviews and videos); 2. Immerse the team in the context the experience of receiving referrals for substance-exposed infants (e.g., observation and interviews), and 3. Brainstorming through analogous situations for inspiration (e.g., child care, home visiting).
During the development of the proposal, team members worked with VCU da Vinci Innovation Center students engaging in several exercises to assist in building the end-user experience map, story map, and interview guide. The design exercises assisted us in rethinking the end-user. It also helped in mapping out the substance-exposed infant's transition from hospital to home and potential touch points for coordination of care during transition into the community. For example, working with Social Services and substance abuse staff to understand their roles and responsibilities in providing treatment for both mother and infant. We captured some of this work in photos, which are included under visual attachments. The end-user experience maps of early intervention staff really helped to put the end user at the center of concept development; visual attachments show some of the maps that were developed.
User feedback incorporated interviews using the interview guide produced as part of in-class exercises with the da Vinci Innovation Center students at VCU. Insights and feedback that were collected from the end-users helped to support and refine the idea. A key finding from the interviews identified the needs of early intervention staff to address capacity to meet increased demand of referrals of substance–exposed infants. Staff expressed concern about understanding by hospital providers about elements of the Plan of Safe Care toolkit. Early intervention interviewees expressed the potential need for more training and technical assistance with health care providers and hospital staff to improve quality of referrals.
Team member subject matter experts provided testimonials from their own practices in early childhood mental health and early intervention. A sample of one video has been included in the proposal from an expert in infant mental health. It provides a brief snapshot of why the idea is needed and how it can help foster positive attachment, bonding, and a relationship between mothers and substance-exposed newborns. Brainstorming through analogous situations for inspiration helped the team to explore other applications for the innovation design through related services for the family such as childcare or home visiting. Plans of care developed during the hospital stay would need to be coordinated with these other resources to ensure continuity and smooth transitions.
The team has also been working with students from the da Vinci Innovation Center with expertise in IT to develop a prototype for the app, which was grounded in the information gathered from interviews with end users and subject matter experts. Providers are frequently in low health opportunity areas and have limited access to information or resources during their follow-up visits with the family in the home. The focus on developing the app/web platform will support the tools and resources reported as essential by the early intervention providers in conducting the follow-up visits to families with substance-exposed infants. The next steps in the design process will be to engage more end users on the conceptual model of the prototype for further refinement and then building the platform for testing.
The team opted to take advantage of the December opportunity to upload a draft of our innovation prize idea and be connected with mentor design specialists. We worked with two mentors as part of the Early Childhood Prize Mentor and Innovator Connection. The experience was invaluable and helped the team examine our idea through a different lens as well as from a perspective outside the healthcare field. Resources provided by the mentors included other programs nationally addressing similar problems as well as tools that were useful in refining the proposal. In addition, the questions mentors posed helped us do a reality check on clarity and feasibility of implementing a project with a one-year time frame.
Tell us more about you (3000 characters)
We would like to share something about ourselves. Members of our team have been working in the fields of Early Childhood Health/Mental Health and Early Intervention for many years and have working relationships with a variety of partners needed to carry out this idea, including the Virginia Department of Health, Virginia Treatment Center for Children, and Behavioral Health. Over the past six years, VCU's Partnership for People with Disabilities has been home to Virginia's Early Childhood Mental Health initiative, funded by the Departments of Health and Social Services. The team has active relationships with hospitals, early intervention systems, and with service providers who have expertise to serve families with substance-exposed infants.
The OpenIDEO team members include a range of health care sectors; team members also include a mix of generations such as university students, a new mother of an infant and a grandmother of a toddler. The inspiration for the team’s idea came through reports from local communities in Virginia reeling with the increased referrals of infants born exposed and the strain on local health and mental health program capacity to meet the needs. The increased demand on existing systems and ongoing rise in infant referrals began a state level conversation about how to address this need. Our idea evolved from a call to action in 2016 to study the problem by Virginia’s Governor's Children's Cabinet. Several team members served on the task force that developed a Virginia Plan of Safe Care tool kit, completed in 2017. In mapping out the experience of early intervention providers, we started seeing an application that could give access to the most current information from the tool kit, resources and community services, and share information in a user-friendly, efficient way. Important information will also include care of substance exposed mothers and infants, health and mental health needs, and newborn and post-natal care. What excites us about working in the early childhood space is the impact of improving systems of care for infants and their families who are substance exposed. Members of the team have seen the benefits of work to address the social and emotional needs of young children. A recent project provided developmental screening training, coaching and mentoring to teams across the Commonwealth; the teams included childcare workers, doctors, nurses and early intervention staffs to improve the system of coordinated care from screening and surveillance to referral and follow-up care.
Building an experience map with our team
Building a wireframe prototype based on insights from interviews and user feedback.
Team developing and prioritizing content for an interview guide.
Do you have the people and partners you need to do what you’ve described? (600 characters)
We have a strong team which includes representatives from a variety of agencies and organizations from the state and community. Team members are from the Partnership for People with Disabilities at VCU, Early Childhood Mental Health, Virginia Department of Health, daVinci Center for Innovation at Virginia Commonwealth University, child care, early intervention, and IT design. In addition, the team capitalized on the cross-generational thinking that evolved through the inclusion of a wide range of age groups.
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)
The team recognizes that information for providers who work with high risk families needs to be current and readily accessible. They work in homes in the community and are on the road where computers are not readily available. In addition, providers need to be responsive to teaching and providing resources in the moment, depending on what they find is needed by the family. In doing research to develop this early childhood space, prior efforts have not taken advantage of technological resources and approaches. A platform is needed to support the ability to access and pull out resources as needed when working directly with clients in their homes. The early intervention staff need to know and use plans developed by the hospital staff based on the drug screen results and the plan of care to support the newborn in recovering during the withdrawal period. We recognize, in moving forward, our team will be looking to add other members of the toolkit advisory group to assist with operationalizing the elements of the algorithm this prize is looking to address. For example, social services has put their component of the Plan of Safe Care on line and we shall need to partner with them to obtain permission to upload or link on the IT platform as well as identify local resources. Another critical team member is someone with expertise in maternal mental health and maternal/infant substance abuse. This team has been primarily early childhood focused and we need to to build out the parenting space. In addition, we have been working with some IT assistance and will need to further incorporate experts as we move to finishing testing and finalize our IT prototype.
Would you like mentoring support?
If so, what type of mentoring support do you think you need? (1200 characters)
The team has benefited from learning with partners about innovative design methods to incorporate into the prize work. We were able to access technical knowledge on tools such as videography and app design. As this innovation moves forward and matures, we shall need to continuing mentoring support to grow our depth of knowledge to support further advances in our design. In addition, there will be a need for us to work with an IT design team to test and retest the IT portion of our innovation until it is ready to bring to scale. We have appreciated the ongoing communication, webinars, and mentors supplied through the prize and hope some form of this support will continue as we move forward in moving this innovation from concept to practice.
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).
Bethany Geldmaker https://www.linkedin.com/in/bethany-geldmaker-42543617
Deana Buck https://www.linkedin.com/in/deana-buck-04992434
Aaron Forrester https://www.linkedin.com/in/aaron-forrester-86b37215/
Jackie Robinson Brock https://www.linkedin.com/in/jacqueline-robinson-brock-a1640625/
Abie Kanu https://www.linkedin.com/in/abie-kanu-23b393149/
Krissia Castillo Ventura https://www.linkedin.com/in/krissiacast
Radha Kapadia https://www.linkedin.com/in/radha-kapadia-280b79130/
[Optional] Attachments: Please upload relevant attachments or graphics or show us how you prototyped.
The Idea team with Bethany, Deana, and the VCU daVinci Center for Innovation students' brainstormed to develop a paper model prototype. The paper map includes the intended users and information needed for mother and baby. The second visual shows the IT prototype app developed from the paper model. The prototype app has evolved to include functioning feature cards.
The app includes the ability to search for resources based on the needs of different families.
The app includes information about the child's medical information and schedules, too.
The Idea team with Bethany, Deana, and the VCU da Vinci Center for Innovation students' paper model as we move forward developing a prototype for the end user. The paper map includes the intended users and information needed for mother and baby. It is directly linked to the user experience and story maps completed over the past two weeks.
The first draft of an IT prototype based on key informant interviews by students on the team from the da Vinci Innovation Center at VCH.
[Optional] Video: You are invited to submit a 30-60 second video that introduces you and/or your team and your idea.
Visit the daVinci Center for Innovation website for more information on the program and how it works with community partners: www.davincicenter.vcu.edu
The Partnership for People with Disabilities at VCU is the University Center for Excellence in Disabilities (UCEDD) in Virginia and coordinates professional development for early intervention providers in Virginia: https://partnership.vcu.edu/
Team members with students in the Innovate program at the da Vinci Center at VCU who have been essential partners on the team, bringing expertise and skills in the area of human centered design, engineering, and business.
Mentorship: How was your idea supported? (5000 characters)
The team took advantage of the December opportunity to upload a draft of our innovation prize idea to be connected with mentor design specialists. We were assigned two mentors from different fields that supported our idea as part of the Early Childhood Prize Mentor and Innovator Connection. The experience was invaluable and helped the team examine our idea through a different lens as well as from a perspective outside the health care field.
Specifically, the experience with mentors matched through the Prize walked us through their initial impressions of the idea and concept. Questions focused on inconsistencies and helped us sort through the logic of our idea. The conversation informed further development of our concept by thinking through who our end user was based on our experience map. In addition, the questions mentors posed helped us do a reality check on clarity and feasibility of implementing a project with a one-year time line. The changes made with our idea were primarily related to narrowing down the extent of our design to a more realistic project. The most significant contribution was to help us narrow the idea to focus our work to meet the needs of a single user group -- early intervention providers.
Resources provided by the mentors included other programs nationally addressing similar problem. Links were shared to Openideo tools that were useful in refining the proposal.
The regular communications from the EC prize community were helpful to keep out team on task and on time with things that needed to be completed in order to meet deadlines. The technical assistance received through the OpenIDEO process was especially helpful in forming this decision; they helped us refine and clarify the application of the human centered design process for this work.