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Baby Steps: A Digital Baby Record Book for Every Child

Engaging parents with technology in a universal experience of celebrating children's milestones to increase developmental screening rates

Photo of Julie A Kientz
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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)

Feedback to our concept has continued to be positive and encouraging. We have been experimenting with some new positioning of Baby Steps as a digital baby book. A member of the OpenIDEO community shared some feedback with us that they had gotten from focus groups on a related app; dads think of baby books as something moms do and respond better to words like log. We have designed our app to be used by multiple parents and will continue to play and experiment with this positioning. For now, we have renamed our title “Baby Steps: A Digital Baby Record Book for Every Child” to make it sound less like a baby book and more like a book of records. In addition, by adding in the “for Every Child” we are emphasizing the universal nature of our approach. In addition, since submitting our initial idea, we have engaged with a class of students participating in a class at the University of Washington’s Design program on Interaction Design to think about how we might build and design a smartphone app version of Baby Steps and reimagine the app to also engage childcare providers beyond the parents. This has led us to think more about expanding our timeline feature into more of a newsfeed and using a favoriting system similar to Instagram to help curate a digital collection that will be more easy and natural than the current design. We also have worked with students on ideas for how we can introduce more social support into the system, allowing parents to invite family and friends to view images in a private group. We expect to finish this quarter with a set of new design documents that we can use to seek funding for our next steps. Finally, it was really inspiring to read through the many wonderful ideas that others have submitted to this design challenge. It gave us a lot of hope to see so many people have really innovative ideas that all care about creating outcomes for our children.

Name or Organization

This is a joint effort between WithinReach, a non-profit serving families in Washington State and member of the national Help Me Grow network, and researchers at the University of Washington in the department of Human Centered Design & Engineering. If awarded, funding will go to the University of Washington, who will contract with Within Reach to share the funds in our partnership.

Geography

Seattle, Washington, USA We will first implement in Washington state, then expand to other states

What is your stage of development?

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

Type

  • Non-profit

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)

By making developmental screening less scary, more engaging, more accessible, and part of a universal experience of parenthood, we can increase the rates at which children between 0 and 5 are screened and connected to early intervention resources, ensuring the best outcomes for children and families. Current programs only identify half the children who need intervention for healthy development.

Select an Innovation Target

  • Technology-enabled: Existing approach is more effective or scalable with the addition of technology

Tell us more about your innovation (1500 characters)

Baby Steps is a set of interactive technologies that allow parents to create a digital baby scrapbook with photos and videos to celebrate their child’s milestones and successes, and while doing so engages parents to complete screening questionnaires at regular intervals during their child’s first five years. Baby Steps follows a “no wrong door” approach to tracking, allowing parents to interact with the system in multiple ways, such as through a web portal, mobile phone texting, and social media. The system currently connects parents to WithinReach, Help Me Grow-Washington’s central access point, where they can be referred to early intervention resources and other needs. Baby Steps was designed using a human-centered design process and research-backed methods for behavior change and public health. It provides screening results in a way that reduces parental anxiety, offering actionable information if the child is behind developmentally and empowering parents to connect to their primary care provider and Help Me Grow-Washington. Baby Steps is designed to be a universal parent experience for all families rather than targeting people of specific needs or risk for developmental delay to broaden its appeal. It supports multiple children and multiple caregivers all working within the same family.

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

Developmental screening is effective at identifying developmental delay, but it is currently fragmented as parents, doctors, and schools all use different screeners on different schedules. Washington promotes universal developmental screening in clinical settings, but almost half of WA's neediest children are not making these visits. There is a need for a coherent, integrated, family-centered approach to engage parents in regular developmental screening that is fun and less scary.

Explain your idea (5000 characters)

Currently, the Baby Steps interactive technology prototypes for parents to engage with developmental screening have been designed and developed through a human-centered design process that has engaged over 400 stakeholders over a 10 year period starting when Dr. Kientz first began this research as a graduate student. Our ideas came from interviews, focus groups, surveys, and with parents, pediatricians, childcare workers, parent advocates, public health officials, and attendees at a Latina health fair. We have developed numerous sketches, personas, scenarios, storyboards, paper prototypes, Wizard of Oz prototypes, and fully functional prototypes all along the way of our process. Our design principles that we have worked from in the beginning have been a result of this process, which are as follows: -Celebratory: Many parents find the idea of looking for “problems” in their child to be anxiety-inducing. However, they find the idea of celebrating milestones (both developmental and sentimental) to be fun and exciting. If we can leverage the celebratory nature of tracking children’s development by making it fun, we can reduce the anxiety of screening. -Multi-platform: To reach all families across Washington State with a universal approach, no single technology solution will work. Thus, we have to work to build an ecosystem of tools that will reach families using whatever technology they are most comfortable with and with which they have access. -Meeting families where they are: Although parents may have the best intentions, they are busy and working hard at raising and providing for their child. By meeting them where they are rather than expecting them to come to us, we can improve engagement. Today’s parents, 80% of whom are millennials, are using mobile phones and smartphones much more than the telephone or in-person meetings. Based on these principles, the components of the current Baby Steps are: -Web-based Parent Portal: The Baby Steps web portal is a family-friendly design that first presents a timeline of a child’s history, including photos and memories alongside developmental milestones. Parents can respond to prompts relating to sentimental activities (e.g., first holiday or a trip to the zoo) in addition to answering developmental screening questions and add them to their timeline, or they can add their own memories, including photos and videos. The timeline can be shared with friends and family on social media such as Facebook and Twitter or via email, or kept private for the family's own enjoyment. Parents can add multiple users to the system who can all add information to the timeline. Once the parents have completed enough milestone questions through the website, they can review a report of their child’s progress and are connected to Help Me Grow-Washington if there is a concern or they are curious about their child’s development. The progress report was designed through a number of iterations before settling on a tree-based metaphor representing whether the child is on track developmentally. The website is accessible from a traditional laptop/desktop computer as well as from a mobile phone's web browser. -Text messaging: Parents and caregivers can opt-in to receiving text messages from Baby Steps that will automatically send age-appropriate milestone questions and enable entire screens to be conducted via text message. Families can answer questions by responding with “yes,” “sometimes”, or “not yet” directly through text and can also receive progress reports by texting “report” and suggestions for activities by texting “activity.” Parents can also send memories and photos to the system as well. The text messaging component of Baby Steps works seamlessly with the website or can be used alone by families who do not have internet access or a smartphone. -Social media: Parents can currently share their child’s timeline to their social media accounts (including Facebook, Twitter, and more) and choose to follow the Baby Steps Twitter account for reminders to complete screens on the web portal. Future Work: We plan to build a smartphone app component that makes accessing the timeline and uploading pictures and videos more seamless, which was the top request for parents who have engaged in our pilot studies. We also plan to build a back-end interface for Help Me Grow Washington (and other states to follow) that will allow them to download anonymous data for reporting, track referrals, and reach out to parents who may need assistance and sync with the Help Me Grow STAR database system. A future stretch goal will be to integrate into a statewide data system for developmental screening once that system is in place and translation to Spanish and other languages. All future work will also be continued to be designed with a human-centered design process, where we will engage stakeholders all along the way, generate ideas and get feedback, and create and iterate on prototypes.

Who benefits? (1500 characters)

There are multiple beneficiaries of our solution. At the center are children who will be identified and connected to the services they need during the critical 0-5 age window. Families will benefit from the extra support for their parenting, and society as a whole will benefit when children are positioned to succeed in school and in life. Our plan is to launch a free service to all parents. It is important that the app is free in order to have population-level impact on early intervention rates and allow families from underserved populations to participate. We plan to work and align with government organizations (e.g., WA Department of Health, Department of Early Learning), non-profits (who run federally-funded parent hotlines), and healthcare entities (e.g., managed care organizations) who all have incentives to identify, support, and track children receiving early intervention services. Within Reach has actively engaged with these beneficiaries for nearly 30 years, Kientz has been working closely with them for 10 years, and jointly we’ve engaged for the past 7 years leading the State Universal Screening Partnership and conducting research studies with Baby Steps.

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

Our ultimate goal is to make screening something every parent does easily and without anxiety. We want parents who have concerns about their child's development to be able to articulate their worries so pediatricians can respond during a 15-20 minute appointment. We know that half the children who would benefit from services don't receive them. We want to find those children and connect them to the freely available interventions so they can be ready for school and thrive in life rather than constantly trying to just keep up. Our research studies have already identified that Baby Steps is successful in engaging parents and encouraging them to complete more screens, especially the text messaging component. In addition, we have identified some specific metrics to indicate success and user engagement in our pilot studies, including 1) the number of accounts/active accounts, 2) the number of screens completed per child, 3) sustained account usage over time, 4) referrals to statewide early intervention hotlines for eligible children, 5) increased diversity of parents completing screens, 6) decreased emotional burden of developmental screening, and 7) increased parent knowledge of child development. In addition to any quantitative metrics, we will also interview parents to provide us a more holistic picture of how Baby Steps fits into their lives and continue to listen and implement their suggestions for improvement.

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

As part of our design process, we engaged with stakeholders, advocates, and families from Latino families across Washington State, which provided a focus to explore issues around income disparities, cultural barriers, and varying access to healthcare. The design of the text messaging component, which works entirely by itself on “dumb phones” without a data plan, was designed for this population in particular, though we’ve also seen it have great success with all families. According to the latest data from Pew Internet, 100% of people in the US between 18 and 30 own a cell phone, including those from lower incomes. We piloted our text messaging version with patients at a local clinic who serves lower income families and found that over 90% of them were able to complete entire developmental screens and review the results entirely over text message. Increasing rates of smartphone ownership, including of those from lower income populations, have led us to add a smartphone app option as our next step in this project to make a more seamless and engaging mobile experience.

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

Our concept is innovative in that we leverage the parent instinct to record and share memories to engage parents in developmental screening. We use technology already at parents fingertips to fit seamlessly into their life, especially as the digital natives are becoming parents of the day. And we are mindful of the supports parents need to take meaningful action when they learn their child needs a boost. We also want to leverage parents’ use of technology for positive focus on their children, allowing for a sense of mindfulness to remind them to think about their child and engage with them after recording their memories and milestones. Technology-enabled solutions are relatively new to the early childhood space. To date, campaigns directed at parents typically broadcast information leaving parents alone to navigate next steps. And statewide efforts around developmental screening systems focus on childcare providers and primary care physicians. These are important systems to support, but they miss 40-50% of children not in formal care, which are often children who need the most attention. We are parent-centered in our approach – we believe that supporting parents is the best way to ensure that children get the best start they deserve.

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

We plan to launch in Washington State where Within Reach is the state’s contracted central access point for early intervention referral services and has successfully launched and managed multiple web-based services for families. Within Reach supports 350,000 families each year and expects Baby Steps to increase that number. Then we plan to expand beyond Washington via the Help Me Grow network of affiliates in 25 states. We were promoted at the 2017 Help Me Grow conference as an innovative service, and we were invited back to participate in the conference in 2018. We are already building support and name recognition for our program within this community. Within Reach proposes to manage the program centrally so that Help Me Grow affiliates may share the cost of the service across multiple states. This model has already been successfully implemented with the STAR database system, a service managed by the California affiliate.

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 completed 2 1-month long pilot studies and 1 longer term 15 month research study with working prototypes to prove our engagement model and collect parent feedback. Additionally, we have met with key stakeholders at the local, state, and national level who are enthusiastic and supportive of our approach. We are ready to further develop Baby Steps so that we may launch a pilot to build the programmatic elements that will be necessary to scale and deploy this service. Our team currently consists of researchers, community innovators, and a technology partner with the connections and experience to complete the larger goals of the work. Julie Kientz of UW and Sharon Beaudoin of WithinReach have been working together for the last 7 years with the Washington State Universal Developmental Screening partnership that has engaged over 50 organizations in Washington State that work with children and families to develop an approach and thus have significant connections and experience. We have also worked with a technology partner, Cayzen Technologies, who did contract work with the WA Department of Health to investigate the business case for a universal data system for developmental screening. Dr. Kientz has two Ph.D. students working full time on research related to Baby Steps. Hyewon Suh is doing her dissertation work on the design of parent-facing tools for developmental screening and conducted all of our pilot studies on the project so far. Sean Mikles is doing his dissertation on the integration piece of the project, interviewing and engaging the diverse stakeholders across WA state and designing workflows for technology-enabled developmental screening. Thus, we have deep knowledge of what it takes to build such a system and the experience to design the system to make it engaging for parents.

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

This remains our biggest challenge, and we are hopeful to continue to work with the OpenIDEO community to crack this nut. Fundamental to our approach has been the idea that the app should be free to all parents. Our measure for success is bold – we want to impact early intervention rates. It is unacceptable to us that half the children who need intervention are not identified before kindergarten. We believe helping parents understand and track their children’s development will change this. Have you heard of the baby boxes in Finland? (http://www.bbc.com/news/magazine-22751415) We have this idea that Baby Steps could be a virtual baby box in the United States. Instead of clothes and a place to sleep, every parent gets a virtual place to celebrate and share their child’s milestones and access tips on child care and development. When a parent has a concern, the parent is connected with early intervention resources. Our understanding of child development has grown tremendously over the past couple of decades, and now we have a chance to share it meaningfully with parents and make an impact on our next generation. Our challenge with the business model is that the early childhood ecosystem is complex and diffuse with dollars rippling down to the local level. That is why our partnership with Within Reach and the Help Me Grow network has been so important. Through this partnership, we have access to a nationwide network as well as to a key point of intervention – federally-funded early intervention resource hotlines. What remains elusive – especially in our political climate – is funds to support moving our technology from prototype to a commercial system.

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

Human-centered design has been the driving process behind the entire Baby Steps project! We are at somewhat of an advantage in that Dr. Kientz is an expert in human-centered design, developing both innovative research and teaching in the areas of user research, human-centered computing, and user experience design. The initial idea started with collaboration with domain experts, followed by deep user research with stakeholders at all levels. We have engaged with over 500 families using human-centered user research techniques including interviews, co-design sessions, design ideation and sketching, storyboards, personas, and scenarios. Baby Steps is currently in its second major implementation phase as well, having had more than a dozen prototypes, including paper prototypes, wizard of oz prototypes of the text messaging component using Google voice, mockups, click through prototypes using Azure, and more. We expect to use the feedback from our latest round of research and our participation in this challenge to embark on our third major revision. And finally, we are have engaged in many forms of user testing, ranging from in lab user testing to a 15 month real world deployment. We have been using Dr. Kientz’s research on understanding user burdens in technology systems to work to understand the different types of burdens that technology can have on parents to maximize the benefits of Baby Steps while minimizing the burdens to create a successful and engaging experience for parents that engages them in important activities related to child health and development while minimizing effort and the emotional that developmental screening can have. Although we were already familiar with and had employed many of the techniques described in the IDEO toolkits, it was really fun to look through them. Dr. Kientz is excited to share the toolkits with students who take her classes at the University of Washington as well and encourage them to participate in future IDEO design challenges!

Tell us more about you (3000 characters)

Julie Kientz, Associate Professor of Human Centered Design & Engineering at the University of Washington: Julie has been the primary investigator on the Baby Steps project since 2007, which was inspired by a presentation she saw by the CDC’s Learn the Signs: Act Early campaign. As a human-centered design researcher, she saw the opportunity for technology to make tracking developmental milestones engaging and sustainable and did initial design work as part of her dissertation. After moving to a faculty position at the University of Washington, she obtained a grant from the National Science Foundation to explore prototyping Baby Steps, which funded the design and development of the web portal, text messaging, and social media prototypes and a 15 month long research study with 137 families to assess their feasibility. She has been co-chair of the Help Me Grow Washington Universal Developmental Screening Partnership Steering Committee, along with Sharon Beaudoin. Julie is also a parent and an avid user of Baby Steps herself, having a 5 year old daughter and a 2.5 year old son. Sharon Beaudoin, Chief Strategy Officer of Within Reach: Within Reach has been serving families in Washington state for 27 years to pursue their mission to build pathways to make it easier for Washington families to navigate our complex health and social service systems and connect with the resources they need to be healthy and safe. They currently serve 350,000 families per year with 4 hotlines, 2 coalitions, and 2 resource websites. Hyewon Suh, Ph.D. Candidate in Human Centered Design and Engineering: Hyewon’s research investigates how interactive technologies can be designed and developed to facilitate one’s health awareness and understanding while minimizing its user burden. Hyewon is the lead research student working on the design and evaluation of the Baby Steps parent tools. Sean Mikles, Ph.D. Candidate in Biomedical Informatics and Medical Education: Sean has worked in healthcare and informatics for over a decade, including spending 6 years at Epic. Sean’s dissertation explores the design of information technology tools to help parents and health and education professionals collaborate in the identification and treatment of child developmental disabilities. Angela Finney, product and marketing expert with 16 years of experience. Since November 2014, she has worked as a marketing consultant to early stage projects. She has focused on projects in the education, public service, and healthcare sectors. Sanjeev Batta, Technologist, Entrepreneur, and the founder of Cayzen Technologies: Sanjeev works with his clients in providing strategy, business transformation, and business and technology architecture. He helped Washington State develop the architecture and application for Infant and Toddler Early Intervention program and consulted for Washington’s Department of Health on exploring the technology direction for universal developmental screening.

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

Our biggest gap is funding. We need help connecting with funders who will support the technology development we need to complete to move from prototype to pilot and support the marketing efforts to make parents aware of the program.

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 is significant enthusiasm about the Baby Steps project and its potential in Washington State, but due to the complexity of the project, our engagement with government and non-profit individuals, and our insistence that this service be free to parents, it has been slow to develop a path of sustainability for our approach. We have been leveraging research funding and processes to move the work forward, but the goals of academic research and the goals of building and scaling a sustainable product and service as complex as this do not always align. What we could use help with is someone who might be willing to work on this project full time to drive it forward and potential funders who could support the people to do this.

Would you like mentoring support?

  • Yes

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

The best type of mentoring support would come from those who can help us determine and secure the best path to sustainability for bringing Baby Steps to the general public for Washington State and then expanding it to other states via the Help Me Grow network. This includes identifying initial funding and paths to sustainable revenue that can maintain the system over the long term.

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

  • Yes, share my contact information

[Optional] Attachments: Please upload relevant attachments or graphics or show us how you prototyped.

Mentorship: How was your idea supported? (5000 characters)

We were very thankful to have two phone calls with our mentors as part of the Open IDEO process. Both Jomayra Herrera and Rick Winter had valuable advice to give in terms of improving on our idea and thinking about possible sources of funding for continuing work on Baby Steps. Jomayra in particular, with her expertise in funding businesses, had some interesting insights around advertising models that could work within the Baby Steps framework and potentially developing a sustainable plan around funding the collection of data for state and local public health programs. Rick had some great ideas for non-profit funding sources which we are currently looking into, and he really encouraged us to think about including a video demo of the Baby Steps system. We thus recorded two videos demoing the Baby Steps website and the Text Messaging component and have added them to our project idea. We are thankful for their advice and guidance!

Select an Innovation Target

  • Technology-enabled: Existing approach is more effective or scalable with the addition of technology

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Photo of Leisa Hirtz
Team

Hi Julie,

Terrific idea and submission. There's so much data that can be pulled from your application. I'm wondering if like the Clue App, the menstrual tracker app, parents can choose to upload data anonymously that can be collected and shared with researchers in ECD as this data could provide global patterns, new strategies or innovations to level the early education experience globally irrespective of geographic location or economic status.

Best of luck!

Leisa Hirtz

Photo of Julie A Kientz
Team

This is a great idea, Leisa! We are working with Washington State's Department of Health to identify ways of sharing data anonymously into a statewide data system, but I totally agree that we should consider thinking about how we could do this more globally as well!

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