Clinically-supervised AI Behavioral Health Safety Net

Behavioral healthcare provides crucial, affirming support for people with mental health needs, including psychotherapy and support services for learning disabilities, substance abuse, and autism. But our current system has proven insufficient, inequitable, backlogged, and ineffective for our global population's growing social and mental health needs.  Female, youth, rural, low-income, ethnic minority, and LGBTQ populations are particularly underserved. 

• 57% of teenage girls in the US felt persistently sad or hopeless in 2021

• Youth hospital admissions from self-harm rose 95% from 2019 to 2021. 

• Less than 20% of children in need and 10% of those with mental disorders in low-income countries receive care. 

• People struggle for an average of 11 years before obtaining treatment. 

• Poor mental health is projected to cost the global economy  $6 trillion annually by 2030.

• Almost 1 billion people suffer from mental disorders worldwide

Multiple industry-wide, social and systemic problems contribute to the global mental health crisis.

• Disjointed: Many receive services from multiple providers (counselor, behavior therapist, psychiatrist, etc.) in various settings (e.g., home, school, and community). Efficacy and efficiency are lost among a weakly connected team. 

• Noncomprehensive: Only working with kids or parents rather than the whole family and entire support system

• Ineffective: When healthcare providers make the same amount of money for a service, even if the treatment makes no or negative difference, there is no incentive to be effective and excellent, and it can harm patients further by giving doctors less time with each patient. 

• Unaffordable: Requires consumers to invest significant time and money to obtain appropriate care, thus perpetuating social determinants of health.

• Inequitable: Cultural stigma and lack of discreet, culturally sensitive, multilingual, inclusive care 

• Reactive: Lack of preventative behavioral healthcare ⟶ increase the cost of treatment.

• Unavailable: Workforce shortage (in both volume and diversity) and high turnover, especially for special education and behavioral healthcare, and in densely populated BIPOC neighborhoods and low-income countries.

• Underfunded: Limited funding and regulatory requirements harm the behavioral healthcare industry’s resiliency.

  

Quest Depot is a perpetual digital hub for family wellness that brings parents, kids, educators, and behavioral healthcare providers together to deliver evidence-based social and mental health support, save everyone time and money, and improve efficacy, engagement, and access.  Users receive AI-personalized, real-time, and context-aware coaching via text, social media, or online based on content created by a multidisciplinary team of licensed counselors, psychologists, and behavior analysts.  With the help of data science and natural language understanding, curaJOY’s Quest Depot automates currently manual, time-consuming clinical psychoeducational intake and evaluation processes for both the beneficiaries and service providers.  The extensive use of gamification and 3D animation further enhances user engagement and retention, making it faster and easier to collect multidimensional health data from multiple sources. 

The direct outcome we expect from this solution-forward product is clearing the backlog of under-treated and undiagnosed mental and behavioral health conditions, offering immediate relief for people waiting to receive mental health or behavioral health services, including families of the 7.2 million special needs children who experienced service disruptions and skill/behavior regression since COVID.  Quest Depot reduces the average time it takes to perform a thorough manual assessment from 10.6 hours (average from 16 providers we surveyed, range: 3-16 hours) to under 8 hours (a 25% reduction in resources) to improve provider capacity, assist in clinical decision-making, and expedite time to service for users as well as current and prospective clients. The program reduces disruptive behaviors which prevent youth from accessing their school, peers, and community by reducing incidents to 50% of baseline, which should positively impact mood and learning for the child and their family.

Every aspect of this HIPAA-compliant SAAS product is designed to prioritize users’ privacy and choice. Inside the Quest Depot app, users find goals suitable for their age and ability, social-emotional learning activities, built-in digital and real-world rewards, clinical scales, assessment reports, and a diverse selection of animated 3D avatars who share their racial and gender identities and speak their languages to serve as their virtual mentor and central point of contact.  This kid-centric and culturally-sensitive design promotes psychological safety and continued user engagement. 

Quest Depot takes a proactive and relationship-focused approach to wellness, combining multiple therapeutic practices such as Cognitive Behavior Therapy, Applied Behavior Analysis, and Somatic Psychotherapy, to work with all family members to improve interaction dynamics, identify root causes of problems, and towards more positive family environments where both parents and youth can thrive.  The inclusion of body-centered trauma-informed care also enables people of all abilities and in fragile contexts (war, natural disaster, foster) to best experience benefits and see progress.

Quest Depot aims to give all populations a behavioral health safety net despite the ongoing healthcare workforce shortage and lagging global behavioral health infrastructure.

curaJOY seeks to remedy the disparities in behavioral healthcare and education perpetuating the downward spiral that low social determinants of health beget. Our solution is designed to benefit both B2C and B2B clients in the behavioral healthcare ecosystem.  

Quest Depot improves, monitors, and maintains the social and mental health of children from 7 -18 years old (who lack agency over their own care) and their parent(s) – globally.  We focus especially on marginalized communities in fragile contexts with the greatest mental and behavioral healthcare needs, such as neurodivergent youth, refugees, and immigrants.

Some other notable populations we target include:

• Children with parents who don’t recognize the need for behavioral interventions or behavioral healthcare

• BIPOC, multicultural families where language or providers’ demographics impede the therapeutic relationship or access to care

• Families with special needs children, including those with subclinical symptoms who have been denied services that would significantly improve their quality of life and students’ learning outcomes

• Families with incarcerated caregivers, single parents, or caregivers with long-term disabilities, substance abuse, or mental illnesses

Families use Quest Depot to deepen relationships and change behaviors independently or in connection with schools or healthcare providers to enhance those services’ effectiveness.   With this growth-oriented program that looks like a non-stigmatizing game, underserved communities with learning differences and mood disorders can be identified early, properly diagnosed, and supported discreetly, even when caregivers are unaware of their educational and healthcare rights.

Practice makes perfect. By delivering an integrated and continuous system of care that proactively builds social-emotional skills and guides users to apply what’s learned, this program works to replace harmful family interaction patterns and prevent trauma (adverse childhood experiences).  Our work ultimately mitigates social determinants of health, reducing crime, substance use, abuse, and unemployment and increasing the high school graduation rate and physical health.

Furthermore, Quest Depot strengthens the healthcare ecosystem by helping healthcare organizations and schools to

• Increase capacity and provider satisfaction

• Reduce overhead and hiring needs

• Meet IDEA, ADA, insurance, and regulatory compliance requirements more efficiently.

• Decrease workload

• Provide inclusive care and reach DEI goals

• Quantify outcomes of provided services

These outcomes from curaJOY’s program should prompt public policy changes and stop the growing behavioral healthcare workforce deficit.

curaJOY is well-positioned to provide this solution because we are personally affected by the issues we tackle.  Our combined lived experiences drive us to reduce pain, deeply embrace community co-creation and place families’ welfare above all else.  

This problem is too urgent and complex for any single expert or organization to tout a panacea.  The often anonymous faces of nonprofit volunteers are curaJOY’s valued collaborators. We have a growing volunteer base, with more than 46% holding graduate degrees from Carnegie Mellon, Rhode Island School of Design, INSEAD, etc.  Drs. Jordan Bailey and Marc Lanovaz of the University of Montreal help us refine our study objectives and include their data and machine learning algorithms for our behavioral assessment. Sean Inderbitzen, LCSW, a trauma-informed therapist specializing in children and teens with PTSD, contributes valuable feedback to ensure that our solution is trauma-friendly. 

curaJOY comes from the communities we serve.   We empower clinicians, healthcare administrators, and communities with direct experience with the issues we address to progress toward our vision jointly.  curaJOY’s founder, Caitlyn Wang, is an international business leader who has worked and parented in the US and Asia and is intimately familiar with each region's psychoeducational resources. At Johns Hopkins University, Caitlyn’s work with twice-gifted children gave her an intimate look at how these challenges affect families and their wellness, but it’s her first-hand struggles parenting an autistic child and journey moving across the Pacific in search of behavior therapy that motivated her to seek a root-cause solution for families like hers. For over 20 years, she has led marketing, product development, and supply chain in the audio/video industry with teams in China, Taiwan, and the US to bring products from concept to market for companies like Harman, Acer, and Amazon.  Program Director Caitlin Marcus is a neurodivergent behavior therapist with 15 years of experience working with autistic children and neurodivergent populations in urban areas with low-SES, immigrant, and BIPOC/AAPI families. She’s passionate about curaJOY’s work to make therapies accessible and inclusive. Anthony Pajot, Ph.D., MBA, Executive Board Member Anthony is a bi-racial entrepreneurial, passionate & highly results-oriented leader who serves as Global Project Head, Research Portfolio & Strategy, in Vaccines R&D at Sanofi. With over 22 years of experience, he has held various commercial & scientific leadership roles in big pharmaceutical companies (Sanofi, E.Lilly) & research institutions. 

We designed our programs by listening to our communities and working backward from the problems youth and their families want to solve and the improvement they wish to see.  Rather than only conducting focus groups after the fact, curaJOY includes our communities from the beginning, allowing them to participate in program design and development and learn from our team.  An agile, grassroots tech nonprofit like curaJOY is best suited to maintain families’ trust, drive fast changes, and collaborate with larger organizations.

We already have an MVP, a private beta, and more than one larger-scale research study planned with institutional partners to further document the assumed efficacy of this solution, which incorporates several already-recognized behavioral science machine learning algorithms and somatic psychotherapy curricula.

1000, and 20,000 committed before Fall 2023 for our pilot studies.

We are applying to the globally recognized Solve challenge so that everyday people– kids, parents, clinicians and minorities– have a voice in the future of AI and its use in healthcare.  curaJOY is pursuing an ambitious tech healthcare solution with the deliberate added challenge of operating as a nonprofit because we believe our community-driven, circular economy model equalizes opportunities, power and wealth.   It is also vital for the responsible development and use of technology.  We look forward to connecting with global social impact leaders and MIT’s network to validate and extend business models like ours that emphasize accountability and value those with both expertise and lived experiences. Being selected as a Solver team would also be a meaningful recognition for our team members who have made financial sacrifices to make curaJOY’s solution free for all youth and affordable for the rest of the population.

Quest Depot builds upon proven therapeutic techniques, clinical decision-making tools, and social-emotional learning curricula from multiple disciplines. Then it incorporates best practices from conversational AI, game design, machine learning, and data science to enhance those tools further.

Integrates the latest evidence-based treatment methods

We implement valuable academic research for the general public and integrate disparate services and stakeholders. Quest Depot is the first digital tool to guide users through body scanning and other somatic psychology techniques. Our solution makes it possible to discover the relationship between mood, behavior, and physical health for an individual and in correlation with a group (i.e., family, classroom).

Kid-centric and fun at the core

Quest Depot blends various motivators (visual, social, real-world gift cards, in-game) to increase user engagement and retention. We adapt to our users in program delivery channels as well.  This relationship-focused program can also interact with users (with consent) via SMS, Facebook, Discord, and LINE so that it stays impactful even if users delete the app.

Inclusive

curaJOY employs diverse-looking avatars in this solution and re-frames the purpose and benefits of social-emotional learning to appeal to universally accepted values, like success and growth, so that stigma related to mental health doesn’t deter people from getting help. 

Guided practice and application

There is plenty of instructional content, but the problem is in implementation.  Quest Depot’s virtual mentors encourage and guide users to apply the lessons learned in real life.

Whole family

When aggravating conditions exist in people’s environments, solutions that only target individuals are limited in their outcomes. Therefore, curaJOY flexibly engages the whole family, facilitating positive communication and dispersing bite-sized lessons via chat throughout the day.  

Scalable, synergistic, and sustainable system design

Epitomizing the circular economy model, curaJOY cultivates mutually beneficial vertical channel partnerships to feed Quest Depot’s continuous development. Quest Depot doesn’t replace in-person services. We have taken great care to design a mutually beneficial solution for the entire behavioral health ecosystem, accommodating the existing workflows of our target customers so that we disrupt, not destroy. 

If the goal is to go beyond crisis response and provide the high frequency and intensity of continuous support that families need to get back to wellness, then any solution that depends on human resources, such as those that rely on the availability of human providers, cannot scale to meet society’s demand.

Our goal is for our proactive approach to behavioral health to reduce disparities and service costs and increase innovation and access to emotional wellness support for all populations.

Next year, our most important goals revolve around the digital program Quest Depot–developing irrefutable proof of its value to clinicians, schools, and families and securing a large enough institutional user base to expedite wide industry adoption.

Scientific research 

• Study improvement in employee satisfaction and absenteeism from Quest Depot use.

• Complete Quest Depot efficacy research study with multiple healthcare and academic organizations in the following areas.  Then we seek publication of our findings through academic partners and further disseminate results.

• Accuracy of behavioral health data collected by Quest Depot compared to in-person observations by Registered Behavior Technicians when performing Functional Behavior Assessments of children with autism.

• Amount and rate of behavioral data collection as a result of Quest Depot use.

• Ability to complete third-party billing (insurance-mandated) assessments and reports within the hours authorized

• Hours of human resources saved in preparation for special education students’ IEPs

Market Adoption

• Partner with ten other organizations for joint marketing and advocacy

• Officially release Quest Depot to the general public in the Fall of 2023

• Secure Quest Depot subscription contracts from 100 schools and ABA agencies

Our mid-term goals include:

• Obtain government contracts and eligibility as a Medicaid provider.

• Implement Quest Depot in three non-English speaking schools and document improvements in the overall well-being of teachers, students, and parents separately.

• Compile a directory of providers who will work in conjunction with Quest Depot to provide services.

• Continuous content refresh cycles (updates and new) from B2B user-generated content and anonymous data collected.

• Offer paid in-app purchases for psychoeducational assessments and consultations.

• In-house development specialist to pursue grants

• Active, volunteer-led committees (fundraising, advocacy, international partnerships, research outreach)

• Localize Quest Depot into three additional languages.

Plans for the $10k Solver funding

Provider and parent education videos and emails  $1500 

Data collection and analysis from healthcare agencies $3000 

Clinicians review Quest Depot proposed treatment plans and behavior functions $5500

Key Milestones 

Quest Depot QA and private beta May 15, 2023

Quest Depot Pilot Study begins June 15, 2023

Quest Depot V1 general public release August 29, 2023

Begin selected language translation on October 1, 2023

Initial study results, data analysis December 1, 2023

Final data collection for research study February 27, 2024

curaJOY follows IRB protocols and uses well-recognized clinical scales to obtain baseline data and measurement metrics. Our impact measurement focus areas are detailed below.

Healthcare Equity

• Number of clients who report adequate culturally appropriate services

• The number of clients from the following groups: non-white, low-income, rural, international single-parent.

• Accuracy of machine learning in aiding clinician’s functional behavior analysis 

• User engagement and retention from curaJOY’s hybrid in-app and real-world gamification

• Number of people whose primary or only source of behavioral support is Quest Depot

Accessibility

• Number of psycho-educational assessments facilitated  through Quest Depot

• Decrease in staffing and cost required to perform Functional Behavior Assessments required by the law and third parties

• The total decrease in the wait time to receive behavior interventions for youth

• Number of institutions using Quest Depot 

Effectiveness

• NPS ratings of all user groups (clinicians, schools, parents and kids)

• Improved behavior (using data from ABC, behavior, and replacement behavior goals) in children 

• Parents reported improvement in children’s social and friendship skills 

• improved family dynamics using the Family Health Scale

• User-reported increase in self-esteem, resilience, and emotional intelligence in the Brief Resilience Scale (BRS)

• Reduced anxiety or stress as measured by the Warwick-Edinburgh Mental Well-being Scale (WEMWBS)

Problem: Poor access to mental healthcare causes rippled consequences far and long through society – lower graduation rates, unemployment, substance abuse, crime, and the downward spiral from low social determinants of health.  

We assume that

• People who experience behavioral or emotional distress will function better and negatively impact their families and communities less if can get timely help from behavioral health professionals.

• When people with learning differences and mental illnesses are undiagnosed, un/under-treated, it robs them of the opportunity to learn and thrive and, therefore, often communicates externally in the forms of unemployment, crime, and violence.

• Reducing clinician workload, especially in non-billable hours, will increase capacity and provider satisfaction.  

curaJOY leverages innovation and best practices from the healthcare, gaming, education, and data science to increase access, availability, equity, and effectiveness of behavioral health support with easily scalable software solutions by digitalizing and automating currently manual and labor-intensive clinical processes

The program collects multidimensional wellness data (physical, behavior, mood, multiple parties) for all stakeholders (parents, clinicians, and teachers) with utmost emphasis on scalability and privacy, thereby also alleviating the operational challenges of healthcare organizations and schools.  curaJOY collaborates and works to overcome larger systemic problems in behavioral healthcare, so all populations can have a champion who puts their well-being before all other considerations. The long-term impact of this approach is the wider acceptance and de-stigmatization of behavioral health supports, healthcare equity, and education equity.  It is also a crucial missing element in building the resiliency of the behavioral healthcare industry by decreasing provider workload and operational costs.

Our family wellness hub, Quest Depot, heavily leverages machine learning and Natural Language Understanding.  We hire licensed psychologists, behavior analysts, and counselors to create content, train NLU to classify users’ needs correctly, then utilize omnichannel delivery to push appropriate content in a realistic conversational style. 

Our Guardrails: 

• Clinician Curated Content

• Information Security 

• Customer Privacy 

• Regulatory Compliance

Our modular monolith and microservices-based enterprise architecture is built on AWS, leveraging best-of-the-breed third-party solutions.  The tech stack includes Remix Reactjs, node.js, Python, three.js, Redis, MySql, and DynamoDB.

Quest Depot’s data is segmented into various tiers. Each tier is stored in a separate vault to prevent data linking and reconstruction in case one or more vaults are compromised. The APIs and public interfaces are deployed on a Publicly accessible VPC.   Each of the underlying data is hidden inside a Private VPC and accessible only to our applications.

On the conversational AI front, we are bolstered by a key player in the conversational AI space, kore.ai, to help accelerate our product to market time. They will not only be providing their platform to us and co-developing parts of it with us. Ultimately, AI is as good as the data, and we have access to large behavioral health data models.

We list a few examples of the many research on which our solution is based upon. 

Families are guarding themselves against the pitfalls of technology and social media. Many laws have been passed and PR campaigns attempted, but people still don't trust tech companies not to sell their data or protect their children online. curaJOY fills a vital role in safeguarding the future of AI in healthcare.

Bailey, J. D., Baker, J. C., Rzeszutek, M. J., & Lanovaz, M. J. (2021). Machine learning for supplementing behavioral assessment. Perspectives on Behavior Science, 1-15. https://doi-org.ezproxyberklee.flo.org/10.1007/s40614... 

Chan, P., Furlonger, B. E., Leif, E. S., D’Souza, L. A., Phillips, K. J., & Di Mattia, M. (2022). An evaluation of the behaviour change content and quality of smartphone apps designed for individuals experiencing anxiety: an illustrative example for school psychologists. Educational and Developmental Psychologist, 39(2), 209-218.

Romani, P. W., Luehring, M. C., Hays, T. M., & Boorse, A. L. (2023). Comparisons of functional behavior assessment procedures to the functional analysis of problem behavior. Behavior Analysis: Research and Practice, 23(1), 36–48. https://doi-org.ezproxyberklee.flo.org/10.1037/bar0000258

Scott, S., & Dadds, M. R. (2009). Practitioner Review: When parent training doesn’t work: theory-driven clinical strategies. Journal of child psychology and psychiatry, 50(12), 1441-1450. https://doi-org.ezproxyberklee.flo.org/10.1111/j.1469-7610.2009.02161.x

Wu, J., Kopelman, T. G., & Miller, K. (2022). Using Functional Communication Training to Reduce Problem Behavior. Intervention in School and Clinic, 57(5), 343–347. https://doi-org.ezproxyberklee.flo.org/10.1177/10534512211032628

At curaJOY, our commitment to diversity, equity, inclusion, and accessibility isn’t just something we talk about — it’s fundamental to who we are and how we do our work.  We create equity by inviting underrepresented communities to co-create.  Our 70+ volunteers come from every continent: stay-at-home parents, high school and college students, retirees, refugees, those in developing nations, people with learning differences, and folks in career transition. Providing diverse populations to learn new skills and earn certifications opens doors to employment, higher education, new research, and staying abreast of new technologies and best practices. 

Our responses include the following:

a) allowing users to access support privately in their homes, where they are less likely to face stereotypes; 

b) prioritizing culturally-competent care to benefit the most diverse audience possible. Quest Depot is home to multiple realistic virtual mentors of different demographics. Our solution is available in English, Chinese, and Spanish; curaJOY plans to expand language offerings.

c) creating psychological safety for those who desire providers that share their cultural background and life experiences. Research has shown that racial and ethnicity match predicts greater satisfaction with treatment, lower treatment dropout rates, and better therapeutic outcomes for people of color and Asian Americans. By addressing the dire need for diverse mental health providers, curaJOY aims to close the social-emotional learning and behavioral healthcare DEI gap. 

Our multi-prong fundraising plan includes grants, government contracts, corporate sponsorships, and earned income from our services and programs.  curaJOY’s Quest Depot program allows IDEA-mandated and Medicaid/insurance-funded behavioral health benefits to be completed with less cost, time, and errors.  It is also the first behavioral health app in Chinese, filling a void in a large market. Our close research collaborations and vertical channels have been set up to be mutually beneficial and fuel Quest Depot’s continuous development, further expanding its social impact. 

curaJOY is a lean, volunteer-driven tech nonprofit. Many of our core team members are donating their time. Generous promotional credits from AWS, Google, Microsoft, White & Case, kore.ai, TrueWorks and others support curaJOY’s mission and enable us to keep operating costs minimal.    curaJOY has offered Quest Depot free in exchange for qualified clinicians' and institutions’ content contribution, design participation, and research collaboration, kickstarting a circular model of continuous product development. 

After Quest Depot’s initial development is completed in 2023, the program’s ongoing cost comes mostly from content updates and operational support. Quest Depot will be self-sustainable, operating on a SAAS model for consumers, schools, corporations, and healthcare providers.  

curaJOY began as a personal philanthropy endeavor by its founder to create an immediate and scalable behavioral health solution designed by the community it serves. As AI and other technologies emerge, we believe that families are looking for an accountable, non-partisan, not-profit-driven champion of their wellness who will always put them first.   Focusing on direct social impact from the start rather than fundraising is our concrete way of showing, earning, and proving curaJOY’s trustworthiness,  accountability, and dedication to our mission.

Tulane University will examine the utility of Quest Depot with children with PTSD to develop trauma-informed care practices. Kore.ai is also deploying Quest Depot for all its employees in the United States and Asia.   Another show of financial sustainability is the completion of Quest Depot’s MVP.

In 2022, small and large non-public agencies (NPAs) alike have been forced to close clinic locations and schools, including the country’s largest Applied Behavior Analysis provider, the Centers for Autism and Related Disorders, shutting down all its Oregon locations,  leaving many neurodivergent kids and their families without support.  This and the backlog of behavioral health needs resulting from COVID are just one of the many macro-environment factors that buoy our confidence in curaJOY’s financial sustainability.