Mental health and developmental disorders begin early in life, are prevalent, impairing, and predict mental health and health challenges in later childhood and in adulthood. One in nine preschoolers has an impairing mental health disorder, yet less than 15% receive any treatment. In immigrant communities, the disparity between mental health needs and care is greater because of cultural and language barriers, limited mental health literacy, and decreased use of health IT solutions, like Electronic Health Record (EHR) patient portals. Chinese American immigrant families are a fast-growing immigrant group with unmet early childhood mental health needs. We propose to design, build, and implement OurChild, an integrated mHealth/EHR solution to increase access to early childhood mental health knowledge and mental health services and resources for Chinese American children ages 2-6 years old and their parents in Sunset Park, Brooklyn. Our proposal unites our longstanding partnership with the Chinese American community in Sunset Park and the safety-net clinics serving it with our team's 1) clinical and scientific expertise in health disparities, participatory research and early childhood mental health and 2) the digital health/health IT expertise of the WonderLab, a digital incubator in the NYU Langone Department of Child and Adolescent Psychiatry. Our goal is to reduce health disparities by explicitly designing a digital solution that facilitates connection and bidirectional exchange of information across the cultural, contextual, language, and setting differences that are key barriers to early childhood mental health knowledge and access to care for this immigrant population.
Our first aim i s to iteratively design, build, and test OurChild. To do this we will 1) collaborate with our family, clinical, and community stakeholders to conduct an early childhood mental health context/needs analysis and participatory design and discovery activities; 2) use these insights to adapt and user-test iterative prototypes; 3) evaluate the usability and acceptability of a beta version of OurChild in a mixed-methods pilot with 20 Chinese American parents and their 2- to 6-year-old children who receive care at the Sunset Park 7th Avenue Family Health Center; and 4) optimize the design, features, and performance to create OurChild 1.0.
Our second aim i t to evaluate the Reach, Effectiveness, Adoption, and Implementation of OurChild 1.0 with a 6- month longitudinal implementation cohort study with 200 parent/child dyads. We will use a mixed-methods approach using metadata collected with the OurChild app, parent-reported data from the app, EHR data, and post-implementation focus groups with providers to determine whether use of Our Child increases referrals of young children for a mental health consultation or evaluation (Primary Aim). Our secondary aims will examine whether use of OurChild 1) increases parent self-efficacy; 2) parent?provider engagement; and 3) linkage with community early childhood resources. Both OurChild and our digital methodology will be designed to be scaled to other Chinese populations and efficiently adapted for other health disparity populations.
OurChild is a digital platform that links an in-home smartphone app (available in Chinese and English) with the electronic health record to improve access to mental health knowledge and care for Chinese American young children and their families. Parents collect information about their child?s mental health and receive real-time actionable insights and resources. Clinical information is automatically shared with the child?s doctor to improve referral to mental health services, parent-provider engagement, and linkage with clinical and community services.
