A Mightier healthcare system: Introducing a game-based pediatric mental health intervention into payor-sponsored care to evaluate financial and clinical outcomes

项目总结 在美国，获得有效的儿科精神卫生治疗是一个主要的公共卫生问题，因为 儿科提供者的缺乏导致了漫长的等待时间、经济负担和耻辱，构成了巨大的障碍 去接受治疗。数字心理健康承诺补救我们在提供及时和 儿童可获得的心理健康干预措施。考虑到这一点，我们创建了Mightier，一个基于应用程序的心脏 评价生物反馈视频游戏平台，旨在教授和促进情绪调节技能的练习。 自2016年上线以来，Mightier已覆盖1.7万个家庭，月增长率约为 10%，每月保留率为90%。Mightier背后的技术得到了三项试验的支持 临床疗效和自商业推出以来75%的家庭参与了该产品的报告 进步。然而，我们的核心使命仍然是增加获得护理的机会，以及直接面向消费者 数字健康的分发也面临获取方面的挑战。我们认为，获取有效的数字心理 可以通过会见已经知道寻求护理的家庭来增加卫生干预：传统的 医疗保健系统。我们已经与一家全国性的行为健康保险提供商合作，试行 Mightier与传统医疗诊所的整合。 拟议的研究将试点将Mightier整合到以下两家行为健康诊所 我们的付款人合伙人。为了模拟真实世界的整合，医疗保健提供者将负责参考 患有慢性情绪失调症的孩子要更坚强。一旦被提供者确认，孩子们将被 随机分为试验组和对照组，连续使用6个月。通过这项工作，我们将展示 通过降低长期医疗保健利用率(目标1)，确认Mightier对各种利益相关者的价值 更强烈的使用会减少情绪失调、易怒和父母压力的症状(目标2)。 最终，这项工作将为数字医疗和更多的大规模集成铺平道路 传统的医疗保健途径，同时提高了Mightier帮助有需要的儿童的能力。

PROJECT SUMMARY Access to effective pediatric mental health treatment is a major public health concern in the United States as paucity of pediatric providers leading to long wait times, financial burden, and stigma pose significant barriers to treatment. Digital mental health promises to remedy many chronic problems we face in providing timely and accessible mental health interventions to children. With that in mind, we created Mightier, an app-based heart rate biofeedback videogame platform designed to teach and facilitate practice of emotional regulation skills. Since launching in 2016, Mightier has reached 17,000 families, with a monthly growth rate of approximately 10%, and month to month retention of 90%. The technology behind Mightier is backed by three trials showing clinical efficacy and since commercial launch 75% of families who have engaged with the product report improvement. However, our core mission remains increasing access to care, and the direct-to-consumer distribution of digital health also faces access challenges. We propose that access to effective digital mental health interventions can be increased by meeting families where they already know to seek care: the traditional healthcare system. We have partnered with a nationwide behavioral health insurance provider to pilot the integration of Mightier with traditional healthcare clinics. The proposed research will pilot the integration of Mightier into the two behavioral health clinics identified by our payor partner. To simulate real-world integration, healthcare providers will be responsible for referring children with chronic emotional dysregulation to Mightier. Once identified by their providers, children will be randomized into Mightier or control groups for 6 months of use. Through this work we will demonstrate the value of Mightier to various stakeholders via decreased long-term healthcare utilization (aim 1), confirm that Mightier use results in decreased symptoms of emotional dysregulation, irritability, and parent stress (aim 2). Ultimately this work will pave the way forward for large scale integration of digital healthcare and more traditional healthcare avenues while simultaneously increasing Mightier’s ability to reach children in need.