MHSR Day 1: Harnessing Technology to Optimize Mental Health Care

FREED: So really excited to introduce this
next panel. We talked a lot about public health impact
and target populations and denominators. And I’m not sure — I see something sitting
right next to the drawer (ph) and it looks like a Pokemon Go character. You know, I wonder if anybody from either
NIAAA here to help with my screen addiction. And I have to wonder how wonderful that would
be if providers were so addicted to their training that they were just running into
things and stepping off platforms. You know — or when we’re thinking about reach
of intervention. Do we really need to think about that when
we have nine zeroes after who uses our platform and I think that’s billion, right, for Facebook? And finally, when we tend to make upward comparisons
when we have new interventions that we’re thinking about testing, but sometimes when
we think about the other way downward comparison of who’s getting nothing at all. And so that’s really important as well, as
we think about, you know, how innovative and how kind of risk we’re willing to take to
do something that’s pretty exciting. So with that, I’m really excited about our
technology panel and I will introduce Dr. Adam Haim who is our moderator. Adam, take it away. HAIM: Good afternoon, thanks Mike. I have to say I’m really, really excited about
this session. So over the last several years we at the NIMH
have seen technology really blossom and really be leveraged in novel and innovative ways
to predict and prevent mental on this to deliver more efficient and effective diagnosis and
treatments. And today, we really have a great opportunity
here from a number of experts we’re going to describe their research and their experiences
with leveraging novel technology to identify and treat mental health disorders. I’m, again, really excited that we have this
panel here. We’re going to start the first presentation
we’re going to hear from Dr. Lisa Dixon. And Lisa is a professor of psychiatry at Columbia
University Medical Center where she directs the Division of Behavioral Health Services
and Policy Research and the Center for Practice Innovations at the New York State Psychiatric
Institute. Dr. Dixon is an internationally recognized
health services researcher with over 25 years of continuous NIMH funding. And she is the P.I. on the NIMH RAISE Implementation
and Evaluation Study and is leading the innovation program Contract New York which is a state
wide initiative designed to improve outcomes and reduce the disability for the population
of individuals experiencing their first episode of psychosis. She’s published more than 250 articles peer-reviewed
journals and received the 2009 API Health Services Senior Scholar Award. The title of Dr. Dixon’s presentation is “The
Use of Technology and Behavioral Health of Youth from the field”. I’ll introduce everyone and then and we can
start with the presentations. Our next presenter and these two presentations
are tethered. Dr. Dixon and Jeff Olivet have partnered on
an SBIR project. And Jeff Olivet is the President and CEO of
the Boston-based Center for Social Innovation, a small business which is dedicated to improving
the lives of vulnerable people. For more than 20 years Jeff has been a leader
on Homelessness, Poverty, Affordable Housing, Behavioral Health and HIV. More recently, he has focused his efforts
in mental health. He’s been the P.I. on multiple NIMH funded
small business innovation research studies including a motivational interviewing simulator
an (ph) online learning platform for dissemination of CTI, a role playing video game for young
adults who have experienced the first episode psychosis and the title of Jeff’s talk is
“Tough Challenges, Elegant Solutions, Harnessing Design and Technology to Improve Care for
Marginalized People.” Following Jeff’s presentation, we have a presentation
from Dr. Jennifer Guadagno, who is currently working at Facebook. She’s been there for around four years. And part of that she had completed her PhD
in Psychology from Duke University where she studied the effect of mindfulness and acceptance-based
interventions on well-being. She now leads research for the compassion
team at Facebook which seeks to encourage more supportive and compassionate interactions
online. She conducts surveys and qualitative interviews
to understand both the meaningful and difficult experiences that people have online. In her work, she works closely with psychologist,
researchers and mental health experts to acquire evidence-based practices to enrich and support
Individuals experiences particularly, during difficult life moments. Her team’s suicide prevention work was recently
featured in New York Times and the title of her presentation is “Facebook Providing Support
during Difficult Life Experiences.” Our last presentation is going to be conducted
by Danielle Schlosser. And she is an Assistant Professor of Psychiatry
and Director of the Digital Health Core, UCSF. The goal of her research program is to design
and develop and investigate neuroscience inform digital health interventions to improve the
lives of people with schizophrenia and depression. Dr. Schlosser has a broad background in clinical
psychology with specific training in Cognitive Neuroscience focusing on the early detection
intervention of psychosis and digital health research. The focus of the research is on targeting
domains that transcend diagnostic labels. So just motivational states and enhancing
outcomes such as body of life. More recently with NIMH funding the researchers
focused on developing noble therapeutics and which is called Prime and the design of this
project is to target the motivational system and enhance the drive to improve one’s quality
of life and health outcomes. Her lab is currently testing the feasibility
and efficacy of this interventionist in two ongoing clinical trials. And they recently completed a pilot trial
depressant (ph). The title of her presentation is “Eliminating
The Barriers To Mental Health Services By Embracing A Digital System Of Care.” So our plan is to hear from our four presenters
and hold the questions until the end and we look forward to hearing your questions and
hearing your presentations. Dr. Dixon. DIXON: Thanks. Good afternoon everybody. Can you hear me? I’m really, you know, very — feel very flattered
to have been asked to speak on this panel and I — first, I thought it was a big mistake,
because I’m not a technology expert. And I start to think, I said, well, you know,
actually I do use technology in the work that I do and I am a clinician, I am a patient,
I’m a clinician, I’m a practitioner, I’m a researcher and I run a big sort of training
and implementation institute and it’s actually everywhere. Technology is everywhere. So I think — and so part of what I wanted
to do in this 10 minutes or so is to sort of kind of walk you through a little bit of
my journey in putting this talk together of thinking sort of rather in a big more conceptual
way and then drilling down to I think at least some of my own experiences with trying to
put technology sensibly and thoughtfully into the work we do and that will lead into Jeff’s
presentation because we’ve had great partnership. OK. So the first thing I did was I went to the
computer and I went to Google, sorry. And I found this, so I thought it was really
interesting list of kind of the 10 biggest technological advancements for health care
in the last decade. And I thought that sort of put some perspective
on this kind of this process that we’re all living with every day. And I think that most of you will recognize
these items and I’m not going to go through all of them. But you know, what’s interesting to me is
that this is the last decade. I mean, that means that a decade ago, we didn’t
have these things which seems so, you know, part of our normal daily experience of healthcare. And I will say, the only thing I didn’t know
was — what it was, was real-time locating services and that was described as like tracking
people in the hospital so that, you know, the flow of people and tools and stuff is
made more efficient. But I’m — think that you’ll see if you look
at this list. You’ll see the echoes of patient activation
and you’ll see the echoes of efficiency and case identification. And then we get to Healthy People 2020. And I think of the tools and the advancement
as the “how” and I think of this as the “what.” You know, what are we — what do we want? What is our health care system? And then I think obviously after this morning’s
presentation our health care community more broadly. You know, these are at least the goals that
have put forward by Healthy People 2020 and you see how the tools that have now become
a part of our everyday life in health care can support these goals, of supporting shared
decision making between patients and providers, providing personalized self-management tools
and resources — and I know that many people in this room are doing this with their research
–, building social support networks, delivering accurate, accessible and actionable health
information that is targeted and tailored, et cetera. And so, I think, you know, again, for those
of us here who are working on research, who are trying to build that transformative alacritous. I don’t know. Is that a word? Alacrimonious (ph)? Electric? Proposal that makes change. I think you know, this is — I think offers
a very — a nice structure within which to put sort of these activities. And so, you know, activation, increasing health
literacy skills which again reaches beyond the health care system to the community, providing
new opportunities to connect with culturally diverse and hard to reach populations. And again, what so pops out when you look
at these goals is that, this cuts across, you know, the patient, the provider, the system
and the community. And that is where I’m going to go next. So, I think — so, in my own work and trying
to kind of use my work to shed some light on sort of the promise of technology that
we want to harness. You know, again, I think at these levels. And so, what I’m going to do in the next few
minutes is just walk you through some of, you know, some examples that my group has
done and I know that others have as well. So, you know, if we start with — and I – you
know, it’s funny. I had the patient and then I changed it to
the person. You know, as I was influenced by this morning’s
presentation. But here we have, you know, just some of the
very, very palpable uses of technology that we all feel. So, of course increase access to treatment
via tele-health and online treatment in my work. You know, this is very much in play in virile
first episodes psychosis programs and we know that in implementing first episode psychosis
services it’s a little bit easier to do when you have a more dense population because the
incidence of first episode psychosis is not that high. So then, how do you deploy these teen based
models in communities that are much less populated? So, this is where — I mean, I’m obviously
for virile health — tele-health it’s not just for FEP but in my work, it’s been with
the FEP programs, online CBT. Colleagues have worked on developing CBT for
OCD or OCD via online methods. And again, many people here have worked on
this, this notion of increasing participation and the efficacy of treatment. So, it’s really fundamentally changing the
quality of care and increasing the quality of care by increasing, you know the outcomes
it can achieve. And so, we have ecological momentary assessment
and the use of apps for self-management drawer. You have this here other colleagues have also
done this work in illnesses such as schizophrenia– really know all and in so many of the mental
disorders that we’re focusing on. I wanted to call attention to common ground
which is an application that’s support shared decision making that was developed by Pat
Deegan, who is a woman psychologist who has schizophrenia and she is created this unbelievable
fantastic I think structure within which patients can identify their goals and then work with
their clinicians to do shared decision making. So, keep your eyes out for common ground. And again, data support website that has been
developed by Armando Rotondi which again sort of pulls in each of these of strategies of
communicating with the patients, passive information exchange, prompting and messaging to, again,
improve the quality of care. And then, Jeff will talk about an effort that
we undertook as a part of On Track New York, our first episode psychosis program of increasing
essentially the relevant and salience and the engagement of the intervention by gamification. The providers view. So, in this, I wanted to say that everything
in the patient’s view then sort of gets embedded in the provider’s view because the provider
then has all these advantages and tricks up their sleeve that we see from the person’s
view. And in my work at the Center for Practice
Innovations in New York, we do a lot, a lot of training online synchronous and asynchronous
training of the workforce using technology and Jeff will also talk a little bit of — about
that, about motivational interviewing, critical time intervention as sort of community treatment. All of these programs particularly team-based
programs I think can benefit from the use of technology. And right now, I don’t know how any training
— I mean, I know everybody loves in-person training and I’m not against in-person training,
but it needs to be enhanced that, you know, if it’s one or the other, I think hybrid methods. So I think we need to do more research actually
on these different strategies. And then finally, a more recent project that
I think, again, stimulated by NIMH effort to jump-start efforts to measure fidelity
in psychosocial intervention. So here’s again where apps and technological
strategies can actually bring the patient’s voice or the person’s voice and actually the
provider’s voice very rapidly into the fidelity assessment process. Then moving up, the chain here, the agency
system view, again, everything from the patient and provider’s view is sort of game here. And then here again, it’s really — the ability
to train the workforce not as individual workers but as teams and as programs. And through all of that, we can increase standardization
and consistency. We can increase efficiency, identifying for
example, high utilizers, targeting high risk, high need patients. All these strategies have been really supported
by technology. And I think for us in New York, for Ontrack
New York, in using — in pulling together all of these tools, it’s, you know, doing
training that is online that we can measure that we know whose doing what. We know how it’s working and then integrating
that with data from patients from, you know, from clinicians in terms of outcomes and cost. We can sort of leverage all of these things
together and understand, you know, what we need to do to produce the outcomes from one. And then finally, is the community view. And I confess, I actually was listening this
morning and I was like ah. I didn’t have the community view in my original
slide deck. And I said like that was so wrong. So, fortunately, I had time to add it. And again, so everything from, you know, person
provider and the provider in the system and I just listened to Arthur Evans. He’s just — and stopped there. But I wanted to highlight something that we’re
doing with New York City drive – developing a virtual learning center for community-based
organizations. And again, sort of taking this message out,
taking the tools, taking the strategies, taking knowledge and bringing it out of the health
care system and into the community, and that’s a project that I’m looking forward to. So, I’m going to conclude just by underlining
some lessons on the ground. And so, you know, again, I started in the
sky and I ended on the ground which is where I liked to live, frankly. Partnership, partnership, partnership is critical
in use of technology from having the tech, you know, having a technical know-how to the
— the knowing what to put in, and again, getting advocates and people with experience
as well as then the delivery system to roll it out. Investment, and again, in my experience and
maybe this is just kind of naive. But in using technology, it usually involves
buying stuff and expertise that we don’t have or at least ensuring that our users have some
of the materials and tools. And I think that’s something that has — I’ve
seen it over and over again as a grant reviewer, as a paper reviewer, that it interferes with
moving things out quickly. And that’s just something that we have to
get through. Evaluation, again, just because something
is cool and looks good, it doesn’t mean it works. And I’ve seen my share of these great interventions
that actually don’t work. And, unfortunately, we’ve had some of those
in my shop, and then others that do. So we can’t think that just because it’s got
all this — you know look sexy and all that, that it’s going to work. It — we really have to do research. And finally, my last point is the fast pace. And, you know, it’s this notion that we — it’s
the — you know, one — a version of the new normal that what is possible technologically
changes so fast, that you think you got it and then you turned around and everything
you’re doing is old and, you know, doesn’t look good, and it doesn’t — and so, you know,
we have all these — this is, I guess, probably the rationale for partnering with industry
that can keep us moving fast. But by the time you got the IRB approval,
you know, your module looks like, you know, it’s, you know, 15 years old. And that’s a problem. It’s a problem for knowledge acquisition. And so, in some ways, we have to build into
our models the notion that what we’re testing doesn’t stand still, that what we’re testing
has to have the capacity to grow and morph, and then we have to figure to measure that
so that the research is sound. Anyway, I’m going turn it over to Jeff who
I will — have pictures and not just words. OLIVET: I think it’s my job to show you some
stuff to looks sexy and cool. Hopefully, it works also and we have some
data to back that up. I come out of the background in homeless services
and I got into homelessness work about 23 years ago and had absolutely no idea what
I was doing. I was untrained to work with a very complex
population and had very little opportunity for ongoing professional development. And so, a number of my colleagues and I got
the bug to figure out how best to train folks who are serving incredibly underserved and
marginalized and vulnerable people. So, some of what I want to share with you
in the next few minutes is in that kind of provider training space. And then I’ll share some of the work that
Lisa and I have been engaged in together over the last couple of years as well. We start with a really basic premise and that
is if we can bring together cutting edge scientific knowledge, all that knowledge that is in your
heads and in the heads of the people you work with in your academic institutions and research
organizations and here at NIMH. If we can add that to great adult learning
principles and then package it up here as the sexy and cool part with beautiful design,
that what we end up with is awesome stuff that people can use to achieve better outcomes. And we believe that that packaging matters. And I love, Lisa, what you just said about
the need to be adaptable and the need to sort of have materials and products that evolve
over time. That’s got to be built in because stuff gets
stale very, very quickly. And, you know, what was once a bad PowerPoint
in a conference like this becomes a bad online learning module and then gets archived for
all time. And we’ve got to get beyond that. So one of the challenges we took on – and
this was with Adam Haim’s guidance a number of years ago — was how do we train the behavioral
health workforce on evidence-based practices. And we took, as a starting point, critical
time intervention. This was a great intervention with great outcomes
around psychiatric symptoms, around housing stability. We partnered with the developer of CTI, Dan
Herman and his colleagues, who were then at Columbia and now at Hunter School of Social
Work and decided we were going to build a dynamic instructor-led online learning package,
and that we were going to pair that with community of practice support. So, we weren’t just going to say, “Here’s
the body of information we’re going to blast at you.” Instead, we basically said to teams around
the country, we’re going to connect you with the experts who developed this model and we’re
going to connect you with your peers across the country who are trying to implement it. And we based this on a number of theoretical
frameworks. One of those was the notion of problem-based
learning. And at the time, my wife had just finished
medical school at the University of New Mexico which had a fabulous problem-based learning
curriculum. And so this was, you know, drilled into my
personal and family life for four years in a really powerful way. And so, we took the idea of problem-based
learning. It’s been so effective in legal education,
medical education. We paired that with the educational approach
around communities of practice. And what we came up with was a really dynamic
online immersive course that was intended to be delivered over eight weeks that blended
all sort of things. It blended self-paced modules with lifetime,
with instructors and peers. The modules are very well-designed. They’re beautiful. They lead with the question of what do people
need to know, not what is the information that we’re trying to push upon people. So, you start with a learner, what is it that
they need, what are the knowledge and skills they need to be able to do this practice. We built the whole course around the story
of Michael, who is sort of a quasi fictionalized person that we built out of all our collective
experience and the guidance of people who are in recovery from homelessness and mental
illness. And Michael became the touchdown for learning
over this eight-week period. You saw CTI teams wrapped care around Michael
and learned — you know, helped these providers learn how to implement the model. The course includes many simulations in response
to what’s going on in Michael’s life. And then there are live sessions that would
take place every other week for the eight weeks. And that’s if you know Dan Herman or Sally
Conover in New York. They’re there in the little Hollywood squares
meeting with small cohort of teams. What we saw was when we compared the online
training intervention to traditional in-person training; we saw almost identical knowledge
outcomes. Knowledge outcomes were very strong across
both. The thing that we saw different was knowledge
retention over time was better in the online group. And this bears out all the research that’s
been done in distance education where we know that if we can deliver information in bite
size chunks over a period of time, it seems to stick better for longer. And so, we saw a significant increase in knowledge
retention nine months later for the online condition. We saw slightly better implementation outcomes
in the on-site group, but comparable. They weren’t far off. And, when I sort of came to Adam wondering
what to do with that finding, he said, “You know, how many people do you think you can
potentially reach with the online intervention? You’re going to have much more scalability
with an intervention like that.” The other thing that we saw was a fantastic
client-level outcomes with both groups, about 87 percent housing retention after nine months
for client served by both conditions at a third of the cost for the online learning
condition. It costs but $3,000 a team to train them versus
$9,200 a team to do the on-site training. Another problem that we took on then was how
do you support knowledge and skills retention over time? We do all this great training. It happens in medical education and then counseling
education and in trainings that we do. You come together for a couple days of conference. You learn all this great stuff. You go back home and do things more or less
like you were doing in the week before. And we know that knowledge decays over time
following training whether it’s in-person or online. That’s been very well-documented in the motivational
interview and literature where there’s a great training that happens. People learn a lot and then fidelity to the
model and knowledge retention and skill retention decays. So, we took motivational interviewing and
said, what can we do to support ongoing learning long after the trainers are done whether it’s
in-person or online? And here, we stole from things like universal
design for leaning or UDL that was developed at the Harvard Grad School, then we stole
from the literature that some of our motivational interviewing colleagues had done around simulation. And in part with support from NIHM and in
part just kind of on our own, we built a suite of motivational interviewing products. And I’m just going to show these. I’ve got the sound turned off. I hope the sound is turned off so I can talk
over them. But we created a basic sort of hour long introductory
course to motivational interviewing and lives online. People can take that in their jammies at 10
o’clock at night or whenever. We also decided that that would suit itself
pretty well to an iBook or an eBook delivering mechanism. So, we repurpose a lot of that content and
created an eBook that could deliver a lot of that same kind of basic training and motivational
interviewing. The thinking here is if you’ve got trainer
who — and maybe you have felt like this person if you’re teaching. You pull the string on their back and the
same words come out. If you’re doing that, cut it out. Capture that stuff on video, capture it in
text, capture it in multimedia, and use the immense skills of our trainers, of our faculty,
to do the stuff that only they can do, to go deep, to go contextual, to go individualize. So, the way we did that was to develop instructor-led
courses. And that’s — a colleague of mine, Ken Kraybill
and I teaching a motivational interviewing course. This is like the CTI one I showed you a little
awhile ago. And then with SBIR funding from NIMH, we developed
a prototype motivational interviewing simulation game which you see there in the bottom right-hand
of the screen. We are now in phase two of that study trying
to see what is going to work. But, we got very promising outcomes in phase
one. In phase one, we basically had people playing
against the machine or against each other via the machine. Now, we’ve got, this is — I’m interested
to hear, Jennifer, the Facebook perspective on this. We sort of stole some ideas about Facebook
walls, about how we really connect people to each other in an ongoing learning process
for the phase two. But the idea here was get people multiple
ways of accessing the information over a long period of time with a reason to kind of keep
coming back. And what we’ve seen so far, as I said we’re
in the phase two of that study, but what we’ve seen so far is improved scores around the
motivational interviewing, treatment integrity scale, around the helpful responses questionnaire. We got great qualitative results as well. People loved the experience of being able
to work on their MI skills through the simulator. And those mighty scores in particular indicate
better fidelity to motivational interviewing over time. We’ll know more about that when the phase
two results start coming in about a year from now. We also know that through this process of
connecting people with all these different learning opportunities, that people are engaged
in an ongoing learning process with one another, within their agencies, with peers around the
country. Now, the first-episode psychosis research
has moved very rapidly over the last few years as many of, you know I think through the leadership
of Bob Heinssen, Susan Azrin and others here at NIMH, through the fieldwork of Lisa Dixon
and John Kane and many others. There’s been an extraordinary explosion of
understanding about what works in the area of first-episode psychosis care or coordinated
specialty care for first-episode psychosis. Now, the dilemma is how do you speed along
the dissemination uptake of those best practices that have emerged? And so, what we’ve done, and I say what we
have done, meaning what we are about to do over the next 2.5 years or so, this project
was just funded about 30 days ago, I believe. Susan, does that sound right? We’re in partnership with Lisa, with Mary
Guerinot at Dartmouth are launching into a process by which we’re going to pair a lot
of what I’ve shown you so far, the dynamic online curriculum that people can access on
their own, instructor-led courses, implementation coaching and support. And then in phase two, we’ll begin looking
at how kind of hybrid versions of that, paired with face-to-face training and consultation
can really work to disseminate coordinated specialty care. So, here we’ve drawn on various theoretical
backdrops. One of those certainly has the findings of
the various studies that have emerged over the last few years. And then we tried to put together approaches
like universal design for learning which I can talk more about in the Q&A if you’d like
along with what’s — what we know about peer-to-peer learning and ongoing coaching for implementation
to really see how you can make this stuff stick. Our concern obviously is that when you start
implementing things outside of the kind of laboratory research context even the very
community-based research that it gets watered-down, that it ends up being a game of telephone
from one provider to another, from one state team to another. And you end up with models that are very far
from where they originally started. I love the novelist, Milan Kundera, who is
a Czech novelist, wrote in Czech for a long time, now he writes in French. He, for a long time, started trying to chase
down all of the bad translations of his work and he writes about this. He’s got a little book called “The Art of
the Novel” and he writes about this and he finds a guy who speaks Portuguese and known
Czech who translated one of — “The Unbearable Lightness of Being” into Portuguese and he
said — they’re speaking French together. He said, “How did you translate it if you
don’t speak Czech?” And the guys said, “With all my heart.” And Kundera went nuts. He started just trying to like, you know,
track down all these things and finally he gave up and started writing in French. So at least that’d be sort of one degree of
separation. But the question for us as we really look
at scaling up was working around coordinated specialty care is how do you prevent that
from happening, how do you prevent the decay of quality and the decay of kind of best practices
and best knowledge. So, I don’t have anything to show you yet
on this. So I’m going to show you the Secretary of
Housing and Urban Development instead. I show you this because this curriculum is
one that our organization built in partnership with HUD. We do a lot of national training and technical
assistance with HUD and this curriculum in particular I think is a model for how we’re
going to do this CSC on demand work. So, the page you’re looking at right is kind
of the landing page for the entire curriculum. It’s the coming back to point. It organizes everything. Each of the modules is color coded so you
kind of — or is subtly oriented of where you are but they’re all interwoven behind
the scene. So, you can find multiple pathways through
the material. This is not a linear process where you take
module one, then do your quiz, module two, do another quiz. It’s intended to be a resource that you can
back to for just-in-time learning, for refreshing — you’re thinking about something and that
it can also be added to over time. So, this architecture and even the backend
code is what we’re planning to use for the new first-episode psychosis curriculum work. As you can see with this, we’re using a lot
of video where we sent film crews out into the field, into public housing authorities
in this case, to really contextualize the learning process. We, again, start with the question of what
do learners need and not what is the information we’re trying to shove down their throats. And so, the information is very — it’s layered. There’s a lot of sort of click and reveal,
like you’re looking at right now. So, you’ll see on the headlines and then you
can sort of zoom in and zoom out. Never is a slide more than one layer deep. So, you can always very easily come back to
that kind of landing page. And in large part, this technology and the
— even the design and the delivery of it is intended to be flexible and adaptable overtime. So, the idea is, can we create a house in
which the growing and evolving body of knowledge around coordinated specialty care can find
a home and can find ways of adapting over time? So, I think — I share this with you just
sort of as an example of what CSC on-demand is going to look like. And the results, we have no idea. We’re launching in the phase one right now. We’ll have preliminary data about a year from
now and how this approach holds up with three sites and then we’ll scale that up to 30 sites
in phase two. This should coincide with the uptake of coordinated
specialty care in states and communities around the country over the next couple of years. I’ve got one more thing I want to show before
we turn over to Facebook to just eclipse this whole thing I’m afraid because you guys are
incredible. We also partner with Lisa and her team at
OnTrack New York to think about how we could improve engagement for young adults who had
experienced first-episode psychosis and we decided that an online role-playing game would
be a cool thing to try. This is not coming out of nowhere. Again, we’re drawing on the RAISE findings
and knowing that engagement in care certainly improves outcomes and the earlier you can
do that the better. We also drew on a lot of game theory and just
the explosion of online role-playing games and, Mike, I don’t know if we can make it
quite as addictive as Pokemon GO, but we’re going to — we’re doing our best. We just finished phase one of the study and
I just wanted to show you just little bit of the game. The idea here is that people could go into
this sort of fictionalized world that’s a bit playful, that’s about school and work
and connection with family and connection with community and not just about your symptoms
and your medication management and all of them work on a clinical support to provide
people. Those are certainly important. They’re part of the game as well but it’s
really about how you think about recovery in the broader context of your life. And so, people can go in and kind of customize
their character. They can choose skin color and hair color. We learned from our youth advisors that shoes
were quite important. So we spent a lot of time with our artist
working on shoe choices. Again, this will get more sophisticated presumably
in the phase two. But the idea that the character could be customized
not only with their physical appearance but what their kind of attribute which I’ll show
in just a second was very, very important to the young people who are advising us. So what happens here is that the character
lands in an apartment with unpacked boxes in the middle of a city and the idea is that
they go out and explore that and they go out and explore areas that represent different
facets of their lives. So there’s a gym where you can go and take
care of your physical well-being. There’s a workplace. There’s a therapist office. Here, you see the character roaming around
the apartment, exploring for the first time. You can take a shower, you can go to bed. These things recharge the energy bar at the
bottom of your screen there. You can gain currency; those little coins
at the bottom. You can gain OnTrack coin which lets you buy
stuff. And we don’t have this on phase one because
we didn’t have enough time or money, but we’re going to have skateboards and backpacks and
cool things that people can do to get around town. But the idea is that as people are doing this,
they’re experiencing a destigmatization of their mental illness. They’re experiencing skill building and empowerment
that helps them apply of what they’re doing in the game into real-life settings and either
you can see the town, the job, the therapist’s office. There’s a boss there and you can kind of go
through workday and symptoms intrude into the workday. Here, this is — I think the video moves through
it very quickly but we see a situation where the character is hearing auditory hallucinations
during the day, voices whispering to do things or not do things, and then the person can
choose how to handle that. Choose how to interact with coworkers and
that sort of thing and then take refuge in home, in the park for walk, some things like
that. One very, very cool part of this experience
that we didn’t — we have no idea how powerful this would be when we started developing it
but what we heard from our — the young people who are our advisors, they said, we want to
hear the stories of other people in recovery. And so, what we did in working with a lot
of the clients in OnTrack New York was capture their stories on video and package those up
so people could watch recovery stories, kind of an action and you can actually go to the
movie theatre in the whole town and watch movies. And when we did all of the qualitative data
collection in phase one, that particular part of the game stood out, absolutely everybody
who took it. We loved hearing other people stories. We loved seeing the hope that’s possible. Here’s the movie theatre with the curtain
coming up. I thought that was nice touch. But the power of stories in that was absolutely
incredible. So here, you’re seeing a little bit of Jason’s
recovery story. And these are like five minute videos that
can also then be repurposed to another training program in standalone videos on YouTube and
things like that. So, that kind of power of storytelling is
essential to this. And what we saw in phase one, I know that’s
going to be a little small on the screen but what we saw is at least a small effect size
on four out of the five measures that we applied. So we saw improvements in people’s perception
of recovery. We saw hope scores go up on the heart – hope
index. We saw just a lot of sort of positive movement
of that needle. And for a phase one prototype, that was pretty
simplistic and pretty rudimentary, we were very heartened by that as well as all the
qualitative data where people had high satisfaction rates, loved to playing this game, wanted
to see more. So, that’s what I have to share with you. I appreciate you giving me the time to show
you a little bit our work and I would just leave you with the question of how can we
continue to partner between academia and the sort of creative types like I think you can
see we have in our shop and certainly the Compassion Team that Facebook quite fabulous
name that is. It makes me want to call our whole organization
the Compassion Team. But how can we continue to work together? How can we continue to drive a faster process
of dissemination and implementation of what’s working? Thank you. GUADAGNO: As we’re getting that setup, I’ll
just briefly say thank you so much for the invitation to be here. I’m so honored to speak with all of you and
share what we’re doing. We all are doing such important and meaningful
work in the world. So, I’m excited to share a little bit more
about what we’re doing at Facebook. I’m not sure how many of you are wondering,
you know, what’s Facebook doing here, why Facebook, how do we fit in? So hopefully, I’ll able to walk you through
a little bit about the experience that we’ve been building in that mental health suicide
prevention space. So, as Jeff very well set this up, I’m part
of the Facebook Compassion Team. And so, it’s a smaller team within basically
many, many different teams. And our team’s mission is to support people
through sensitive life moments and enhance wellbeing in their lives. So, as I like to think of it about — as I
like to think this is really, you know, people experience different things throughout their
lives. We all know many different challenges and
given that social media is such a big part of people’s lives these days, many of these
experiences now show up online or on Facebook. So when these things happen on Facebook, show
up on Facebook, how do we as Facebook support people through these experiences or provide
resources that may help? And also, the two parts here, I’ll also leave
it also as almost an intervention side and prevention side. So the intervention side being that these
sensitive life moments are already happening, they’re already occurring, people are going
through it. So how do we possibly intervene, provide some
resources as this is happening to provide some support? Whereas the wellbeing side, this is more proactive,
more prevention-focused, what do we do, what could we possibly do to help people before
things get so bad and before they are in the moment of crisis or distress? And this is an ongoing effort and investigation
for our team. And so, some of these difficult moments that
we’ve worked on have included things like death of a friend or a loved one, so what
do we do with people’s accounts when somebody dies, passes away? Suicidal thoughts, I’ll be sharing more with
you, all about breakups. So, how do we support people when people break
— have a romantic break up or just a tiff with a friend that they may have ruptured
some relationship with and need a break from seeing or interacting with person online,
interpersonal conflict, people not getting along, illness and injuries? We’ve done a lot of work around support groups
and helping people through these different experiences and bullying, especially in the
teen space. How do we support teenagers who have experienced
bullying online or on Facebook? And so, I want to really emphasize this point
that a lot of this work is — all of it is done with expert input. So, you know, we on our team have some internal
experts or expertise in these areas. Many of the people on my team have graduate
degrees in these areas. But in addition to that, we work very closely
with people, researchers much like yourselves, practitioners who are designing these interventions,
people who are in this space doing this work, who are experts in this space. And so, we harness some of the technology
expertise and you all harness all of the knowledge-based expertise and as was mentioned by Lisa, how
can we work together. And this is something we do a lot. How can we mend those two to really provide,
really, the best support we can at this scale that we as Facebook can. So this has been hugely important for all
of our work and just made it really academically sound and how do we, you know, implement evidence-based
practices and support to really help people in need. So, I’ll share a little bit about the suicide
prevention work that we’ve been doing. So, why we focus on this? How we got started? I’m sure as many of you know or all too familiar,
this is a really huge problem. You know, the CDC rates all-time, 30-year
high. It’s really a problem and we need an innovative
solution. And so, what we’ve heard from a lot of the
experts that we worked with from science is that social support is really, really helpful
when it comes to preventing suicide. So, having a friend reach out, whether that
be sending a text message, calling, writing on their Facebook wall, sending a message,
this sort of outreach is really helpful for those people. And given that Facebook is a place where friends
and family are connected, we thought we had a role to play here. So how can we best support people who are
in distress, connect them with their love ones and friends to write some sort of support? And also, how do we help the people who – the
concerned friend, the people who are seeing these posts, who are interacting with her
may know somebody who is distress really help them in the best way that they can. And so, again, this has been a very collaborative
project. Though the things that I’ll show you have
been more or so developed in the last year or two, this is initiative and effort has
really started 10 or 11 years ago, pretty much right when Facebook started. Given that, this was a noticeable problem
that came up early on and really wanted some ways to support people right away. So, we provided some preliminary support in
forms of providing a helpline for people to reach out. But as you’ll see, we provide a much more
of a support as the years have went on, and like I mentioned, really collaborating with
experts in this space. Some of our strongest collaborators have been
at the University of Washington, people who are doing this work and leading intervention
and leading trainings on suicide prevention and, you know, learning the best practices
from them and as well as internationally. Given Facebook thinks at an international
scale, everything that we do, we have to also think about how the rest of the word is experiencing
these issues, so also working with partners and people around the world. And also, one of the other big parts of this
work that I feel most fortunate to be able to do is really talking with people who have
involving people with load of experience, so talking with people who have been through
this. And these people that we have talked with
have been really instrumental in every step of the way. So, from the start of, you know, we want to
do more for suicide prevention, what should we be doing? So going to them, what are you going through,
how are you experiencing this, how are you experiencing this online, what do think would
be most helpful? So just getting, you know, big sky ideas and
just learning what’s most helpful. So then turning that in with our designers
or engineers on what we could build, taking that, building something, taking that back
to people who have experienced and then writing that by, you know, what do you think of this
language, what do you think of this design, what do you think of this interaction, and
really getting in some great feedback along the way that really helps us iterate and really
make sure the products and experiences that we’re building are truly meeting and matching
people’s needs. So, the suicide prevention support experience
is the — we’ll talk about now have two main parts. So the first is the support for a concern
friend. So this is really where it all starts. So a person who has seen a post — so I’m
not sure how many of you all around Facebook or have seen hopefully not many of you have
seen a post like this. But this is an example of post of something
that maybe concerning or somebody expressing some suicidal ideation. And so, if a person — if you’re on and you
see — a person sees this, they can click this little arrow, upside (ph) an arrow there
and get few options. So, sorry, this is a little bit small but
I can walk you through it. So this is something that we’ve recently provided
more options here, more robust support for the person, this concern friend, the person
who wants to help somebody in need. So at first, we call out, you know, this is
immediate danger, an eminent threat, please reach out to local authorities. That’s your best bet at this point. The next options here are to reach out to
the person in need. So here is a way to quickly send a message
to that person in distress, you know that social support is so helpful. The next two options here is that the person
who is concern can reach out to another friend maybe to ask, hey, how do I help deal with
this situation? The third option being some tips and support
for — on our help center page that walk people through the best things that they could say
or should not say. And what we heard a lot is that people who
are, you know, have friends who are in distress seen this type of thing, contact from people
really want to help but they’re not really sure how. They’re not really have the words or know
exactly what to say or worry about finding somebody or not sure that they can help. So, providing some information about, you
know, this is something that is, you could say that the person might find helpful, so
to better equip them to support their friends in need. And the last option here is the option to
flag it into Facebook. And so, people can do any of these options,
all them, none of them. But this last option here if somebody does
flag it into Facebook, it sends to one of our teams, and so we have a team that works
24/7 everyday around the world that reviews every single one of these reports that comes
in and will assess if it is a credible suicide concern. And if it is, the next time that that person
who posted, the concerning content logs on the Facebook, they’ll be shown a set of resources. So, this is then the experience that this
person will receive. So, again, the person posted something that
was in distress, the person who was in distress posted something about that distress, it gets
flag into Facebook and now we provide some resources. So instead of — when you open Facebook, instead
of your normal newsfeed coming up and what you’re expecting to see, this sort of experience
will pop-up. And so, it starts out by saying someone saw
your post and is concerned about you. If you may need some support here, some options. So letting them know why they’re seeing this,
where it’s coming from, they can click in to see the post if they need to understand,
you know, what exactly is triggering this experience here. And, one of the things we really wanted to
emphasize here was that, this is totally optional. So, though we are showing to it people, you
know, when they first come on to Facebook, they can quickly get past it at the end. So really understanding that people may not
want to see this, may not want to see it from Facebook, may not want to see that this time,
so they can quickly move past it. But for the people that may want some help,
who may want some tips, this information is here that they can interact with. One of the other things that we wanted to
do is provide a couple of different options. So, as I mentioned, what we had before was
just a helpline number to the National Suicide Prevention Lifeline which is great. And we decided or we thought, you know, we
could do so much more. And in talking with people who lived the experience,
you know, they referenced all these different things and, you know, some people may not
feel comfortable calling the helpline but they would want to reach out to a friend or
some people would just want to do something themselves in their own room where they are
now. So, how can we provide some different options
that may meet most people where they are? So, I can just quickly walk through some of
these options and what was included behind each them. So, if you’re going to contact a friend, you
get this option here to select a friend. And so, this is again where the expert input
and talking to people who lived the experience was so very helpful because in a normal experience
where we have somebody pick a friend, we would normally just show people their closest friends
like assume, hey, we think these are people you may want to interact and then talk to. But talking with people, we realized that
sometimes these closest friends are the people that could be involved in the distress that
the person is the experiencing. So, we don’t want to advertently cause any
more harm when we’re trying to support somebody through this experiences. So really, we wanted to take a more neutral
approach and just have an alphabetical person that people could pick from. Once they’ve selected a friend, they can go
in and write message to that person. And so, this is, again, inspired by people
who with the experience and that often we heard they wanted to reach out but in that
time of the distress, just didn’t have the words just to know exactly what to say to
this friend, choose somebody to get help, to express where they are coming from. So, we worked with many different people to
craft a message that could at least start this conversation. And this could be sent as is, it could be
completely erased, it could be edited, it could be added to, but at least people have
a baseline of something they can start with to maybe reduce that first barrier or hurdle
for reaching out for help. So, the second option here contacting the
helpline. So, here, pretty straight forward, we have
options to call the National Suicide Prevention Lifeline and also added the additional option
to text us. We’ve heard a lot that some people may not
feel comfortable talking on the phone, but maybe more feel comfortable typing and texting,
so have, you know, both options readily available. And the last option here is the tips and support. And so, we wanted start here with a moment
of pause, just a screen encouraging the person to take a breath. And they could run pass this really, really
quickly or spend quite a bit time on it. We’ve seen both happen in the experiences. But, you know, you could take a moment to
watch kind of the clouds go by, the steam come up. Or if you didn’t like that, just click right
through and gets more tips. And so these were created in partnership with
many different organizations and people who lived the experience on things that may help
them kind of have a moment where they’re just thinking about something else even for one
brief moment or second. So, providing some options and things that
they could do. And I have another here screen here that’s
not listed but it ends with some more options including videos of people who lived the experience,
who have been through this and what they’ve gone through. It’s good that we heard that that was so powerful
and moving for a lot people to hear about people who have that experience themselves. And also more links or to have resources and
support that people can get. And so, just to end that out, you know, we’re
— we just launched that globally. It’s been out in the United States for the
last year, but in the last month really set across the world. And we’re really excited to see how people
are using it, learn about it, iterate on it, see what we could be doing differently. And the real goal, that was, you know, you
know, really just planting a seed of things that people could do to provide some support
or get some help for themselves, not necessarily to treat them to make all better. You know that’s a much bigger, takes many
more people and services to facilitate that. But really, this is one step that could provide
some sort of hope or some actions in that– toward that direction we feel good about it. So just take close up, some other topics that
we think about which I’m really curious, hopefully during the Q&A can get some of your feedback
and thoughts on some of these things. But, first is just awareness for us at Facebook. And so, we built these products and experiences
and we want to make sure that they’re used, they are reaching the people that are most
in need of reaching them. And so, how do we make sure that people that
are in need are actually seeing these things? You know we do have great scale but even so,
we as Facebook have some trouble sometimes making sure that people who need it most are
seeing it best. And with that measurement and evaluation,
so we do a lot of measurement and evaluation internally on the research team with all the
products and experiences that we built up for Facebook and this is no exception. So, we’ve done many qualitative investigations
of this, more survey work around this. But, it’d be really interesting to know, you
know, how do we measure the real world population impact of an experience like this. So, really are less people dying by suicide
from this experience or any other ripple effects that are important and meaningful on evaluation
criteria? And if — how do we make sure that these experiences,
how do we — what can we change, you know, what we can add to increase this real world
impact. And prevention. So I mentioned this a little bit at the beginning. And this is a newer area for our team that
we’re just starting to think about. But really, you know, these moments, this
experience is for the person in distress is for the person in crisis. How do we reach that person earlier on when
they’re depressed, when they are having, you know, a couple stages earlier in the funnel,
and for many different experiences as well not just suicide. It’s something that, as I mentioned, we’re
currently thinking about. We’d love to hear, you know, put on and see
what we could do and possibly do together. And the other thing that I think is really
exciting is how we at Facebook can empower other people much like yourselves impact by
leveraging the Facebook platform. So, I think our really great example of this
is Daphne Watkins at the University of Michigan. And she has this project called the Young
Black Men Project where she uses Facebook support group. So this is — you know, these are groups that
are already available on Facebook. Anyone can create a group. But she’s chosen to leverage this by really
doing an experimental intervention using these groups for young black men, talking about
mental health, mental illness, masculinity and really providing education to people as
an intervention using Facebook groups where, you know, you’re able to access people where
they are, and have, you know, the scale available to you. So really curious how this sort of thing could
be leveraged by many more people and what we at Facebook can do to help support that
or even add some different products and services that may be able to help with those endeavors. So, that is what I have today and I’m really
looking forward to question and answer and hearing from all of you, you know, part of
all if this. Thank you. SCHLOSSER: All right. I’m glad they made it really freezing in here
so none of you guys can fall asleep. So, I am not going to talk about one thing. I’m going to talk at a higher level about
how technology can help us address so many of the challenges that we’ve been talking
about this morning. Actually, when Susan and Mike talked to me
about giving this presentation, they said, you know you’ll be successful if people get
mad at you because you’ve shaken them up. So, don’t throw anything at me. So, the challenge we’re contending with is
so large. We have a problem where one in five adults
in this country is struggling with mental illness. And although we take depression, a condition
in which we’ve had decades of research and development on learning what works, it’s risen
from the fifth leading cause of disability in this country to the leading cost of disability. And then we have serious mental illnesses. I do a lot of work in early psychosis. It’s also a huge driver of disability worldwide
even though the prevalence is only around 1 percent. So what is driving this disability? What we see is people are not accessing care. We have nearly three quarters of people with
depression are not receiving treatment, 50 percent of people with schizophrenia are not
receiving treatment. We also have a very serious problem that I
know we’re working diligently on but the duration of untreated psychosis for instance is one
to three years in this country. And the folks who are affected most prevalent
on this are the young people who are developing these illnesses at a very young age. Until — I would say this is a real critical
period of development and if we don’t intervene during this early time, we see lifelong problems. And one of the challenges is we don’t always
have these signs that are very clear that something is wrong. Another challenge is how do people get introduced
to care? So, the most common introduction to care for
serious mental illness is unfortunately emergency care or from the police. You know, I got a call the other day from
a mom in Memphis, Tennessee and her son is 22 years old. He is going to college, really great student. I have a quote here. And when he became psychotic, he was not willing
to talk with anyone about his symptoms. He ended up getting in such a state that he
ended up going into the street, he laid down, a car stopped and he got confused. He got in the car. He thought it was his ride, end up getting
pulled over by the police, arrested. And that’s how he learned he has psychosis. So a very traumatic experience. So the family was looking for another way
that they could access care that wasn’t associated with the health care system actually. So they were interested in some of the work
we’re doing which I’ll tell you a little bit about. So, what are some of our challenges? Well, we have a real serious problem with
— it’s good to memorize most of this talk because I can’t see it. But we have real challenge with limited access. So, they’re just straight logistical challenges
people got to work, there are cost issues. Another issue is with providers. I love hearing the work you guys are doing
at training because a recent IOM report came out looking at the state of psychotherapy
in this country and they found that, A, we don’t have enough providers trained in evidence-based
practices. And the ones who are trained, they’re just
too few of them, so — and then how do we sustain their knowledge? So I love that you guys are using technology
to address that issue. And then stigma isn’t enormous. I love hearing the keynote today, all the
creative solutions that weren’t necessarily technology solutions of how we can help people
not feel deterred to seek care because of the stigma associated with mental illness. So, I think that we can do better and I think
if we think about a series of questions and I don’t want to take it through some examples,
not necessarily with my work but a lot of good folks in the community. First, what I want to ask is what if we could
identify individuals who are at risk before they end up in emergency care? So, we have MHA represented here today, Mental
Health America. They’ve been doing great work to advocate
for people who are struggling with their mental health and they have put a series of gold
standard, mental health screening tools available online for free, and the depressions. They also just added the PQB, so we’re going
to all these psychosis screener online about 10 months ago. So, are people completing these screeners? What do you think? 1.5 million people have completed the screeners
since 2013. I mean, that’s just astounding. I was blown away. Good work you guys. And then psychosis, you think old people,
you know, that’s such a stigmatized condition. Well, they’ve had over 26,000 people complete
the PQB in the last 10 months. And enormous numbers of the people completing
the screenings also have depression. What’s remarkable is these people are suffering. There’s such a high rate of positive, so people
who are struggling, moderate to severe level of depression and screening positive who are
being at clinical high risk. But get this, how many of them want to be
referred to see any of you guys or me? Only a quarter of them. So, they are suffering but they do not want
to come into the hospital. They don’t want to get a referral to care. Yet when we asked them, would you like an
online option? Would you like a mobile treatment tool? We have 50 percent of people saying yes, I
will take that. So there’s something going on here, where
the idea of seeking care in a traditional health care setting is a deterrent or at least
something they’re not ready to do even though they’re suffering. So what if we could deliver treatment to individuals
the moment that we identify that they’re at risk? I love the work you guys are doing at Facebook. It’s certainly an example of how they’re trying
to do that. How about crisis text line? Anyone in this room, anyone in the United
State can text 741-741. You will get immediate access to training
crisis counselors. They will give you support through your phone,
24 hours a day, 7 days a week. You do not have to pay for the service. And get this, they have received nearly 20
million message since 2013. There’s something very appealing for – and
most of their users are young people. So, they do get some demographic data on this
population. Many of them are strugglin with depression,
suicide. They report that each day, they make a rescue. So, what that means is they take somebody
who is at imminent risk of hurting themselves and get them to a place where they are no
longer at risk. This is remarkable. And this is just a quote from someone who
— a client who’s been working with us in our research study where he was at risk of
suicide when he came into our user app called Prime, our mobile platform. His life was in shambles. He said he was ready to blow his head off. And he said, you know, it’s funny how just
connecting with other coaches, other people on an app, they gave him hope. They made him feel like this was not the outcome
he was going to have to contend with. So a question I’ve asked is, what if we do
not require consumers to become patients in a health care setting to receive mental health
services? This is some work we’ve done at UCSF at my
lab. We asked, how might we design a new treatment
experience for young people with psychosis? We did partner with a lot of folks. We worked with IDO, the Design and Innovation
Firm, and we engaged stakeholders, young people with psychosis, treatment providers, research
experts to help us design a new experience that would make young people want to get some
help from us. We’ve expanded the platform and been testing
it in number of NIH funded trials. So what do we learn when we are doing the
design research? We learned that individuals with schizophrenia
strive to have a really healthy relation with this diagnosis but they do not want to constantly
reminded of it. Who would? You know, we do not want to be defined by
our illnesses. You know, people sometimes use the word schizophrenic
and I correct them. And they said, what’s the problem? I say, well, you are not your illness, you
know, and no one wants to be their illness. That is what we heard from the young folks. So when we were thinking about how can we
design a treatment experience, we had to keep in this mind, not an easy feat. So, what do we — so we needed to not lead
with illness, and instead what we wanted to do was inspire changes to improve quality
of live through a tone of happiness. This is just a high level view of – that
we created the social media platform that was for young people with psychosis. They do use Facebook. They do use other commercially available platforms
but they really wanted a community that was safe and for them, you know, the same – it
was this interesting ambivalence where they didn’t want to be defined by the illness yet
they wanted a community where they can be with others who are relatable. And so, we really embrace those tenets of
not leading with illness in every aspect of the treatment experience itself. So what happens when you provide a different
treatment experience for young people with psychosis? We’ve just been testing this in some preliminary
trials. So, I don’t know yet. But so far, what we’re seeing is very high
retention rates, I mean 93 percent retention in our CT which is very high for this population. We also are seeing this remarkable finding
where two-thirds are self-referred. I mean, this is just — you just don’t see
that in early psychosis research. And one of the ways we’re seeing that is we’re
doing online recruitment as well where it’s a remote clinical trial. And we are seeing gains and outcome. But what I want to say is the intangible outcomes
are the things that make me feel really good. So we got a letter from a mom. Her daughter joined our trial. And afterward she said, “I wish you could
have seen Anna’s first response to seeing the faces and profiles on her phone. She looked at me and said, ‘Everyone looks
normal and everyone looks like you and me,'” the people that you see every day. I can’t read it you guys, I’m sorry. I can’t see. But basically, what we did is we — it was
like she looked at hope, you know, and found hope in the mirror. And that is exactly what we need to do when
we think about how we can really harness technologies that really provide a different experience
about what it means to be living with a mental health issue. So, I think we can do all these things. I think we can address these issues of access. I think we can intervene early on and these
are just a few examples but, you guys, there are so many others out there. And so, I think it’s a really exciting time
where we can partner with technology leaders to really transform care in this country or
around the world. And so, what I want to promote is a digital
system of care. I think that if we can move immediately from
when we identify that people at risk to support, we’re going to see dramatic changes in mental
health outcomes in this country. And then also, I think that we can improve
and not just equivalent levels of benefit from what we’ve seen in person care but I
think there are innovations and technology itself where we can optimize the effectiveness. But really what we have to do is as partner
I guess that’s a big take home today. You know, we can be — we could be some of
the thought leaders from the scientific perspective, but we have to partner; you know, in my case,
we did it with IDEO. We did with it a development company and then
also NIMH was brave enough to let me develop a social media platform for people with psychosis. There were a lot of questions and concerns
about it but we were able to do it and so far it seems to be working. So, thank you. HAIM: OK. Thank you all for the great presentations. I don’t think I’m on here. Can you guys hear me? Oh, thank you all for the great presentations. Why don’t we open the floor to questions? Anyone who has questions, please come up to
one of the microphones and hope that it’s on.

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