From role-play to situated feedback: re-envisioning child mental health promotion interventions with digital technology

Lead Research Organisation: King's College London
Department Name: Informatics

Abstract

The aims of the fellowship are to examine how emerging technologies can fundamentally re-envision the conceptual models and mechanisms-of-delivery for existing prevention interventions in the context of child mental health. Such an innovative approach is needed to address the unprecedented mental health treatment gap faced across the UK and worldwide: more than 1 in 10 children and young people have a clinically diagnosable mental health disorder, yet only 30% have had access to appropriate intervention, and less than half of these improve from the treatment. Mental health promotion interventions are seen as one of the principled ways of addressing these issues: by developing key protective factors (such as emotion regulation or parenting techniques) for both at-risk and general populations, such interventions can improve wellbeing and reduce the incidence of mental disorders. However, even the most effective programmes are still dependent on in-person delivery techniques and intervention mechanisms available since the 60s, thus lacking scalable mechanisms to support children in the everyday settings where protective competencies are needed, and being developed.


The core vision proposed by the fellowship research agenda is that digital technologies can lead to entirely new model of prevention interventions that are fully incorporated into the lives of target populations, thus addressing the need for situated learning support. However, beyond PI's pilot work, HCI and Prevention Science fields lack even a basic understanding of the fundamental research questions necessary to deliver such situated interventions: it is not at all clear, for example, how to design technologies that provide useful contextualised support for children and their adults around protective competencies (technical RQs), how to do so in a psychologically effective way (psychological RQs), and how to design interventions that are engaging for users and are addressing their immediate needs (socio-technical RQs).

The fellowship takes up these challenges and lays out an ambitious programme of work designed to start unpacking these broader issues at the intersection of technology, psychological theory, and human-centred design. We address such highly interdisciplinary agenda by grounding the work in specific case studies that target fundamental protective factors for child mental health --- emotion regulation and positive parenting --- while encompassing all of the issues outlined above. The case study interventions then serve not only as exemplar proof-of-concept of how situated interventions can be developed (and shown to be efficacious), but also as initial steps towards extrapolating the psychological mechanisms and design patterns that are generalisable to other populations and protective factors. By focusing on carefully selected case studies---complemented with a strong interdisciplinary mentorship network across KCL, Oxford, Stanford, Harvard, Northwestern U, and U of Michigan, among others--- the ambition is to not only create effective interventions that can be deployed at scale, but also influence the wider research communities, and contribute to the UK and EU policy calls to deliver new approaches for mental health promotion.

PI's personal and career growth will be substantially boosted by the fellowship. Beyond enabling a full cycle of truly interdisciplinary work, which would traditionally span a range of UKRI panels and epistemological commitments, the fellowship structure will facilitate a network of academic and clinical partnerships across a range of leading research centres worldwide, developing the basis for PI's interdisciplinary thought leadership for years to come. These will include, among others, long-term residency at Oxford; as well as close collaboration and repeated visits to US-based mentors (Harvard, Stanford, University of Michigan, Northwestern University).

Planned Impact

The fellowship aims to develop a fundamentally novel model of situated intervention delivery to start addressing the key challenges of scale, impact, and reach faced by existing prevention programmes; enabling a wider shift in how prevention interventions are conceptualised and designed. We have identified 3 key impact objectives to contribute to this long term goal, both during and beyond the duration of the fellowship: >> (1) Transfer of proof-of-concept research prototypes to large scale deployments. A crucial focus of the fellowship work is not only to envision novel intervention approaches, but also enable their real-world application and wide deployment, beyond the duration of the fellowship funding. A range of project partners and research plans are in place to support this process: - In depth engagements with clinical partners (KCL, UCL, Stanford, Georgetown) to enable rigorous validation of the proof-of-concept interventions, enabling their transfer to clinical practice. - We will partner with Committee for Children (leading US non-profit developer of SEL interventions used in over 70 countries worldwide) and Silvercloud (online mental health treatment platform used by NHS among other partners). This provides the team with access to two parallel pathways to real-world, large-scale deployments beyond academic settings. - Finally, a partnership with Westminster City Council provides a pathway to local impact and exemplar council deployments for developed interventions. >> (2) Influencing wider research agenda to impact provision of mental health interventions. The impact of the newly developed situated intervention models will be further compounded by rapid dissemination and their application across clinical and research environments beyond the immediate PI's mentorship and collaborators' circle. To support such dissemination, the PI will: - Dedicate at least 5% of his time to serve as an expert advisor to external research groups-across disciplinary settings to apply the emerging conceptual ideas to other related projects. This will speed up transfer of knowledge, develop interdisciplinary community of researchers and clinicians, and lead to follow-up funding ensuring the sustainability of the broader research agenda. - The open-source toolkits, developed in years 4-7, will further support the cross-disciplinary collaboration. Through a range of engagements, we will facilitate the uptake, use, and development of new interventions based on the toolkits for at least 15 research and/or clinical groups worldwide. - Finally, the mentorship and collaboration arrangements with world-leading academics will provide a platform to influence the conceptual models and mechanisms of delivery within the research communities broadly; including publications in high-impact journals and workshops/panels at leading conferences. >> (3) Sustainable economic and public sector impact. The ethical and policy implications of IoT technologies are stark, especially in a sensitive context such as mental health. We will draw on the responsible innovation (RI) approaches as outlined in the proposal, to provide a unique opportunity to foresee and deliver an `anticipatory governance', impacting relevant policies as the notions of embedded, situated mental health interventions are first examined and developed. The PI will utilise the ongoing Oxford secondment to draw on Prof Jirotka's and Prof Shadbolt's expertise in engaging with and influencing policy in the UK and elsewhere. Finally, we will utilise both internal (IAA) and external grant mechanisms (Innovate UK and KTP) to support transfer of knowledge to local start-up companies in this space: we will work with start up incubators (such as Promise Ventures
) to identify suitable companies, and then develop competitive proposals (such as at least 5x Innovate UK) to facilitate academy-to-commerce knowledge transfer.
 
Description Adolescent Mental Health and Development in the Digital World
Amount £3,935,073 (GBP)
Funding ID MR/W002450/1 
Organisation Medical Research Council (MRC) 
Sector Public
Country United Kingdom
Start 07/2021 
End 08/2025
 
Title Remote, ongoing co-design methods to co-produce mental health interventions 
Description We are developing a new constellation of online tools to enable young people to more efficient provide suggestions, feedback, and co-produce mental health interventions. These consist in a set of co-design approaches that enable asynchronous participation and situated feedback by the young people, over multi-week periods ... thus enabling iterative, on-going support for the research team that ensures young people have an active voice in the interventions designed for them. Practically, we are using free-for-academics resources (GatherTown, Miro, GoogleDrive), combined in innovative ways to enable asynchronous and remote co-design experiences. 
Type Of Material Improvements to research infrastructure 
Year Produced 2022 
Provided To Others? No  
Impact These methods are being developed as part of the SSI collaboration project, and have contributed to a Single-Session Intervention that is more likely to be appealing and effective to the target population. We are also incorporating these approaches to other upcoming research studies within the group. As part of this work, we have already started discussion with other clinical groups (Prof Schleider, Stony Brook University; Johan Bjureberg, Karolinska Institutet) to explore how these methods can be used more broadly. We are also in ongoing discussions with the PPI groups within a recent MRC Programme Grant on Adolescent Mental Health (led by Profs Townsend & Hollis, Nottingham; myself co-I) in making these available to all work packages as useful. 
 
Description Design and execution of RCT trial on innovative child-oriented emotion regulation intervention 
Organisation Stanford University
Department Department of Psychology
Country United States 
Sector Academic/University 
PI Contribution As part of my fellowship, I have convened a group of experts across basic psychology, clinical psychology, and innovative methodologies (mRCTs) to help design and execute a Randomised Control Trial on an new intervention model which has emerged from my team's prior work (Purrble). I have led and project managed the work of the group, throughout the process of study design, pre-registration and protocol paper development, RCT execution (in collaboration with CfC), and the data analysis.
Collaborator Contribution The research partners (all professors) provided expert support on methodological and psychological decisions outside of my expertise, such as helping design and validate a bespoke set of EMA measures, providing input and suggestions on an intricate study design, and providing data analysis. Committee for Children has funded the study pragmatics, including access to their warehouse, research staff, and coordination, enabling us to deploy research units to more than 130 households across US, as well as collect daily and weekly data from all participants as part of the Randomised Control trial.
Impact - Peer reviewed protocol of the RCT study (An In Situ, Child-Led Intervention to Promote Emotion Regulation Competence in Middle Childhood: Protocol for an Exploratory Randomized Controlled Trial -- see publications) - Collected RCT data (1 months of daily data collections, in addition to a 1-month and 6-month follow-up). Data analysis and write up of the study is ongoing. The same team is currently preparing a follow-up RCT, with the promise of an additional funding from CfC (~$100k, to be available in May 2022). Strongly multidisciplinary: - Human computer interaction (user-centred design) - Psychology (emotion regulation) - Prevention science (child protective factors)
Start Year 2021
 
Description Design and execution of RCT trial on innovative child-oriented emotion regulation intervention 
Organisation University of Illinois at Urbana-Champaign
Country United States 
Sector Academic/University 
PI Contribution As part of my fellowship, I have convened a group of experts across basic psychology, clinical psychology, and innovative methodologies (mRCTs) to help design and execute a Randomised Control Trial on an new intervention model which has emerged from my team's prior work (Purrble). I have led and project managed the work of the group, throughout the process of study design, pre-registration and protocol paper development, RCT execution (in collaboration with CfC), and the data analysis.
Collaborator Contribution The research partners (all professors) provided expert support on methodological and psychological decisions outside of my expertise, such as helping design and validate a bespoke set of EMA measures, providing input and suggestions on an intricate study design, and providing data analysis. Committee for Children has funded the study pragmatics, including access to their warehouse, research staff, and coordination, enabling us to deploy research units to more than 130 households across US, as well as collect daily and weekly data from all participants as part of the Randomised Control trial.
Impact - Peer reviewed protocol of the RCT study (An In Situ, Child-Led Intervention to Promote Emotion Regulation Competence in Middle Childhood: Protocol for an Exploratory Randomized Controlled Trial -- see publications) - Collected RCT data (1 months of daily data collections, in addition to a 1-month and 6-month follow-up). Data analysis and write up of the study is ongoing. The same team is currently preparing a follow-up RCT, with the promise of an additional funding from CfC (~$100k, to be available in May 2022). Strongly multidisciplinary: - Human computer interaction (user-centred design) - Psychology (emotion regulation) - Prevention science (child protective factors)
Start Year 2021
 
Description Development of a bespoke Single-Session Intervention for clinically anxious university students 
Organisation Stanford University
Department Department of Psychology
Country United States 
Sector Academic/University 
PI Contribution I convened this collaboration as a follow-up on open-trial data showing that Purrble intervention could support clinically anxious university students (d ~ 0.9 on GAD7 measures over 6 weeks). The collaboration brings together Prof Jessica Schleider (a world-leading expert on single-session interventions) and Prof James Gross (leading researcher in emotion regulation). Our team has designed and carried out the open trial data, as well as project managed and led the single-sessions development (including substantive co-design sessions with target users), and drove the analysis and write up of the first publication. We have further led on the development of the SSI, with support from Prof Schleider's team (see below), as well as on a RCT study to test the resulting intervention (which is now in ethical review).
Collaborator Contribution Prof Schleider has advised the team on SSI methods, as well as dedicated approximately 1.5months of one of her postdocs to develop a core template for the intervention. Prof Gross has advised on emotion regulation theories, appropriate measures, and gave ongoing feedback on the intervention and study design.
Impact - Open trial data from Spring 2021. First publication accepted to CHI'22, will be formally published in May'22; another publication for JMIR MH in preparation. - Developed SSI bespoke to Purrble and university students (also first SSI to combine on-going physical support with cognitive SSI components) - RCT trial design, currently under review. Strongly multidisciplinary: - Human computer interaction (user-centred design) - Psychology (emotion regulation) - Clinical psychology (single-session interventions)
Start Year 2021
 
Description Development of a bespoke Single-Session Intervention for clinically anxious university students 
Organisation Stony Brook University
Department Department of Psychiatry
Country United States 
Sector Academic/University 
PI Contribution I convened this collaboration as a follow-up on open-trial data showing that Purrble intervention could support clinically anxious university students (d ~ 0.9 on GAD7 measures over 6 weeks). The collaboration brings together Prof Jessica Schleider (a world-leading expert on single-session interventions) and Prof James Gross (leading researcher in emotion regulation). Our team has designed and carried out the open trial data, as well as project managed and led the single-sessions development (including substantive co-design sessions with target users), and drove the analysis and write up of the first publication. We have further led on the development of the SSI, with support from Prof Schleider's team (see below), as well as on a RCT study to test the resulting intervention (which is now in ethical review).
Collaborator Contribution Prof Schleider has advised the team on SSI methods, as well as dedicated approximately 1.5months of one of her postdocs to develop a core template for the intervention. Prof Gross has advised on emotion regulation theories, appropriate measures, and gave ongoing feedback on the intervention and study design.
Impact - Open trial data from Spring 2021. First publication accepted to CHI'22, will be formally published in May'22; another publication for JMIR MH in preparation. - Developed SSI bespoke to Purrble and university students (also first SSI to combine on-going physical support with cognitive SSI components) - RCT trial design, currently under review. Strongly multidisciplinary: - Human computer interaction (user-centred design) - Psychology (emotion regulation) - Clinical psychology (single-session interventions)
Start Year 2021
 
Description Research agenda for the emerging field of HCI and Technology-enabled Emotion Regulation interventions 
Organisation Simon Fraser University
Country Canada 
Sector Academic/University 
PI Contribution I have convened a set of experts (Prof Gross, Stanford; Prof Isbister, UC Santa Cruz; Prof Antle, Simon Frasier University) to help synthesise the work on technology-enabled emotion regulation so far, to identify existing gaps, and to propose a research agenda for HCI and Psychology communities. My team has led on - the scoping review of existing HCI work, including papers published in HCI between January 2009 and December 8 2021, as primarily indexed across ACM digital library and IEEE; and complemented with an additional Google Scholar search; - synthesis of existing body of knowledge in psychology and learning sciences around emotion regulation; as well as - taking the lead on the write up of the results.
Collaborator Contribution Prof Gross (Stanford) has advised on the psychology aspects of the work, building on his established Process Model of Emotion (as the currently most commonly accepted emotion regulation model in the literature.). Profs Isbister and Antle have helped advise on HCI content, supported the scoping review, and will support the upcoming community building around the research agenda
Impact An extended review paper draft will be submitted to TOCHI by end of March 2022. The work has also led to invitation to a CHI'22 Workshop organising board -- this is accepted and will be published in May 2022: (The Future of Emotion in Human-Computer Interaction. Greg Wadley, Vassilis Kostakos, Peter Koval, Wally Smith, Sarah Webber, Kristina Höök, Anna Cox, Regan Mandryk, James Gross, Petr Slovák) Strongly multidisciplinary: - Human computer interaction (user-centred design) - Psychology (emotion regulation)
Start Year 2021
 
Description Research agenda for the emerging field of HCI and Technology-enabled Emotion Regulation interventions 
Organisation Stanford University
Department Department of Psychology
Country United States 
Sector Academic/University 
PI Contribution I have convened a set of experts (Prof Gross, Stanford; Prof Isbister, UC Santa Cruz; Prof Antle, Simon Frasier University) to help synthesise the work on technology-enabled emotion regulation so far, to identify existing gaps, and to propose a research agenda for HCI and Psychology communities. My team has led on - the scoping review of existing HCI work, including papers published in HCI between January 2009 and December 8 2021, as primarily indexed across ACM digital library and IEEE; and complemented with an additional Google Scholar search; - synthesis of existing body of knowledge in psychology and learning sciences around emotion regulation; as well as - taking the lead on the write up of the results.
Collaborator Contribution Prof Gross (Stanford) has advised on the psychology aspects of the work, building on his established Process Model of Emotion (as the currently most commonly accepted emotion regulation model in the literature.). Profs Isbister and Antle have helped advise on HCI content, supported the scoping review, and will support the upcoming community building around the research agenda
Impact An extended review paper draft will be submitted to TOCHI by end of March 2022. The work has also led to invitation to a CHI'22 Workshop organising board -- this is accepted and will be published in May 2022: (The Future of Emotion in Human-Computer Interaction. Greg Wadley, Vassilis Kostakos, Peter Koval, Wally Smith, Sarah Webber, Kristina Höök, Anna Cox, Regan Mandryk, James Gross, Petr Slovák) Strongly multidisciplinary: - Human computer interaction (user-centred design) - Psychology (emotion regulation)
Start Year 2021