forest.
Background.
Long-term inpatients at hospitals can face a myriad of comorbid mental health disorders. The most prevalent ones are hypertension and depression, with projections indicating that by 2020, depression will become the most prevalent comorbid disorder. Multiple studies have confirmed that an individual in a hospital is more likely to face depression, most likely due to the stresses that come along with an extended hospital stay.
In short, long-term inpatients suffer from:
- Lack of meaningful interaction
- Loss of independence
The combination of these two factors creates an ideal environment for CMD to take root. How can we avoid these two factors?
Interaction
What do we mean by "meaningful?"
Patient care journals list a parameter known as self-perceived burden, which is how patients tend to view themselves as a burden on those they are communicating with. This can play a large part in leading to CMD. Conversations which patients perceive as a burden are not meaningful interactions, and therefore counterproductive to our goal of improving patient care.
By what means can a patient interact with others?
There are many ways, each with their unique pros and cons.
Converse with other people in the room (medical personnel, visitors).
This is the ideal form of communication, but it is quite hard to come by. Hospital staff are incredibly busy, and it is impossible for them to hold extended conversations with each and every patient. Some patients are lucky enough to have close relatives or friends as visitors, but often times the patient can feel as if they are being a burden on the guests, especially if these guests have jobs, errands, and activities to attend to.
Social media (Facebook, Twitter).
Social media is an excellent alternative to face-to-face conversation, especially due to the "equalizing" effect of the Internet, and the convenience for the other party. However, social media can be a wild card, as a patient's news feed is usually filled with pictures of their friends' interesting activities. This can be very demoralizing, as they cannot do anything exciting in their present condition.
To avoid the shortcomings of these interactions, we need a population of people who have plenty of free time, as well as an implicit respect for the physical limitations of a long-term inpatient.
Who fits this description better than other patients?
Indeed, this is where our app, forest, comes in.
Forest is a social network app designed for rest, not for activity.
Design Philosophy.
The design philosophy of forest is to give users as much independence as possible, while upholding strict privacy and safety standards.
Not all of these functionalities are implemented in their entirety due to time constraints, but the information given in this section details the result of continued development on forest.
Privacy and Safety
Although patients' use of forest is purely voluntary, adhering to HIPAA standards was a chief concern for designing forest, as we want to encourage patients to take advantage of the service as much as possible, and this will only happen if they are not worried about disseminating protected health information. Also, as access is only given to inpatients, users of the chat service are all actually patients.
Mental health is a very sensitive issue, and we treat it as such. Forest implements a "better-safe-than-sorry" approach to filtering offensive words and explicit content. Also, users have the ability to block other users, making that user's messages invisible to them. Forest is an awesome system for spreading positivity and kindness, which unfortunately makes it equally effective at breeding pessimism and malice, and we employ this system to protect users from the destructive outcome.
Independence
While in the hospital, patients have very little control of their lives. Their entire schedule revolves around whatever medications, procedures, and exams that they will have that day, and they are offered very little opportunities to make their own decisions. This is why giving the users as much independence as possible within the bounds of privacy and safety was our goal.
Usernames
Creating your forest username is simple.
- Choose an animal.
- Choose a color.
That's it! You're now signed in to forest. If someone else has chosen the same animal and color, you'll get a number at the end to distinguish yourself from the other creative folks who wanted to be "Red Bull" or "Orange Chicken."
Having just two degrees of freedom seems counterproductive to the philosophy of independence, but, indeed, this is the optimal middle ground between anonymity and personalization.
Curating your forest
Users can subscribe to interest trees, which contain top-level discussion about broad conversational topics, as well as user-generated branches which aim to discuss more specific topics.
Again, the ability to customize the topics they are interested in provides a way for patients to express themselves. Also, our terminology emulates a trek through nature, which can be soothing for long-term inpatients.
Connections
There are three unique trees:
SupportSuccessDirect Messages
Support and Success are entirely anonymous channels, i.e. even usernames won't be visible in these channels.
A patient, upon discharge, will retain access to Success and Direct Messages for one week. During this time, it is up to their volition whether they would like to post a farewell comment in Success and if they want to exchange permanent contact information with any of the users in their direct messages.
Support
A place for people to express their complaints and frustrations to others, promote healthy expression of emotions
Success
A place for those about to be discharged to say goodbye to the community.
Direct Messages
If two users form a more personal friendship in one of the chatrooms, they have to option to send a direct message to them. From here, these users can have a personal conversation.
Benefits.
Forest is well suited to urban hospitals with a small doctor:patient ratio. This is where patient need is the greatest. The use of forest can greatly improve patient satisfaction, which can lead to better performance on Press-Ganey surveys.
As per our mission, forest creates an environment for patients to socialize with a group of people that are empathetic to their current situation, and not feel like they are burdening their audience. By restricting access to only inpatients, we can minimize harassment and abuse.
Business Model.
Forest creates clear value for hospitals in the form of decreasing their healthcare expenditures, while simultaneously improving their patient’s quality of care. This is achieved through improved recovery times, patient short and long term outcomes, and quality of life during their stay. As a result, our business model will be to charge each individual hospital per average number of active users per month. More specifically, we would use a step-pricing program.
In order to penetrate the market we plan to create a pilot program in conjunction with an urban hospital. We would ask the hospital to cover the costs of setting up the program in exchange for use of the application for the extent of the trial. This program would be used to evaluate the efficacy of our app while simultaneously using the potential success of our program as the beginning of a marketing campaign.
Future Directions.
Accessibility features
As many inpatients may need to use accessibility features, our goal with continued development is to provide a comprehensive accessibility suite for these users. Examples include:
- Large text
- Speech to text
- High contrast
Deep Learning
Sent messages on forest can be used to monitor mental state of patients. With deep learning algorithms, we can train the computer to become more accurate at identifying early signs of mental health disorders based on their usage of certain flagged terms in forest. This is an incredibly important application, as catching signs of mental illnesses early can significantly increase the potential effectiveness of the treatment.
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