Seattle Children's Scales Out its PRISM Connected Health Platform

Two years after piloting an mHealth app for children dealing with serious illnesses, Seattle Children’s Hospital is scaling up the platform to a much larger population.

The hospital has unveiled the new PRISM (Promoting Resiliency in Stress Management) connected health platform, designed to help young patients with serious health issues like cancer and type 1 diabetes – and their families - develop resilience skills to deal with the challenges that a chronic disease has thrown into their lives.

The redesigned app and mHealth platform, developed in a partnership with Artefact and the Seattle Children’s Research Institute and assisted by grants from Cambia Health Solutions and the Arthur Vining Davis Foundation, expands a program developed more than a decade ago to help hospital patients cope with chronic illnesses. The platform will first be made available to patients at 10 participating clinics, and eventually expanded to children’s hospitals across the country.

“Our goal is to reach as many young patients facing serious illness as possible, and evolving the mobile app for greater access is one path to attaining scale,” Abby Rosenberg, director of palliative care and resilience research at the institute, and Joyce Yi-Frazier, a senior clinical research scientist, said in an e-mail to mHealthIntelligence. “For example, we are exploring ways to make the app easy for other hospitals across the country to integrate into their care practices. We’re eager to hear from other healthcare organizations and funding providers who are interested in partnering with us to help PRISM reach as many patients in need as possible.”

Rosenberg and Yi-Frazier developed the app not as clinical tool, but as a coping tool for patients and family members who might otherwise feel overwhelmed. It’s designed to give users the resources they need to improve coping skills and boost resilience, forward thinking and quality of life while reducing clinical depression and the need for psychological intervention like therapy or medication.

They said they spent the past two years refining the platform after listening to those who’ve been using it.

“Designing any user-centered program begins with understanding user needs, experiences and preferences,” they said. “We started our work by asking teen and young adult patients with serious illness and their parents what they had learned about being resilient, what they thought would help other people like them, and what they think would be a doable program for future patients and families.”

“Over a series of projects, we learned that patient and parent ideas mapped onto existing theories of resilience - namely, that resilience is a process of harnessing the resources we need to navigate adversity, (and) that these resources are reproducible and teachable,” they noted. “They include personal resources (i.e., skills in stress-management and goal-setting), existential resources (i.e., skills in reframing experiences to make them less catastrophic and more manageable, and skills in finding meaning, purpose, and identity in the face of adversity), and community or social resources (i.e., identifying who helps us when times are tough). Because we were working with individual patients and families, we opted to target the first two sets of resources in our program.”

“Similarly, the next steps in our program's development included getting patient and family feedback about our design and, when we had it, the curriculum,” they added. “We asked users to try it and tell us what they thought. Then we confirmed that it was possible to deliver the program to teens and young adults with serious illnesses like cancer, diabetes or cystic fibrosis. And after that, we confirmed that it worked in a randomized clinical trial. All of this helped us design something people liked and would use. It also taught us that users really wanted something they could access ‘at their fingertips’ at any time. Hence, through that same process of listening to our stakeholders, we translated PRISM into a new digital app.”

Through the pilot program, hospital officials said they’d been contacted by other healthcare providers asking when the platform might be made available to them. They also realized, through dealing with the coronavirus pandemic, that other might also benefit.

“The COVID-19 pandemic has made us rethink our initial philosophy that PRISM was only for kids and families facing serious pediatric illness,” Rosenberg and Yi-Frazier said. “The demand for resilience-building is so great in our society at large, and the PRISM program has proven clinical impact that could help other high-risk populations as a primary community of use but secondary stakeholder groups as well.”

As a result, they’ve launched the PRISM At Work program, targeted at front-line medical workers, and are developing similar platforms for teachers and school children. To do this, they modified the app platform so that users could access the resources they need, rather than simply being connected to a care provider.

“The initial version of the PRISM app required in-person onboarding with an interventionalist from Seattle Children’s Hospital,” Matthew Jordan, healthcare practice lead for Artefact, added in the e-mail. “Yet not all patients have access to such care or want to sit with a specialist to discuss their emotional state. In order to scale the app to reach the greatest number of patients, we recognized that it needed to be an entirely self-guided experience. The updated app designed this year breaks down the patient onboarding experience with the value proposition of each exercise - in other words, demonstrating why, not just how, patients should use each element of the app.”

Rosenberg and Yi-Frazier said the platform might someday be integrated with other telehealth resources, such as care management platforms for people living with chronic conditions.