[HN Gopher] Launch HN: Daybreak Health (YC S20) - Online counsel...
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Launch HN: Daybreak Health (YC S20) - Online counseling designed
for teens
I'm Alex, one of the cofounders of Daybreak Health
(www.daybreakhealth.com) along with Luke and Sid. We help teens
feel better, build skills for life and achieve their goals through
online counseling. Our licensed counselors provide evidence-based
counseling to teens through online video sessions, messaging, and a
mobile app. The evidence supports that behavioral therapy like CBT
and DBT is effective. It works to treat diagnosable conditions like
anxiety and depression, and it also works to help young people feel
happier and achieve their goals [1][2][3][4][5]. But too often
teens don't get the mental health support they need because it is
stigmatized, difficult to schedule and attend, and expensive. At
Daybreak we bring counseling to the teen on a digital device and we
charge less than half the cost of a traditional therapy session.
In October of 2018, my younger brother nearly lost his life due to
the lack of accessible mental health resources supporting our young
people. He is not alone. 1 in 5 teens struggle with a diagnosable
mental health condition, but estimates suggest that up to 1 in 3
actually struggle with anxiety - or between 6 and 10M total teens
[6][7]. That means the odds are greater than 50% that if you are
the average parent raising a family in America with 2 kids, one of
your children will struggle with a mental health condition in their
teens. To make matters worse, 80% of teens who need mental health
support do not receive care today [8]. This results in
deteriorating academic performance, increased rates of juvenile
crime and substance abuse, and suicide rates that are at an all-
time high. Every day, 17 young people commit suicide in the US. It
is the #2 cause of death among 15-24 year olds, after accidental
injury and ahead of homicide [9]. This isn't a niche problem. Our
current system makes mental health support nearly impossible to get
for a teen. Stigma makes it hard to admit to yourself you want
support, let alone talk about it with your parents. There is a
shortage of therapists who specialize in adolescents, making it
hard to find a therapist that is close enough to drive to on a
weekly basis. Private practice therapy averages more than $200 per
session. Even if you could afford to pay, you're going to be met
with 2-3 month wait lists. And when you finally do arrive, you sit
on an awkward couch in an environment that you may not be
comfortable in. That is why an average of 11 years pass between
when a teenager first needs mental health support and when they
eventually start receiving it in their 20s or even later [10].
That is why we started Daybreak Health. Everything we've built is
designed intentionally for teens and their parents. Teens can
download the Daybreak mobile app and are instantly connected to a
live guide (Mon-Fri 7am-7pm) who asks about mental health goals and
needs. After a video assessment where we loop in the parent, we
create a plan and match teens with a counselor based on goals,
needs, interests, hobbies and more. Once matched with a counselor,
teens meet with them once a week through a 50-minute video call,
and can message them on a daily basis through the app. Our
counselors help teens develop emotional life skills and work
towards goals in a personalized plan that has thematic focus on
teen-specific areas like school, healthy relationships and more.
Teens can also meet with small moderated groups of other teens on
those same topics. And parents are a core part of the process,
starting with the assessment, through planning and regular progress
reports. For all of this we charge an $89/week subscription, less
than half the price of a single 50-minute session in traditional
private practice. Dr. Neha Chaudhary, our lead Clinical Advisor,
is a foremost expert on adolescent mental health and co-founder of
Stanford's Lab for Mental Health Innovation. Together with her and
experts from UCSF we have designed a program for teens grounded in
clinical science, while at the same time reimagining the way it is
delivered to teens. The core of our clinical program is rooted in
evidence-based methods like DBT and CBT, but we have taken these
approaches and brought them into an easily digestible online
experience. But there is a problem: stigma around mental health
stops people from sharing their great experiences with counseling,
so its benefit is under-appreciated. If you know any parent or
teens who might benefit from counseling, make sure they know about
its benefits. And if you have thoughts about how to solve the
awareness problem, or any stories you can share that may help us
better understand the needs of teens and parents, we would be
grateful. Thank you! Sources: [1]
https://www.sciencedirect.com/science/article/abs/pii/S00057...
[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3073681/ [3]
https://acamh.onlinelibrary.wiley.com/doi/abs/10.1111/j.1475...
[4] https://acamh.onlinelibrary.wiley.com/doi/abs/10.1111/camh.1...
[5] https://www.tandfonline.com/doi/abs/10.1080/0963823060118209...
[6] https://www.cdc.gov/childrensmentalhealth/access.html#ref [7]
https://www.nimh.nih.gov/health/statistics/any-anxiety-disor...
[8] https://www.cdc.gov/childrensmentalhealth/access.html#ref [9]
https://www.nimh.nih.gov/health/statistics/suicide.shtml [10]
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1361014/ Visit us at
www.daybreakhealth.com
Author : alexalvarado
Score : 38 points
Date : 2020-07-27 15:13 UTC (7 hours ago)
| eganist wrote:
| This is cool. Do you have any documentation around the security
| controls implemented to protect sensitive communications between
| patients and therapists? Among others? I presume this is
| ultimately still protected information under HIPAA
| alexalvarado wrote:
| Thanks. This is an important question. You are exactly right
| that under HIPAA, there are a few basic data protection
| requirements. These encompass administrative, physical and
| technical requirements. A few examples of the technical
| requirements: all protected data must be encrypted at rest and
| in transit, each medical professional authorized to access PHI
| must have a unique identifier to monitor access, and automatic
| log-off must be implemented to protect data. We've architected
| from Day 1 to be able to meet these needs. You can read more
| about HIPAA requirements here: https://www.hhs.gov/hipaa/for-
| professionals/security/laws-re...
| btown wrote:
| Amazing - you all are doing vital, lifesaving work! Curious -
| did you determine that you needed to use any existing
| software systems to help with regulatory compliance, such as
| any big-name EMR solutions and/or single-sign-on with the
| same? Or were you able to meet HIPAA requirements with
| standard web application tools & stack? Do you feel any
| choices of language, database, even things like advisory
| board, etc. made this easier to do?
| alexalvarado wrote:
| Working with existing software systems make this compliance
| much easier. Many of the big name service providers
| (Twilio, Sendbird, Auth0, Heroku, AWS, etc) have out-of-
| the-box HIPAA compliancy. And working with an EMR is
| tablestakes for a healthcare provider, we definitely did
| not build that from the ground up! Our work is about
| bringing these solutions together into a unified UX and
| ensuring compliancy / security across the stack, while
| gradually introducing secure and compliant native
| functionality. Language itself does not have a huge impact
| (we've seen it done in many different languages), but
| having the right advisor can make the build process a lot
| easier if they know what to look for!
| tkt wrote:
| Thanks, this is a vital service, especially now when many teens
| are struggling and virtual is the only option. Designing
| specifically for virtual may be an advantage over therapists who
| usually work in person, but are now trying to do the same thing
| online, but may see challenges in adapting their approach. I
| didn't see this on your FAQ. Can your counselors prescribe
| medications, or make referrals if they think it may be needed?
| alexalvarado wrote:
| Thanks for the kind words! We do believe designing for virtual
| first offers a lot of advantages vs. tacking it on to a
| traditional practice.
|
| You ask a great question, and we'll add it to our FAQ. We
| currently refer out for the medication prescription needs, and
| are evaluating bringing the capability in-house.
| archarios wrote:
| Are y'all hiring JS devs at all? I'd love to work for a company
| with such a great mission.
| alexalvarado wrote:
| Thanks for the kind words about our mission! We aren't
| currently but that may change in the next 6 months. Can you
| shoot me a note alex at daybreakhealth dot com and I will
| connect you to our CTO?
| pal_9000 wrote:
| Great job! What would you say are the most challenging gaps
| between online sessions compared to traditional in-person
| sessions? What are your plans to bridge the gaps?
| alexalvarado wrote:
| Very important area to explore. Let me first start by saying
| the the evidence suggests that telepsychiatry is as effective
| as in person therapy for adolescents (article link below), and
| our data shows that it is more engaging as measured by session
| attendance and number of weekly engagements.
|
| That said, there are three primary challenges in the online
| environment.
|
| First and most simply, it is harder to create rapport online.
| We require for that reason that all of our teens use the video
| sessions (in addition to messaging and the app), and we place
| high importance on the match itself (which we can do since we
| have a group of diverse counselors across California geos). We
| also place high importance on the therapeutic alliance and give
| our counselors techniques during training to develop that
| online.
|
| Second, privacy can be a challenge in small or crowded homes.
| We work closely and set expectations with parents to ensure
| that our teen clients receive privacy during their session
| times.
|
| Third, online counseling is still primarily best for mild to
| moderate acuity. At the more severe acuity levels, or with
| psychotic disorders for example, we haven't yet nailed how to
| treat online effectively and safely. We screen members during
| the assessment and refer them out if in-person counseling is
| better. We also put an emphasis on our online safety plan,
| which gives us knowledge of parent whereabouts and trusted
| contacts in the case that a crisis situation does escalate.
|
| Link to efficacy of telepsychiatry in adolescents:
| https://togetherthevoice.org/wp-content/uploads/2020/04/AACA...
| vegannet wrote:
| Access to healthcare is a big challenge in the US because of
| cost: your pricing seems to be very accessible but I'm curious if
| you have any specific ideas around how you can make therapy more
| accessible to people who can't afford these prices.
|
| I guess my question is whether your vision is a digital version
| of traditional therapy, or if you see your mission as making
| therapy more accessible which _currently_ is digital traditional
| therapy but could evolve substantially over the coming years?
| alexalvarado wrote:
| Thank you for the great question about access: access and
| quality are our twin aims when it comes to delivering mental
| health support to teens. The product is in service to those
| aims.
|
| So to answer your question: our current product reflects what
| we think is the best solution to increase access to therapy
| while maintaining quality. Over time, as we learn more, the
| product could evolve to become even more accessible (e.g., more
| digital) if we are able to maintain quality with that solution.
|
| One other piece I'll say on access: for a healthcare company
| the 'insurance plans' control the keys to access. From Day 1 an
| important part of our strategy is pursuing reimbursement so
| that the cost of our services reaches $0 for teens and families
| who need it and cannot afford the out-of-pocket cost. We are
| not there yet, but it is our goal!
| djsumdog wrote:
| I'm pretty skeptical about online therapy. Creating yet another
| abstraction between human and human seems to be going entirely in
| the wrong direction.
|
| One of the big issues with the lockdown was that many
| municipalities considered substance abuse meetings (AA and
| others) as non-essential. These types of programs do not work
| anywhere near as well online. Meanwhile liquor stores remained
| open as essential.
| alexalvarado wrote:
| Thanks for the push, this is something we think about a lot.
|
| I'll start by saying that we look to data to drive our
| perspective here. The the evidence suggests that telepsychiatry
| is as effective as in person therapy for adolescents (article
| link below), and our data actually shows that it is more
| engaging as measured by session attendance and number of weekly
| engagements than traditional therapy benchmarks. The way teens
| engage with the world is changing (to more digital), and rather
| than try to swim against the current, we hope to reach the most
| teens by meeting them where they are, and then changing their
| behavior in ways that matter. Our programs do focus on the
| importance of things like limiting screen time and developing
| healthy relationships.
|
| Ultimately I won't disagree with you -- in-person is at least
| as effective and for many people can be more effective.
| However, what we are hoping to do is increase access to those
| people for whom going to an in person session might present to
| high a barrier, whether it be geographically, financially, or
| from a stigma perspective.
|
| Article on efficacy of telepsych:
| https://togetherthevoice.org/wp-content/uploads/2020/04/AACA...
| toomim wrote:
| Actually, online therapy can be _more_ effective than in-
| person:
|
| [1] https://www.thelancet.com/journals/eclinm/article/PIIS258
| 9-5...
|
| [2] https://healthsci.mcmaster.ca/news-events/news/news-
| article/...
| euse42 wrote:
| I'd also love to learn more about increasing access for young
| people. I spent many years working with low income teens and
| unfortunately this pricing is entirely out of reach. Do you have
| any plans to offer free services for the young people most in
| need who could never afford to pay out of pocket.
|
| I've also worked with young people whose parents, even if they
| could have afforded it, didn't believe in therapy and weren't
| willing to support their child's efforts to obtain it. So yet
| another reason why access is super important.
|
| Just as a reference point, I run OkaySo, we offer free support on
| sex, relationships, and identity to young people. Happy to chat
| and connect. elise at okayso dot co (not com)
|
| Thanks for this work!
| alexalvarado wrote:
| Thank you for your great comment and for your important work at
| OkaySo.
|
| We recognize that our current pricing, while an improvement
| over private practice, is still out-of-reach for much of the
| country. Our plan is to: 1) continue to evolve the product to
| reduce cost of care while maintaining quality, 2) pursue
| partnerships with health plans and eventually Medicaid (which
| covers the lowest income teens) so that our services can be
| offered for free to those teens. We are very open to other
| funding models to increase the access of our services for teens
| as well! I'll reach out to learn more
| pryelluw wrote:
| There is very noticeable lag when navigating the site. Clicking
| the counselors link takes seconds to open. This on a top of the
| line android phone.
|
| I strongly suggest you do performance a/b testing.
| desireco42 wrote:
| It seems that template they use is just terrible.
|
| It is not trivial for this service how your website looks. It
| should provide some confidence that you know what you are
| doing.
| alexalvarado wrote:
| Thank you both for the usability feedback, on both the
| performance and the UX side. We will absolutely take that
| into account in future iterations. And agree 100% with
| performance testing!
| zoomablemind wrote:
| Congrats on the launch!
|
| Question: your site emphasizes a "guarantee of good counselor
| match". Importance of a rapport and trust between coach and teen
| (especially) is hard to overvalue.
|
| How does this guarantee translate into practical terms? Is it a
| guarantee to have access to all currently available coaches
| before making the choice, or more like a "money back" kind of
| guarantee?
| mangoman wrote:
| Congrats on the launch. I think this is an important issue and it
| is good to see some focus on this area.
|
| How did you arrive at your pricing? I am curious how, if a
| therapist normally costs $200 per session, you can offer it at
| less than half that price? Are the counselors certified
| differently? What's unique about Daybreak that makes it cheaper
| to offer therapy?
|
| Another question I'm curious about - do you address medication at
| all? How does that work, do you have psychiatrists that patients
| can talk with? Or is medication out of scope?
|
| Congrats again!
| alexalvarado wrote:
| Thanks for the kind words.
|
| On Pricing - our counselors are certified to practice and pass
| a rigorous interview process ensuring the highest quality. All
| are licensed to practice in California and have 5+ years
| experience working with adolescents. The primary differences
| are: 1) real estate (our therapists work from the comfort of
| their homes, so we don't have that cost), 2) cost of living
| (because we can work with therapists in varied geographies,
| their cost of living may be lower than in the highest
| demand/need geos), 3) value prop (adolescent-focused therapists
| want to work with us because of our flexibility and focus on
| teens which is rare to find)
|
| On medication - today we refer out if patients need medication.
| It is an area we are actively thinking about how to better
| serve in house!
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(page generated 2020-07-27 23:00 UTC)