After more than year of battling COVID-19, healthcare workers have experienced stress and trauma on the front lines, all against the backdrop of increased social isolation and the fear of becoming infected by COVID-19 or infecting others. But while mental health issues have been exacerbated by the pandemic, there was also an existing mental health crisis in the country among healthcare workers and the general public prior to COVID-19. In 2019, it was estimated that over 50 million Americans were living with a mental health disorder, such as depression or anxiety. A truly silent epidemic, over half of those experiencing a mental health disorder never seek treatment, possibly due to fear of stigma or concerns about being treated differently from their peers, family or colleagues.
While the COVID-19 pandemic may have exacerbated the mental health crisis in the U.S., it also focused a newer, brighter spotlight on the importance of talking openly about mental health, taking steps to address risks and root causes, and developing more effective and comprehensive tools to support it.
“The current mental health crisis is affecting not only our frontline health workers, but also children, friends, co-workers and communities. With invaluable hands-on patient care expertise, nurses are poised to see the challenges, and develop meaningful solutions to improve mental health,” said Lynda Benton, Senior Director, Corporate Equity at Johnson & Johnson. “We were pleased to partner with the American Psychiatric Nurses Association for this QuickFire Challenge that helps to bring these transformational solutions to reality, at a time when it’s never been more important.”
As part of our larger commitment to supporting frontline health workers, Johnson & Johnson partnered with the American Psychiatric Nurses Association (APNA) to launch the Johnson & Johnson Nurses Innovate QuickFire Challenge on Mental Health, which was aimed at advancing the nurse-led solutions that have a strong potential to transform the landscape surrounding mental health care and well-being for healthcare professionals and patients during the current pandemic environment and beyond.
“Nurses are the backbone of the healthcare system, and their expertise is crucial in efforts to create change within the system and provide additional access to mental health care resources. Their efforts are not going unnoticed,” said APNA President Matthew Tierney, MSN, PMHNP-BC, FANP-BC, FAAN. “We are proud to be a part of the process and are thrilled to see what will come next from the solutions presented through the QuickFire Challenge on Mental Health.”
Launched in late September 2020, the Johnson & Johnson Nurses QuickFire Challenge on Mental Health invited nurses and nursing students from around the globe to embrace their innovative, novel ideas and concepts aiming to improve key aspects of the mental health crisis, including key mental health conditions, remote care delivery opportunities such as telehealth, the impact of health disparities and health inequities on mental health needs, and access to care and treatment for those with mental health and/or substance use conditions.
After receiving a record number of applications through the Johnson & Johnson Innovation platform, we are excited to announce the Awardees of the Johnson & Johnson Nurses Innovate QuickFire Challenge on Mental Health: The co-founders of the health tech start-up Nurse Disrupted, Bre Loughlin, MS, RN and Tracy Zvenyach, PhD, APRN-NP, and the developer and founder of the texting bot app Hello Harmony, Chris Recinos, PhD, RN, FNP-BC, NEA-BC.
The Johnson & Johnson Notes on Nursing team recently spoke with nurse entrepreneurs Bre, Tracy and Chris to learn more about how being awarded the Johnson & Johnson Nurses Innovate QuickFire Challenge on Mental Health can help them take their inventions regarding the ongoing mental health crisis to the next level.
Nurse Disrupted
For those experiencing homelessness, finding support and quality resources can be extremely challenging. But for those who are also in urgent need of mental health support, the obstacles are even more acute. Nurse Disrupted, a trailblazing, nurse-led start-up founded by Bre Loughlin, MS, RN and Tracy Zvenyach, PhD, APRN-NP is committed to closing the mental health care gap for some of the most vulnerable members of their Madison, Wisconsin community and beyond. They are working to evolve The Care Station, their low-cost, one-touch telehealth video solution, to help connect people in homeless shelters and other healthcare resource deserts with mental health care providers.
Johnson & Johnson: Can you tell us what The Care Station is, what inspired it and how it could help improve mental health outcomes for those experiencing homelessness?
Bre: The Care Station is an all in one, low cost telehealth video station created for areas that need a simple video connection to a healthcare professional. The package arrives in a single lightweight box pre-configured for care locations. This includes the hardware, software, built-in internet and technical support. The story of The Care Station began in March 2020, when my daughter and I chose to volunteer to help those experiencing homelessness amid the COVID-19 pandemic. I’ve always been passionate about helping the homeless community but realizing the immense pressures homeless shelters were experiencing during COVID-19 took my commitment to a new level. As a self-proclaimed tech nerd nurse, I knew instantly how I would solve the problem—develop an easy-to-use video station that would leverage telehealth to conduct virtual COVID-19 screenings and connect those in need at shelters with healthcare providers. I leaned into my passion for tech and my colleague Tracy tapped into her health policy expertise—and that’s how our organization, Nurse Disrupted, and The Care Station began.
Tracy: Because of the great response to The Care Station screenings during the pandemic, Bre and I realized that this technology could also potentially have a huge impact on tackling the mental health crisis in our communities, especially for those experiencing homelessness. Homeless shelters can be a great place to connect individuals to the resources they need, as many seeking shelter may also be battling a mental illness or issues with substance use. We are now working to expand The Care Station experience to also include mental health screening questions and connect the user to a mental health care professional. The overwhelming majority of shelter guests have shared with us that they feel hopeful and supported after our COVID-19 screenings, so we believe the level of trust that we’re able to establish can go a long way in connecting those in need to mental health support.
Johnson & Johnson: What makes The Care Station an innovative way to provide mental health care?
Bre: The promise of telehealth is that it can make care providers more available, but in public health, we need to make sure everyone gets across the finish line. We knew we had to create, iterate and improve The Care Station to be a solution for low-resource environments and a patient population that may not have a lot of experience with or access to technology. Getting the design and workflow right was vital. The Care Station is innovative because it is a simple technology that can be set up and implemented quickly with little to no training. The digital divide has a big impact on health disparities. The Care Station is a bridge for those who may be experiencing mental health challenges, connecting them to mental health care providers and resources in their areas. In this way, The Care Station has the potential to address healthcare resource deserts, eliminate patient care barriers and alleviate the mental health crisis for those in need.
Tracy: I think our biggest strength, and what also makes this work innovative, is the relationships we’ve been able to develop with nursing schools and students in Wisconsin. To help execute these screenings for COVID-19, we connected with local colleges and universities who had nursing students in need of completing clinical hours in order to graduate. Over the past few year, we’ve established six partnerships with schools of nursing and supported over 200 students. But most importantly, this work is reinforcing the importance of compassion in patient care and introducing students to care delivery through new settings - Telehealth. While healthcare is starting to embrace virtual mental health screenings, not many are tapping into the power and potential of the nursing student population to help get the job done like The Care Station will. I’ve heard from many of our students that they’ve never had the opportunity to deliver care to the homeless community and it has opened their minds to new models and settings of care. Not only are we putting a more human element into technology, but we’re helping teach empathy, compassionate care and the importance of supporting low resource settings to the next generation of nurses.
Johnson & Johnson: How do you believe your perspectives as nurses helped you develop and improve The Care Station?
Bre: For hundreds of years, Nurses have transformed our communities. The Red Cross was founded by Clara Barton, The House on Henry Street (Public Health) by Lilian Wald, The British Hotel by Mary Seacole, Planned Parenthood by Margaret Sanger - the list is massive. What we do as Nurse Disrupted is based on the very foundation of nursing: solve problems we encounter in our communities through science, communication, innovation, and compassion. We are like conductors of an orchestra- bringing musicians together to play a piece. In COVID-19 response for homeless shelters it was working with the excellent leadership of Porchlight, collaborating with public health and other community resources, networking with the nursing community, and, for me specifically, having a software-hardware background in healthcare.
Tracy: Nurses are constant innovators, finding ways to do more with less and lean into the resources available to them. When Bre and I first started the screenings, we only had ourselves and two other volunteer nurses as care providers and one utility trailer that we had up and running in under two days. as care providers and one utility trailer that we had up and running in under two days. We’ve since expanded to more shelters and are proud to share we’ve completed over 19,000 screenings across our team of 250 care providers. We also realized we had to innovate for low-tech, low-resource areas with poor Internet quality and tailored the software to meet this need. It’s been humbling to see such a simple telehealth solution have such a meaningful impact on the healthcare of our community.
Johnson & Johnson: How does it feel to be an Awardee in the Johnson & Johnson Nurses Innovate QuickFire Challenge on Mental Health, and what does this mean for the future of your potential solution?
Tracy: Everyone deserves access to mental health care, and we’re so excited to be selected as an awardee. We believe the financial support from the QuickFire Challenge will help us to bring mental health care to additional low-resource areas in our community, while the mentorship offered will help open more doors for Bre and me to drive the future of telepsychiatry and make a difference for homeless shelters across the country.
Bre: This award means so much to Tracy and me. Nurse Disrupted is a self-funded, woman-led start-up. We know the odds of success are against us, but we believe this award is going to help us beat the odds. Tracy and I have invested everything—our time, our energy, our finances—into making Nurse Disrupted a success, and to have a large healthcare company like the Johnson & Johnson Family of Companies believe in us and champion nurses is so rewarding. Any nurse with a good idea to improve healthcare should be inspired by our story and apply to a future Johnson & Johnson Nurses Innovate QuickFire Challenge. Your idea is worth it.
Johnson & Johnson: Do you have any advice for nurses with great ideas to improve healthcare, who may be looking to apply to innovation opportunities like the Johnson & Johnson Nurses Innovate QuickFire Challenge series?
Tracy: Nurses are natural problem solvers. I think any nurse thinking about applying for a chance to develop either themselves or their ideas should apply, because the worst thing you’ll ever hear is “No.” Why not throw your idea into the ring? If you don’t, it’ll never move forward.
Bre: We get it—putting your own original idea out there is terrifying. It’s hard and scary to put yourself and your idea out there. But in healthcare innovation, I think it’s NOT better to be safe than sorry. The difference between your idea succeeding or never being heard is you stepping off the curb.
Hello Harmony
Suicide is a leading cause of death in the United States among young people. Currently, it is estimated that one in five adolescents* have contemplated ending their life, and it is thesecond leading cause of death for those aged 10 to 34. After her daughter Harmony died by suicide in 2017, Chris Recinos, PhD, RN, FNP-BC, NEA-BC learned that Harmony’s friends had known she was struggling but were unsure how to help. This heartbreaking information inspired Chris, a former nurse executive, to start creating real change in the mental health care landscape. During a collaborative weekend with other nurses leaders, developers and IT experts at the NurseHack4Health virtual nurse hackathon in November 2020, Chris started the development of the texting bot app Hello Harmony, named in memory of her daughter, which aims to de-stigmatize and normalize the important topics of suicide and mental health among adolescents.
Johnson & Johnson: Can you tell us about Hello Harmony? What was the journey of developing it like, from ideation to implementation?
Chris: Hello Harmony is a texting bot app that lets you interact with a virtual friend through a scenario-based game. It was developed by nurses, with input from adolescents aged 10 to 21, and incorporates cognitive behavioral therapy techniques delivered in the form of gamification. It aims to help anyone who struggles with any kind of mental health condition talk about their feelings and gain the confidence to seek help when they need it, and it hopes to give people who have a loved one struggling the chance to find the words to start the conversation.
In my own life, there were significant and unimaginable circumstances that led to the ideation of Hello Harmony. In 2017, my daughter died by suicide—there’s not a string of words in this world that describes the feeling and drastic shift in worldview that a mother experiences after losing her child. It wasn’t until after her death that I discovered Harmony had confided in some of her friends and shared that she was struggling and contemplating suicide, but that they didn’t know how to help her. My daughter’s struggle is one story in the sea of the many teens who are facing immeasurable isolation, shame and fear. After that happened, I didn’t want to be a nurse anymore. I didn’t think I would ever be able to create anything—let alone become the nurse entrepreneur I am today. Throughout the past few years though, I would speak at conferences as a nurse leader, talk with people who would message me on social media and who would confide in me and ask for advice on how to talk with those in their lives who were struggling with their mental health. I slowly realized that while I may not have been able to save my daughter, I did have the power to use my skills as a nurse clinician, a mental health advocate and a mother to try and save other people’s children.
In November 2020, I attended “NurseHack4Health: Pandemic Management—Improving Education & Communication,” which is where Hello Harmony really began to develop. I recruited my family to be a part of my team and during the process of trying to figure out what we wanted to solve for, my 10-year-old son sparked the concept of Hello Harmony by suggesting we create an app. Then, my older daughter helped us narrow it down by suggesting we focus on mental health and suicide prevention. During the hackathon, we held a focus group with children and young adults from 10 to 21, and almost all of them had a diagnosis of a mental health condition, such as anxiety or depression. Their perspectives were crucial and emphasized to us that we needed to gamify the app, like many apps on the market, and make it ad free, which is a top reason why many teens stop using various apps.
Johnson & Johnson: How does Hello Harmony aim to address an unmet need for adolescent mental health?
Chris: While Hello Harmony is designed with adolescent mental health in mind, it can also be used by anyone who is looking to learn how to talk about mental health—parents, veterans, business executives. It gives the user a chance to practice these crucial conversations. Still, the original aim of the app was to help higher risk groups, like adolescents, learn the language around how to discuss their mental health and develop a sense of normalcy and confidence in having these difficult conversations. When someone downloads the app, they will start off by designing a “virtual friend” and choosing everything from clothes to hair color, and everything in between, including their hobbies. From there the user can move into a gamification scene that is relative to whatever the preferences or features the individual chooses—baseball, for example. What makes Hello Harmony stand out is that the user collaborates with their virtual friend in this game-like setting and ultimately has conversations that move into topics or scenarios related to mental health.
Hello Harmony is unique because it meets the individual where they are cognitively, by incorporating a form of artificial intelligence called natural language processing. You know a 10-year-old and an 18-year-old are developmentally different. They text, use emojis and interpret their emotions differently, so with this technology we aim to ensure the app is able to adjust based on the user’s communication style. No two people are alike and, similarly, no two mental health journeys are the same. With my clinical experience and nurse lens, this was one component I knew I needed to incorporate. This way the user feels like they are speaking to a friend and the conversation feels more natural and the necessary information is communicated in a way that allows the user to comprehend the topic at hand. If a user's safety is determined potentially to be at risk, they will be offered the Suicide Hotline Number or Crisis Text Line and information collected at sign-up can be sent to emergency medical services.
Johnson & Johnson: Why are you passionate about the adolescent demographic?
Chris: Even before the pandemic, mental health and suicide was an increasing problem. Many people don’t realize that it’s the second leading cause of death for those aged 10 to 34. While there are some resources out there, it is evident there’s not enough to provide adolescents with information needed to recognize that there is a problem and then seek help.
While my own experience losing my daughter to suicide is a large motivator for me, I’m adamant and passionate about the fact that no one should suffer in silence. While it may not be you struggling, maybe it’s your best friend, your sibling or your partner. As someone who has also contemplated suicide myself and has struggled with my own mental health, it is important to me that I use my own experiences and clinical skillset to drive forward resources and help normalize conversations surrounding mental health. It’s not a crime to have a mental health disorder and it’s not a crime to want to die, but the current language (committed suicide) makes it seem like it. I’m working to change the narrative surrounding mental health, not just for adolescents, but for everyone. As nurse leaders, clinicians, mental health experts and advocates, and as a collective society, we need to do better—we can help our children, friends, parents and colleagues understand and navigate these mental health challenges.
Johnson & Johnson: How does it feel to be an Awardee in the Johnson & Johnson Nurses Innovate QuickFire Challenge on Mental Health, and what does this mean for the future of your potential solution?
Chris: I’m so grateful to be an awardee of the Johnson & Johnson Nurses Innovate QuickFire Challenge on Mental Health, because now I can take Hello Harmony to the next level. Logistically speaking, we are now going to be able to begin implementing our plans for natural language processing and artificial intelligence, and start working on the Application Programming Interface (API). The API is important because it serves as an intermediary system for health plans, schools, and the app. It allows us to alert their plan if, for example, the user needs intervention. Finally, we are anticipating real change from this app, and in how we as clinicians are providing care and information around suicide prevention and mental health. I know in my heart that Hello Harmony can save lives if we can get it into the hands of those who need it.
If you are feeling suicidal, thinking about hurting yourself, or are concerned that someone you know may be in danger of hurting themselves, call the National Suicide Prevention Lifeline at 1-800-273-8255 or the Suicide Hotline: 1-800-784-2433, both of which are staffed by certified crisis response professionals. If someone is in immediate danger, please call 911.
Being awarded the Johnson & Johnson Nurses Innovate QuickFire Challenge means nurse innovators Bre, Tracy and Chris, and their teams, will gain access to grant funding of up to $100,000 and support to help advance their solution and innovations forward. This includes mentoring and training opportunities from the Johnson & Johnson Family of Companies and access to the Johnson & Johnson Innovation – JLABS ecosystem, which helps innovators accelerate discovery and get operational support to bring their healthcare solutions to life.
Learn more about the Johnson & Johnson Nurses Innovate QuickFire Challenge series and meet past Awardees here. Follow @JNJNursing on Facebook and Twitter to stay up to date on upcoming 2021 Challenge opportunities. To be one of the first to know about our next Johnson & Johnson Nurses Innovate QuickFire Challenge offering, sign-up here.
Hackathons provide a fast-paced, high energy, community-building opportunity for a wide spectrum of participants to flex their innovation muscles and solve for some of today’s greatest challenges. While these events have traditionally been geared towards computer scientists and software developers in recent years nurses, clinicians, and health innovators have started to convene health-challenge inspired events. Today the health hackathon landscape is exciting, rapidly evolving, and nurses are playing a lead role in driving them. Tune into a recent episode of the SEE YOU NOW podcast for "What the Hack" featuring Chris Recinos, PhD, RN, FNP-BC, NEA-BC on the guest line-up. Listen here.
