A Mightier healthcare system: Introducing a game-based pediatric mental health intervention into payor-sponsored care to evaluate financial and clinical outcomes

PROJECT SUMMARY Access to effective pediatric mental health treatment is a major public health concern in the United States as paucity of pediatric providers leading to long wait times, financial burden, and stigma pose significant barriers to treatment. Digital mental health promises to remedy many chronic problems we face in providing timely and accessible mental health interventions to children. With that in mind, we created Mightier, an app-based heart rate biofeedback videogame platform designed to teach and facilitate practice of emotional regulation skills. Since launching in 2016, Mightier has reached 17,000 families, with a monthly growth rate of approximately 10%, and month to month retention of 90%. The technology behind Mightier is backed by three trials showing clinical efficacy and since commercial launch 75% of families who have engaged with the product report improvement. However, our core mission remains increasing access to care, and the direct-to-consumer distribution of digital health also faces access challenges. We propose that access to effective digital mental health interventions can be increased by meeting families where they already know to seek care: the traditional healthcare system. We have partnered with a nationwide behavioral health insurance provider to pilot the integration of Mightier with traditional healthcare clinics. The proposed research will pilot the integration of Mightier into the two behavioral health clinics identified by our payor partner. To simulate real-world integration, healthcare providers will be responsible for referring children with chronic emotional dysregulation to Mightier. Once identified by their providers, children will be randomized into Mightier or control groups for 6 months of use. Through this work we will demonstrate the value of Mightier to various stakeholders via decreased long-term healthcare utilization (aim 1), confirm that Mightier use results in decreased symptoms of emotional dysregulation, irritability, and parent stress (aim 2). Ultimately this work will pave the way forward for large scale integration of digital healthcare and more traditional healthcare avenues while simultaneously increasing Mightier’s ability to reach children in need.