The goal of this project is to promote resilience and social skill building in the youth aged 10-24, reported in quantifiable metrics. We will adapt and contextualize a learning management system in the local language focused on digital community among peers, with digital program monitoring and evaluation, delved into a tiered integrated peer mentoring model. doctHERs masters the art of cost-effective and cost-cutting technologically driven and business-savvy, scalable solutions across communities in Pakistan and across the South Asian diaspora in the US, Canada, UK, Singapore, and the Middle East.
Over 1 billion people live with a mental health disorder worldwide. The mental health stigma, negative perceptions and outdated service models are pertinent healthcare gaps in Pakistan. The financial burden of global mental health is expected to reach $16 trillion by 2030. There are only 7-10 psychiatrists trained in child and adolescent mental health for a target population of 140 million under the age of 25 in Pakistan. Western literature posits that wellness and resilience building have a positive impact on mental health; we extrapolate this application with our intervention (Resilience And social skill Building in Teens), that sets out to instill Social and Emotional Learning and Emotional Intelligence in children and young adults. Our one stop M-health platform will enable youth to seek mental health prevention using a peer-to-peer (P2P) mentoring model incorporating mental health literacy, leadership skills and aspects of financial literacy in slum youth communities across Lyari—a densely populated, urban slum area in south Karachi facing considerable trauma and gang-based violence since 2001.
We propose a culturally contextualized Emotional Intelligence/Social and Emotional Learning (EI/SEL) blended curriculum for those aged 10-24 years with an integrated, tiered, peer-mentorship model delivered through a user-friendly and trusted, open-source Learning Management System (LMS). The curriculum will be adapted to the needs of three cohorts (aged 10 to 14, 15 to 19, and 20 to 24). The curriculum for the oldest cohort will include elements of Mental Health Literacy (MHL) and leadership skills, including financial literacy. The middle cohort will work on simple and low-resource community projects designed for the youngest cohort. With this model, we aim to create peer mentoring ‘families’ across the age groups. The intervention addresses the mental health gap and permits the application of wellness and resilience skills for community building and empowering youth in a slum community, housing nearly 0.2 million residents that would otherwise be neglected.
For this intervention, Synapse and doctHERs will partner with the Lyari division of the non-profit organization called Rizq. Project RABT will be inclusive and enroll marginalized individuals such as transgender youth and youth with disabilities in the design, implementation, and evaluation of the intervention by initially conducting a needs assessment, including Focus Group Discussions (FGDs) with the target youth with additional feedback sought from community leaders pre- and post- intervention. Rizq will facilitate physical access and serve as a trusted intermediary between Synapse, doctHERs and Lyari youth. Our intervention is focused on an implementation program with a rigorous research arm to evaluate the program’s processes, implementation effectiveness and impact. We will evaluate mental, emotional, and social health indicators by collecting quantitative, questionnaire-based data at baseline and end line. During the course of implementation, qualitative data collected from FGDs will inform our curriculum content and delivery.
We seek like-minded partners such as Digital Square, USAID, Bill and Melinda Gates Foundation to improve our open-source mental health prevention and promotion, financial literacy empowered, and community strengthening platform powered with a digital health approach. doctHERs is a digital health platform that matches the underutilized capacity of female healthcare professionals to the unmet needs of marginalized communities via AI-enabled telemedicine in real-time. Synapse, Pakistan Neuroscience Institute, is a team of highly-skilled and experienced healthcare professionals who offer quality, evidence-based, integrated, and multidisciplinary services, education, and capacity building in the area of mind and brain. Synapse focuses on clinical psychiatry services, psychotherapy, advocacy, mental health consultancy, psycho-education, and research. Synapse will work on curriculum development, project implementation, monitoring and evaluation; doctHERs will focus on technological integration, provision of mental health therapy via paramedic-assisted telemedicine and community mobilization.
To scale internet data use, doctHERs’ existing model runs on the SAMSUNG Knox solution with 109 purchased licenses across 14 districts in Pakistan in addition to the open standards ClickMedix platform. The solution along with our LMS— Moodle— increases the effectiveness and impact of the RABT program. We use a variety of mobile network operators, including Jazz, Zong, and Telenor. Our innovation is based in an urban slum— Lyari, one of the oldest and most densely populated neighborhoods in Karachi. The blended learning EQ and SEL curriculum content will be delivered via a technologically integrated platform, Moodle, a trusted platform with content pre-translated into local languages (Urdu and Sindhi). DoctHERs has been working across these communities since 2015 in collaboration with UNILEVER and UKAID, with a special focus on digitially empowered prevention and promotion of mental health. We have established trust across a myriad of urban, semi-urban and rural settings in Pakistan. Having worked with a cohort of 200 female healthcare workers, we engage over 1 million lives a year. DoctHERs has an established million plus user base with set KPI project-by-project, and it opts for Series A funding. Most of our work is financed through development agency grants such as the UKAID. Around 30% of our budget is currently earned through earned income with the remaining balance covered through various grants and award activities. Our goal is to become grant independent by the first quarter of 2023.
Background: The glue that holds our intervention together is the learning management system- Moodle. With engaging the private, governmental, and commercial partnerships over the next 3-5 years, collaborators will find that distance mental health programs of such grandeur can lead to 90% less energy consumption and 85% fewer CO2 emissions per student than physical programs. The ease of integration/access, user-friendly features once taught, and simply the cutting-edge technology allows partners to cut 1. Transportation costs, 2. Salaries of non-essential employees, 3. Course materials and delivery. The program will also lead to less spending by the participants who enroll in the program and are much more economical than conventional psychotherapeutic and counseling services. The subsequent steps of our program will be the development of a '360 mental health literacy' curriculum for the wider community, especially teachers and community health professionals, allowing them better safeguard the mental health needs of the marginalized youth. We would also engage with government-led and commercial programs to scale our innovation at a local, provincial, and national level within the stipulated period. We will expand our collaborations with existing programs, such as Kiran Foundation (NPO) and Sina-Health, Education & Welfare Trust (NPO). Once we demonstrate the efficacy, feasibility of use, and scalability of the platform, we will prompt for integration in non-profit academic programs like The Citizens Foundation (access to 200,000+ children in Pakistan) as well as private sector schools in all provinces of the country (Balochistan, Punjab, Sindh, Khyber Pakhtunkhwa), and international localities such as India, East Africa and Korea.
Objectives: The ultimate objectives include increased wellbeing and resilience among the youth in Lyari, Pakistan. In order to measure wellbeing and resilience, we will use the WHO-Five Well Being Index (WHO-5) tool and the Child and Youth Resilience Measure (CYRM; ages 5-23) tool, respectively. Since our program delves into EQ and SEL, we will also conduct screening of emotional and behavioral problems using the Strengths and Difficulties Questionnaire (SDQ). The WHO-5, CYRM, and SDQ questionnaires have been tested worldwide, with good reliability statistics. However, the limitation of no human-based assessment will be overcome with our focused group discussion sessions that will employ structured interviews to measure the primary outcomes of wellness and resilience qualitatively. We expect to enroll 400 individuals aged 10-24. It is essential that over 50% of this anticipated sample count is achieved and that 50-75% of the final sample demonstrates improvement in intermediate and ultimate outcomes. During the timeline of the intervention delivery, we will promote community engagement leading to positive results of mental health, specifically, wellness and resilience. Our curriculum will shape our curriculum through group-based discussions, structured interview settings, quantitative assessment, and open feedback and discussion forums. What we do truly desire is for there to be widespread community engagement, piqued interest in our blended program/curriculum, active participation by leaders and receptors, and we wish for the older cohort of individuals to employ our training, courses, and psychological care learnings in their lives. As a result of our innovation, we expect a 50-75% increase in knowledge related to mental health literacy and support among the program users. With an intention to enroll at least 50% of the targeted 400 young individuals, in the intermediate-term, 200-300 lives will experience mental health disease symptom relief, awareness about the occurrence of a mental disorder, and they will be better able to mentally, emotionally, socially, and financially function in their lives. Our resilience and wellness program will also be the torchbearer of the sustainability culture in the youth.
Deliverables & Schedule: We will allocate the first three months of the 18-month grant period to pre-intervention activities, termed AP-1, i.e., Award Phase 1. Firstly, a needs assessment will be conducted by the HCPs equipped to weigh in the pediatric mental health indicators of interest and the skills to be instilled in the youth. During this time, our team members will determine the need for crisis and prevention counseling, mental health treatment to be administered, community education with the amalgamation of SMART clinics (our psychologists specialize in mental health prevention, treatment, and awareness-raising while incorporating real-time online technology). Secondly, our course and tools for the focused group discussions (FDGs) will be curated, piloted in groups of 3 individuals before community application. Thirdly, our community mobilizers will be equipped with the technology we are leveraging, including smartphones, laptops/PCs, and software training. At the end of AP-1, we will be fully equipped with the community-based delivery of the intervention, termed AP-2. During AP-2, we will have had technologically equipped community leaders, the required software/hardware for the youth at Lyari, and a piloted FGD pathway. For 12 months, our platform and curriculum will reach an estimated 400 youths. The feedback, quantitative checklists, and verbal receptiveness of participants will help us refine the tools, including software, content, and mode of delivery. The final AP-3 stage is the last glue to the grant period where we will preliminarily report the qualitative outcomes of FGDs, and evaluate the tangible benefits of project RABT.
Submission of Application (December 2021-January 2022); Award of Grant and other Formalities (February-March 2022); Pre-Intervention activities AP-1 (needs assessment, FGD, community leader) (August-October 2022); Intervention AP-2 (November 2022-October 2023); Post-Intervention Activities AP-3 (FGD, program evaluation and reporting) (November 2023-Januart 2024).
Risk Mitigation: Risk is inevitable, hence contingency plans are in place for project RABT. The team is fully equipped to deal with the impact and mitigate risks that are technical, political and executional in origin. Access to smartphones, laptops/desktops, connectivity issues and the acceptability of the online platform are possible technical risks. Given the marginalized status of the target community, resistance from older age groups, the local leadership, and seeing eye to eye with the leaders are worth noting. Ultimately, gaining the trust and reaching a level of acceptability is the plan of action, which we have already demonstrated with our strong presence in the community. To further overcome these challenges, our posited involvement of the youth community consists of well-designed, implementation and execution with both technological and human intelligence/involvement. The community leaders are furthermore the gatekeepers of Lyari, and it is solely by extending the established trust and buy-in that our risks will be eradicated at the ground level.