CogniABle

Access to evidence-based interventions for Autism Spectrum Disorder (ASD) is limited in Bangladesh, owing to information asymmetry, lack of affordability and geographical immobility.

Inner Circle, a center providing research-based interventions for children with special needs in Dhaka, Bangladesh, has collaborated with CogniABle, a Florida, USA based firm to release a digital technology-based solution in Bangladesh to address this problem.

The solution is an affordable digital platform, developed on Artificial Intelligence technologies, that allows behavioral treatment of ASD remotely and by non-experts, from the comfort of one's home. The platform operates based on a combination of machine learning, data collection, user-friendly teaching material, and specialist input.

The solution will enable those in lower-middle and middle income groups to avail evidence based interventions for ASD at a fraction of the market cost.

A UNICEF report published in 2014 estimates that between 1.4 and 17.5 percent of children in Bangladesh have special needs or disabilities - as many as 10 million. A more recent 2017 study indicates that 17 per 10,000 children are affected by ASD, nationwide.

A 2018 study shows early intervention based on evidence-based practices can raise IQ by 10-15 points in autistic children. However, access to such interventions is limited due to poor infrastructure, affordability and quality.

Due to inaccessibility, families from villages, towns shift to metro cities for treatment which increases their financial and emotional burden. In Dhaka, the behavioral treatment services cost over BDT 276,000 per year, an amount that is not affordable by the majority.

Due to limited number of skilled clinicians, the treatment quality is not optimum and treatment plans lack customization options for children. Usually treatments last for years, with slow progress. The lack of uniformity in interventions by schools, parents and clinicians compounds issues with treatment quality and information symmetry.

Lack of access to evidence-based treatment prohibits integration of children into schools and the society. Ultimately, they cannot contribute as a productive workforce in the economy.

We will directly improve the lives of individuals, particularly children, with Autism Spectrum Disorder (ASD) and their parents. The socioeconomic class of our target group will be lower-middle and middle income earners with internet access.

Through Inner Circle, we cater to the higher income groups, providing early interventions encompassing of ABA Therapy, Speech and Language Therapy and Occupational Therapy for children with ASD. 

Through a combination of competencies with Cogniable, we bring in a digital platform that improves access and affordability for ASD treatment. This is done through an integrated assessment and treatment recommendation framework for ASD coming out of the digital platform, that can be used for those by non-experts remotely to deliver a guided behavior intervention model. The digital platform can be used by parents, schools and other caregivers improving information asymmetry.

Moreover, the need for physical infrastructure for the solution is minimal, hence it is relatively much more affordable and scalable which further increases accessibility.

Another version of the solution can be used by clinics and schools to digitize Autism intervention process. Our distribution model to reach parent community will be through doctors and schools (B2B2C).

Our solution is a digital platform that offers guided intervention model available on the internet through smart devices. The tool has assessment integrated behavior treatment protocols, teaching pedagogy and video modelling modules incorporated allowing it to be used remotely and by non-experts. Parents, clinics and school teachers can follow a guided process resulting in skill building and capacity enhancement to manage autism therapeutic interventions.

In a low resource setting such as that in Bangladesh, it is imperative to build skills and enhance the capacity of clinicians, parents and teachers to deliver behavioral interventions using technology. Availability of a digital platform in Bangla and cultural contexts can fast-track skill development and augment skills of parents saving commute time for therapy. Adoption of technology within a community can be fast-tracked by training sessions (online and in-person) involving hospitals, non-profits and schools. The machine learning models built on top of digital platform brings in decision support capacity to recommend and customize the treatment and allow families to start behavioral treatment remotely.

The solution is designed with 4 important pillars to improve service delivery.

1. Used by non-experts: The digital platform empowers parents, schools and clinicians with availability of an integrated assessment and treatment model with built-in curriculum, learning management system incorporating teaching pedagogy via video modelling.
2. Remotely available: The wholesome treatment experience is brought home on mobile phones. The hassle-free process can be experienced without any support from skilled clinicians.
3. Customization of therapeutic interventions: Machine learning models customize the therapeutic interventions plan based on longitudinal treatment progress data of a child. The plan is customized for a child in the area of social skills, expressive language, receptive language, etc. The AI model customizes the plan specific for the child doing away with the need of skilled clinicians, who are limited in number.
4. Affordability: Our services can be availed at 25 percent of the market cost.

The solution is integrated with evidence-based curriculum from the US i.e. VB-MAPP (Verbal Behavior Milestones Assessment and Placement Program) that will be used to suggest targets as per the assessment results of the children. The digital platform provides parents with chat support and 4 hours of personalized consultation session per month.

Judiciary use of our treatment service brings significant change in the self-dependency and skills of special needs children at a young age, teaching them relevant life skills to sustain themselves.

Our innovation is a digital platform that integrates evidence based behavioral assessment and treatment framework and can be used by non-experts remotely.

The digital platform empowers parents, schools and other institutions with the availability of an integrated assessment and treatment plan at 25% of the current cost. The model would the first of its kind in Bangladesh that significantly improves access, affordability and quality. The platform will also consist of teaching pedagogy along with 40 hours of behavioral treatment training.

The product when integrated with Machine learning models builds customized treatment for the child measuring longitudinal treatment progress data. The value proposition is that our services can be used by non-experts, remotely at affordable cost and can be accessed on mobile.

Vision: Delivering affordable, accessible and data-driven behavior treatment for children diagnosed with autism that can be used by a non-expert.

There are three pathways to reach this vision:

1. Affordable and accessible treatment: Child specific training of non-experts such as parents via a digital platform. This overcomes the immediate need of an affordable and accessible service that is available locally to parents in comfort of their homes.
2. Improving information symmetry: Access to a digital platform by schools and clinicians that supports delivery of high-quality data driven intervention with guided curriculum and pedagogy, improves treatment quality and collective teaching approach.
3. Capacity building of skilled clinicians and teachers, at grass root level: This is a long term goal as this requires significant involvement of government and policy makers.

Building a strong foundation: All three pathways mentioned above complementing each other, so that the children can have holistic support with respect to their short-term and long-term objectives. Development of language and communication skills in children improves integration opportunities.

Long term outcomes: The pathways mentioned above results in three long-term outcomes as mentioned above. These long-term outcomes once achieved, will make important contributions to achieving our vision and developing necessary skills in early age of children diagnosed with Autism Spectrum Disorder.

We have not served anybody in Bangladesh yet. However, CogniABle is currently working with 100 families across India and the USA, in a controlled environment on the digital platform.

Both Asian Development Bank and Bangladesh Institute of Development Studies estimates that middle income earners make up 20 percent of the total population of 165 million. Considering average household size of 4.65, there are over 7 million middle income households. Assuming each household has two children, there are 23,800 children with ASD from middle income families.

In year one, we expect to serve approximately 2.5 percent or 600 of these children.

By year five, we expect to reach and serve 30 percent of these children, keeping in mind that absolute number of children with ASD will very likely increase. We expect to reach exponentially more people through increased uptake of services and operational expansion.

Within next year:

• Launch the digital platform in Dhaka city.
• Sign MoU with 5 doctors.
• Serve 600 children wish Autism Spectrum Disorder in Dhaka. We are expecting that the families of these children will use our digital platform with a dropout rate of less than 20%.

Within next five years:

• Reach 100 clinics and 30 schools across Bangladesh for adoption of our platform. 
• Serve at least 8000 children with ASD.
• Have a presence in all major cities across the country.
• Improve overall awareness of ASD.
• Develop and validate machine learning models to personalize behavioral treatment protocols using longitudinal treatment data of children across multiple skill set such as expressive language, receptive language, social skills, requesting and so on.
• Build capacity among clinicians and teachers at the grass root level to manage ASD.

The prominent risks we foresee in our project are:

1. Adoption of digital platform by non-experts require familiarity with technology and comfort. If the recipient, is not familiar with the use of smartphones/computers, the service uptake will be negatively impacted. Acceptability of such services provided through digital channels is relatively lower in general, and even more so in developing countries like Bangladesh, compared to traditional in person consultation.
2. Digital platform localization – Without proper localization in terms of language and cultural context, service uptake will be negatively impacted.
3. As a child diagnosed with autism may have multiple challenges, the statistical significance of the outcome may have varied sensitivity.
4. Co-morbidity - Any additional physical or mental illnesses/handicaps can affect treatment results and impact outcomes.

1. In India, CogniABle has deployed company representatives at doctor’s site who can hand-hold patients on the digital platform and provide in-person training. We have to utilize a similar approach in Bangladesh. We will use company representatives to guide and train service recipients to help them navigate the digital platform. Our doctors will advocate the use of the platform to build trust among recipients.
2. Proper translation of the digital platform to Bangla and tailoring it to the cultural context of Bangladesh to ensure accessibility and acceptance of the solution.
3. Our feature of treatment plan customization based on individual assessment and progress of a recipient will help reduce variance in sensitivity and increase outcome convergence.
4. The participants inclusion details need to be carefully captured to reduce the impact of co-morbidity as much as possible.

1. 10 Psychologists
2. 4 Machine Learning Experts

From CogniABle:

• Manu Kohli (CEO) - An industry-sponsored Ph.D. candidate at IIT-Delhi with 16 years of technology consulting experience in multiple geographies.
• Dr. Prathosh AP - A technical advisor and technology expert in the area of computer vision, with multiple patents and publications.
• Dr. Joshua Pritchard - A Board-Certified Behaviour Analyst (BCBA), he runs various autism clinics in the US and takes care of business development there.
• Swati Kohli - 18 years of experience in autism intervention.
• Prof. Samir Kumar Brahamchari - A J.C Bose National Fellow and Founder Director, CSIR-Institute of Genomics and Integrative Biology (IGIB).
• Dr. Stephen Freind - An advisor to the company. He is also Chairman of the Board and Past-President of Sage Bionetworks.

From Inner Circle:

• Onaiza Owais - Founded and currently managing Inner Circle, Dhaka- Bangladesh’s first high quality ABA-VB centre. She is a graduate in Psychology (Applied) from Durham University, U.K.
• Zahida Fizza Kabir - Founder and MD of Inner Circle, and Executive Director of SAJIDA Foundation, she has been part of the Foundation since its founding in 1987.
• Sum Hui Ting - A fully-registered Speech Therapist under the Allied Professional Council (Singapore) with more than ten years of experience working with children with special needs.
• Guo Hua - A full-registered Occupational Therapist in Singapore with more than 7 years of experience in working with children with special needs across the U.K and Singapore.
• Harshita Bhatt - A BCBA, from the Florida Institute of Technology, she has years of experience working with individuals with autism, including outreach and autism awareness activities.

• Academic institutions both from technology (IIT-Delhi) and ABA clinics in the USA
• Leading neuro-pediatricians in India
• Leading schools for the distribution channel
• Nonprofits and special needs centers 

The value proposition of the solution is to improve the lives of those suffering from Autism Spectrum Disorder (ASD) through access to evidence based interventions.

Our key customers would be parents/guardians of individuals with ASD, schools catering to children with ASD and clinics specializing in ASD interventions. Individuals with ASD, particularly children, will be the direct beneficiaries of our services.

Our solution will sell monthly subscriptions to said customers and provide them with a tailored package, which includes assessment, treatment, training and counselling to alleviate ASD.

The solution will be IT based; hence, it will increase accessibility. Reduced costs mean more people can afford our services. Customers will avail our services from home, with a smart device and internet connectivity which will circumvent issues of geographical immobility. This will give a lot of families, particularly belonging to lower-middle and middle income groups, access to evidence based ASD therapies, who are currently deprived of them.

Our enterprise fits best to the fee-for-service model. Through selling our services directly to the target group, we will earn revenue, the profits from which will be used for improvement and expansion of the enterprise.

The treatment service is a monthly subscription based model that costs USD 70 for a family as it integrates personalized training and counselling sessions. In a subscription, a family, school and caregivers all will have access to the following components:

1. Evidence based assessment and treatment plan recommendation.
2. Teaching pedagogy.
3. Training of how to conduct behavioral treatment – 40 hours.
4. Four hours of personalized counselling, feedback and training sessions.

Another model allows a clinician to use our platform at a cost of USD 15 per month only for his/her use in the clinic. This model has no personalized training or counselling sessions.

The fund from Tiger Challenge will help us incubate and kick off operations in Bangladesh. The solution has yet to reach breakeven. Hence, without additional funding operational expansion is virtually impossible.

The fund will be used to increase adoption and accessibility of the digital platform, which will require significant investments in marketing activities and capacity building. It will also be used for localization of services in terms of translating the platform to Bangla and aligning it with the cultural context of Bangladesh. The fund will also help with further development of CogniABle's algorithm.

Operational support in terms of office space will help us reduce operational costs, and reach sustainability quicker.

Strategic support in terms of legal support, lobbying and opportunities for promotions to reach a wider audience will help cement our foothold in the country.