Triumf digital therapeutics for kids

The coronavirus pandemic causes uncertainty and it is expected that mental health disorders will peak both among children and adults. Traditional healthcare services are disrupted. Even during the times of normal operations, only one in four children who need mental health treatment receive the help they need. There is an urgent need to deploy digital tools to mitigate the pandemic impact on behavioral health. Our evidence-based digital health platform delivers behavioral therapeutics to children through an engaging mobile game. The clinically validated solution with research findings published is listed as TOP2 digital solution for pediatric patients globally according to ORCHA. The aim of the platform is to improve the mental wellbeing and quality of life of children while delivering standardized coronavirus specific information. Access to psychological support in the early adolescence increases the likelihood of patients entering into adulthood healthier and contributing towards the society in a more positive way.

The focus of the response to COVID-19 pandemic has thus far centred on the acute threat to life of individuals, however, we are quickly closing on the window of opportunity to mitigate the severe long-term harm caused by the impact of COVID-19 on individual psychosocial wellbeing. Health care institutions warn us of a global spike in mental health disorders, with children and adolescents among the most vulnerable groups. The IASC and the WHO both identify the need for special attention on supporting the mental health needs of children during COVID19. 

The consequences of leaving mental health issues unattended during childhood have serious and long-term negative effects on individuals - first, by keeping children from reaching their full developmental potential, and second, having a significant impact on their quality of life throughout the course of their lives. At the same time, 50% of mental health disorders develop in childhood and adolescence, thus, at this early stage, it would be important to intervene. However, existing healthcare services fall short in their ability to prevent long-term negative impact on child health.Digital health provides a unique opportunity to meet the mental health care needs of children and adolescents during this pandemic and beyond. 

The award-winning Triumf Health delivers digital therapeutics to children through a mobile game platform. The solution has been developed primarily to improve the mental wellbeing and quality of life of children (7-14 years). The innovative health game uses clinical research, validated psychological techniques and data analytics to assess as well as support the well-being of children and induce the creation of healthy habits during gameplay. An interactive gamified setting is used to put theories of emotions, coping, problem-solving, activity-based learning, behavior change techniques and psychotherapeutic methodology to practical use. Clinical trials have shown positive effect of the game on pediatric patients, the research findings have been published. 

In response to COVID19, Triumf Health has developed a virus specific pathway to the platform to support all kids, irrespective of their current health situation. The interactive game environment is used to deliver information related to coronavirus. The aim is to provide a safe environment through which to deliver up-to-date information related to the pandemic and relieve the mental burden amongst children. Since the launch of the public health app in Estonia and UK, the solution has been a top app on Google Play. The need for support is evident.

The target users are children with reading skills. To develop a solution with maximum impact and understand universally applicable burdening factors, the digital intervention has been designed in cooperation with children, their parents and clinicians. Identifying the game environment together with the stakeholders as a medium to deliver comprehensive care has allowed the Triumf Health team to approach children in a way that is familiar, safe and intuitive to them. The aim now is to launch the Triumf platform internationally on a population level to improve the health and wellbeing of children in as many countries as possible.  

From the perspective of children, Triumf game provides them with trustworthy, and operative information about the virus; addresses the topics of isolation, changes in daily routines, confusion and worry that likely accompany the situation of crisis; offers empirically valid information and support on emotion regulation, helps them cope with strong emotional reactions and stress, adapt to change and learn problem solving skills. 

The aim of the game is to help children better understand themselves, support their locus of control and skills in stressful situations. The intervention aims to prevent and/or lessen the development of psychological problems.

The focus currently is understandably on containing coronavirus. However, it is important to take action to mitigate the pandemic impact on behavioral health. Already now, based on March 2020, 64% of adults reported to be anxious or depressed (McKinsey Consumer Healthcare Insights, 2020). Not only does it place a major burden on the individual, it has a significant impact on the economy. In the US alone, the cost of mental illness on global economy reaches $1 trillion per year in lost productivity (World Health Organisation, 2019). Clearly, effective measures need to be deployed for managing mental health.

Triumf's proprietary platform provides personalized support based on patients' strengths and difficulties. Thus, the user experience depends on the progress in the game, no two users have the same experience beyond the onboarding. This algorithmic approach is difficult to replicate; the underlying algorithms have been developed within the team and categorize as a trade secret. Whilst there are a lot of digital therapeutic solutions addressing the needs of adults, there aren’t many comprehensive solutions focussing on supporting the behavioural health of children. We have identified a few indirect competitors who similarly to Triumf use innovative mediums by which to reach children in need, such as Akili Interactive, Cognoa and Worrinots. That said, Triumf solution is the only product that provides an end-to-end solution by combining research-based approach with machine learning, engaging game environment and therapeutic methodology. None of our competitors offer personalized psychological support and educate kids about health and their disease. At the same time, traditional personalized psychological support is expensive and difficult to scale. Our app brings unique value to the market – it can be easily downloaded and will provide support for a fraction of the cost required for behavioral therapy, whilst focusing on the same outcomes as traditional methods. The fact that the digital intervention is delivered through an application enables us to reach children irrespective of their location or other aspects that may influence the access to care. Moreover, our competition deals with developed problems, we're the only solution focusing on prevention. 

Triumf's comprehensive intervention is delivered in the form of digital therapeutics, i.e. evidence-based therapy is delivered via software. An innovative mobile health platform is used to deliver the digital therapeutics to children in a safe and interactive way. We reach out to kids through a game environment not only because it is safe and intuitive but also because an interactive gamified setting is an ideal way to utilise dynamic theories about human perception, behavior and behavioral change and put these theories into practical use. That said, we use gamification principles to deliver research-based content for maximum engagement.
We use Artificial Intelligence for several features in the game to adjust the individual level of the player so that both the youngest players and the oldest can benefit from playing the game. Additionally, comprehensive data is collected to implement machine learning for personalized care and timely support in the game. We're currently preparing a large scale population study proposal (2021-2022) in collaboration with an international consortium to implement a comprehensive machine learning model and provide personalised health behaviour support to children.

From the technological perspective, the mobile game Triumf is made with Unity 3D cross platform development engine that allows the creation of Android and iOS versions. The game requires internet connection to log in and store player’s progress.

The platform is evidence-based and highly recognized. In 2019, Triumf Health published the findings of the multi-site clinical study amongst pediatric cancer patients, which showed high acceptability and feasibility of the solution amongst kids. Furthermore, the findings demonstrated that as a digital intervention, Triumf game can improve both mental wellbeing and health-related quality of life while boosting patient engagement. Research findings have been published (Tark, 2019; open access: Tark et al., 2019) and the platform has also been evaluated by an international app reviewer ORCHA. Based on the 260 criteria involving safety, clinical assurance and user experience, Triumf health app received a high quality mark of 81%, which puts the game among TOP 10 solutions for children’s health globally. In Level 4 category (highest clinical impact), Triumf's platform is among the TOP 2 digital health interventions for children. Furthermore, the solution is currently implemented in four hospitals in Finland, Singapore and Estonia through research collaboration among various disease groups (surgery, diabetes) in the form of the randomized controlled trials.

The COVID19-specific pathway has been publicly launched in Estonia and UK. Since the launch, the app has been trending on Google Play and is currently amongst TOP solutions. We're working with public institutions, including governments and schools, to increase the awareness of the solution and reach as many children as possible. Population wide study lead by University of Tartu is currently ongoing in Estonia to measure the impact of the game on mental health.

Video for demo here.

Published research on Triumf's game indicate a within-individual improvement for mental health and quality of life following the intervention (2-months). It's recommended to play the game 10-minutes/day. The current crisis situation leaves no time for creating or conducting applied research on new digital tools, their implications remain unknown. Furthermore, it would not be feasible to reshape adult-oriented solutions to suitable versions for children. Hence, an already established, evidence-based health game designed specifically for (and co-developed with) children creates a meaningful opportunity to deliver support on a large scale and prevent mental health problems. The positive impact on individuals is achieved through improved coping skills - how to approach problems, ie problem solving skills; better understanding of oneself and how a crisis situation may influence an individual, ie self- and emotion regulation; equipment of mindfulness techniques, and more. 

The impact of the solution on individuals could be directly measured based on the game data: how much information has been read, understood, and applied; how many problem situations (correctly) solved; how much psychological support received, and the change in mental and general wellbeing in the beginning of gameplay compared to the wellbeing in the end of the gameplay (pre-post in-game measurements).

In the long run, the content could be modified to non-coronavirus specific, for the game to become available as a general behavioral health and stress management tool as the behavioral health basis of the game is applicable across multiple stressful situations.

Our product is ready to be launched internationally. It is important to scale the platform internationally under the current heightened stress situation (crisis and beyond). It is especially crucial for children because if psychological issues develop during childhood, they are likely to carry on into adulthood. Not only does it place a major burden on the individual, but it also has a significant impact on the economy. The economic impact of the Triumf solution would result in long-term cost-avoidance (prevention of mental health conditions), cost reduction (offering "digital-first" option for those with already developed early symptoms), and freeing up resources (so critical cases can continue receiving care).

Two weeks after the public version launch (only for Android) the current number of children in Estonia who are playing Triumfś game is in thousands. The number is rising continually and is expected to increase exponentially after the iOS release (the version is ready, waiting for the App Store approval). We've prepared a European Commision proposal for EU-wide deployment in collaboration with strong academic consortium from Scandinavia, resulting in hundreds of thousands of users.

Our disease management platform (that caters to children with the following conditions: asthma, diabetes, cancer, overweight/obesity, surgical care) is also implemented internationally through research collaboration: in Estonia, Finland, Singapore. We aim to convert the research collaboration into paying customer relationship within a year. 

It is important to bring out that the end users (children) are not the payers of the solution. Customers are hospitals, health insurance providers, governmental institutions. 

We aim to become the global leader in digital therapeutics for children. Our total addressable market is 10% of the whole global population that belongs to the middle childhood age group. As our solution is ready to be deployed internationally, the immediate impact would mean that 10% of the population is granted access to behavioral health/psychological support to better cope with the uncertain situation (crisis and beyond).

Our goal is to reach 1% of potential users from our total addressable market.

We aim to become the global leaders in digital therapeutics for pediatrics as we strongly stand out from our competitors. In response to COVID-19 pandemic, we have changed out business approach as it is important to provide immediate psychological support to children under the current uncertain circumstances.

Step 1: immediately launch the platform as a public service internationally in response to the COVID-19 pandemic. All kids in our target markets are potential users, we are launching it free of charge for users (for a limited time period). Covering the costs from our side until we are negotiating with buyers (governments). This also informs the public and policy-makers of our disease management platform. 

We've also prepared a European Commision proposal for EU-wide deployment. The goal of the project is to use digital health platform Triumf to assess the prevalence of mental health problems and provide high-quality, evidence-based psychological support for children: a successful deployment allows the consortium to map the mental health status of children across the EU and provide psychological support based on individual psychological profiles in an age-appropriate manner.

Step 2: 40% of kids have at least one chronic condition or are having weight issues (56M US and Europe users as our Potential Market Opportunity). Our long-term goal is to reach 5% children with health issues with our disease management platform (2.8M end users). The customers are paying an annual license fee that is based on how many patients are treated in a specific department annually.

The main barrier is related to the regulatory environment. Many countries in our target markets do not have a pipeline for the implementation of digital health innovations. Piloting and research collaboration is possible, reaching the contractual relationship is proven to be difficult. However, the crisis situation has made a timely implementation process possible.

Involving funding to continue improving the platform and provide care to as many children as possible. Funding is also needed for effective marketing, translation costs to enter new markets, customer management.

Entering new markets is also restricted to establishing strong networks. 

As the solution is designed together with stakeholders, we do not see user acceptance as an issue (we have already published our research findings as well) and are comfortable with navigating the legal landscape. 

We're also actively working together with governments to have the solution reimbursed as a public health solution. Current negotiations with the Ministry of Social Affairs in Estonia have shown that governmental institutions have a strong interest in employing digital tools to mitigate the effect of the pandemic. Moreover, the Ministry of Foreign Affairs in Estonia is supporting us in new market entry efforts. All EU wide networks are exploited to establish new leads for market entry. We have entered into negotiations with the United Nations and Plan International to reach kids irrespective of their physical location.

In addition, we're applying for several regional and international grants to ensure we can continue providing the public health solution for free for users. 

Triumf Health's team consists of 6 full time members and two advisors.

CEO Dr Kadri Haljas, clinical psychologist and researcher

The Chief Engagement Officer Riin Tark, clinical child psychologist and researcher 

The lead developer Leandro Gil, extensive background in game development

Data analyst Mait Metelitsa, a PhD candidate, in charge of comprehensive health data analysis and machine learning.

Chief Health Officer Kaari Kink, expertise in health science and constructive behaviour change 

Financial officer Sander Orhidejev, an extensive background in the field of business development and taxation. 

Financial and academic advisors, Madis Pappa and Dr. Kirsti Akkermann.

Our team has strong domain expertise in the healthcare field. Triumf Health was incorporated in 2017 by a female founder Dr. Kadri Haljas. Kadri has a health psychologybackground and saw the need for a digital intervention for children when she was working with pediatric patients as a psychologist. She has a PhD from the University of Helsinki, Faculty of Medicine. In addition to Dr Haljas, Triumf team has five expert team members of whom all have been with the company since it was incorporated. 

Our team has strong domain expertise in the healthcare field. We have a team of international experts who contribute with their expertise in various areas such as health psychology, game development, and data protection and analytics. The content of our novel digital intervention is created by clinical child psychologists and health experts, tested by patients and validated by doctors and care teams. With the expertise of our team members and the involvement of stakeholders, we have been able to develop the solution that is not only effective and safe but also attractive and engaging for users, as shown by clinical trials. Triumf's highly qualified team members have been with the company since its incorporation, which results in dynamic and strong collaboration and demonstrates strong commitment towards the mission. Moreover, having all the multi- disciplinary expertise readily available in the team means we are able to innovate quickly and provide regular improvements to our solution.

EIT Health - business and mentoring advice, access to international network of academic and business partners

Plan International - potential distributers in new markets, including rural and poor areas where access to care is even more limited or non-existent 

United Nations - advisors for deployment under the European Commission proposal

The Ministry of Social Affairs, The Estonian Health Insurance Fond, the Ministry of Education - potential customers

The Ministry of Foreign Affairs in Estonia - support for internationalisation 

Estonian Research Council - funding for research

The Northern Estonian Hospital - co-development of clinical content (including COVID19), validation of information

Tallinn's Children Hospital, University of Tartu, Helsinki New Children's Hospital - research collaborations, potential customers 

Estonian Association of Parents of Children with Cancer, Estonian Children and Young People Diabetes Associaion - platform validation and improvement according to users' needs

Estonian Connected Health Cluster - funding and business management support

Triumf platform is created to support disease management. The disease management platform is implemented through hospitals/insurances for an annual license fee (B2B). It allows the clinicians to prescribe the game to patients. The annual license fee per department starts from 50 000€ and includes the game for patients and dashboard for doctors for remote monitoring. At this stage, the negotiations with the hospitals are on hold due to the crisis situation, it is expected that we can continue the licensing term negotiations only in 2021.

Now, in response to COVID-19, Triumf Health has launched an extension of the evidence-based Triumf platform to provide age-appropriate support to all children, irrespective of their health status. The underlying aim of the intervention is to prevent the development of mental health issues. In the current crisis situation we have launched an extension of the solution for free for a limited time period to support children in a timely manner. After the free pilot, we provide a 90% discount from the disease management platform pricing on the license fee to the governments (buyers; B2G) to deploy the public health version with the aim to prevent the development of mental health disorders among children. The aim of the open platform is to support public health, provide standardized virus-specific information and shift the focus on prevention of mental health disorders.

We are working under grant basis as our solution is highly valuable on a societal level. With that being said, we are constantly applying to national and EU grants, resulting in an unstable financial status because grants are not the easiest source of financing. However, we have been able to meet (and exceed) our goals even under uncertain financial terms, the total funding up to now is around 300 000€.

Our seed funding round open. We are seeking for 1M€ investment that we will use in connection with the H2020 SME equity free grant (2.5M€).

We aim to close our first governmental deal in Estonia. Annual license fee contracts would allow us to break even already in 2021.

As a social enterprise, access to Solve's highly qualified networks, mentoring and advice is highly valuable for us. Triumf Health places significant importance on collaboration - we’ve been very successful in partnering with various consortiums and institutions through which we create awareness, form potential client relationships and improve the visibility of the platform amongst target users.  

Previous innovation programmes similar to Solve have been a great success for us. Following several pitching rounds, mentoring and business development advice, Triumf got into the finals of EIT Health Catapult competition where we were chosen as TOP2 digital health solution in Europe in 2019 and received an audience award for the best solution. Nasdaq congratulated Triumf for that in Times Square in January 2020. Participation in EIT Health and H2020 programs have significantly eased market entry efforts and initiated customer relationships in various locations. We’ve established a good awareness of the company through active participation and enthusiasm for collaboration. We're committed to take the most out of the challenge.

Additionally, as we're mainly working under grant basis and have been providing our solution for free during the pandemic, the access to prize money would enable us to continue our efforts to help as many children as possible. All financial support goes into scaling and modifying the solution to fit the needs of children across the globe.

Triumf's evidence-based digital health platform is ready for scale. The launch of the public health app in Estonia and UK has been very successful and we've seen increased traction from numerous other countries, such as Sweden, Guatemala and Singapore. Thus, the current objective is successful implementation of the product in additional markets/product distribution. Marketing and media efforts are needed to ensure the product reaches to the target audience- parents and children. To be able to continue providing the solution for free, financial support is needed.