Social Cascade

Social Cascade works to reduce health disparities in underserved communities by increasing medical trust and literacy through health education. Trust is a multi-faceted construct that “includes perceptions of the healthcare provider's technical ability, interpersonal skills, and the extent to which the patient perceives that his or her welfare is placed above other considerations” (Halbert, 2006). Trust is associated with a variety of health-promoting activities including well-visit compliance, use of preventative services, and other outcomes across social determinants of health (Birkhäuer, et.al., 2017; O'Malley, et.al., 2004). Conversely, Americans reporting lower levels of trust often also suffer poorer health outcomes (Armstrong, et al., 2006). Historical events, systematic factors, and provider cultural misalignment occlude trust in the healthcare system meaning levels of medical trust are disproportionately low among underserved communities of color (Hostetter & Klein, 2021; NASEM, 2019). In fact, an estimated 70% of African Americans feel they are treated unfairly by health systems and the majority report distrust in the medical system (Fletcher, 2020). Children in such communities are especially vulnerable (Halle, et.al., 2009) as children exposed to as many as three non-medical risk factors (e.g., low maternal education, medical mistrust) experience a greater likelihood of having one or more developmental delays (Barth, et.al., 2008).  Therefore, regardless of how many programs and resources are created to reduce health disparities, if the communities they are intended to serve do not trust and utilize such services, efforts will drastically miss the mark (O'Kane, et.al., 2021). 

Consequently, there is much interest in enabling medical providers to engage in the trust-building activities known to increase trust among communities of color; namely, consistent communication, patient-centered care/language, patient education and cultural awareness (IMCQC, 2001; Powell, et.al., 2014; Grob, et.al., 2019). While progress can be made through provider professional development and training for in-person visits (Thom, 2000), it is difficult to drive marked change in 15-minute increments–the average time of an annual well visit. Furthermore, Aletha Maybank, MD, MPH, the AMA’s chief health equity officer, claims “80% of what creates health happens outside of the doctor’s office, therefore it is critical that physicians know and can be responsive to the full context of patients’ lives to ensure optimal health outcomes." We can almost guarantee circumstances will shift and issues will arise when particular social services could be needed at times other than the annual well visit. Therefore, to optimize progress in increasing trust, we must explore mechanisms by which we can infuse consistent, patient-centered communication and education throughout the year between office visits. 

Similarly, achieving authentic cultural awareness can be difficult in an environment where patient and provider are so often a heterogeneous dichotomy. It comes as no surprise that community health workers, entities integrated within a patient community serving as a culturally-centered liaison between community members and medicine, tend to receive higher levels of trust among communities of color for their relatability and empathetic approach to health education (Families USA, 2019). However, reach is often limited and fragmented with little to no collaboration between pediatric healthcare providers and the community health workers in their communities (Families USA, 2019). 

Social Cascade offers a unique solution mitigating contributing factors and enabling collaboration between community health workers and pediatric healthcare providers to deliver consistent, ongoing, culturally-relevant health literacy campaigns through pervasive tools already in the hands of these communities. This problem is critically in need of solutions. It has been amplified by the COVID-19 pandemic and associated infodemic leading to ever-increasing amounts of health misinformation readily available online.

Bibliography and References

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Social Cascade is an intelligent health literacy solution for providing relevant information and breaking through cultural barriers that limit parents and caregivers of children and adolescents. By pairing revolutionary technology with influential, trusted voices (e.g., community health workers and pediatric healthcare providers), Social Cascade makes it possible to support families like never before on the free social media platforms they use everyday. First, our solution curates credible health-promoting social marketing content from reputable national, regional, and hyperlocal organizations into content streams. From there, healthcare providers subscribe to the streams and topics they trust and deem most relevant for their patient panel. 

At this point, the platform takes over, intelligently scheduling an always-on, personalized social media presence covering a range of topics, such as seasonal and environmental threats, developmental milestones, positive parenting strategies, community resources, and more. Content is authored by organizations skilled in liaising between the community and the medical home,providing culturally-aware and patient-centered messaging known to positively influence levels of patient trust. Ultimately, healthcare providers signal support throughout the year providing consistent in-the-moment guidance when parents need it most–and all parents have to do is follow their pediatric healthcare provider on their preferred social media platform. Additionally, the underlying system data warehouse ingests and processes clinic-provided patient demographic data, post metadata, post engagement data, and other data sources to provide insights at both the clinic and content provider level. This unprecedented dataset promises to answer some of the most pressing questions in public health social marketing as well as the potential to inform other advanced technologies such as health chatbots and natural language processing models. 

Social Cascade Solution: Streams of information. One trusted voice.

Social Cascade Explainer Video, with Dr. E:

https://www.socialcascade.co/video

Initially, we are targeting the families and caregivers of young children with a priority focus on historically marginalized communities in the United States. Product roll out will begin in North Carolina where affordable housing, homelessness, food insecurity, and interpersonal violence continue to widen health disparities. One in 28 children under the age of 6 is homeless, one in five experience food insecurity and one in 4 face adverse experiences at home (NCDHHS, 2019). Unfortunately, like other states, health disparities in North Carolina disproportionately affect low-income communities of color where health literacy and medical trust are the lowest (NCDHHS, 2019). Consequently, children within these communities are especially vulnerable (Halle, et.al., 2009) as children exposed to as many as three non-medical risk factors (e.g., low maternal education, medical mistrust) experience a greater likelihood of having one or more developmental delays (Barth, et.al., 2008). Therefore, Social Cascade enables pediatric healthcare providers to pull the levers known to increase medical trust and health literacy as a means to thereby increase health-promoting behaviors and services utilization within the families they serve. Through market expansion, the Social Cascade solution easily scales to communities across the country.

The founding team consists of career technologists bringing a combined 25 years of experience in early childhood education, as well as their personal experiences as parents of young children. We have assembled a board of advisors consisting of pediatricians working in distinct communities across demographics, nonprofit partner organizations working with the medical home, researchers studying health-promoting behavioral change, and business professionals from healthcare, education, and technology markets. We continue to expand our use of voice of customer interviews and survey instruments to understand the intricacies of the challenges facing our target population. This April we are launching our first pilot in Charlotte, NC. The pilot will bring together area pediatricians and a parent advisory group to contribute to refinements in the Social Cascade solution.

Key personnel:

Scott McQuiggan, PhD, Co-Founder/CEO, brings startup and executive leadership experience with a 20 year career creating innovative technology solutions that scale. His graduate work on human-centered computing in intelligent learning applications fostered a passion for using technology to impact lives around the world. Scott has led work on educational technologies that have reached more than 7 million students in 100 counties. From this experience he has developed a deep understanding of the opportunity to reach children during 80% of their development in the first five years. As a father of two, Dr. McQuiggan has lived in both rural and urban settings and experienced the disparities that arise along such geographic dimensions.

Lucy Kosturko, PhD, Co-Founder/Chief Product Officer, brings graduate-level degrees in both computer science and educational psychology, uniquely representing the intersection of technology and behavioral change. She has15 years of experience advocating and solving for equity for our youngest generation. As a Social Innovation Director at a global analytics company, Lucy leverages her significant program and product management expertise collaborating with leading nonprofits to apply analytic solutions to some of the world’s most pressing issues. Most importantly, a mother of two herself, Dr. Kosturko understands the challenges facing new and young parents as they navigate the complicated first five years.

Scaling and partnering: Although Social Cascade is deployed through the medical home, the solution aims to solve across all social determinants of health which means the interdisciplinary nature of the Solve community can provide insights in guidance in all areas affecting today’s families.  

Networking and mentoring: We are excited at the opportunity to join an esteemed network of peer organizations focused on solving pressing challenges with solutions that impact society. We believe this network is filled with significant learning opportunities, advice, peer support, and collaboration.

Global expansion insights: We would welcome the opportunity to network and learn from partners around the world. Extending relationships into the peer network would enable Social Cascade to accelerate our growth as we engage in the broadened community of strategic and financial resources. While our immediate focus is on the US market, we believe our solution has global potential. Solve would give us the opportunity to establish key partnerships and relationships to support international growth and impact.

Social Cascade is a first-to-market solution. To date, social marketing solutions have turned to technology, namely smartphones and advanced analytics, for opportunities to scale human capacity in solving this problem. To the former, the proliferation of smartphones provides a significant opportunity for disseminating dynamic content with real-time engagement data.  Eighty-five percent of Americans own a smartphone--a number that only drops to 75% when looking at households earning less than $30,000/year (Pew, 2021). However, to date, smartphone-based interventions have come with significant shortcomings. Online repositories (NC Care 360, 2021), texting solutions (York et al., 2018), and mobile apps are bulky or ineffective as they either do not provide consistent nudges (Thaler & Sunstein, 2008), do not fit into regular routines, or require significant literacy proficiency to sort through massive, encyclopedia-esque resources. Scheduled text messages push content at inconvenient times rather than allow the user to pull content when they’re ready to consume it, and mobile apps suffer a similar fate. While we populate our smartphones with an average 21 apps, individuals spend 84% of time using only 5 apps. Many parents might be  willing to download another app but the data shows they do not use it consistently. By capitalizing upon the limitations of previous solutions, Social Cascade is a revolutionary health literacy tool pairing best practices with advanced technology all while remaining hyperlocal and culturally relevant.

What is truly innovative about our solution is that it enables other community health organizations serving the same population to scale their positive impact. Many nonprofit and government organizations with resources, support, and services for parents and caregivers have difficulty reaching them. Our platform gives them a path to their target audience with the support of locally trusted voices in the community health workers and pediatric healthcare providers of each community.

The Social Cascade is intentionally prioritizing the following impact goals to actively reduce health disparities facing our youngest generation and their families. 

1. Increase levels of medical trust and health literacy in the areas at highest risk. Over the next year we plan to reach 1,000,000 children and their families through the medical home via social media. Over the next five years we strive to expand that reach to 30,000,000 children and their families. With intentional, strategic focus on increasing trust within the medical home, we, ultimately, seek to push the needle of progress on closing health disparities.

2. Evaluate impact and elevate successes. In correspondence with the roll out of social determinants of health screening tools, Social Cascade will collaborate with public health officials to understand the tool’s formative impact and progress trajectory. Over the next five years we also strive to see a correlation with public messaging powered by Social Cascade and social determinants of health data from sources, such as the CDC, including the Area Deprivation Index and the Kids Count Data Center.

3. Contribute to the research community. Engage in strategic partnerships with community health organizations and public health researchers to understand the levers available through social marketing techniques for increasing medical trust among racial and ethnic minority populations. By widely disseminating such findings, Social Cascade hopes to accelerate progress toward a more equitable future.

We have 3 systems in place to measure our impact progress and answer critical public health research questions:

1. Company KPIs and benchmarks ensure our messages reach as many families as possible. To that end we are monitoring our progress towards 2022 goals:

   1. 500 new pediatric healthcare provider accounts

   2. 20 content partners

   3. NPS > 8

   4. 1,000 website visitors

2. Public Impact Dashboard. Later in 2022, Social Cascade plans to release the first version of its Public Impact Dashboard - a public view of the reach obtained through Social Cascade’s network of locally trusted voices on social media platforms. In 2022, we hope to surpass a reach of 500,000 children, families, and caregivers. We will correlate the reach and engagement obtained through Social Cascade with publicly available social determinants of health data.

3. Engagement Research Data Warehouse. A key component of Social Cascade’s Platform architecture is a data warehouse readily prepared and available to public health researchers. This unique data contains reach and engagement data related to public health messages enabling researchers to analyze vast amounts of variables contributing to the reception and engagement with public health messaging. Our 2022 goal is to engage 3 research partner organizations with our Engagement Research Data Warehouse.

4. A key hypothesis of the Social Cascade theory of change regards the role of hyperlocal and culturally-aware public health messaging. As impact is measured we plan to share results with the organizations providing public health messaging content such that collaboratively we can continue to refine and test messages across demographics.

Our mission to create a positive change in every community drives the work we do every day. This change begins with nudges and support from trusted voices within the community to share critical, timely health messages that are optimized to best serve their community. By delivering hyperlocal, culturally-aware public health content, we believe communities can unleash positive impacts on social determinants of health, combat misinformation, and improve medical trust.

Social Cascade Theory of Change Framework:

Activities/Inputs: We provide Social Cascade’s platform to pediatric healthcare providers so that they can automate the population of their social media accounts with public health content optimized for the community they serve.

Outputs: 1) Content providers from non-profit and government organizations develop and refine messages using real-time engagement data, culturally-aware, patient-centered language, with locally-reflective imagery; which means, 2) Healthcare providers signal a continuous partnership in care, relaying information developed by national and regional voices; which means, 3) Parents and caregivers receive carefully-crafted, regionalized messages throughout the year on the social media platforms they are already using everyday from voices they trust. 

Outcomes: Increased healthcare provider trust, increased resource utilization among community service organizations, increased data and data quality regarding public health messaging, increased access to health literacy, and reduced levels of misinformation.

Impact: Reduced health disparities, particularly among racial and ethnic minority communities.

Social Cascade is a web-based platform accessible from desktop and mobile computing devices. The core technology that makes Social Cascade innovative is the underlying AI engine that accomplishes 4 key features: 1) recommendations of health-promoting content automatically scheduled for publication on social media channels on behalf of healthcare providers, optimized for their community, 2) data and analytics that refine the recommendation engine and inform human intervention, 3) image analysis and text generation to create public health message variants customized for community culture and demographics, and 4) mitigating human biases through content recommendations and model refinement.

Social Cascade: Technology Overview

Diversity, equity, and inclusion are core tenets of Social Cascade’s purpose to deliver public health content customized for the diversity of local communities. Social Cascade strives to eliminate one-size-fits-all public health campaigns. Further, the Social Cascade Engine seeks to go farther by reducing human biases, conscious or unconscious, to recommend and schedule social media posts that include content a particular healthcare provider may otherwise overlook. As a for-benefit organization, we are implementing policies and practices that consider DEI at initiation. For example, we have drafted and plan to implement a transparent salary schedule for all employees of Social Cascade. Additionally, we are well-versed in hiring practices that reduce human biases to enable any talented individual to surface to hiring teams. We plan to monitor DEI through regular employee engagement (e.g., anonymous surveys) and third-party audits and assessments.

At Social Cascade, we believe that every child deserves to grow, live, and learn in a supportive, nurturing environment. Therefore, our mission is to reduce health disparities by eliminating barriers through equitable access to health literacy materials, community resources, and other drivers for change. 

Social Cascade’s novel, yet simple, approach utilizes the medical home, the most consistent touchpoint for children and their families, to deliver valid, reliable information on the platforms parents and caregivers are already using everyday: social media. In fact, "90% of millennials, regardless of ethnicity or socioeconomic status, say they use the internet as their primary – or only – source of health information, and nearly half of U.S. adults rely on social media for healthcare decision making" (Bulgaru, 2021). Therefore, we provide software subscriptions and services to pediatric healthcare providers enabling them to meet parents where they are–and where bad actors are already populating feeds with medical misinformation and misguidance. 

We also provide services to our primary user, pediatric healthcare providers. In addition, we provide services to content partners as well.

As we ramp up to becoming financially sustainable, we are targeting a blended investment stack including grants, customer revenue, and investment capital. Recent attention toward the care economy (Holding, 2021) has created “a window for innovation and a receptivity to elevating the importance of parent-child relationships and social and emotional development” (PSP, 2021) making it no surprise that health tech venture funding hit a record high in 2020 (Micca, et al., 2021). Specifically, investors indicate early childhood education and innovative parenting technologies to be a prioritized opportunity (Holding, 2021) as every dollar invested in early childhood programs holds an estimated economic return between $4 and $9 (Karoly, et. al., 2006), and investment returns are higher when placed earlier in a child’s life (Heckman and LaFontaine, 2007) and within high-risk families (Karoly et al., 2005). Consequently, we are fielding interest from potential investors while also pursuing several zero-equity funding opportunities released in response to these findings.

In the long term, we plan to utilize grants to support research and development efforts as well as market expansions, while customer revenue sustains the long term availability of Social Cascade. To that end, customer revenue will be generated using a tiered SaaS subscription model starting at an annual rate of $600 paid by the healthcare provider/clinic. Voice of customer interviews corroborate the pricing model commenting that prioritizing proactive, preventative patient education serves to influence a long-term strategy for cost-saving behaviors such as well-visit compliance, empowering patients to know when and where to seek care between visits, and taking advantage of community services that advance progress across SDOH. Additionally, providers from capitated models, such as Medicaid providers, indicate purchase of a Social Cascade subscription is motivated through incentives and requirements around patient engagement aimed at social outcomes fully realized through long-term strategizing.

To date, we have received a grant to support our pilot study in Charlotte, NC beginning April 2022. We have received financial support from a friends and family raise as well as bootstrapped the start of Social Cascade. We continue to submit competitive grant applications to organizations such as NIH, NSF, and IES while we pitch friends, family, and potential venture capital partners ahead of projected customer revenue beginning in summer 2022.