Launch HN: Daybreak Health (YC S20) – Online counseling designed for teens
The evidence supports that behavioral therapy like CBT and DBT is effective. It works to treat diagnosable conditions like anxiety and depression, and it also works to help young people feel happier and achieve their goals [1][2][3][4][5]. But too often teens don't get the mental health support they need because it is stigmatized, difficult to schedule and attend, and expensive. At Daybreak we bring counseling to the teen on a digital device and we charge less than half the cost of a traditional therapy session.
In October of 2018, my younger brother nearly lost his life due to the lack of accessible mental health resources supporting our young people. He is not alone. 1 in 5 teens struggle with a diagnosable mental health condition, but estimates suggest that up to 1 in 3 actually struggle with anxiety - or between 6 and 10M total teens [6][7]. That means the odds are greater than 50% that if you are the average parent raising a family in America with 2 kids, one of your children will struggle with a mental health condition in their teens.
To make matters worse, 80% of teens who need mental health support do not receive care today [8]. This results in deteriorating academic performance, increased rates of juvenile crime and substance abuse, and suicide rates that are at an all-time high. Every day, 17 young people commit suicide in the US. It is the #2 cause of death among 15-24 year olds, after accidental injury and ahead of homicide [9]. This isn't a niche problem.
Our current system makes mental health support nearly impossible to get for a teen. Stigma makes it hard to admit to yourself you want support, let alone talk about it with your parents. There is a shortage of therapists who specialize in adolescents, making it hard to find a therapist that is close enough to drive to on a weekly basis. Private practice therapy averages more than $200 per session. Even if you could afford to pay, you're going to be met with 2-3 month wait lists. And when you finally do arrive, you sit on an awkward couch in an environment that you may not be comfortable in. That is why an average of 11 years pass between when a teenager first needs mental health support and when they eventually start receiving it in their 20s or even later [10].
That is why we started Daybreak Health. Everything we’ve built is designed intentionally for teens and their parents. Teens can download the Daybreak mobile app and are instantly connected to a live guide (Mon-Fri 7am-7pm) who asks about mental health goals and needs. After a video assessment where we loop in the parent, we create a plan and match teens with a counselor based on goals, needs, interests, hobbies and more. Once matched with a counselor, teens meet with them once a week through a 50-minute video call, and can message them on a daily basis through the app. Our counselors help teens develop emotional life skills and work towards goals in a personalized plan that has thematic focus on teen-specific areas like school, healthy relationships and more. Teens can also meet with small moderated groups of other teens on those same topics. And parents are a core part of the process, starting with the assessment, through planning and regular progress reports. For all of this we charge an $89/week subscription, less than half the price of a single 50-minute session in traditional private practice.
Dr. Neha Chaudhary, our lead Clinical Advisor, is a foremost expert on adolescent mental health and co-founder of Stanford's Lab for Mental Health Innovation. Together with her and experts from UCSF we have designed a program for teens grounded in clinical science, while at the same time reimagining the way it is delivered to te...
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[ 4.4 ms ] story [ 130 ms ] threadThat said, there are three primary challenges in the online environment.
First and most simply, it is harder to create rapport online. We require for that reason that all of our teens use the video sessions (in addition to messaging and the app), and we place high importance on the match itself (which we can do since we have a group of diverse counselors across California geos). We also place high importance on the therapeutic alliance and give our counselors techniques during training to develop that online.
Second, privacy can be a challenge in small or crowded homes. We work closely and set expectations with parents to ensure that our teen clients receive privacy during their session times.
Third, online counseling is still primarily best for mild to moderate acuity. At the more severe acuity levels, or with psychotic disorders for example, we haven't yet nailed how to treat online effectively and safely. We screen members during the assessment and refer them out if in-person counseling is better. We also put an emphasis on our online safety plan, which gives us knowledge of parent whereabouts and trusted contacts in the case that a crisis situation does escalate.
Link to efficacy of telepsychiatry in adolescents: https://togetherthevoice.org/wp-content/uploads/2020/04/AACA...
How did you arrive at your pricing? I am curious how, if a therapist normally costs $200 per session, you can offer it at less than half that price? Are the counselors certified differently? What's unique about Daybreak that makes it cheaper to offer therapy?
Another question I'm curious about - do you address medication at all? How does that work, do you have psychiatrists that patients can talk with? Or is medication out of scope?
Congrats again!
On Pricing - our counselors are certified to practice and pass a rigorous interview process ensuring the highest quality. All are licensed to practice in California and have 5+ years experience working with adolescents. The primary differences are: 1) real estate (our therapists work from the comfort of their homes, so we don't have that cost), 2) cost of living (because we can work with therapists in varied geographies, their cost of living may be lower than in the highest demand/need geos), 3) value prop (adolescent-focused therapists want to work with us because of our flexibility and focus on teens which is rare to find)
On medication - today we refer out if patients need medication. It is an area we are actively thinking about how to better serve in house!
One of the big issues with the lockdown was that many municipalities considered substance abuse meetings (AA and others) as non-essential. These types of programs do not work anywhere near as well online. Meanwhile liquor stores remained open as essential.
I'll start by saying that we look to data to drive our perspective here. The the evidence suggests that telepsychiatry is as effective as in person therapy for adolescents (article link below), and our data actually shows that it is more engaging as measured by session attendance and number of weekly engagements than traditional therapy benchmarks. The way teens engage with the world is changing (to more digital), and rather than try to swim against the current, we hope to reach the most teens by meeting them where they are, and then changing their behavior in ways that matter. Our programs do focus on the importance of things like limiting screen time and developing healthy relationships.
Ultimately I won't disagree with you -- in-person is at least as effective and for many people can be more effective. However, what we are hoping to do is increase access to those people for whom going to an in person session might present to high a barrier, whether it be geographically, financially, or from a stigma perspective.
Article on efficacy of telepsych: https://togetherthevoice.org/wp-content/uploads/2020/04/AACA...
[1] https://www.thelancet.com/journals/eclinm/article/PIIS2589-5...
[2] https://healthsci.mcmaster.ca/news-events/news/news-article/...
My psychiatrist has found doing things over video is much more effective than in person for most of her patients. It’s easier for me to take 20 minutes out of the start of my work day than spend two hours after my work day to drive to her office, wait to have an appointment in person, and then drive home.
I guess my question is whether your vision is a digital version of traditional therapy, or if you see your mission as making therapy more accessible which _currently_ is digital traditional therapy but could evolve substantially over the coming years?
So to answer your question: our current product reflects what we think is the best solution to increase access to therapy while maintaining quality. Over time, as we learn more, the product could evolve to become even more accessible (e.g., more digital) if we are able to maintain quality with that solution.
One other piece I'll say on access: for a healthcare company the 'insurance plans' control the keys to access. From Day 1 an important part of our strategy is pursuing reimbursement so that the cost of our services reaches $0 for teens and families who need it and cannot afford the out-of-pocket cost. We are not there yet, but it is our goal!
You ask a great question, and we'll add it to our FAQ. We currently refer out for the medication prescription needs, and are evaluating bringing the capability in-house.
I’ve also worked with young people whose parents, even if they could have afforded it, didn’t believe in therapy and weren’t willing to support their child’s efforts to obtain it. So yet another reason why access is super important.
Just as a reference point, I run OkaySo, we offer free support on sex, relationships, and identity to young people. Happy to chat and connect. elise at okayso dot co (not com)
Thanks for this work!
We recognize that our current pricing, while an improvement over private practice, is still out-of-reach for much of the country. Our plan is to: 1) continue to evolve the product to reduce cost of care while maintaining quality, 2) pursue partnerships with health plans and eventually Medicaid (which covers the lowest income teens) so that our services can be offered for free to those teens. We are very open to other funding models to increase the access of our services for teens as well! I'll reach out to learn more
I strongly suggest you do performance a/b testing.
It is not trivial for this service how your website looks. It should provide some confidence that you know what you are doing.
Question: your site emphasizes a "guarantee of good counselor match". Importance of a rapport and trust between coach and teen (especially) is hard to overvalue.
How does this guarantee translate into practical terms? Is it a guarantee to have access to/try all currently available coaches before making the choice, or more like a "money back" kind of guarantee?
How it practically plays out: teen members can switch between counselors on our platform if they are not satisfied with their first match. If they don't find a match that is a fit within the first few sessions, we do offer a money back guarantee.
We do also focus in the upfront assessment on gathering the input we need from both the teen AND the parent to make the matches we select higher quality. This input includes goals, needs, specialty areas, interests and hobbies -- among other inputs.
During the whole quarantine, I have had no complaints about online therapy (unlike online school). I can say personally you do not lose out by going the online route. It is certainly more convenient, and because it is (mostly) one on one, you don't have the issues that come with a 50 person zoom call. I really appreciate that you get parents on board because having an open dialog is extremely important.
I have two specific questions though: (0) How will you deal with crisis situations? How are you planning to take on the legal responsibilities that come with that? (1) Any potential solutions to improving access to psychiatrists and medication? Therapy is just one piece of the puzzle to my ongoing recovery. Medication really helps, but I am concerned that these teens might miss out on that important part.
Thank you for doing what you are doing. If I did not get help, I probably would not be here leaving this comment today.
1) Crisis situations: safety is our #1 priority. We create a safety plan that includes coping skills, strengths, local resources and people to contact. If a crisis situation arises we have this in advance as a resource. We recognize online can create more challenges than in person for maintaining a safe environment, so we also refer patients who we believe might need more intensive care to in person treatment.
2) We firmly believe telehealth is a great vehicle for psychiatry. We haven't quite arrived there yet, but it is on our 'roadmap' to have psychiatrists. And in the meantime, we refer out for teens who need medication support.
Thanks again for sharing your story!
from my experience there has been a constant refrain about CAPS (Counseling and Psych - usually called CAPS in school systems) departments everywhere being
1) hard to access 2) underfunded 3) unresponsive
super excited for this product :)
As a medical student interested in psychiatry and rehab, that is mindblowing and touching.
I really with you the best with this!