Adolescence is an extended developmental time frame of risk and resilience – from brain growth to education completion to labour market participation. The World Health Organization defines “youth” as in the 15 to 24 year-old age group, acknowledging this as a time between reliance on caregivers and environmental shapers. Resilience is an adaptation process supporting the management of extreme stress, such as adverse childhood experiences (ACEs), as well as chronic, daily stress, and discrete events, such as pandemics and disasters [1-5]. It is well-accepted that stress narrows the focus of attention to the most salient features, oriented towards detecting threat and managing risks. One model of post-traumatic stress highlights that: (1) traumas may reduce the positive value of activities (i.e., they need to be more intense to be experienced positively) and (2) positive experiences may be nested within chronic backdrop of tension (reducing the detection of, and engagement in, positive affect and activities). This research base points to an intervention need to buffer stress effects effectively, promote positive engagement, and create daily routines that maintain emotion regulation. Specifically, a daily resilience routine may ensue from efforts to: (1) create an easy-to-access resilience intervention that bundles multi-modal evidence-based features to help balanced emotionality. The JoyPop mobile application development process was begun with reviewing research findings, including the work done on bolstering male youth resilience within our CIHRTeamSV (see below). We then conducted pre-app and post-app consultations, and initiated research with late adolescents in their first entry of an urban university. Thus, to be able to detect any unintended negative consequences and usability data on the app, a more resilient population of youth was first considered. This is further described below.
CIHRTeamSV Research Findings Review
JoyPop was developed from a cumulative research and parallel consultation approach. A Canadian federally-funded team has, over the past five years, published epidemiological and clinical research projects investigating sex/gender differences in the linkages among ACEs, child sexual abuse, trauma, resilience and health. Collectively, these research results highlighted important constructs to carry forward into intervention: (1) the trauma-informed care approach [7,8]; (2) the context of trauma-based negative emotionality (i.e., depression, anxiety, PTSD symptomatology, suicidality) and the usefulness of behavioural activation to address negative mood states; (c) to address unmet mental health needs of male youth by including gaming features. Emotion-mediated pathways emerged as key mediators for targeting in intervention. Work pointed to the resilience value of developing internal assets (i.e., positive identity , well-being[12,13], self-compassion[14,15] and mattering[16,17] to support increased contact with positive self-mood, self-reflection and self-regulation. Finally, technology was identified as a “good fit” with youth, across domains of assessment (e.g., icons/visuals) to intervention mode (e.g., virtual reality mindfulness)[19-21]. To date, no resilience-focused mobile apps exist, despite the parallel development of resilience alongside mental health issues and daily living challenges of sub-groups of youth experiencing transitions, poly-victimization, and limited effective social supports.
In parallel, a consultation process proceeded which informed a week-long design and discovery exercise with Clearbridge Mobile, a top-tier app development company. The pre-app consultations included male and female undergraduates and system-involved youth (child welfare and victim services), as well as adult service providers to youth victims. Over the course of a year, the app features were developed to target daily emotion regulation, via research-based approaches (e.g., deep breathing, journaling with self-compassion and resilience prompts), incorporating Tetris-like gaming to be more attractive to male youth, given research impacts to trauma symptoms. Post-app consultations included a different group male and female adolescent and young adult trauma survivors, as well as clinician-scientists working in the trauma, mental health and resilience fields. Following the completion of the first app version, two feasibility and pilot research studies were launched with more resilient sub-populations, who also experienced high stress, namely adolescents making the transition to first-year university (Lead: Dr. Aislin Mushquash, Lakehead University) and young adults making the transition to social work studies (Lead: Dr. Katherine Maurer, McGill University). Studies with child welfare system-involved youth (Leads: Drs. Deborah Goodman and Kim Snow) and youth engaged in other trauma treatments (Leads: Drs. Ashwini Tiwari (Augusta University) and Shannon Self-Brown (Georgia State University). Research-based JoyPop app development is on-going.
Support for this phase of development was via a Canadian Institutes of Health Research, Institute of Gender and Health Team Grant (Lead: Christine Wekerle). In working with a computer science McMaster professor, university undergraduates in the computer science and health science programs participated in pre-app consultation (8 females, 3 males). This work identified mood ratings as a primary feature of interest. These youth further consulted their networks which indicated that: (1) the ability to distinguish among gradations of mood (low mood to sadness to depressed mood) was too difficult, and (2) a “catch all” for negative or low mood that is difficult to label or described be available. Consequently, JoyPop has four possible moods, focusing on happy, and if that is low (operationalized as 50% or lower on the rating scale), then sad, angry and “meh” is available to rate. This is designed to keep the emphasis on positive mood and if negative mood is significant, to be guided towards activity engagement. Further, youth from a large urban centre’s police victim services who completed a leadership training program were consulted (8 females, 1 male) on apps that they enjoy and features they would like to see. Youth identified journaling as a valuable activity and having a calendar to support a diary-like function. Youth concurred with the value of mood awareness, and especially endorsed a positive mood and activity focus. Arts engagement was identified as a positive coping strategy for youth. Privacy and safety were emphasized as important considerations.
Social workers, helpline counselors and other healthcare clinicians, as well as an inter-disciplinary child maltreatment specialty clinic team (14 females, 3 males) provided input into youth resilience needs, and app feature consideration, in terms of fit with youth with trauma backgrounds and those experiencing mental health challenges. Privacy and safety were key considerations, with support for including 24/7 help or crisis lines. The telephone contact support function for a close circle of trust was seen as potentially relevant for caseworkers to engaged with.
Support for this phase was funded through a corporate donation to McMaster University (Lead: C. Wekerle) to work with youth from diverse communities. Indigenous and former foster care youth (7 females, 4 males) provided review of the app in demonstration and discussion. Uniformly, positive feedback for all features of the app and the user experience was provided. Youth reinforced the presence of population-specific helplines (LGBTQ+, Indigenous).
The app has been presented to various agencies, including in the areas of child advocacy, youth justice, child welfare, bullying prevention, education, Indigenous mental health and wellness, public health policy, environment and health, in Canada and internationally. At the CIHR Idea Fair, technology as an education for health was presented along with the JoyPop app specifically.
On-going JoyPop Development
From a Canadian Institutes of Health Research, Institute of Indigenous People’s Health, we are conducting research in partnership with Six Nations of the Grand River to adapt JoyPop to an Indigenous culturally-relevant version. This will include a water-based “ease-to-sleep” feature (Leads: Drs. Christine Wekerle, Dawn Martin-Hill, McMaster University).
Our future goals will be to develop an Android version, as JoyPop is currently only iOS.
Interested in conducting a JoyPop research study?
Contact please Dr. Christine Wekerle at firstname.lastname@example.org.