Audrey Tang: …an hour ago, I thought this would be a video conference. [laughs]

Keng-Yen Huang: Oh, OK. I want to meet you in-person.

Audrey Tang: Very nice to meet you you. I don’t have any meeting after this, so we get a full hour.

Keng-Yen Huang: OK, great. Thank you.

Chia Ying Lee: Thank you.

Keng-Yen Huang: Do you want to use the projector?

Audrey Tang: Sure. There’s a presentation.

Keng-Yen Huang: I’m going to tell you a little bit about why we’re here. [laughs]

Audrey Tang: OK.

Keng-Yen Huang: Just introduce myself. [laughs] I’m a faculty associate professor at NYU School of Medicine. I am still a Taiwanese.

Keng-Yen Huang: The reason I’m here is also because I’ve been doing a lot of global mental health work, and some of these can be applied in Taiwan. I see a lot of similar challenges in Taiwan, it’s very consistent with what I saw in the global world. Some of the digital solutions that I have developed through research for different populations could potentially apply here. A lot of my work…

Audrey Tang: Do you do development primarily for the practitioners or for the client?

Keng-Yen Huang: Both.

Keng-Yen Huang: Both for community and also for health facilities as well.

Audrey Tang: That doesn’t seem to be work there.

Keng-Yen Huang: It’s working.

Chia Ying Lee: It work earlier.

Audrey Tang: It did work. Really?

Chia Ying Lee: [laughs]

Keng-Yen Huang: Right now I’m still like…(setting up the presentaiton equipment)

Audrey Tang: It’s fine, if you retest, but I guess you…

Keng-Yen Huang: [laughs] I could also choose…

Audrey Tang: …choose a smaller screen, and there’s three of us. [laughs]

Keng-Yen Huang: It’s easy. It’s closer to me too.

Audrey Tang: That’s right. It’s more.

Keng-Yen Huang: This is my Chinese (point to the name on the slide). [laughs] I’m still doing global mental health work and a lot of the degital solutions are primary developed for Africa, because of the low resource. Some of the work, now, I’m testing in the US context, both in community and healthcare context.

Keng-Yen Huang: The reason I’m here is to share a little bit about what I’m doing, but also to get your input on where I might be able to connect. The model that I’m doing is not to create a new structure, but to integrate into the existing structure. I am thinking about policy-academy-private partnership. It depends on the structure and considers partners’ priority and develops ways to integrate.

Keng-Yen Huang: My background is in multiple areas, I have multi-disciplinary training. Originally, I had clinical psychology training in Taiwan; and in US, I did public health, and also the mental health implementation research. I have background both in intervention and service development research and am thinking about adapting some of those intervention research work to the digital platform. Most of my work is funded by National Institutes of Health from the US.

Audrey Tang: It magically fixed itself.

Keng-Yen Huang: I don’t know if you want to see that or hear it in the way.

Audrey Tang: Sure, it’s fine. Digital double. Digital twin.

Keng-Yen Huang: The digital tool that I named, it’s called mSELF (mHealth Toolkit for Screening & Empowering Lives of Families). It’s an empowerment tool for screening and empower life of family. I’m interested in focusing on family-centered approach. Sorry, I forgot to introduce you (colleague Chia Ying).

Chia Ying Lee: [laughs] That’s OK.

Audrey Tang: It’s fine.

Keng-Yen Huang: I’m sorry. I got too excited.

Chia Ying Lee: I’m Chia Ying Lee. I curate work at 中央研究院語言所/at the Institute of Linguistics. I do ERP MI for brain &  language (大腦與語言實驗室). We were classmates in the Kaohsiung medical college. We talked about this issue very frequently. This is why I’m also here.

Chia Ying Lee: I also care about children’s education and develop app for children in need for special aid. Today, we just want to propose one of the approach for adolescents & young adults. This peripheral can be the applied to young children and also for elders.

Audrey Tang: For lifelong learning and care.

Chia Ying Lee: It’s just the concept of trying to make some connections.

Audrey Tang: Cool.

Keng-Yen Huang: I will take about 10-15 minutes to present the concept.

Audrey Tang: Of course, while I have my morning coffee.

Keng-Yen Huang: Enjoy. The digital tool that we’re thinking is using a personalized/precision medicine approach. Precision medicine is also a new field in mental health in the US context. Just to give you a sense what are some common global mental health service challenges first (showing the slides). We know cultural norm, such as stigma and not talking about mental health issues, is a big problem in mental health service. We see that…

Audrey Tang: Yes, I brush my teeth every day but I don’t usually communicate that I talk with a psychoanalyst.

Audrey Tang: Actually, I did. I was very public about it but it’s not the norm. [laughs]

Keng-Yen Huang: Yes, you’re not the norm. [laughs]

Audrey Tang: No, I’m not. [laughs]

Keng-Yen Huang: Even for parents to recognize kids’ behavior issues, that could be a problem, and so, parents tend to overlook child mental health issue. It depends on the culture, we need to find a way to help parents recognize the issue. The approaches need to fit into the culture, and develop the engagment approaches to fit specific culture. There’s also communication barriers– a lot of mental health information is not accessible in public domain.Communication through a web platform or outside of the healthcare system is very critical. This is an issue that we are trying to address (throught the digital tool).

Keng-Yen Huang: There’s also intervention design issues in the service area. A lot of mental health intervention resources have been put into treatment, but not in public health prevention. This pyramid (point to the WHO’s service Pyramid model) with the wider bottom shows the need for a more self-care service model. The Pyramid model is a framework proposed by WHO. It suggests more health resources should be put into self-care approaches of health promotion, and less resources in treatment.

Keng-Yen Huang: When you have a larger population that needs wellness promotion or mental health problem prevention, you need to put more resource into the prevention.

Audrey Tang: Yes. Tooth brushing.

Keng-Yen Huang: That’s right.

Audrey Tang: I had a root canal. I wasn’t really happy about the process.

Audrey Tang: Treatments are always more painful. [laughs]

Keng-Yen Huang: That’s right. That’s right. It’s better to have a good life habit. Also, lack of professional resource is another common issue (point to the slides for 3 common service issues). What are the consequences of not setting up the service in the right way? We know,high prevalence of mental health problem will be one of the consequences.  It’s pretty much the same globally. In many country: about 10 to 20 percent of children and young adults have a mental health issue.

Keng-Yen Huang: We know that in Taiwan, the suicide rate and depression in young people is pretty high.

Audrey Tang: Definitely.

Keng-Yen Huang: That’s a little bit higher than the rate in the US, we know for Asians, we have higher rates of anxiety and depression. We also know that most of the mental health problems developed by the age of 14. [laughs] The majority of the problems are anxiety, depression and conduct problems, and these contributes to 75 percent of mental health problems in young people. If we can focus our energy targeting those issues, it would be super useful.

Keng-Yen Huang: This Figure is to gives you a sense of the global health diseases burden. Mental health burden is in top three, it’s an issue that hasn’t been paid a lot of attention. We know parents constantly complain about kids’ problems, and parents don’t have a place to get effective parenting solutions. Same thing for health provider. They have challenges to give parents needed information.

Keng-Yen Huang: School, it’s also a good system to target on children’s mental health, but usually is not that well implemented. The approach that we developed is, we bring in the evidence-based interventions that we tested using face-to-face approaching, and modify it to a digital appraoch and see how it works in the digital platform. This just gives you…

Audrey Tang: …report.

Keng-Yen Huang: Scale of problems for the three issues that we just discussed are pretty high in taiwan. We know the same workforce challenge in Taiwan: low pay, not enough professionals and accessible services. It has exactly the same problems as many other countries.

Audrey Tang: The last one, we have installed, by law, the consultation service workers in schools, not just public schools, but mandated in all levels of schools. The critical thing is that when people report only when they are quite late in development of depression or anxiety, there’s a limited efforts that most well-meaning consulting psychologist.

Audrey Tang: It need a lot of personalized care, which it’s beyond the capacity of schools. If we could report much sooner, then I think the existing resource may actually be sufficient.

Keng-Yen Huang: That’s right. That’s the exactly the same problem. [laughs] The digital solution that we’re thinking, it uses an integrated approach. We focus on not just getting the data, but also use the data to help families to make decision before problems developed. This is the process that we have tested in African contexts. We starting by sharing with community. Depending on the resources in the setting we’re targeting, we develop different implementation strategies to support.

Keng-Yen Huang: One example that we have targeted is in faith-based organizations. I will illustrate this here (point to slide), just to give you a sense of how that [mSELF] is implemented, but similar approach can be applied to healthcare settings.

Keng-Yen Huang: In faith-based setting, we work with the leader to announce that the digital tool exists for people to use, and then depends on the literacy level of the targeted population, we give them needed support.

Keng-Yen Huang: We also develop the community health worker implementation approach to support participants who have low literacy. We are not using hospital resources, more on using community resources. Taiwan has a lot of volunteers, which is nice and can be used to support mSELF digital tool implemenation.

Audrey Tang: Oh, yeah, definitely. Even in this incubator, we have a couple of startups just working on the board games for mental health literacy and competency.

Keng-Yen Huang: That’s great. The tool that we are focusing on in this digital tool combined with a lot of functions, and I’ll explain a little bit more later. After people using the tool, we can help them decide what resources they need to use, and help them get access. The last solution is, we refer them to the healthcare resource.

Keng-Yen Huang: This figure shows a digital approach that is combined multiple functions and major service steps. Our approach is an integrated health behavior intervention model, including “ask, advice, access, assist, and arrange” to help people learn about information and chang behavior all at the same time. The first step is that we ask questions. The way we ask questions is different from the convention approach. We integrate health education and health literacy promotion while asking questions. I’ll give an example…

Audrey Tang: Now there’s simple survey or a simple assessment, like whatever scale.

Keng-Yen Huang: That’s right. A lot of…

Audrey Tang: The usual psychometrics.

Keng-Yen Huang: The existing service is more focusing on problem assessments, which is not very helpful.

Audrey Tang: That’s right, and labeling. There’s this whole taxonomy.

Keng-Yen Huang: Taxonomy. Yes. The piece is very different. We think about the context and also personal characteristic. After we ask people question, we give them the results, advice. We share with them their strengths and weaknesses, and also give them the reason why they are making change. They could assess what their rating is and decide what they want to do next.

Keng-Yen Huang: Based on the consumers’ decision, the digital tool also prioritizes what advices/information should be given. The decisions are based on not only our clinical experience, but also based on families’ preference. We based on these to provid health literacy information. This is also the place that we adapt the material from evidence based interventions to the digital. Then we ‘arrange’, it depends on what they need and we connect them with the needed resources.

Audrey Tang: The advice stage comes before the assessment?

Keng-Yen Huang: Yeah. Assistance, once you make decision…

Keng-Yen Huang: Like committing to it, like acceptance and commitments, right? Acceptance first and then commitment.

Keng-Yen Huang: Here is an example for the mSELF contents (shows “what does a toolkit session look like” slide), this is all in English.

Audrey Tang: It’s fine. I think in English anyway.

Audrey Tang: If you speak in Mandarin, I have to translate.

Keng-Yen Huang: This is also the concept. We’re using the opportunity to educate parents as well. The figure also gives you a sense in terms of.., I don’t know if you can see it.

Audrey Tang: Yeah, I can see it.

Keng-Yen Huang: You can see it, OK. The assessment will evaluate individual characteristic, it will also assess the family and community resource related. A lot of time, seeking for services also depends on what’s your immediate context. We call that social determinants.

Audrey Tang: The prompt says, and I quote, “We will look at the results together.” This we, it’s the whole family?

Keng-Yen Huang: THe version I am showing here is a different version. This is more for low literacy. For low literacy parents, We work with volunteer to provide the mSELF. The prompt you saw is a volunteer guide. We  developed the prompt to help volunteers to know what to say.

Audrey Tang: That’s right.

Keng-Yen Huang: They don’t have the skill and so we…

Audrey Tang: Right. This is a one-to-one relationship in this context. The assessment is personal/individual, it’s not yet like family therapy assessment. It’s not about the group dynamics.

Keng-Yen Huang: No. [laughs] We make it more casual now, therapeutic. That reduce the stigma.

Audrey Tang: It’s like the social media know yourself better tests.

Audrey Tang: Except more scientific.

Keng-Yen Huang: That’s right. There’s also self-management version of mSELF which is for high literacy parents, they could just do it themselves in the system. The second step (of the mSELF tool) is that we give them the report card. This is giving you an idea (point to the example in the slide), you can see there’s many different domains will be assessed.

Keng-Yen Huang: This is me showing you, but there’s a lot of other thing that we’re still developing. Our second phase is to use AI approach, which will need to wait till we get a lot of data, otherwise, we cannot do that. The goal is using this step, to share information (in multiple domains), and also to help people make decisions on what to focus.

Keng-Yen Huang: From our work, we know that a lot of parents, even after we ask them questions, they already self-realizing what they need to make changes. In a way, the questions that we asked have mixed good and bad. If you know you’re bad, then you know which direction you’re heading. It’s intentionally designed in that way.

Audrey Tang: That’s a change talk.

Keng-Yen Huang: The changing talk, that’s right.

Audrey Tang: The changing talk. What’s a rapped up? You actually write from hip hop lyrics? [laughs]

Keng-Yen Huang: Once you review the results, we have a few follow up questions. We ask if this in line with what you think about your family? What would be the factors that may influence your family the most. WE also give a list of learning options, so they could pick, tick which one option they want to learn more and focuse on?

Audrey Tang: It’s more like a theory for change, not just personally, but for the family to share.

Keng-Yen Huang: Yes. It depends on age, for young children, the only people we can work with is parents. For adolescents, we can work with both adolescents and parents. Working with both is also one way to address the communication gap. There’s a perception gap between parents and adolescents. The adolescent version is a different approach of implemenation.

Keng-Yen Huang: When working with family, a lot of issue come up, but one major one is family functioning issue, it’s a dynamic issue. If we don’t address that issue, parents will never pay attention to their kid. That’s why families…

Audrey Tang: They would pay attention on the front lines to tackle the problem?

Keng-Yen Huang: That’s right. Then we share with them the material. When sharing, We’re trying not to overwhelm them. We pick the top priority areas to give materials, but also give them the option to pick. We then send results to their own email so they could…

Audrey Tang: It doesn’t make sense because habit change happens one at a time.

Keng-Yen Huang: That’s right.

Audrey Tang: I can’t just say I’ll change 20 habits [laughs] tomorrow. It’s just not possible. [laughs]

Keng-Yen Huang: This is also where sometimes the support system is critical, it’s important because behavior change is hard. That’s why we need to think about the support system when helping people make changes. This is shown here (point to the support system in the figure) as the additional referral resource. Past year, because of COVID, digital health as the changes are skyrocketing. Even in US context, telehealth space has changed and improved dramatially. It’s the right time to do more on mHealth and telehealth.

Keng-Yen Huang: The links hear are for two versions of mSELF that are much ready to be used. Right now, I’m going to also show you some other examples and give you some timelines for things/differnet mSLE versions that we’re working on. This is another version. You can see, it’s a similar assessment. We first introduce what we’re doing, and then ask questions.

Keng-Yen Huang: The goal is to help them understand multiple areas of need. This is more like discussion. Then we show them their result on their mental health. In young-adult, because relationship issue is also a big issue. We assess their relationship health and give them some advice.

Keng-Yen Huang: Then we look at some of the interrelated factors, that’s based on the epidemiology research that we know, it’s important. There is a self-appraisal piece (after reviewing results). We ask what they think about the result, and then pick the areas where they would like to learn more. Then select the factor that they think might contribute to their wellness issue.

Keng-Yen Huang: This is a slide that just gives you a sense of how we developed and when we started (point to the timeline slide).  I started this project in 2018, like I say, I started in Uganda, and we tested in faith-based organization. This is also in partnership with the Minister of Health and Education.

Audrey Tang: The volunteers are local.

Keng-Yen Huang: It’s local.

Audrey Tang: The local people who volunteer to ask those questions and complete this assessment. You basically train a trainer to enable them.

Keng-Yen Huang: That’s right. We trained health committee members in faith-based organizations. [point to the timeline slide for 3 versions of mSELF],In the US, We also tested somewhat similar concept like in pediatric care, but this is a little bit harder, [laughs] because there’s too many professional dynamic, there. Right now, 2020, after COVID, it’s a very different environment. we are continue testing these in diverse contexts in the US.

Keng-Yen Huang: Given the lesson learned, we have also applied these and starting mSELF project in Kenya. Last year, we test out, again, a community-health facility partnership model. In this example, community agencies provide mSELF to indiviauls, and Health facility actually provide referral intervention services for needed people. I think that partnership also worked very well.

Keng-Yen Huang: The adult wellness version that I’m also currently testing is in Ugandan schools. This is part of the school mental health intervention that we’re scaling up and working with Minister of Education to test adult version.

Keng-Yen Huang: Machine learning method, we also started developing. We are using the current trial data to explore. We have about 2000 cases that will allow us to start experimenting that. The picture that I show you includes multi-dimension, multi-area. Those are thinking about what would be the intervention for individual, but there was also system intervention.

Keng-Yen Huang: Using some of the system domain, that’s also helping us think about how we integrate the strategy. It’s really long time local intervention. The US, the adolescent version, now, I’m also working with Asian American [laughs] in New York City, trying out what kind of adaptation need to be made. I could see a lot of commonalities and the same issue that we see in Taiwan.

Keng-Yen Huang: I also here them from college students. Like I mentioned that a lot of platform potentially, can be targeted. Usually, I tend to go with the community approach because less stigma. Web platform, it’s also a good source, because a lot of projects right now is a phase one is developing the digital tool, then moving toward using expert approach compared to the machine learning approach.

Keng-Yen Huang: That’s something we’re hoping to do in the next couple of years. Thinking about the scaling of it, when we’re developing, we’re thinking about what system, what setting would be the priority for the local context, so we can use that.

Audrey Tang: For Uganda and Kenya, do they all use the English version?

Keng-Yen Huang: Yeah. We do have local language. It’s a good thing their national language is English.

Audrey Tang: I wonder if that’s a factor in choosing that. A lot of just the subtle phrase choices could really impact how young adults feel about this assessment. In Taiwan, language is going to be one of the primary concerns. Otherwise, you can build this as an English learning tool.

Audrey Tang: That would also work actually. [laughs]

Keng-Yen Huang: That’s true. Usually, the timeline in terms of how to make it scalable and also I do think evidence, it’s very important. There’s many different ways of doing testing, developing evidence at scale all happen at the same time. That’s what we are excited about.

Audrey Tang: How do you sync this sort of thing? Do give them random advice? [laughs]

Keng-Yen Huang: Randomized and control trial.

Audrey Tang: I know, but what’s the control group?

Keng-Yen Huang: The control group is that you give them the same survey or you don’t give them. It’s a control. They get something out of it.

Audrey Tang: They get something out of it.

Keng-Yen Huang: People need to get some benefit to motivate them. This is the approach. We’re not just thinking about a digital solution, but also think about implementation model approach, it’s very important. This is also where a lot of approaches reducing healthcare resources using. Partner with use and also with the community, that’s one cost-saving approach.

Keng-Yen Huang: This is something that I’m interesting to explore what’s look like in Taiwan. Because some of the work, I’m also in discussion with different African countries, and I do, though some of my multi country partnership, those are also an opportunity. I do think Taiwan, Asia, and African, a lot of similar cultures because the education system is the same [laughs] is a top-down exam. I say…

Audrey Tang: We used to be the same. As of a couple of years ago, we changed that. For the young adults and adults, they were still brought up the previous education curriculum.

Keng-Yen Huang: The community and family centered culture also created a lot of stress. [laughs]

Audrey Tang: Definitely.

Keng-Yen Huang: Some of those health systems change and become a consultation implementation model. Some of the AI systems, my colleagues are doing it. Think about once we develop some of the solutions that could be applied to a different setting. I do think Taiwan has good technology. [laughs] The speed of work is also pretty efficient.

Keng-Yen Huang: That’s also why I think we figure out a way to partner would be something.

Audrey Tang: To explore a little bit of the AI methodology. Is this about an automated assisted computation between human to human, or is it done into the volunteer? Is it replacing or augmenting the volunteer?

Keng-Yen Huang: No. It depends on population. This is why multiple population is important. In the US study, we are trying to get a diverse populations, so the black population, Latino, and Asian can participate. Usually, from the current literature, we know we can based on 600 to 900 cases’ data to do a very stable estimate. We can also use different data sources to validate the findings.

Keng-Yen Huang: My colleague and I, are working on developing some of those using a trajectory approach, but also understand when you have multiple risks, what do we do about that?

Audrey Tang: What are the outcomes here?

Keng-Yen Huang: [laughs] This is the picutre show the domains that we’re assessing in the digital tool. You can see this part represent findings from multiple individuals.

Audrey Tang: Each column is a individual.

Keng-Yen Huang: This, right now, is individual, and we’re adding environmental factors. Those are all including in the digital tool assessment. Those are the domains recommended to be assessed based on the US National Institute of Health. This is based on a framework they are developing. We need to understand behaviors from normal to abnormal, and the processes of development?

Keng-Yen Huang: If we’re doing a new screening integrated into school, again, it’s easy to do a new screening, providing education. At the same time, you could not understand how the student change over time. That’s an ideal way and healthcare system allow us to do that very easy. It’s integral. A lot of mental health wellness issue, it’s all relate to those domain.

Keng-Yen Huang: How we think, how we regulate, what do we do, like positive aspects, or more negative aspects, you can see, those multiple domain. Same thing, a lot of health disparity gap is also coming in from the environment. This is also from WHO. There’s a 5G area that you have SDGs.

Audrey Tang: Yes.

Keng-Yen Huang: …for example. This is also in line with SDGs, WHO framework, how we think about changing environment that will also support individuals’ wellness. We include those, the right side, give you pictures, like variation. The green meant that the strength and you can see anyone. This is, I forgot, this is from Kenya.

Audrey Tang: I see. Everything – except for individual sleeps – look pretty well.

Keng-Yen Huang: Maybe the way that we assessed it didn’t capture it nicely. It gives you a sense that people the way. It’s like something needs to change, more on the negative side than the orange. It’s more like some way in the middle. How do you help an individual like this is, you have different profiles? [laughs]

Audrey Tang: That’s right.

Keng-Yen Huang: That’s why I think the machine learning key was a different way of exploring what would be a way to personalizing. My colleague and I, were talking about, “You could have the same risk, the same anxiety, depression scope, but your profile is really different.” How do we prioritize impacting people? That’s the concept.

Keng-Yen Huang: Sometimes it’s an environmental factor, the weakness is stronger than the individual. That’s where resilient individual, why some people in such difficult time, they’re still like, “So easy,” and they can overcome. Those are the things that the machine learning could help us.

Audrey Tang: Essentially, helping to navigate a higher dimensional and finer resolution overview of the current profile of not just the child, but also the environment.

Keng-Yen Huang: That’s right. Right now, we’re hoping, and we’re applying for the grant [laughs] in the US context, and trying to figure out it’s the expert version versus machine learning version. That’s one of the project that we’re hoping to do. Just give you a sense about what that looks like.

Audrey Tang: Excellent.

Keng-Yen Huang: What do you think? [laughs]

Audrey Tang: Any additional thoughts from the National Academy?

Keng-Yen Huang: She could come from a cognitive perspective, because the design is also… [laughs]

Chia Ying Lee: I’m doing something similar, but for children have difficulty learning. We know there’s so many different factors that affect how children achieve success learning. One difficult issue is how we integrate all these factors. Not a researcher, as a parents, [laughs] I have a kid, not a kid, he is 18 years old. I know we have very good school system and also healthcare system.

Chia Ying Lee: In the school, they collect children’s data every semester, for sometimes now. They rarely identify children have difficulty. Or just as you mentioned, we identify children when they have difficulty rather than…

Audrey Tang: That’s right. Quite late.

Chia Ying Lee: Quite late, actually we have a lot of data and the school have very limited manpower. Although, they collect questionary, psychological test and everything, but they don’t have a good setup to integrate all this information and also for prediction. This is a very good concept. We also have very good school system and healthcare system.

Chia Ying Lee: It would be very nice to have a top-down process from the government because if we want this to be successful, you can see there are so many things for integration. As the scholar, [laughs] sometimes we have a good idea and we also have a grant from government, but when we do something like provide some idea, but it’s very difficult for the real implement.

Chia Ying Lee: I’m thinking about having this model as a testing ground, [laughs] and also have your help. We know there are so many important issue, but one of them is that mental illness in children, and also how we can help the school and also the family to identify children at risk.

Audrey Tang: One of the more recent development in Taiwan, and also partly thanks to the new curriculum is the idea of early intervention. For example, for learning difficulties, many early indicators could be as early as kindergarten age, like when they’re five, or six, or even four, already showing the signs of alternate, individualized…

Audrey Tang: …individualized, [laughs] indication programs of the neurodiversity of the children involved. I think a lot of parents nowadays are really on-board with that.

Keng-Yen Huang: That’s right.

Audrey Tang: Because they get a very clear support system from fellow families with similar adjustments needs for the IEP. Because it is early enough, it doesn’t feel like it’s a treatment, but rather just a coaching that they receive from the professional supporters. That is, I think, the case with LD and certainly more biological apparent LD symptoms.

Audrey Tang: For anxiety and depression, that’s probably not where we’re in. We’re not seeing anxiety and depression as on the other side of spectrum and maybe the autistic spectrum, maybe Down syndrome and so on. These are fairly well understood and exists a very good support system. I don’t think for anxiety and depression where we’re quite there yet.

Audrey Tang: Maybe piggybacking on some of the existing social support system here, which is pretty good evidence-based development at schools, I think that might help.

Keng-Yen Huang: I think Chia Ying is right about the partnership. All the African work that we’re doing, if we don’t go with the policy guideline and we’re just developing a solution for the policy guideline and to see how model work. It’s really because the policy stakeholders speak their language, that’s how they help us to facilitate. That process partnership, it’s very critical.

Audrey Tang: How early is early intervention for your model?

Keng-Yen Huang: Three years old.

Audrey Tang: Three years old.

Keng-Yen Huang: Now, I see 3 to 8 years old or 10 years old, that could be a same model. The intervention that we’ve been testing this strategy apply to that age range. After that, it become like an Alice and virgin because the developmental process, the focus is a little bit different.

Audrey Tang: As you started in pediatric care.

Keng-Yen Huang: Yeah. Infancy piece, I don’t get involved because that’s a whole different work.

Audrey Tang: That’s right. It’s a different world.

Keng-Yen Huang: It’s much easier to managing when kids can express it, and how do we help parents. That’s a lot of interventions that I’m focused in 3 to 10, and then now it’s Alice that I’m also focusing on. Because in the school context, adult also helping those kid, it’s like parents help the kids, teacher help the kid, but adult has a lot of problem.

Keng-Yen Huang: Without helping them, it’s not going to work. We also think about the well-being, social, emotion issue need for adult as well. That’s why the adult version comes up, and then I was like, “Wait, adult version if…” I’m just thinking about as an adult helping my parents, I was like, “I could see that. Why my parents need one?”

Keng-Yen Huang: For the senior, because I’m like, “Wait, they’re over-utilized.”

Audrey Tang: They don’t lose on the finishing line here. [laughs]

Keng-Yen Huang: A lot of mental house issues is a history. It’s not just the parents, it’s their kids, all related. [laughs]

Audrey Tang: When you say the wellness version is for the Ugandan school teachers, does that mean that the teacher go interfacing with the parents?

Audrey Tang: The teachers are, in this case, the person who used this tool to educate the whole family? Are they equipped socially to do that?

Keng-Yen Huang: It’s different. The teacher program, that’s a whole different program training teacher on the strategies that they could use to help the kids. It’s like the parenting program. Right now, we’re integrated into the education training system. In the past, usually for in-service, like teacher already teaching, we have to provide them continuing education so they can learn the skill.

Keng-Yen Huang: We are also thinking developing the video version that would allow us to scale in a better way. At the same time, how do we integrate into education system so it’s a more sustainable approach? Whether the teacher training center, or as I see as similar to Taiwan.

Audrey Tang: Of course, the normal university.

Keng-Yen Huang: Integrate into that part of that system, it’s actually more efficient. Those are things that we’re testing in Africa because there’s no school mental health system, it’s much easier to try out new things. In US context, we have to work within the existing system, to identify where would be fit and trying to integrate into the existing structure.

Audrey Tang: You mentioned film/movie-based curriculum for the school teachers. Is this something produced locally or are your center…?

Keng-Yen Huang: It should be locally. Those are training local people, and then have them to create a video. That’s something that we are in that process to develop in the Ugandan context. The virtual format, it’s also very interesting. From the literature, we know there’s a different way of mix it up. Usually, in-person context’s still very important.

Keng-Yen Huang: Coaching support to the teacher to the parents and continued support, that’s very important. That’s why it’s good to have a government system or whatever agency system to have that long-term service support.

Audrey Tang: I do see that. In Taiwan, basically everything after the first grade, that’s the Ministry of Education. If it’s early as, say, three years old, that’s the Minister of Health and Welfare. Probably different worlds, actually, with very different terminology even and the different strategy for intervention.

Audrey Tang: I do in view agree that maybe working with the existing structure in Taiwan about continuing education for teachers is the way to go. According to a new curriculum, the school teachers, via counselors or the teacher that does a leading of the head of a class, they all need to come up with their own curriculum to work with the competency-based new curriculum to make sure the students get individualized care.

Audrey Tang: The individualized education program is not what they have learned in new normal university. They were not brought up with [laughs] the system of IEPs. There’s a lot of appetite for continuing education to empower themselves. I’m thinking about among the dream to the nth dimension, to the power of N.

Audrey Tang: They list around 20 percent of all basic school teachers in Taiwan in such a continuous education, mutual support group. In this community, they are your natural allies because they are developers. If you need localization help or making movies, they’re actually very proficient in doing so.

Keng-Yen Huang: Yeah. If it is some education platform, it’s already well-established and integrated into that it’s much easier.

Audrey Tang: This is a very vocal community. Yu can look into that. They especially care about the rural and the places where it’s certainly not possible for one teacher to serve the role of poster parents, professional counselor, and many others.

Audrey Tang: This kind of digital-assistive platforms that can bring in outside support through either video conferencing or, as I mentioned, a machine-learning-based dashboard or analytics and things like that, that’s going to be very helpful for them.

Keng-Yen Huang: Who is doing those kind of technology supported by this platform?

Audrey Tang: The teachers themselves. They do share, for example, their curriculums and the tools, utility that enables such curriculums. They share usually the content as in creative commons. Meaning, the copyright is partially relinquished so that everyone can build upon the open innovation system. They also have the local workshops where they train the trainers.

Audrey Tang: I attended one of their national-wide symposium gatherings of the trainer to the trainers. It’s an annual thing that shares new methodologies for them to localize and develop their own variations on the theme for that. This is essentially a toolkit-based approach.

Audrey Tang: Each rural or a local teacher choose the part that is beneficial for them without a previous top-down approach where the schools are just implementers of a national curriculum strategy. We’re past that. Nowadays, the local school have a lot of say in developing their curriculum.

Keng-Yen Huang: I see. Some say a lot of module approaches, not like the whole package. Is this government-supported?

Audrey Tang: Yeah, it’s government-supported. The Ministry of Education do support the endeavors of such continued education. We don’t control the program or the agenda. This is a community by the teachers with the teachers.

Keng-Yen Huang: Wondering about the expertise piece, because sometimes it’s more efficient. How does that process work in terms of bringing the evidence?

Audrey Tang: One example is the introduction of SDGs in education. When we finalize our national curriculum, the main part of it, the backbone of it, that’s in 2014, SDGs wasn’t there. SDG is introduced in 2015. Basically, we can’t just go back and restructure the entire curriculum based on SDG values.

Audrey Tang: On the other hand, we understand, especially on the undergrad level, the capstone project, the university’s social responsibility, everything is now indexed via SDGs.

Keng-Yen Huang: You’re tracking those indexes.

Audrey Tang: We’re tracking those, similar to how the US publicly listed companies are now doing GRI reporting and building the indicators purely based on the 169 concrete targets. We are now doing the same in higher education as well as public-listed companies and all the registered social innovation organizations, they could be nonprofit, co-op, and so on.

Audrey Tang: The only requirement for a day to register is to give out impact reports in terms of the SDGs. It’s a unifying vocabulary. For the basic education, how to interweave the SDGs into the curriculum become a major challenge. We discovered that it could only be done in a very federated way. A rough consensus not a very fine consensus.

Audrey Tang: In each setting, for example, how to teach climate change is very different based on where you are in the country, and based on the social composition of your students. What we are doing essentially, is to introduce the latest research on sustainability and so on, as a continuous education and working with but not for, with the pilot schools so that they can develop their interpretation.

Audrey Tang: For example, the media competence example, because mental health is related to the infodemics. If people protect themselves better mentally against disinformation and misinformation, then they don’t get so isolated and suicidal just by browsing the more anti-social part of social media.

Audrey Tang: Then we have the pilot schools in different grades doing their own interpretation, own search like health in media competence curriculum. Then we share this as open innovation so that other schools, if they want to adopt this system, they get the full support from those pilot schools, from the whole systems.

Audrey Tang: That’s right, not just technology. Of course, more detail could be looked up in m-learn, that’s media learn. M-learn in K-12 education, and there’s a center for the new curriculum in K-12 education that take care of those focus areas to integrate. SDG or infodemic, or things like that is such what we call it this cross cutting issues that all follow very similar approaches.

Keng-Yen Huang: That’s great. Where should we go? [laughs]

Audrey Tang: I can make some introductions to the teacher community to the basic education, what I just called the cross cutting issues, introduction, community, this is the K-12, new curriculum office.

Audrey Tang: There’s also, I think I mentioned in the very beginning, some of the social entrepreneurs using board games to teach mental health and family dynamics, right in the settings. I think they are based here. I don’t know what it is.

Audrey Tang: Certainly, shouting here, we can look up the incubator, they’re incubatees. [laughs] Maybe you can share this slide, this is public information. Maybe we can get a copy and upload it on our website along with this transcript, so that they can read this before a briefing session with you and see.

Audrey Tang: There’s the open toolkit based approach that maybe they choose to pick, like some aspects of it and integrated into do board games or video games.

Keng-Yen Huang: OK. The resources from government, right?

Audrey Tang: Yeah. The resource for incubation is from the government, but once they grow beyond the initial startup stages, then of course, there’s a lot of funding. Also, for example, google.org funds a lot of digital education intervention special on the rural areas.

Keng-Yen Huang: That process, I know there’s a way to connect with them, but you have successful example to get.

Audrey Tang: Yeah. The google.org/genie is a good example and Genie is also connected via this alliance of conditional information in education with a Teach for Taiwan, which is another good example and I’m pretty good friends with both founders. There are a couple of excellent.

Audrey Tang: There’s this Social Enterprise Entrepreneur in Education Technology, and that’s, again, your natural ally because they are, in a sense, also a teacher community even though they work mostly in the rural places. According to your methodology, that population base or a local norm based development methodology is actually a better fit because your model is adaptive.

Audrey Tang: This is not about having everyone conform to one social norm. This is about appropriate technology integrated into the local norm.

Keng-Yen Huang: Yeah. I’m also curious because my work in global health, that’s also something I’m interested in. I do see a lot of thing that we develop can be globalized, but also looking for resource from global. Some of my African work is I discussion with UNICEF.

Keng-Yen Huang: Some of those long term tracking, that’s something that they’re also interested. I am wondering, in Taiwan, do we think about those global partnership approach…?

Audrey Tang: Yeah. We do. For a lot of health based startups here, we first look at for example, there’s one about tuberculosis, and that also use AI system, but in a much more mundane way. This is just to screen like a rapid test, instead of using purely visual ways to see whether a specimen indicates to hypothesis. AI has performed pretty well, in doing so.

Audrey Tang: Taiwan doesn’t have a high prevalence of that disease, but there’s still some pockets in the indigenous areas. They first work in their local partnership, almost pro-bono are subsidized by the local government, I forgot. Anyway, they did a few trial and it was pretty successful. WHO standardizing is US$6 per screening.

Audrey Tang: This company lowered using AI to less than US$1 screening, which is a huge thing. After approving rigorously, Dave, because he is the one in a local context, I then introduced them. We went to Ethiopia together in the Social Enterprise World Forum introducing in the African Union Building to 14 or 15 African Union members about this new technology, which is a specific SDG target, just to eliminate tuberculosis.

Keng-Yen Huang: Their targeting SDG as well.

Audrey Tang: Yeah, that’s right. If it’s SDG index, if it’s connected to the social entrepreneurship community, then most of the stakeholders are going this April, if I’m not mistaken, to the face-to-face based but also online, Asia Pacific Social Innovation Summit, the APSIS. Microsoft is also going to be part of it, Vitalik Buterin of Ethereum.

Audrey Tang: There’s many people looking for the Tech for Good angle to make SDGs informed investment. I would also encourage you to look into the APSIS and especially the related award partnership in Asia-Pacific on social innovation, where we invite the judges from the leading social innovation ecosystem leaders in Asia-Pacific. I’m the convener of the jury, but I don’t score.

Audrey Tang: They do the scoring. We reward the most unlikely partnership across sectors.

Audrey Tang: The more international, the better. The first award went to the Indonesian Cigondewah community, where they did this circular economy, transforming this fashion village and negative to the environment, by-products into local co-op, co-owned. This piece of cloth is literally recycled coffee bean waste and [laughs] plastic bottles like this, so up-cycling, and that’s one.

Audrey Tang: Another recent case, went to the Singaporean startup BeamAndGo where they work with Filipino migrant workers that work in another non-Singapore country, three countries right here.

Audrey Tang: The Singapore app that enabled a migrant worker to essentially buy grocery using their local earnings and with microcredit, and so on, for the local family so they don’t do the remittance and it gets spent on alcohol or gambling or things like that. They can still do some homemaking and home care to their family using this app. That thing gets recognized and amplified by this show investors.

Keng-Yen Huang: That’s great. That’s the dream thing that I want to do more. I do think, for example, Africa is like 70 percent are under age 30. In a few years, this big population doesn’t have a job. The innovation, helping them it’s in some way to adjust that issue. Education, it’s a huge problem.

Audrey Tang: When I was in Addis Ababa, they care a lot about education and also the kind of energy profile that would enable them to access to education via telecommunication means. There’s a lot of useful work skills, education.

Audrey Tang: Truthfully speaking, they don’t lack the literacy or the devices themselves, but they lack the competence to connect to a wider community, to make use of the digital connectivity, because just having the proper connection without such a supporting community means nothing, or it means some negative things. [laughs]

Audrey Tang: We’re quite aware of that. That’s a very exciting place for us to go together.

Keng-Yen Huang: That’s also where Taiwan’s relationship in Africa still pretty good. [laughs] People could tell what machines was made in Taiwan. [laughs] Wait, we got to go there. [laughs] If I’m doing work there, what’s the connection? [laughs]

Audrey Tang: [laughs] Well, formal channels, here the government can’t really help you that much.

Keng-Yen Huang: I know. [laughs]

Audrey Tang: We have the official diplomatic relation with one plus half country there. [laughs]

Keng-Yen Huang: The work speed is so much faster here. The partnership, learning from my US colleague and do it locally, that would be an ideal partnership. It could be a much faster way of scaling.

Audrey Tang: We have a representative office in the Somaliland, but the official embassy, the only one, is in Eswatini. There are some pretty good continuous education, life-long education job training and so on going on in Eswatini. That’s through the ICDF it’s a NGO by itself, and it also does crowdfunding in Zeczec.

Audrey Tang: The ICDF is probably the community to talk to, to do work there. The access to Africa, as opposed to say the Caribbean or the Pacific Islands, are more limited from what I’ve gathered.

Keng-Yen Huang: I see. This is great. How can I continue make connection with you? [laughs]

Audrey Tang: You have my email, or you will have my email in around two seconds. [laughs]

Keng-Yen Huang: Is it OK to email you?

Audrey Tang: [laughs] Email me directly. Yeah, definitely. The communities that I mention especially the incubatees and the k-12 office in NAER, my executive secretary has the connection to these people. After publishing the transcript and hopefully, the presentation that goes with it, we can also just nudge them to read the transcript a little bit.

Keng-Yen Huang: Then we can contact…

Audrey Tang: You can contact with them, or you can just write an email and CC us, that’s the usual way to go.

Keng-Yen Huang: We’ll start from there.

Audrey Tang: We’ll see what we can do. Are you still around Taiwan in April?

Keng-Yen Huang: I come back because COVID. I work from home. I’m going to make this as…

Keng-Yen Huang: …three months. I have to come back once every year. It worked out last year, and so I’m going to continue doing that, especially when I have my own project and I do a lot of conference call.

Audrey Tang: Nowadays, conference call, it’s the norm for me…

Audrey Tang: This early morning, I was having a Stanford conference call, which is why I defaulted to video conference.

Audrey Tang: I think this is really good if you’re around, then also consider attending the APISIS in person. The theme here this year is going to invest in Asia. The focus is on social innovations that’s actually getting investments and then sharing this strategy, of how to receive the purpose-driven investments so that they work for a purpose but with profit.

Audrey Tang: That’s the theme and that connects well to your expansion strategy.

Keng-Yen Huang: I’m starting learning about the business research partnership. [laughs] I have some idea, but I’m not quite there as a business plan I can do.

Audrey Tang: I think that’s fine. The promise of a national academic support system is that you can pivot an infinite number of times trying to find the service market fit, or the proper market for you and not under pressure to make a profit. That goes tempo for the national academy.

Audrey Tang: The national academy gets good transfers, actually, to commercial ventures. Because they are at a strong position of bargaining, [laughs] until they actually find a good partner, they don’t have to sell out. I think that’s the beauty of a state-supported research agency.

Keng-Yen Huang: Thank you.

Audrey Tang: Cool.

Audrey Tang: Learn something today, thank you.

Keng-Yen Huang: Thank you.

Audrey Tang: I can play with the system myself?

Keng-Yen Huang: Yeah, I could send you.

Audrey Tang: Just email me the link and then…

Keng-Yen Huang: We’re constantly improving its…I don’t know how many words. [laughs] User testing.

Audrey Tang: Continuous integration.

Keng-Yen Huang: It’s always. I know the current version is a little bit long because until we can do some data prediction and simplify it, we have…

Audrey Tang: Long as in 15 minutes 20 minutes?

Keng-Yen Huang: It’s 170 questions.

Audrey Tang: OK, OK 17 minutes.

Keng-Yen Huang: 30-something domain in there.

Audrey Tang: Wow, OK, that’s pretty comprehensive.

Keng-Yen Huang: In the future, I think we can spread it out, depends on the schedule. If it’s kids, we can make it to two parts. That’s one way to simplify.

Audrey Tang: I think building it as learning some English would…

Keng-Yen Huang: Let me send you before I walk out. It’d be easier.

Audrey Tang: OK.

Keng-Yen Huang: Yesterday, I have a problem sending an email to you. That was that because the file is too big.

Chia Ying Lee: Maybe you just put it on Cloud.

Keng-Yen Huang: When is your next appointment coming?

Audrey Tang: No, I don’t have the next appointment.

Keng-Yen Huang: Really?

Audrey Tang: My next stop is lunch, I guess…

Keng-Yen Huang: Wow.

Keng-Yen Huang: That’s great. I’m just curious. This model, I could see a lot of innovation in my view. It’s also doing that partner with business one and then giving out the guide. Similar model, it’s facilitate a lot of good stuff, so I do like to approach that…

Audrey Tang: This is purely open innovation.

Keng-Yen Huang: Yeah, connection.

Audrey Tang: Because this is open in a transcript version, people who don’t know English, you just feed it to machine translation and they’ll read exactly what we have said here.

Keng-Yen Huang: The Internet connection is not very strong. [laughs]

Audrey Tang: That’s OK, you can do that later.

Keng-Yen Huang: I’ll do that later.