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I n n o v a t i o n f o r Yo u t h We l l b e i n g

Headstream by

Contents 2 Introduction 3

Research summary


Driving impact where it counts

Focus on teenagers

Solutions for vulnerable populations

Solutions for the individual


Innovation and youth mental wellbeing

Wellness Relationships Protective factors 12

Mental health and identity


The role of technology


Program timeline and next steps

15 References

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ON YOUTH MENTAL WELLBEING There are many narratives surrounding youth mental wellbeing. This is ours. In the coming pages, we share insight into what we learned through our research process and how each of those learnings has been incorporated into the Headstream program design Starting in June, we will publicly launch Headstream. In July, we will kick off our open innovation programming with the goal of building an innovation ecosystem that: • Sources and develops market-based solutions to improve teenager mental wellbeing; • Accelerates these solutions by creating and/or growing markets for evidence backed innovations with demonstrated impact; • Provides customized approaches for addressing the needs of the most vulnerable populations; • Serves as the foundation for an inclusive narrative that inspires stakeholders to collaborate and design ecosystem shifting innovation, strategy, and policy; • Builds and nurtures a cross-cutting community of collaborators that support Headstream innovation and benefit from the network effect; Your support has been vital to shaping Headstream and we hope that you will continue to guide our work building a better place for youth mental wellbeing.





Russian author Leo Tolstoy opened his novel Anna Karenina with a profound line: “Happy families are all alike, every unhappy family is unhappy in its own way.” Replace “family” with “teenager” and “unhappy” with “depressed”, and you start to see the test we face as a society. Depression, anxiety, suicide – these are complex challenges, often with multiple causes, not like bacteria or viruses or parasites whose eradication heals. They are not like a pulled muscle or a broken bone, easy to diagnose and understand the harm they cause. Rather, the harm of anxiety and depression manifests uniquely with each person. Despite our ideal desire for straightfoward solutions like a vaccine or cast, there simply aren’t any easy answers to the challenge Headstream is taking on, “How can we use technology to reduce the rising rate of anxiety, depression and suicide among youth in the US.” At least none have yet been found.

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It takes time and real effort for teenagers to become functioning members of society, and to learn the different norms and roles that occupy our day to day lives. They experiment, learn from mistakes, and develop their social and emotional learning skills. It really is harder to be a teenager today compared to two or three – or even one – generation ago. There’s just more to learn, more to know, more choices to make, more “things” happening in the world and a variety of pressures from friends, adults and society. Thinking about it this way, it’s perhaps not surprising that the rates of adolescent anxiety, depression and suicide, while slowly rising over the last fifty years, have risen sharply in the last decade. It may be only slightly less surprising to realize over this same time period there’s been a corresponding introduction — and near total global adoption — of all manner of “social technologies” — including social gaming, social discussions, social photos, social videos and all forms of instant social connection. For most people most of the time, social technologies have been fantastic. But for others, the experience can be fraught. Online and

offline experiences — separately and together — can stimulate and exacerbate vicious, downward spirals adversely impacting adolescent mental health, shattering confidence, self-esteem and a general sense of well-being. And while negative experiences like bullying also occur in person, these experiences online can be magnified and amplified — being pointed, pernicious, public and permanent. Finally, this is all happening at the very time when teens are working their hardest to learn about themselves and others as they form relationships and become integrated members of society.

young people say mental health is a priority but only

4 of 10 rate their own mental health highly1

It doesn’t have to be this way. Up until now, the impact of social technology on adolescent mental health wasn’t really on the radar. Now it is. At Headstream we believe it’s possible to make the digital world a better place for everyone — especially adolescents. We believe it’s possible to be kinder to each other, to limit the impact of inadvertent negative experiences, to help teens learn how to recover from various harms, to recognize and encourage prosocial behavior, and to build healthy relationships. Together we can take a stand on youth mental wellbeing. 4

Technology has really taken over our lives to an extent that’s pretty unprecedented, and so I think our work needs to change dramatically to pull together a really wide range of partners. Vicki Harrison Stanford Center for Youth Mental

Regardless of all the blows that we’re throwing at them [youth] environmentally, politically, economically, racially, we’re not really giving them the tools to be able to say pause, reflect, bounce back.

Health and Wellbeing

Ivan Villaseñor Madriz Catholic Charities

I think getting ahead of those [apps] in one way or another so that we can make those spaces that are being created safer spaces for young people to express themselves is going to be vital to the wellness of young people in the future. Shadille Estepan


Born This Way Foundation

Driving impact where it counts. We turned to all of you to better understand the complex nature of mental health and have asked for your help in navigating where to focus an innovation program like Headstream. What follows are the learnings we’ve synthesized from the two Big Thinks, the countless conversations, the creation of the causal loop system maps, and the work that you all are leading. These learnings are the hands that shaped the design of Headstream. We honed in on three collective characteristics of the people we hope to impact. First, Headstream will focus on teenagers, specifically ages 13-19. Second, our innovations and impact will be geared towards the needs of vulnerable communities. Third, while keeping in mind the broader community needs, we will focus on solutions that can be tailored to effectively serve individuals and their specific circumstances.


FOCUS ON TEENAGERS Adolescence is when a person learns the most about “relationships�; specifically forming, maintaining, extending and ending relationships of various kinds.2 Social technologies have become a central platform for these relationships whether through video games, social media, or watching the same show. On a daily basis, thirteen to nineteen year olds are experimenting with new social technologies and are eager to adopt the ones that meet their needs and desires. As teenagers become increasingly aware of relationships in an adult fashion, they become more powerful as consumers, demanding that new social technologies augment and bolster their relationships. There are also more than enough market participants to create novel and impactful solutions for teens that may also be aspirational for younger youth. We recognize the strong role that caring adults can have helping teens sort through and recover from real and perceived harms that youth are bound to encounter as their protective factors are still developing (more below on protective factors).3 These caring adults need solutions to help guide and support teens as they grow up in an environment that is unfamiliar to older generations.




SOLUTIONS FOR VULNERABLE POPULATIONS Mental health is an individual journey. That said, we recognize there are sub-populations whose mental health is disproportionately affected due to cultural and structural barriers including access and availability to mental health resources, familial relationships, and community norms. These groups are often left-out of the conversation when it comes to designing solutions and their exclusion is promoting greater disparities. To address this head on, we designed a program that incubates, sources, and supports innovation that can address the specific needs for the most vulnerable communities of teenagers.


SOLUTIONS FOR THE INDIVIDUAL Returning once again to the quote from Anna Karenina, Headstream intends to primarily support innovations focused on the intricacies of each individual’s needs to support wellbeing rather than a shared experience across groups or society as a whole. There are certainly attributes common to youth like facing bullying or feeling excluded because of race or identity. While these shared experiences need - and are receiving - thorough attention, Headstream will primarily focus on approaches that support the deeper and more personalized engagement for the individual. That means supporting customized solutions that meet teenagers or caring adults where they are; whether they are developing protective factors, dealing with a harmful event, or building relationships. 8

Understanding the role of innovation in youth mental wellbeing. There are many factors that influence mental wellbeing for an individual. The system map helped us hone in on six points of inflection. These became the six challenge areas that we focused on at the Big Think. With your help, we’ve narrowed the focus of this program to those factors which are most in need of attention, and which we believe can most readily be shifted and improved through open innovation. Guided by specific criteria such as the size and maturity of the market, the state of the existing innovation landscape, and where investment is happening in the space, Headstream is looking to support innovations that are focused on one or more of the following: wellness, relationships, and protective factors.

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WELLNESS Addressing anxiety and depression directly requires alleviating that which causes them. We are not entirely sure about the causes – especially not the contributions of social technology. Alleviating anxiety and depression due to technology would require knowing and addressing their technological underpinnings. That question remains unanswered definitively. What we were able to learn definitively was that wellness requires building innovations that support genuine relationships and the skills necessary to form, maintain, extend and end relationships.4 In addition, solutions for wellbeing can support the ongoing development and formation of protective factors such as self-esteem, confidence, resilience, ease with self/others, and belongingness. Our research also analyzed whether Headstream could more effectively catalyze an economy focused on remedying teenage anxiety, depression and suicide, or preventing incidences from arising. Focusing on “wellness” rather than remedy allows Headstream to lower the barrier of entry for innovators, investors, governments, companies and institutions looking to address youth mental health and wellbeing. There is enormous demand from consumers, the health sector, and the tech industry for wellbeing solutions. We hope that the accessibility of our focus will

draw in new entrepreneurs, partners, and funders to a space that is both in need and filled with market opportunity. Throughout the design process, we grasped that we wouldn’t be able to solve the myriad of complex challenges that influence youth mental health and wellbeing. We acknowledge that preventative wellbeing solutions will not remedy mental health challenges for everyone. We do hope that over the long run, the community Headstream helps build and the innovations we scale can offer some level of support to everyone, including those most in need. We also hope that a focus on wellness will encourage the tech industry to build wellbeing in their products.

RELATIONSHIPS We acknowledge the broad literature that developing and having relationships and relationship skills – good ones – are fundamental to adolescence. Youth must learn to become adult members of society, and simply put, access to information and our interconnectedness has apparently, over time, created a lot more to learn. Ironically, while the digital age has made connecting easier, it has not necessarily made relationships easier — certainly not for teenagers. There’s simply so much more to learn and it all has to be learnt at the same time. 10

Learning how to drive — or to walk or talk — doesn’t come all at once, but happens step by step by building up various cognitive and motor skills until one becomes proficient. Learning “relationship” isn’t any different — it’s just that it seems to happen kind of all at once, and across various media and in a wide variety of contexts — all of which the teen essentially faces on day one of high school, if not earlier. For adolescents, developing strong relationship skills feeds the development of positive attributes of mental health. Similarly, developing strong attributes of mental health feeds the ability to handle the ups and downs all teenagers inevitably face as they grow up. For these reasons Headstream has honed in on relationships as a central theme. The program will identify innovations that provide teens with opportunities for developing healthy relationships, and that help teens and caring adults navigate the complexities of human interaction.

PROTECTIVE FACTORS Protective factors such as self-esteem, confidence, resilience, ease with self/others, and belongingness, are necessary not only for strong mental wellbeing but also for sturdy, beneficial relationships. If all goes well, teenagers learn these skills of positive mental health as they’re growing up, participating in activities in a variety of contexts, and hanging out with people from different groups and backgrounds and taking chances and making mistakes with their peers.5 We recognize this isn’t straightforward and that there are interaction effects. For example, on its own, a “bullying event” might be minor, but magnified by social media, it may be disastrous. On the other hand, the same events happening to a youth with strong family support may be a learning experience. We choose to focus Headsteam on supporting innovation that builds social and emotional skills. As the playgrounds and neighborhoods shift to digital places, Headstream intends to support the design of online environments that are conducive to developing these protective factors.

U.S. Millenials spend


of their disposable income on wellbeing6


It’s estimated that by 2030 depression will cost

$6 trillion globally, becoming the largest single healthcare burden7

The Wellness economy for Preventative & personalized medicine and Public Health is over

$600B in 20198

We want to talk openly about mental health and identity. We understand that depression and anxiety affect us all differently as individuals. We also understand that some groups of young people, such as LGBTQ+, Native American, and women, can have shared experiences when it comes to the cultural and structural barriers they must overcome when accessing care or even talking about mental health. In some cases, mental health may still be seen as taboo. In others, individuals may not have a supportive community because of the way they self-identify.

Recognizing that some youth populations are more at-risk than others, Headstream will focus on sourcing innovations tailored for three broad teen communities: LGBTQ+, teenage girls, and youth of color. We’ve chosen these groups for a few reasons. First, these populations are often underrepresented and underserved when it comes to mental health services. Second, the evidence suggests that these groups have an incredible need for such



of young people with mental health challenges receive services9 LGBTQ+ individuals are


more likely to experience a mental health condition10

services when considering rates of anxiety, depression, and suicide, among other factors. Third, the intersection of these groups represents some of the most vulnerable populations in the US. Finally, in innovating for these underserved communities, we hope to make mental health and well-being more open and accessible for all youth living in the US today.



Looking at the intersection of technology & mental health.

Rates of anxiety, depression and suicide among youth has increased substantially over the last 10-12 years. This point seems settled. Similarly, it doesn’t take a survey to realize that over that same period rates of social tech adoption and use have sky-rocketed. This has led to numerous studies and pronouncements that smart phone use and social tech is responsible for rising rates of adverse mental health conditions. This is, at best, fraught and overstated. At worst, it’s a distortion due to imprecision.


It does seem that there’s some connection between the rise of social tech and declining youth mental wellbeing, but is it the “device”, per se, or what happens on the device? And to that question, what is it that specifically happens on the device that may contribute to increasing anxiety and depression? Those are questions that many of you are exploring right now. Headstream intends to entice, encourage and enlist you and your ongoing research insights to guide

the role of social tech to support mental wellbeing during the incubation, sourcing and acceleration stages of the program. Search almost any technology trends analysis in 2019 and wellbeing or digital health are bound to be highlighted. The consumption of and investment into mental wellbeing has corresponded with technological advancements of potential solutions. The sophistication of artificial intelligence, virtual and augmented reality, wearables, and communication interfaces will continue to increase. We see a myriad of ways that these technologies can play a positive role in addressing teen mental wellbeing. Our work is laid out for us. Now it’s time for Headstream to start accelerating a group of ambitious and creative innovators to leverage these technologies for youth wellbeing while integrating evidence based approaches, and striving to provide additional solutions for health systems and big technology companies.


Co-design Kickoff Event


Communications Launch



Headstream will be announced to the public, and the website and social media channels will go live.

A multi-day, highly curated session to incubate new solutions for teen mental wellbeing.

Headstream Challenge Launch


An open call for market-based solutions addressing the Headstream focus areas and vulnerable populations.

Finalist Collaborative Design Event


A multi-day design sprint for the challenge finalists and stakeholders with expertise in evidence backed design, ethical business models, and vulnerable populations.

Finalist Announcement & Accelerator Kickoff

The selected Innovators from the open innovation challenge will be announced and begin the Accelerator process with the Headstream team and advisors.

Program timeline and next steps. Following months of market research and innovation landscaping, it became clear that Headstream needed to not only source innovation, but also to spur new ideas and innovations for youth wellbeing if we hope to accomplish our goals. Below are our plans for the first iteration of Headstream Innovation programming.

2020 Headstream Accelerator Headstream will run a nine month accelerator including a multi-day forum in February to focus on the growth of the selected innovations as well as impactful collaboration across the ecosystem.

Headstream Growth Over the course of 2020 Headstream will evaluate the first iteration of the program with an eye towards scaling the program. We foresee opportunities to scale internationally, focus in on additional challenge areas, and continuing to develop the ecosystem infrastructure in areas like policy and funding.



Youth Mental Health in America: Understanding Resource Availability and Preferences. Born This Way Foundation and Benenson Strategy Group, 2019. 2





Being Adolescent, Csikszentmihalyi & Larson, Lost Connections, Johan Hari, Alone Together: Why We Expect More from Technology and Less from Each Other & Reclaiming Conversation: The Power of Talk in a Digital Age, Sherry Turkle The Teen Years Explained: A Guide to Healthy Adolescent Development, McNeely & Blanchard. Helping Teens Develop Healthy Social Skills and Relationships: What the Research Shows about Navigating Adolesence, Hair, Jager & Garrett. Dumont, M. & Provost, M.A. Journal of Youth and Adolescence (1999) 28: 343. https://doi. org/10.1023/A:1021637011732


Transformative Technology Special Brief, 2018


Out of the Darkness: Making Mental Health a Global Development Priority. Seth Mnookin, World Bank Group, and World Health Organization, 2016.


Global Wellness Institute, Global Wellness Economy Monitor, October 2018


Martini R, Hilt R, Marx L, et al.; for the American Academy of Child and Adolescent Psychiatry. Best principles for integration of child psychiatry into the pediatric health home.



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