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HRSA Word Gap Challenge Yields Low-cost, Scalable, Tech-based Interventions

HRSA embarked upon this federal challenge to address the "Word Gap," the large difference in exposure to language for children from low-income families compared to children from high-income families. By age four, children from low-income families have heard 30 million fewer words than those from higher-income families. This affects how young children develop language skills, their performance in school, and eventually their success in life.

Crowded around a speakerphone at the offices of the Health Resources and Services Administration (HRSA), members of the Maternal and Child Health Bureau (MCHB) announced to Dr. Melissa Baralt that she and her colleagues had won the Bridging the Word Gap Challenge. When Dr. Baralt heard the news on the other end of the line, she was leaving a preschool where she had been assessing the language development of a child, and was delighted that the child's vocabulary had improved since the last visit. Hearing the news, she tearfully noted how hard the team had worked and that the $75,000 in prize money would allow the Hablame Bebe app to be freely available to the public.

After we delivered the news to Dr. Baralt, we were silent. Many thoughts ran through our minds. On one hand, we experienced a sense of relief. Three years in the making, filled with planning, scrambling across the government to get required approvals, and uncertainty of whether we would succeed. On the other hand, we were excited to have tapped into a vast reservoir of innovation. Maybe federal challenges are something that should be more readily utilized across our agency to complement our large grant portfolio of programs. Was this the new way of doing business?

HRSA embarked upon this federal challenge to address the "Word Gap," the large difference in exposure to language for children from low-income families compared to children from high-income families. By age four, children from low-income families have heard 30 million fewer words than those from higher-income families. This affects how young children develop language skills, their performance in school, and eventually their success in life.

While HRSA and others are actively investing in research to better understand the Word Gap issue, we realized approaches to develop tools to encourage parents and caregivers to better interact with their kids and expose them to more words were also needed. We crafted the Bridging the Word Gap Challenge to attract a wide range of innovators and to encourage development of low-cost, scalable technology-based interventions. These interventions would not only more immediately benefit children from low-income families, but serve as tools to further research. It would also encourage more diverse approaches to increase the odds of breakthrough solutions.

Dr. Baralt's team's solution, Hablame Bebe, was exactly the outcome we had envisioned. Hablame Bebe is a dual language app that promotes "language nutrition" and builds on cultural strengths and beliefs to reduce the word gap for low-income children. The other teams' interventions represent an incredible diversity of approaches and expertise, including wearable devices that measure words spoken to a child, apps that provide feedback and modeling to caregivers, apps that are location-based and send prompts to parents in real-time, and community-based strategies.

We designed the challenge as a three phase accelerator, allowing us to widen the aperture initially and to select and support only those approaches that demonstrated value. In Phase 1, we issued a call for ideas, detailed in five pages or less. Of the 80 submissions, we selected 10 to proceed, providing each with $10,000. The low barrier to entry allowed non-traditional participants with promising ideas but perhaps too few resources an opportunity to apply. We leveraged both traditional and social media as well as partnerships to reach a broad audience, and received submissions from individuals, private businesses, and non-profit organizations. The unexpectedly large and diverse response validated to us how well a challenge could easily engage a broad set of innovators focused on solving a particular problem.

Passage into Phase 2 unlocked a suite of resources for the 10 teams. HRSA provided access to one-on-one mentoring with a select group of challenge advisors, HRSA staff, and the challenge contractor. The teams were given six months to fully develop their intervention (or, if already developed, to implement the changes that were described in the initial application) and test its usability on a small target population. We invited the nine winners (one team chose not to continue participation) to the Department of Health and Human Services (HHS) headquarters in Washington, DC to pitch their intervention in a live "Shark Tank" style presentation (Demo Day) to the challenge advisors, judges, and the public. The nine teams had a chance to interact with panelists, private sector incubators, other federal staff, and of course, each other. They received insight on options to continue development and ensure broad reach of the interventions. After the day of presentations, we announced five winners, each receiving a $25,000 cash prize.

Phase 3 required the final five teams to demonstrate low-cost scale of their intervention, supported by evidence. We held a virtual Demo Day six months later, and selected the final winner.

The challenge yielded many desirable results. Of course we awarded a grand winner that demonstrated the most promising product, but we also catalyzed the development of four other evidence-driven products that are currently available to the public, and in so doing proliferated multiple interventions to address the Word Gap. We linked the winners from each phase to our Bridging the Word Gap Research Network (http://www.bwgresnet.res.ku.edu/), where they have access to partnership with researchers in this field. We helped convene "Silicon Valley" approaches to a complex problem not often approached that way within the Federal Government. The Maternal and Child Health Bureau will continue to support the cohort of semi-finalists, and to provide them with additional opportunities for connection, collaboration with federal programs and partners, and opportunities for further promotion and partnerships. Several teams offered unsolicited feedback immediately after the challenge had concluded.

One semi finalist shared, "I wish more of the Federal Government were like this. In contrast to this experience, I've submitted super long grant applications with bizarre formatting requirements. The result is normally an unnecessarily complex explanation for what we're working on. Due to their sheer length, I now disregard most such programs. In contrast, I have nothing but positive things to say about this experience. If the government really wants to attract innovation from places like Silicon Valley this is how you should do it."

The winning team told us, "The 'Incubation Structure' of this challenge is precisely why and how we learned what we did. Had it not been for the deliberately different phases, had it not been for the explicit 'What did you learn? What mistakes were made? What did NOT work?', I do not know if I would have changed my approach of inquiry."

We are confident that as a result of this challenge, we have made a real impact in addressing the Word Gap on a national scale to ensure that all kids have a fair shot at reaching their fullest potential.

Challenges with our Challenge

While we recognized the unique value of using challenges to address complex problems at HRSA, the execution was a learning experience. Most of the HRSA staff were unfamiliar with the reauthorized COMPETES Act prize authority, so it was often difficult to navigate approval from various approving offices. We learned that as an organization we need more familiarity with the COMPETES Act, so we are able to effectively leverage the challenge mechanism when a need arises.

A key factor in our success was the support of champions at HRSA and HHS. Associate Administrator for Maternal and Child Health Dr. Michael Lu, and our HRSA Acting Administrator Jim Macrae were incredibly committed to working out the internal challenges that arose in order to keep the project moving forward. Our advocate in the HHS IDEA Lab, Sandeep Patel, was incredibly helpful in continuously providing guidance on issues that came up, in providing examples of other agencies' challenges to use as models, and in tirelessly supporting our program staff in their efforts to maneuver the red tape hurdles that were often disheartening.

The Maternal and Child Health Bureau at HRSA clearly sees the power of the federal challenge mechanism to attract a broad swath of innovators from the public we otherwise could not attract, focus public attention on an issue, and catalyze development of innovative products to address that issue so rapidly.

Read about the winners here: https://www.wordgapchallenge.hrsa.gov/content/champion

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