Introduction

ShockTalk is a culturally tailored telemental health platform focused on alleviating unresolved historical and intergenerational trauma for Indigenous peoples. ShockTalk seeks to address the following fundamental problems:

1. Lack of access to culturally tailored mental health services and facilities
2. Difficulty in researching and identifying a culturally tailored mental health provider
3. Identifying providers currently accepting new clients
4. Finding a provider with the best therapeutic fit

ShockTalk is comprised of three primary verticals to address these challenges:

1. Indigenous provider network
2. Culturally tailored content and resources
3. Culturally tailored support groups

Prototyping

To address the challenges Indigenous communities face in accessing culturally competent mental health services, we began prototyping and exploring potential solutions. The vision for ShockTalk was originally developed through conversations with my co-founder Sutton King, as well as Urban Indigenous Collective team members. As CEO & Co-Founder, I led the co-creation of ShockTalk’s design and development, ensuring consistent alignment through pivots between the product solution and the needs of Indigenous community. We identified the primary issue of a lack of access to culturally tailored mental health services and sought to better understand what a scalable solution would look like.

After initial ideation and prototyping, our team vetted and validated our problem identification and solution proposal through an extensive customer discovery process. In the summer of 2020, we conducted interviews with over 70 therapy seekers and clinicians across Indian Country. These conversations focused on understanding participants’ previous care journeys, identifying key pain points, and receiving feedback on our high-fidelity prototype which I created in Sketch, can be viewed here.

Pilot

With our initial prototyping and customer discovery complete, we moved forward to test our solution by launching a pilot. We recruited Indigenous clinicians in New York State and developed a chatbot prototype accessible through Facebook Messenger.

Given Facebook’s deep penetration in Indian Country—where some tribal nations maintain active Facebook pages but not websites—it was the ideal platform to connect with users. Often, historical and intergenerational trauma issues are discussed on social media, making it an effective space for mental health interventions.

We created a chatbot prototype, Shakoe AI, which connects users in New York State with our directory of Indigenous clinicians, supports appointment creation, and sends appointment reminders. Shockoe AI welcomes users, checks their location, and provides access to the clinician directory. Each directory entry allows users to view a provider’s profile or schedule an appointment. If the user opts in, they receive appointment reminders and can join their Zoom appointment with one tap.

In 2022, we piloted ShockTalk with four users, incentivizing them with up to five free therapy sessions to assess their ShockTalk provider’s fit.

Insights & Learnings

The pilot provided valuable insights into how Indigenous therapy seekers interacted with the platform, as well as their needs and preferences. Key findings from our entry surveys include:

1. 66% of participants had met with their therapist between 2 and 9 times. One respondent attended only one virtual session.
2. 100% of participants agreed that the race or ethnicity of their therapist should align with their identity, emphasizing the importance of not having to explain Indigeneity.
3. 100% of participants valued therapists who offer sliding scale fees.

The pilot was supported by a $600-per-person subsidy from a Columbia School of Social Work (CSSW) grant. In some cases, insurance allowed for over three months of free therapy.

The three-month follow-up surveys were promising:

1. 100% of participants agreed or partially agreed that they felt in control using ShockTalk and trusted the app.
2. 100% agreed or partially agreed that the scheduling system made it easy to book appointments, and automatic reminders helped them attend on time.
3. 100% agreed or partially agreed that they would recommend ShockTalk to a friend or family member.

The most exciting insight, however, was the following user experience:

• “[ShockTalk] saves me the hassle of having to scour all of New York City for a Native therapist. This is wild! [My therapist] is incredible… We’re going to continue working together. I felt like your pilot was specifically for me.”

These insights validated our team’s approach and confirmed the demand for culturally tailored mental health services. However, they also revealed that in order to effectively scale, we need to expand the design of our provider network to accommodate the increasing demand for services and the limited availability of Indigenous licensed clinicians.

Identified Barriers

While the pilot feedback was overwhelmingly positive, several challenges pointed to areas for improvement.

One major barrier was the limited number of Indigenous licensed clinicians. When recruiting more Indigenous clinicians in New York State, we found demand exceeded capacity. Similarly, clinicians at IHS confirmed that services are often overbooked.

To move forward, we recognized the need to expand ShockTalk’s vision by including peers, elders, and traditional healers in our provider network. Safely incorporating these support providers will require creating culturally tailored frameworks and training programs, which will need additional funding to facilitate. Since our pilot program, I’ve been stewarding the development of our peer support protocol alongside our team’s clinicians, Dominique Negrette, and Sandra Suasnabar.

Our peer support protocol focuses on evaluating and developing competency in the following areas:

1. Origins & Impacts of Colonialism
2. Origins & Impacts of Historical & Intergenerational Trauma
3. Cultural Competency
4. Crisis Intervention Strategies

We also identified the need for an in-house scheduling system. Calendly, used during the pilot due to relaxed HIPAA rules during the COVID-19 emergency, is not a permanent solution. To comply with HIPAA regulations, we need a cost-effective, HIPAA-compliant scheduler.

Accelerator Participation & Funding

Over the course of ShockTalk’s development, we’ve had the privilege of participating in several prestigious accelerators and programs, which have helped us refine our vision and expand our impact. These opportunities have also provided us with approximately $62,000 in crucial funding to move the project forward. Below is a summary of our accelerator participation and the amounts raised:

1. Headstream Accelerator – $40K (program participant)
2. Columbia School of Social Work – $3K (used for the ShockTalk private pilot)
3. PowWow Pitch – $373.50 USD (500 CAD) (Winner, USA semi-finals)
4. MIT Solve – $10K (Indigenous Communities Fellow, 2020-2021)
5. Blackstone x TechStars Launchpad – $5K (program participant, Summer 2020)
6. Firefly Innovations Solveathon Prize – $1K
7. NYU Sprint Follow-on Funding – $1.5K
8. NYU Summer Sprint Prize – $1K

Next Steps

To address these barriers, we are planning several next steps to ensure ShockTalk continues to meet the needs of Indigenous communities.

First and foremost, we are exploring the creation of culturally tailored support groups to provide care to Indigenous communities, regardless of recognition status. We expect to share more details about this initiative in Fall 2024.

While our clinical team is focused on the creation and launch of our support groups initiative, my focus is continuing to develop our MVP product offering and peer support offering. To support the launch of our peer support offering, our team is focused on first building our in-house scheduling solution, refining the peer-support training materials created by Dominique Negrette, and onboarding a peer to facilitate our trainings.