Flourish: Digital Mental Health Chatbot Platform Offering Tailored Support to Underserved Youth Experiencing Online Victimization

Flourish (https://flourish.pitt.edu) combines a partially automated SMS delivery system and a secure web platform to guide adolescents through social problem-solving psychoeducation, distress-tolerance exercises, and motivational interviewing via a rule-based chatbot persona, Sprout. Interactive web pages host infographics, short animations, and multimedia exercises linked from SMS prompts, while a backend content management system schedules messages, logs engagement metrics, and adapts message sequences in real time. Developed through iterative human-centered design workshops using digital whiteboards, prototype testing via the System Usability Scale, and qualitative analysis in NVivo, the platform supports deployment in school and clinical settings with robust data security and confidentiality controls.

Description

Unlike generic digital mental health tools, Flourish is specifically tailored to meet the needs of underserved youth, including LGBTQ+ youth and youth of color, aged 12–17 who have experienced online victimization (i.e., online bullying, harassment and discrimination). Within current services, online victimization is often left unrecognized with 37% of adolescents never telling any adult in their lives of their experiences, and the majority of those needing services never receiving them, particularly underserved youth who experience disproportionately high rates of online victimization and service access barriers. Flourish’s differentiated approach blends evidence-based modules tailored to online victimization scenarios with personalized timing and content adaptation driven by user responses to augment service provision for adolescents in schools and outpatient mental health. A rigorous codesign process with youth, parents, and school and mental health professionals ensures cultural relevance and trust-building, while privacy protections and CFIR-informed implementation strategies facilitate real-world adoption. High usability (System Usability Scale score of 83 to 91 across studies) and scalability across school and outpatient settings further set it apart.

Applications

- School counseling platform integration
- Clinical suicide prevention service
- Telehealth chatbot support service
- SMS-based crisis support
- Youth mental health SaaS

Advantages

- Personalized, automated SMS and web‐based support via the Sprout chatbot for timely, tailored intervention
- Evidence‐based modules (social problem‐solving psychoeducation, distress tolerance, motivational interviewing) targeting online victimization coping skills
- High usability and adolescent engagement (SUS scores of 83-91 across studies) with multimedia infographics, animations, and interactive exercises
- Enhanced accessibility and real‐time, after‐hours support through text messaging when traditional services are unavailable
- Robust confidentiality and data security measures safeguarding vulnerable LGBTQ+ youth and youth of color
- Codesigned with LGBTQ+ adolescents and youth of color to ensure cultural responsiveness, relevance, and trust
- Scalable deployment in school and clinical settings leveraging existing software infrastructure

Invention Readiness

Flourish has been evaluated in an open trial (NCT05724784)(N=11) and currently is being evaluated in a randomized controlled trial (NCT06002191)(N=80). Also, the team currently has a pilot grant to integrate Flourish into schools.

Related Publication(s)

Biernesser, C., Win, E., Escobar-Viera, C., Farzan, R., Rose, M., & Goldstein, T. (2023). Development and codesign of flourish: A digital suicide prevention intervention for LGBTQ+ youth who have experienced online victimization. Internet Interventions, 34, 100663. https://doi.org/10.1016/j.invent.2023.100663