The R1 Discover Vision — Imagine What We See
Imagine a near-term future when the curricula programs choose to implement becomes a highly valued asset improving outcomes and the financial well-being of the organization. The vision for R1 Discover is deeply rooted in my past and is evolving quickly as Frank Bomher and I build and deploy it with our amazing technology team. Many of you have met me along the R1 journey these past six years. Some of you still see R1 as a colorful and fun card company. Some of you have seen a glimpse of where we’ve been headed from the start. R1’s journey has required patience and persistence given the industry’s slow to change nature and readiness for online solutions. The challenges that emerged from programs struggling to engage individuals from a distance during COVID-19 has sped up the industry’s openness and readiness for innovation. We set off from the start to build a standardized set of interactive topic activities, curated from the evidence-base, and organized into a highly structured taxonomy for engagement, learning, and data generation purposes.
R1’s purpose is to build an interactive curriculum service that positively impacts individuals and their families, equips deeply caring and compassionate practitioners in the workforce, and changes lives. We also set off to build tools to learn from more quickly and easily. We asserted at the start in July of 2017 that it was impossible to understand the impact of curricula until a highly standardized and modular set of tools could be built and deployed, and could generate personalized data to learn from.
After four years of building and testing R1’s highly structured Learning System and the Discovery Cards with a wide range of populations in a variety of settings, we set out to build the online version. We drafted a product concept at the end of 2020 and moved forward in March of 2021 under our new venture R1 Discover LLC to build an operational version. The online space is not new for me, it’s been part of my professional experience leading product development teams leveraging cloud-based enterprise technology. (See my story at the end of this post). With Daniel Pegues at Vertical Square, connected to R1 by my previous technology partner, NTConcepts, in Northern Virginia, and Frank Bomher, then a full-time employee at Booz Allen Hamilton (BAH) building innovative cloud-based pricing and data analytic tools, we set off to build what many of you see today. Frank is now formally my business partner and R1’s Chief Technology Officer (CTO) leading the R1 Discover technology team. He is setting us up for scalability and success on both our front-end user experience and back-end where we’ve built single sign-on (SSO) and application programing interface (API) services for quick integrations with electronic health records (EHRs), learning management systems (LMSs), and other third party platforms. Hats off also to Corinne Karl, R1’s Art Director, and Mike Irvine with PookyHonk Productions leading our animated video development. They are both extremely talented and have brought the R1 Learning System to life on R1 Discover in an amazing and colorful way!
We’re still not there, but the vision is much more visible in the current version of R1 Discover. Our technology roadmap is evolving and exciting too. There are more topic activities, language packages, features, dashboards, and capabilities coming so stay tuned.
The purpose of today’s post is to highlight what some of you already know about us. We also want to spark the curiosity of others who have met us briefly and have not looked at R1 closely. For those seeing us for the first time, “welcome”. We’re excited to meet you and hopefully work with you soon. Don’t worry about us disappearing, our vision is compelling. It is happening now, it’s just a matter of time for it to be fully realized. Our vision brings together the best evidence-based models, theories, and content; psychology and learning theory; the latest web-based technology and data science; and puts the individual in the center of the solution. Exactly where they are supposed to be. There is no other path we see.
The R1 Discover Vision — Do You See What We See?
Engagement: Imagine a future when individuals will be quickly engaged and motivated with online self-discovery tools. Imagine a future where the tools we provide empower individuals to tap into the way they like to process information given their learning styles, literacy level, culture, and native language. An individual’s self-efficacy is best activated through a journey of self-discovery, reflective learning, and with tools that empower them to choose their own path and destiny. R1 Discover was envisioned to tap into how individuals like to learn, tap into information deeply rooted in an individual’s psychology, and enable, through learning and vocabulary building, to effectively express one’s voice. Imagine deploying a standardized and easily scalable set of tools, where programs no longer have to wonder what’s happening behind group room doors. Imagine a day where your program is not defined based on who shows up that day, the facilitation skills of the counselor, or what a decade old curriculum research study says is effective today. How do you get individuals to counseling that don’t want counseling? How do you equip your team with tools that are as fun and interactive for them to lead as it is for the individuals they serve. The speed to engagement and “conscious raising”, the first of 10 Processes of Change according to Drs. Prochaska and DiClemente, is through information, education, and feedback. It is the first step clearing the path toward self-efficacy and improved outcomes.
Exploration, Learning, and Growth: Imagine a future when fundamental behavioral health topic activities are accessible and consumed by individuals based on self-directed choices sparked by an individual’s interest, curiosity, and learning style. Imagine a day when programs will serve up tools where individuals will find topics that resonate with their unique situations and circumstances in addition to what programs assign. Imagine a future where individuals can learn at their own pace, not be held up by a sequential set of modules that are prescriptive, one-size-fits-all, and disengage both the learner and the practitioner delivering them. Imagine if the same tools we use to engage individuals also increase the knowledge, skills, and effectiveness of the workforce, and engage them for their own self-care. Imagine a future when the activities are interactive, fun, put the individual in the center of the learning experience, and drive more thoughtful discussions because of the reflective insights they produce. Imagine when the result of these reflective learning experiences produce personalized goals driven through an individual’s choice and self-efficacy. Yes, the roadmap includes the ability for individuals to created SMART Goals, journals, or cognitive behavioral plans for Discovery Cards bookmarked in activities (warning signs, triggers, traumatic experiences, etc.). Imagine a set of tools that are colorful, approachable, break stigma, and inspire individuals to explore and discuss their mental health and wellness in a healthy productive way. Yes, this is all possible.
Accessibility: Imagine a future where both individuals and programs will easily access tools, resources, and information 24/7. (See Frank’s recent post on Accessibility). Imagine when the curricula programs use are in both hands-on and online formats. Imagine if the online tools are accessible in a responsive format on mobile, tablet, or desktop devices. Imagine the content being accessible in one’s native language, and when literacy is an issue, includes text to speech capabilities. What if even the worksheets you use are available in an editable PDF format so that individuals can type into and save their thoughtful work. This also enables programs to more easily (and in less time) upload these files into the electronic health record (EHR) for documentation purposes. Making best-in-class curricula accessible for both the practitioner teams and individuals in services is not rocket science. Organizations have been utilizing these approaches for decades. Why is behavioral health still not adopting these learning best practices? Link to Frank’s post to see how your program stacks up.
Meaningful Data Generation: Imagine a future when we will capture the information from one-on-one sessions, groups, or assignments (pre and/or post) in real time and use it for multiple purposes. Imagine that the data generated is highly structured, bite sized (a single card or data point), curated from evidence-base models and theories, and derived from a taxonomy that maps to other data and behavioral health constructs such as the Social Determinants of Health. Today, most curricula utility stops at the end of the one hour experience. Very little, if any, moves forward into treatment notes, follow-up assignments, treatment or recovery plans, or for quality reviews by audit or accreditation agencies. There is gold in the data currently housed in hundreds of thousands of paper-based activity worksheets each day. Why can’t we capture, access, and use it to fulfill the golden thread vision from patient voice to treatment plan. Why have we not been able to tap into this warehouse of client/patient generated data to date? “There is gold in them-there hills”, and value-based care is calling on each of us to find it. R1 Discover builds a path to engage individuals, capture meaningful information, and bring it quickly and cost-effectively into program and practitioner workflows.
Streamlined and Useful Documentation: Imagine a future when your staff ( clinicians, counselors, peers, or community service workers) will meet with an individual one-on-one, run a group, or give an assignment, and the data from the session immediately gets listed in the electronic health record (EHR) for each practitioner based on their case load. Imagine that the information is saved for follow-on use becoming accessible and actionable by both the individual and practitioner. Imagine a future when client generated data will be used real-time as the golden thread in a treatment or recovery plan and as the foundation of client generated SMART goals. Imagine this being done real-time with no scanning and uploading of worksheets into a file folder that rarely gets reviewed. Imagine the time that will be saved. Imagine the reduced amount of team stress, and reduced staff turnover that will result from less stress. Imagine a future when the practitioner will spend more time with the individual or family member versus sitting in front of their computer trying to remember what happened and documenting it. R1 Discover will soon include a group facilitation feature enabling programs to engage groups, see individuals results real-time, and aggregate group data for both practitioners and group participants to see depending on permissions. It’s all coming.
Real-time Outcomes Measurement: Imagine a future when we will learn real-time what curricula topics and sequences lead to the best outcomes for different populations, settings, specific substance use, addictions, or co-occurring disorders. Imagine a day when we’ll enable individuals to tap into different topics in different sequential orders based on data versus outdated studies. What if we could link what people self-discover in the curriculum to important constructs such as their quality of life, Adverse Childhood Experiences, Trauma, Co-occurring Disorders, specific substance use, and the Social Determinants of Health? All of this is possible with a topical, modular, and data generating learning system. The research and information is accessible but still in research papers, peer reviewed journal articles, and books. Why not use it, bring it into the workflow, and use technology to maximize the value and impact of it. We are finally at a time to make this all happen and R1 Discover is here to help lead the way.
The R1 Vision is Evolving
As you can imagine, the more we get out to share our vision and tell our story, the more we learn about additional benefits of our system. Since Frank has joined the team, we’ve been able to learn more in every conversation we’re in. Additional areas we’ve added along our path include:
Payer and Grant Funder Audits, Utilization Reviews, and Accreditation Requirements: Imagine a future when we will be able to sit down with payers, grant funders or accreditation agencies, and pull up dashboards with personalized, meaningful, patient/client generated information that highlights golden thread of the patient/client into the treatment or recovery plan. R1 is currently integrating with several electronic health records (EHRs) for both user management and data transfer into clinical notes. This is no longer a vision, the future is here.
Value-Based Reimbursement: Imagine a future when your program will be reimbursed using a code modifier at a higher rate or using a specific code for utilizing interactive curriculum activities that are linked to higher outcomes. Imagine a day when you will be able to bill for and build a revenue stream using best-in-class interactive curriculum as part of your programing. Extending care beyond the time with the clinician, counselor, or peer support provider will improve outcomes cost-effectively. These tools will bring tremendous value beyond the time spent in direct care. All will be better for the individual, their families, and programs bottom-lines. The incentives for programs to provide these tools will create additional and profitable revenue streams. This part of our vision is almost here too.
Research: Imagine a future when the information generated through your interactive curriculum and the millions of data sets produced, becomes a valuable resource to learn from, build better solutions around, and improves outcomes as a result. The R1 Discover platform is a data generating machine, all coming directly from the patient/client voice. Imagine if the warning signs, emotional triggers, or even the values, one chooses, helps us uncover better strategies for treatment and recovery services. We see everyone looking for that depression, anxiety, or stress biomarker to help inform care. We also see a path to better outcomes through that first Process of Change toward self-efficacy, “conscious raising”. What if one of the keys to better outcomes for substance use, addiction, and other mental health conditions, is tied to, and could be sped up through, engagement, self-awareness, vocabulary building, learning comprehension, and the power of choice. We know that these facets are critical to building and sustaining behavioral change. Let’s study it, confirm our hypothesis, and see where this data leads us. There is so much more to learn and our research arm, R1 Research will help pave the way here. All part of our vision.
All to say… watch out our for us and reach out to us! We are ready for 2024. We are finally the interactive, modular, scalable curriculum service that we set out to be. We’re bringing engaging activities into a variety of settings with topics in mental health & wellness, substance use & addiction, and life skills. All making an impact for communities including behavioral health, schools & campuses, corrections, criminal justice, veterans, military, and tribal nations. We look forward to hearing from you and working with you in the near future.
Questions to Explore
Answer these questions for yourself or someone you are working with.
What did your find most interesting about this post? Explain.
How does the R1 Discover Vision resonate with you? Explain.
Which part of the R1 Discover Vision are you implementing today?
Which aspects of the R1 Discover Vision would you like to implement in the future?
What benefits do you see for your program as you implement aspects of the R1 Discover vision?
R1 Discover — A Vision Rooted in My Past
More often today, I’m stopped and asked how I came up with the idea for the R1 Learning System, the Discover Cards, and R1 Discover. Ideas do not come to anyone in a vacuum. At least this one didn’t for me. Most innovation happens by bringing proven ideas in one discipline, industry, or area into another. The idea for R1 Discover has been a journey of its own. R1 Discover is deeply rooted in the ideas from others along my professional path spanning over two decades prior to R1 including Dr. Caela Farren, Beverly Kaye, Dr. Zandy Lebowitz, Joyce Cohen, Pete Hartwick, Heather Kaye, Ralph Larry, Joel Beer, John Tabor, Keith Sheppard, Aaron Rogers, Bhargavi Kodali, Amy Cocke, Cindy Morgan Jaffe, Nola Shelton, Michael Goins, Adam Alexander, Kristen Leverone, Christine Keresztenyi, Anne Raftery, and a countless list of customer stakeholders from Fortune 1000 companies, government agencies, and educational institutions. Their countless ideas, input, and inspiration shaped today’s R1 Discover application. One of the most important people on this journey has been my wife, Pam Harley, one of the smartest people I know. She also has a professional background for both content and technology-based product development. Pam is currently a Partner with Clarke & Esposito, serving the medical and scholarly publishing community. Pam’s resume includes leading the product development team at the American Psychiatric Association (APA) bringing Psychiatry Online online with Silver Chair Information Systems. Her mark on R1 Discover lies at the core of what we do leveraging health and wellness evidence-based and peer reviewed topics and taxonomies. Pam is our number one funder and on our R1 Board. I love her deeply and grateful for her support enabling the R1 journey.
The seed for R1 Discover was planted in 1990 when I interviewed at Farren & Associates, a national organizational development consulting firm located in Annandale, Virginia. I can remember going to the interview and the Founder, Dr. Caela Farren, welcomed me and handed me a set of tools they had created to help individuals with career exploration. I can remember that day vividly as if it were yesterday. At the top of this folder of paper-based instruments, was a card deck. It was called Deal Me In and its purpose was to help individual’s self-discover their career interest based on John Holland’s hexagonal model (which included the RAISEC and PIDT Codes).* The founder, Dr. Caela Farren, with her earlier partners, Beverly Kaye, and Dr. Zandy Lebowitz, had created this product for their joint company, Career Systems Inc. They had large contracts with companies such as AT&T, Chevron, Bayer, Marriott, and many other Fortune 1000 companies. I’ll admit, I was fascinated with the cards over my tenure at the company from 1990 to 2014. We sold thousands of the Deal Me In cards over the years and they were always the most interactive and conversational hands-on tools in the suite of products we offered.
Like many other Human Resource consulting firms, we slowly moved our assessment instruments, mostly questionnaires, from paper onto the computer. Yes, we did operationalize the taking of these questionnaires on 3.5” disks (3 to be exact) for a moment. Pete Hartwick, one of the Senior Consultants in our firm had introduced us to a few of his friends at Bell Laboratories, and Joel Beer was off to the races to build us our first computer-based tools. It sounds cumbersome today, but back then, it was super cool. We were bringing learning and development onto computers. As the web came in, I led our team to bring our content online. We initially worked with John Tabor, an independent consultant with a company call Blue Flame. Around the turn of the millennium when we began to build web-based tools. My sister-in-law, Paige Harley, was working for NTConcepts in Tyson’s Corner, Virginia. I reached out to her technical leader, Keith Sheppard, and we worked with them for almost a decade. (Paige still works there today, as does Keith)
The Deal Me In Cards had been rebranded as TalentSort Cards as “Talent Management” was the new buzz phrase in the Human Resources industry. We worked with a young developer on Keith’s team, Aaron Rogers, and later Bhargavi Kodali, to bring all of our tools onto the web. One of our most exciting projects was bringing the TalentSort Cards online using Java Script and Flash. Aaron, made our first interactive version super cool. Much of what you see today with the R1 Discover pyramid activity and report has its roots in Aaron’s version. It was super cool and enabled us to showcase our broader tools and capabilities. Whenever we demoed the TalentSort cards online as part of our solution, we typically would win the competitive bid. The online interactive version was innovative, unique, and differentiated us from other content companies in the space.
Over the next few years, we had several customers fall in love with the online cards. Capital One was growing and building a large brand with their credit card business headquartered at the time in Richmond, Virginia. CapitalOne was way ahead of other firms on the Talent Management front. They had a key strategy, given their strategic growth plans, to re-skill and redeploy talent as the firm grew and changed vs letting people go and hiring new people. We were partnering with a larger international consulting firm at the time, Lee Hecht Harrison (LHH), an Adecco company. Their lead relationship manager for their CapitalOne account, Amy Coche, helped to sell our Career Focus and Talent Builder workshops as the intake course when entering their Career Centers. That meant that every person in the company that went through their Career Center, went through our course. CapitalOne (and many other companies) bought thousands of workbooks and card decks from us each year for re-skilling and redeploying their talent.
Around 2009, we had added a few secondary activities that derived from the initial Talent Sort profile. The online card version now enable individuals to 1) get their color-coded Career Interest profile and report 2) assess their profile against their current job/role (for career fit assessment purposes), and 3) asses their profile against a future job/role they were exploring. All inputs for the comparisons were self-reported. One of CapitalOne’s Senior Human Resources Managers wanted the profile to be linked to internal career mobility options and job search. With that funding, we built a capability and data structure to load in all of the job families and jobs in the organization mapped to the Holland Code dimensions. That enabled us to build in logic for individuals to do these comparisons automatically. It also enabled individuals to search for and explore job profiles that matched their career interest profiles by job families, salary ranges, location, and other search criteria. When individuals located jobs/roles they were interested in, they could link directly to the job posting system to see if there were any opportunities open in the organization at that time. All pretty cool… and yes, it all started with self-discovery.
The interactive TalentSort Cards were just one tool in our onlinie suite of tools. We had built a customizable Career Portal platform that we white-labled for many of the Fortune 1000 companies. We used our online cards capability as part of the solution with companies including Sprint, Gillette, Embraer Jets, Reebok, Mass Mutual, Suntrust Bank (now Truist), Caterpillar, Lockheed Martin, Northrup Grumman, Sargento, Stanford University, TIAA-Cref, The U.S. Mint, Capital One, and many others. Our TalentSort card game was our demo tool, was super cool, extremely interactive, now linked to internal job search, and engaging thousands of individuals within organizations.
Fast forward… my alcoholism was at its height at the close of 2011 and landed me, reluctantly, into my first substance use addiction treatment program at the Virginia Hospital Center (VHC) in Arlington, Virginia. It would be a 5 year journey of ups and downs, multiple treatment settings, recovery meetings, with setbacks personally and professionally along my path. My journey had me enroll in several more medically monitored withdrawal stays at both VHC and Inova’s CATs program, two 60-day intensive outpatient programs (IOPs), and a 45-day residential stay at the Meadows in Wickenburg, AZ. All informing me of some best and not-so-best practices in treatment settings.
In the Spring of 2015, I had just lost my role at LHH as the company acquired mine. The loss was primarily due to my alcoholism and my lack of engagement in my new global role. During the Fall of 2014, coming out of the Meadow’s 45-day residential treatment program just before Halloween, I learned that I had to have triple by-pass surgery and a Maze procedure for my plumbing and electrical heart issues. My physical deterioration was the direct result of my alcoholism. The next year showcased my sobriety and career journeys to be unstable. After a few more returns to brief binges of use, I chose to enter a second Intensive Outpatient Program (IOP). This is where I had a new perspective of what was happening with my substance use treatment and recovery acquaintances… they were not showing up, not staying in the program, and not participating in groups when they did show. I too was finding it extremely difficult to stay engaged with antiquated worksheet-based group activities that felt dated and boring.
Fast forward one last time… at the end of 2016 and the beginning of 2017 I was lost and rudderless concerning my future personally and professionally. In January of 2017, I had yet another binge week drinking alcohol, which was the impetus for me to reexamine everything I was doing. Sitting on my desk were those TalentSort cards. With my recent experience in my IOP and my 12-Step sponsor asking me to pull together yet another Step 1 inventory, the idea hit me. Why don’t I take my engagement knowledge, the idea of the TalentSort cards sitting on my desk, my online experience deploying multi-language career portals, and in service to others, build a behavioral health learning system and online engagement platform. In April of 2017 I had my last binge weekend, fully committed to my sobriety, and my new purpose. In July of 2017 I started R1.
In closing, the R1 Discover part of the journey has been the highlight of my professional career. I am grateful for finding two talented and passionate technology collaborators in Frank Bomher and Daniel Peques, They have made this phase of the R1 journey intellectually stimulating and extremely fun. Let me remark one last time about Frank Bomher. He is passionate and extremely talented and now leading the product and feature development roadmap for R1. His contribution and impact on R1 and R1 Discover are taking us to a level I could not imagine at the onset of this journey. I’m grateful that he has hooked his amazing talents to the R1 ship as we are now building this vision together. We’re inspired to make a difference, enable individuals to reach their full potential, and equip practitioners to be the best that they can be. Please reach out to us and be part of the innovation that’s already here.
The rest of the story can be found in our blog posts from 2017 up to this one. With Frank Bomher, our development team at Vertical Square, and an amazing group of early adopter customers like Oregon Treatment and Recovery Centers (ORTC), Community Health Alliance, Ujima Family Services, Central Valley Recovery Services, Gateway Rehab, and scores more, we’re on our way. As you can see, we are one-step away from realizing the vision we see. If you can see it, join us today, and be part of the innovation that’s already here.
* Realistic, Artistic, Investigative, Social, Enterprising, and Conventional (RAISEC Codes) and People, Idea, Data, Things (PIDT)
Copyright 2023 R1 Publishing LLC / All Rights Reserved. Use of this article for any purpose is prohibited without permission.
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