Behavioral and mental health issues represent some of the greatest unaddressed challenges for young children, impacting their school readiness [1]. Preschool children who exhibit behavioral challenges are suspended and expelled from early care and education (ECE) programs at 3 times the rate of children in kindergarten-12th grade schools [2]. Moreover, racially and ethnically diverse children living in low-income communities are more likely to exhibit behavioral challenges leading to suspension or expulsion [1,2]. ECE programs play a vital role in promoting young children’s mental health by providing environments where children can develop social-emotional skills, including emotional regulation and resilience [3]. Research indicates that young children who attend high-quality ECE programs exhibit lower levels of behavioral problems and higher social competence compared to those who do not attend ECE programs [1,4].

ECE teachers in high-quality ECE programs can act as a protective factor by supporting young children’s burgeoning social-emotional development, thus preventing challenging behaviors [1,5]. Moreover, enhancing young children’s social-emotional development is linked with their school readiness, making a focus on this aspect of children’s development a mechanism for eliminating disparities [1]. However, there are limited professional development supports available to ECE teachers for implementing evidence-based social-emotional practices, particularly to support young children from low-income communities [6].

Infant early childhood mental health consultation (IECMHC) is an evidence-based model for supporting teachers in developing competencies for implementing social-emotional practices to support young children’s social competence and prevent challenging behaviors [7-9]. In an IECMHC model, teachers receive support from trained mental health consultants (MHC) to learn and practice new skills related to building social-emotional skills. Less than 10% of ECE teachers across the nation report access to MHC, yet over half report feeling that they struggle to manage children’s behavior [10]. IECMHC models offer accessible continuous professional development (CPD) for ECE teachers to guide the implementation of evidence-based social-emotional teaching practices. In a CPD model, teachers are responsible for creating their learning journey [11] which can increase their knowledge, sense of agency and confidence, perceptions of their competence, and ability to reflect on their practices leading to sustained use of new skills [12].

Mobile technology is a CPD mechanism that may increase the uptake of IECMHC practices. The prevalence of mobile technology is increasing, suggesting that mobile apps may be a critical mechanism for eliminating disparities in service receipt. For example, 258 billion apps were downloaded in 2022 [13], with the World Development Report indicating that the poorest households are more likely to have a smartphone than electricity [14], and Hispanic adults are one of the leading users of smartphones [15].

Mobile apps are critical CPD tools for just-in-time, on-demand learning [16]. Mobile apps address the personal agency of the learner to decide when, where, and how they want to learn [16]. Mobile apps are becoming an increasingly common mechanism for providing CPD support in ECE programs [17]. ECE teachers have made progress in integrating digital tools and technology into their everyday practice [18] and these tools can support the sustainability of new skills by teachers [18]. In the ECE space, mobile apps are used for a variety of pedagogical purposes, including teaching strategies to increase young children’s physical activity, implement educational activities (eg, science, technology, engineering, and mathematics), and increase teachers’ creative competence [19-21].

There is emerging evidence that mobile health (mHealth) apps can support the development of a therapeutic alliance between an MHC and teacher [22] which is a key component of IECMHC models. However, there is limited research on how mobile apps support teachers in building relationships with children and collaborating with families [23], which are also essential elements of an IECMHC model. To our knowledge, there is yet to be a mobile app dedicated to providing IECMHC content to ECE teachers.

To address a gap in IECMHC mobile technology, our team engaged in a community-based participatory research (CBPR) model to co-develop a mental health app to provide the Jump Start (JS) program, an IECMHC model [7]. Jump Start on the Go (JS Go) is a mechanism for providing CPD to ECE teachers. The first objective of this study was to document the development and features of the JS Go mobile app, which emerged through CBPR methodologies The second objective of this investigation was to systematically evaluate and refine the JS Go app through comprehensive feedback from ECE teachers, using a mixed methods approach to assess both implementation successes and opportunities for app enhancement. The findings were used to evaluate teachers’ perceptions of the perceived ease of use, usefulness, user interface, and the predicted future use of the JS Go mobile app as a CPD tool for the delivery of IECMHC practices to ECE teachers in Miami-Dade and Broward Counties, Florida. Children and teachers in ECE programs in Miami-Dade and Broward Counties are racially and ethnically diverse, and many live in lower-income communities with multiple neighborhood risk factors contributing to poorer school outcomes. Given the population of children, teachers, and ECE programs in these counties, it is a priority that the community voice and perspective contribute to the development and evaluation of JS Go.

The study was implemented in three phases using exploratory sequential mixed methods. Phase 1 focused on the use of CBPR principles to develop the app. Phase 2 was dedicated to preliminary user testing using qualitative interviews with a small number of ECE teachers who reviewed mock-ups of JS Go to answer the following research questions in order to refine the app: (1) What feedback do ECE teachers have about the interface and aesthetics of the JS Go app for ease of use? (2) How do ECE teachers describe the usefulness of the JS Go app for both current and new teachers? Phase 3 used formal real-world testing of the app by ECE teachers currently receiving JS IECMHC services to answer the following questions: (1) What are ECE teachers ratings for the ease of use, their satisfaction, the user interface, and the usefulness of JS Go for accessing IECMHC content using JS Go? (2) What are teachers’ ratings for the usefulness, ease of use, and predicted future use of the JS Go app as a mechanism for consultation?

This study was approved by the University of Miami School of Medicine, Human Research Subjects Internal Review Board (approval number 20231026). Written informed consent was obtained from all participants prior to data collection. Study data are anonymous, and all participant responses were deidentified using unique identification numbers. Data were stored in cloud-based electronic systems for security. Participants in phase 2 received a US $20 gift card for the interview and participants in phase 3 received a US $20 gift card for beta testing the app and a certificate for 5 hours of in-service training for their participation in the study.

During phase 2, rapid qualitative analysis was used to identify pertinent themes from the interviews with teachers [44-48]. The rapid qualitative analysis allowed the software developer to make real-time changes to the app based on feedback from teachers in phase 2 to optimize beta testing in phase 3. Rapid qualitative analysis has standards for rigor [47] and the use of this type of analysis is supported by implementation science research. Rapid qualitative analysis is a method of expediting qualitative analysis to address pressing issues, such as the timely adaptation of the app to meet the needs of the ECE workforce. The process involves summarizing interview transcripts using a standard template and subsequently transferring key points into a matrix to explore relevant themes [48]. The MHC who conducted the interview completed the initial summaries. A second member of our research team transferred the key points from the interview summary into the matrix. A third member of the team used the matrix to identify themes, which were then refined through discussion with study investigators and other members of the team.

Quantitative data collected during phase 3 were analyzed using SPSS (IBM Corp) [49]. The Cronbach α was calculated for both measures, including each subscale. Descriptive statistics were used to calculate the means and SDs for each of the subscales for both the MAUQ and FF-TAM as well as the total score and item range.

The content of JS Go is based on the evidence-based JS program [50]. JS includes 4 pillars based on Caring for Our Children–National Health and Safety Standards [51]. The 4 pillars are safety and planning, trauma-informed behavior support, adult self-care, and effective communication. JS Go encourages independent learning by allowing users to drive their access to the app by navigating content based on their personal needs. The app includes a self-assessment for using JS practices, infographics describing JS content, videos illustrating JS practices in action, and access to other supplemental materials and resources. JS Go also includes an artificial intelligence–driven chatbot that is specifically trained on JS content. Teacher users can ask questions and receive responses based on machine learning. An app, such as JS Go, developed with community partners via CBPR, could serve as a scalable paradigm shift by bringing MHC to teachers who need it most in real time.

All of the teachers in phase 2 were female. Most of the teachers reported they were White and Hispanic, and their primary language was Spanish. The majority of the teachers were between the ages of 40 and 49 years and most have a bachelor’s degree (Table 1).

All of the teachers in phase 3 were female. Most of the teachers reported they were White and Hispanic, and their primary language was Spanish. The majority of the teachers were between the ages of 30 and 39 years and most reported having some college, which includes technical training and holding an associate’s degree (Table 1).

This study provides preliminary evidence regarding the benefits and usefulness of the JS Go mobile app as a CPD tool for teachers in accessing IECMHC practices in a timely, on-demand manner. The ECE teachers in this sample were all from centers in low-income tracts in Miami-Dade and Broward Counties, Florida. Focusing on the delivery of CPD in these centers is critical for minimizing disparities typically encountered by young children in these underserved neighborhoods [53]. To further address the diversity of the communities and where these centers reside to ensure the app’s social validity, we used a CBPR approach based on 9 principles to develop and test JS Go [54].

By using a CBPR approach, we recognized and valued our community partners and the neighborhoods they represent, as important units of identity. Recognizing each community as a unit of analysis allows us to build on their strengths and resources by facilitating collaborative and equitable partnerships in all phases of our research. Through our ongoing and regular meetings with our community partners, we achieved a balance between knowledge generation and intervention about JS Go, mutually benefitting all partners. Including our community partners as co-investigators affirmed their value as trusted knowledgeable sources assuring our reach to ECE teachers and programs in their neighborhoods to understand their experiences with multiple determinants of health.

Similar to other CBPR research, we used an iterative approach to develop, refine, and test the JS Go app across multiple phases [15,29,30]. One aspect of the JS Go that appears to be particularly appealing to ECE teachers’ is the access the app provides to IECMHC resources, which is in line with prior research on mobile technology using a CBPR approach [30]. One reason for this may be due to support for not only implementing IECMHC practices but also for successfully navigating the app itself as a CPD tool [30]. A strength of our research design and approach is the use of ECE teachers in the communities we strive to reach as end users to obtain valid and culturally relevant information about the usability of the app [30].

This study used an exploratory sequential mixed methods design to gather information from ECE teachers working in existing centers participating in the JS program to inform app development and evaluation across 3 phases. The iterative design allowed us to include our community partners’ voices and perspectives during each phase to ensure the acceptability, feasibility, and usefulness of JS Go for ECE teachers and programs in underserved neighborhoods. Finally, we are ensuring a long-term commitment to sustainability, with pledged support from our community partners, who will support ongoing dissemination about JS Go as a germane CPD tool. This long-term commitment can lead to widespread use of JS Go across South Florida and nationwide.

Notably, the ECE teachers who participated in this study were from ECE programs in typically underresourced neighborhoods serving diverse children. To address the diversity of teachers and ECE programs in these neighborhoods, we used the Ecological Validity Model as a framework to guide the development and evaluation of JS Go, ensuring it is culturally relevant and generalizable to the communities in Miami-Dade and Broward Counties [31,32]. Given our attention to the cultural contexts of the neighborhoods in which JS Go will be implemented, it is culturally sensitive. For example, the teachers can use the app in any of three languages, English, Spanish, and Haitian Creole, with teacher participants indicating their appreciation for the availability of app content in multiple languages.

ECE teachers had overall favorable perceptions of the JS Go mobile app, including their satisfaction and high perceived use of the app’s interface. Feedback garnered from teachers about the app’s interface during the qualitative interviews in phase 2 and quantitative real-world testing was shared with the app developer to aid in making adjustments to improve functionality. Users found the app to be easy to use, functional, beneficial, and useful for both current and new ECE teachers. Yet, they were less likely to rate it as a tool they would use in the future for telehealth consultation, suggesting some hesitancy with mobile apps as useful for this form of professional development. This was in contrast to their favorable report about using the app where they indicated they would use the app again in the future. One explanation for this finding could be that the teachers in this study were older, and research suggests that the age of end user influences their willingness to use mobile technology as a professional development tool while still valuing access to IECMHC content via an app [55].

A CPD tool that delivers individualized IECMHC content in a timely, on-demand manner can be a critical mechanism for training new ECE teachers while addressing their personal agency, confidence, and competence in their new role [12]. Addressing new teacher training, agency, confidence, and competence is vital, given the ongoing ECE workforce crisis exacerbated by the COVID-19 pandemic [52]. Thus, JS Go has the potential to be a viable tool for onboarding new teachers by giving them immediate access to the app with essential information on how to improve classroom quality. Additionally, teachers felt JS Go is an important mechanism to support the sustainability of JS practices by ECE teachers following receipt of IECMH consultation. Implementation science cites the sustainability of evidence-based practices as critical for scaling interventions [56]. The app would allow us to sustain and quadruple our reach across South Florida. As such, the JS Go app has the potential to increase equitable access for teachers to evidence-based IECMHC content helping to eliminate disparities typically experienced by young children in these communities. The JS Go app is a tool that could offer a paradigm shift in how teachers receive timely on-demand CPD tailored to their individual learning needs, increasing their autonomy and potentially leading to sustained use of JS practices.

This study contributes to a growing body of research regarding the viability of mobile apps for the delivery of CPD [19-21,57]. Research indicates ECE teachers integrate digital tools into their everyday practice to construct their learning using informal resources [17,18]. Mobile apps offer a tool for timely, on-demand learning, which can be a critical feature for ECE teachers working with diverse children in dynamic classrooms [16,18]. Additionally, mobile apps are a viable option for access to help and resources when in-person services are unavailable [58]. Mobile apps are also a CPD tool with the potential to support teachers’ sustained use of new practices [57], critical for scaling evidence-based interventions [58]. Prior research shows that mobile apps are rated highly for their usability [59], which is in line with the findings in this study. However, there is a paucity of research on the use of mobile apps to support young children’s social-emotional development, such as building relationships and communicating with families [22,23].

Future research by our team will pilot the efficacy of the JS Go app through a randomized controlled trial in six centers in South Florida. Each of the centers will be randomly assigned (via a random number table) to 1 of 2 arms, the intervention arm or the attention control arm. Both arms will be followed for 1 school year and then a 1-month follow-up. Centers in the JS Go arm will receive their IECMHC through the app in which they will participate in 12-24 mental health consultation sessions. Centers in the attention control arm will receive business-as-usual JS mental health consultation. We will implement the randomized controlled trial using CBPR using the 9 principles of Israel et al [54]. Our community advisory committee will continue to meet quarterly to review findings and recommendations and to support dissemination and sustainability. Meeting with partners will allow us to achieve knowledge generation that will mutually benefit the community and the research team by focusing on the local relevant public health issue regarding implementing IECMHC to support young children’s social-emotional development and school readiness. Involving community partners in the research process will also allow us to build on each community's unique strengths and resources to attend to the social inequities ECE teachers and young children experience in these neighborhoods.

There are several limitations to this study that should be noted. First, participants in qualitative interviews and quantitative testing were not identical, although both came from the same population of teachers currently participating in the JS program. Different populations pose a threat to the legitimation of making inferences from both qualitative and quantitative data [60,61]. However, using this sampling strategy is in line with the purpose of this research by allowing us to compare perceptions about the app from 2 separate groups of teachers from the same population. Additionally, the sample for the quantitative testing was small, limiting generalizability about the satisfaction and usefulness of the app with teachers who are not participating in the JS program, thus it is not possible to know the perceptions of these teachers [60]. Moreover, purposeful sampling of teachers may have introduced bias as MHC selected teachers based on their perceptions about teachers’ ability to engage in the research. We attempted to minimize bias throughout the study in our methodology. However, it is possible that the response of teachers participating in phase 3 may not be entirely independent given their close relationship with their MHC. Finally given the different sample sizes of teachers in each cycle, with decreasing sample sizes, we elected to present total scores for the overall sample. The changes in scores across the 3 cycles are difficult to interpret given the differences in the sample sizes of teachers.

This paper describes the use of CBPR to develop the JS Go mobile app, a tool for delivering IECMHC content to ECE teachers in real time. The communities in this study face ongoing disparities in access to high-quality ECE service. Community stakeholders provided input at all stages of the app’s development, including participation in data collection, allowing for contextualization of the data. This study used sequential exploratory mixed methods to evaluate the usability, acceptability, and feasibility of JS Go. Exploratory sequential mixed methods research is particularly salient for evaluating new approaches, as it allows for nuanced feedback via qualitative methods, and measurable input through quantitative data [60,61]. Specific to our population, the JS Go pilot data shows teacher satisfaction, given quick, easy, anytime-anywhere access to IECMHC information. To our knowledge, the JS Go app is the first mobile app that addresses the CPD needs of ECE teachers in implementing IECMHC content.