Maternal Mortality Crisis - DoulaID: An identity solution bringing caring support for the most at-risk mothers

[GENERAL] Name and surname of main applicant

Lance Byrd

[GENERAL] Email address of main applicant

Lance.Byrd@RootsID.com

Additional applicants

The core team on this project is:

• Annie Byrd - Talent Acquisition Specialist & Community Leader, UMBC and Co-founder of DoulaID
• Ana Rodney - Executive Director, MOMCares
• Micknai Arefaine - Leadership Team Member, Baltimore Doula Project (BDP)
• Lance Byrd - RootsID CEO, Co-founder, and software developer, RootsID
• Rodolfo Miranda - RootsID CTO, Co-founder, and software developer, Roots
• Alex Andrei - RootsID Chief Product Officer (CPO), software developer and JFF plugfest 2 participant, RootsID

[GENERAL] Please specify how many months you expect your project to last (from 2-12 months)

3

[GENERAL] Please indicate if your proposal has been auto-translated into English from another language.

No

[GENERAL] Does your project have any dependencies on other organizations, technical or otherwise?

No

[GENERAL] If YES, please describe what the dependency is and why you believe it is essential for your project’s delivery. If NO, please write “No dependencies.” .

No dependencies

[GENERAL] Will your project’s output/s be fully open source?

No

[GENERAL] If NO, please describe which outputs are not going to be open source. If YES, please write “Project will be fully open source.”

We will be leveraging open source software from the RootsID, Cardano, KERI, and GLEIF ecosystems to implement our platform. All open source software that we use is Apache 2.0 licensed. The DoulaID app, network, and usage will be free but not open source. RootsID has delivered many open source solutions through Catalyst. This solution will leverage those open source projects including RootsWallet, the Cardano KERI Backer, and more. We will also be making improvements to some open source projects as needed for DoulaID.

[METADATA] Category of proposal

Identity Solutions

[METADATA] SDG rating

Target3.1

By 2030, reduce the global maternal mortality ratio to less than 70 per 100,000 live births

Target3.2

By 2030, end preventable deaths of newborns and children under 5 years of age, with all countries aiming to reduce neonatal mortality to at least as low as 12 per 1,000 live births and under-5 mortality to at least as low as 25 per 1,000 live births

[IMPACT] Please describe your proposed solution.

What is a Doula?

Doulas are non-traditional learners who may enter birth work through apprenticeship or shadowing. Most doulas are trained and certified, but there is not one standard training/certifying body. Each doula training organization teaches core competencies that are necessary to provide appropriate doula support. When a doula learner downloads the app, they are guided through introductory material about doulas, doula organizations, and becoming a doula. If they choose to begin the doula learning journey, DoulaID will connect them with certifying doula education organizations. As the doula learner completes courses and milestones they are given digitally verifiable credentials that can be used to assess their ideal placement as birth workers. Based on this assessment, learners can apply for jobs, register with Medicaid, and unlock new opportunities in the app. DoulaID will enable culturally congruent doulas to connect with the clients who need them the most.

What is DoulaID?

DoulaID is a RootsID app and grassroots organization that is helping address the maternal mortality disparity crisis in Baltimore. Over the last year DoulaID has teamed with community doula organizations to manually enroll culturally congruent doulas with Medicaid. In collaboration with the Maryland health department, we are identifying how to improve successful enrollment of doulas. This effort is strengthening the doula network in Baltimore with Medicaid registered doulas who can access sustainable income while helping the clients who need them the most.

As the parent company of DoulaID, RootsID is leveraging our digital identity ecosystem to power the DoulaID app. DoulaID helps doulas navigate the complexities of a healthcare system that was built for doctors including; training, enrollment, scheduling, and payment. DoulaID allows users to focus on what really matters, healthy mothers and babies.

DoulaID is a RootsID app that invests in human potential by empowering doula learners and workers to engage with underserved clients, connect with sources of sustainable income, and access other vital resources. DoulaID guides users through the education, certification, networking, and payment process. DoulaID also helps birthing individuals connect with culturally congruent doulas. The DoulaID app is one part of the greater vision for doulas in underserved communities. We have partnered on a government proposal to build a learning collective hub for doulas, similar to what has been successful in Oregon and New Jersey. The hub is an environment where doulas receive training and certification and are provided support to be successful in the larger birth ecosystem. The doula hub would advocate for a thriving doula community, equitable compensation, ease of Medicaid reimbursement, and sustainable doula careers. DoulaID would be an integral part of the doula learning hub.

DoulaID on Cardano

There will be many different types of digital interactions that will require support from the Cardano blockchain. This includes strong cryptographically verifiable digital identity, transparent interactions and training/career/financial achievements that are cryptographically verifiable. Cardano and the Catalyst community will benefit from the rise of usage in the Cardano network, all in support for this important and visible human challenge and solution.

DoulaID mocks

https://www.youtube.com/watch?v=_0fse0irwC0

Additional information:

Complimentary proposal:

This proposal is focused on the human and governance of the DoulaID solution. We have a supporting proposal to fund the app and technology components, in the Products and Integrations challenge.

More about the Maternal Mortality Crisis and Medicaid support:

Black women in Baltimore are 2.25 times more likely to die of pregnancy-related causes than their White counterparts. Medicaid eligible Black mothers are at an ever higher risk for negative birth and postpartum outcomes. Birth work has a long tradition in black communities. Doulas of color are an integral part of the well-being of new families. Doulas have been shown to be especially effective at improving birth outcomes and maternal health in communities with the highest disparity.

Doulas are professional labor assistants and advocates who provide non-medical physical and emotional support during pregnancy, labor, and postpartum. Maryland Medicaid recently added reimbursement for doula services (up to $1427/birth). This funding is a key part of the solution to the maternal mortality inequity.

More about the organizational identity governance framework:

GLEIF, Global Legal Entity Identifier Foundation, was created in the wake of the 2007/08 economic crisis by the G20 countries to help improve financial stability worldwide and make sure counterparties to transactions could be readily revealed. GLEIF issues Legal Entity Identifiers (LEI) that provides key information about businesses, funds and governmental organizations participating in business transactions, including their name, when they were formed and, crucially, their ownership structure. More than 2.3 millions of Legal Identifiers were issued so far to companies around the world, a number that is rapidly increasing over time as the regulation enforces their use.

Recently, the GLEIF began to issue a verifiable credential called vLEI (verifiable LEI) that allows the assertion of delegation chains and the digital proof of correctness of things like signatures in financial reports. The vLEI allows those Legal Entities to participate in the verifiable credential ecosystem.

Those verifiable credentials are based on a fully Decentralized Identity technology called KERI/ACDC that requires supporting witnesses to provide a second source of trust. On Fund 9, rootsID got funded to develop the first Proof of Concept for a KERI witness on a blockchain, a project that was delivered successfully on time. 

[IMPACT] How does your proposed solution address the challenge and what benefits will this bring to the Cardano ecosystem?

DoulaID is solving the business coordination and stakeholder challenge in parallel with the technology implementation effort. DoulaID is a RootsID identity app that connects Doulas to the identity, training, insurance, credentials, accounts, professional experience, etc required to bill Medicaid. At the same time, DoulaID is a grassroots organization engaging with local doula communities, doula training organizations, doula practices, the Maryland Department of Health and many more stakeholders. The interactions between doulas and their customers, providers, insurers, and more requires a rich set of verifiable credentials. DoulaID will promote a credential ecosystem that is rooted in the vLEI governance framework provided by GLEIF. This framework is the first major implementation of the open standard governance framework specification provided by Trust over IP. RootsID are contributing members of Trust over IP and are developers as well as participants in the GLEIF governance framework. DoulaID simplifies the complex processes for doulas who do not have the infrastructure and support of their medical counterparts like doctors, nurses, midwives, etc. We help them engage with training companies, doula practices, insurers, managed care organizations, and more.

DoulaID provides a community and governance framework that uses decentralized identity roles and extends the GLEIF governance:

1. Doulas
2. Holder
3. ECR credential from Doula Practice
4. Trained Doula credentials
5. Certified Doula credentials
6. Insured Doula Credential
7. Medicaid registered Doula credential
8. Issuer
9. Client service provided credential
10. Doula Practice Member
11. Verifier
12. Medicaid qualified training service
13. Medicaid qualified client
14. Medicaid qualified doula practice
15. Medicaid qualified insurer
16. Doula Practices
17. Holder
18. vLEI credential
19. Doula Practice Insured Credential
20. Issuer
21. ECR credential issued to Doulas
22. Verifier
23. Verify Doula training credential
24. Verify Doula 
25. Doula Training Providers
26. Holder
27. Medicaid qualified training service
28. Issuer
29. Doula training credentials
30. Verifier
31. Pre-req training credentials
32. Doula related service/product provider
33. MCOs
34. Issuer
35. Service provided credential
36. Doula Insurers
37. Issuer
38. Doula insurance credential
39. Maryland Health Department
40. Holder
41. Medicaid State Administrator
42. Issuer
43. Qualified Medicaid Clients
44. Qualified Medicaid Doula Practice
45. Qualified Medicaid Doula Insurer
46. Qualified Medicaid Doula Training Center
47. Verifier
48. Qualified Medicaid Clients
49. Qualified Medicaid Doula Practice
50. Qualified Medicaid Doula Insurer
51. Qualified Medicaid Doula Training Center

The app also helps doulas:

• Incentivizes participation
• No need to manage user accounts
• reduce liability
• reduce IT infrastructure
• increase access
• increase support for multiple sources
• Provides complete cryptographic verifiability of every interaction
• increases speed
• decreases friction
• eliminates fraud
• Non-traditional learners like doulas are empowered with nuanced careers
• all significant interactions are verifiable and can be used to bolster Resume.
• Promotes Interoperability
• Leverages the global network of 2.4M LEIs
• Open Source/Standards identity software
• ISO standards
• Trust over IP
• Unlocks positive impact
• Doulas have been shown to reduce Maternal mortality in the US
• Creates sustainable non-traditional learner jobs
• Better care for low-income mothers
• Streamlines coordination in a decentralized ecosystem
• An extension of the GLEIF governance framework can be extended

Our proposal allocates funds for the RootsID administrators to converse with these stakeholders to provide the simplest app possible, to handle these complex interactions.

RootsID works closely with the GLEIF governance framework and the ToIP Governance Working Group. We are extending these specifications and frameworks for the Medicaid and doula structured ecosystems.

DoulaID has already published an initial report to the Maryland Department of Health who manages Maryland (Baltimore) Medicaid. The report detailed how to improve their doula registration process. The DoulaID will make this process easier for Doulas to follow and complete. It will include step-by-step instructions and unlock new features as the doula further qualifies as a care provider.

We will continue to publish more reports to Catalyst, the doula community, Maryland department of health, and other stakeholders for how to improve the access of doulas, Medicaid insured mothers, etc.

[IMPACT] How do you intend to measure the success of your project?

Our core metric is how many doulas have been guided by DoulaID, to register with Medicaid. Medicaid mothers are at the highest risk of negative birth outcomes. Research shows that doulas improve maternal mortality outcomes. Therefore we are focused on brining as many doulas as possible to the highest risk populations. Doulas need funding from Medicaid to sustain their work and so connecting doulas to Medicaid funds and Medicaid covered mothers is our target metric.

As the number of doulas, training institutions, insurers, mothers, etc grows, the Cardano network will benefit from usage and the community and ecosystem will benefit from this high visibility and extremely important human challenge.

We believe our success is very realistic. DoulaID has already helped several doulas and practices to get registered with Medicaid. This proposal builds on that success to provide an app based on previously funded open source Catalyst projects that RootsID completed in previous funds (since Fund 6 through Fund 9). 

DoulaID will be the first production decentralized identity app (and infrastructure) built to use Cardano. RootsID will leverage their previously Catalyst funded open source projects to implement this exceptionally impactful and innovative project. This will help establish the Cardano blockchain as; an important part of our decentralized identity app, an important part of the GLEIF ecosystem, and an important part of the challenge to improve the maternal mortality rates for low-income mothers.

We will provide metrics on the number of doulas guided through medicaid registration, provide reports about the governance framework and provide qualitative responses from users and stakeholders.

We propose the following metrics for this proposal DoulaID app:

• Number of Doula education organizations that have seen DoulaID alpha and are aware of the process and how the issuance of their credentials benefit; them, the doulas, the clients, and the Medicaid system.
• Number of Baltimore City doula organizations that have seen DoulaID alpha and are aware of the process and how the collection of doula credentials benefit; them, the doulas, the clients, and the Medicaid system.
• Number of Baltimore City doulas who have started the training and certification process
• Number of doulas who have started the Medicaid registration process
• Number of DoulaID users

[IMPACT] Please describe your plans to share the outputs and results of your project?

We will share the results through our DoulaID website, through the RootsID YouTube channel, on the RootsID LinkedIn page. We will also continue to produce internal reports to stakeholders like Maryland department of health. In our Catalyst and community meetings with will give regular updates on our progress and needs.

Throughout this project and development of DoulaID, multiple research papers and surveys were created to better understand the needs of doulas as they engage with training, certification and enrollment processes.

• Medicaid Doula Survey
• Impact of Doula Services on the Maternal Health of Black Medicaid-Insured Mothers: A Regression Analysis
• Community Action Plan
• Becoming a Mother: Digital Storytelling
• Improving The Maryland Medicaid Doula Program

Over the last year RootsID has completed 14 community funded proposals.

[CAPABILITY/ FEASIBILITY] What is your capability to deliver your project with high levels of trust and accountability?

The DoulaID team has been working on the community portion of this proposal. Annie has successful registered multiple doulas and a doula practice. She has also documented the barriers in the process and reported the results to the Maryland department of health. Her work was part of her Masters degree in community leadership and now has funding from the Baltimore Field School grant with additional grants applications in process. She is an expert in the doula Medicaid process in Maryland and the US.

Over the last year DoulaID has teamed up with MOMCares and Baltimore Doula Project, organizations that support underserved birthing people who are at high risk of negative birth outcomes in Baltimore City. The goals of these organizations is to address the gaps in birth care and reverse the Black maternal health crisis nationwide by providing life-saving doula services. We have collaborated with these organizations to enroll their doulas with Medicaid manually. Through this enrollment process, we have discovered the need for a technological solution to manage the administrative tasks.

Over the last year the RootsID development team has completed multiple versions of its verifiable credential app called RootsWallet. The development, testing, user feedback and lessons learned are the basis for the DoulaID app. This work included our participation in the JFF PlugFest 2 challenge which resulted in several interoperable apps and services for issuing and receiving verifiable credentials based on the Open Badge specification.

The RootsID team has been delivering Open Source building blocks for the Self-Sovereign Identity ecosystem in Cardano. We have been funded in several Catalyst projects since Fund 6. Our funded proposal are listed in our web page and also in lidonation, where you can find that we have delivered successfully and on time 18 out of 19 funded proposals. Proposal links, reports, and final videos can be found in those links.

The team is constantly engaged in all Self Sovereign Identity Cardano activities such as Atala Prism Astros, Atala Prism Pioneer Program, Prism+SSI After Town Hall break rooms, and meeting periodically with partners or related Catalyst projects with the aim of collaboration and help adoption and growth of Cardano in the Identity world.

Additionally, the team participates actively in the worldwide SSI community by attending and collaborating to several working groups in the Decentralized Identity Foundation, the Hyperledger foundation, the Trust over IP foundation, and the KERI community.

We’ve been providing technical services and consultancy on Decentralized Identity to several companies and organizations including:

• IOG
• Cardano Foundation
• GLEIF

A general timeline of our previous work and achievements include:

RootsID joins the first cohort of the Prism pioneer program September 2021

RootsID development group formed November 2021

RootsID startup established February 2022

RootsID completes RootsWallet alpha - android mobile app June 2021

Meeting with Maryland Medicaid Deputy Director, Office of Innovation, Research and Development August 2022

Maryland Medicaid and Maternal Mortality Disparities Research August 2022

Meeting with State Senator Ellis re: Maryland Medicaid Doula Program September 2022

RootsID completes RootsWallet beta - android mobile app September 2022

Partnership with Baltimore Community Doula Groups October 2022

RootsID begins verifiable identity and verifiable credential standards, education, and consulting October 2022

RootsID completes JFF Plugfest 2 interoperability development December 2022

Begin MOMCares and BDP enrollment process with Maryland Medicaid January 2023

Launch of DoulaID January 2023

RootsID completes RootsWallet alpha - iOS mobile app January 2023

Baltimore Field School Grant Awarded February 2023

RootsID completes 14 community funded prototypes February 2023

Baltimore Field School 2.0 work with Baltimore City Doulas begins June 2023

RootsID delivers 5 open source projects within the KERI identity ecosystem July 2023

[CAPABILITY/ FEASIBILITY] What are the main goals for the project and how will you validate if your approach is feasible?

The main goals for this proposal focus on establishing the community and governance related to registered Medicaid doulas. Future work will be focused on the other participants including; the doula clients, training organizations, etc.

The DoulaID community and ecosystem is made up of several type of participants that interact to support Medicaid registered doulas. Doulas, doula practices, doula training providers, doula related service/product providers, MCOs, doula Insurers, Maryland Health Department will all have roles in the community and governance framework. Their roles and credentials (digital identities) will connect through the verifiable Legal Entity Identifier (vLEI) from GLEIF and extend into the DoulaID framework based on the roles and credentials defined by Medicaid for doula services.

When a doula learner uses the app, they are guided through introductory material about doulas, doula organizations, and becoming a doula. If they choose to begin the doula learning journey, DoulaID will connect them with accredited doula education organizations. As the doula learner completes courses and milestones they are given digitally verifiable credentials that can be used to assess their ideal placement as birth workers, apply for jobs, register as a Medicaid doula, and unlock new steps to help them have a wider reach with clients, organizations, and the greater birth ecosystem.

When a doula worker downloads the app, they are guided through introductory materials helping them organize and process appointments, services, and payments. DoulaID will manage their credentials and provide a tailored guide to help them connect with clients, register with Medicaid, and advance their birth work career.

The feasibility of this proposal is obvious, the community is waiting for this solution. Most of the communities are established but a comprehensive governance framework does not exist to make the processes between them easy. So we now need to socialize the roles (trainers, practices, care providers, etc) and socialize the app within those communities.

[CAPABILITY/ FEASIBILITY] Please provide a detailed breakdown of your project’s milestones and each of the main tasks or activities to reach the milestone plus the expected timeline for the delivery.

This phase of DoulaID consists of the following three milestones and activities with its corresponding duration:

Milestone 1:

• Design the DoulaID governance framework extension of GLEIF: 1 week
• Tech team, Community team planning: 1 week
• Project planning and task allocation: 1 week

Milestone 2:

• Engage Baltimore City doula community stakeholders to plan and socialize the effort and requirements: 4 weeks

Milestone 3:

• Implement the Milestone 2 plans with doulas and doula practices in Baltimore city: 3 weeks
• Presentations of DoulaID governance implementations to the community and stakeholders: 2 week

TOTAL DURATION: 12 weeks

[CAPABILITY/ FEASIBILITY] Please describe the deliverables, outputs and intended outcomes of each milestone.

The deliverables of this projects are:

• Milestone 1: the design documentation of the project in a document and summary slides as well as tasks created for each individual.
• Milestone 2: Documentation and presentation of the meetings and agreed upon plans for the governance implementation.
• Milestone 3: A review of the achievements from the implementation of the governance framework with doulas and doula practices.

Additionally, this team adopts Agile methodology based on the tools provided by Github. Besides progress reports, the advancement will be tracked by Github issues, project views (like Kanban board) and commits. Intermediate progress will be reported as a Sprint Burndown, a KPI metric that shows the progress in percentage of each development sprint.

[RESOURCES & VALUE FOR MONEY] Please provide a detailed budget breakdown of the proposed work and resources.

Our budget is mostly composed of implementation hours at a ratio of $100/hr (aprox ₳400/hr), plus the hosting costs. There are also costs for interacting with the RootsID development team and marketing/promotion. Based on the activities defined above the requested breakdown budget is:

DoulaID Alpha Medicaid doula and doula practice governance

• Design: 20hr = $2.000 = ₳8.000
• Project Plan: 20hr = $2.000 = ₳8.000
• Engagement, coordination, and execution with community: 300hr = $30.000= ₳120.000
• Feedback collection and documentation: 50hs= $5.000 = ₳20.000
• Improvement iterations: 50hr = $5.000 = ₳20.000
• User meetings, review, feedback, and changes costs
• Focus Groups with feedback: 20hr = $2.000 = ₳8.000
• Alpha User Testing: 15hr = $1.500 = ₳6.000

TOTAL BUDGET: $48.025 = ₳190.000

[RESOURCES & VALUE FOR MONEY] How does the cost of the project represent value for money for the Cardano ecosystem?

We have been funded by 14 Catalyst proposals and several grants and are highly confident that our plan, budget, and team are an excellent combination for success for us and for the Cardano community.

Our costs are based on all of our work at DoulaID and RootsID over the last 2 years. We have optimized those costs to provide the maximum value while giving us a strong chance for success. We have not raised our costs over the last 14 funded Catalyst proposals. Those previous proposals can be leveraged to reduce costs for our future Catalyst work.

We are charging the lowest rates to the Catalyst community than any other customer. Catalyst was our first customer and benefits from having funded us over 14 proposals.

The Cardano ecosystem is still looking for its first significant identity app success. And at the same time the Cardano community want to show the power of Cardano applied to real human challenges. This proposal represents an excellent opportunity to satisfy both, and can establish Cardano as a governed blockchain ecosystem with the maturity and funding to support production identity solutions.

[IMPORTANT NOTE] The Applicant agreed to Fund10 rules and also that data in the Submission Form and other data provided by the project team during the course of the project will be publicly available.

I Accept