Deploying a virtual platform to expand maternal mental health access
ChristianaCare has launched an app to provide mental health education and resources to pregnant and postpartum people in a stigma-free and accessible way.
Pregnancy, childbirth and postpartum are periods of intense emotions. As their lives change to accommodate new life, pregnant individuals must contend with a surge of mental health upheavals, making maternal mental healthcare critical.
However, supply is often not able to keep up with demand when it comes to maternal mental healthcare. A 2023 Policy Center for Maternal Mental Health report revealed that 70% of U.S. counties don't have the mental health resources to meet the needs of pregnant and postpartum people.
To close these gaps, healthcare organizations are turning to virtual care tools, which are proving effective at supporting maternal mental healthcare. The latest example of this trend is ChristianaCare, which recently partnered with digital behavioral healthcare provider NeuroFlow.
"[Maternal mental healthcare] requires a tremendous amount of monitoring and support services that can be difficult to deliver," said Malina Spirito, PsyD, a licensed psychologist and director of the Center for Women's Emotional Wellness at ChristianaCare. "ChristianaCare has always really strove to find novel ways to address those challenges…and we saw digital therapeutics as just the next level in ways to provide support for the broadest range of patients."
Since launching on July 1, the NeuroFlow app has been well-received by patients and providers. The health system employed several strategies, including publicizing the app's benefits and addressing social determinants of health, to ensure equitable access and patient engagement.
WHAT THE MATERNAL MENTAL HEALTH APP ENTAILS
The perinatal phase is rife with mental health challenges, ranging from generalized anxiety and depression to obsessive-compulsive disorder and post-traumatic stress disorder. These conditions require significant attention and between-visit support, which the NeuroFlow app aims to offer through text-based communications, education and assessments.
We're supporting our patients between their visits when it's convenient for them and where it's convenient for them. And we're taking the ownership of reaching out to them based on how they're engaging with us through this digital application.
Mary Fran Storm CrowleyChief OB-GYN advanced practice clinician at ChristianaCare
Mary Fran Storm Crowley, chief OB-GYN advanced practice clinician at ChristianaCare, explained that any patient who is pregnant or has given birth can access the app and continue using it for two years postpartum. Once registered, the patient selects the kind of mental health support they want based on their situation.
"So if pregnancy is something they want to focus on, they can choose that," Crowley said. "If they are in a stressful job situation, they can focus on that. If it's more about work-life balance or financial stressors or anything -- the patient selects what they choose to work on and then the application supports them on that."
For instance, if the patient indicates they need help reducing stress, the app provides videos on mindfulness and breathing exercises and suggests complementary resources like yoga and journaling.
Spirito noted that information from the app flows into a patient dashboard, which NeuroFlow and ChristianaCare clinicians monitor to ensure they can provide immediate crisis response. If it becomes apparent that a patient needs more support, their care team can step in and connect them with behavioral health and other services.
In addition, the app includes different validated screeners to determine whether they may need an extra layer of support.
"There are screening tools, assessment tools that are offered upon registration," Spirito said. "And then there are other ones that will trigger based upon the activities that a patient is engaging in, the things that they are reporting."
These include screeners assessing measures of depression, anxiety, substance abuse, trauma and more.
"We're supporting our patients between their visits when it's convenient for them and where it's convenient for them," Crowley added. "And we're taking the ownership of reaching out to them based on how they're engaging with us through this digital application."
Further, Crowley noted that the data points collected by the app are available to the patient's entire care team at ChristianaCare. This means physicians and specialists outside the women's health and behavioral health teams can track their patients' mental well-being and emotional state and step in, if needed.
ENSURING A SUCCESSFUL DEPLOYMENT
Deploying virtual mental health apps requires buy-in from two key stakeholders: patients and their clinicians.
With the former, offering a destigmatized pathway to care is critical to engagement, which the app allows the health system to do.
"We know that in terms of service delivery, if we are attempting to engage patients directly at every visit in various mental health-oriented services, it can be quite stigmatizing," Spirito said. "Whereas when we're providing them this app that is very patient-driven, it's not just patient journeys that are labeled as depression or anxiety or bipolar disorder. There are resources focused on work-life balance, general stress, smoking cessation, diet and exercise -- and so it takes away that stigma and really puts the emphasis on wellness."
This is a two-way street in which patients are not just being given access, but providers are also given access to see how our patients are engaging with it and have that capacity for a dialogue when needed as a provider.
Malina Spirito, PsyDDirector of the Center for Women's Emotional Wellness at ChristianaCare
Crowley shared that ChristianaCare surveys its patient population regularly and only invites patients to participate in digital health programs if they have access to the needed devices and WiFi. The NeuroFlow app is also free for ChristianaCare patients, which removes another major digital health access barrier.
Additionally, the app's content is at a sixth-grade or lower reading level and is available in Spanish. Other languages will be included later.
On the provider side, ChristianaCare leaders have publicized the app, educating office and clinical staff about its benefits, Crowley said. They have also communicated the app's benefits to its community health workers and patient ambassadors, who can support patients using it.
The app is now available at all ChristianaCare hospitals, OB-GYN outpatient locations and the Center for Women's Emotional Wellness. According to Crowley, the feedback so far has been "tremendous."
"The app has been well received, and we're already seeing that our patients are engaging in this application more than they engage with other applications that we've used previously," she said.
The health system is collecting data to measure the app's impact, including the number of registrations, time spent on the app and the content viewed.
"This is a two-way street in which patients are not just being given access, but providers are also given access to see how our patients are engaging with it and have that capacity for a dialogue when needed as a provider," Spirito noted. "For a long time, I've certainly been able to encourage my patients to use different resources and to use free apps that are available to the general public. And that's lovely, but the reality is I don't ever get any direct feedback."
Through the app, ChristianaCare hopes to expand maternal mental healthcare access to 8,000 patients across Delaware annually. Crowley and Spirito emphasized that this kind of access could significantly change the perinatal experience, potentially saving lives and supporting people who may not otherwise be able to seek the help they need.
"If we prevent a mental health crisis for one patient, I really think that's successful," Crowley said. "I don't think you can put a value on a human life. And I think that any interventions that we're doing, helping anyone navigate a mental health journey throughout a pregnancy and beyond, I think it's invaluable."
Anuja Vaidya has covered the healthcare industry since 2012. She currently covers the virtual healthcare landscape, including telehealth, remote patient monitoring and digital therapeutics.
