Through her work in perinatal psychiatry, Megan Smith, Dr.P.H., assistant professor of psychiatry, in the Child Study Center and of epidemiology (chronic diseases), realized that existing approaches were not effectively reaching low income women postpartum women who were depressed.
At the same time, she noticed that 80 percent of low income mothers used smartphones. When she delved into how they used these devices, she learned that they were accessing a wealth of information on infants, child development, and parenting. She also learned that their depression was linked to social isolation, even when they lived in densely populated areas.
Using an interdisciplinary approach, Smith collaborated with Linda Mayes, M.D., Arnold Gesell Professor in the Child Study Center and professor of epidemiology (chronic diseases) and 2012 YCCI Scholar Frederick Shic, Ph.D., assistant professor in the Child Study Center and of computer science, to create MoMba, a mobile app that utilizes behavioral economics via a challenge and reward system to connect mothers to one another and the larger community. The project recruits women in the third trimester of pregnancy and measures their depressive symptoms, stress and social support before and after using the app. Data show that the mothers are excited about using MoMba and that utilization is high across the challenges.
Originally funded with a pilot award from YCCI and the Child Health Development Institute of Connecticut, MoMba received additional funding through an R34 from the National Institutes of Mental Health. The program has been expanded to create MoMba Smoking, funded by an R01 from the National Cancer Institute. Smith was looking for a way to target smoking abstinence during pregnancy and prevent relapse. Social networks are one approach, but one of the most effective interventions is contingency management, in which participants receive rewards such as financial compensation when they adhere to a desired behavior. MoMba Smoking takes contingency management out of the provider’s office and into the community by delivering it on a smartphone platform. In this case, the social networks and challenges are related to smoking cessation and mothers use a carbon monoxide sensor at community locations to obtain rewards. “In both cases, we’re looking for ways to broaden mental health approaches in the community,” said Smith.
MoMba is also being adapted for use with the New Haven Mental Health Outreach for MotherS (MOMS) Moms Partnership. MOMS is a collaborative community-based participatory research project involving community members who serve as Community Mental Health Ambassadors. Together with clinicians, they deliver brief mental health interventions and are part of the research team. The State of Connecticut recently allocated $3.4 million for the creation of ‘MOMS Zones’ in 4 New Haven neighborhoods and the MoMba app is being built into this expansion.
While health disparities are narrowing in other fields, they are growing in mental health. Smith hopes these interventions will move the needle for New Haven families and ultimately be even more broadly disseminated.