The women dressed up for their graduation, wearing green for the theme of spring renewal. With their hair done and makeup on, they waited for the ceremony to begin as the host played Alicia Keys’ female empowerment anthem “Girl on Fire.”
One woman spoke about how learning the power of praise instead of punishment deepened her relationships with her four children. How she has let herself off the hook for her understandable moments of frustration. How she has accepted the difficulty of the challenges she faces and credits herself for the progress she has made in overcoming them to become a better mother and partner.
Her testimonial elicited tears and bursts of praise from the other graduates: “You go, girl!” “Congratulations!” “You rock!”
It was a scene like others Hilary Hahn had witnessed before: Participants in the Mental health Outreach for MotherS (MOMS) Partnership’s interventions for under-resourced, over-burdened pregnant and parenting women, gathered to celebrate their achievements and a better future for themselves and their families.
Only this time, during the pandemic lockdown, the women gathered online from the safety of their individual homes.
“This was fantastic, so inspiring,” Hahn said of this first remote graduation, held in late April for 12 mothers in Washington, D.C. “The chat board was filled with lively comments. A continuous stream of positive affirmations.”
Hahn is the Executive Director of Elevate, Yale’s new policy lab working in partnership with Women’s Health Research at Yale to generate the science necessary to break the cycle of poverty through effective mental health interventions for mothers. Acting rapidly after states and municipalities ordered people to shelter at home, Elevate accomplished the significant task of moving the MOMS programs and research to remote platforms.
“The collaboration of Elevate with WHRY propels one of our major initiatives — building a national effort to bring evidence-based interventions to women that advance their lives and the lives of their children and families,” said Dr. Carolyn M. Mazure, Director of Women’s Health Research at Yale.
The MOMS Partnership was originally developed and tested in one community to address the mental health needs of under-resourced pregnant and parenting women. Elevate, launched a year ago, has established substantial evidence of the MOMS Partnership’s ability to scale upwards. Women participating in eight-week programs on stress management and parenting skills have shown significant reductions in maternal depressive symptoms and maternal stress and increases in social support and maternal employment.
“The work of Elevate shows how we can help women and families with community-based interventions built from empirical research, enlarge the program to reach wider groups, and now adapt it to overcome obstacles like the physical distancing required by the coronavirus pandemic,” said Dr. Megan Smith, the founder of MOMS and Elevate. “By demonstrating the efficacy of these data-driven interventions for improving the mental health and thereby the economic prospects of women, we can join with policymakers to greatly increase and broaden this outreach across the country.”
Building on the success of the original work in New Haven, Elevate has worked with government partners to expand MOMS to Washington, D.C., Kentucky, and Vermont and will soon launch services in New York and Bridgeport, Conn. Elevate has set a five-year goal to help 5,000 women achieve significant relief from their depressive symptoms and find ways forward in terms of economic mobility.
“I think the urgency for the type of services we provide has become increasingly apparent,” Smith said, noting that four new potential government partners have recently contacted her to ask about replicating the MOMS interventions in their states and cities. “We are seeing increased value for social connections and programs focused on working families, reducing stress, and meeting the growing needs of employment and parenting.”
Transitioning to a remote platform required radically re-thinking the program’s core component: meeting women where they already are. Before the pandemic shutdown of non-essential businesses and limits on gathering in groups, this meant setting up tables at high-traffic locations such as grocery stores, libraries, and laundromats.
“Before COVID-19, we went out into the community to meet moms where they felt safe and where they could participate in stress management cognitive behavioral therapy classes together,” Hahn said. “We wondered, ‘Can you build personal connections in a Zoom call or over the phone?’”
At first, mental health clinicians who partner with MOMS were not all equipped for tele-medicine, particularly to provide group cognitive behavioral therapy sessions. Elevate created a digital screening assessment for participants, developed a set of technical resources, and hosted regular calls to walk their on-site partners through the challenges of transitioning participants to virtual meetings.
For some mothers, challenges included the basics of working the technology to join a video conference. Even for mothers who had smartphones, computers, or tablets, they might not have reliable internet connectivity. Others were reluctant to turn on the video feed, an important component to project and detect visual cues when trying to connect with others in a group.
But the Elevate team succeeded in helping provide the technical assistance to sites to overcome these obstacles, and early data have shown that attendance has increased following the institution of virtual meetings.
“This speaks to something we will have to consider when quarantine guidelines are relaxed,” Hahn said. “Perhaps we have to expand our definition of meeting people where they are. Maybe telemedicine is valuable to people who have difficulty with child care or transportation. Or who are suffering from depression and struggling to motivate themselves to get out of the house.”
Elevate’s staff has written a series of technical assistance documents as a model for others to apply what they have learned about delivering stress management services remotely. The team is also working on ways to recruit new participants through email campaigns, webinars, and digital referrals.
“This experience, while so difficult and sad for so many, has offered an opportunity to gain valuable insight into how we can deliver MOMS services to women in need,” Smith said. “It really speaks to the spirit and dedication of the staff in our communities. They truly understand the importance of this work and the research behind it. In the context of COVID-19, the link between mental health and future economic mobility has never been clearer.”