COBALT

A mental health platform for health care workers

Opportunity

Mental health needs were disproportionately high among health care workers before the COVID-19 pandemic. However, the rapid spread of the disease forced providers to grapple with additional stressors, including longer shifts, shortages of personal protective equipment, increased mortality and morbidity, and the fear of exposing family members and loved ones upon returning home.

Emerging evidence indicates that more than two-thirds of frontline health care workers battling COVID-19 will experience psychiatric symptoms, including post-traumatic stress, acute anxiety, substance use, depression, and suicide. With this increased need for support, already lacking access to mental health care was sure to decline further.

Intervention

COBALT is a web-based platform designed to help health care workers access mental health support easily and on their terms. Through a self-assessment, users receive personalized recommendations for support most relevant to their needs. 

Resources available to COBALT users include:

  • Articles, podcasts, and worksheets,
  • Groups focused on mindfulness, election stress, and antiracism,
  • One-on-one help from peers, resilience coaches, psychotherapists, and psychiatrists,
  • And urgent intervention for those at highest risk for self-harm.

Thanks to embedded scheduling and telehealth capabilities, COBALT provides HIPAA-compliant mental health care at a safe distance. And by leveraging a full spectrum of care, the platform ensures that clinical support is available for those in greatest need.

Impact

COBALT is available to all Penn Medicine employees. 

In the first 30 days, more than 8,000 sessions were conducted by over 5,000 individuals accessing a wide range of content and virtual support. Six months in, more than 14,000 users have engaged with the platform, there have been over 1,500 appointment bookings, and 111 individuals have identified thoughts of self-harm.

With more than two-thirds of users choosing to log in anonymously, COBALT overcomes concerns about lack of confidentiality and impact on one’s career that interfere with health care professionals seeking support.

The team is currently building on the COBALT platform to provide access to patients as well as exploring partnerships with other health systems to support front line workers beyond Penn Medicine.

Phase 2: It does work
Collaborators

Cecilia Livesey, MD
Lisa Bellini, MD
Penn Medicine Workforce Wellness Committee

Innovation leads

Kelley Kugler, MS
Avanti Rangnekar
Dakota Marine, MS
Jeremy Asch
Roy Rosin, MBA
David Asch, MD, MBA

External partners

UnitedHealth Group

Innovation Methods

Fake back end
It is essential to validate feasibility and understand user needs before investing in the design and development of a product or service.
 
A fake back end is a temporary, usually unsustainable, structure that presents as a real service to users but is not fully developed on the back end.
 
Fake back ends can help you answer the questions, "What happens if people use this?" and "Does this move the needle?"
 
As opposed to fake front ends, fake back ends can produce a real outcome for target users on a small scale. For example, suppose you pretend to be the automated back end of a two-way texting service during a pilot. In that case, the user will receive answers from the service, just ones generated by you instead of automation.
Fake back end
It was important to launch COBALT quickly to ensure that health care workers knew where to turn for support at the start of the pandemic.
 
Rather than waiting until the technology was fully developed, we used fake back ends to move from concept to launch within two weeks. Running the service as a fake back end in the early weeks helped us learn what type of functionality was needed to onboard providers, host live sessions, generate reminders, gather post-session feedback, share newsletters, and more.
The concierge
A concierge provides hands-on, efficient, and proactive services for customers.
 
Similar to the concept of walking in someone's shoes, a concierge walks alongside someone and helps them get things done.
 
Acting as a concierge or high-touch helper for a small sample of people will enable you to get deep into the reality of their journey and learn about the barriers they face, because like a real concierge, you'll help them navigate those barriers. You can also test solutions in real time as you explore the problem space in context.
The concierge

To understand what resources resonated most with users and identify gaps in content, we curated a COBALT resources package and sent links to participants with a personal note. Then, we interviewed employees to learn about their reactions.

Through this process, we learned that there are different types of users: those who are motivated to seek resources themselves and those who require that resources be pushed to them in a targeted and tailored way. We intend to explore the latter in COBALT’s future developments.

Fake front end
Piloting a fake front end involves putting a simulated version of a product into the hands of intended users - one that doesn't yet actually perform the intended function - so that you can observe if and how it will be used in context.
 
A fake front end will help you answer the question, "What will people do with this?"
 
The first successful mobile device was created by an innovator who carried a block of wood around in his pocket to see when and why he pulled it out to pretend using it, revealing both what to build and how to build it.
Fake front end
Before developing a new feature, we asked individuals to tell us what they wanted, assembled a prototype, and then asked them to use it. This often demonstrated the difference between what one says and what one does.
 
For example, when providers said they wanted control over their profile, we learned they also did not want to put much energy into the process. This led us to design a mad-lib style bio generator and offer pre-populated recommendations with the option to customize at the end.