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#188 - 🧑 Tech Tuesday - Elevating Care for Parents’ Mental Health (Ft. Maureen Fura from Mammha)




Hello Friends 👋

In this episode of the Incubator Podcast, Ben and Daphna discuss maternal mental health with Maureen Fiora, CEO of Mammha, a femtech startup aimed at revolutionizing maternal mental health care. Mammha focuses on addressing postpartum and perinatal depression by improving identification, diagnosis, referral, and treatment processes. Maureen shared her personal journey, highlighting the significant gaps in current healthcare systems regarding maternal mental health, emphasizing that less than 20% of physicians screen for these conditions. She detailed how Mammha streamlines screening with technology and ensures that women who screen positive receive comprehensive follow-up care, overcoming the usual fragmentation in care pathways.

The conversation also touched on the importance of screening in NICUs due to the heightened vulnerability of parents there, with Mammha capturing significant data on both mothers and fathers experiencing mental health issues. Maureen explained how Mammha operates, starting with provider-initiated screening using QR codes and validated tools, to engaging care coordinators for immediate follow-up. The company's success stories include partnerships and awards for their innovative approach to closing care gaps, especially among underserved populations.

Mammha's model has significantly increased engagement and follow-up care for screened parents, showcasing a promising pathway to better maternal mental health outcomes. Maureen's background in policy and advocacy, combined with personal experience, positions her uniquely to lead this initiative, aiming to make a tangible difference in the lives of parents navigating the challenges of mental health during the perinatal period.

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Find out more about Mammha at https://www.mammha.com/


Social Media Handles:

@mammhacare

@mammha

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Short Bio: Maureen Fura is the CEO and Founder of Mammha. Mammha is a health tech start-up in the fem tech space created to leverage technology and innovative care delivery to target gaps in the diagnosis, prevention, and treatment of perinatal mental health to ensure no woman slips through the healthcare cracks. Maureen has spent the last 13 years building key relationships with policymakers, advocates, leaders, survivors, scientists, researchers, providers, and families to close maternal mental health care gaps. In addition to creating Mammha, she is the Writer, Director, and Co-Producer of Dark Side of the Full Moon, the first documentary exposing the gaps in care in the US. She was a founding member of the National Coalition for Maternal Mental Health (NCMMH) and Awareness Chair, spearheading the first National Awareness Campaign for maternal mental health for four years. She was a founding member of Postpartum Support International (PSI) Miami (now Postpartum Support International Florida Chapter). She is a PSI coordinator and PSI Support Group Leader. Maureen earned a master's in Public Administration from the Middlebury Institute of International Studies with a focus on leading social change organizations.

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The transcript of today's episode can be found below 👇


Maureen (00:00.564)

Fiera.

Ben Courchia MD (00:01.488)

You're on. Very cool. Hello everybody. Welcome back to the Incubator Podcast. We are back with another Tech Tuesday episode. Daphne, how are you this fine morning?

Daphna Yasova Barbeau, MD (she/her) (00:12.295)

I'm post call, but I'm invigorated about our conversation today. This is something I have been looking forward to.

Ben Courchia MD (00:20.352)

Yeah, we are joined by Maureen Fiora, the CEO and founder of a company called MAMA, spelled M-A-M-M-H-A. Maureen, thank you. Thank you so much for being with us this morning.

Maureen (00:34.396)

Thank you so much for having me, it's an honor.

Ben Courchia MD (00:36.956)

Oh, the pleasure is all ours. And I guess we will begin right with the definition and inception of your company. Can you tell us a little bit what MAMA is? What are you and what is its mission?

Maureen (00:53.272)

So, Mama is a fem tech startup company. We created Mama to close the biggest gaps in maternal mental health care. We have been studying this, me and my team have been studying this for 15 years now to address postpartum depression and perinatal depression.

it like the identification of it, the diagnosis of it, the referral of it, and making sure women are getting better. So we're like, we're on trying to do a moonshot to get become the new gold standard of maternal mental health care in the United States.

Ben Courchia MD (01:36.728)

What is femtech?

Maureen (01:39.412)

Femtech is any kind of technology that is geared, focused on women. So reproductive health, any kind of tech that's focused on women.

Daphna Yasova Barbeau, MD (she/her) (01:53.806)

It's a big growing field, isn't it?

Maureen (01:55.628)

Yes, thank God, right? There's so many women.

Ben Courchia MD (01:57.12)

Yeah, I think so. And I think that's a word that is coming up more and more. And I think I always like to take the opportunity to define these terms for the audience. Like, oh, I've heard about this. I just don't know what it is before we move on. That's great. So yeah, go ahead.

Daphna Yasova Barbeau, MD (she/her) (02:03.918)

Mm-hmm.

Daphna Yasova Barbeau, MD (she/her) (02:14.07)

Well, why don't you tell us what MAMA stands for? That way I think it will help people remember.

Maureen (02:19.036)

Well, so we work with mothers and embedded in the name is MMH. So people are like, mama ha. But it's mama. And MMH stands for maternal mental health, which are, it's the number one complication of having a baby. It hits during pregnancy or the postpartum period. So maternal mental health complications, like depression or anxiety.

and they happen to be the number one most overlooked and undertreated. So we put the MMH inside of the name.

Daphna Yasova Barbeau, MD (she/her) (02:55.911)

I love that. Tell us about the gap that you're trying to fill. Why is there a need for a system like mama?

Maureen (03:06.056)

So I got pregnant about 15 years ago with my son. I was in California, never had a mental health diagnosis in my life and got pregnant and within the first couple of weeks felt like I had gone to bed someone and then woke up someone else. I had suicidal ideations.

and they would come in my head like once every second and I felt very unsafe. And I told every single doctor from that eight weeks on of pregnancy and nobody knew what to do with me, no doctor. So I ended up going to 29 doctors and social workers and psychiatrists and nobody knew what to do and I wasn't sure I was gonna make it through. So.

what we're trying to do is less than 20% of physicians, OBGYNs and pediatricians are screening for these most common disorders that happen during pregnancy and postpartum period, up to one year. And so every woman is basically screened for gestational diabetes, but the rates are so much lower. And so this is the one time that physicians are, you know, they're not doing

do if she screens positive, which we understand. So we came to solve that, first of all, was how to make screening so easy and seamless for physicians. And so we solved that with technology really easy. But then there's a whole other gap, which is once the woman screens positive, 75% slip through the gap. So just because you screen her and she's positive,

The normal way of taking care of that positive screened woman is to give her this piece of paper without phone numbers that's a photocopy of a photocopy of a photocopy and it kind of slips in her bag and she doesn't get to those phone calls or maybe she calls one number and they don't take her insurance or they have a three month wait list. So mama takes care, we start with patient with providers and we end with patient care. So we do the whole system. So

Maureen (05:17.916)

That's what mama is, that we came to solve those things.

Daphna Yasova Barbeau, MD (she/her) (05:21.502)

Yeah, and it's certainly, it's a recommendation from the AAP that we're screening postpartum moms, not once, but twice as pediatricians. It's an ACOG recommendation that the moms are screened at least once in the postpartum period. And yet it's a problem that most, the majority of NICUs are not screening. I say NICUs because that's mostly our listeners, our neonatal professionals.

And actually, thankfully the community I think is paying more attention. We just had this wonderful set of carousel care webinars last year trying to discuss the problem. And units are still having difficulty, I think, doing the screening. What are some of the challenges for screening? Why has it been such a problem for medical professionals?

Maureen (06:11.532)

Well, and I love that you brought up the NICU population because we're screening in NICUs and they have like twice as high as rate. We're catching so many moms and dads. So they're one of the most vulnerable groups of parents out there. So some of the biggest challenges for screening are time, not knowing where to send her, what happens if she says she does have thoughts of self-harm, that can be really scary for a lot of physicians. And I think that's something that keeps

people from asking because what if she does say that, then what? And then there are some like reimbursement things too, it's like our physicians are already so overburdened with things and then we're asking them on top of that to do the screen and to do all that follow-up care is a lot, it's a lot for adding that onto everything else that we're asking of them.

Ben Courchia MD (07:06.756)

I wanted to ask you about your personal experience because I think for many listeners, this might be a question. You seem to be describing symptoms of postpartum depression and you mentioned how it's been difficult for you to get the care that you needed at that time. And I'm putting myself in somebody listening in the car and you may say, well, isn't postpartum depression pretty well described in every textbook? So what was the obstacle there in terms of?

getting that screen and getting for you at least the help needed.

Maureen (07:42.196)

So mine was in pregnancy and so they didn't know. They just didn't, they were like, we have to watch this after you have your baby. And I was like, I may not make it to the end of having this baby or I might have this baby and then I'm not gonna make it much longer. So I was like, I might not make it to the end

Ben Courchia MD (07:44.736)

Uh-huh. Uh.

Ben Courchia MD (07:51.216)

I see what you're saying.

Ben Courchia MD (08:00.123)

I misheard. I thought you had described these symptoms after the baby was born and so that's why I made that leap. I'm sorry.

Maureen (08:05.882)

Oh, no, no.

Daphna Yasova Barbeau, MD (she/her) (08:06.13)

But I think that's a great point, Ben. I think even though it's well described, we're not screening for it. That's one. Once we're screening for it, healthcare services are hard to access and they're really underutilized because parents are busy and they're overwhelmed. And especially our NICU parents, gosh, they can hardly get it all together to go seek care. So yeah, I think it's...

Maureen (08:32.689)

and definitely.

Daphna Yasova Barbeau, MD (she/her) (08:34.934)

it's still very much a problem.

Maureen (08:36.752)

And I think for NICU families too, is the heightened stress is kind of like they're in fight or flight. And then once baby is discharged and they're home with baby, there is this surge of anxiety and depression from the traumatic experience that they just experienced. And so we're seeing that what mama does is we do continuity of care. So once the parents, the baby's discharged, we're following mom and dad for up to a year.

doing check-ins because we know that around months six and nine of the postpartum period, women are at the highest rate of suicide. And so it's really important that we continue to do those check-ins and that a lot of NICU families are going home and then these feelings are coming up once the baby is discharged.

Daphna Yasova Barbeau, MD (she/her) (09:25.678)

So tell us how mama works.

Maureen (09:29.332)

So, MAMA starts with providers and they initiate the screen using a QR code. We use the validated EPDES, gold standard screen, for maternal depression. And once they screen positive, a MAMA care coordinator is immediately notified and we do all of the follow-up care. We keep the unit, the physician, the social worker in the loop. We always let them know what we're doing.

And then depending on who we're working with, like we work with Innova and Fairfax through March of Dimes, we have a set of automatic SMS messages that are like gentle nudges of CBT and coping skills and mindfulness so that every parent is getting these every week for the duration that their baby is in the NICU. So they're getting these little reminders to join a group or...

call a friend or let today whatever you do be enough. So there are just these like little digital knocks on the door of mindfulness and some kind of, you're not alone, a little message of you're not alone.

Ben Courchia MD (10:42.912)

Is there a cost for patients or providers associated with using the app?

Maureen (10:48.384)

Not for patients. If anyone needs to be connected with a therapist or a prescriber or group therapy, we always connect them based on insurance. After doing this for so long, we've only ever had one person say, I want to pay out of pocket. So I think that's really important. We always place like that. And units tend to cover the cost and it's very minimal. And it covers the tech cost and a little bit of the care coordination.

Ben Courchia MD (11:04.816)

Mm.

Maureen (11:17.768)

costs. So it goes back on the hospital and then they get to have higher HEDIS scores which show they're doing this kind of you know they're asking parents they're doing the value-based care which is really important for them to check those boxes.

Daphna Yasova Barbeau, MD (she/her) (11:36.066)

Can you tell us about some of the kind of crisis mitigation? You know, you mentioned that is an obstacle, a barrier to people doing the screening because they're worried they might identify somebody who's really in trouble and not know what to do about it.

Maureen (11:51.72)

Right, so what I love about what we've done, I mean, we hit every failure point in the system using technology. So if a parent were to screen positive for thoughts of self-harm, we have a mama mental health professional who will triage with that patient on the spot, or that parent on the spot and create a care plan, working with the unit, but also with that parent. And then we do follow-up care every single day until they're starting to feel better.

And our time, once we get that notification, it's immediate. Our care coordinators are following up within two minutes. So I think that's really important. Providers aren't alone. NICUs aren't alone when they're doing this. And mama's there to handle that. And really that's 2% of all screens that come back with self-harm. So it's a very low number. And I like to let.

Daphna Yasova Barbeau, MD (she/her) (12:41.239)

Mm-hmm.

Maureen (12:46.868)

units know that and providers know that because I know that's the scary thing. But it's very rare and we're there to help do the triage immediately.

Daphna Yasova Barbeau, MD (she/her) (13:01.454)

That's great. For that small segment of the population, it's such a vulnerable time. If we mishandle the crisis management, we can really sometimes cause more harm than good. But it sounds like you have a well-trained group that manages that.

Maureen (13:22.652)

Well, I mean, we were those women. I remember answering all those questions and being let go and then being told by the insurance, we can only give you three free sessions and suicidal ideation. Sorry, it's too big. So good luck. I mean, like, and doctors call 911. We're gonna be on for three weeks.

everything we created is based on our experience and what we knew we needed and the care that we needed and how important and that it's an emergency. So that's what MAMA is all about.

Daphna Yasova Barbeau, MD (she/her) (14:03.47)

And now mama's been growing for some time. Tell us about some of your successes.

Maureen (14:08.48)

Oh, we're doing so great. It's been wonderful. We've partnered with the March of Dimes. They would like to, we're going to get into all the different NICUs in the Virginia, Maryland, and DC area. We won Johnson and Johnson's Quick Fire Challenge for maternal mortality. We also won the Department of Health and Human Services Postpartum Equity Challenge, Phase One.

and as a model program that can be used to close gaps and help women, brown and black women, to prevent death and suicide. We're in California, we work with the state of Maine, we're starting to work with the state of Indiana, we work with UTMB and Galveston, and we're in Virginia at Innova Health System, NICUES, we're finding out such amazing data from that.

working at that NICU, we're catching fathers and they're showing thoughts of self-harm. So it's like opening this whole other kind of population that I've been missing and that we've been missing, not at mama we've been missing, is fathers and the trauma that they've experienced watching their partners almost die and watching their babies code blue.

Maureen (15:37.8)

taking a step back to look at what do we need to create to support them as well.

Ben Courchia MD (15:43.868)

Maureen, I wanted to ask you a little bit about what is the data, you're talking about the data that you've been able to gather. And I'm very curious about those numbers because what are some of the things you're seeing in terms of the translation from the people you're able to screen to what happens after that? Because I think that's what people might be interested to hear where MAMA is being successful.

Maureen (16:09.66)

Well, I think what's really great is we've been able to increase the engagement of positive screened parents, mothers, by 75% or by 60%. So a woman normally would be screened, she gets a piece of paper, 15% of those women engage in care and that care could be therapy or a support group and then do they feel better? We don't really know. With mama, we have 90% engagement.

but that's because it's 100% follow up all the time. And we're never putting the burden on mom to reach out to us, to go find her pathway to care. We are constantly navigating this for her because she can't, I mean, that's a lot to put on her. Mental health, taking care of a baby, other children going back to work, it's just too much. So that's one of the biggest things. And then also we've seen provider

a screening routinely increase using mama, which was another one of our big goals was to move that needle of 20% and to move it. And we've also seen physicians starting to screen pregnant women, which was near and dear to my heart is that if we can catch them in pregnancy, we can get them better before they're having their babies. So we've seen an increase in that.

Ben Courchia MD (17:12.356)

That's huge.

Ben Courchia MD (17:28.784)

100%. Yeah. As we're getting close to the end of our chat, I wanted to maybe shine a little bit of a light on you and your background. And if you could tell us a little bit how your personal background, especially when it comes to working with policymakers, advocates, leaders and so on, has allowed you to be really in this prime position, really, where there's this confluence of events and

and things like that allowed you to be there to spearhead a project like MAMA.

Maureen (18:00.5)

Gosh, I didn't, when I was in graduate school and got pregnant with my son, I was hoping to work for the UN and do civil society and work with gender and equality. And then this happened to me. And for the first time, I focused on what was happening to me and using those skills and then made a documentary about it.

because I was like, how did this happen to me? Is it just me? And then I thought that would be enough. I knew it would never be enough, but I learned that a change in knowledge isn't equal to a change in behavior. And there were women still dying. And so went into the policy and tried to advocate for policy, got policy changed, but the women were still dying. Did national awareness campaigns, could raise awareness until the cows came home, but the women were still dying.

So it was like, this is really just another tool to try to fix this. Like my mother always instilled in me to leave a place better than I found it. And I know that if I had died, I wouldn't have been counted and my kids wouldn't have had me. And so I can't seem to let this go until it is fixed. We did fix it, which is great. My advisor said yesterday, Maureen, we did fix it. Do you want me to? We did, now it's just spreading it. So I think...

Ben Courchia MD (19:07.332)

Mm-hmm.

Ben Courchia MD (19:24.025)

Yeah.

Yep.

Maureen (19:27.736)

understanding all the stakeholder groups, personal knowledge. I have talked to hundreds of women, policymakers, doctors, researchers, and all of that goes into this solution.

Daphna Yasova Barbeau, MD (she/her) (19:42.57)

In case people want to look it up, your documentary that you're talking about, that's Dark Side of the Full Moon, right? And they can find that at darksideofthefullmoon.com. There's also an associated podcast, is that right?

Maureen (20:00.204)

Um, I think with my producer, yes. Yeah. What a co-producer. Yeah.

Daphna Yasova Barbeau, MD (she/her) (20:02.781)

Yes, that's right. That's right. And so how do people get in touch with mama?

Maureen (20:09.128)

They can reach out through the website. There's a contact form and would love to answer any questions or start it, see how it works. And it helps us do our mission of closing these gaps and catching these women.

Ben Courchia MD (20:25.136)

My last question to you is a very practical one as well. Let's say a provider is listening and says, I need to use my mind, my unit right now. Can they just download the app and get started? Is there truly get in touch with you first and then to then be able to use the tool or how does that work?

Maureen (20:32.765)

Hmm.

Maureen (20:42.172)

That is a great question. Yeah, they just reached out to me and they let me know where they want those results pointed to. And it takes less than five minutes and we would love to begin anywhere. So yes, less than five minutes. Let's build that safety net.

Ben Courchia MD (20:54.768)

Perfect.

Ben Courchia MD (20:59.292)

Maureen Fiora, thank you so much for making the time to be on with us this morning. We're very impressed with Mama and the work that you've been doing. Congratulations.

Maureen (21:05.576)

Thank you so much, you guys.

Ben Courchia MD (21:07.824)

Thank you.

Daphna Yasova Barbeau, MD (she/her) (21:08.321)

Thanks.


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