Therahelp

A teletheraphy app which connects people in need to the best therapist for them

Timeline

November 2020-

My Role

Research, Design

Tools

Sketch, Marvel, Zeplin

Project Overview

This is no longer a concept project! This is now spec work for a healthcare client in Rochester, New York

I believe mental health is important. 2020 has certainly been tumultuous year affecting the health of millions worldwide. Although the effects on physical health have been tremendous, I also fear for the effect on mental health it will have for years to come. Having a background in psychology myself, I believe in the power of various forms of therapy with licensed therapists. I believe good mental health services should be accessible to all. With this mission, I set about creating this product. ‍

Project Index

Research

Defining product requirements

User testing

More to come

Research

Having majored in Psychology, I came into this project with some prior knowledge. What I lacked however, was knowledge of the day to day challenges therapists face using existing solutions. I interviewed 5 licensed therapists, psychologists, and clinical directors across various settings in an unstructured format. Here are some key insights from my findings. Understandably, many clients of these apps feel apprehensive to share their experiences via interview. However I did find several public video responses from users of Talkspace, BetterHealh, and Doctor on Demand who talked about their experience using the apps from a client perspective.

I just started a new job, I'll have a lot of clients soon, my old role is all group therapy, I'd say around 25 clients now. Normal caseload for outpatient setting is 100. - Therapist, large NPO

Per week I spend over 20-30 hours writing reports. I had 3800 students at the time. - School Psychologist

Simple practice doesn't integrate with native calendar, it would be nice to have more note templates as well. Noise, video cutting out is an issue. It would be nice to have a data visualization component and location services.

Therapists working in NPO or community settings utilize a combination of EMR/EHR software such as Epic in combination with Zoom in the case of Teletherapy.
Psychologists working in Public School settings have trouble administering diagnostic tests online. EMR in use at schools may not feature appointment scheduling, necessitating the use of a suite of apps such as Google calendar, Skype, Zoom, etc.
There are many assessments done in the initial phases of therapy which are either self or clinician administered. These assessments will measure things such as suicide risk, depression, substance abuse, and more.
EMR/EHR solutions have a steep learning curve, users are given a manual and are required to input code to execute certain commands. Therapists reported that non-tech saavy workers have trouble using it.
All subjects who actively held teletherapy sessions reported an increase in attendance with current clients. They did not see a significant drop in clients overall, speculating the accessibility of teletherapy solutions.
Therapists in private practice settings spend much less time on paperwork, particularly if they don't accept insurance.
All subjects knew about BetterHelp and Talkspace. Opinions varied on the platforms varied. Concerns included privacy and the effectiveness of sessions over the internet.
Clients reported an overall positive experience with Teletherapy apps, and emphasized the importance of being able to change therapists and finding the right fit.

Defining product requirements

Product requirements

After conducting research it became clear that it would be difficult for design a teletherapy platform for use in clinical, school, and private practice settings. The needs of each user differ too greatly for such a panacea solution. A more feasible solution would be to design a platform for therapists to connect with patients on a flexible basis. However, this does not mean I can get by with just copying BetterHelp and TalkSpace. Drawing from my research, I see room for improvement in several areas.

I need to design an app that:

Cuts down on paperwork. Designing a better questionnaire could cut down on the back and forth and number of initial sessions spent on diagnostic questions.
Cuts down on note talking. Having therapists type in code to bring up note templates isn't the best mobile solution, or the best option for non tech-saavy therapists. Reducing the amount of time spent taking notes would free up therapists to spend more time with clients.
Allows therapists to administer diagnostic assessments more easily, and a method which allows them to be done online.
Integrates scheduling, communication, and EMR functionality while being HIPAA compliant.

Limitations

Due to the nature of teletherapy, Therahelp won't be able to treat conditions such as schizophrenia or those presenting with severe psychosis. Those who are an immediate suicide risk must be directed to emergency services immediately.

For medication, Psychiatrists or Nurse practitioners can be assigned to user for a session. They will not be able to prescribe Schedule 1 substances however such as narcotics. This was discovered during my research interviews with Talkspace counselors.

Implementation

This app will rely heavily on camera/mic functionality, and Progressive Web Apps won't cut it. (iOS only allows camera and mic access on Safari for PWA'S at the time writing this). Also, for my startup team of 1, it's infeasible to design 2 completely different native experiences of iOS and Android in terms of cost and time. For this app, a hybrid approach using Flutter or React native which allows fast implementation and utilization of native components would be my recommendation. I consulted with senior engineers and product managers who agreed.

HIPAA compliance

Particularly for apps that have a messaging/video component, HIPAA laws require an end-end encrypted "non public facing communication product". For Therahelp, it would make sense to integrate a white label HIPAA compliant product. Zaurus is just one option. As the company grows we can build out our own solution, possibly using the source code basic design structure of a white label product.

The questionnaire

Screening assessments

There is an alphabet soup out there of different screening assessments used by mental health professionals in a variety of settings. For this app, a screening questionnaire needs to be relatively short, provide adequate information for the initial session with a therapist, and be able to be self administered.
I selected the Modified Mini Screen (MMS) as the foundation for my initial questionnaire. The MMS includes questions to assess depression, anxiety, suicide risk, substance abuse, Based on the responses, clients can be matched with the best therapist for them.

Flows

There is a fine balance between gathering as much information possible for a high quality "lead" and inducing a higher form abandonment rate. Some assessments such as the Yale Brown OCD scale are somewhat long, and considering that the comorbidity of OCD with other conditions such as depression can be over 60%, a patient may end up spending lots of time taking the initial assessment. To reduce form abandonment rate and overall churn, I opted to place the initial assessment after being paired with a matching agent.

Initial matching flow with assessment during onboarding, similar to BetterHelp

Revised flow with initial assessment after speaking with matching agent

Moving from paper to digital

To quickly design and build a cross platform solution, I utilized existing open source design systems (Eva). This allows me to create prototypes in a rapid fashion. UI elements can be tailored to the specific use case and brand. Devs love it too. Keep in mind that these screens are essentially wireframes, and do not yet contain the visual polish of a mockup.

The Modified Mini Screen (MMS) provides good initial information for a therapist

User testing

The first prototype was sent out to subjects from the initial research. The response was very good, but I received some feedback on improvements.
The second prototype was sent out and received feedback. Seem to be closing in on a good initial assessment.

More detail in the screening questions. For example, If the user selects substance abuse and their main issue it could lead to a line of questions based on the CAGE-AID substance abuse assessment.
More selectable options, collecting more information before an initial assessment.

The second prototype was sent out and received feedback. Seem to be closing in on a good initial assessment.

As with a lot of lo-fi wireframe testing, some feedback focused on additional task flows such as choosing a plan or getting matched with a therapist, I decided to focus on this next.

Early concept

Therapist side

Although ambitious, an important piece of this project is to create a therapist portal for practice management that integrates core EMR functionality. In Rochester, Epic is the most popular choice for medical records, and this brings the challenge of simplifying the complexity of legacy enterprise software. Theranotes, which is designed specifically for small therapy practices, is another popular choice.

More to come

This page will be updated daily as more testing and iteration is done.