Each year, as many as 5,000 pregnant and postpartum women across the Carolinas will soon be receiving expanded care through the replication of an evidence-informed, smartphone-powered program. 

It involves an innovative text messaging service that connects women to critically important health care and social supports. Such assistance is needed in the Carolinas, where infant and maternal morbidity and mortality rates rank among the highest in the nation.

The program is called H.E.A.R. (Healing, Equity, Advocacy, and Respect) 4 Mamas and Babies. Created by the Medical University of South Carolina (MUSC) with funding from the Endowment, it harnesses the convenience and ubiquity of text messaging to help medical staff identify patient needs and direct women to care and resources. 

Moms receive a series of texts with interactive screenings on maternal health, including everything from depression symptoms to the health of their baby or even indications of domestic violence in the home. 

For Elena Richardson of Conway, S.C., the program has been a godsend. As a single first-time mom, the program gave her quick digital access to Chinise Clinton, an obstetric nurse advocate and certified family nurse practitioner. Richardson asked about everything from lactation challenges to her 7-month-old son August’s frequent sneezing. 

“I have loved my time with the program,” she said. “It’s just nothing but love and support. It’s all beneficial.” 

Moms enroll at their obstetrician’s clinic as early as the first prenatal appointment and up until the delivery of the baby. When they answer questions through the evidence-informed text screening tools, their responses go into a confidential database. Care advocates like Clinton review the information and guide mothers to resources and solutions. When needs are identified, care advocates make connections to timely and trusted behavioral health, medical and social care throughout pregnancy and the postpartum year. They also provide connections to local community-based organizations who partner to provide additional supports such as food and diapers. 

“We knew there were unmet maternal mental health needs, but the patients were just not getting to us,” said Dr. Constance Guille, director of the Women’s Reproductive Behavioral Health Division at MUSC. “We needed a different approach. We took the evidence-based screenings and components of care that would normally happen in person and delivered them in a way that’s more accessible to patients.” 

A randomized controlled trial published in 2024 showed women in the program were three times more likely to be screened for mental health and health warning signs, interpersonal violence and social needs. They were also five times more likely to attend treatment services, compared to in-person screenings and referrals. 

Additional randomized controlled trials are under way to measure the program’s effect on patient outcomes and reducing avoidable emergency department utilization. 

MUSC’s program has already served thousands of women. Now, other large hospital systems across the Carolinas are preparing to replicate it. The Endowment will invest more than $13 million over the next four years to support five health systems as they plan and implement the program in their communities. 

MUSC and the University of North Carolina at Chapel Hill will provide technical assistance and an evaluation plan. The universities and health systems are working toward launching patient services in 2027. They will also create a peer learning collaborative and develop an implementation toolkit to encourage fidelity to the model. 

“Our hope is that we’ll have substantially and observably moved the needle with respect to the key contributors to maternal morbidity and mortality, and by proxy, improve infant health,” said Dr. Jenna McCauley, a psychologist and associate professor at MUSC who co-directs the technical assistance effort with Dr. Guille. 

The program’s growth from a simple, smart idea to a replicable intervention has taken years. 

“H.E.A.R. 4 Mamas and Babies is a great example of how innovative approaches can improve care and help change lives. When hospital systems are able to share what they are learning, we can accelerate the replication of promising programs to help as many people as possible,” said Linwood B. Hollowell III, director of Health Care at the Endowment. “We are excited by the potential of this work to benefit mothers and babies across the Carolinas.”

5 PARTICIPATING HEALTH CARE SYSTEMS

With support from The Duke Endowment, these five health systems are partnering to expand access to H.E.A.R. 4 Mamas and Babies and improve maternal and infant health outcomes across the Carolinas. 

• Atrium Wake Forest Baptist Health 
• Cape Fear Valley Health System 
• ECU Health 
• Prisma Health 
• Spartanburg Regional Healthcare System