SolanoConnex: developing a web-app for accessing local, up-to-date mental health services in a diverse county

Introduction

While one in five people in the United States (U.S.) experience mental health symptoms, far fewer obtain mental health services (1-4). Mental health services refer to a range of supports, treatments, and interventions designed to promote psychological well-being and address mental and emotional challenges to include counseling, therapy, crisis intervention, and recovery support for conditions such as depression, anxiety, addiction, post-traumatic stress disorder (PTSD), and trauma (1,2,4). Seeking professional support early, when symptoms first appear, can help alleviate stress and promote faster recovery (5). However, many individuals delay or avoid seeking help due to limited understanding of when and where to get assistance, skepticism about treatment effectiveness, stigma and fear, or financial barriers (6). These obstacles lead to postponed or neglected mental health care, intensifying the impact of untreated conditions on both individuals and society. In addition, stigma, fear of discrimination, and a shortage of mental health care providers can exacerbate delays (2,4,7,8).

Effective ways to increase help-seeking attitudes and behaviors for mental health services include interventions targeting mental health literacy and stigma reduction; both of which have been linked to modest gains in attitudes toward seeking help—primarily among individuals already diagnosed with mental health conditions rather than the general population (9,10). Although recent interventions targeting literacy and stigma have demonstrated some success in shifting attitudes (11-15), their effect on behavior remains limited. Consequently, these initiatives appear more beneficial for those already identified as having a mental health condition than for those who have not yet pursued care (9,10). This disparity contributes to a persistent treatment gap, where rising rates of mental illness are not matched by corresponding increases in treatment engagement.

Delivery mechanisms aimed at increasing mental health seeking include digital mental health platforms, mindfulness education programs, telehealth services, school-based mental health initiatives, and the use of social media for awareness and outreach. Digital health interventions, such as mental health apps and web-based self-help programs, have become popular due to their scalability and accessibility, allowing users to seek support at their convenience and sometimes to work more effectively with providers (16). Evaluations of social media platforms aimed at mental health have found mixed results, with some interventions showing short-term improvements in mental health outcomes (17), while others fail to produce sustained changes in help-seeking behaviors or clinical symptom reduction (18).

Experts in mental health access have emphasized the need for more readily available and easily navigable opportunities for individuals experiencing early signs of mental health issues (19). While numerous digital and community-based programs exist, many concentrate mainly on general mental health education or stigma reduction rather than directly linking individuals to specific services. To address this gap, SolanoConnex was developed and launched in late 2021 with the goal of improving access to mental health resources specifically for residents of Solano County, California, which is among one of the most culturally and linguistically diverse counties in the U.S. (20,21). Feeling “very sad, hopeless, anxious, stressed or angry” was the most prevalent reason given by teens for a school absence (22). Community surveys suggest that 45.5% of adults in Solano County who reported needing mental or emotional health services did not receive help for their concerns compared to 26% nationally (23,24). Solano County has nearly twice the rate of Emergency Department visits for mental health concerns compared to the state overall (25). The age-adjusted suicide rate in Solano County for 2018–2020 was 14.0 per 100,000, which is significantly higher than the California statewide rate of 10.5 per 100,000 (26).

Tackling the complex interplay of factors underlying the disparity between need for and access to mental health care requires an innovative approach. Our team sought to provide that innovation with the development of the web-app entitled SolanoConnex. In August 2020, Touro University California (TUC) was approached by Solano County after a needs assessment showed both residents and providers in the county did not know how to access existing mental health services. A project was proposed in response by the university team to enhance access to mental and emotional health services for all residents of Solano County to be accomplished through an innovative, actively-managed access portal supported by live mental health navigators in conjunction with an outreach and awareness social- and traditional-media campaign to guide residents to the portal. With more accessible services, residents will receive care when facing mild or moderate mental health challenges and fewer people will have their concerns escalate to a degree that requires a visit to the emergency room or hospitalization. The purpose of this article is to describe the development of that portal, named SolanoConnex, with a focus on how the development process integrated the knowledge and feedback of the local community to create a product tailored to local needs. We present this article in accordance with the SQUIRE reporting checklist (available at https://mhealth.amegroups.com/article/view/10.21037/mhealth-25-56/rc).

Methods

The development of the SolanoConnex portal was accomplished through a rigorous methodical approach with five stages (I) landscape data collection and analysis; (II) designing the product; (III) web-application development; (IV) beta-testing and revision; (V) launch and continued assessment.

Stage 1—landscape data collection and analysis

Initially, 48 mental health service providers in Solano County were contacted through the Children’s Alliance and Solano Coalition for Better Health, and more than 40 other community organizations including resource centers, temporary housing programs, churches, correctional facilities, Travis Air Force Base, and local educational institutions. Interviewees were also asked to provide contact information for other mental health partners they work with. Individuals who were invited to be interviewed were employees and/or leaders of different mental health organizations including clinics, hospitals, substance use organizations, crisis centers, resource centers or were leaders in the community such as board members or religious leaders. All participants were over 18 years old.

The interviews were conducted by the SolanoConnex Project Manager and Project Coordinator. They were structured interviews and explored the severity of mental health disorders organizations were most frequently coming in contact with; their description of typical patient or community member with mental health needs they encountered; the gaps and barriers to emotional and mental health resources they observed in Solano County; their perspectives on how to best reach and serve individuals with mental health needs; and their feedback and thoughts on our proposed SolanoConnex project.

The team first assessed publicly available data from the county needs assessment to better understand the gaps and barriers residents experienced when seeking mental health care (27). Landscape data collection was performed through thematic analysis of 59 key informant interview transcripts. Between October and December 2020, 120 community members and organizations throughout Solano County were invited to participate. Each interview was approximately 20 minutes long and was administered by Zoom or phone call. Interviews were transcribed and then thematically analyzed via methodology described by Nowell et al. (28), with priority on gaps and barriers in accessing mental and emotional health services. The coding structure has been added as supplemental data (Appendix 1).

This process included pursuing raw data, identifying potential codes, comparing codes between reviewers, deriving initial themes, refinement of themes and categorization of final themes as pertaining to gaps and barriers.

Stage 2—designing the product

The Emotional Health Services Team (EHST) consisted of individuals directly engaged in providing services, while the Advisory Committee included those who could help support the project at a policy level. Whenever possible, we included individuals from the same agency to have them represented in both teams. The Advisory Committee included a diverse group of leaders and experts including leaders from the county office of education, unhoused shelters, family resource centers, substance use centers, mental health clinics, local religious institutions, local National Alliance of Mental Illness (NAMI) chapter, Northern California Planned Parenthood; county behavioral health services, Kaiser of Northern California. The EHST included the above in addition to representatives from the local queer organization. The participants had a wide range of qualifications and expertise; however, they all shared their expertise in the populations that they served. All members of the Advisory Committee were given the same roles and responsibilities.

To create an initial algorithm for the end-product, the team utilized a participatory approach and co-developed the product in collaboration with community members active in serving mental health needs. The EHST was initially formed to co-develop the initial algorithm and to provide iterative feedback throughout the development process. An Advisory Committee was also formed to provide quarterly policy guidance for the project. Iterative algorithm tests were conducted utilizing hypothetical patient profiles developed by the team in conjunction with the EHST. An example of a patient profiles is: A parent is calling for resources for their 4-year-old son. He has been “acting out” and exhibiting abnormal behavior. They think he may need an assessment and they’re not sure where to go. They tried making a doctor’s appointment and aren’t able to see someone. They currently live in Rio Vista and have transportation. They have insurance through Partnership and English is their primary language.

Stage 3—web-application development

The team collaborated with an outside web-application developer to create a suitable interface for the algorithm developed in Stage 2. Alterations to both the interface and algorithm as applicable were made based on the feedback from the EHST until both the team and the EHST felt the product was ready for the next stage.

Stage 4—beta-testing and revision

The process of beta-testing involved assessment and revision utilizing 65 beta-testers. Beta-testers were recruited from the community by members of the EHST, Advisory Committee, and other landscape report key informant interviewees. Beta-testers represented all cities, most cultural groups, and all key language and population groups that we had aimed to include (Table 1). Beta-testers utilized the web-app through exploration of the website. For beta-testing purposes the team’s full-time staff and some student interns served as mental health navigators who help people navigate the broader mental health care system by facilitating referrals, explaining insurance requirements, and supporting residents with other services such as childcare or transportation. Participants were given 5–10 minutes to explore the web-app. Beta-testers were instructed to utilize the web-app as if searching for resources for themselves, family or a friend. Participants were provided previously developed patient profiles to assist in this process. Participants then engaged in a key informant interview with a structured feedback form (see Appendix 1) and were given time to provide verbal qualitative feedback via one-on-one interview.

As part of the beta-testing process, two focus groups were conducted at homeless shelters to ensure inclusion of the unhoused population. These participants were recruited on the day of testing by members of our team visiting the shelter. The only difference in methodology for these groups was that the time for additional qualitative feedback was allocated in a facilitated focus group rather than an individual interview. The time to explore the web-app and structured feedback form remained the same. Data from the feedback form was analyzed via Dedoose and incorporated into the web-app as appropriate.

Stage 5—launch and continued assessment

Preparations for launch including finalizing the interface from beta-testing feedback, translating content to Spanish and Tagalog, training mental health navigators, and other logistical items. SolanoConnex launched November 1^st, 2021 for public access. There was continued assessment post-launch with two more rounds of key informant interviews: one shortly after public launch and one a year later. Key informants were recruited by use of flyers distributed to the community by service organizations, healthcare organizations and in other community locations. Data was collected, and revisions were made as needed. The post launch interviews were structured and covered thoughts on the appearance of the web-app, the wording and language used, the web-app layout, map page and results, and general questions and feedback (Appendix 1). At present, services and information on the web-app are kept current, with the date of the last time a service was verified display on the app for transparency.

Ethical statement

The study was conducted in accordance with the Declaration of Helsinki and its subsequent amendments. The study was approved by the Institutional Review Board of Touro University California (No. #PH-1220). Informed consent was gathered from all participants involved at any stage.

Results

Stage 1—landscape data collection and analysis

Based on our secondary data analysis of publicly available data from Solano County, we found that the county had both a higher proportion of people who needed but did not receive mental health services and higher rates of hospitalizations/emergency room visits for severe mental health conditions compared to the state level (Solano County 2020). Simultaneously, improving access to mental health services was identified as a top priority for residents.

A landscape report was conducted to better understand the locations and characteristics of services available, as well as the gaps and barriers experienced by residents of Solano County. We conducted 59 key informant interviews, with key informants identified from organizations in Solano County serving those with mental health needs, regardless of whether the organization was explicitly considered to be a “mental health organization”. For example, some family resource centers advertised as providing rental, utility and food assistance also provided counseling or support groups. Such an organization was considered to serve mental health needs. Thematic analysis revealed major barriers such as lack of services in a preferred language, services not tailored to specific marginalized groups, a lack of awareness of the existing services, not enough services, being unable to connect with a service, and difficulty with follow-though after initial contact. Full analysis of the landscape data collection and the corresponding themes and codebook is published elsewhere.

From the secondary data analysis and the landscape data collection, the team identified three aspects that warranted inclusion into the algorithm to be developed. Services include individual, couples, and family counseling, substance use disorder counseling, crisis intervention, support groups, assessments, parent education, case management, medical detox, dual diagnosis residential treatment, nontraditional services, and more. Social services were not highlighted in the algorithm, but we planned to have our mental health navigators be knowledgeable about other social services and resources, e.g., food banks, housing support services, transportation, free phones etc.

First was mapping of services physically close to a user’s location. This was because while nearly all services purported to serve all county residents, over half of services were physically located in the city of Fairfield. By contrast the secondary data analysis identified hotspots for emergency room visits and hospitalizations related to severe mental health conditions in the cities of Vallejo and Vacaville. Mapping services in the user’s proximity would provide a user with the most convenient and realistic options for them. The second aspect was for the algorithm to filter services based upon an individual’s characteristics, such as age, insurance status and demographic characteristics. While the project, intended only to connect individuals with existing services, could not directly fill the gap of a lack of services tailored to specific marginalized groups, by providing the ability to filter, the algorithm could allow for people to identify what services, if any, existed that catered to their specific demographics. Finally, the end-product should have availability in at least three languages: English, Spanish and Tagalog. With a major gap being lack of services in a preferred language, it would be remiss to only offer the web-application in English. For Solano County, Spanish and Tagalog are prevalent languages, with Spanish considered a threshold language (a primary language for more than 5% of the county’s population).

The landscape report also provided evidence for a proposed position of mental health navigator to work in conjunction with the web-app itself. A mental health navigator, reachable by phone, text, or email, would not only help people navigate the web app itself but also the broader mental health care system by calling services on a user’s behalf to ensure things like appointment availability and insurance requirements, as well as assisting with connections to affordable childcare, transportation services, and more. A navigator bridges some other identified gaps in accessing mental health such as being unable to connect with a resource, assisting with follow-through after an initial conversation and decreasing the perception of a disjointed mental health system.

Stage 2—designing the product

To create an initial algorithm for the end-product, the team utilized a participatory approach and co-developed the product in collaboration with the EHST and Advisory Committee. Algorithm tests were conducted utilizing hypothetical patient profiles developed by the team in conjunction with the EHST.

Members for the EHST were recruited from landscape report key informant interviewees and were frontline workers interacting with people facing mental health challenges on a daily basis. The EHST met monthly to provide feedback on progress of the project and guide the next immediate steps. The Advisory Committee was formed from individuals who held managerial or director positions in established community organizations such as NAMI Solano County, the local Kaiser Permanente and the Director of Behavioral Health Services of Solano County. The organizations targeted for membership in the Advisory Committee were chosen to establish initial trust from other community groups and to ensure long-term sustainability of the project. The Advisory Committee met on a quarterly basis to provide policy guidance for the overall project.

The initial algorithm was created in conjunction with the EHST. The algorithm incorporated physically mapping of services related to user’s location and filtering of services based on matches with an individual’s characteristics. The algorithm was tested with standard patient profiles developed by the team. The patient profiles were crafted to represent the circumstances and characteristics of a person who may present to a community organization with mental health concerns. An example of the profiles developed follows:

“A 16-year-old youth has recently been kicked out by their Vietnamese parents after coming out to them as gay. They have been going between staying on a friend’s couch in Benicia or living in their car, but do not have a long-term solution. They have been experiencing feelings of hopelessness and don’t see a reason to keep living. They state that they’ve been cutting themselves to get a sense of relief from everything going on. The client speaks both English and Vietnamese fluently. They are still under their parent’s private Kaiser insurance but are worried they will be cut off.”

The EHST verified the realism of the profiles based on their experiences and created additional ones to represent any missing circumstances or characteristics they commonly encountered. Algorithm tests were conducted by our team assuming the role of a mental health navigator, helping someone matching the patient profile to navigate the algorithm to obtain services. This process ensured the usability of the algorithm for users with diverse mental health challenges, demographic characteristics and cities of residence. Capturing a large breadth of diversity was necessary to reflect the situations of people who sought mental health services in Solano County specifically. The algorithm served as a base for discussions on the format and interface of the web-app.

Stage 3—web-app development

The team collaborated with an outside web-application developer to create a suitable interface for the algorithm developed in Stage 2. Alterations to both the interface and algorithm as applicable were made based on the feedback from the EHST until both the team and the EHST felt the product was ready for the next stage.

A driving point in the web-app development was to achieve a jargon-free, intuitive, user-friendly interface. A simple interface would maximize accessibility to those with low technological literacy. Attaining a satisfactory balance of simplicity with needed information and categories was the major hurdle tackled in the development of the web-app.

In the course of development, the team was introduced to the existing web-apps BigBurgh and MyKY (29,30). These apps were designed to help people find low-barrier resources for housing in Pittsburgh, PA (BigBurgh) and the state of Kentucky (MyKy). Connecting with the teams behind both BigBurgh and MyKY allowed SolanoConnex to develop through an evidence-based approach as the housing interface was adapted to mental health and localized for Solano County. After creating an initial interface that closely mirrored the one used by BigBurgh and MyKY, the wording and utility of the interface was reviewed by the team and the EHST.

The initial design of the web-app mirrored that of BigBurgh and MyKY, with two ways to locate services, either via the “Where’s Help” tab or the “For You” tab (Figure 1). In the “Where’s Help” Tab, mental health services could be searched for by location. Users first selected the type of mental health concern they were having from the main page. A map of services for the selected concern would then be displayed based on the device’s location or a provided location. Services would be pinned on the map, as well as displayed in list form, ordered based on proximity to the user’s location. In the “For You” tab, mental health services could instead be searched for based on an individual’s characteristics. An individual could select their age range and their insurance status and would see a list of services that served their age range and accepted their insurance.

Figure 1 Initial 2-tab SolanoCnnex design that closely mirrored layout of BigBurgh and MyKY. The “Where’s Help” tab wherein users could find help based on nature of the mental health challenge experienced. The “For You” tab wherein users could filter services based on desired characteristics of ages serviced and insurances accepted.

Logistical issues appeared in the adaption of the algorithm to this interface, particularly the “For You” tab. Insurance was a major barrier that was uncovered in the landscape data collection, with availability of insurance information on SolanoConnex of vital import. However, the complexities of insurance coverage for mental health care made accurate filtering nearly impossible. To start with, the same insurance company may have several different names, and even those with the same insurance may not have identical plans. Someone’s insurance plan may cover a support group, but not one-on-one counseling from the same organization. Co-insurance also conflicted with this interface. This initial interface had no way to filter based on multiple insurances, and even if this feature was added the filter may not accurately reflect whether an insurance would be accepted. For non-mental health medical care, a person’s primary insurance will cover a portion of the bill, then the secondary insurance will cover another portion. The wide variance of the amount and type of mental health care service covered by insurance companies made determining coverage more complex. A person’s primary insurance may not cover mental health care, while their secondary does, or a service may only be accepted the secondary insurance and not the primary, but the service must first be accepted or denied by the primary insurance before the secondary insurance would provide coverage. Filtering services based on age range also posed complications due to inconsistent cut-offs. For example, one service may accept clients starting at 14 years, while another at 16 years; or two services for “elders” where one defines it as 60+ years and the other as 55+ years. After extensive deliberation with the EHST and team, the “For You” tab was removed.

Even with the removal of the “For You” tab, the information contained within was still considered vital and was added under individual services entries, with each listing the eligible age ranges and accepted insurances as well as potential additional cost of service. Given the influence of insurance as a barrier to care, a flag system was developed to indicate services anticipated to have high usage. The flag displays next to the name of a service in list format (see Figure 2 for example). Flags were created for “Free”, “Medi-Cal” and “Kaiser”. The “Free” flag indicated no cost for the service, services accessible to the largest number of people and presumably highly desirable. The “Medi-Cal” (California’s Medicaid system) and “Kaiser” flags were chosen as they are the two most common insurances among residents of Solano County.

Figure 2 Example demonstrating the appearance of flagged services.

Once the interface was developed, the hypothetical patient profiles created in Stage 2 were used to check the quality of the web-app in reflected the intended algorithm in two iterative rounds. This quality control step was carried out with the EHST and revealed that several organizations were coded into groups for services that they did not provide, i.e., women’s health clinic might under “Parenting and Child Concerns” when the only mental health services offered were related to intimate partner violence. In addition, navigation of the web-app was at times inefficient and burdensome requiring a multitude of selections before reaching a page for a service entry. Following the first round of quality check, organizations were re-coded to properly reflect the services offered and the demographics served and the web-app interface was tweaked. Following the second round, any remaining miscoded organizations were corrected and navigation was shown to be more streamlined as indicated by a reduced number of clicks needed to reach a service page.

The other major changes made at this stage were language and wording issues. The EHST assisted greatly in this process, helping to develop alternatives that would be better received by likely users of the web-app. For example, “Psychiatric Emergency” was found to be unclear and too medical—in additional to potentially evoking feelings of stigmatization—while the term “Detox & Recovery” felt misleading as not everyone seeking help was looking for a detox-programs.

In addressing these issues, the SolanoConnex interface to be used during beta-testing was developed, as seen in Figure 3. A single “Find Help For...” Tab with the 5 categories of “My Mental/Emotional Health”, “Parent, Teens & Families”, “Violence & Abuse”, “Alcohol & Substance Abuse” and “Need Help Now” in addition to options at the bottom to view safe places and hotlines or connect to a mental health navigator. Each of the five categories had sub-categories to further narrow down the type of service desired, such as the categories of “Post-traumatic stress disorder/Trauma” and “Intimate Partner Violence” being consolidated under the “Violence & Abuse” category. Relevant personal characteristics such as age and insurance and instructions on how to access a service were included in service entries (see Figure 4 for example).

Figure 3 Single-tab interface of SolanoConnex produced at the end of Stage 3 and utilized during beta-testing.

Figure 4 Example entry of an individual service as appeared during beta-testing.

Stage 4—beta-testing and revision

In total, 65 community members beta-tested the web-app. Beta-testers were recruited from the community by members of the EHST, Advisory Committee, and other landscape report key informant interviewees through email invitation. By having the organizations serving mental health needs recruit people who sought their services, the beta-testers would be more representative of the target demographics than those selected by random sampling of the general population.

Participants for the focus groups came from the county’s unhoused population and were directly recruited by members of the team on the same day of beta-testing by visiting a homeless shelter and inviting residents to participate. This was deemed necessary to include this population in the demographics of beta-testers, as the unhoused population is an important sub-population among those who need but do not receive mental health services. Demographics of beta-testers can be found in Table 1.

Feedback from each round of beta-tested was analyzed by Dedoose. Qualitative feedback was analyzed using thematic analysis methods and then incorporated into the web-app as appropriate.

Overall, beta-testing led to relatively minor changes to the interface. Changes were more wording changes, what information was provided about a service and recommendations of additional services to include. Wording changes were relatively minor, for example changing the “Early Psychosis” sub-category underneath “My Mental/Emotional Health” to “Psychiatric Help” or substituting the word “abuse” for “use” in the main “Alcohol and Substance Use” category. Additional information beta-testers wanted to know about services was instructions on how to make an appointment and when a service was open.

Stage 5—launch and continued assessment

Incorporating the final beta-testing feedback gave the interface at soft launch, seen in Figure 5. Even with this finalized interface, SolanoConnex is designed to be continually updated, with services being regularly updated, changed and removed as needed, in order to accurately reflect the current resources and needs of the county.

Figure 5 The interface of SolanoConnex developed post-beta-testing and appearance of the web-app at launch.

Prior to launch, our team made final preparations including translations, recruitment and training of mental health navigators, and other logistical details. All English text on the web-app was translated to Spanish and Tagalog. Translations were done by native speakers to preserve meaning and intent that could potentially be lost in more direct translations. Mental health navigators were recruited from TUC graduate students. Navigators were trained in how to navigate the web-app, make and receive phone calls, and direct people to services. They also received Mental Health First Aid training and certification. A phone line was bought for SolanoConnex, and using a service called grasshopper, the number was set up so that multiple phones could make and receive calls that only went to through the SolanoConnex phone number. Secure systems were created to document messages and phone calls to ensure continuity of care between mental health navigators.

November 1^st, 2021 was the launch of SolanoConnex, when for the first time the web-app was accessible to the public on the internet. Post-launch two more rounds of key informant interviews were conducted to further refine the web-app. The first round of post-launch key informant interviews was held shortly following launch, and the second round was held a year after launch. This opportunity for continued assessment and feedback was deemed important in order to keep SolanoConnex as closely tailored to the needs and attitudes of the county as possible.

The data collected showed overall positive feedback on the appearance and navigation of the web-app and suggestions to further improve it. Suggestions included how to improve the Spanish and Tagalog translations as well as suggestions for additional subcategories (i.e., “suicidal ideation”). Updates to the web-app were made as appropriate.

Since the launch of SolanoConnex, there are over 5,000 visitors to the app every year (internal program data).

Data security and privacy

With the stigma surrounding mental health, the privacy and anonymity of users of SolanoConnex was of major import. This played into the decision to create a web-app rather than a normal mobile application, as web-applications are accessible through any device with an internet connection without any need for download. With the stigma and discrimination still surrounding mental health, someone may be less likely to download an app onto a device that could be shared with or seen by others, as opposed to visiting a web-page that can be closed discreetly. SolanoConnex also requires no log-in or account set-up, and the only information a person enters is a location. The web-app tracks usage simply by the number of visits or click on a service or category, disconnected from specific users. If a person chooses to call or message a mental health navigator, they are asked for basic information (name, age, insurance, callback number) so that the navigator can better help them find services, with optional demographic questions. This information is recorded only to ensure continuity of care between navigators, kept in a secure system, and no information is required to receive assistance from a navigator.

Discussion

Key findings

The usage of online maps to find services, whether restaurants, gas stations, grocery stores or anything in between, has become the norm, yet locating services for mental health care or other specific services is far more complex than a quick internet search. Filling the niche of locating these services can help bridge access gaps and overcome many barriers to people accessing the mental health services they need. These lessons aim to serve as guides to increase the initial and sustained success of others striving to create a web-app or other mobile health tool to improve access to mental health services.

While some of these lessons may be familiar to those with public health training, they bear repeating, especially with their application to the less-common context of web-app development. These lessons informed the development of SolanoConnex and the team continues to use them as SolanoConnex improves and expands.

Lesson 1—community feedback

The import of feedback of a target population is major component of public health programming research as well as in marketing research. This makes its importance in developing a web-app for mental health services two-fold, as the web-app is not only a form of public health programming but shares many important aspects with marketing. Aesthetic design, ease of use and accessibility are aspects more heavily considered in marketing context, yet are important to increase the likelihood of someone using the web-app.

In the realm of mental health the language and wording that a community finds attractive may not be what researchers considered to be the most neutral, and it may even vary from community to community or change over time. Throughout development we found that aspects we thought would be appropriate and engage people fell flat, making the feedback we collected vital to the continued success of SolanoConnex.

Another important function of community feedback specific to creating a mapping tool is learning about services available. Even though overall a lack of knowledge of existing services is a barrier, many of our beta-testers and key informants had recommendations on services that could potentially be included on the web-app. This was one of the major categories of feedback we received during beta-testing. Through seeking out extensive community feedback we created a vast pool of community knowledge that further expanded the resources we could direct people to and further broke down the barrier of lacking knowledge of existing services.

Lesson 2—buy-in from established community partners

The inclusion of specific central community partners and their approval of the SolanoConnex project was vital in both the initial acceptance of the project by the community and in ensuring sustainability of the project beyond the initial grant period. Central partners we identified were NAMI Solano County, Solano County Behavioral Health Access Line, and Solano County Office of Education. These services are all long standing organizations in the community, intertwined with its unique history and grown from the community itself. NAMI Solano County, for example, was first started by concerned parents around a kitchen table, only later becoming part of the larger NAMI organization. These organizations carry the community’s respect and trust that a new project such as SolanoConnex lacks. This was demonstrated time and again during beta-testing and post-launch assessments, when interviewees constantly asked if we were working with these organizations, if they were on our web-app or if were otherwise involved in the project. The approval and involvement of these organizations meant community members were more willing to give SolanoConnex a chance.

Involving these established community partners has also contributed to the buy-in of other community organizations. This helped build a strong network of community partners that are today committed to the sustainability of SolanoConnex. As the project is grant-funded there is a time limit to the financial assistance provided by the county, our team was approached by our community partners who specifically wanted to know what role they could take in ensuring SolanoConnex continues beyond the grant timeframe. Our community partners even went so far as to offer to each pay some percentage of SolanoConnex’s operating costs from their own finances to maintain the active management of SolanoConnex.

Lesson 3—building on work of others

Prior to our discovery of the existence of the web-apps BigBurgh and MyKY, progress on creating an interface to map services that reflected our algorithm was incredibly difficult. Our team struggled to learn coding languages to better participate in the process of designing and editing the interface alongside the outside developer. This delayed progress of interface development and severely limited the aspects we could include.

When we discovered the apps BigBurgh and MyKY we immediately saw the utility of their mapping systems, despite their intent of mapping housing services rather than mental health services. Being able to converse with the teams behind these web-apps in turn facilitated communication with the outside developer on how to design our web-app. Finding an existing web-app or other mobile interface that can be used as a starting point for development saves on costs, time and provides a base level of assurance that the system already works. In searching for a model to use as a starting point, it is important to search outside of what may be considered the “target field”, instead looking at the function that is desired. BigBurgh and MyKY have no explicit connections to mental health (though stable housing—or lack thereof—is tied to one’s mental health) but their system of mapping nearby resources was exactly what the system we were trying—and failing—to create from scratch.

Strengths and limitations

The development of SolanoConnex is heavily tailored to and influenced by the local community of Solano County, which is both a strength and a limitation of the project. The strengths lay in methodological inclusion of community members and organizations in form of the EHST and Advisory Committee. Inclusion of the community at every step was a major factor in the ensuring the sustainability and expansion of the project. Strength is reporting how exactly it became tailored. These strong community ties limit the generalizability of the end-product intervention. As the web-app was developed for and by the residents of Solano County, which is one of the most diverse counties in the U.S., the web-app may not be so readily received if applied to another location. Even if the end-product were modified for services in a county with similar demographics the specific demographics, there is not guarantee the wording and navigation would appeal to the population. Moreover, direct application of the end-product web-app would lack the integral community buy-in and trust built through the methodical development of the project.

Following from above the need to perform extensive landscaping process could be a limitation depending on resources availability to do so. Conversely, performing the landscaping process and following the methodology described here is a major strength. The process helps to identify what the specific gaps and barriers are for a community, establishes strong community ties and provides clear direction of what the heart of the intervention should be. A project thus developed should be able cultivate strong community support even if the end-product deviates from that of SolanoConnex.

Additionally, this paper focused on the development of a web-app to begin to address the disparity between individuals who use mental health resources and those who report having a mental health need. This paper does not discuss the effectiveness of using this web-app to connect individuals to mental health resources. Further research is being conducted to assess effectiveness.

Finally, to the knowledge of the team, the format of SolanoConnex is a novel approach to addressing the disparity in access to mental health services, which significantly limits the ability to compare the outcomes and methods to that of previous research.

Implications and actions needed

With the positive response from the Solano County community (beta-tester, EHST team, Advisory Committee members), the next steps for SolanoConnex project are to perform program evaluations to demonstrate the empirical impact of the web-app on the disparities in access to mental health services in Solano County. With the U.S. population becoming more and more diverse an innovation developed in a diverse county is beneficial to look at adapting to other communities (16). If the SolanoConnex framework can be successfully modified for and implemented in other U.S. counties it could lead to significantly ease navigation of the disjointed mental health care system.

Conclusions

In the development of SolanoConnex, we learned the importance of community feedback, buy-in of establish community partners, and building off the work of others. The single-tab 5-category SolanoConnex web-app was developed through continuous feedback and tailored to the specific community it was intended to serve. Through this web-app the residents of Solano County have an easy-to-use, jargon-free, accessible way to learn what mental health services exist in their area for their unique needs. The lessons from the development of SolanoConnex will be strong foundations for others who are seeking to use web-apps to lessen the disparities in access to mental health care. Since launch, SolanoConnex has not only maintained its initial features, but we have also received multiple additional grants to expand our personnel and operations. Moreover, our team has been approached by those seeking to re-create SolanoConnex for other counties in California and even places as far away as Nebraska and Washington D.C., showcasing the dire need for innovative ways to enhance access to mental health services not just in Solano County, but throughout the U.S.

Acknowledgments

The authors would like to thank all of the student mental health navigators and community members who have participated in this project.

Footnote

Reporting Checklist: The authors have completed the SQUIRE reporting checklist. Available at https://mhealth.amegroups.com/article/view/10.21037/mhealth-25-56/rc

Data Sharing Statement: Available at https://mhealth.amegroups.com/article/view/10.21037/mhealth-25-56/dss

Peer Review File: Available at https://mhealth.amegroups.com/article/view/10.21037/mhealth-25-56/prf

Funding: This work was supported by County of Solano (grant number #2020-208).

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://mhealth.amegroups.com/article/view/10.21037/mhealth-25-56/coif). C.B. serves as an unpaid editorial board member of mHealth from March 2025 to December 2026. The other authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The study was conducted in accordance with the Declaration of Helsinki and its subsequent amendments. The study was approved by the Institutional Review Board of Touro University California (No. #PH-1220). Informed consent was gathered from all participants involved at any stage.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

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