Increasing Access to Mental Health Care

Mental health coaching service

  • đŸ‘€Â 100,000+ users
  • 📍 San Mateo, CA
  • đŸ“± iOS, Android & Web
  • 🗓 2016-2022

The Company

Sibly’s mission is to give everyone someone to talk to who's compassionate, helpful and always available. Through its text-based service, Sibly members can chat with scientifically-trained human coaches 24/7, regularly receive guidance reports, and get access to resources that help them navigate life’s challenges and achieve their goals. Sibly partners with organizations such as Comcast, WW, and Rivian to offer the service to their employees, and has generated more than $10 million in revenue to date.

My Role

Being one of the founders, I wore multiple hats at Sibly. At its inception, I lead the technology where I architected and developed Sibly’s entire software system (iOS app, web app, and backend). Then, as the company started to grow, I was able to shift my focus to the field I’m most passionate about: product design & UX. From 2019 until my departure in 2022, I was the head of design & user experience where, with the help of my team, I was responsible for designing the end-to-end member & coach experience. My responsibilities included:

  • The discovery and design of new product features
  • Conducting usability interviews & user research projects
  • Hiring and managing designers & agencies
  • Collaborating with key stakeholders to develop & enhance processes that support the team’s growth
Sibly Member Experience
The coaching dashboard used by Sibly Coaches

Problem & Context

  • > 50% will be diagnosed with a mental illness or disorder at some point in their lifetime [source].
  • 1 in 4 Americans feel they have no one to confide in [source].
  • The current mental healthcare system is optimized for severe mental illnesses, leaving people with mild to moderate stressors vastly underserved.
  • Therapy requires scheduling, but anxiety doesn’t schedule appointments and depression rarely accepts a rain check.
  • Science shows that waiting for help has a negative impact and having immediate access to mental healthcare makes a significant difference.

The First UX Challenge: Maximizing Conversion

One of the biggest challenges we had to tackle in onboarding was that, at some point in the history of the company, all members had to answer a 23-question screening survey about their mental health before talking with a coach. This was required for compliance and member safety reasons. Not only that was a lot of “clicks”, but also these questions required thinking and some were not ‘light’ questions. Our onboarding experience had to solve for that, and also be the place where we educate the member about what Sibly is and how it works.

🎯 Goal / Success Metric: Minimize onboarding drop off rate

Solution

Given the nature of the Sibly service (being chat-based), the whole onboarding & screening survey experience was designed using an interactive chatbot. As soon as members registered their email / password, they were taken straight to the chat section of the app where the Assistant Bot greeted them, collected their basic information, explained Sibly and asked them the screening questions. We also worked a lot on the language to make it friendly and engaging, and included a proper use of emojis that suits our targeted audience. This solution was co-design with Moe AlKadi.

Results

69%

Completion Rate

Even though the onboarding included more than 30 clicks & answering survey questions, it had an astonishing completion rate of around 69%. Moreover, only 1% dropped off after finishing half of the assessment. This could be attributed to how fun & engaging the chatbot experience was. Members also found the survey questions to be helping them reflect on their situation & understand themselves better.

The Power of Design & How it Drives Behavior

One of the ways Sibly utilizes AI & ML is to provide feedback to the coaches to improve the quality of the conversation. For example, motivational interviewing tells us that asking open-ended question often yields better results than close-ended questions. So, we designed a tool that showed coaches the ratio of their open-ended questions vs. close-ended questions.

AI Feedback on the Coaching Dashboard

After we launched, the percentage of open-ended questions asked by coaches significantly rose. But, inadvertently, that created another problem. We accidentally made our coaches ‘interrogators’ asking way too many questions, which was not only an uncomfortable member experience, but also not adherent with science. Motivational interviewing also states that you should reflect more than you ask questions. So, we immediately removed the tool, and then relaunched it with another meter that shows the question to non-question ratio.

Data on how the tool drove the coaches' behavior:

Hypothesize → Build MVP → Measure → Iterate

At Sibly, we designed & built with an MVP mindset. The “follow-ups” feature is a good example of that. Prior to building it, members would always initiate the conversation. Sibly coaches were mostly reactive rather than proactive. Considering some of Sibly’s core values like empathy & compassion, we asked: what if Sibly proactively reaches out to members to check in on them after some time of inactivity? This could make them feel connected to Sibly, cared for by the team, and increase engagement. While that sounded great, figuring out how to automate & scale this was not trivial (as shown below), so we decided to start simple.

At first, we had a subset of our coaches do this work manually. Every day, they would find members who haven’t talked in 3+ days, and send them a custom follow-up message, often referencing something that was talked about in the last conversation. Example:

Hey Annie! Last we spoke, you mentioned you wanted to work on getting to sleep by 10pm every night. How have you been doing with this goal?

> 100% Increase in Engagement

After just a few days of doing this experiment, the engagement in the service was more than doubled, and members often expressed their gratitude for Sibly checking-in on them. So, we decided to build this in a more scalable way. We first worked with the coaching team to understand their process. Then, we added a step in their workflow on the dashboard where, after wrapping up a conversation with a member, they would write a custom follow-up message in a little text box. That message would then go out automatically if the member didn’t come back in 1 day, 3 days, 1 week, or 2 weeks - depending on the follow-up settings for that member. This solution was co-designed with Moe AlKadi.

How Sibly coaches write the member’s next follow-up message

Many, many more specifications & edge cases were considered to build one of the most complicated yet impactful features behind the service. The flow chart below shows an example of the logic that happens behind the scene. Sending a “generic” follow-up was another part that had its own complicated rules & design. Doing all of this work manually at first allowed us to quickly create the proof of concept before digging into these details.

Building Things that Don’t Scale

At Sibly, we usually build new ideas without worrying too much about scale at first. With limited resources, competing priorities, and unclarity regarding how a certain feature would be used, it helps to start simple and manual; automation can happen later.

When we thought about scale, we often thought about the dashboard that our coaches use. Since our service is human-intensive, the dashboard can be the biggest bottleneck. In addition to the follow-ups feature mentioned above, here are a few examples of how certain features have evolved in the coaching dashboard:


Example 1: Assiginig Members to Coaches

When we first launched, our coaches all saw the same list of members on the left panel. When a new member comes, coaches would coordinate between them on who should talk to each member. This wasn’t a big problem at first, since most shifts had only 1 or 2 coaches. As Sibly grew & the number of concurrent coaches increased, we improved this experience for coaches by adding a button to “grab” a member, which would make the member appear under their list. Later, we further improved this experience by surfacing useful information to convey the current load on each coach. For example, the total number of members they have, and the total number of messages they received in the last 15 minutes. This helps coaches when deciding who should grab the next member.

Example 2: Daily Summaries

Coaches wrote down summaries of conversations they had with members. At first, all the summaries for each member were in 1 scrollable text input field. While this did the job, it definitely was not scalable. The more conversations each member had, the harder it became for coaches to read them. However, the flexibility of having them in a text box without constraints meant that our coaches naturally developed the structure they use in writing these summaries. Later, we sat down with our coaches, got to understand their process and structure, and designed a better experience for them.

First version (text input field):


Improved version:


Example 3: Member Search

In its early days, the dashboard displayed all the members in a scrollable list on the left bar. There was no option to search, so coaches replied on using the browser’s “find” feature. This was sufficient at that time, but as the number of users grew, a better solution was needed. We added a new button on top of the list to (Browse All Members). When clicked, coaches were able to browser, filter, sort, and search all the members.

First version (scrollable list on the left bar):


Improved experience to browse, filter, and search all members:

Evolving Sibly - The Wellness Platform

In its early days, Sibly was a B2C service used by self-paid customers. As the company grew, we shifted to the enterprise market where employers would pay for the service for their employees. With that, a big business opportunity came up; expanding Sibly to be a wellness platform that integrates with each company’s existing benefits in order to help its employees utilize the resources & services available to them, and help employers cut down on waste.

Some background:

  • Only a fourth of employees engage in corporate wellness programs [source].
  • 50% of employees say they are often or always exhausted due to work [source].
  • 40% of employees find that dealing with multiple vendors to access their benefits is confusing [source].

The idea is to have Sibly coaches, after developing a relationship with members and understanding their concerns and goals, recommend benefits and services to the members that suits their needs. For example, if a Comcast member expressed concerns with sleep in a conversation, a coach could leverage that opportunity to send them Sleepio, a digital sleep-improvement program offered as a benefit to Comcast employees.

We partnered with Comcast and signed a multi-million dollar contract to co-design & develop this platform & the employee benefit experience. In this 8-month project, I was solely responsible for leading the design efforts, and acted as an interim product manager for a few months.

Framing the Problem

We kicked things off by clearly articulating the problem we’re trying to solve:

đŸ‘€ Member Problem: Today, employees need someone to talk to. Sometimes they’re concerned about topics where Comcast offers resources (finances, maternity, health). They may not be aware of or understand the benefits and/or have a seamless experience to access the benefits. Our goal is to offer them resources most relevant to their needs.

🏱 Employer Problem: Total Rewards provides benefit programs and services to assist employees and their families with their overall wellbeing. Helping employees to take action on their health and engage in the right benefits and services at the right time at the right place and at the right cost is a challenge.

🎯 Team Goal & Working Hypothesis: Using real-time, chat-enabled health coaches trained in motivational interviewing and a recommender engine to guide our employees, we anticipate both:
1. An increase in employees and family members taking action in their own health
2. Increased utilization of priority programs


Designing the Benefit Experience

The first step in designing the benefit solution was getting to understand the benefit space and the employee experience in navigating them. We had some members of our customer success team experienced in that field, and partnered with benefit experts on the Comcast side. We learned that employees often find out about benefits from their employee onboarding, talking to HR, or navigating very lengthy PDF files. Integrating benefits in the Sibly experience meant that we needed to define a structure that was generic enough to afford most benefits, and specific enough to be helpful to members who get them. Here is the benefit data structure we created:


Here’s the member experience in receiving benefits recommendations from Sibly:

Member Benefit Experience

And here’s the coach experience:

Coach Benefit Experience

Revamping Onboarding

With the creation of the new wellness platform, another part of the app that was completely revamped was the onboarding. Up until that point, Sibly members had to go through a lengthy onboarding process that involved answering a 23-question survey (mentioned above). With the transition away from B2C, there was less of a need for such thorough screening, since employer-sponsored members were in general less acute and needed general wellness coaching.

Another UX issue the old onboarding had was that members were asked for their access code (what they enter to redeem the service) at the last step in onboarding. We changed that such that it becomes the first step. This was done for multiple reasons:

  • Upfront transparency & clarity: some users who are not eligible for the service felt frustration when they went through the whole onboarding, and only at the last step realized they needed an access code.
  • Onboarding scalability & customization: knowing which organization the member belongs to early on allows us to customize the whole onboarding experience for them. For example, some organizations need us to ask members some eligibility questions.

We also revisited all the copy and visuals used in onboarding to reflect the new messaging and make it more simple.

Here are some screenshots of the revamped onboarding:

And here’s a video of a prototype showing the whole onboarding experience for a Comcast member:

User Testing

After finishing the design of the benefit experience & the new onboarding, we went ahead to test it out with real users. We met with 8 Comcast employees, 45 minutes each, for a usability test & user interview. The sessions were video recorded and transcribed.

A Comcast employee using Sibly in a usability test
Goals:
  • Evaluate the usability of the new onboarding and benefit experience; is it easy to use? Is it pleasant?
  • Test the revamped onboarding messaging; do employees get it?
  • Get closer to our members, understand their needs & problems, ask them question regarding benefits and how they navigate them.
Format:
  • Intro & persona questions.
  • Using the app:
    • Onboarding.
    • Benefit experience.
  • Overall impressions & need finding questions.
Some Rules:
  • When we ask questions, we mostly make them open-ended.
  • Tried to remove bias by:
    • Introducing ourselves as “part of a research team” rather than using words like “co-founder” or “designer”. We didn’t want them to feel like they should to be nice to the creators of this service.
    • Highlighting that all feedback is good feedback, the more honest the better.
    • No judgments or reactions from the interviewer side as testers use the app.
  • Gave no prior knowledge.
  • Asked them to pretend we’re not there. We don’t answer questions immediately. If testers ask a question about what something means or how it works, we’d say “Let’s pretend that I’m not here. What do you think you’d do to answer that question?”
  • Asked them to speak their thoughts out loud. Sometimes we’d prompt them by saying things like:
    • What comes to your mind when you see this?
    • You’re having an experience / something is going on, tell us what is going on?
    • What stood out to you?

Results

Overall, testers loved the experience. They used the following words to describe it: “Smooth”, “Simple”, “Very clear”, “Easy to understand”. It was also interesting to find out that half of the Comcast benefits we were offering at Sibly were not known to these testers.

Some Quotes:
  • “Validation is important when you are feeling overwhelmed.”
  • “I’m hooked, I definitely want to continue my conversation.”
  • “I deal with anxiety. I might go to talk with Sibly before I burden my friends and family.”
  • “I have probably used things like this, like our benefits apps, but this one feels really easy to use.”

Some interesting minor usability issues were discovered. For example, when reaching the registration screen, about half the testers stopped to think. When I asked what was going on in their heads, they said they weren’t sure whether to put their work or personal email. We later fixed this by changing the placeholder text from (Email) to (Personal Email). This is because the Sibly service is designed to be portable and about the person. Meaning, if the employee left the company, they can still continue to use the service if they chose to pay for it, or if they go to another company that offers Sibly as a benefit.

Before
After

Another interesting finding was that even though testers, after finishing onboarding, knew that Sibly is a mental coaching service, they did not know how to use it; how to start a conversation, what to say to Sibly, and how Sibly can help them exactly. The scope wasn’t clear. It felt too broad and wasn’t specific enough for them. To mitigate this problem, in one of the onboarding slides, we added sample conversation starters that members come to Sibly for. Here’s the before and after:

Before
After

How Sibly Helped Comcast Employees

More than a year after its launch with Comcast, Sibly did a study with Comcast employees to measure the impact it had on their lives.

  • 154 Comcast members were asked to complete a baseline assessment.
  • 93 Comcast members completed the assessment (60.4%).
  • 31 Comcast members were sent a follow-up assessment.
  • 19 Comcast members completed the follow-up (61.3%).

Outcomes

Absenteeism
  • Sibly helps Comcast employees miss fewer work days due to mental health symptoms.
  • Members reported a 21.3% reduction in “leave hours” at follow-up.
Distress Levels
  • Comcast employees go to Sibly when they are feeling high levels of mental anguish (distress) and Sibly helps them feel better.
  • At baseline, 45% of members indicated severe distress.
  • At follow-up, the number reporting severe distress had dropped by 78%, and we saw a corresponding increase in moderate and none/mild distress as members reported lowered levels of distress.
Wellbeing
  • Comcast employees attribute improvements in their mental health to their work with Sibly.
  • 80% of members indicated that their mental health had improved.
  • 15% indicated that their mental health had stayed the same.
  • 5% indicated that their mental health had worsened.


📰 In the Press

Sibly managed to gain some spotlight. Here is some of the coverage in the press:



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