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Abstract Introduction Perinatal mental health conditions are common yet frequently undertreated. Perinatal collaborative care models improve access to evidence‐based care but face implementation challenges related to workflow efficiency and scalability. Digital innovations may enhance care delivery and sustainability within perinatal collaborative care models. This study evaluated whether a technology‐enabled service, designed to support and streamline care manager workflow in a perinatal collaborative care model, improves depression and anxiety symptoms, patient satisfaction, and engagement compared with the collaborative care model without digital support tools. Methods This randomized controlled trial was conducted from October 2022 through January 2024 within a perinatal collaborative care program serving five obstetric clinics in Chicago, Illinois. Participants included 75 pregnant or postpartum individuals enrolled in collaborative care with symptoms of depression (Patient Health Questionnaire‐9 [PHQ‐9] ≥ 5) or anxiety (Generalized Anxiety Disorder‐7 [GAD‐7] ≥ 5). Participants were randomized either to a technology‐enabled service incorporating a cognitive behavioral therapy mobile application with text‐based coaching and a care manager–facing dashboard or to usual perinatal collaborative care without digital tools. Depression and anxiety symptoms were assessed biweekly for 12 weeks using the PHQ‐9 and GAD‐7. Score results were analyzed using generalized linear mixed models. Additional outcomes included symptom response (≥50% reduction from baseline), symptom remission (PHQ‐9 and GAD‐7 < 5), stepped care utilization, patient satisfaction, and engagement. Results A total of 75 individuals were enrolled with 38 randomized to the technology‐enabled service. Depression (β = −0.24; 95% CI, −0.45 to −0.03) and anxiety (β = −0.24; 95% CI, −0.46 to −0.03) symptoms improved over time in both groups. There were no significant differences between the technology‐enabled service and usual care groups for depression (β = −0.06; 95% CI, −0.06 to 0.17) or anxiety (β = −0.06; 95% CI, −0.30 to 0.19). Response and remission rates did not differ between groups for depression (43% vs. 53%, p = 0.4; 46% vs. 32%, p = 0.2) or anxiety (35% vs. 55%, p = 0.08; 32% vs. 32%, p = 0.9). Stepped care occurred in 21% of participants in the technology‐enabled service group and 20% in the usual care group (p > 0.9). Engagement at the study midpoint was higher in the technology‐enabled service group, while satisfaction was comparable across groups. Conclusions Although symptom improvement was similar between groups, the technology‐enabled service improved patient engagement within perinatal collaborative care. These findings suggest that while digital tools may not directly benefit clinical care, they may enhance operational efficiency and support the scalability and sustainability of perinatal collaborative care models. Trial Registration ClinicalTrials.gov identifier: NCT05525689
