Webinar summary: Making sense of Digital Support options for better youth mental health
The strain on children and young people’s (CYPs) mental health services is apparent and acute, resulting in a frustrated workforce having to deal with the added challenge of increasing levels of complexity and acuity in cases.
Digital health technologies (DHTs) provide a compelling solution to fill this gap and adoption rates have increased significantly since the onset of the pandemic. However, navigating ‘which’ DHT to adopt, integrate into care pathways and ‘how’ is complex, with multiple barriers and pain-points.
We hosted a webinar on 2nd February 2023 which unpacked the challenges of commissioning digital health technologies to support CYP’s mental health and examine real world experiences and learnings when embedding digital health technologies.
We had a stellar line-up of expert speakers to learn more about differentiating, adopting, implementing, utilising and achieving outcomes with DHTs including:
Dr Tim Clarke
Principal Research Clinical Psychologist – Norfolk & Waveney CFYP Care Group
Clinical Advisor – East of England Clinical Networks - NHS England & NHS Improvement (East of England)
NIHR ARC Implementation Fellow (East of England)
CYP MH Clinical Advisor - Norfolk & Waveney CCG
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John Sainsbury
Innovation Manager, Greater Manchester Mental Health NHS Foundation Trust
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Hayley Payne
Programme Manager, NHS Gloucestershire ICB
Beth Gibbons
Programme Manager for Children's Mental Health & Maternity, NHS Gloucestershire
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HOST
Manjul Rathee
CEO & Co-founder of BFB Labs - democratising access to timely mental health support
Here’s a summary of speaker presentations and key takeaways:
Dr. Tim Clarke, Principal Research Clinical Psychologist – Norfolk & Waveney CFYP Care Group. NIHR ARC Implementation Fellow (East of England)
In Dr. Tim Clarke’s presentation ‘Not all digital health technologies are created equal’, Tim highlighted his personal journey of overcoming key barriers faced by providers. Takeaways include:
Clinicians and practitioners speak a different language to those that are developing such interventions. This can lead to avoiding and not making full use of digital mental health interventions. It's really important to work closely with technology companies to understand their language, and to ensure they also understand practitioners' language.
Attitudes and expectations around digital mental health interventions can divide opinions among clinicians, commissioners, families, and young people. It can be really confusing to know which digital product or intervention to select, or to recommend - for example - does it have good-quality evidence behind it. NICE provides the evidence standards framework that a digital health technology needs to demonstrate in terms of value to practitioners and systems. Organisations that help review health and social care apps e.g. ORCHA, can also help to make sense of them.
Emerging findings from an ongoing study on Lumi Nova and digital CYP MH interventions more widely, funded by NIHR Invention for Innovation (i4i), provide important learnings on the successful implementation of digital mental health intervention for young people.
The need for specific roles or teams with frontline service delivery experience, at a local system or regional level - responsible for supporting the implementation of digital mental health interventions.
Ensuring the voice of children and their families in development and implementation.
The importance of adapting digital interventions to the individual needs of certain populations and promoting accessibility and inclusion.
Of paramount importance is supporting clinicians buy in to integrating a digital intervention into a treatment pathway to ensure successful implementation.
Dedicated funding for adoption and implementation of digital technologies for CYP mental health.
Hayley Payne, Programme Manager, NHS Gloucestershire ICB
Beth Gibbons, Programme Manager for Children's Mental Health & Maternity, NHS Gloucestershire
Hayley and Beth shared learnings from two case studies which can be summarised as follows:
Digital is seen as a low priority, with services, schools and commissioners who are all feeling overstretched and not having enough head space to ensure a measured approach to considering digital options or lacking digital literacy. These are all barriers to starting conversations. There is a need for extra thinking time and a focus on the evidence base to build digital projects.
Working closely with the technology company is essential – with Lumi Nova, BFB Labs stuck with us, and supported us throughout every stage of our journey - that's important - the relationship with the digital provider is vital.
Governance is another major challenge, as there is a lack of understanding of how digital fits into commissioning and a lack of streamlined approval processes.
Managing the expectations of digital, with some feeling nervous about how it can complement rather than replace clinicians.
There is also a perception that digital is a cheaper alternative, when in fact it requires investment and external expertise.
Ensuring continuous improvement and co-creation and that there is adequate funding allocated for this.
John Sainsbury, Innovation Manager, Greater Manchester Mental Health NHS Foundation Trust
John’s Sainsbury’s presentation ‘Health Tech Adoption Journeys in the NHS’ focused on the journey of adoption and development of new systems using S-curves and the Hero's Journey narrative to illustrate barriers and enablers in creating ‘step change’ . Key takeaways:
S-curves can be found in nature and human systems and describe the development and improvement of products and services over time. The Hero's Journey is an archetypal journey of the hero that can be applied to mental health recovery and health tech adoption.
The ‘Call to Adventure’, is the need to deliver evidence-based interventions to meet CYP mental health needs as early as possible.
John used three case examples: Game Change VR - real world pilot implementation of exposure therapy for people with psychosis & anxious avoidant experiences/behaviour, Management and Supervision Tool (MaST) - ‘pilot and scale’ roll out of a dashboard of structured data-driven insights for staff in Community Mental Health Teams Management and Supervision, and Lumi Nova - implementation study for children from deprived areas within Greater Manchester in partnership with MH support teams in schools.
“A key principle of systematic innovation is that somebody, somewhere has solved the problem.” He highlighted how the Oxford NHS Trust Global Digital GDE Blueprint was used in the Game Change VR project. He emphasised how the NASSS Framework, of Prof. Trishia Greenhalgh & co, can help understanding of complexity in health tech implementation.
‘Crossing the threshold’ is when you’re in business and have investment, funding and instructions to get on with it.
He shared how there will be tests, allies and enemies. In health tech deployment in the NHS ‘tests’ takes the form of project set up - governance, authorisation, ethical approval, IG, DTACs, Clinical Safety Cases. ‘Allies’ help with the heavy lifting, & cutting through barriers, while ‘enemies’ can add layers of bureaucracy - they can however, enable us to think more deeply and incorporate other thinking styles.
He discussed the ‘Approach the innermost cave’ and how at this point, the stakes are raised and the project may be close to life or death. Here, it’s time to call on clinical leaders to recommit and get champions to on board people and share their learning. Here it’s time to think creatively by using tools such as de Bono's 6 thinking hats.
‘The Ordeal’ is where hope appears lost and “hostile forces are in their strongest state of opposition.” He discussed how ‘Inventive Principles’ can generate solutions. The ‘Reward’ can be a product, learning or inner change that was sought at the outset of the health tech journey.
John described how peer expertise sharing can be a pivotal point in implementation and how it helped filter and make key decisions.Committed local/ground level leaders are probably the most crucial influences of success.
‘The end of the journey’ - the hero has returned with knowledge, love, wisdom or treasure. With Game Change the RCT has gone through the entire cycle. The real world implementation pilot and that of Lumi Nova study are still in the early phases or mid phases of the hero's journey.
The readiness for digital health tech interventions will require
Strengthening innovation capability maturity
Giving people confidence to give things ago
Measuring return on investment
Learning innovative thinking methods