Health Visiting Digital Lab - 5th September 2016

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MON 5 SEP AT 10:30, LEICESTER
Health Visiting Digital Lab
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@digital_labLLR @LPTnhs @ChatHealthNHS
@HealthforTeens1 @WendyJNicholson @jimmyendicott
@carolinerpalmer @shinalpancholi @RuthGrantru
@lewiskat30 @emilygrundy_ @lemoncake
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Health Visiting for the Smartphone Generation
Wendy Nicholson
National Lead Nurse
@WendyJNicholson

Health visiting for the
smartphone generation
Wendy Nicholson
National lead Nurse Children, Young People &
Families, PHE
September2016

PHE
Protecting and Improving the
Population’s Health

PHE national priorities
Longer Lives
Improving health outcomes - reducing
inequalities
• Tackling obesity, particularly among
children
• Reducing smoking and stopping children
starting
• Reducing harmful drinking and alcohol-related
hospital admissions
• Ensuring every child has the best start in
life
• Tackling the growth in antimicrobial resistance
Getting it Right in Early Years
Public Health England (2014) From Evidence into Action: Opportunities to Protect and Improve the Nation’s Health

Best Start in Life
• Evidence for Early Intervention
• National support for local leadership (PLACE)
• Parent/public information
• Reducing inequalities
• Increase breastfeeding
• Improve oral health
• Support development of speech, language &
communication
• Reduce injury from accidents
• Immunisation
‘Healthy
Maternity’
Ready to
Learn at 2
Ready for
School at 5
Reducing
Childhood
Obesity

Transformed Services – Evidence Based
Practice

Understanding the world we live in
13 Longer Lives

So what’s the link to technology?
• 24% of teens go online “almost constantly”
• Aided by the convenience and constant access
provided by mobile devices, especially smartphones,
• 92% of teens report going online daily — including 24%
who say they go online “almost constantly,”.
• More than half (56%) of teens (13 to 17) — go online
several times a day, 12% report once-a-day use.
• Nearly three-quarters of teens have or have access to
a smartphone, 30% have a basic phone, while just 12%
of teens have no phone of any type
‘Get in ‘synch’ with the way I
lead MY life

How does this link to the early years?
• The next generation of parents are here and now!
• Many experiment with a range of social media
platforms such as Facebook, Twitter, blogs & Youtube.
• The vast majority of 16 to 24-year-olds use social
networks
• Supports prevention & early help
• Silver surfers – intergenerational usage and learning
http://www.qni.org.uk/docs/smart_new_world_final_web.pdf
You need to understand this world!

Why technology & the digital revolution matters
• The way parents, carers, families lead their lives
• Digital platforms can help Health Visitors provide
more timely, discreet, safe and secure services
• They help engage vulnerable families
• Offer more comfortable way for families to be
empowered & to get in touch

Getting the balance right
17 Best start in Life
Using professional curiosity to improve access and quality

Health visitor contribution: a smart new world
Health visitors have a leadership role in determining how successful the use of
technology is within a service:
• Meeting local need and improve CYP & families experience
• The right kit to support delivery & reduce burden
• Governance to support safe confidential services
• Exploring opportunities eg: CPD, re-validation
18 Best Start in Life

Success will mean …..
19 Getting it Right in Early Years

1 2 3 4
Co-ordination and
leadership
Strong local
leadership
Early years and
health services
working together
(Sustainability and
Transformation plans)
Commissioning
Integrated whole
systems
commissioning
Communication
Community
engagement: needs
and preferences and
of the local population
to develop effective
services
(Care) pathways
Vital to support
sustained
improvements in
service delivery
and quality
Korkodilos M, Earwicker, R, Perry M, Thorpe A Perspectives in Public Health 133(1):2013 Tackling Inequalities in Infant and Maternal Health Outcomes
Success requires sustained integrated
approach

Positive places for children, young people & families
There is a place for technology to support:
• ‘Getting it right for children’s services’ using all local resource public health,
Children’s Centres, early years, schools, wider family services……
• One ‘Healthy Child Programme 0-19
• Improved communication between children’s services and primary care
• Improved integration of services - access and experience for families ..
‘one stop shop’ e.g. integrated 2 year review
• Improved communication for families with complex needs and in
safeguarding
• Improved inter-professional working with joint training improving continuity
and communication for families
Getting it Right in Early Years

22 Getting it Right in Early Years
Wendy.nicholson@phe.gov.uk
@WendyJNicholson
Using professional leadership to bring about change……..

FOLLO
W US
A New Digital Offer for 0-19’s
ChatHealth Messaging Service
Jimmy Endicott
Mobile Media
Development Manager
@jimmyendicott
Caroline Palmer
Digital Clinical Lead
@carolinerpalmer

FOLLO
W US
Communications Market Report
2015
The use of text messaging has
continued to be a more popular
form of communication than voice
calling.
• Text based services - 93%
weekly use.
• Voice based services – 65%
weekly use

TRACY’S CASELOAD
Schools – 15
Vulnerable young
people in inner city
FOLLO
W US

• Imminent high risk
• 24/7
• Shared responsibility
• Availability changes
• Missed messages
• Excessive record keeping
• Identity verification
CLINICIAN’S THOUGHTS ON RISK IN MESSAGING …
Since 1980 - young people with DEPRESSION has doubled
Since 2004 - hospital admissions with SELF HARM up 70%
FOLLO
W US

FOLLO
W US
SAFETY FEATURES
• School Nurses
• Safeguarding, IG and
Clinical Governance
Leads
• Teachers and Governors
• Police
• NSPCC
• Royal College of Nursing
• Sexual health text-based
helplines
Governance and risk
assurance
• Team inbox
• Bounce-back
information
• Out of office settings
• Unread message alerts
• Automated fail safes
• Auditable transcripts
• Buddy system
• Tasking to colleagues
• Supports “casual users”
• Guidance &
competence

FOLL
OW
US
PATIENT
RECORD
FOLLO
W US

FOLLO
W US
88% students said a
messaging service would
make access to school
nursing easier and more
likely.

ChatHealth Young People
and Staff Feedback 2016

Health Visiting for the Smartphone Generation
Kamy Basra
Head of Communications
@kamybasra
Meals on Heels

Meals on Heels
I want a web page …

Meals on Heels
Audience and Objectives
• New and expectant mothers
• Family, friends and carers of the above
• Influence attitudes and behaviours

Meals on Heels
The Approach
• Co-design a campaign from concept to delivery
• 100 mums
– Focus groups
– Representative project group
– Peer supporters’ network
– Briefing packs
– Surveys
– Peer supporters’ conference

Meals on Heels
Identifying Barriers
• Don’t preach!
• Guilt when it doesn’t go right
• Embarrassment
• Lack of time
• Don’t know how to ask for help
• Feeling rubbish about myself
• Views of friends and family

Meals on Heels
Key Messages
• Empower mums about their infant feeding
choices!
• Celebrating what mums do
• Be fun – not preaching

Meals on Heels
Tactics
• Multi-media and targeted communications
• Go all out!
• Strong branded materials co-designed with
mums
• Briefing packs
• Meals on heels mobile app
• Dedicated website
• Flashmob
• Peer supporters’ conference
• Social media

Have you
downloaded the
meals on heels app
yet?
View this short demo
film – and pass it on!

Meals on Heels
Meals on Heels app
• Peer support group’s info from dedicated
page www.leicspart.nhs.uk/infantfeeding
• Peer supporters being trained to upload
your info on to the mealsonheels mobile
app
• #mealsonheels campaign hook
• Peer supporter social media activity pushing
mealsonheels app and LPT facebook page
• Developing own HV Facebook page

Meals on Heels
Raising Public Profile

Meals on Heels
Evaluation
• Over 10,000 downloads of the app
• Over 20,000 unique visitors to the webpage
• 60 mums across Leicestershire participated
in the flashmob
• Breastfeeding rates spiked and continue to
improve
• Unicef baby-friendly accreditation
• The campaign continues….

Health Marketing Websites for 0-19s
Shinal Pancholi
Digital Engagement Lead
@ShinalPancholi
Ruth Grant
Digital Practitioner
@RuthGrantru

Us …
2016
1970’s

Mission
• Raise the profile of school nurses
• Make school nurses more accessible - round the clock
• Help parents, children and young people to learn to manage
their own health
• Have clinically safe information that is age appropriate
• We started with Health for Kids
• This success led to Health for Teens
• Both aimed to release more time for face to
face contact

Health for Kids & Health for Teens
Health for Teens
Over 20,000 visitors and over
90,000 page views
Health for Kids:
Over 61,000 visitors and over
310,000 page views

Co-design with Children and Young People
Children from Leicester, Leicestershire &
Rutland were involved in:
• Concept
• Content
• Designs
• Testing
• Launch Event

New Venture
HEALTH
FOR....?
A seamless digital journey 0-19s

What do you think …
What do you think parents find difficult when trying to get hold
of access to reliable, trustworthy health advice?

What we found …
Difficulties were:
• Accessing healthcare
professionals
• Inaccurate conflicting advice
• Right information at the
right time

What they used ...
• Health visitors,
GPs and walk in
centres
• Online forums
• Friends and family
• Google
• And even
Facebook!

Life of a Health Visitor
• Overload of
information
• Lack of support
for partners and
grandparents
• No easy access to
information
• Not quickly
accessible

What the future holds for 0-5
HEALTH FOR …?
• Preparing for my
baby
• Your life as a parent
• Feeding your child
• Child Health
• Learning and play
• Behaviour
• Getting help
• Information for
professionals

Health for … ?
• Health for early years
• Health for babies
• Health for under 5s
• Health for little ones
• Health for toddlers
• Health for pre-schoolers
• Health for families

Thank you for listening. Any questions?

Want to adopt?
Enquiries
ChatHealth
Jimmy.Endicott@leicspart.nhs.uk
Health Websites
Shinal.Pancholi@leicspart.nhs.uk

Virtual Clinics, Video Calls and Web Chats
Caroline Palmer
Digital Clinical Lead
@carolinerpalmer
Katie Lewis
@lewiskat30

Virtual Clinics
2015/16

Outcomes
38 contacts (Sep 15 – Jun 16)
50% increase in contact time

What do you think are the
POSITIVES?
What do you think are the
NEGATIVES?
• Helps shy people
• People feel more confident
• Not as nerve-wracking
• More confidential
• Builds trust
• Less scary
• More open and honest
• People will open-up more
• More privacy
• Less intense
• Cannot do physical
examinations
• Cannot give out leaflets
• Cannot do tests e.g. pregnancy
Feedback
Total Sample (80) Skype Clinic Users (14)
YES NO MAYBE YES NO MAYBE
Did you know about the School Nurse Skype clinic? 91% 9% - 100% - -
Could attending a School Nurse skype clinic
improve someone’s health and wellbeing?
85% 10% 5% 100% - -
Would you or your friends attend a Skype clinic in
the future if needed?
70% 5% 25% 100% - -
User Ratings
10/10
(8)
9/10
(1)
8/10
(5)

Web Chats

Topics
( Bullying
( Anger Management
( Help, My Body’s Changing
( Healthy Relationships
( Stay safe online
( Bereavement
( Drugs and Alcohol
( Healthy Living
( Sex, Consent and the Law
( Anxiety
( Sleep
( Positive Mental Health
( Exam Stress
( Peer Pressure
( Young Carers
( Pictures and Videos online
( Smoking Information
( Consent, Sex and the Law
( Migraine
( Improving Mental Wellbeing
( Tobacco, E-cigs and Shisha
( Need help with your sleep
( Tips to improve self esteem
( Managing stress
( Protecting yourself online
( Risky Behaviour
( Nutrition and diet
( Self harm

Top 10 Viewed
Topic Date Views
Anxiety 9th Nov 15 388
Consent, sex and the law 26th Oct 15 299
Stay safe, online social networking 5th Oct 15 280
Healthy relationships 16th Nov 15 256
Self harm 30th Nov 15 248
Bullying 12th Oct 15 244
*Bereavement 16th May 15 185
*Managing stress 11th Jan 15 180
*Risky behaviours 21st Dec 15 177
* Topics are possibly more
popular – they break
chronology with
disproportionately more
hits

Topics

Reflection
Lurkers make up the majority of all online communities.
Nonnecke & Preece (2001). Why lurkers lurk.
LURKER
A lurker is a member of an online community who
observes, but does not actively participate.
This allows users to learn the conventions of the
community first, which improves socialisation when they
eventually de-lurk.
1. Want to remain
anonymous, preserve
privacy and keep safe
2. Feel shy about posting
publicly
3. Don’t feel part of the group,
new to group and learning
4. Have nothing to offer,
group is very
knowledgeable
5. Too low/high volume of
messages
6. or poor quality of
messages e.g. off topic
7. Never intended to post
from the outset. No
specific need to post
8. Poor user interface
9. Time constraints
Top reasons for lurking

Virtual Clinics
2016/17

Using Messaging with Service Users in Health Visiting
Sharon Downing
Digital Practioner
@lemoncake
Emily Grundy
@emilygrundy_

Co-design
27 events with a total of 484 parents / carers across Leicester and Leicestershire
designed to asked parents their views on the provision of the health visiting
service
• Accessibility of buildings
• Privacy & suitability of buildings
• Stop smoking support
• Dental health
• Feeding your baby
• Emotional and mental health support
• What changes would you like to see to the service from the health visiting
team

Co-design with Children and Young People

Co-design
• Easier access
• Clear expectations
• Consistent advice and support
• Positive professional support and advice
• Community groups and support

Co-design
• Single point of contact
• Phone calls returned promptly
• Facebook, texting, phone
• More support through journey

Co-design
• Right information at the
right time
• Information overload
• Leaflet overload
• Central booking
• 24 hour access
• Consistent service

Co-design where do we go from here?
• Continue to work with
families to co-design
service
• ChatHealth for parents pilot
project

Smartphone Ownership
• 90% 16-24 year olds
• 87% 25-34 year olds
• 80% 35-54 year olds
Two thirds of people now own a smartphone using it for
nearly two hours every day to browse the internet, access
social media, bank and shop online
Communications Market Report 2015

Smartphone Ownership
• Virtually all 25-34
year olds own a
mobile phone (99%)
• Half of those over
75 own a mobile
phone (51%)
Ofcom 2011

ChatHealth

How does it work?
ChatHealth is a programme which is used on a
laptop through a secure internet connection or
through VPN on a mobile phone. It has been
successfully implemented into School nursing
within Leicester and is now being rolled out into a
parents line.
Health professionals will cover the service on a
rotational basis to answer questions received
from parents of 0-5 year olds with the roll out of
the service to parents of 5-19 years olds after a
period of piloting the service.

Recruiting Ambassadors
Staff were asked if they wanted to become ambassadors to run the
ChatHealth parent line. 15 Health visitors came forward from various
areas across Leicester City and County.
Currently ambassadors within Leicestershire are a band 5 or 6.
Ambassadors will have regular meetings to discuss what is working/not
working to well and will have time to share their stories with each other.

Pilot Sites
• 5 pilot sites across Leicester City and County.
• Roll out will begin with parents of 0-5 year olds.
• Parents of 5-19 year olds will follow this.

How are we rolling it out?
• Staff are currently having ChatHealth training.
• Staff have guidance which they use alongside
ChatHealth.
• Staff work on a rotational basis covering
ChatHealth. Staff cover both City and County
messages despite which team they work for.
• Staff will be working on a buddy system and will be
paired with a school nurse that has been using the
system.

Specialist Sites
• Travelling Families
• Early Start
• Family Nurse Partnership

Specialist Sites
Each of these specialist sites has their own phone
number. Text messages received into the service are
managed by their own staff.
Specialist sites will have their own promotional
material

Questions …

Health Visiting Digital Lab - 5th September 2016

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Editor's Notes