Reviewing current services and implementation
Reviewing current services
Children and young people's mental health is an increasing national need. In 2023, 20% of children aged 8 to 16 had a probable mental health disorder. Numbers of young people in contact with children and young people's mental health services is also increasing, in November 2019 there were 231,000 children and young people in contact with mental health services, by November 2023 these numbers had nearly doubled, with 445,000 people in contact. Mental health services are struggling to keep up with the increase in need and therefore we were keen to think outside of the box and consider the use of innovative technologies to support children's mental health.
Lumi Nova is one of the technologies recommended within NICE's health technology evaluation on guided self-help digital cognitive behavioural therapy for children and young people with mild to moderate symptoms of anxiety or low mood: early value assessment (HTE3). Lumi Novia is for children aged 7 to 12 with symptoms of anxiety. It combines evidence-based therapeutic and psychoeducational content with an intergalactic role-playing game.
Reviewing the services that were already available to children and young people it became clear that there was a gap in support aimed at primary school children, with the services available being aimed either at parents or older children. Lumi Nova had the potential to meet this unmet need and so we decided to investigate ways to trial this technology within our geographical footprint.
Mental health support teams (MHST) were identified as the ideal service to implement this technology as the focus of the team is on early intervention and prevention. The use of digital technology within children and young people's mental health is a new way of working, therefore takes a team culture welcoming change and innovation. These teams were perfect for the trial as they were relatively newly formed teams and in a strong position to try new ways of working
Implementation
As the Trust, we commissioned the technology directly using the mental health support team service development fund budget for early interventions within schools.
The technology company who developed Lumi Nova were extremely supportive throughout the process of implementation. They provided as much support as was needed to make implementation as simple as possible. For example, the company arranged and led staff and parent training and also provided resource and support with the paperwork that was needed for commissioning (DTAC approval/data protection impact assessment and communication support).
When the technology was first launched within schools the policy was that practitioners would lead on referring children for the service, with mental health practitioners based within schools identifying and registering individual children. It could quickly be seen that some clinicians were strong champions of the technology and initial uptake varied depending on clinician. This process also required clinical time as each child referred had to be registered with CAMHS to access the app (with minimum data set requirements), an episode of care was opened and internal oversight needed. Clinicians are time poor and therefore in order for the technology to be a success we realised that the process needed to be adapted to reduce clinical workloads.
As a Trust we worked closely with the technology company to change the model so that parents can refer their children directly for app access. This resulted in increased uptake. The company continue to provide virtual training for parents and written information and QR codes in local GP services to raise awareness and increase the reach of access. To meet the needs of the local community the company have also translated the written information into locally used languages.
The company registered as a provider and is now listed within the mental health services data set. This reduced the admin burden for Trust staff as parents can now input the necessary data for governance arrangements.
There is an online dashboard where clinicians can access patient level data, see outcome measures for mental health and identify risk. There is also a commissioner dashboard, where trends and downloadable data packs can be reviewed.
Throughout implementation we as a Trust have considered the needs of the local community and have worked to provide feedback to the company to help the technology be as useful as possible. For example, digital poverty was a concern and as a result the company have adapted the app so that it now runs on older operating systems widening access.