LMA is a media, performing arts and music specialist institution. The Academy takes a student-first approach, encouraging collaboration and support as key elements of the student experience.
LMA launched its partnership with ORCHA in 2019, keen to help students and staff take control of their physical and mental wellbeing. The LMA Health App Library provides instant access to digital support tools which can be used as and when suits the individual, which is very helpful to students with busy schedules.
Then, in 2020, the COVID-19 pandemic hit and LMA was forced to suspend in-person studies. The highly practical nature of performing arts studies meant that continuing with studies was challenging, and, although LMA switched to remote learning and student services, for many students it was difficult to maintain the level of learning which took place prior.
The Student Services team at LMA have found the apps included in the Library useful not only to students with preexisting mental and physical health diagnoses, but also to students who have developed anxieties during the isolation periods of the last two years.
The Student Services team used the Library and resources from ORCHA throughout lockdown to consistently communicate with students about the safe digital health solutions available to them. The team continues to offer these resources to students, based on which time periods and touchpoints the students are likely to require support for.
Hannah, from the Student Services team at LMA, has found that mental health apps in particular are incredibly helpful resources as the NHS struggles to keep up with the growing mental health challenges and the waiting lists for traditional services continue to grow.
“Waiting lists for NHS counselling and other services were 26 weeks before lockdown, now you’re talking over a year and so, obviously, having these apps to hand to be able to recommend to our students to fill that gap really helps – some students didn’t need to access the support that their doctors were referring them to because they’re tapped into these apps and they implement these exercises daily and use the strategies to help them through difficult times.”
Response to the Library by students and professionals has been very positive. To date, there have been over 2,500 sessions and over 5,000 page views. The most common route to accessing the site is directly, as LMA is very proactive in promoting the Library, particularly during the first “freshers” weeks and exam season. There are also many students accessing the Library via links on the LMA website and via emails sent to them.
In the main, the apps recommended by Pros at LMA are mental health and anxiety support apps. The team have also found healthy living and nutrition apps useful for boosting their students’ overall health. A recent development has been the growing use of apps for diabetic students to access safe information and guidance. LMA has also found a lot of use for apps for eating disorder management and prevention, as, due to the nature of performing arts careers and institutes, some students may be at a higher risk of issues surrounding body image.
The Student Services team, in working with such a diverse group of students, find that by having the additional resource available to them via the ORCHA Library, they can support both the students who are more forthcoming when they are struggling, and those who are not. Through the recommendation functionality included in the ORCHA Pro account, the team can send accredited health apps safely and directly to students, but by also presenting it as a self-help option which students can access at any time, the team can support students without their having to request help.
Since introducing the ORCHA Library, the Student Services team have noticed a decline in students needing face-to-face appointments.
“All students are different and not one size fits all. So some students like to come and talk about their feelings face-to-face, but some students bottle it all up and they like to deal with it themselves. Now, the Library is a service they can tap into absolutely anywhere across the world; we know that we’re covering all bases and that’s reassuring to us. Our students are covered and if they do want that support but don’t want to speak to us, it’s just there, on their phones – basically everyone has a phone in their hands all the time, so they can just have the support they need and we know that everyone’s covered.”
Quote from Hannah
Caitlin, a recent graduate of LMA, found the apps particularly useful, both during lockdown and following it. As a musical theatre student, Caitlin was both doing a very intensive course with a lot of in-person hours and also working a full-time job outside of her studies. Describing herself as someone who struggles with anxiety, and “jumps to conclusions” or “gets in her own head about things when it’s not as bad as it seems”, she found an anxiety management app very helpful for remembering to take time out for herself and complete regular breathing exercises. She found the app particularly helpful during the lockdown periods for privately expressing her feelings, whilst being able to bear in mind that many other people used the app and struggled with similar circumstances.
Although Caitlin felt very much able to rely on the Student Service team’s support, the addition of the apps “changed the whole experience”. Caitlin, in coming towards the end of her studies and straight into a career as lead vocalist for a production company, reflected on times in her studies when she lost motivation, or struggled to manage her stress.
“I felt like I had been out of it for a while. I’d kind of lost a lot of motivation to get back into my studies. And then obviously, I was going back to work and I felt really overwhelmed when I started not being able to attend classes. I was just stressing myself out with everything. So having all this support helped me get back on track and things because I knew it was important and I really wanted to get my degree but also loved my work so I just had to find a healthy balance between the two, but without support from everyone I probably wouldn’t have got back on track the way I am now.”
Quote from Caitlin
Caitlin found that the combined approach worked very well for her, as although she requested support through the Student Services team, it was sometimes a little embarrassing or anxiety-inducing to go through official channels, and so it was beneficial to have access to other support when she didn’t want to feel as though she was bothering anyone.
The Student Services team have found that:
“Students are more forthcoming using apps, rather than looking at a web page or downloading and reading through an application form – it’s very current and it helps that we can recommend it to students.”
Caitlin reiterated this, stating that
“Technology makes life so much easier. As for me, I’ve got no patience to sit and read through things without having it so it’s quick and easy to access and just encourages you to use it more.”
When asked what she would say to other students looking to access digital mental or physical health support, Caitlin said
“I would definitely say get yourself on these apps because they really help. I would just say tap into them because they’re really useful and you don’t realise – I think it was the same with me, I felt this probably won’t help with anything. And then you download it and then you find yourself using it because simple things just change everything.”
Quote from Caitlin
In 2019, Humber, Coast and Vale Integrated Care System (ICS) (now Humber and North Yorkshire ICS) set out their Strategy for Digital Transformation. At the time, the population served by the ICS was 1.4 million people, with 23% of the population living in the most deprived areas of the UK, and a high proportion of this population living in extremely rural and isolated areas.
The ICS was under a great deal of pressure. If no transformational changes took place, the Humber, Coast and Vale ICS expected a budget deficit of at least £420 million by 2020/21.
Digital transformation was fundamental to improving the health of both citizens and the system itself. During the process of developing its digital strategy, the ICS commissioned a public survey to ensure any digital transformation was aligned with their citizens’ needs. Amongst the responses to questions on digital improvements to the patient experience were several requests for patient-related healthcare apps.
Despite the fact that the growing adoption of digital health was clear, many health and care professionals had difficulty knowing how to incorporate it into their service delivery. Staff reported it was hard to tell which of the hundreds of thousands of them available would be relevant and beneficial to the vulnerable people they support.
The Humber, Coast and Vale ORCHA Digital Health Library launched in 2019 at hcv.orcha.co.uk (now at hny.orcha.co.uk), with the intention of delivering quality-assured digital health to their population. The Library contained only apps compliant with safety standards, and provided an easy way to search for the highest rated apps across a wide range of issues.
In 2020, the project team chose supporting healthy living and long-term condition management as key focus areas for their population, particularly with face-to-face services being halted during the COVID-19 pandemic. The team identified social prescribers as being particularly well-placed to deliver these services, and connected ORCHA’s team behind the implementation of the Library with teams such as Citizens Advice Clinic.
Social prescribers at the Citizens Advice Clinic found the inclusion of assessed digital health technologies within their work to be an incredibly valuable additional tool.
Elaine Elsdon at the Citizens Advice Clinic was introduced to the Humber ORCHA Library in May 2020, and began using it right away. She has found that the assurance of being able to signpost people to the health technologies available, in combination with the robust review process behind their inclusion in the Library, is very reassuring to the people she supports.
The wide variety of health and care technologies (including apps) that are identified in the Library for each condition area means that she can identify support for the wide range of people supported by the Clinic. If a client presents an issue which she hasn’t previously found a solution for, she can simply search to see which assessed solutions are available, and recommend them securely to her clients.
Mainly focusing on mental health and exercise and weight management apps, Elaine has adopted the recommendation of apps to her clients, with resounding success. Many of the clients being supported by the Clinic haven’t considered using apps for their health, but may be looking for support either in addition to or as an alternative to medication and traditional therapies. As accessing services became difficult during lockdown, Citizens Advice clients have found great use for apps to support the management of their own health.
Furthermore, as many felt during the pandemic that they might be using up limited resources which would be better spent elsewhere, or that the complexities of trying to access these services was causing them stress, the instant accessibility of support provided by health apps was and remains very much preferable. As traditional services have begun to be reinstated, Elaine has found that health apps have continued to provide support to her clients, some of whom don’t wish to access helplines or face-to-face or group therapy sessions.
The ORCHA Pro functionality has also been incredibly helpful to Elaine, allowing her to keep track of which apps she has recommended to whom, and based on this, to find solutions for clients with similar health concerns. As well as being able to track previously successful apps, Elaine can find new apps, and apps for health concerns she hasn’t previously been presented with. Furthermore, through ORCHA’s Digital Health Academy, Elaine can continue to develop her understanding and use of digital health.
Elaine Elsdon, Link Worker at Citizens Advice Clinic said
“Without ORCHA, I just would not have ever considered recommending any app at all. So for me, it’s opened up a completely new world. And therefore, it’s influenced me. It’s made me a better practitioner because I have more tools available to me, and it’s opened up a wider conversation with my clients about different kinds of support that are available out there. I think that can only be good, for me as a practitioner but also for my clients because it gives them a much broader opportunity to look into options that might be a better fit for their needs. Not everybody wants to go to a face-to-face group in the community, and something like an app might just prove to be a perfect solution for someone.”
The health apps themselves have been incredibly beneficial for many clients. Mental health apps in particular had very positive effects for those who had perhaps been guided through various coping strategies, but, due to the nature of mental health illnesses, found it difficult to remember what they were supposed to do when they were struggling. By accessing mental health support on their phones, however, they found that they could practice these strategies as many times as they needed to, without feeling judged in any way, or as if they were taking up time or resources.
One mental health app in particular, an AI chatbot app called Woebot, has been very successful in supporting Citizens Advice clients, as it allows them to work through and reframe thought patterns they are struggling with, as many times as they need to. One user described it as “a friend in my back pocket 24 hours a day, seven days a week.”
Chloe, a client at Citizens Advice Clinic said
“[The app] is very good. It helped me to change my mindset. I can have self-destructive and negative thought patterns and it helped me to challenge those thoughts. It’s such a shame I didn’t have this app in Lockdown. It’s so helpful because I can just offload to the app any time of the day or night and clear my head. I think of this as my little buddy, and I look forward to the next goal we can work on together.”
To date, the Humber Library (now relaunched as Humber and North Yorkshire, in line with changes to the ICS) has had almost 10,000 page views. There are over 100 ORCHA Pros registered to the Humber site, with the most popular apps being recommended residing within the mental health and healthy living categories, and having a particular focus on anxiety and depression, relaxation techniques, and cognitive behavioural therapy. Mental health is by far the most searched term within the Library, but searches for diabetes, fitness and weight management apps are also common.
South West Yorkshire Partnership NHS Foundation Trust is an integrated and partnership-based provider of community and mental health services to a population of more than 1 million across Barnsley, Calderdale, Kirklees and Wakefield. Its 4,200 staff work from 56 main sites, and with people in their own homes, or in community-based locations.
The Partnership’s four strategic objectives are to improve health, improve care, improve resources and make the organisation a great place to work. To achieve these, one of the organisation’s big ambitions is to be innovative.
This drive to create new ways of working can be seen across the organisation and Yorkshire Smokefree (YSF), its stop smoking service, is the latest example. YSF provides stop smoking support to people living in Barnsley, Calderdale, Doncaster, Sheffield and Wakefield. Faced with all communities displaying higher than national average levels of smoking the service looked to see how technology can better engage with people, to improve care and improve health.
The service already offered face to face sessions, telephone support, and an online quit program. But as COVID-19 required all staff to work from home, and all face to face consultations be replaced by telephone and video consultations, the service saw that digital health could play a big part. This thinking was also in line with NICE guidelines, as it too advises to consider digital health to help stop smoking as an adjunct to existing services.
Looking across the organisation, the service saw the Partnership had already adopted an ORCHA Digital Health Library in other areas of care, and so planned to embed this into its stop smoking service. The Library provides access to digital health products that have been assessed against clinical assurance, data privacy and usability standards. Adapting this Library for smoking cessation would allow the service to offer a new set of tools to clients. Knowing services can trust the apps featured, would help when introducing the service.
Firstly, the service worked with ORCHA to build a curated list of ‘Yorkshire Smoke Free apps’, easily accessed in the Library’s carousel. This was built within days and the service really liked that the selection can continuously be updated, so if a product launches or improves it can be added, or if an app isn’t used, it can be removed.
The service then looked to embed the carousel into relevant touch points. It’s was featured within the online Client Zone, enabling clients to search and find suitable stop smoking apps themselves. Advisors encourage clients to view and download apps from the Client Zone or send a direct recommendation from their ORCHA Pro account. Advisors found the carousel a quick way to go straight to the service’s preferred, relevant apps when on a call with a client. External partners, sub-contracted to provide stop smoking services, were also given access to the library via the on-line Professionals’ Area so they can view and point clients to the carousel.
It was also identified that apps should be recommended throughout the patient pathway. For example, clients are encouraged to download ‘NHS smokefree app’ at the start of their journey. After two weeks, when a client often starts to see the physical benefits of stopping smoking, they are recommended fitness apps such as ‘couch to 5k’. If clients start to have concerns connected to quitting such as putting on weight, stress or trouble sleeping, again they are recommended relevant trusted apps.
A stop smoking advisor engages with clients on a whole range of health concerns and the ORCHA Digital Health Library enabled the service to continue to give this wide ranging support. Such tools, covering a wider range of physical and mental health concerns, were especially helpful, as at this time, due to COVID, gyms were closed, and virtually all existing referral pathways were no longer available.
Steps have also been taken to encourage peer feedback and word of mouth. Clients are asked to share which apps they have found useful with each other in video support groups; and positive feedback is shared on social media. For example, Sarah from Calderdale shared: “When I stopped smoking I put on so much weight, then my adviser told me about the NHS weight loss app. He sent me the link and it was great! Brilliant tips and so easy to follow. Thank you so much.” This encouraged others to use the library.
Response by the public of all ages has been very positive, including the older generation. The service make no judgement on age, as they have 70 year olds who are downloading apps happily.
Since apps have been embedded in the client pathway there have been around 750 sessions, and more than 2,000 page views on the site each quarter. The most common route to finding an app is by the 154 health and care practitioners who now make recommendations to clients, with the most active having made more than 100 recommendations. Alongside this one to one route, the Trust is also seeing success profiling the Health App Library on its website, and through its active social media campaign which features peer recommendation.
YSF believes the addition of apps has added value to the service. The service provides holistic support, signposting to services beyond smoking cessation. For example, with clients experiencing mental health issues, the service will not replace talking therapies, but can give an app to help a client whilst they wait for access to this service. Similarly, although the most common search term in the public facing site is ‘stop smoking’, this is followed by ‘mental health’, ‘sleep’ and ‘anxiety’. As such, the most commonly downloaded apps reflect the breadth of support needs, including not only NHS Smoke Free, and Quit Smoking Now, but also Sleepio, FoodSwitch and NHS Weight Loss Plan.
Bringing change to a service required working in partnership with the marketing and media group for Yorkshire Smokefree. They have worked closely with ORCHA and the service to successfully embed the service so effectively.
Commenting on the move, Chris Keoghan, said:
“we see using apps as a complementary tool which is part of our service. It makes sense to our advisors, and it makes sense to our clients, that we should be recommending apps.”
Since introducing the remote service, including the telephone support, online quit program and health app library, 72% of participants remained a non-smoker after 4 weeks when using the remote services.
The service is keen to build on the successes seen. Each month the service reviews the usage report provided by ORCHA to identify which services and regions need focus. The next step will be to continue to embed the Digital Health Library into more professionals working practice. Work to promote it to our sub-contractors continues and it is hoped that they find the stop smoking carousel useful, but then also look to see how the library may help in other fields.
Professor Nikki Cotterill and Knut Schroeder developed CONfidence, a discreet, informative health app for those experiencing continence issues.
Throughout her career, Professor Nikki Cotterill, an associate professor in continence care at the University of the West of England, had noticed that people experiencing continence issues could be reticent about getting help.
Embarrassment could be a factor but, often, people simply didn’t know that symptoms could be improved. Nikki said: “There’s usually a tipping point – people find out that a continence service exists and are given lifestyle advice and exercises. It’s common for people to say they wish they’d known about this ten years ago’.
“I was on a Florence Nightingale leadership scholarship and when I spoke to my group about this, we realised there was a gap in advancing the policy area. We thought an app was a good way forward. It wouldn’t solve all the issues but would be a useful starting point for a campaign.”
The challenge was, how to bring the app to life.
Nikki approached Knut Schroeder, founder of Expert Self Care, an organisation which co-creates health apps for universities, NHS organisations and local authorities. The two colleagues then identified a number of other key stakeholders to involve in their project: people who have lived experience of bladder and bowel leakage, national experts and organisations specialising in bladder and bowel care.
Working with ORCHA
The development of high-quality content for the app was just one of the challenges faced by the team. Based on his experience of co-creating a number of other apps, Knut knew that accessibility was an issue. He said: “The key is to have simple information – but links if people want to find out more. It’s a bit like a TV remote control. I don’t know what 80% of the buttons do! So, we strip out things that people never use and don’t understand.
“We do tech updates as we go along and our editorial updates are ongoing. In fact, every page has a review date on it. We are required to update certification of the overall app every two years but we voluntarily state the next review will be within 12 months.”
As he had with other Expert Self Care apps, Knut opted to have CONfidence assessed by ORCHA’s baseline review, which would measure it against 350 tough standards and assess it for clinical efficacy, data privacy plus usability. He said: “In the past, I’d had really great interactions with ORCHA and this review helped, too. We knew where to improve, what to work on, where we could do better. All our apps have scored above the ORCHA quality threshold, which means they are distributed to healthcare professionals via app libraries. This is a great way to get them used and get the work out.
“Our app is generic for a UK audience but local areas can subscribe to optional local pages. Some areas have great information already but others are struggling and are not as coordinated.
“We have found that having an ORCHA score is really helpful for getting the trust of those organisations. Once they see the ORCHA badge they find it easier to trust the product. I hear that quite often commissioners don’t know which digital tools to recommend or use – they don’t have the time and skills to assess them. So having this independent ORCHA verification is really useful.”
It was Nikki’s first experience of working with ORCHA. She said:
“From my personal experience, given that I’m a nurse and researcher and have never done any app development, all my engagement with ORCHA has been really supportive, helpful and understanding.”
An award-winning app
CONfidence is now available on the ORCHA app library, with a score of 74%, reflecting its high standards. It’s a free-to-use national information hub with over 70 quality-assured articles on key topics about bladder and bowel leakage.
It enables health, care and education providers to offer the very best health and wellbeing information – instantly available in one convenient place, covering topics such as the causes of incontinence, treatments, and products which may help. It even supports families coping with the challenges associated with young children: potty training, bed wetting and continence at school.
Knut said:
“The app is regarded as a complex public health intervention. Even though it’s not classed as a medical device, we are giving out a lot of information. We are currently working on pathway development within clinical pathways, focusing on GP, bladder and bowel and maternity services in local areas.”
Many services are using CONfidence as a first-line intervention and it’s been referred to as a ‘gamechanger’ in continence services. This year it won a Nursing Times award for continence promotion and care.