Messaging with young people about anxiety -blog

We were lucky enough to have Jo Bates, Emotional Health Nurse, Leicestershire Partnership NHS Trust as a guest speaker recently on the national ChatHealth conference call. These calls take place every 6 weeks, chaired by Caroline Palmer, ChatHealth Clinical Lead and leads from all of the ChatHealth services across the country are invited to take part.

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Nurses from the Suffolk County Council ChatHealth team celebrate one year anniversary

In November 2016 School Nurses from Suffolk County Council celebrated their ChatHealth one year anniversary. The messaging service has allowed young people in Suffolk to send text messages to a dedicated number in order to receive support from School Nurses on a wide range of health and wellbeing issues including self-harm, bullying, drug and alcohol use, smoking, healthy eating, sexual health and mental health.

A messaging service was introduced by the organisation with the aim of improving access to the school nursing service to widen participation and enable early intervention, as well as improving efficiency of current resource. Traditional ways of contacting the school nursing service also remain including their well-attended drop ins in secondary schools.

A review of the Suffolk ChatHealth service has been carried out at the end of the first year of implementation. The text messaging service has been found to be positively received by staff, young people and clients with key benefits demonstrated as follows:

  • An increase in contacts to the School Nurse service
  • Access to the service available throughout school holidays
  • The School Nurse service was used by those who had not previously used it
  • Some students accessed the school nurse for the first time
  • Access to the service was provided to young people and parents/ carers not in mainstream schools e.g. home educated pupils
  • There is Improved governance in managing text messages
  • Most queries were dealt with in a timely, efficient manner and therefore there was a cost benefit to service

A number of challenges in providing the text messaging service have also been identified as follows.

  • The ability to cope with increased demand
  • Staff availability to respond to messages in a timely manner
  • Delivering a consistent approach to queries
  • Staff confidence in delivering health advice in this new way
  • IT equipment and infrastructure
  • Continual marketing of service is required

The varied range of health queries asked via the text service reflects the topics asked within School Nurse face to face contacts. The majority of conversations related to emotional health and wellbeing (39%), followed by queries regarding physical health (32%) and sexual health (10%). Requests to see a school nurse accounted for 19% of messages. An impact on health outcomes have been demonstrated in the majority of conversations and a number of case studies to illustrate the broad range of health advice and support given, and impact gained can be found here.

Bethan Stott, Clinical Health Manager, CYP Health, Suffolk County Council

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Guys and St Thomas ChatHealth Team – Consultation with the Metropolitan Police

Nurses using the ChatHealth messaging service are equipped with a Standard Operating Procedure (SOP) which provides comprehensive guidance around messaging with service users – particularly in relation to young people at risk of significant harm. The guidance has been developed following consultation with school staff, parents, governors, clinical leads, school nurses and safeguarding colleagues, as well as other organisations with relevant experience, including Leicestershire Police, NSPCC, Royal College of Nursing and some sexual health message-based helplines.

Following the launch of their messaging service in October 2016, nurses using the ChatHealth messaging service within Guys and St Thomas NHS Foundation Trust have recently met with representatives from the Metropolitan Police to think through the process of responding to anonymous messages which indicate a risk of significant harm.

Richard Cross, Safer Schools Police Sergeant and Sian Sweeting, Assistant Manager, Met Communications Centre have visited the team to highlight some of the difficulties they can face when locating a person solely by using their mobile number. As a result an aide memoire has been created and added to the teams SOP to provide nurses with guidance on how they can aid emergency responders in the identification and location of a young person where there is a risk of significant harm.

Nicola Wales, Specialist Community Public Health Nurse, Guys and St Thomas NHS Foundation Trust has been keen to share this learning with nurses from other organisations using a messaging service and this is now available to view on the ChatHealth staff website.

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ChatHealth Launch in Hampshire

Blog by Jane Levers, Professional Lead for School Nursing

Growing up can be tough at times. Do you ever remember feeling stressed, sad, lonely or worried during your teenage years? Were you worried about the way your body was developing or spots on your face, or sad because a pet or relative had died? We may have had friends or family members that we could turn to for advice and support, but I think many of us can think of times when we didn’t know who to speak to, to get reliable confidential information. Young people these days have the added complication of navigating social media, chat rooms and conflicting internet information. A little worry or concern can become much bigger if we don’t seek help early enough.

I am really excited that as a School Nursing service we have launched ChatHealth in Hampshire. ChatHealth is an award winning young people’s texting service which has been successfully rolled out to many areas in England. Young people were involved in the initial design and delivery of the service so that it suited their needs.

In Hampshire the service is manned by our Specialist Community Public Health School Nurses. Our School nurses are skilled in working with children, young people and their families and have ongoing training and supervision. ChatHealth enables young people aged 11-19 to get evidence based health information, advice and support from a health professional.

The service is open 8.30-16.30 Monday – Friday [excluding bank holidays]. This means that young people are able to get support during school holidays when they may be feeling at their most vulnerable, such as when they are moving to a new school year and when they may not have the support from friends in school. During weekends and evenings users will get a bounce-back when they text the service to direct them to information until a School Nurse is able to return their message during the working day.

Having a texting service does not replace face to face contact from a School Nurse it just increases the ways that young people are able to communicate with a health professional. Young people are still able to access a school nurse in a health drop-in or through a direct request for support.

Jane Levers, Professional Lead for School Nursing, Southern Health NHS Foundation Trust

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Patient privacy and safeguarding the digital generation

In this smartphone age, healthcare providers are encouraged to be digital by default. Whilst service users administrate their lives on mobile devices, we aspire to offer them more choice around how they communicate with us. You’ve probably noticed how access to our services is increasingly provided via websites, email, social media, mobile apps and messaging these days, in addition to “traditional” face-to-face contacts. It all aims to improve convenience and timeliness.

As digital data becomes the prevalent currency in communications, privacy is higher on service users’ agendas. Choose any big brand social media site and you’ll find users discussing how best to configure their privacy settings and whether or not they are comfortable with how the operator uses personal information.

When we invite service users to contact our frontline services digitally it involves them submitting personal data (like their contact details) by default. You are probably already aware of two operational basics that help us respect their privacy in these circumstances:

Firstly, it’s suggested that if a service user initiates contact by one method, you should generally respond via the same method unless otherwise specified in advance. For example, in relation to engaging with young people through text messaging, the Royal College of Nursing says, “Mobile phone numbers that are collected in two-way messaging services must not be used for any purpose other than to respond to the text. If you need to make verbal contact with the young person, you should obtain their consent by text message first.”

Secondly, service users are generally entitled to prevent us from using their personal data to make digital contact with them. For example, the Data Protection Act ensures any person can stop an organisation from using personal data to send unsolicited direct marketing messages. Along these lines, best practice in healthcare might be to provide the opportunity for service users to ask that we respect their digital privacy. Using the example of a young person’s messaging service again, this could be as simple as saying, “Text STOP to prevent the nurse from contacting you” in the small print.

You might consider this second suggestion quite a stringent application of the act. Why? Because our frontline clinicians aren’t usually sending unsolicited direct marketing bumf – they are more likely to be responding to complex personal enquiries across a broad range of health issues. This is where our duty of care to safeguard the service user begins to influence how the statute is applied. So, what exactly do we mean when we say “a confidential service”?  And how we interpret the act when we need to process personal data – say to safeguard risk to life?

Staying with the example, let’s say a young person sends a nurse a text messaging disclosing that they are at risk of harm. They have provided us with their mobile phone number but not their name. Although they have sent the message anonymously, they regret their disclosure and quickly follow up with a message requesting us to STOP further contact. How does the nurse now exercise their duty of care?

Here are two options:

A referral to emergency services could be made. In the majority of cases the police would be able to locate the user via their mobile number and conduct a safe and well check. Your view on whether this is appropriate might be influenced by how your organisation or professional group defines your specific duty of care and what guidelines they provide on breaching confidentiality without consent. Approaches differ between professional groups and organisations. Depending on the nature of the disclosure, this escalation could seem unnecessarily heavy-handed to some healthcare professionals.

A different response is to acknowledge that, in these circumstances, STOP might not apply. The Data Protection Act is clear about exceptions which can be made in situations where safety or a person’s best interests are threatened. Whilst the act says personal data must be processed “fairly and lawfully”, it also say that health professionals can process personal data without consent when the “processing is necessary to protect the vital interests of the data subject” (DPA, Schedule 2). This suggests that you could continue to encourage the young person to engage with you, explaining that you are concerned about their safety and you want to ensure they stay safe and well. Within the bounds of the act, this could be pursued until you have satisfied yourself that the young person is safe. Or, until you decide that escalation to emergency services is the only remaining option. This scenario may at first seem uncomfortable to some colleagues. To ensure the service user continues to feel respected and cared for in these circumstances, the tact and diplomacy applied by experienced healthcare professionals becomes really significant. You can imagine the kind of sensitivity that would be required.

Critical to each of these options is that you clearly define your approach to confidentiality and make it known to service users from the very beginning. Print it on your promotional material and send it out as a standard message when users first make contact. This supports the notion of having a privacy notice which is required under the Data Protection Act. The Royal College of Nursing says, “Young people must be made aware that confidentiality cannot be guaranteed if a disclosure is made.” As you know, many services for young people already commonly use a disclosure statement in the face to face environment.

There seems to be increasing dialogue amongst young people about the impact of what they say in their digital communications. Words are indeed like toothpaste: “easy to let out, impossible to take back” – especially when put in writing (and some young people tell us they are increasingly mindful of what words they are prepared to put into writing).

The data protection act requires us to respond with fair use of personal information, handling it only in ways that the subject would “reasonably” expect. It is our responsibility to manage expectations about what “reasonably” means to the smartphone generation, by explaining our duty of care in relation to privacy and how we might respond to words that cannot be ignored.

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Are you going to replace us all with robots?????????

There seems to be a worry that if healthcare practitioners are asked to engage with technology they are going to eventually be replaced with technology, more specifically by ‘robots’. 

This is absolutely not true!!!!! I get that technology can be scary and that that this is not the way we have done things before BUT technological advances are about enhancing service user care and experience and about giving service users a variety of ways to engage with healthcare practitioners and not replace face to face care that some service users will still want and/or need.

In Leicestershire I am working with our nurses and schools in rural areas to set up virtual clinics through the use of video calling.  The video calling will involve a nurse using a tablet device with internet connection at any health centre/base and the young person using a tablet device with internet connection within a clinic setting in school.  They will both connect at the same time to communicate with each other visually via the devices. 

These virtual clinics will enable our nurses to see more Young People, spend less time travelling, have greater access to patient records (connectivity in health centres for nurses is less temperamental than in other places!) and our nurses will also be able to use their time more efficiently between clinic appointments.

The nurse will run the virtual clinic in addition to their face to face clinic when they are in the office carrying out their admin work.  Adding a virtual clinic to the current School Nurse offer will make the nurse more accessible and visible.

Increased choice = increased access = better health outcomes = happier and healthier Young People! 

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‘A trusted source of health information so I don’t make the wrong choice’

Following the success of the School Nurse messaging service within our mainstream schools the next step is to implement this into our special schools.

Innovation is the key to our special school work, we need to be forward thinking and ‘get with the times’ and look at how we can develop on from text messaging and do this swiftly!  However, we have to start somewhere and texting is where it’s going to be!

Following an amazing focus group and a very upbeat and motivational conversation with an innovative and technologically minded head teacher, I feel even more fired-up to provide this service to Young People (YP) in our special schools.

The focus group was led by a creative design team in one of our special schools to enable YP to have their voice heard and be at the forefront of the design process of the material we will use to promote the messaging service in special schools.

There were 10 YP involved in the focus group all with varying needs and disabilities including ASD, Epilepsy and Cerebral Palsy they were all fantastic, got involved and gave some brilliant views about the advertising material and the reasons why they would want to contact the School Nurse.

The key themes that emerged from the YP were:

  • It was clear that the YP want support with their ‘embarrassing’ issues that they couldn’t talk to their parents about,
  • The YP want to have someone to talk to about relationships and peers behaviours towards them.  When’s a friend a friend???
  • The YP want a trusted source and one that is not going to provide conflicting/unhelpful advice, i.e not search engines on the internet!
  • The YP want to know how they can help their friends
  • The YP want to know how to make the right decision in situations they are unsure of

What really shone through for me was the attitude of the YP, they were really conscious about their peers needs and disabilities, how others would feel about accessing the School Nurse and their interpretation of the posters.

There was a really caring and inclusive attitude amongst these YP and this was fantastic to see.

A truly inspiring group of YP, exciting times are ahead with this project.

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What “cool” Social Media should you use to connect to young people?

At a recent quick conversation with some secondary school students I asked, “What social media apps and sites are currently cool?” I realise, of course, by saying “cool” I looked decidedly old, but it seemed a cooler alternative to “trendy”.

Their responses taught me a valuable lesson – being down with the kids requires a permanent level of engagement. You can maybe achieve this if you work with kids every day.

I’m interested in understanding how 11-19s like to communicate in order that we can better communicate with them. Our discussion revolved around a list of the top social media sites published this year in “Texts, Tweets, Trolls and Teens”, a Teen Life Confidential survival guide for social networking, written by Anita Naik. It’s a fabulous read for any grown-up who wants an easy-to-consume insight into teenage social media use.

My question to the group was – do these sites still get a “thumbs up” or a “thumbs down”? The sites listed in the book are as follows:

Facebook – Has so many users, if it was a country, it would be the third biggest in the world.
YouTube – 54% of all teens are on YouTube.
Twitter – 12% teens are unsure if their tweets are public.
Skype – free over internet video chat – one of the originals.
Tumblr – Most people on Tumblr are aged 14-25.
Kik – A smartphone instant messenger.
Instagram – For sending photos and another way to connect with people?
Vine – For publishing short videos on loop.
Pheed – 81% users 14-25.
SnapChat – Photo, and now video, sharing. – Get responses to questions from peers in under 300 characters.
Omegle – For chatting to strangers with similar interests.
Keek – Instagram for videos.

Interestingly, only Kik, Skype and SnapChat got unprompted mentions. Surprisingly, many of the mainstream brands did not qualify for an unprompted mention. Are they’re assumed to be known by everyone? Or, like much in fashion, is mainstream no longer cutting edge?

I certainly sensed an appetite for young people to tell me about their apps. The ones they were using to communicate with their friends. They were:

Pin It – a way to share interesting internet content via a virtual pinboard .
iMessanger – iPhones’ native messenger service that is effectively free from iPhone to iPhone.
Oovoo – video chat with up to 12 friends and instant messaging.
Tango – free over internet voice and video calling plus messaging, much like Skype.
WhatsApp – a smartphone instant messenger.
Viber – free over internet calls, text and picture sharing .
Fring – free over internet text, talk and video calls.
Instachat – the new messenger app from Instagram
Google Hangouts – instant messaging and video chat for two or more users online, or on Android.

So what did I learn? Well, for the first time I got a sense of a highly fragmented market place, where this group of young people like to use that messenger service whilst that group of young people prefers another. You might say a social group’s chosen communications channel is becoming one of its defining characteristics. One girl describes how she connects with one circle of friends through Viber whilst her other main circle of friends tend to connect on WhatsApp .

I sensed fickleness too. To keep a fragmented market afloat there presumably has to be willingness to casually switch between providers – so what’s cool this week may not be cool next. At the moment there seemed to be a growing popularity for apps that enabled group based video chats. Meanwhile, it seems something as simple as a quirky feature, like an unusual range of emoticons, could be enough to propel an app into fashion. They didn’t mention some of the apps in the list from the book – not because they’re no longer the “in thing”, I suspect, but because they aren’t the in thing this week in this school.

I’m nearing 40, and the value for me of connecting with friends and colleagues through the social media giants like Facebook and Twitter is that “everyone is on there”, so it’s easy to connect with the majority of people, all under one roof. Maybe our young people don’t think quite like that – happy to live in a market place full of smaller providers. Is it even preferable to seek out a lesser known app as a unique way to connect with your friends? That would be classic teenage trend setting. Whilst I’m a Tesco shopper, they’d be seeking out underground boutiques.

I detected from the young delegates a sense of apathy about Facebook . I’ve no doubt they’re on there as standard (whether or not they’re over 13 years, the minimum age for users) which means they must value it in some way. But, is it now just a bit too middle of the road to warrant a mention? Ruined by the “oldies”? Can a social networking site be cool if you’re likely to get a friend request from your Mum and Dad whilst you’re on there?

It’s harder to define “cool” than I thought. I suspect the list of currently trendy communications channels for young people is not nationally definable. In a short group chat I noticed clear differences in the communications app choice between friendship groups, and I’d suggest the difference would widen between schools, regions and counties. I wonder how your young people like to communicate?

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