Tag Archives: mental health

Digital innovations are not always digital (and other reflections on youth-focussed digital innovation lab design)

[Summary: assorted learning from participation and hack-days applied to ideas about a youth-focussed digital innovation lab.]

Right Here, Comic Relief and Nominet Trust have a really interesting tender out right now for someone to deliver two ‘Innovation Labs’ focussed on helping “young people to look after their mental health and to access appropriate help and support”.

They describe how the labs should provide young people with the opportunity to work with mental health, youth work and design professionals to design digital tools that will meet their needs.”  If it weren’t for the unknowns of the schedule for my PhD that starts in October, it’s exactly the sort of project Practical Participation would be putting in a proposal for*, but, with the freedom to adopt a more open innovation exchange style bit of sharing around a proposal, and having been unable to resist jotting a few notes about how I might approach the tender, here’s a few quick reflections on youth-focussed digital innovation labs, drawing on learning from previous participation projects.

Digital innovations are not always digital

In my experience working with youth services and mental health services exploring use of digital tools, the biggest gaps between the potential of digital tools and their use in practice is not down to a lack of Apps or widgets – but comes down to a lack of training, inadequate policies, or other small barriers.

The most effective outcomes of a digital innovation lab could be how to guides for practitioners, youth-led training for mental health workers in how to engage online, or new protocols that make sure mental health staff have a framework and incentives to make use of digital tools – as much as they might be new apps and websites.

Set up to succeed

I’ve experienced and observed a number of participation projects in the past that have, mostly unintentionally, set young people up to fail by asking them to redesign services or systems without reference to the staff who operate those systems day-to-day, or the realities of the budgetary and legal constraints the services operate under. Instead of empowering young people to bring their lived experience to real problems, whilst avoiding organisational agendas crushing the ideas and insights young people can bring, participation projects can end up asking young people to solve problems without giving them all the information they need to find viable solutions.

In innovation events with both young people and adults ideas often come up which, whilst great in principle, draw on mistaken assumptions about resources that might realistically be available, or about how digital tools might be adopted and used (it’s not uncommon to hear ‘innovators’ of any age suggesting they’ll build ‘the next Facebook’ to bring together people to discuss some particular issue). Finding the balance between free-flowing innovation, and realisable ideas is a challenge – and increased if, for the majority of participants, the event is their first innovation lab, or project teams don’t have people with experience of taking an project through from idea to implementation. Finding facilitators who can combine the right balance of technical realism, with a focus on youth-led innovation, is important, as is offering training for facilitators.

Projects like Young Rewired State offer an interesting model, where young people who have participated in past events, return as young mentors in future years. Finding a community of young mentors may also prove useful for an innovation lab.

Involving adults

It’s not only mentors and digital experts who have a role to play in the design process, but also mental health professionals and volunteer adults who work day-to-day with young people. In policy consultations in the past we’ve used a ‘fish bowl’ like approach to adults involvement, starting the day with adults as observers only on the outside of circles where young people are developing plans and ideas; moving to a stage (perhaps after an hour) when young people can invite adults into the discussion, but adults can’t ‘push in’; and then (another hour or so later) moving to a stage when adults and young people participate together. Whilst artificial, in a policy consultation, this sort of process helped address issues around the balance of power between young people and adults, without removing the benefits to be found from youth-adult dialogue. In an innovation and design situation, this exact model might not be appropriate – but thinking about lightweight processes or ‘rules’ to help the relationship between young people and adults may be useful.

An alternative approach we’ve taken at past participation events is to have a parallel track of activities for workers coming to the event with young people: could you set a team of adult innovators competing with young innovators to contrast the ideas they come up with?

There are no representative young people

I’m not a representative 26 year old. There aren’t representative 17 year olds. Or 15 year olds. Or any age for that matter. People often design innovations for themselves: that doesn’t mean they’re designing for all young people. Not all young people are technology experts. In fact, most aren’t. There is no such thing as a digital native. Bringing the lived experiences of young people with experience of mental health services and challenges to the design of services is still a very very good thing. It can mean massive improvements in services. But often there’s a risk of implicitly or explicitly thinking of service-user or youth participants as ‘representatives’ – and that tends to be an unhelpful framing. Understanding participants as individuals with particular skills and insights to bring tends to work better.

Freedom and frameworks

I’ve spent most of this afternoon at the Guardian offices in London as a mentor for young hackers at Young Rewired State. Young Rewired State is a week-long event taking place across the country for young people interested in building things with open data and digital platforms. Young Rewired State centres have varied in how much structure they have had: some simply providing a room, and some mentors on hand, for young people to identify what they want to work on and get hacking. Others have supported the participants to work through a design process, offering more structured how-to guidance and support. Some young people thrive and innovate best with a framework and structure to work within. Others need the freedom from pre-planned programmes and tight agendas in order to innovate. Having no agenda at all can exclude those who need structure. But an agenda that is too tight, or a programme that is too prescriptive can miss innovation opportunities. Fortunately, the Innovation Labs tender that sparked this post highlights that the events themselves should be co-designed with young people – so there’s space to negotiate and work this one out.

Keep out of the dragons den

I’ve sat on a few ‘dragons den’ style panels recently – responding to presentations about young people’s project ideas. And I’ve yet to be convinced that they really make a useful contribution.

 

This post has been in the spirit of reclaiming reflective space, and has no neat ending. 

*Although I’m not putting in a proposal around the labs, I’d still be really interested to get involved should a youth-engagement and effective technology focussed facilitator/action researcher/data-wrangler be useful to whoever does end up running the labs.

Blended services: bringing digital and face-to-face together

[Summary: Instead of funding new ‘online’ services, what happens when we fund ‘blended’ services: can we get realistic cost-savings, and enhanced provision – rather than inefficient pseudo-savings and restricted services]

Each face-to-face contact in the delivery of service is expensive. On online contact can be a lot cheaper. Plus, quite a lot of service users are asking to be able to access services online. It might be a support group for carers; careers advice for young people; mentoring and counseling, or any number of other services that I could be talking about. I’ve seen a number of cases where services take note of the above, and quickly decide that what they need is an online service. Perhaps to replace their current provision, or perhaps as a pilot in addition to it. But generally as a distinct service from existing offerings, and more often than not, with plans to build some new platform for delivering their online service – with a very linear process of consult->build->use.

But, as some of the presentations and discussions at today’s imh2011 (internet & mental health) workshop suggested, that doesn’t really make much sense.

Firstly, evidence was presented from trials of online Cognitive Behavioral Therapy (CBT). Broadly – it was only with a blend of online self-service CBT, and continued direct meetings with practitioners – that positive outcomes, equivalent to those from existing face-to-face services were maintained. Comparing the £50 per-contact cost of a face-to-face session, with the £5 cost of an online intervention, and supposing online offers a £45 saving* only makes sense if the two lead to equivalent outcomes. If what’s really needed is £25 worth of practitioner time, and £5 worth of online provision, including online in the mix can still lead to savings, and significant savings: but it’s important to have a realistic sense of what the savings can be.

Secondly, the challenge with delivering online services is widely acknowledged to be not so much to do with having the right tools, as with having skills and organisational culture to be able to work in new digital ways. So spending all the budget on building an online platform (and expecting that a £5k, £10k or £20k budget is going to deliver a platform to rival existing off-the-shelf offerings that have had £millions invested in them) doesn’t seem the most worthwhile investment. Investing time instead in exploring different ways that a service should communicate digitally – iteratively negotiating different platforms to find those that work for service users and staff – makes a lot more sense.

(There was some, in my opinion, unhelpful talk in a few presentations and workshops about ‘digital natives’ and presentation of statistics on particular technology platforms with the largest market penetration (SMS; Mobiles; Social Networks), with the implicit or explicit suggestion that, as these were the widest used platforms, these were the ones which services should be adopting as digital service-delivery channels. It’s far too easy to gloss over the subtleties of how different communication tools work in practice: and to miss the dynamics that mean how a tool works will change as different network effects kick in. Even if the majority of service users say they want access to services via mobile phone for example, it’s only when you pilot and take an ethnographic or grounded approach to researching how your service works over SMS or smart-phone channels that both you and service users can come to understand whether such a service really makes sense and will have enough uptake to justify more investment. And even then, chances are that changes in the market (e.g. when low-cost data plans on mobile become available to young people), the structure of the network (e.g. when parents started joining Facebook), or innovations (e.g. when the next platform comes along…) mean that you’ll need to take your service to new spaces within the next few years at most. The notion of ‘digital natives’ is particularly unhelpful when trying to understand how young people and adults with complex needs and different life-experiences use, adopts and appropriate technology. Finding low-cost experiments that can help staff teams and service users explore different potential communication tools (why not try holding a planning meeting via skype? take notes on an etherpad? or even try a field-trip to a virtual world or other online community?) and then reflect on their various merits may prove much more valuable than many meetings spent discussing statistics on popular platforms or drawing up specifications to build new platforms).

Thirdly, the culture change needed to engage effectively with digital service provision – a culture change involving being more agile in moving from platform-to-platform – needs to apply to ‘offline’ services as well. If you’re running an online support group, and it becomes apparent that members would find a face-to-face meeting useful too, can you easily find meeting space and resources to help that happen? Rather than booking rooms and times for regular sessions, and then worrying about making sure there are always people there: are there some groups who would prefer online engagement, with the option to organise face-to-face meetings on-demand – perhaps even choosing the coffee shop over the community centre as the meeting place. If the available budget is more transparent to service users, how can they negotiate the balance of how much of it gets spent on digital services, and how much is spent on enabling other provision? Some ‘blended services’ (blending online and offline) might be predominantly face-to-face, enhanced by a bit of online interaction (as simple as using Doodle.com to arrange meeting times, or Facebook to remind people about sessions); some ‘blended services’ might be predominantly digital enhanced by the occasional face-to-face meet up or service. Some blended services could turn out to have no face-to-face at all, but retaining it as an option.

Of course there are big challenges transforming services to work in these ways – but if the alternative is either seeing more services set up ‘online-only’ side-projects based on false cost-saving or demand assumptions, or seeing services fail to take advantage of opportunities to enhance practice, and find reasonable efficiencies through delivering some of what they do in digital ways – then the challenge is, I think, worth engaging with.

So, this post rather unexpectedly seems to have got me to three draft principles of blended provision:

  • Identify realistic cost-savings from going digital if you budget for a mix of online and face-to-face
  • Invest in skills, understanding and iterative development rather than platforms
  • Allow services to be agile in how the mix digital and face-to-face provision; engage service users in setting the balance.

What do you reckon?

(*Figures are illustrative only.)