ChatHealth was implemented by the Children’s Diabetes Team at Locala Health & Wellbeing in June 2021 to enable patients and their families to directly contact their Children’s Diabetes Specialist Nurses for support.

---

Organisation: Locala Health and Wellbeing
Service: Children’s Diabetes Team

---

Situation

The Children’s Diabetes Team at Locala Health & Wellbeing cover the area of North Kirklees in West Yorkshire. The team consists of two Children’s Diabetes Specialist Nurses providing support to children aged 0-19 who have diabetes and their families as well as to nurseries and schools working with children who have diabetes.

With a caseload of more than 100 patients, the Children’s Diabetes Specialist Nurses help children with diabetes and their families to learn about diabetes in all aspects of their life through regular contact and when urgent advice is needed. The main way to contact the team was to call Locala’s Single Point of Contact telephone line. However, patients and parents and carers needed a quicker way to contact the service directly when they needed help or advice. They expressed a desire to communicate via text message, but the nurses could not share their work mobile numbers due to the clinical safety risk of being contacted out of hours or when unavailable to respond.

Solution 

ChatHealth was recommended to the Locala Children’s Diabetes Team by their colleagues in the Thriving Kirklees 0-19 Service who had already implemented messaging services for young people aged 11-19 and parents and carers of children and young people aged 0-19. Locala Sexual Health service were also setting up ChatHealth during this time. Setting up their own ChatHealth messaging service would enable the Children’s Diabetes team to safely offer confidential help and advice via text to patients on their caseload.

The award-winning ChatHealth messaging platform was developed by Leicestershire Partnership NHS Trust in 2013 and has now been adopted by more than 80 NHS Trusts and healthcare organisations. The robust safety and security features offered by ChatHealth helped the Children’s Diabetes Team feel confident in deciding to set up a messaging service. With both nurses having access to a shared inbox, no messages would be missed and as an agile service they could receive and reply to messages, no matter where they were working, when connected to the HSCN network (Health and Social Care Network). ChatHealth’s project team at Leicestershire Partnership NHS Trust, provided project management support throughout the service’s implementation which was followed by staff user training on using the ChatHealth platform to respond to messages. One of the Children’s Diabetes Nurses, Kate Scott, gave positive feedback on the implementation:

“It was very easy. We had training and support all the way through and have not looked back since!”

The Children’s Diabetes team launched their ChatHealth messaging service in June 2021, offering it to the parents and carers of children and young people on their caseload and to the young people themselves who had their own phones. The messaging number was shared on patient appointment letters, with key information about using the messaging service, including response times, emergency contacts and confidentiality policies. The messaging service was set up to send automated bounce-back replies sent to messages received in-hours and out-of-hours to help manage expectations and signpost accordingly for emergency advice.

Outcomes

Locala’s ChatHealth messaging service for Children’s Diabetes has proven to be well-utilised and much appreciated by patients and their families. It has enabled them to directly contact the Children’s Diabetes Nurses in a convenient way, as and when needed, for a quicker response rather than taking the longer route of the Single Point of Contact telephone line. It has allowed the Children’s Diabetes nurses to receive and respond to messages no matter where they are working in a safe and managed way.

The Children’s Diabetes messaging service has proven to be very popular, with more than 1,500 messaging conversations between the Children’s Diabetes nurses and the families on their caseload since it was set up. As shown by the statistics below, the service is consistently busy:

• An average of 66 messaging conversations a month
• Busiest time for contact is Monday and Tuesday at 9am.
• Reasons for contact is for issues with diabetes technology, insulin adjustment and sick days, as well as appointment information.

Staff, patients and their families say that ChatHealth has helped to enhance the service offered by Locala’s Children’s Diabetes Team to support children and young people with diabetes. One parent gave positive feedback, saying: “Yes, it has helped. If for any reason I am worried about anything I can text one of the nurses for advice.”
Kate explains how it has benefited their Children’s Diabetes service:

“It is an excellent service. Patients and parents and carers like that they can text us whenever. No member of staff ever needs to worry about missing a message and the bounce-back reply ensures that our emergency advice line number is given in case more urgent care is needed.”

School Nurses in Kent have been promoting their ChatHealth messaging service on Snapchat to reach young people across Kent.

Background

The success of ChatHealth’s national campaign on Snapchat inspired the Kent School Health team to start their own local campaign on Snapchat. This enabled the team to determine their own objectives in promoting their local service, create their own ad content, define budgets and set the ad location and audience to specifically reach young people in Kent.

9 out of 10 young people are on Snapchat*, using it to connect with friends and family and share their experiences. By creating awareness of the Kent School Health service on Snapchat, young people can understand what the service is and how they can get confidential help and advice from NHS nurses via their ChatHealth messaging service.

Solution

The Kent School Health team spoke to young people to gain feedback about the video content used in the national campaign for ChatHealth. Young people said they liked the informal nature of the video, that the nurses came across as friendly, approachable and from diverse backgrounds and they understood it was an NHS service. However, young people said they did not like the names ‘School Nurse’ or ‘Public Health School Nurse Team’.

Considering the feedback from young people, the team created two short videos for their ad creative, featuring local ChatHealth nurses talking to camera about the types of health issues they can help young people with. With a budget of £10 a day, the audience for the Snapchat ads was set up to reach 15–19-year-olds in the Kent area as this is the group that the team are trying to improve access to. The videos are used as creative on the social media ads as well as on other forums such as on websites and in schools.

In video 1 (45 second length) ChatHealth nurses are speaking to camera to introduce themselves and how young people can ask questions about their body, feelings, sexual health and relationships to get advice.

In video 2 (50 seconds length) there is an example of a ChatHealth conversation explaining how it works.

The key message on both videos is ‘text us for help’ via the ChatHealth messaging service. When swiping up, the user is taken to their messaging app, which is pre-populated with Kent’s ChatHealth number, allowing them to send a message to contact a local school nurse.

Results

An immediate impact was made by Kent’s local Snapchat campaign, with 2,574 swipe-ups for video 1 and 2,604 swipe-ups for video 2 in the first 2 months.**  Another key indicator of success was the huge increase in the number of ChatHealth messaging conversations taking place between young people and health professionals for the Kent School Health service. Before the campaign, there was 7 conversations in December 2022 and 9 conversations in January 2023. When the campaign started on 17^th February 2023, this resulted in 26 conversations in February 2023 and an even greater uplift in March 2023 with 70 conversations. Since then, the Kent School Health team have continued running the Snapchat ads and are still seeing strong results.

Between February 2023 and July 2023, the campaign achieved**:

• 3.4 million impressions
• 21,329 swipe ups
• 0.61% swipe rate
• £1,501 spent

The campaign has delivered a consistently high uptake of ChatHealth with an average of 87 conversations taking place a month, which is an huge increase of 1211%.***

Risk management learnings

An increase in ChatHealth conversations has inevitably led to more high-risk cases being identified, including young people experiencing suicidal thoughts, self-harming, severe anxiety and safeguarding cases. The Kent School Health team have taken steps to manage high risk cases, such as logging on the risk register, joint partnership working with local counselling services, tracking time spent on ChatHealth to establish a case to increase staff user licences and sharing ‘good news’ stories with stakeholders.

Conclusion

In creating their own video content for the ad creative, the Kent School Health team listened to the feedback of young people, ensuring that the ChatHealth adverts attract their attention when using Snapchat. The successful performance of the campaign has been measured by a high number of people who saw the ad and clicked on it (swipe-ups). This has resulted in a substantial increase in the number of ChatHealth conversations opened and the service has maintained this high uptake whilst the campaign continues to run. Not only has the campaign exceeded the expectations of the Kent School Health team, but they are also effectively meeting their objective of reaching and supporting more young people across Kent. Due to the increase of high-risk cases, the Kent School Health team have taken steps to safely handle and escalate cases appropriately.

* Snapchat website

** Data from Snap Ads Manager as of 17/02/2023 to 31/07/2023

*** Data from ChatHealth reports as of 01/11/2022 to 31/07/2023

 

If you have any questions about running a similar campaign to this in your area, please contact us.

 

In January 2018, Compass BUZZ, based in North Yorkshire, was one of the first mental health services for young people in the country to offer a confidential text messaging service to young people.

---

Organisation: Compass
Service: Compass BUZZ (North Yorkshire)

---

The situation

Compass BUZZ offers mental health and wellbeing training to school staff and key partners to help them to support young people in North Yorkshire with emotional and mental health concerns. Alongside this, its sister service, Compass REACH, offers one-to-one interventions as well as referrals into specialist or universal services for children and young people.

In order to offer a direct route for young people aged 11-18 to get confidential advice from the Compass BUZZ team, the service was commissioned to set up a ChatHealth messaging service in January 2018. Young people were consulted to name the Compass BUZZ messaging service, which is called BUZZ US. The messaging service enables young people to text in for support about any mental health or wellbeing concerns such as low mood, stress, eating problems, self-harm, anxiety, or self-esteem.

YMM recognised that mental health is a stigmatised topic amongst young people and understood that they needed to operate a discreet service to help young people feel comfortable in accessing mental health support.

Compass BUZZ Team Leader, Rachael Askew explains how the messaging service makes it easier for young people to reach out for mental health support,

“A lot of young people don’t want to make a telephone call to get help, so text messaging helps to overcome that fear of reaching out for mental health support. The fact that it’s anonymous also makes it appealing to young people.”

---

The solution

The Compass BUZZ team was supported by the Digital Health Transformation Service, based at Leicestershire Partnership NHS Trust, to set up their messaging service and continue to offer support via their technical helpdesk and access to a national network of ChatHealth practitioners.

As well as following the tried-and-tested ChatHealth standard operating procedures, the team has continued to evolve its clinical quality processes. Regular group supervision provides the opportunity to discuss messaging contacts, how it went and what could have been done differently. Annual desktop exercises are carried out to simulate fictional challenging scenarios that might occur during messaging conversations.

Rachael explains how the team supports each other to offer the best experience to service users,

“As we’re dealing with conversations around emotional health, there is often no quick answer. Some conversations take place over a few days. We have controls in place, such as handover notes and reviews, ensuring that young people are getting what they need out of a conversation, that it comes to a timely conclusion and not left to drift on.”

There is a rota system in place for responding to incoming messages from young people. One member of staff is on duty for the day and this is planned out for the whole year. Good links have been established with North Yorkshire Police, which has been essential for escalating crisis situations.

Compass BUZZ works closely with schools and key partners in North Yorkshire, who support the BUZZ US messaging service by promoting it to young people in schools. Posters are displayed across schools and pocket-size BUZZ US cards are handed out. The service had to be promoted differently during the lockdown, with digital copies of BUZZ US cards, posters with QR codes, and resource packs supplied which could be emailed out and sent to young people at home and shared on school websites. Young people accessing one-to-one support from the Compass REACH are also signposted to use the BUZZ US messaging service. It is also listed on the CCG’s mental health support website The Go-To.

---

The results

The BUZZ US messaging service is now well embedded into the core service offering of the Compass BUZZ team. It is providing an accessible way for young people to get mental health support.

• An average of 500 messages from service users is received each month.
• Have seen increased contact for concerns around anxiety and panic attacks during the pandemic.
• For the majority of messaging contacts, young people’s questions are answered within the messaging conversation, or they are signposted to suitable web-based information and services.

The forward-thinking Compass BUZZ team has embraced using messaging to engage directly with young people. Over the time it’s been in use, staff users have increased their confidence and competence in structuring a clear and succinct response to offer trusted mental health and wellbeing advice and information via messaging.

Young people are getting a great user experience, which is evident from the regular positive feedback from young people received following their messaging contact.

“Thank you so much! I messaged here before and it really helped me.”

“It definitely pointed me in the right direction to getting the help I need. Thank you for all of your help.”

“Thank you I appreciate your support. I slept really well as I was very relaxed, this was greatly appreciated as I usually have trouble with falling asleep.”

---

Recommendation

“We’re so proud that our team offers such a unique service in North Yorkshire – we were the only service running a specialist messaging service for young people’s mental health support for quite some time. It’s now a key part of our day-to-day routine and we wouldn’t be without it as we have been able to help and support so many young people.”

Rachael Askew, Compass BUZZ Team Leader

In October 2020, the Mental Health Support Team (MHST) in Gloucestershire, known as Young Minds Matter (YMM), set up their text support service, powered by ChatHealth, for young people to get direct access to mental health support in selected schools and colleges.

---

Organisation: Gloucestershire Health and Care NHS Foundation Trust
Service: Young Minds Matter, Gloucestershire’s Mental Health Support Team

---

The Situation

Gloucestershire was one of the first 25 trailblazer areas to establish an MHST, as mandated by the Government in December 2018 as part of the NHS Long Term Plan to expand access to mental health care for young people in schools and colleges.

Delivered by Gloucestershire Health and Care NHS Foundation Trust’s (GHC) Child and Adult Mental Health Services (CAMHS), the purpose of the MHST is to develop early models of intervention to support mild to moderate health issues, such as exam stress, behavioural difficulties or friendship issues. The service is offered to 50% of senior schools in Gloucestershire covering a population of 43,000 students. Following engagement with young people and parents, who felt that the ‘Mental Health Support Team’ terminology did not resonate with young people, the service name was changed to ‘Young Minds Matter’ (YMM).

YMM recognised that mental health is a stigmatised topic amongst young people and understood that they needed to operate a discreet service to help young people feel comfortable in accessing mental health support.

Young Minds Matter, Clinical Lead, Becky Flory-Bryan explains,

“The ethos of our mental health support team is about improving accessibility to mental health support. It’s a big challenge for young people to turn to a teacher or their parents for help. We are aware of the barriers they face in getting help and we want to help to break those barriers to offer support when it’s needed.”

Initially the service trialled paper-based self-referral forms for young people to access help. However there were safety concerns around the information governance of handling referrals in this way. The team were keen to explore how digital technology could be used to improve the way young people could access the mental health service.

---

The solution

ChatHealth has been used by the school nursing team at GHC since May 2019. This allows young people to send a message to school nurses to get advice about a range of physical and mental health concerns.

As ChatHealth meets all NHS guidelines in relation to data protection and related compliance frameworks around confidentiality, the YMM team were encouraged to consider the use of the messaging service for young people to access mental health support from their practitioners. Becky said,

 “ChatHealth is a tried-and-tested method for engaging young people, so it made good sense to replicate this model for our service. As it was already used in school nursing, it gave us the confidence to implement a messaging service that would ensure patient data is kept safe and secure and meet our information governance requirements.”

YMM’s messaging service was launched as YMM Chat in October 2020. Like many other ChatHealth services, they have a rota system in place, with one member of staff on duty at a time to respond to messages. If a conversation needs to be continued to the following day, the next member of staff can easily pick this up within the shared inbox. Becky explains how it works,

“YMM Chat is available for anybody within our trailblazer senior schools. It’s manned by professional staff who are there waiting to support and advise young people if they have any worries or concerns around their mental health”

The YMM team are available for young people to chat via text between 9am and 4:30pm Monday to Fridays, except bank holidays, and aim to respond to messages the same day or the next working day. Young people can use the service to get advice or can self-refer themselves to get a 1:1 appointment with a mental health practitioner. If they send a message out-of-hours, a bounce-back reply advises them when to expect a response and where they can find support elsewhere.

---

The results

The YMM Chat text service has been welcomed by young people in the selected schools where it’s available as a more approachable way to reach out for mental health support.

• Young people say messaging is one of the easiest ways to access the service.
• Young people use YMM Chat for mental health support for issues such as low mood, depression, self-esteem, anxiety and emotional wellbeing worries.
• YMM mental health practitioners have found the ChatHealth system to be user friendly and enjoy using it to respond to messages.

Feedback from service users has been positive. This is what some young people have said about using the messaging service to request support,

“[Texting is] something we use every day. It’s casual and easier than talking to someone face-to-face as there’s less commitment than getting a teacher or doctor involved.”

“A text service is a good place to start for someone who doesn’t know where to get advice from.”

---

Key learnings

When the COVID-19 pandemic occurred, YMM Chat had to be rolled out quicker than planned across all the selected schools to put a route in place for young people to easily request support. However, the closure of schools meant it was more difficult to make young people aware of how they could access mental health support during lockdown.

Becky explains the importance of promoting the availability of the messaging service to young people,

“It’s important that schools are well engaged in promoting our YMM Chat text service to young people. If they don’t put up the posters and show the video, then young people are not going to know how to contact us and the service is not going to get used. It needs to be kept fresh in people’s minds.”

A promotional video about YMM Chat was produced, which was shown to young people in the pilot schools via their online home learning platforms. As soon as the schools were back open, posters were displayed around the schools and business cards handed out to young people. The team also worked closely with young people’s to determine their understanding of what ‘self-referral’ meant. As a result, the posters were designed to clearly convey that young people can text for mental health support in an easy and confidential way.

---

Becky’s recommendations

“I would recommend that other MHST services consider setting up a messaging service. The biggest benefit for us is the infrastructure and support behind ChatHealth. We were fully supported by the project management team, which made it easier to get up and running and there’s a helpdesk available if you have any technical issues.”

Becky Flory-Bryan, Clinical Lead of Young Minds Matter

Download case study

In September 2020, The Royal Wolverhampton NHS Trust’s  Sexual Health Service, known as Embrace, launched the safe and secure messaging helpline, ChatHealth. This allows local people in Wolverhampton to quickly and easily contact a sexual health nurse for confidential advice about a range of sexual health issues.

---

Organisation: The Royal Wolverhampton NHS Trust
Service: Embrace, Wolverhampton Sexual Health Service

---

Situation

Embrace wanted to adapt their service model to offer more than the traditional walk-in clinic. They needed a more effective way to ensure that people most at risk could easily get help, whilst promoting safe sex universally and efficiently signposting people for sexual health treatments.

Matron of 0-19 Services and Sexual Health, Kirsty Lewis explains,

“Anyone could turn up in the morning and come in to ask for an appointment. There was a big demand and we simply didn’t have enough appointments. Most days we would have a queue across the car park.”

“This was a concern because the person at the front of queue would be guaranteed an appointment, but they could have been one of the ‘worried well’ and simply looking for reassurance. However, the person at the back of the queue could be the symptomatic patient who we didn’t get to see that day because we had run out of appointments. We realised we needed a triage system to identify those that needed urgent help from those that simply needed advice.”

Embrace also recognised that attending a clinic doesn’t suit everyone. For young people, in particular, the stigma attached to attending a sexual health clinic meant they worried about who they might bump into! Nevertheless, they understood that people wanted to take responsibility for their sexual health. Knowing younger people are very technologically advanced, Embrace saw the benefit of reaching this age group via their mobile phones.

In addition, the impact of the COVID-19 pandemic led to the reduction of face-to-face clinics. It became even more crucial to offer a more accessible, digital route into their sexual health service.

---

The solution

ChatHealth, a safe and secure healthcare messaging system, is widely used by NHS public health, mental health and community teams across the UK. Developed by Leicestershire Partnership NHS Trust, ChatHealth provides a way for service users to easily, anonymously if preferred, use messaging to get confidential help and advice from healthcare professionals.

Following the success of the Trust’s school nursing messaging service, the Embrace team felt reassured that ChatHealth met their criteria for clinical safety and information governance. Kirsty describes how they felt confident it would offer best value for money and work well with their IT set up and team capacity.

“We felt that now was the time to give ChatHealth a go and see if it had a place in sexual health services. As it had just been set up by the school nursing service, we were able to replicate and transfer many of the same standard operating procedures. We found the system training to be quite straight forward in learning how to use it to respond to messages.”

Guided by the tried-and-tested deployment process and ongoing support of ChatHealth’s central support team, Embrace set up their messaging service in a safe and manageable way. Using a duty system, the clinical staff respond to messages sent to the dedicated messaging helpline number, offering advice on a range of sexual health issues including STI testing, safe sex, smear tests, pregnancy advice, counselling, HIV testing, emergency contraception as well as signposting to other local NHS or support services.

Promoted as ‘ChatSexualHealth’, the messaging service is available 10am to 4pm, Monday to Friday (except bank holidays), responding to messages within 48 hours. The promotional materials were designed to appeal to a wide range of ages and diverse population in Wolverhampton. Local communications specialists created a range of promotional materials and a robust communications plan, including posters put up across the organisation, email signatures on emails, regular social media posts, displayed on TV screens in GP practices and stickers on packs of condoms.

---

The results

Since setting up their ChatHealth messaging service, Embrace have received a consistent amount of messages from service users and it is helping them to work in a more efficient way.

• An average of 350 messages from service users are received per month.
• Around 85% of contacts are completed via the messaging conversation.
• More time freed up for clinical staff to offer face-to-face or telephone consultations to people most in need.

Many barriers that some people face have been removed and this is encouraging more people to reach out. This was the case for a female user who had a hearing impairment; she found it easier to text than speak on the phone. In another case, an autistic male felt more comfortable seeking help from his own home than navigating difficult social situations, such as getting on a bus and sitting in a waiting room to be seen in clinic.

In recent feedback after a messaging conversation, one service user said:

“Thank you so much. Have to say what a wonderful service this is. It’s not always easy to make outgoing calls from work and I had the fear of explaining myself! You’ve made this so easy!”

---

Key learnings

Embrace plans to continue delivering virtual contacts in this way. Clinical staff have found that they really like using ChatHealth to engage with service users. The Embrace team are now working in a more efficient way.

Kirsty explains how it has worked well for both staff and their service users,

“ChatHealth has opened up a whole world of people that I’m not sure we were seeing before in any capacity. The pandemic has given us permission to work in a different way and recognise that not everybody needs to be seen face-to-face.”

When on ChatHealth duty, clinical staff  respond to messages as part of their working day, often in between working on other tasks. Although some flexibility is required – on some days a few messages will come in and other days can be much busier. The monthly messaging reports from ChatHealth are useful to the team, showing the busiest days and times of contacts, contact types and outcomes.

---

Kirsty’s recommendation

“I would say don’t be afraid of trying something different – if there is ever a time to do it, now’s the time. We sometimes get contacts from across the country, which shows that messaging is what people want. It really feels like other NHS trusts could benefit from a similar approach.”

Kirsty Lewis, Matron of 0-19 Services and Sexual Health

Download case study