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Careview is an app which aims to reconnect socially isolated individuals with their communities, and refer them to services to improve their health and wellbeing.

Case Study Care View Word Cloud

Intro

Careview (https://leeds.care.vu/) is owned and supported by Leeds City Council. It has been developed by the Urban Sustainable Development Lab, which has been named as one of UK’s New Radical social innovation projects by Nesta and the Observer newspaper. Careview has also won the prestigious Medipex Innovation Award.

Careview is an app which allows approved professionals (such as police officers and charity workers), to log concerns about houses which may be indicative of a resident in need, such as an untidy garden or post piling up. When a Careview user flags properties, they appear as patches of colour which build up to a heat map. Careview does not store any personal details such as name, address, postcode, or anything that can be used to identify a resident. The higher the intensity of the colour on the heat map, the more concerns were flagged in this area. Outreach teams can then focus on visiting the flagged areas, trying to make contact with residents and helping those in need.

Given the small scale of the project and the fact that this was the first feasibility study, we focussed on process evaluation (is it implemented optimally?) and simple outcome evaluation (are there any benefits?). We created the evaluation plan using a co-design approach, where we worked with all stakeholders to find out what is meaningful and feasible given real world constraints. Stakeholders included the public health and digital project team members who created and manage the app as well as outreach team members who would be using the app and door knocking houses which showed concerns.

The decision was made to focus on unmet need more broadly rather than social isolation. Outreach teams were only expected to have short doorstep conversations, which wouldn’t allow for formal testing of social isolation or loneliness. The study was restricted to six Lower Layer Super Output Areas (LSOAs) which fall into the worst 1% nationally in terms of deprivation. Data was collected through automatic tracking of user activity in the app (analytics), questionnaires and interview with the outreach teams, and paper forms and spreadsheets filled in by the outreach teams about their door knocking activities. Midway through the project, a workshop was held involving the same stakeholder groups to discuss preliminary results and barriers and agree on potential solutions and adaptations.

Learning Points

Around two thirds of all households targeted did not engage with the outreach teams, mainly by not opening the door. Of the residents who did engage, about 35% (67 cases) were reported as experiencing unmet need. Most outreach teams felt that external signs of concern are linked to a higher likelihood of finding a resident in need, but the current sample size was too small to confirm the predictive value of Careview signs quantitatively. There was anecdotal evidence that Careview may be missing some instances of unmet need which are not associated with external signs of neglect, such as residents in flats or with specific mental health difficulties.

Additional benefits for outreach team members and organisations were reported, such as discovering new areas and desired activities for outreach, closer networking between outreach teams and uncovering gaps in the current referral pathway. Also, the evaluation helped raise awareness and led to interest from other teams, such as the fire service and street cleansing, who are interested to (re)use the app for their own purposes.

We have identified a number of barriers and explored potential solutions which can be used to inform future studies. The current signs of neglect may need reviewing as some were seen as irrelevant, too vague or missing. Given a potential impact of area (such as through deprivation or cultural composition), Careview would benefit from being tested in a wider, more diverse area. Also, the app was intended to rely on crowdsourcing by non-experts on a continuous basis and should be tested this way. Strategies to improve door knocking success as well as resident engagement should be considered and include training teams, optimising leaflets and linking Careview with other funded initiatives. Finally, Careview flagged up several issues with the existing systems it relies on for helping the identified residents, including referral pathways, services’ capacity and outcome collection methods.

Based on the results from this trial, it is clear that Careview has the potential to help find residents with unmet needs and may be valuable beyond social isolation. Careview would benefit from a large scale evaluation study in order to assess the replicability of these results, determine its predictive ability and quantify the resulting social and economic value.

Feedback

‘Enlisting mHabitat’s guidance for the evaluation purposes has to date proved invaluable. They have demonstrated their added value approach time and time again. This is essential for us with finite resources in terms of time and money. More importantly digital innovation is a completely new environment for us, one that mHabitat are adept at. mHabitat’s objective methods have helped us make sense of what we need to do to create a process model (Logic model) to ensure we have a rigorous trial of the CAREVIEW platform. In their planning and creation of the workshops we have been able to bring the three elements of the 12 month academically evaluated pilot smoothly together without friction. Consequently the digital development, evaluation and operational outreach components have gelled together to work coherently side by side for mutual benefit. The workshops have been honest and straightforward allowing the operational team to begin to create a superior product, as the app moves from prototype to fully working model. Within mHabitat’s mechanic we have also been able to anticipate any problems and barriers. Their constant professional curiosity is engaging, effective and energising. Lastly one of the elements we have really appreciated born from the workshops is the fact mHabitat personal actually come out into the field with us and support and guide teams in training, operation and review. This is a very reassuring, open, inclusive and rewarding way of working which gives all the partners increased confidence in the evaluation.’

Jon Hindley
Advanced Health Improvement Specialist-(West North West Locality)
Public Health Localities and Primary Care
Adults and Health Directorate
Leeds City Council

Portrait Natalie Nelissen

Natalie Nelissen

Research Fellow

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