Shared learning database

Published date:
November 2013

Lincus, a tool designed to capture the impact of interventions on individuals and their communities, has been developed by Rescon, a UK technology company, in collaboration with the: Liverpool City Council (LCC), 3rd sector providers, NHS and industry. Following on from work with the Technology Strategy Board funded Dallas Mi project Lincus was developed for the Liverpool based Big Lottery project that is focused on utilising a variety of interventions to address the needs of those with any three of the following: poor physical health, homelessness history, substance misuse issues, mental ill-health and offending risk (multiple and complex needs). Due to the multifaceted needs of the users, a new evaluation approach was required to capture the impact of interventions on the target population and city ecosystem. A bespoke Lincus tool was co-developed with LCC and Liverpool YMCA. A pilot study was then undertaken to test its usefulness and usability by service users and providers.

Guidance the shared learning relates to:
Does the example relate to a general implementation of all NICE guidance?
Does the example relate to a specific implementation of a specific piece of NICE guidance?


Aims and objectives

The aims of the pilot were to:
- assess the current usability of the Lincus system in allowing support workers to assess people with complex needs and record interventions or events for each person;
- establish how effective the data recorded was in potentially measuring the effect of interventions or events;
- progressively develop the system and create lessons learned for future developments. Lincus is a tool by which to survey populations. It enables users to record and visualise individuals' data, to store details of all significant events in their lives and any interventions that are performed to help them, and to capture their perception of their wellbeing with respect to different areas of interest. The surveys use a number-free icon-based assessment system with single word or simple phrase coupling. The user is encouraged to point to a level on a slider, between two extremes, to provide an answer to each question. The position of the slider is then translated into a numerical answer (between one and 10), but this is not displayed to the user. This is designed to prevent users attaching significance to certain numerical levels for a question that might bias future answers. The interface is designed to be user-friendly and incorporates clear and specific icons to demonstrate what each question means where possible, so that translation is not required if users speak a different language. Lincus has the capability to be expanded to include other languages as needed. The Lincus system is secure and permission based with varying permissions depending on the user type and what has been allocated. It consists of a secure website with a dashboard interface; an evaluation application that runs on both Android devices and any device with a browser. Lincus also features photo, location and time tagging of evaluation inputs. There is a secure database backend to store credentials and user data. The web-based application also analyses and visualises data per user or group with search and sorting functions available for dates, interventions or events.

Reasons for implementing your project

Liverpool YMCA is commissioned by Liverpool City Council to provide temporary accommodation and support for up to 70 people at any one time at risk of homelessness. The aim of the service is to help vulnerable people who have experienced homelessness to receive high quality support to enable them to move onto to live as independently as possible, within the community. The Support Service has a team of Resident Support Workers, Engagement Officers and a Drugs and Alcohol Support Worker. This multidisciplinary team is responsible for the provision of support to the members through risk assessments, the support planning process, sign posting to external agencies and involvement in innovative training and other projects run by the YMCA.

Any homeless person, male or female, over the age of 16 can apply to become a YMCA member. Each member is allocated a support worker who works with them on their support plan (Outcome Star) which addresses: motivation and taking responsibility; self-care and living skills; managing money and personal administration; social networks and relationships; drug and alcohol misuse; physical health; emotional and mental health; meaningful use of time; managing tenancy and accommodation; offending.

Liverpool YMCA wanted to use Lincus to improve their method of capturing information about mental health, physical health, alcohol and substance abuse, risk of offending and housing and homelessness issues in the target population. Lincus enabled them to capture this information in a way that was minimally disruptive and that the end users responded to very well. Lincus was particularly appealing as it allowed them to capture day-to-day interventions and track the effectiveness of these interventions and their whole program. With particular reference to the NICE guidelines there were three main barriers to behaviour change that Lincus could be used to address, being: poor tracking of wellbeing; self-ownership of the issue; and engagement with professionals. Hence Lincus was deployed for:
1.) Tracking of wellbeing leading up to and post events such as intoxication allowing users to identify how it was impacting upon their quality of life resulting in; 2.) Ownership of and engagement in the issue of the self-harm done by poorly controlled alcohol consumption; 3.) With users being able to view their own data in real time and review it with their caseworker stimulating conversations about change in a nonjudgmental way.

How did you implement the project

The Lincus trial was performed by the YMCA in Liverpool and commissioned by LCC. Before the trial subject matter experts met with the team from Rescon to refine the evaluation questions and come up with required specifications. Once the bespoke Lincus YMCA product was produced 12 suitable, willing and fully consented participants with complex needs, living in the YMCA, were recruited. The 5 key areas of need targeted were: mental health; housing/homelessness; general health; alcohol/substance use; offending. Participants were surveyed on weekdays for 4 weeks. Each need had a separate survey of 10 questions, designed to quantify service users feelings on their situation. Each sub-survey was mostly performed once a week, with a different survey per day. For routine use of Lincus, support workers would survey users according to their individual needs. Those with issues with drug/alcohol dependency might be surveyed more often in that area, and surveys would be performed at a frequency that was determined in concert with participants' needs and wishes. This trial was set up to determine Lincus? usability by organisations such as the YMCA. The support workers used it to record data that could be visualised such as the participants? wellbeing scores over time in different areas coupled with all events and interventions that occurred relating to each user. Events, interventions, notes, and photographs were visually displayed in a single timeline associated with icons that could then be further investigated. The central data-base was designed so that data relating to each participant could be easily accessed, searched for and visualised, including the work that was been done by support workers in dealing with events and performing interventions. Events or notes were represented as a clickable icon from which a popup appeared showing any notes or photographs taken on that day, or listed events/interventions that occurred. User data was visualised as overall wellbeing over time, and also shown split by category, and question so that individuals, or their support worker, could track progress in different areas and drill down when needed. A feature of Lincus is that trends in a population can be recorded, analysed and compared. Events and interactions data can also be searched, counted and compared with the user being able to analyse changes that may have led up to certain events. User tracking, engagement, and ownership (through notes) of issues were recorded.

Key findings

The trial ran smoothly with 2 support workers and 12 service users taking part. No data was lost and the support workers and service users found Lincus intuitive and easy to use. The support workers and developers continued to co-develop the software during the trial. The workers found it easy to record and upload the information via the laptop and android application. The length of the assessment was been greater than anticipated with the average length of the assessment being between 5-7 minutes, mainly from increased engagement with the participants.
Interventions, events and wellbeing scores were tracked however, due to the low numbers involved firm conclusions on the relationships could not be drawn. The data was easily visualised and using the search feature the different wellbeing metrics leading up to and after an event or intervention in either an individual or the entire cohort could be tracked. This provided hints of interesting insights though was not enough to make any firm conclusions. However, data collected indicated that the interventions in the context of the trial were appropriate. With a larger dataset services would be able to gain a more informed analysis of key interventions and their effects and meaningful connections between interventions, events, and wellbeing scores. In cases where events occurred Lincus provided useful audit data. That is, the wellbeing scores, interventions and other events could be tracked. This was found to be useful for reviewing and continuing to improve service delivery and outcomes. The effect of participating in Lincus itself appears to have had a measurably positive effect on the participants involved, as measured by improved wellbeing scores, especially in mental health (50% improvement over the trial). Feedback from the support workers suggests that the participants felt more "listened to" as a result of user Lincus. As well as the increased engagement it was identified as a long-term outcome that there are likely efficiency savings for service providers such as the YMCA in relation to reduced assessment time, being able to effectively target interventions in a timely manner, continuously refine service delivery and do so with reduced administration. The updated NICE public health guidance Behaviour change: individual approaches (PH49) recommends that evaluation plans are built into all individual-level behaviour change interventions and programmes, Lincus addresses this recommendation.

Key learning points

Lincus is a rapid, modifiable minimal intervention assessment system designed to capture key markers of 'health' that improved the practice of engagement, auditing and assessment in the Liverpool YMCA multiple and complex needs pilot. Lincus was shown to be a useful tool that addresses NICE intervention evaluation guidance. It was beneficial that questions, event and intervention logs were developed with subject matter experts - it was tailored to the organisation and user needs. It is important to consider the number of categories or questions: too many results in sparse data and difficulty coming to any strong conclusions regarding interventions whilst too few leads to difficulty drilling down into causes of events and outcomes. Organisations are encouraged to classify interventions at different levels and capture this: an organisational change on a high scale or taking to an outdoor activity on a day-to-day scale. Different levels allows for more structured analysis and audit. Weight the outputs according to relevance and reliability. For instance, an individual who is intoxicated is most likely less reliable at reporting their wellbeing than when sober so the scores should be appropriately weighted. It is important that staff are well trained and comfortable working with technology. The key areas for training and development for service users are:
-Computer literacy with hardware and software systems including familiarity in interpreting data;
-Questioning techniques, prompts and contextual/emotional input/interpretation and appropriate levels of engagement. This is crucial for both gaining accurate information and in building trust;
-Recognising an individual's preference to the relevancy and frequency of assessments. Some individuals prefer a lot of contact whereas others are best surveyed infrequently. The provider must read the non-verbal and verbal clues as to what is intrusive as this could negatively impact on the quality of assessments.

Contact details

Tom Dawson
Managing Director

Is the example industry-sponsored in any way?