Although digital technology is transforming all our lives, many organisations in the field have been slow to keep up. A recent EUDA webinar offered some practical lessons for adopting and developing new solutions. DDN reports.
‘Digital technology is all around us – it’s integrated into our lives and the services we use,’ EUDA chief scientist Thomas Clausen told the agency’s Tech-based health and social responses to drug problems webinar. ‘But in our sector there’s potential for more development to provide new and improved services and responses for people who use drugs.’
Tech could improve health and save lives, as well as enhance training and service quality, he said. ‘We know there are gaps in our field between service need and service provision’, and new tech-driven interventions could help narrow them. Many people who used drugs, however, didn’t have the same access to technology as other people, he said.
Innovation was about having a vision to find a new way of solving a problem, said Alexander Baldacchino, clinical professor at the University of St Andrews School of Medicine. The challenge in the addiction field was to have an ‘innovative health and social care-related ecosystem for the common good’, he said. However, it was becoming more obvious that the data the field tried to link into meaningful predictions was far from perfect, partly through flawed or under-reporting. For drug-related deaths, for example, technology had the potential to make recording far more accurate and intelligent – to genuinely ‘understand the populations and their vulnerabilities’.
Problems like complexity and fragmented systems meant that addiction care was ‘uniquely challenging’, he said. ‘So if we’re able to utilise new technologies to help us in understanding clusters, predictions and preventing further harm, then we should welcome that.’ We all utilised AI every day, often without realising it, he said. ‘So let’s not be afraid of this technology.’
The potential uses of innovation in the field covered a huge range of areas, he pointed out – pharmacological and pharmaceutical, digital health and telemedicine (such as recovery apps and wearable technology), biotechnology and neuroscience, behavioural and psychosocial, virtual and augmented reality, the use of blockchain for patient data, cryptocurrency-based rewards, and more. His organisation had obtained funding from the Office for Life Sciences and Scotland’s Chief Scientist Office and now had seven products about to enter the market. These included skin sensors for overdose detection that could be fitted into clothing, a low-cost AI-enabled overdose monitoring system, and wearable devices for monitoring oxygen, heart and respiratory rate.
The lessons his team had learned included the need to constantly monitor the digital divide, he said. ‘We need to reach out to different settings, and we need to combine with face-to-face interventions – this is an add-on to services, not an alternative.’ Other important considerations included flexibility, privacy and data security, the need to strengthen evaluation to make sure products were safe and effective, and the importance of engaging stakeholders early – including people with lived experience. ‘A common pitfall is designing in a silo then discovering, too late, that it doesn’t fit into the workforce,’ he said. ‘It’s not about the digital, it’s not about the products, it’s not about the innovative technology – it’s about the people.’
‘I’m going to talk about bridging a nursing capacity gap, but it could just as easily be about outreach workers, community services, or a needle exchange bus,’ said Catherine Comiskey, professor of healthcare modelling, global addiction and transformation at Trinity College Dublin’s School of Nursing and Midwifery. ‘It’s a widely applicable approach.’
Her team ‘didn’t know we were going to use innovation,’ she said. ‘We just knew there was a problem that needed to be solved.’ Although very highly regarded, the Dublin-based nursing practice she worked with had always been reactive – ‘just dealing with what’s coming through the door, as you often do.’
She and her colleagues set out to develop a ‘massive open online course’ (MOOC) for an addiction treatment nursing model, partnering with organisations like EUDA, the Ana Liffey Drug Project and others. ‘You need people along the way you can learn from and who will challenge you,’ she told the seminar. The development process involved looking at both nursing needs and client need, she said, including speaking to more than 130 people who were using the services.
They named it the healthy addiction treatment model, with a focus on ‘the greatest need of the clients – psychosocial support.’ They then applied for funding to develop the nursing model and MOOC to provide training for both nurses and allied health professionals, with the proviso that it was ‘free, accessible to large numbers of people, and informed by all of the learning that the academics, nurses and clients had brought.’ The finalised six-hour course now included videos, audio and a discussion forum, and so far more than 3,500 people worldwide had completed it. ‘Don’t be put off,’ she said. ‘You don’t necessarily know all the steps, but you figure them out as you go along. Address the challenge, look at your client need, and go one step at a time.’
Her organisation had now moved on to a new digital technology project, SUMIT – substance use and mental health interventions – which will cover both the Republic of Ireland and Northern Ireland, as they faced common challenges including a lack of integrated substance use services, with ‘people having to tell their story over and over again’.
Part of the preparation was to develop an ‘evidence and gap map’, she said. Over a four-year period the project would provide an integrated, cross-border programme of intervention research, training and skills development, working with around 1,500 people and implementing technological solutions. One challenge would be ensuring everyone in the those cross-border regions had access to the innovations, she said. ‘None of us know how this is going to work out, but we’re looking forward to learning.’
‘What we don’t do is just take a piece of technology and somehow land it within a service model,’ Moira Mackenzie, deputy chief executive officer and director of innovation at Scotland’s Digital Health and Care Innovation Centre, told the seminar. Her organisation worked in partnership with the Scottish Government’s drug policy division, and their methodology was to look at service models and identify opportunities for digital interventions. It was also important to find the most commercially sustainable models, she said, as ‘businesses need to make money from selling these devices and initiatives. We try to not look myopically at a particular issue, but across the very complex environments we all work in to make sure it’s as sustainable and adoptable as it could be.’
The organisation was also one of the delivery partners of the government-funded Digital Lifelines Scotland, a project that had now been running for five years. ‘It’s about how we can use digital to keep people connected to the services that keep them safe as well as family, friends and other support mechanisms.’
Many people living with addictions were digitally excluded, she said. ‘Much of that is around the cost of connectivity and data, so we looked at what the motivation would be for them to go digital. What’s the right device for them, what are their literacy levels, do they have an interest in trying to re-engage with the education system, how can we use digital to build up skills and confidence?’ It was important to always provide reassurance around privacy and security concerns, she said, ‘very much designing the whole approach for inclusion’.
The methodology was predicated on ‘learning by doing’, and had so far funded 35 organisations to provide digital inclusion support, upskilled almost 520 staff and volunteers, and connected with more than 5,500 people at risk of drug-related harm. ‘We work with people to build up skills and confidence, and then start to introduce them to digital products and services,’ she said. ‘People don’t tend to think “I’m trying to manage an addiction issue”. There will be a range of other issues they’re trying to manage in their lives – access to housing, debt advice, loss of connection to family and friends.’
Echoing Comiskey’s sentiments, she told the seminar her team ‘didn’t know if this was going to work or not. But we knew we had a problem and we needed a solution, so look for partners who are prepared to work with you – as clearly you need some funding in there.’ Finding partners prepared to develop the product as they go was key, as ‘it’s more satisfying for everyone and meets the needs of the individual and the services’.
Current projects included a video consulting platform and a smartphone-based navigation app to find services and receive alerts. ‘That one is going from strength to strength’, she said, although others, such as adopting Canada’s ‘Brave’ app – which connects people vulnerable to overdose with peers – had generated ‘a lot of interest and enthusiasm’ but so far the necessary funding hadn’t been available.
‘But the experience we’ve had has given us confidence, even though the context in which we’re working is continuously changing,’ she said. ‘We need to get devices and connectivity out there to people,’ especially those who were falling through the cracks. Part of the challenge was choosing which projects could be progressed within tight timelines, she said, and wouldn’t cost ‘huge amounts of money in terms of development’.
On the question of how to motivate people who use drugs to use the tools, codesign was fundamental, she said. ‘We have to engage with people, and it has to be something that’s important to them. Find out what the individual wants to do with the digital technologies, and use that as the focus for upskilling. You need to find the hook that’s going to add value to their lives. It’s not something you can force on people.’ ‘You don’t just jump in with a solution,’ agreed Comiskey. ‘The answer will emerge through that engagement.’ 