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Announcements and latest updates

Right Decision Service newsletter: October 2024

Welcome to the Right Decision Service (RDS) newsletter for October 2024.

1.Contingency arrangements for RDS outages

Development of the contingency solutions to maximise RDS resilience and minimise risk of future outages is in progress, aiming for completion by Christmas. As a reminder, these contingency arrangements  are:

  • Optimising mobile app build process
  • Mobile app always to be downloadable.
  • Serialising builds to mobile app; separate mobile app build from other editorial and end-user processes
  • Load balancing – provides failover (also enables separation of editorial processes from other processes to improve performance.)

 

In the meantime, a gentle reminder to encourage users to download essential clinical toolkits to their mobile devices so that there is an offline version always available.

 

2. New deployment with improvements.

A new scheduled deployment with minor improvements drawn from support tickets, externally funded projects, information related to outages, and feature requests will take place in early December. Key improvements planned are:

  • Deep-linking to individual toolkits within the RDS mobile app. Each toolkit will now have its own direct URL and QR code, both accessible from the app. These can be used to download the toolkit directly where users already have the RDS app installed. If the user does not yet have the RDS app installed, they will be taken to the app store to install the app and immediately afterwards the toolkit will automatically open and download. Note that this will go live a few days later than the improvements below due to the need to link up the mobile front end to the changes in the content management system.
  • Introducing an Announcement Header field to replace the hardcoded "Announcements and latest updates" text. This will enable users to see at a glance the focus of new announcements.
  • Automated daily emptying of the recycling bin (with a 30 day rolling grace period)  in the content management system. A bug preventing complete emptying of the recycling bin contributed to one of the outages earlier this year.
  • Supporting multiple passcodes (ticket 6079)
  • Expanding accordion section to show location of a search result rather than requiring user coming from a search result to manually open all sections and search again for the term.
  • Displaying first accordion section Content text as a snippet on the search results page as a fallback if default/main content is not provided
  • Displaying the context of each search result in the form of a link to the relevant parent tool/section. This will help users to choose which search result is most likely to be appropriate for their needs.
  • As part of release of the new national benzodiazepine quality prescribing guidance toolkit sponsored by Scottish Government Effective Prescribing and Therapeutics, a digital tool to support creation of benzodiazepine tapering/withdrawal schedules.

We are also seeking approval to use the NHS Scotland logo and title for the RDS app on the app stores to help with audience engagement and clarity around the provenance of RDS.

3. RDS Search, Browse and Archive/Version control enhancements

We are still hopeful that user acceptance testing for at least the Search and browse enhancements can take place before Christmas. Thank you for your patience and understanding in waiting for these improvements. Timescales have been pushed back by old app migration challenges, work to address outages, and most recently implementing the contingency arrangements.

4. Support tickets

We are aware that there continue to be some issues around a number of RDS support tickets, in part due to constraints around visibility for the RDS team of the tickets in the existing  support portal. We are investigating the potential to move to a new support ticket requesting system from early in the new year. We will organise the proposed webinar around support ticket processes once we have confirmed the way forward with the system.

Table formatting

There is a known issue with alterations in formatting of some RDS tables which seems to have arisen as a result of the 17 October deployment. Tactuum is working on a fix and on implementing additional regression testing to prevent this issue recurring.

5. New RDS toolkits

Recently launched toolkits include:

NHS Lothian Infectious Diseases

Scottish Health Technologies Group – Technology Assessment recommendations

NHS Tayside Anaesthetics and Critical Care projects – an innovative toolkit which uses PowerAutomate to manage review and response to proposals for improvement projects.

If you would like to promote one of your new toolkits through this newsletter, please contact ann.wales3@nhs.scot

A number of toolkits are expected to go live before Christmas, including:

  • Focus on dementia
  • Highland Council Getting it Right for Every Child
  • Dumfries and Galloway Adult Support and Protection procedures
  • National Waiting Well toolkit
  • Fertility Scotland National Network
  • NHS Lothian postural care for care homes

6.Sign up to RDS Editors Teams channel

We have had a good response to the recent invitation to sign up to the new Teams channel for RDS editors. This provides a forum for editors to share learning, ideas and questions and we hope to hold regular webinars on topics of interest.  The RDS team is in the process of joining participants to the channel and we’d encourage all editors to take part, using the registration form – available in Providers section of the RDS Learning and Support area.

 

7. Evaluation projects

The RDS team has worked with colleagues in NHS Grampian and the Digital Health & Care Innovation Centre to evaluate the impact of the Prevent the progress of diabetes web and mobile app in a small-scale pilot project. This app provides access to local and national resources and services targeted at people with prediabetes, a history of gestational diabetes, or candidates for remission. After just 8 weeks of using the app, 94% of patients reported increased their knowledge and understanding of diabetes, and 88% said it had increased their confidence and motivation to make lifestyle changes, highlighting specific behaviour changes. The learning from this project is informing development of a service model based on tailored support for patient groups with, high, medium and low digital self-efficacy.

Please contact ann.wales3@nhs.scot if you would like to know more about this project.

  1. Training sessions for new editors (also serve as refresher sessions for existing editors) will take place on the following dates:

  • Friday 29th November 3-4 pm
  • Thursday 5 December 3.30 -4.30 pm

To book a place, please contact Olivia.graham@nhs.scot, providing your name, organisation, job role, and level of experience with RDS editing (none, a little, moderate, extensive.)

 

To invite colleagues to sign up to receive this newsletter, please signpost them to the registration form  - also available in End-user and Provider sections of the RDS Learning and Support area.   If you have any questions about the content of this newsletter, please contact his.decisionsupport@nhs.scot  If you would prefer not to receive future newsletters, please email Olivia.graham@nhs.scot and ask to be removed from the circulation list.

With kind regards

 

Right Decision Service team

Healthcare Improvement Scotland

 

The Right Decision Service:  the national decision support platform for Scotland’s health and care

Website: https://rightdecisions.scot.nhs.uk    Mobile app download:  Apple  Android

 

 

0 - 5   6 - 8   9 - 11   12 -14   A - Z

Typical development 15-18 years

Each child will be different and may not present as their chronological age because of past experiences or additional needs. (8) Therefore, you may need to use language and resources from other age/stage sections of this toolkit.

All children should learn about the changes at puberty for both boys and girls, to help understand what is happening to them and to their peers.

Puberty can be a distressing time for transgender and non-binary young people, who may feel even more out of place in their own body than they did before puberty changes started. In addition to open discussion and support from staff and carers, it may be helpful to have some discussion with a GP. Some young people will find peer support helpful; carers can connect them in with one of the support groups run by LGBT Youth. Go to Website: Groups and Support LGBT Youth

  • Young people become more independent and have less close ties to their parents/staff and carers 
  • This stage of life brings increased expectations of young people’s academic and social skills at a time of significant brain development, especially in relation to their executive functioning skills. Most young people will struggle at some point to juggle the many demands on them from school, home and friends and need help with planning and decision making.

Our Brain's Air Traffic Control (Executive Function) | NSPCC (3 min 43s) YouTube

  • The way in which the brain develops at this stage can increase young people’s chances of experiencing harm. The increased desire for peer approval, reduced ability to delay gratification, and tendency to make more impulsive decisions, particularly when peers are present, can all increase risk. (7)
  • Young people are generally more certain now about their sexual orientation and their gender identity though this can change over time. 
  • They experiment with relationships. 
  • Young people gain sexual experience: kissing and sexual touching, some sooner than others.
  • A typical pattern of how sexual behaviour develops in young people is as follows: kissing, touching and caressing with clothes on then naked caressing, oral sex and then penetrative sex (vaginal or anal)
  • They gain more experience in how to interact with each other: negotiating, communicating, articulating wishes and boundaries and showing respect, see A-Z Consent Awkward Moments
  • The typical development described above is now set in the context of 96% of young people at this stage owning a smartphone with exposure to pornography not experienced by previous generations, as outlined by the Children’s Commissioner for England (2,3): 

“Young people are frequently exposed to violent pornography, depicting coercive, degrading or pain-inducing sex acts; 79% had encountered violent pornography before the age of 18. Young people expressed concern about the implications of violent pornography on their understanding of the difference between sexual pleasure and harm. Indeed, this report finds that frequent users of pornography are more likely to engage in physically aggressive sex acts. 

Pornography is not confined to dedicated adult sites. We found that Twitter was the online platform where young people were most likely to have seen pornography. Fellow mainstream social networking platforms Instagram and Snapchat rank closely after dedicated pornography sites”.

What young people should be learning at school and how to back it up at home

All children in Scotland should be getting Relationships Sexual Health and Parenthood (RSHP) lessons at school as part of the Health and Wellbeing curriculum. Individual schools can choose what resources to use but most will now use Go to Website: rshp.scot, as it is the most up to date resource. All the content on this website is available for anyone to view and use.

These links take you to an overview of what children are learning at school and what you can do in the home setting to back this up.

Go to Website: RSHP Senior Phase 

Puberty

  • Young people explore what can influence choices about making a relationship sexual, and if it becomes so, what a positive sexual relationship might be like. Young people think about whether they are ready for a sexual relationship, and are encouraged to delay having sex until they feel ready. Young people consider the idea of ‘relationship rights’. 
  • They learn about gender equality and the law in relation to this. 
  • Young people are informed about the purpose and main methods of contraception. They learn where contraceptive advice and information are available and how to find and use sexual health services. 
  • Young people evaluate how the media, including social media and pornography impact on physical and mental health.  
  • Pornography is discussed as a medium through which people are objectified, hurt and exploited. 

Healthy Relationships and Consent

  • Young people learn about the skills needed to manage challenging situations within relationships, including sexual relationships, for example, compromise, empathy, decisiveness. They learn the rights and responsibilities required for safe and enjoyable sex.  
  • Young people learn about the role and impact of alcohol and drugs in relationships and on choices and experiences of sex. 

Sexual Health

  • Young people learn the importance of self-examination of breasts and testicles and have factual information about common sexual problems.

Support and learning required from carers and staff

All children need help from adults to distinguish between appropriate and inappropriate behaviour. Past trauma may mean that a child or young person displays inappropriate and sometimes sexualised behaviour. Be clear with everyone in the house or care setting about what is acceptable and about the need for personal privacy. (8)

  • Boys will need ongoing information and support about the physical and emotional changes that come with puberty. See video clips in A-Z Puberty, and A-Z Anatomy which provide a good overview.  
  • Some girls will need staff and carers to continue discussions about physical and emotional changes at puberty. If they haven’t started having periods they will need support with feeling different and to link with their GP. This is some information about late onset of puberty: Early or delayed puberty – information about reasons Go to website: Early or delayed puberty - NHS (www.nhs.uk)
  • All young people at this stage need staff and carers to help them understand some of the ongoing changes as a normal part of developing adolescence. Phases of physical growth and change cause tiredness and often align with changes in sleep patterns. Staff and carers can help young people to have a good sleep routine and should include a cut off time for use of phones/tablets and other electronic devices. 
  • They will need help with navigating friendships and relationships, risk taking, peer pressure and making healthy choices. 
  • Different sexual orientations and gender identities need to be included in discussions, along with the acknowledgement that some young people will not be very interested in romantic relationships yet/at all. See A-Z LGBTQ+
  • All young people need staff and carers to help them learn which behaviours within relationships are healthy, which aren’t, and the support available. Young people will benefit from ongoing, short, chats about healthy relationships and consent throughout the teenage years.  It can be feel more comfortable for to use situations in films/TV/on social media to start discussions about this. These resources provide an overview of some useful key messages to include and an interactive game to play with young people. See A-Z Healthy Relationships, and Consent

    Go to website: Healthy Relationships and Consent: Key Messages for Young People

    Healthy relationships and consent resource for professionals working with young people

  • Almost all young people will have a smartphone and be using a range of social media for entertainment and to socialise. It is still important to have parental controls on their phone but equally important to have ongoing discussion about who they are socialising with online and what they are watching. Peer sharing of images is common and staff and carers need to talk with young people about what is ok and what is not. Sharing intimate images should be discussed, in general, as part of ongoing conversation about socialising online, not just in response to a situation where this has happened. These videos can help start conversations:

Send a Mole Rat Instead (1min 30s)

Forever (1min 52s)

These are some key messages to use, that you can put into your own words. See P17 of Healthy Relationships and Consent Resource for Professionals working with Young People

  • Sexual harassment is any form of unwanted sexual behaviour. Many young people at this stage and older will experience some form of sexual harassment in a range of settings – school, in the street, online – and need staff and carers to talk with them about this and that it is not their fault if it happens. This is a helpful overview  from Brook - Go to website: What is sexual harassment? This is a short video about Go to website:sexual harassment in Scottish schools - scroll to play video.
  • Much of the free and easily accessed pornography that this age group may see shows sexual violence, mostly carried out on women by men. Staff and carers need to talk to teenagers about this and be clear about the difference between consensual sexual activities that give people mutual pleasure and sexual violence. See RSHP's What is pornography and what is it doing to us?
  • At this stage, young people need to learn basic info about contraception, STIs, clinics and other helpful sources of information. 

Behaviours that are not developmentally typical and how to respond

This tool has been developed by Stop it Now for parents, but is suitable for carers and staff to use. It describes behaviours that are developmentally expected and behaviours that are not healthy or safe.

Carers who are concerned about a child’s behaviour should share their concerns with the team around the child as a first action.

Staff should refer to their locality guidance and protocols.

Traffic Light Guide - Teenager