 Rwy'n go i'n dda i ddweud y gwaith i dwy'n gweithio i'r bwysig, nad oedd yna gweithio. Felly mae'n gweithio. Mae'n gweithio. Rwy'n gweithio. Fe oedd ymlaen nhw, dyma. Mae'r unrhyw. Mae'r pwysig. Mae'n gweithio i'w cta. Mae'n gweithio i'r rhai. Mae'n gweithio i'r pwysig. Mae'n gweithio. Felly, hefyd. I'm excited to be here talking again at Drupalcom Prague. In this session, we're talking about the equip projects. It's a pretty non-technical talk in terms of Drupal and technology. There's a lot of domain-specific knowledge about mental health. My name's Anthony Fox-Davis. I'm the CEO at System Seeds. This is Elise West, who heads up our UX and led the equip project. For some extra background, System Seeds is a full service agency with a focus on Drupal and HCD or Human-Centered Design-Driven projects. We only go after social impact work because life is too short to make rich people richer. I think we can all agree on that. Equip fits nicely into that definition of social impact. Over to me. Hi, I'm Elise. Nice to meet you. I head up UX for System Seeds. There's me with a glass of wine. That's how I'm happiest. I'll be like that later, hopefully chatting to you all. I was managing the Human-Centered Design and Product Strategy for this project equip. It's been one of our largest projects which we've been involved with from concept right through to launch. I've been managing the design and product strategy for every kind of industry you can imagine over the last 16 years. I was only lucky enough to move into social impact work in the last five years. I can't tell you the difference that I personally feel in my motivation to do my work and go to work in the morning with that change that I actually can have a positive impact on people's lives. How many people in the audience are designers or working user experience here? Two over there? Oh, a few. That's good. Good to see. So as you all know, our whole job is to know about people and understand what makes them tick. So when I used to work in the private sector for corporate companies, a lot of my day-to-day job was helping companies get people to get their credit cards out. How are we going to get them to buy the earrings to go with the suit or upgrade their hotel room? So going from that to what I do today, I can't really even describe the difference in how I feel about my day-to-day. So equip was my first large social impact project and it's a project that I feel incredibly passionate about. We're not on that slide yet. Got to predict, surprise. So yeah, so it's a project that I feel really passionate about and it's been a real privilege to be honest, to be on this journey with the WHO from where they wanted this to go to the impact that we've been having with this project today which I'll start to describe when we start to talk more about it. How many of you have worked for an NGO or the UN? Lots of you, as it should be in the Drupal community. And how many of you don't yet work in social impact but it's a space that you're interested in getting into? A few, one. So basically I think for a lot of you that already work for social impact projects in the UN, there's things that we learnt and things that we did on our journey that will probably sound very familiar to you. Those of you that are looking to move into social impact, I hope that there'll be some information and some tips and tricks that will help you as well. So why talk about a case study today? What's in it for you? Obviously not enough people thought there was a knot in it for them but there is. So for the video it's not as crowded as we would like in this lovely big room. So I've taught a lot of organisations over the years how to work in agile and even more how to focus on the user. Human-centred design, which is something we'll talk more about a bit later on. And every time we have new clients come to us I hand on heart commit to them that they will have a significant positive impact by focusing on their users' needs. So that really is what I want you to take away from today that if you change your ways of working and if you really look at a human-centred design process first and foremost your projects and products will be more successful. And if you don't, probably your projects will fail. So we'll talk about that a little bit more later on. So equip. What is equip? Equip stands for ensuring quality in psychological support. But what does that really mean in layman's layperson's terms? Next slide. So basically the basic premise is to train and assess people in humanitarian settings that have no background in mental health care. But why do this? Why do we even want to go there? So basically in high poverty areas and humanitarian emergencies at least 97% of people suffering from depression or with other mental health problems receive absolutely no mental health care or support. Now that alone is a shocking statistic but I want to bring it even further home with another stat from War Child that I saw recently. In the Gaza Strip right now four out of five children are suffering from severe depression, fear and grief and have absolutely no access to any mental health care at all. So I'll just let that sink in. And this is an issue that NGOs have been struggling with, global NGOs have been struggling with for years. And how can they really scale, I think it's the next slide, how can they scale this ability to give support that just basically is not enough psychiatrist and psychologist and even more so in humanitarian settings. So this was really where a quip came in and how a quip was created. So the goal for a quip and the two main goals for the WHO now in partnership with UNICEF and funded by USAID is number one as I've just said is to increase the number of people the number of non-specialists who are safe and able to give mental health support and secondly eventually to become the standard tool, the standard platform to train and assess all people for the fundamental mental health interventions. So before we go any further and before I talk through the details of what we did and how that's interesting for you, I'll go through a few terms that for those of you that have worked a lot for NGOs these probably seem quite familiar but it will just help for the details that we'll go through. So these are all different user types that we broach all the time. So a helper is basically the person I've been talking about it's the non-specialist, the person with no mental health background who was being trained to give mental health support. So those generally are people doing this. They're often volunteers in their community that have seen the destruction and cause of in their community of severe depression, post trauma and post war or if there's a bad level of substance use and they want to help. Well they could be professionals that work with the community but have no mental health experience so teachers, pharmacists, police officers to give some examples. And a client. A client is the person in need of mental health services so basically what we would normally refer to as a patient. And a trainer. So a trainer is a person normally employed by NGOs who is a mental health expert who is training the non-specialists in the mental health skills that they need. So normally a psychologist or a psychiatrist in the area. Over to you. So why Drupal? Why are we presenting about a quip at DrupalCon? Well the executive summary would read it's open source and it's scalable. First let's talk about open source. When we first talked to stakeholders about technology choices and systems architecture they immediately knew that open source would help them in the following ways. Make it easier to get projects signed off through legal contracts. It would mean that the project can easily move between departments which is a very common occurrence in the UN where one takes over ownership from another. And it means that partner organisations could also share or transfer ownership or easily fork the project code base. Obviously Drupal is open source but how else would it benefit a quip? Honestly I've never considered Drupal to be specifically cheap or fast to use for MVPs or starting with an MVP or a minimum viable product. But our engineering team is always up for a challenge so we set them one to quickly build an MVP while also laying the foundations for scalable architecture. In human centre design the faster you can show results even for the smallest thing the faster you can go back and talk about future budgets as I say this is an iterative project which is obviously great for project longevity so we knew no code prototypes showing a proof of concept needed to be quickly followed by an MVP for users in the fields real beta users. By design this MVP was built for English speaking users but we knew that the future of a quip meant supporting more of the official languages of the UN as well as the less common languages native to where a quip was going to be rolled out. These included Arabic a right to left language which meant that page layout adaptation was crucial included the language of Tigrinia this is a new one to me and that has its own alphabet which is spoken by the global diaspora of people from Ethiopia and Eritrea had support Nepali and others as well. One important consideration we had around being ready to scale into these regions was not just about adaptation of language and layout but about regional content as well. Here's an example of why that's important. In the UK and in much of Europe making eye contact is used as a way to show you are being attentive you're looking to make a connection and empathise when people are speaking. In these countries a therapist or psychologist might use eye contact as a way to form trust with patients. But in some African and Middle Eastern countries eye contact can be considered rude a cultural difference and a psychologist using eye contact with patients would get the opposite of that desired effect. In some regions even the word depression needed to be adapted to be understood by the helper receiving the training. It's not in the dictionary. Let's talk about internationalisation. To achieve all of this we use Drupal core translation modules and translation management tool to go multilingual and roll out regional specific content in one sprint. We went from supporting one language to four in two weeks. I think now is a very good time to say thank you to Drupal for making that possible. Also we wanted admins to feel good about the UX and UI in their back end specifically in the workflows of their back end. They needed something that looked and felt great and in the past Drupal wasn't exactly famed for its user friendly admin UX. So we had some work to do there. We used the Claro theme and customised it to help guide the admins UX and through roles and permissions we tried to hide all of the irrelevant features and all of the navigation items that admins didn't really need to see. The end result was actually quite a slick and crisp UI in UX that made a good first impression on new site admins, very important. And it put their equipped specific forms front and centre in those workflows. So human centre design which I've mentioned a couple of times has been caught of the success of this project because at the end of the day understanding the people that are going to use the tool that we're producing has to be the forefront of everything we're going on to develop and I hope after this talk it will be the forefront of everything you go on to develop. So what is human centre design? It's basal That just flipped. Oh, next slide. No, next one, sorry. It's basically the focus is understanding the perspective of the person who is experiencing the problem and finding a solution that meets their needs solves that problem. So let's talk a little bit about when we don't do this. What happens when human centre design is ignored? And this is a real example. So this was a campaign in the US with the strap line, two call to do drugs, went on every pencil in every school in the US and they didn't really think about the end user, the student. They thought, yeah, great. We've got these pencils, students write with pencils. What else do they do when they've written for a while? Is they sharpen the pencils and so very quickly that strap line called to do drugs or just do drugs. Not quite the impact I think they were looking to have. So back to our human centre design processes where we actually do it right. And we always kick off, we always start with a workshop where we get everyone into one room together. So that's our stakeholders during the research phase that was the WHO, George Washington University and eight NGOs around the world that were helping us with the research. And it was also our team. So not just me, but our designers, our developers. We were all involved, all in one room. And this is an opportunity for us to do many visual exercises with the stakeholders and the co-design wireframes. And it really helps the stakeholders go from we need everything for all users straight away. It's got to just do everything. That kind of typical mindset to starting to understand well who are the most important the target users we need to meet their needs first and which needs do we need to meet first. As well as that it's a great opportunity to build trust with the stakeholders and really get them to lean into the HCD the human centre design process. So after a workshop of five days and I have to say that the stakeholders were very reticent that we were making a digital tool for this. It wasn't like a yay we're here and we want to do this. So just before I move on to these quotes to give one example at the very beginning and I did exactly this I introduced human centre design and what we would be doing. And the lead of Warchild, a very important man who has headed up a lot of this research literally just said I don't want to do this and I don't want to be here I've been using pen and paper for years this is pointless but regardless he was under contract with the WHO so he had to stay which was lucky for me because by the end of five days it was a real change two statements like this this will aggregate all of my data for me and my colleagues can see all of the assessment results without me having to do any extra work and now beyond some of the other impact that a quip can have saving time for any of us is great right but saving time in NGOs is astounding before meeting all these different NGOs I couldn't really grasp how under staff they truly were so to give just one example health right which is an organisation in Uganda have just two staff training hundreds of helpers every week in the whole of northern Uganda I mean I just couldn't even get my head around I kept going where are the others you have a team right no it's just us okay so going back to the war child scenario they are now our most active users so much so that they now train other smaller organisations in how to use a quip because they want it to scale and they literally phone us often asking we've got more interventions please put them into a quip we really don't want to use pen and paper so seeing that kind of impact and that kind of change of viewpoint for people that really are not digital natives are used to using pen and paper was really excited for us it was a game changer for us and for them right so once we'd had that workshop and we had some concepts in place we went away and we prepared code free interactive prototypes now the code free aspect is super important because we're looking to do this as cheaply and quickly as possible there's still so much we don't know so we don't want to waste budget on months of development at this stage so once we had these interactive prototypes ready the George Washington University team and myself went into the field to do research with the prototypes in real trainings real assessment so we went to Lebanon Peru, Uganda Ethiopia and Nepal and we used the prototype we were like pretend you're doing a real assessment well actually do a real assessment pretend this is already the real tool and assess with it obviously as you can imagine doing that kind of testing in the field was invaluable and we really found some blockers and engagement flows that we needed to fix but we also found some quite surprising results that we couldn't have predicted so to give some examples some of the user flows or labels or icons that you and I are super used to using on our iPads or android phones were really not working for them if you're not a digital native we needed some things to just be made clearer and done in a different way but the great thing was we could literally adapt the prototypes there and then on the go test again until we knew it was right and again the same as with the stakeholders a group of very non-digital native people when we first arrived the whole idea that we were making this digital tool they were definitely reticent and by the end they were both excited and they were asking when's the real thing going to be ready I want to use it for my next training so it was really great to see that enthusiasm so how does I've talked very briefly about agile but how does this human-centred design approach the discovery process fit with agile development well it actually fits perfectly because in both cases we're looking for the smallest iteration that can meet the user's needs measure the impact check we're on the right path and then loop around so it's a constant loop CD discovery through to agile development measuring and then on we go so I'm going to talk about iterating for a moment most of my experience in technology has been in management and when I learned about agile for me it was mind-blowing nowadays I coach agile with our clients and nowadays I coach agile with our clients and I feel it's really key to our project successes so why is it such a strong tool we've got the iterations that's it a few reasons you start by prioritising and specifically you start by prioritising your time we set minimum agile ceremonies like sprint planning, sprint review, retro and a daily stand up and we timebox those to make sure we spend that time wisely and just that in itself helps cut extraneous costs there's too many long limited length meetings that go on and that costs the client money and costs the project it also helps us focus on delivery the more time we have back the more we can build something and get it out this focus was so important given that we needed to get things out quickly to real users to me already so agile is obviously great for shifting needs but it is especially prevalent especially needed when Covid hit so at this point we were deep into sprints dealing with iterations for the assessment tool and they couldn't run the NGOs couldn't run in person trainings or assessments which by the way was everything we'd designed up to that point was for in person trainings in assessment but even worse than that was they couldn't support their current clients who they normally supported by being in one room so we were having NGOs calling us going and no one meant to be testing out the trainings and the assessments but honestly we don't know what to do because we've got our current clients and we can't support them we don't know how to do that remotely so this is where the project pivoted there we go stop so we moved from a focus on the assessment feature that was going through MVP trials in the field to bolstering our open source Drupal based LMS that system seeded built in the past our LMS is called ANU and is used by other WHO projects as well as a quip and it's used by other social impact and NGO organizations around the world ANU runs as a PWA a progressive web app and this was originally so that we could keep a single code base and not build a separate native app for field users who wanted to use tablets they wanted a large screen real estate and you had to add data, collect data to keep it local before you could get back into internet connectivity this choice actually turned into a real blessing when the pivots occurred and ANU was called to the offering via browsers on the web another pivot was for our own editor team to prioritize enhancing the LMS course content this allowed NGO staff to continue delivering urgent remote support to clients online as opposed to tablets in the field so the impact of a quip so I talked to a lot at the beginning that I promised clients that they will have a positive impact so let's talk about the impact that a quip has had so far so a quip was launched to the public in May so pretty recently and we've already seen active use of a quip in 46 countries we have over a thousand monthly active users already and hundreds of helpers already being trained now a thousand monthly active users for those of you working in the private sector doesn't sound that amazing but in NGO world this really is already fantastic the WHO and these NGOs don't have big sales and marketing budgets so most of this number of users already is just from NGO to NGO word of mouth as well as that the WHO has already measured an 18% increase in the safety and ability of helpers trained with a quip compared to standard trainings before now obviously now data aggregation is immediate I talked before about how under staffed NGOs are before they were having to use multiple employees to aggregate the data from various trainings multiple assessments per training send them to their headquarters where they were aggregated further all of that is now just done by the platform the USAID is so pleased with the results so far of a quip that they've agreed to fund the fourth year in a row for a quip so as well as the data on a more analytical level we also obviously touch base and find out information from our users in the field all the time to check that this is working well for them and rather than go through data points which we have many of I'd rather give you one story one example of talking to different people in the field so I was actually there at the time when this happened in Uganda with Healthrite Healthrite are an organisation that focus on post war post severe trauma depression and Josephine is the director for Uganda and she was about to run a 10 day training for 20 volunteers who wanted to become helpers and I was there just to watch and check how a quip was being used and how we could further refine it now I have to say at the beginning of this training on day one Josephine looked pretty despairing these volunteers were going to be hard to train they were starting from a place of literally zero understanding or knowledge of depression and due to many cultural reasons a total stigma about discussing mental health at all as well as that there were societal norms for the area that we were in that meant that the women in the group, the women volunteers really struggled and were very uncomfortable to look anyone in the face never mind eyes at all when they were practicing to support and would often kneel in front of people especially their male counterparts so Josephine felt this was going to be pretty hopeless but regardless we were like let's go ahead and see what happens at the end of 10 days using a quip for the training and then using a quip for the assessment I was there when Josephine was literally in tears and she was in tears because she was so moved to see this group of people able to support people understanding how to be effective and safe helpers and she couldn't believe it now I talked before about the emotive elements of social impact work in general but also how passionate I am about this project and I can't really describe a moment like that where you get to see that happen for a project that you've designed that you are part of a team developing it was really an amazing moment an amazing moment to know why you do the job that you do so as well as talking to the trainers in the field we also spoke to the people being trained the people that were becoming helpers to get their feedback and again I have just one example that I'd like to give of many examples from one helper who was being trained with a socios in Salud which is partners in health in Peru and I'm just going to read this quote I was able to support my neighbour who lost her husband to Covid and was dealing with profound grief she has now started to get back to her routine and engage with her family I'm so grateful to have these skills that enable me to support my community particularly at a time when the mental health of so many people has been impacted by the pandemic as well as that already Equip has been widely featured in various publications I'm only going to name a few Cambridge University Press Scientific American many others we get very excited and it's all over our slack when it happens but just so that you know it's out there and a lot of NGOs have started to know about it and use it Before we wrap up there's a couple of things first of all I want to thank the Equip team that have been involved in this project it's been over the last four years an emotional ride for all of us just as passionate as I do about it works super hard on it so if the people that are on Equip want to stand up for a moment, give a wave give a wave, go on Kate, Bran Allie, Allie thank you there are more out there on our stand as well but I just want to say a big thank you because I know it's been a project we all feel so strongly about as well as that if you remember what I said at the beginning I promise clients and what I hope you have had from this talk I hope you go away from this talk and you are more interested in really thinking about and solidifying the idea of thinking about your user first serving your user and what do they need what problem are you solving for them to really have both successful projects but also if you're working in the social impact space to be able to really impact people's lives positively that's what it's all about obviously on that note any of you that are like that sounds super interesting but we're a group of developers we're here to support you feel free to come and discuss with us what we can do for you to help on your human centre design processes and our stand is just opposite the photo booth just outside so we're going to watch this video it's in Spanish but it has subtitles it's just a couple of minutes long we had a link we no longer have a link give us one moment in the google slides it's a link if you use that no sound? have we got any sound? in our intervention to improve the training of non-specialised providers that is to say health community agents and specialised health providers in the same way it was of great use the fact that it was simply during the attention in the community specialised professionals virtually train health community agents using the Equip platform once the training is combined health community agents are evaluated and accompanied in the use of skills learned during the sessions with the managers with Equip we can continue the progress of the participant and perform feedback when they need it the most and in real time this has been of great help during the implementation of the project the experience in the use of the Equip platform shows that its implementation increases the quality of services provided by health community agents on the other hand considering that the integral care of maternal health is important is trying to establish spaces that link to communities with health establishments or other support institutions for this reason it is expected that the Equip platform escalates to public and private institutions in this way we guarantee that this platform comes to organisations that give attention to people that need attention in mental health health partners intend to establish alliances with the Ministry of Health and other UNG so that it is implemented at the national level and be a country that is referring to the level of Latin America we continue to work to give attention to quality in mental health and just a reminder that there's a contribution day on Fridays Anu is open source our LMS if anyone would like to contribute to Anu there's other contribution days scattered throughout the week here at Drupalcon also we have a stand please come and say hello to us we can't wait to meet you all properly it's S14 opposite the photo booth and I hope you enjoy the rest of the time at Drupalcon this week goodbye are there any questions before we go? second sorry can we grab that for the people watching online who asked the question okay sorry there's people watching online hi I was curious what is the LMS platform if you use the Opinio Drupal distribution for LMS we created Anu ourselves so it's not based on another Drupal platform it really had to be flexible and we didn't want to be bound by someone else's roadmap so it uses a great deal of Drupal country modules so we tried to not fork from what the rest of the community is doing as a whole but we prefer the building blocks rather than someone else's complete package and just to add to that especially for the UN because we now use this LMS for various UN projects and it really has some elements that really lends itself now to their needs so it's been excellent in that way that I haven't really seen off the shelf LMSs be able to do for us and how long did it take you to build that okay so this is a trick you might want to employ in your own agencies or dev teams we told our CTO to go away and come back in two weeks and he wasn't allowed to talk to anyone else in the company two weeks we shut him in a cave we called it the cave and he came back and had built the fundamentals with a roadmap as to what would come at specific times and what community-contrib modules would be incorporated at the right times depending on the feature roadmap so two weeks lock away your CTO he can create great things and now we iterate on it all the time but we iterate based on what real users need not on a bubble of our own gases which is what's important any other I do have a question so you talked about muddlingwyr capabilities so have you provided this to the admin side as well can you repeat that? have we provided the admin side to the admin to the content editor on the admin side have you provided the muddlingwyr capabilities there yes we have is the short answer but it has been really an interesting journey because obviously NGOs and the WHO have restricted budgets and how much they can spend and if we went full whack with every desired thing on the admin side we'd end up with the same amount of money spent as on the front end so we had to be very and again we're dealing with a lot of non-digital natives who are content admins and admins on different levels but yes we've built in various elements and the multilingual element on the admin side as well what we found was helpful when we started talking to senior stakeholders at the WHO they mentioned many different projects that would benefit from an LMS and what we did is we started to talk to other projects it's actually within the same mental health department of the UNWHO but what we found was feature commonality that people were requesting and so when we went to build something we specifically went to build it in a generic way and we talked to other ongoing projects to get feedback from all of them so they had not just one shareable distribution but they could do feature switching so when Anu is used in different projects it may not have all of the same projects as the neighbouring application of Anu but when we build once it's ready for release Maybe I'll connect with you later because I do have more questions I would love that Anyone else? The same for everyone feel free to come over to us and there is jam and other gifts and then if you do have more questions or want to chat more deeply about the project then do come over Tam I don't know everyone's name This question is prepared Would there be an opportunity potentially tomorrow for people who are interested in LMSs to join a Birds of a Feather session maybe led by Kate It's fun This is Kate You now have to say that all over again with the microphone It doesn't matter for the recording It's an in-person event Tomorrow What time did you say it? One o'clock 11.30 Tomorrow at 11.30 more discussion specifically about the Anu LMS Very good One final question If the microphone can get over that I actually have a bunch but I'll just narrow it to one So as a product designer I really focus on accessibility and knowing the type of work that you do I'm wondering how you are able to integrate accessibility in EQUIP or is that in the future because I know budget and timeline is very challenging So if you could talk about that That's a great question and I'll answer it briefly but I would recommend that you come over to our stand to discuss it in more depth with Alejandra who is our specialist who's just here but on the brief answer to that at the moment is yes we've built some elements of accessibility in and it has to be right on a standard for the UN it's not really acceptable not to but you're also right that within the budgets the level that we would like to isn't always possible but what we try and do on an agile level is within the same stories when we're looking at this is the user behaviour we would expect in this story we also put and this is the behaviour we would expect on an accessibility level Now on a design level we all know to design in a way that's accessibility friendly I think that's it Thank you so much everyone Thank you