Cove – being tested in the NHS

Today we are very proud to announce that Cove has been added, amongst 20 other health apps, to the new NHS app library. In partnership with NHS England and mHabitat as part of the Digital Development Lab, we have received funding to evaluate Cove for approval by the NHS later in the year.

What is Cove?

With Cove, you can capture your mood or express how you feel by making music and storing it in a personal journal. Cove has been designed as a tool for young people who have experienced bereavement or loss, but adults may find it equally useful to express and capture a mood or emotion. We are using an evidence-based, human-centred design approach to build an app which encourages self-expression during difficult periods of life, which we believe can improve emotional and mental health over time.

We have partnered with clinicians from Imperial College London and the charity Child Bereavement UK to evaluate Cove as part of the Digital Development Lab for NHS England. 

By adding Cove as a digital support tool for young people experiencing bereavement, we believe we can help support young people to cope better with their experiences. In conjunction with professional therapy, is the goal of Cove to empower young people to self-express and grow from their experiences.

The problem

Every year, almost 6 million young people in the UK experience the loss of someone close or significant to them - as many as 92% will endure this life-defining and profound loss before the age of 18.

A survey by the Office for National Statistics of the mental health of 5-15 year olds in Great Britain in 1999 found significant associations between mental disorder and the death of a parent, sibling or close friend.

In our original discovery phase in 2015, we identified adolescent bereavement as an area with a lack of modern support tools, and engaged with a number of professionals who work in and around child and adolescent bereavement, including Dr. Heather Servaty-Seib of Purdue University, The Dougy Center for Grieving Children & Families and Hospice Calgary in Canada. We subsequently led co-design sessions with the UK charity Child Bereavement UK to understand the needs of service users and began to develop Cove as a modern tool for young people.

Beyond needing modern tools, access is an issue. Among 53 local authorities responding to a survey carried out by the Childhood Bereavement Network (CBN) nearly two thirds reported that they had an ‘open access’ service working across the whole area with children bereaved in any circumstances, and to which families could refer themselves directly. However, even where such services exist, they may only be able to see a very limited number of children due to funding difficulties, and families may need to travel long distances to access support.

The death of a parent during childhood has been linked with a wide range of serious health consequences ranging from schizophrenia to major depression and suicide. For young people who experience bereavement amongst other difficulties, they can be 'at risk' of experiencing negative outcomes - in areas such as education, depression, self-esteem and risk-taking behaviour - later in life.

How we understood the problem
We have identified a need for a digital tool to support young people experiencing bereavement, and have received feedback on the wider potential of a tool with other mental health problems such as depression or anxiety. Informed by professional insight and validated through user testing, we believe Cove functions as an effective tool for young people to improve their emotional health. By increasing confidence through self-expression and utilising the everyday technology of smartphone apps, we can deliver innovative mental health support to young people who need it the most.

During early development phases in late 2016, we held sessions with the Young Person’s Advisory Group at Child Bereavement UK, to discover young people's habits and preferences for digital products, which has directly fed into our understanding of Cove as a tool for self-expression. The Childhood Bereavement Network reports that it can take up to 3 months before young people are seen by a counsellor or therapist. Even when in therapy, they often don’t possess the emotional maturity to effectively communicate their complex emotions. We understood that many social media platforms used by young people everyday and other existing therapy tools do not support the forms of self-expression often needed by young people experiencing grief or loss.

How does Cove work?

Using Cove, users create small loops of music on a highly visual, touch-based interface. They can pick a general ‘mood’ and then simply arrange notes and chords to create a short composition. They can choose from a variety of instruments and effects to find a sound that matches their mood. They can then store these loops in a private journal, selecting professionally-accepted tags, and/or adding text to describe their mood.

Cove can be used any time, but it may be most useful when people find it difficult to express themselves through other means, such as talking or writing. Cove can be used whenever they feel like it, there is no right or wrong way. They can use it by themselves, or with other people. We believe for the greatest benefit, Cove should be used alongside professional therapy.

Cove draws from the literature on the use of 'therapeutic arts' in bereavement, and though not technically a form of music therapy does use some elements of established music therapy practices, which has been classically described as "a systematic process of intervention... health is promoted using music experiences and the relationships that develop through them as dynamic forces of change."

Music therapy has been declared 'the most successful' intervention for supporting bereaved youth, according to meta-analysis (Death Studies, Rosner, Kruse & Hagl, 2010). Qualitative studies in Australia (Grief Matters, Skewes & Grocke, 2000) have highlighted that "music therapy is valued because of the opportunities for both expression and connection that are made available through musical participation."

Cove is not a substitute for professional therapy, and not suitable for those experiencing severe distress or suicidal thoughts.

About Humane Engineering
When they were teenagers, Ivor Williams and Alex Rothera – the co-founders of Humane Engineering and makers of Cove – both lost close friends to suicide and a car accident. As a result, they understand the problems many young people face when they are having a difficult time, and the importance of being able to express oneself in a meaningful way.

They have used their experience as designers and technologists to create a new tool for young people that was designed from the start to tackle an important, yet problematic issue: communicating complex feelings and emotions.

Their company Humane Engineering, is dedicated to designing and inventing products that improve the lives of people. It is supported by the Bethnal Green Ventures and NHS England.

Contact Details
Ivor Williams, co-founder
Twitter: cove_app