Max Davie: Right, hello and welcome to the ADHD UK podcast. I'm Max Jamie: Jimmy Max Davie: and we are joined today by Ben Kosh. Ben, please introduce yourself. you're going to talk to us about silver. Ben Cosh - Sylva: Hi, I'm, I guess a dad in this situation. I've got both my kids have ADHD and autism and I found the process of working out what's going on for them and then working out how to get life to in such situations so they could really thrive was very, very difficult as many families find it. And so we built silver to try and help families in that situation. Max Davie: So could you tell us a bit more about that? Ben Cosh - Sylva: so Silver is a digital tool that's available on, on web or on people's phones. It essentially has two modules in it. One module is a profiling tool which takes all of the best screening tools out there that are associated with autism and ADHD. So it might be anxiety or depression or PTSD and all these sorts of tools. it then builds a profile of anybody in the family. could be a young person or it could be the user themselves or their partner. And then we've got multiple AI specialisms in the tool that can help people get very, very nuanced advice about how to deal with a particular situation. So there's one module which is about self-care and there's another module about parenting. And then there's a third module about how you try and stay on the same page with your co-parents or partners. And what we find is that the most used section is people who are completely burnt out and depleted, people who are exhausted by this situation. And to answer your earlier question, the reasons they're exhausted are the system is so broken in so many ways, as you will have heard many, many times. And parenting in this environment is tough. Parenting kids who have differences is tough. And so people talk a lot about that. People talk a lot about how they might be, they don't feel seen by their partner. People talk a lot about, how do I get my kids to school? How do I get my kids to bed? How do I get my kids on the plane so I can go on holiday and have a nice time? I should say that all the conversations in Silver are confidential. So we just see a a summary of those conversations. don't sit there and read the conversations unless there's a safety issue in those conversations, in which case they're reviewed by our... designated safeguarding need and escalated if that's appropriate. Max Davie: So this is the this conversation comes off the back of the Fonegie report in a way. And I think that's why this is a really good moment to start thinking about how we think differently about people's needs when they're str struggling with neurodevelopmental needs, ADHD, whatever. Just to spell that out a little bit, the Fonogie report recommendation two is that basically we move towards a needs-led plus diagnostic system. Now, the idea has always been that we have an needs-led. However, in practice, a lot of people are saying, well, that is just not happening. Is that your experience? Ben Cosh - Sylva: Yeah, guess, I mean, the fundamental issue is that services are overwhelmed and they need to gate their services, whether it's disability living allowance or it's special educational needs, reasonable adjustments in the school, or it's, you know, GP access or it's CAMS access, all these services need to gate their resources on something. And so what a lot of them will do is gate the expensive parts of the services on a diagnostic approach. And that just shunts the waitlist into another part of the system. Max Davie: Yeah. I I 'cause I think for for me, when people started talking about needs led approaches a couple of years ago, I as someone who's been in the system for twenty plus years, kind of slightly rolled my eyes. I'm like, well, it is a leads led system, what on earth are we talking about here? but then I thought then I thought a bit more and I thought, well, actually, I have noticed particularly I mean I moved areas which probably is a part of that, but I've noticed much more recently parents coming and saying, school will not help my child unless I get a diagnosis. They will not provide anything unless I get a diagnosis. Or I can't get into this service or I can't get I I can't get any help from CAMS is a bit of a special case, but I can't get help from from from particular outreach services unless I get a diagnosis or something like that. And and that is that's definitely got more in the last few years. plus of course, I think the services have just generally been much less imp just present. And I think we'll come back to that. this difficulty once you've assessed needs, what if you can't then meet them? That in a way, sometimes this gatekeeping is a way of acknowledging It's a way of hiding the fact that you actually can't meet the needs. Ben Cosh - Sylva: Yeah, and it's in this aspect, I kind of go back to my role when I was working in the centre of Whitehall and look at the whole system and how kind of people are being shoved around between all the different parts of the system and who gets what, where and when. And so to take my local primary school as an example, there's about 600 kids in there. There's 120 or so who are on have some level of special educational need. 10 % of them. So what's that about 60? have an EHCP, which is higher than a typical school, and the SENCO is completely swamped. They can deal with maybe the top 30 or so people who have the highest level of need. And the school's budget, my wife's the governor there, and she just says it's absolutely desperate because the school has to fund the first £6,000 of anyone's additional needs. And the school just hasn't got the money to do that. And so you're absolutely right. The schools are in a complete bind. And they have the lovely phrase. They'll say, we'll do everything we can. which is apparent when you first hear that, you that's great, they're going to do something. But the reality Max Davie: Yeah. Ben Cosh - Sylva: is, the reality is they just don't have the resources and the poor Senkos and teachers and teaching assistants in the front line are completely overworked it. Max Davie: You dropped a little I I like the fact that you basically came out I'm I'm just a dad and you and you're I'm like, No, well, you are, you are, but then you dropped in, yeah, when I was in Whitehall, can you just tell us a little bit? I mean, obviously w again, n not necessarily needing a blow by blow, but what were the kind of dysfunctions that you saw? 'Cause you've seen the system in lots of different perspectives. What are the Ben Cosh - Sylva: Yeah. Max Davie: sorts of things that drive this dysfunction that that that that we could try and somehow remediate. Ben Cosh - Sylva: Wow, that's a massive question. So one of the tools, so I guess to give a bit of context, I used to work for a management consultancy group. During the Blair government, we had a contract to work for the team that he called the Prime Minister's Delivery Unit, which was basically Max Davie: Yeah. Ben Cosh - Sylva: trying to unblock things that were blocked. they were typically multi-system things that were blocked. And so I got In those couple of years, I got very involved in some of the issues on immigration, on youth justice, on any wait lists. And it's typically multi-agency problems where you've got perhaps the business case of making the change doesn't sit inside one organization. And so it might be the chief exec of the local authority owns part of the problem, the chief exec of the ICB owns part of the problem, the chief exec of the trust owns part of the problem, the head teachers of the school own part of the problem. And joining it up is properly difficult just because of the way the government structures and the way budgets work. Max Davie: Yes. So when something is a shared responsibility, it becomes no one's responsibility, essentially. Ben Cosh - Sylva: Exactly, exactly. Yeah. Max Davie: And I think that is also something I've just written it down because it is definitely something we will return to in this conversation. I I think it's fair to say. I was interested you're working with the delivery unit, because that was that was a really good idea that I think they're trying to bring back. Anyway. That's fine. Ben Cosh - Sylva: I have to say it was a stressful period of my life, but being a dad with a child whose mental health was not in a good place was way more stressful. Way more stressful. I have so much empathy for people in this situation. It's like we're not Max Davie: Absolutely. Ben Cosh - Sylva: trained to do it. We can't, you you don't just go to an NCT class and learn how to do it. You can't read a book and solve it. It's not just about learning new knowledge. It's about changing that knowledge into behaviors and in moments of pressure and high stress. And almost everybody who comes into our app has clinical levels of stress when they start. It's a really, really tough environment. Jamie: So I've I've I've I've got a question about the app and so who like who trains the sort of AI Ben Cosh - Sylva: Yeah, so what we did, I sat down with my colleague, Freddie Jackson Brown, who runs the high needs team in Avon and Wiltshire. And we tried to disentangle what actually makes a difference to people. And so we disentangled all of the third generation CBTs, so acceptance commitment therapy, dialectic behavioural therapy, and so on and so on and so on. And we said, what are the active ingredients in those that actually help people change? Because as you'll have seen from NHS talking therapies data, I think the King's Fund did a report, or Nuffield did a report last year. And they said that 20 % of people that are referred to NHS talking therapies feel better after it. And so that's function of, you know, a lot of the people in the front lines there haven't got masses of training. If they do Max Davie: Yeah. Ben Cosh - Sylva: have training, they might have training in a bit of acceptance commitment therapy, in a bit of CBT, but nobody has training in the full range of third gen CBT. And certainly they don't have training in psychodynamic stuff to get into the really in a child stuff. And they definitely won't have training in family systems. And they definitely won't have training in parenting and they definitely won't have training in couples therapy. And so there's not a single human being who has training in all of the active ingredients that a family needs when they're in these high stress situations. So what we did is we took the active ingredients, as I said, from third gen CPT, from family systems therapy, from couples therapy and from parenting interventions. All of those interventions that had systematic review level evidence, which is the jargon for saying it's really, really solid science. And so, okay, what are the active ingredients? And then we trained our AI in that. Jamie: And I know that you you you said earlier on that all of the conversations are anonymous except from if it's an emergency situation. I I know a lot of people listening will have this fear that AI is sort of harvesting all of their data. I don't know if you can sort of touch on that and maybe explain that for the benefit of the audience. Ben Cosh - Sylva: Yeah, yeah, yeah, sure. I've got lots of issues with the general AI models. And perhaps we can come back to that as part of the second question. But the what we've we've done, we've been super, super careful, because we're holding children's health data. And that is like the most sensitive data you can you can hold. So, for example, the data we might hold might not just be health data, it might be that they're transitioning, transitioning gender, and maybe they've come out. at home, but not at school. And so it's really sensitive data. And so Max Davie: Yeah. Ben Cosh - Sylva: our principle is that we store that all locally and encrypted on people's own devices. So we don't want to hold that on our servers. We have a very, very scrambled encrypted version on our servers as a backup. So if they lose their phone, they can download a new version of it. And it's all completely private, unless there's a safety issue in there. And so we scan every message. for safety issues. it's things like the issues that we see coming up a lot of coercive control situations. A lot of people saying they can't cope and then trying to disentangle is just, how active is that? A lot of people saying their kids can't cope, kids with eating disorders, kids with drug issues. It's just really, really challenging conversations going on there. So we have a human psychologist who reviews all those conversations and they're doing two things. The first is checking that our product is saying the right thing and is being appropriate in how it's handling those situations. And the second thing they're checking is what needs escalating to the local authorities. from an escalation perspective, it might be, I don't know, if we see, it's really dark stuff, so trigger warning to people who Max Davie: Mm. Thank you. Ben Cosh - Sylva: might be affected by this. But it might be, if kids are being groomed for terrorism, we would escalate that. might be... at any child sexual abuse stuff we would escalate. There's about 10 categories that we would escalate it to the local authority and just say that this family may need another outreach. And we want to give the dot in their dot to dot picture so that they've got the full context. But we want to do that in a way that doesn't undermine confidentiality and sense of trust that people have. Jamie: Of course. So I guess the system would would flag key themes to you that might be problematic and then y you would sort of take it from there. Ben Cosh - Sylva: Yeah, so on an individual basis, we get the individual message. So to give you an example, someone last night was having a dark chat about, I won't go into it because it's for the trigger warning perspectives, we reviewed that and we thought that the appropriate thing to do was just drop them an email saying, look, we can see that you're talking about some really challenging stuff. Here are some helpline numbers if you want to reach out to them. That would seem more appropriate in that situation than escalating it to the local authority. And then of course, across all the other conversations, we see the themes with every day I get a notification that says, people are at the moment, it's a lot of people talking about just still trying to get their kids back into school after some holidays, still trying to get Max Davie: Really, yeah. Ben Cosh - Sylva: that system all stable again. And therefore the parents just exhaustion with that. And parents then affected by work because it's really hard to hold down a full time job for people who have these high level of caring needs. Max Davie: So d can we t if we take a step back. This is this is an app for families. Ben Cosh - Sylva: Yeah. Max Davie: Please tell me if I've gotten any of this wrong. If you are a family under stress, you'll go to this app and you will what will it do? Will it give will it spend some time trying to give you, lots of information from you? Ben Cosh - Sylva: So it's the first phase, I guess, of using the app is to try and teach it about your personal circumstances. And so Max Davie: Mm. Ben Cosh - Sylva: in that, know, onboarding, you just say your challenges, which is a tick box list of school, eating, whatever, you know, all the issues that everybody knows about in this sector. And then there's the opportunity in there to do the screening tests. And we put all of the really high quality screening tests in one place. And we think we're one of the very few organizations in the world that put them all in one place accessible to to lay people, not just to the professionals. Max Davie: Mm. Ben Cosh - Sylva: And so that those screening tests are for obviously autism and ADHD, but also all the other associated conditions that an assessor should check for when they're going through. And to unpack an example, some of the behaviors that you might interpret as ADHD might also or might be instead a PTSD. And so we're trying to help this sort of understand the full picture of what's going on for the young person. And then once we've got the full picture of the young people, anybody in the family, we've then got this very specialised, bite sized advice. How do I deal with this situation? How do deal with that situation? Max Davie: Because there's three things that might be spitting out of this. well there's lots and lots of different things, but the three things that are in my head are advice for parents themselves. How do I deal with the things that are in front of me now? Getting out of the house, getting everyone to bed, you know, just not j just coping with, you know, the the basic stuff, the stuff I spend all of my clinical time asking people about the difficulties of. Around. Then there is what should I advocate for what my child needs when they're in school? So you've talked about school avoidance, which is now officially what we call it. We don't call it school reviews on this podcast, since our episode with K Kelly Jarvis. so so just look that up. so sc if you if you're experiencing school avoidance, would Silver be able to say, Well, here's what we think school could do to make that transition easier? Because if you look at the Fonagi report, of course, this needs led assessment should be cross agency, as you've said from your work with the delivery unit. If you're doing everything right at home and school are not, and we've already talked about the pressures on school and we're not that's not a this is not a school bashing point. But if both parts of that system are not working together, then it's sort of pointless if you're doing everything right. Ben Cosh - Sylva: Yeah, absolutely. So at the moment, what the tool will do is help you craft the email you might send to school and to do that in a way that's A, personised and B, not inflammatory. Because I think a lot of what happens is parents are stressed and so when they write an email, it can be maybe a little bit blunt maybe sometimes. And then schools will get maybe get a little bit defen... Max Davie: I don't Stressed people who are really, really invested in an outcome, writing blunt emails. Gosh. Ben Cosh - Sylva: Understandably, understandably, but then what happens is you escalate because then the Senco is feeling defensive. so the Senco then, yeah. Max Davie: Yeah. absolutely. Ben Cosh - Sylva: And so things escalate. So what we try and do is help people really have a really constructive conversation. One of the modules we're building is to help people understand the law better. Because when we talk to schools, we hear that they're getting inundated in emails, which are basically generated by chat GPT. And chat GBT makes up a whole bunch of laws, some of based in California, some of them based in who knows where. Max Davie: Yeah, yeah. Ben Cosh - Sylva: And so schools are just inundated in nonsense. And so one of the modules we're building is a way of helping people understand their rights. And whether it's their rights with the school or their rights with trying to apply for disability living allowance, make that form, we're also working to make that form easier because that's a horrendous form. Max Davie: No, it's awful. it it's I I think it's scandalously bad that form. I've tried I've tried to help people with it a number of times and it's just all it's just dreadful. Ben Cosh - Sylva: Yeah, one of the people in my team thinks she's helped about 500 people filling that for me and she says almost all of them are in tears. It's such a dreadful form, but I think it's a dreadful form as a gating mechanism. Max Davie: d it's obviously it's deliberately deliberately bad. Which is which is a scandal in itself. Yeah, of course. Ben Cosh - Sylva: Right, Max Davie: it's just the worst. Ben Cosh - Sylva: So yeah, so if people have been using Sylvan for a while, then Sylvan will know about all the issues. And so again, one of the modules that's in our roadmap over the next few months is just to say, just press print and it will print out all of the stuff you need for your DNA form. And you can Max Davie: So I think Ben Cosh - Sylva: just send that off. Max Davie: so I think that's the that's one of the questions and I think that may come with time, but if you have a Senko who is and j I I know I do this every time we mention Senko's special educational needs coordinator. I know we talk about them a lot, but we may have new new listeners. who are not in the UK 'cause not everyone is in the UK. Anyway, fine. and now the Scott the now the Scottish people are saying we don't call them Senko either. Okay, fine. All right, Scottish. All right, Scotland. Ben Cosh - Sylva: Senkos and the equivalent in your national level. Max Davie: All right, Scotland, it's fine. Jamie: Should we we shall we do a separate episode of just of spelling out all the different and we could and we could reference Max Davie: Every episode is a separate You're that's what you're for, Jamie. Jamie: it in in the show notes. Yeah, I guess maybe that's what I'm for, yeah, good point. Max Davie: no. so but ha so they're th they're in inundated with nonsense. As you rightly say, how are they gonna say, well, this stuff by this AI agent is trash and I'm just not gonna need I'm not gonna use it? But this from Silver is something that I think is legit and I'm gonna make reference to it. and treat it seriously when I'm trying to formulate plans or advocate to my head teacher, to my board of governors that this is what the the child this is what this child needs, or to my local authority of what this child needs. How are you going to get that authority within the system? Ben Cosh - Sylva: So what we've done so far is basically every compliance, box ticking exercise that we can do for the NHS. And so we've done the paperwork for medical device data is 783 pages of risk assessments and benefits analysis and process analysis, which we're a really little company and it is absolutely insane piece of work to do. So at the moment there isn't... there isn't a regulatory status if you can say that a SENCO can look at and say that's perfectly safe. And the NHS has got this medical device status thing. The NHS has also got something called DTAC, which I won't get involved in, but it's a whole other checklist. But the education system doesn't have many of those checks and balances. So it's very easy for someone to build an app and say it's brilliant and shove it into the education sector. But I think what has to happen from a regulatory perspective is a little bit like what happens with HMRC with your tax return. HMRC has a list of we approve these apps, these websites, and we've checked them and we will take imports from them because they're an approved system. And Max Davie: Yeah. Ben Cosh - Sylva: what I think the government may have to do in response to Phonagy is set up a similar sort of approval system. It's not dissimilar to if you've got an electrician coming into your house, you want someone who's got a particular certificate or if you're your gas boiler monitored, they've got a particular certificate. Max Davie: Yes, the Corgi, is it something like that? Ben Cosh - Sylva: Yeah, exactly. So I think the government's going to have to put in something like that to say these tools are accredited under whatever they call the system and these tools are Max Davie: Yeah, 'cause my my my immediate reaction to I'm I I'm think there's probably a couple of listeners who are like, Max said there were three things and you've only talked about two. I am coming back to the third thing. There's a couple of there's I think my immediate response to Fonegie's advocacy of AI and digital led assessment tools was first, of course, we should not we should not be doing paper stuff, you know, endless repetitive paper exercises by which I include, word documents as well. But also, my gosh, that's gonna be a ro that's gonna be a wild west within six months with all of the AI ability. You know, everyone can just kind of code themselves up a an agent in half an hour. So so what would you, if you were back in Whitehall, what would you be advocating for for that regulatory system? Ben Cosh - Sylva: So again, to draw on HMRC and what happens in the health sector. So to get a new piece of IT into the health service, you've got to go through a whole bunch of hoops. DTAC is one. If you're offering a therapeutic intervention, which is what we're doing, then you also need to be a registered medical device. And it's a bit weird because it's software as a medical device. But there is legislation there on the health side. And I basically lift that over and say, if you want to talk about any of these health related conditions, whether it's autism or ADHD or any of the developmental differences in education, you should also have to the same boxes because the systems are there. So they can just lift them over rather than generating a whole new bunch of, frankly, I don't want to do it anymore forms for my company, Max Davie: No, qua well exactly. Wouldn't that be wonderful? we tal I think we'll come back and talk about forms because I'm gonna br bring in the third thing because I was really interested and and a bit surprised when you when you introduced silver, you introduced therapy, essentially. You introduced therapy methodologies. So cognitive behavior therapy, access acceptance and commitment therapy, which I keep thinking we should talk about in the context of ADHD and I keep forgetting to get somebody on to talk about it. We will promise. but we can't go into exactly what it is today. surprises me, 'cause are you getting therapy from Silver as a parent? Ben Cosh - Sylva: So the technical language is where, I mean, and this is again another trigger warning. In law, autism and ADHD are considered medical conditions and disabilities. And some people find that language very difficult. So we take a social model, but in law, we're serving a medical condition. And when we read the NICE guidelines around what people with these conditions need, or people who are caring for people with those conditions, The nice guidelines will set out, I don't know, psychoeducation. And psychoeducation, the problem is not parents knowing what to do. The problem in our experience is more often is parents, they might have heard the technique before, but doing it is the hard bit. Max Davie: Yeah. Yeah, yeah. Ben Cosh - Sylva: So learning new bits of knowledge is easy, or easier, Max Davie: Mm. Ben Cosh - Sylva: but doing it is really, really hard. And therefore it's essentially a therapeutic intervention from a nice perspective. What we're doing is a therapeutic intervention. Max Davie: But what do you get so what but what does that look like? So let's I think the really good example of that is sleep because, it it frustrates me, frankly, that health professionals think that they can go, I just talked to them about sleep hygiene. And you're like, Do you really seriously think that people Jamie: Yeah. Max Davie: don't know about sleep hygiene? And and that they're not just nodding and going, Yes, yes, we already do that. Fine, this person doesn't know what they're talking about. I'm gonna go away now. It's just so it frustr frustrates me so much because you're right, that and that's a classic example of everyone knows what to do, Ben Cosh - Sylva: Thank Max Davie: or at least I mean, there's complications around that, which again we're gonna come back to in another episode. But but it's just doing it. It's it's ov overcoming the resistance to it, it's overcoming all of the emotional aspects of it. So what does silver do practically to help you over that hump, I suppose? Ben Cosh - Sylva: So that I guess let's drill into the specifics now. It might be it might be behavioral issues around the parents. So I don't know Just general depletion not having the energy to deal with this this issue again and again and again and again It's boring Max Davie: Yeah. It's boring as well, apart from the house. Ben Cosh - Sylva: is exhausting and and and the kind of the easy thing to do is to say okay, whatever I'm not going to deal with it tonight that kids do their thing and that's completely understandable response in these situations. Yeah Max Davie: completely. Yeah. Ben Cosh - Sylva: So I don't judge, I've been there, it's so hard. Max Davie: No. Ben Cosh - Sylva: And then you've got the behavioral challenges for the young people. And those behavioral challenges are not just about the moment of bedtime, they're about the whole day. So how much caffeine are they getting in the afternoon? Are they getting enough exercise? What's their sugar like? What's their screen use like? What's their wind down routine? What's their lighting routine during the wind down? So there's so many aspects to it. And so and different people are struggling with different parts of that aspect, those aspects. So giving someone a leaflet saying here's sleep hygiene on one page of A4 is nonsense because well, you might be doing seven of the things, but the two things that you're not doing, you're really, really, really struggling with. So the question is what to do, it's how to do them. And so silver is the way a lot of people will talk about it is a bit like having a, it's not a psychologist, but they say it's a bit like having a psychologist in your pocket that can chat to on WhatsApp. really trained in these issues and really knows the people in your Max Davie: I want to stand up for therapy, I think, a little bit. And and I this is a challenging one. I don't think there's an answer to this, but I think it's really important. I do have a worry. I think again, Silver will give you mo both the information and also the encouragement and and the kind of problem solving that a psychologist might give you or a therapist on other ways, but they won't give you the relationship. And I I know this isn't aiming to res replace a relationship with a s with a professional or with a psychologist. But there is that loss, isn't there? That there's that that's not there. Ben Cosh - Sylva: Yeah, and I think if we were in an ecosystem where everybody was getting their needs met with human therapists or human psychologists, then we wouldn't need to do silver. But the reality is there's hundreds Max Davie: Yeah. Yeah, exactly. Jamie: Yeah. Ben Cosh - Sylva: of thousands of people in the UK alone who just can't access those people. Either they're in a wait list for the NHS services or they're trying to go private and that's so expensive. And if you go private and you may have an appointment once a week, that's nice. But the issues come up every day and they come up at two in the morning and they come up at six in the morning. Max Davie: Yeah. Yeah, yeah. Ben Cosh - Sylva: so people tell us, Silver, know, as a, between those who are in some sort of therapeutic support will use Silver between times for the, you know, in the heat of it. They'll clear off to the toilet. I just need two minutes to sort my head out. What am going to do? And they go and sit in the toilet, go and sit in the car and just say, okay, here's my strategy. And then they go back in and they're calm, they calm themselves and they've got a strategy and they know what to do. feel less at sea. So to me, I think there's a place for both. know, Max Davie: Yeah. Ben Cosh - Sylva: an AI can never put his hand on your shoulder if you're grieving. And Max Davie: Exactly. Ben Cosh - Sylva: you know, an AI cannot look you in the eye and say, you are autistic, or you have ADHD. just that doesn't work. AI is also terrible at accountability. So the future we see is, hopefully is, is a situation where more people have access to human services. and they may check in once a fortnight and those human services can then have a larger caseload because their day-to-day is being dealt with by AI. So I think it will be a blended solution eventually. Max Davie: Yeah, I I think that's right. I think I I'm not necessarily in a a sort of AI doomer when it comes to healthcare, because I think you're right, it can relieve so much of the not mindless, but but but the stuff that doesn't need my particular expertise or actually my p interpersonal, you know, it it actually takes away the stuff that's about my job that's not relationship based. so I sp can spend more time with people and talking to people. Ben Cosh - Sylva: Yeah, Our psychologists talk about three layers of need, I guess you've got that layer of need where people can cope on their own or with their family and friends, their network, reading the books or listening to podcasts or whatever. And they're okay. You've got a layer in the middle, which it has a maybe a medium level of need. And that's the layer where tools like silver can help. And you've got a layer at the top, which has a much higher level of need, it maybe needs a multidisciplinary team. And my hope is that tools like silver can capacity so that the humans can deal with more complex cases. Max Davie: that is the hope. I I I suppose thinking about hope, I always there are parts of the Fonegie Review when I'm standing up and going, Yeah, this is a great idea. And there are other parts I'm like, I've read this so many times. You talk about being around Jamie: in different capacities. Max Davie: you you talk about being around in the Blair years. You know, they had I can't remember if this was a Blair one, but they had, you know, mental child mental health, everybody's business. They had every child matters, they've had all of these things and every Single one of these reports advocates joined up shared responsibility across agencies for children's mental health slash neurodevelopmental conditions slash whatever. And it never happens. Now, silver is not the answer to this, but you you do have a data component to it, if you have shared responsibilities, you've got to have shared data. It doesn't I think that slightly answering my own question, but That's the that's the extent to which Fonagi I think makes an advance on previous reports. You have to have shared data. So how what do you think about that and how might Silver fit into that as a as a as a piece of the puzzle there? Ben Cosh - Sylva: Yeah, so I agree you're going to have shared data and also I think budgets are really important. Who owns the budget for this? Let's maybe come back to the budget. But in terms of shared data, the principle we've taken at the moment is silver is a single user device. So a parent or a carer, foster carer, maybe or a grandparent will use it and they'll talk to an individual about that family unit. Again, one of the things that we're working on is how to make it a multi-user system so that you can have your teaching assistant. who, know, lot of teaching assistants are extraordinary people, but a lot of them don't have a lot of training in dealing with, you know, supporting young people with differences. So you can have them in the system, can have the senko in the system, you can have the teacher in the system. So you get this rounded view of the young person. The tricky bit, and the reason we're not rushing into it is making sure that the right information goes to the right people and doesn't breach the competence issues. right, Max Davie: Yeah. Well, you talked about the sensitive information previously. Ben Cosh - Sylva: right. And if you've got a young person who's over 13, they've got rights to say I don't want my teacher to know I'm coming out. And so how Jamie: Okay. Ben Cosh - Sylva: we get those rules appropriate for everybody is something we're working on but we're doing it very carefully because I'm not interested in leaking data. Max Davie: No, it's it it's incredibly tricky. even the stuff about electronic health records in teenagers you've touched on is so tricky because wha what point can they get access to their own? What point do parents lose access to it? All of that stuff needs to be worked out. And in fact, in a way, when you start to get into a multi user your environment, you're almost rebuilding Ben Cosh - Sylva: you Max Davie: a electronic health record in a way. Do you see what I mean? And I know Ben Cosh - Sylva: Yeah, yeah. Max Davie: How complicated those are. That's a nightmare to to try and build. Ben Cosh - Sylva: Right. Yeah, but the electronic health records don't plug into the schools. So even that is just, yeah. Yeah, yeah. Max Davie: No, no, sure, but it's almost like but do you see what I mean? In you've got data about one person that multiple people can access. So you've got those Ben Cosh - Sylva: Yeah. Max Davie: similar access difficulties. But you're right. No, of course it's better in some ways because you can't because it's not tied to one organization, so therefore people can plug into it. I mean, I i I have to say I'm worried about the data side of it, and this might not be the most compelling bit of the podcast, but the problem being we always have we already have within the NHS such a demand for data passed up to Whitehall, it saps a lot of energy and it it's actually a lot often it's stuff that isn't necessarily what you need to be gathering for other reasons or for that are just a kind of paper exercise, just a do just a box to tick, essentially. My worry if you have a agency wide minimum data set for children with children's needs in the sort of neurodevelopmental arena is you just get another set, another layer of mandatory data extraction from people who are already trying to do difficult jobs at the front line. And this wouldn't be a parent thing, but I think it's a worry for professionals that, gosh, here Ben Cosh - Sylva: Yeah. Max Davie: we go again. Ben Cosh - Sylva: Yeah, and that worry that that's manifesting itself now in schools, the amount of paperwork they've got to do for for off-stead reviews or to show progress or to, you know, whatever the children's needs are, that means horrendous. And so, my principle is that any data that anybody enters into any system should always be useful to that person. If it's just there to serve someone else, it's never going to enter well, never going get done Max Davie: Exactly. Ben Cosh - Sylva: well, it's going to just... So I'm really passionate about if it's not useful to the person entering here or it can't be just collected off by them doing their day job then we're not thinking about it in the right way. Max Davie: Well yes, ple please tell everyone in the NHS that every o Ben Cosh - Sylva: Hahaha Max Davie: every opportunity. yeah, exactly. I I don't we probably not that is not something we're gonna solve today, but I think I I do think I I think it's important. that because I think AI is both I mean obviously there are lots of problems with AI, but actually AI potentially, if we can build it smart and with interconnected systems that speak to each other, it is an opportunity. Because we have this huge revolution. If we are open-minded about it and we don't corral our information in different organizations, we really could get to a point where that it's another it's a was it a Kennedy report about 20 years ago that people shouldn't be telling their story. Again, I've I've been through this process a lot. Ben Cosh - Sylva: again and again and again and again. Max Davie: People shouldn't be telling their story again and again and again and again every time they meet a new person. But that's only possible if you have effectively a single record that everyone can access across different Jamie: But then it Ben Cosh - Sylva: Yeah. Max Davie: agencies. Jamie: is is part of that not down to G D PR and not being able to share certain things between Max Davie: Yeah, absolutely. But GDPR has a massive exemption for healthcare. The GDPR I mean Jamie: there you go. I didn't know that. Max Davie: which people in healthcare don't understand. Actually, if you're doing it for the purposes of healthcare, GDPR more or less goes, Fine, do it basically. If you can justify it on the base. Jamie: Alright, it's l if you can justify it basically. You can justify it. That makes a lot of sense. Ben Cosh - Sylva: Yeah, it's really it's, I mean, I agree with everything you're saying. And it's, and it's, there's another level of complexity. So I was talking to a psychologist recently, who received the enormous case file, there's someone who works in Cannes, they received a very big fat case file. And they're like, they don't have the time to read the case file. They're not allocated enough time for that. And so the first thing they do when they see a new family is they want to hear the family's version of the story. And because they want to hear it from the horse's mouth, so to speak, and like, that's so frustrating for the family. And the psychologist is like, but I have no other option. Because if I spend two minutes skimming this inch thick file, I'll miss the important points that they want to deal with today. So they need to tell me the story. But it's so frustrating for us to tell those stories again and again. It's really eye-wateringly. Max Davie: Yeah, and in fairness to AI, you you could potentially I I think I have that as well. I mean, I sit down with a patient, because I'm in neurodevelopmental assessment clinic, I generally allocate myself half an hour, which is very generous. I know I get that's very good, I get that. and try get up to speed with this family, and and everything that goes on in there. but yeah, for a lot of people don't have that luxury. And I think AI could help with that, just to structure it all together, throw all of the stuff in there. But the problem is often the case files are so disjointed and badly honestly badly written, and this bloated notes of every single email that's ever been written about this child being just basically on this what we call progress notes all the way along. I think we'd we've got the legacy of some very poor data. practices within all of these organizations which are quite defensive. everything's got to be recorded, but then actually the things that matter get lost in a big forest of a thicket of just I Ben Cosh - Sylva: Yeah. Max Davie: I emailed you because to to to to rearrange my appointment. I'm fine. Whatever. Ben Cosh - Sylva: Yeah, yeah. And I guess someone some point will computerize all of that and scan in all those files and produce an IT AI summary of it. But given the Max Davie: Yeah, maybe. Ben Cosh - Sylva: history of NHS IT projects, it's not going to happen quick. Max Davie: No, no, I pe users on YouTube will have seen me roll my eyes. Not at you. Not at you. So so what's the business model here? What's wha how is this funded? How are you paying for all of this? Ben Cosh - Sylva: So the business model is, I guess there are, there's a few strands to it. We have some families who will pay directly to subscribe through the app store. Just as you would do if you go into private therapy, but we can support someone for a year if it's about the same prices you pay for an hour's therapy. So it's a dramatically different price point. We are working with local authorities and schools to try and make this free at the point of use through them. And we're working with... health services to try and make it free of point of views. We're also exploring opportunities with employers. So lots of employers will have a package of things in there available to their teams. then, you know, it might have a cycle to work thing. You might have a stress management thing. And so the impact on the workplace is quite profound as we touched on earlier, Max Davie: Mm. Ben Cosh - Sylva: whether it's unplanned, unplanned absences, because, you know, if your young person has an appointment or needs a, isn't in school on time, then you're late to work. Or just the presenteers and the being so overwhelmed and stressed you can't do your job as well as you might want to do. And so there's a few big employers we're talking to saying, look, you make this available to your people and you'll help them out and you may get more out of them when they're at work too. So our fundamental principle in the UK is that this should be free at the point of use. In other markets around the world where they're more used to paying for this type of service or more used to paying for healthcare as they go. then it'll be more of saying directly to families. Yeah. Max Davie: Or a subscription model. Yeah. Yeah. I think there's obviously a a a criticism that could be leveled if if you have this needs led service, the people who have access to the smart, evidence based, and and authoritative tools like silver would have a, know, an unfair advantage. I'm sure there's somebody writing an article about that as we speak. Ben Cosh - Sylva: Yeah, I'm sure you're right. And at the moment, you you see that massive difference, don't you, between the, if I can just sort of lull them loosely into the middle classes who maybe have got the capacity to learn everything that needs to be learned about both the psychology of the systems. And they can be, you know, going there and fighting advocate. And then you've got a whole group of people who are disenfranchised, who aren't empowered. And so I'm really passionate about trying to get silver in the hands of in Bristol, we've got a very big Somali community, for example. Max Davie: Yeah. Ben Cosh - Sylva: And these conditions in those communities, it's really tough because there's a whole set of cultural things, a set of shame going on for many of them. And so I'm so keen to get it in their hands, but we can't give it to them for free because ultimately we've got to pay for the thing to run itself. So we're working with the councils and the NHS groups to try and work out how to get that funding. Max Davie: Presumably, of course, one of the advantages of using AI and all of this technology is the language barrier. I I'm not assuming that people from from Somalia don't speak English. I I'm not, but but I there are a lot of people who for whom English is a second language within that community. particularly in my experience of the Somali community when I worked for them in in with them in London, the mothers would often speak less good English. So and they would also be the carer. which so so I think, you know, that is a significant issue as well. Ben Cosh - Sylva: Yeah, I agree. I agree. And again, we've had people talking to silver in multiple languages. I get told it speaks rubbish Welsh. It's got a GCSE level Welsh. But yeah. Max Davie: the Welsh the Welsh and the Scots have made it into the podcast. Welsh Ben Cosh - Sylva: Yeah. Max Davie: listeners, come and train silver. Jamie: Yeah. Ben Cosh - Sylva: But it's, you know, I'm really keen that we can meet people where they are. And if that means meeting where they are in their language, then we need to be able to do that. Max Davie: Yeah, yeah, absolutely. Absolutely right. Fantastic. So I only have one more question. Jamie, do you have anything else? Jamie: I I I guess the only question I have is you know, what have you got any like case studies, like how's it how's do you have any data or tales to tell us of, you know, any success stories? Max Davie: Mm. Ben Cosh - Sylva: Yeah, so I'd say from a boring data perspective, I touched on it earlier, almost everybody who comes into the app has clinical levels of stress when they start. They fill in a questionnaire about their stress levels. And for the majority, stress levels are significantly reduced in two months. And that's not breathing exercises. It's like being heard, it's being understood, it's having some strategies, it's getting their partners on side. It's the whole shebang. So that piece of data is good. And then in terms of the anecdotes, we hear stories like, got an unsolicited message earlier this week. I'm going to read it to you if I may. Max Davie: Yeah. Ben Cosh - Sylva: It says, I cannot explain how life-changing your app has been for me as a parent to neurodiverse children. I recommend it to so many other parents that are struggling. It has been a great source of support to me and I really value the instant support I can get as opposed to waiting for an appointment with a professional. So we get those types of messages often. We hear stories about people who's like, who was a young girl last summer who was very stressed. She'd gone mute. Some kids will go mute when they're stressed. Wasn't going to school. Schools said, well, you can go see the school counselor. And she's like, well, she's not talking to anybody. The school counselor's not going to go do anything. Max Davie: Yeah, yeah. Yeah, exactly. Ben Cosh - Sylva: went to see the GP, GP was like, well, the talking therapy is not going to be very much good. So the mum's completely lost. And then someone said to her, try silver. So the mum's there at home, you know, on the app saying, my daughter's doing this, my daughter's doing that, what should I do? What should I do? And it suggested to her that she should just start with super, super simple, low demand conversations. So for example, sit and watch telly with her. And when there's a character on the screen, just say, can you remind me the name of that character? Max Davie: Yeah, yeah. Ben Cosh - Sylva: Just very, very, very simple things. And within a month, that mum got the girl talking again, back in school, Max Davie: Fantastic. Ben Cosh - Sylva: in time to do the GCSEs. Max Davie: So it was guide parent parental guidance. I just I just want to put make one small point just in case people don't is actually if somebody has selective mutism, talking therapy properly done and properly administered with somebody who can adapt to their needs can still be an option. It is worth making that point. Ben Cosh - Sylva: That's a good point, but tell me how you find that person. Jamie: That's a different one. Max Davie: No, that's very good. checkmate. No, that's very yeah, absolutely. No, absolutely. Ben Cosh - Sylva: Hahaha! Max Davie: I mean d I just I because I've been through that s situation and actually one of my patients did did end up getting some put some talking therap talking in inverted commas therapy by, you know, using other means of communication. But actually, you know, at talking therapy communityism, we've got quite a long history already of text based therapy, therapeutic modalities, particularly for teenagers. For younger children this is much more difficult, but for teenagers actually that works very well. My question, why silver? What's why do you call it silver? Ben Cosh - Sylva: So I'm very conscious that we have lots of digital stuff in our lives. And certainly one of the things that we saw with our kids is when things were going off the rails, taking them out to the woods was probably the best thing we could do. Let them be feral in the woods for a while. And so one of the guys in my team who's very clever said the Latin word for woods is silver. And that's why we chose silver as a name for it. Max Davie: So just to be clear, it's S Y L V A. It's not the metal, it is the Ben Cosh - Sylva: That's correct. Max Davie: Latin word for a wood. Sylvan glade, as often we think about it in kind of Tolkien esque. Yes. Ben Cosh - Sylva: There you go. There you go. Yes. S-Y-L-V-A. Which causes a problem because people spell it as Sylvia or S-I-L-V-E-R. And, you know, that's annoying for everybody. Max Davie: Yes, yes. It's very clever. It's very clever. I think a marketing person might have gone, hm, but never Ben Cosh - Sylva: Yes, but sadly I took advice from the Latin expert, not the marketing expert. Jamie: Yeah. well you that was your f that was your first mistake. Ben Cosh - Sylva: Mmm, what a menu. Max Davie: Well, thank you very much, very, very much for joining us, Ben. We will put the links to Silver and the socials on the show notes. Was there anything else you wanted to share before we say goodbye? Ben Cosh - Sylva: What I can say is that we can give you a code. So we can give anybody who accesses it through your show notes three months free. So they can try it out. Max Davie: There you go. Ben Cosh - Sylva: We'd love to do that. We'll share a code with you by email after then. You can pop it in there. I'm really, really keen to get feedback from people. So if people say this bit could be better or that bit could be better, love to hear about it. Max Davie: Amazing. It's a brave new world, but we have to embrace it. I think it's fair to say I think it's all fair Jamie: Yeah. Max Davie: to say. All right, Ben, thank you so much for joining us and goodbye. Jamie: Thank you very much, Ben Cosh - Sylva: Goodbye. Jamie: Ben.