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The Hexagon: An Exploration Tool
The Hexagon can be used as a planning tool to guide selection and evaluate potential programs and practice for use.
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Core Components
Lumi Nova: Tales of Courage is a Cognitive Behaviour Therapy (CBT)-based digital therapeutic intervention that facilitates graded exposures, delivered via a gaming application (App) so that it’s non-stigmatising and engaging. It is designed to help children build life-long skills to self-manage their worries and become more resilient. The App is aimed at children and young people with mild to moderate levels of anxiety and is not suitable for high-risk children with complex needs or in crisis. The therapeutic game sessions auto-conclude after about 30-40 minutes of play per day, supporting healthy digital interaction.
Lumi Nova: Tales of Courage aims to empower the user to learn to self-manage and tackle common fears and worries associated with social anxiety (such as speaking in front of group, making new friends), separation anxiety (such as going to school or sleeping on their own) and phobias (such as fear of dogs or spiders). The App encourages the support of a parent/carer and helps to facilitate dialogue about emotional wellbeing between the parent/carer/trusted adult and child. Taking an action-oriented approach, some challenges are in-game, and others happen in the real world with appropriate safeguarding measures.
The App is designed as a gender-neutral goal-based therapeutic game with an intergalactic narrative and currently has 15 goals to choose from. Each in-App goal, through play, focuses on a worry that a child may have. The goals are broken down into several small challenges that start off easy and gradually get harder, encouraging the child to use their imagination, draw, look at photos and watch videos (including 360° videos) whilst immersing themselves in a progressive narrative which includes psychoeducation, rewards, completing quests, customization of avatars, and unlocking new levels.
The goals and challenges help children to overcome real-world fears and include to: (1) Be comfortable staying at home without their guardian; (2) Be ok with making a mistake on school work; (3) Be able to sleep away from home overnight; (4) Be comfortable speaking in front of a group; (5) Be able to sleep on their own; (6) Feel comfortable visiting a busy or crowded place; (7) Be able to spend time in the dark; (8) Be able to spend time near a dog; (9) Be able to spend time near insects or spiders; (10) Try to make a new friend; (11) Feel comfortable going to a party or social gathering; (12) Feel comfortable going to school; (13) Be able to spend time in a high up place; (14) Be able to eat or drink in front of other people and; (15) Be okay seeing vomit or thinking about vomiting.
The App can be accessed through participating health, social care or education services. They will provide access to parents/carer or trusted adult through a code. As the child works through the game, the adult receives SMS notifications prompting them to support their child in planning the challenges, triggered by the child’s progress. A trusted adult needs to facilitate any in-vivo exposure. The App can also be used in a community mental health service setting supported by a professional who also has access to the VitaMind data Hub. Professionals can then track progress and outcomes data securely; they can also provide brief periodic check-ins (e.g. 10 mins) with the family.
Fidelity
Access to Lumi Nova: Tales of Courage is provided through a secure web-based platform and the user is guided through the intervention taking on individual challenges based on the chosen goals. To support fidelity to the game, standard training for practitioners can be provided as well as agency supports. Progress data is also collected through the app as are worry scores before, during and after each challenge.
Modifiable Components
Each parent/carer initially shortlists 3 goals out of the 15 available in dialogue with their child, and the child chooses one of the three shortlisted goals that they want to work on first giving them agency and choice.
Imagine activities and real-world challenges are voice-guided for accessibility and users tap on the screen to move on to the next sentence to cater to different reading speeds/ability. Written instructions have been designed in a simple and clear format to ensure suitability and easy understanding.
Lumi Nova: Tales of Courage has been developed by BfB Labs based in London, co-designed with children, parents, teachers, clinicians, game industry experts and academics in the field of children’s mental health via partnerships.
Support for Organisation / Practice
Implementation Support
The BfB team works collaboratively with services to ensure that the offer is well integrated and run a collaborative service pathway mapping session during mobilisation to help better embed the use of Lumi Nova within existing pathways. Support with communication and marketing materials to raise awareness with key stakeholders is also provided. Support is available to practitioners during implementation and throughout their journey via the team behind Lumi Nova: Tales of Courage, providing briefing, training and refresher sessions and online technical support.
Information and guidance are provided to parents via the microsite and directly via the therapeutic game in the use of the App and to professionals in the use of the VitaMind Hub. Professionals can track the child’s progress with the therapeutic intervention access information on child-reported and parent-reported outcomes data (validated scales). Progress data include the goals the child is working on, child worry scale scores before, during and after each challenge step, weekly child-reported progress towards reaching their goal (Goal Based Outcomes) and scores on a brief guardian-reported outcome measure (Child Outcomes Rating Scale, CORS) before the intervention and on a weekly basis.
Licence Requirements
A time bound licence (eg. annual or multi-year) is required to deliver Lumi Nova: Tales of Courage to a population however the app is free for individual users to download.
Services can purchase specific licence quantities and each annual licence allows for the licence to be reassigned multiple times over the course of the year.
Universal Open Access across a whole site/geography can be provided, this might be across Scotland or a specific local authority area, there would then be an open access offer where families can sign themselves up for access directly.
Start-up Costs
Lumi Nova is typically commissioned for use in specific areas / regions. Costs can be negotiated directly with the developer, dependent on service requirements.
Building Staff Competency
Qualifications Required
The digital therapeutic intervention does not require any qualifications to use. Professionals with a health, social care or educational background can identify, signpost and provide access to Lumi Nova.
Parents can also self sign-up if the Open Access model is commissioned for a region / area.
Training Requirements
Practitioner training is recommended and is provided by the BfB lab and takes 1.5 hours.
Supervision Requirements
Supervision or coaching is not available and is not a requirement to deliver Lumi Nova: Tales of Courage.
Theory of Change
Lumi Nova: Tales of Courage is a Cognitive Behavioural Therapy (CBT) based intervention, grounded in the strategies of optimising learning during exposure (exposure therapy), based on inhibitory learning perspectives. Negative expectancies associated with a perceived aversive outcome are countered by emphasising the mismatch between what is expected to occur and what occurs. The gamification design elements of the App aim to help to make more complex models of therapy more understandable for children and provide motivation for engagement and treatment adherence.
Primary school: 6 to 12 years - Rating: 3
Research Design & Number of Studies
One multi-method evaluation was identified, conducted by MindTech (based at the University of Nottingham, an independent NIHR funded national centre for evaluation of digital technologies for mental healthcare) in collaboration with the programme developer. This study included English speaking children (n=120) aged between 7-12 years across 9 primary schools and 3 secondary schools.
Outcomes Achieved
Child Outcomes:
Lumi Nova was associated with a reduction in anxiety symptom severity and progress toward treatment goals after 8 weeks of game play. (Lockwood, J. et al 2022).
Parent Outcomes:
No parental outcomes identified.
Key References
Lockwood, J., Williams, L., Martin, J.L., Rathee, M. & Hill, C. (2022). Effectiveness, User Engagement and Experience, and Safety of a Mobile App (Lumi Nova) Delivery Exposure-Based Cognitive Behavioural Therapy Strategies to Manage Anxiety in Children via Immersive Gaming Technology: Preliminary Evaluation Study. MIR Ment Health. 2022, 9(1), pp. 1-16.
Need
Comparable Population
Lumi Nova: Tales of Courage is designed as a universal plus or targeted intervention for children with mild to moderate anxiety between the ages of 7-12 years across a diverse range of communities and culture. The App is not suitable for high-risk children with complex needs or in crisis.
Evidence of Lumi Nova: Tales of Courage’s effectiveness includes families with children from in the age range of 7-12 years in primary and secondary school in the UK.
Is this comparable to the population you serve? Does your organisation have existing contacts with parents in this population? Are you likely to receive enough referrals for eligible families?
Desired Outcome
Lumi Nova: Tales of Courage aims to improve children’s ability to build resilience, self-manage and reduce symptoms of anxiety.
Research has identified that Lumi Nova: Tales of Courage was associated with a reduction in anxiety symptom severity and progress toward treatment goals after 8 weeks of game play.
Are improvements in anxious children’s ability to self-manage fears and worries a desired outcome for your organisation? Do you have other existing initiatives that would be supportive of addressing this need and achieving these outcomes?
Need Score
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Fit
Values
Lumi Nova: Tales of Courage is designed for children aged 7-12, to empower them to self-manage their worries and anxieties through a non-stigmatising, interactive game play, underpinned by exposure therapy and goal setting.
Does promoting interventions that enable children to self-manage their own difficulties and anxieties align with the key values of your service/organisation?
Priorities
Lumi Nova: Tales of Courage’s mission is to support children regardless of background, to self-manage fears and worries and be confident in new situations that may be stressful to them, using an immersive mobile game which aims to develop lifelong coping skills.
Is working with parents and children to develop coping skills to manage their anxieties a current priority for your organisation? Is your service looking to provide a targeted intervention to treat childhood / emerging signs of anxiety disorders? Is your service looking at different ways to engage with primary school aged children with mental health difficulties?
Existing Initiatives
Does your service already provide interventions which aim to reduce child anxiety and improve child development? Does your area have practitioners trained to support the role out of Lumi Nova: Tales of Courage intervention? Could this intervention help support children while they are on your CAMHS waiting lists?
Fit Score
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Capacity
Workforce
Practitioner time can be spent bring the game into conversations with parents to promote the benefits of home learning, and for brief periodic check-ins (eg. 10 mins) informed by usage analytics and progress and outcomes data in the VitaMind Hub. If the Open Access model is adopted, families can self-sign-up and professional time is limited to briefing sessions to make them aware of the offer and to help signpost. It is recommended that Practitioners undertake training (1.5 hrs) prior to supporting children and families accessing the game.
Are practitioners available to commit to undertake training and supporting families through the intervention when required?
Technology Support
For families to access Lumi Nova: Tales of Courage access to a tablet or smartphone and internet connection is required. It is compatible with iOS and Android mobile devices. Practitioner dashboards can also be accessed through a PC, mobile phone or tablet. Internet connection is only needed to download the app and transmit data to the Hub but not needed during gameplay.
Do families have access to an internet enabled mobile device?
Administrative Support
Administrative support may be helpful to help set up each child’s access via the Hub by filling in a short profile form. Parents receive automated SMS’s thereafter. Administrative support may also be helpful to disseminate information sheets, awareness materials and support with comms and engagement efforts if deemed helpful by the service.
Do you have capacity and systems to meet these administrative needs?
Financial Support
The financial support required to implement Lumi Nova: Tales of Courage includes the cost of annual licences, or the cost of universal open access based on population needs.
Do you have the finances to roll out this intervention?
Capacity Score
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