AV1

Beyond health challenges, children with rare diseases face significant educational and social challenges. Doctors appointments, faraway treatment, medical trials, or days at home recovering, children with rare diseases often have to miss out on days, weeks or even months of school, which only contributes further to the loneliness they may already feel due to the rarity of their condition.

When persistently or sporadically absent from school, it is hard to remain socially, emotionally, and educationally involved. Worksheets might be sent home, a teacher might visit you for 1 hour a day, or you might be offered to join a static video call. However none of these traditional remote education methods allow for proper social interaction with one's peer group, nor for discussion or collaboration. As a result, the absent pupil may experience concentration problems, low self-esteem, relationship disruptions, anxiety about school, and much more. This can have severe consequences not only for their educational attainment, but also for their social development, and can significantly affect the long term life chances of children with rare diseases and other illnesses that prevent consistent school attendance.

In 2016 we identified that there was no existing solution for absent pupils to actively participate in the school environment, to ensure they remain socially connected with their peers, and actively engaged in their education. We spoke with those affected and they told us that traditional video calling solutions were not working, and what they really needed was a way to be physically present and fully in control of when and how they can participate in school.

Using Eurostat school data and rare disease diagnosis figures, we have estimated that there are at least 1.5 million children of primary and lower secondary school age in Europe living with a rare disease which may affect their schooling, and this is the main target group we are aiming to address today, with ambitions for further global expansion in the years to come.

Children and their peers love the AV1 telepresence robot. AV1 is an inclusive tool, designed through testing and iterations with children with chronic diseases. It is made to represent the absent student’s social and educational needs in the classroom, and provide them with a sense of independence and normality.

The AV1 is placed in the classroom and the child is at home, in hospital or at a distance on their device. AV1 has a built-in camera and microphone to transmit sound and video of the lesson back to the child.

From their smartphone or tablet via a secure app, the child can control their AV1, turn the camera to view every corner of the classroom, and interact with the class on their own terms. This enables the child to take part in the lesson as though they were physically present.

In the app, the child can change the animation of the eyes to express emotions. Another feature is the ability for students to “raise their hands” signalled by AV1’s top head light flashing. If the child wants to be present, but is unable to actively participate, they can set AV1’s top head light to blue. A motor in AV1’s neck allows the child to turn it 80 degrees up and down and side to side, and a motor in at the bottom allows the robot to turn 360 degrees.

Teachers proceed as if the child was present and their teaching styles do not need to be adapted. Teachers have access to an additional app when they can carry out administrative tasks like check the network connection and add WiFi details. The privacy of the teacher and students at home and in the classroom is never compromised. AV1 cannot record or make screenshots, as it only transmits a live stream. No data is recorded and the live stream is end-to-end encrypted, meaning it is impossible for any external party, including us, to access the stream. 

AV1 was developed to improve social and educational outcomes for children with long-term illnesses. Our conservative estimate shows that prolonged school absence (>1 month a year) due to having a chronic disease affects more than 1,2% of the student population worldwide. We currently have active robots helping children connect to school in Norway, Sweden, Denmark, UK, Finland, and Germany.

In many countries, public institutions are legally obliged to ensure alternative educational provision if a child is absent from school for more than 15 days due to a chronic medical condition. However, this provision is often heavily delayed, and might in some cases amount to deliveries of home worksheets or access to a bank of online learning activities, whilst others children might attend hospital schools or receive home-tutoring with a main focus on being kept up to date on maths and language, with few other subjects to choose from.

AV1 is fundamentally both a social and an educational tool, it's a sturdy tool that can be used outside the classroom as well. AV1 supports student wellbeing in equal measure to their studies and offers them the chance to participate in all parts of school life. In fact, research from the largest hospital in Denmark (Rigshospitalet) shows that it allowed children to “remain socially and digitally connected despite [not] being physically present”. Researchers from Oslo Metropolitan University find that AV1 enables the child to be present without draining them of energy, which being physically present at school often results in. Moreover, AV1 makes it easier for some children to follow normal study progression, and lowers the barriers and worries related to returning to school, because it gives the child a feeling of having been partly present throughout the absence period.

Evaluations from the education sector also show that AV1 improves educational outcomes and saves costs. The Department of Education in the UK tested 90 AV1s over a period of two years, and concluded that 75% of the pupils using AV1 increased their attendance, experienced improvements in their mental health and confidence about their future, and improved their relationships with teachers and classmates. Moreover, 50% of the AV1 users made greater progress in lessons and achieved higher grades than expected, returned to mainstream education at a quicker rate and avoided referral to Alternative Provision (AP) or hospital school.

Although rare diseases are diverse in their effects on children's school absence and educational disruption, many of these children face similar challenges which AV1 can solve. With AV1 these children can connect with peers when they feel well enough, thereby avoiding social isolation and emotional detachment. By using AV1 they can also avoid long stretches of absence from school, thereby avoiding educational disengagement and academic under-achievement.

At No Isolation we develop solutions to reduce social isolation and loneliness for specific target groups. Loneliness is a feeling that stems from a discrepancy between wanted and actual levels of social contact, and it is more likely to manifest when major changes happen in our lives. Examples of such life transitions can be moving to a new city, acquiring a health problem, retiring and so forth. Most people experience loneliness at some point in their lives, us at No Isolation included. We have people in our No Isolation team with direct experiences of school absence as a child, such as our School Ambassador, whose sister underwent cancer as a child and was in and out of school, our Sales Director, who missed a year of school due to absence, and our researcher who has muscular dystrophy and therefore experienced school absenteeism firsthand. Others of No Isolations employees have moved to a new country to work for No Isolation, whilst others have become parents, both of which increase the likelihood of experiencing loneliness.

We work methodically to ensure that our products fit the needs of the users of AV1. The design and production of AV1 lie embedded in a thorough and extensive User Experience (UX) Design process - this means that AV1 has been designed together with end users during a crucial research and piloting phase. The initial prototype was tested by 20 real end-users over a period of five months. Seven years later, the AV1 robot is continually developed and modified based on feedback from users (i.e., the children using AV1, teachers, schools and municipalities) and research partners (e.g. Oslo Metropolitan University, University of Oxford and the Telepresence Experience Network). Since launching the first version in 2016, new versions of AV1 have included major software and hardware updates, along with eyes to mimic feelings (to improve interactions), and an app for school teachers to better help the student. New ideas and requests are regularly reviewed by our product team. 

Our vision of continually improving AV1 is also what has led us to partner with university researchers. No Isolation’s research team has built extensive experience with managing external research collaborations over the past seven years (by initiating and coordinating collaborations with e.g. the University of Oslo, Oslo Metropolitan University, University of Oxford). Our research team functions at the intersection between product impact and product development, by synthesising research which feeds into the product development process. The team consists of two women with a Master in Political Science, and one Ph.D. student connected to the University of Aarhus, Denmark.

The MIT Solve global challenges are recognised worldwide and connect startups with funding and resources to solve global challenges. Our participation will hopefully open doors to relevant stakeholders or connect us with investment opportunities, and both opportunities can enable us to scale beyond our current markets, enabling us to help even more children access their education.

Moreover, we hope our participation can help increase awareness of AV1 in the rare disease community, even though we experience parents of children with rare diseases (and rare disease advocacy organisations) as very politically active and up to date on new technologies or treatments that could help themselves or their children. However, we do see participating and competing in the challenge as building credibility, which in turn can help parents and teachers convince school boards or governmental institutions to provide this type of solution to children affected by a rare disease.

AV1 was the world’s first telepresence robot developed with and for children with long-term illnesses. Compared to generic telepresence solutions, video-conferencing systems or alternative education provision, AV1 is innovative in three ways;

1) AV1’s functionality is tailored for children with chronic conditions. The wish to remain out of sight and not feeling pressured to video-call was feedback we got in initial pilot tests, consequently AV1 does not have a screen for video-conferencing the child to the classroom. To enable the child’s emotional expression, we added emotive eyes so that the child can express whether they’re happy, sad or confused. It also allows for signalling whether a child wants to speak (flashing headlight) or be silent and listen only (blue headlight). Compared to AV1, other telepresence solutions (developed for business settings) do not meet these specific needs of this user group. AV1 is unique in its suitability for children with long-term and chronic illnesses.

Moreover, AV1 respects the busy schedules of teachers. We encourage teachers not to change their teaching methods, and AV1 is plug-and-play with a battery time of 8 hours. Peers are usually given the task to charge AV1 and move it between classrooms, a task which we are told pupils perform with great eagerness.

2) AV1 enables access to the child’s regular classroom. Having to move into special education or hospital school means that few other children are present, and increases disengagement with regular school peers. With AV1 children with rare diseases can access all subjects they had been taking if they were physically present.

AV1 is also a physical reminder of the child who is absent. Its presence fosters inclusion and awareness of the challenges that these children live with.

3) AV1 is both an educational and social tool. Video-streaming services, like Teams, were frequently used during the pandemic for all pupils. However, most children are back in the classroom and using video-streaming services does not address the importance of school as a social arena, as it limits interactions to those had during classes only. AV1 is portable, and is also used during break times to have conversations with friends.

One of our users with Ehlers-Danlos Syndrome told the Guardian in an interview: “I have security now because of AV1. She (AV1) gave me hope in a very dark time. She has allowed me to make commitments that previously I would have been too worried about not being able to meet. As a teenager, it is incredibly reassuring to know this assistive technology is available and can help me forge my future.”

Our goal is to have a positive impact on the social isolation and loneliness experienced by children and young people (CYP) unable to attend school. We aim to have an impact at three levels:

1. Primarily by increasing CYPs potential access to everyday life, regardless of their ability or health. 

2. Secondly by increasing CYPs participation in everyday life, regardless of their ability or health

3. Thirdly, reducing CYPs social isolation and perceived loneliness

In addition, it is our goal to target the causes of social isolation and loneliness through the advancement of knowledge, as well as general care for people and the planet. We aim to do this in several ways, but relevant to this application:

1. Primarily by increasing the longevity and reusability of the AV1 design

In order to measure whether we are increasing CYPs potential access to everyday life, and if so by how much, we are keeping track of the number of “available” AV1s as a proportion of the addressable market, “available” being defined as an AV1 whose activation code has been used. This impact measurement is linked to UN SDGs 4 and 8, because it aims to a) support equal access to education and b) promote inclusive learning environments. The indicator we use to track our progress is the number of available AV1s as a proportion of the estimated addressable market in our core markets.

Our hairy long-term goal is to reach 100% coverage for those who could need AV1, but this will take time. Today we have 2000 robots in use in Europe, but our estimate shows that 677,000 children (1,2%) of the European Union student population experience prolonged absence due to long-term and chronic illnesses every year. Our goals for the next five years is to increase the number of AV1s helping by 300% (16,000 units). To reach this goal we are working to scale our operations in all existing markets and to launch AV1 in 3 new markets within the next five years.

In order to measure whether we are increasing CYPs participation in everyday life, and if so by how much, we are measuring the percentage of available AV1s that are “active” within a month. This impact measurement is linked to UN SDG 8 because it aims to a) Increase opportunities for higher school completion rates, and b) increase the proportion of youth in education or training. The indicator we use to track our progress is the percentage of available AV1s that are actively used in a month. Our goal is to increase usage statistics by 60% within five years. To reach this goal we continuously work to improve the app and informational material on AV1.

Thirdly, in order to measure if our AV1 solution is indeed reducing CYPs social isolation and perceived loneliness, we are sending out an in-app survey to AV1 users, and collating this data anonymously. The survey was created together with child psychologist and Professor, Steven Asher, and is designed to collect information on the effectiveness of AV1 in a child friendly and appropriate manner. This impact measurement is linked to UN SDGs 3 and 16, because it aims to a) promote mental health and wellbeing, and b) reduce the proportion of people who feel discriminated against under international human rights law. The indicator we use to track our progress is the in-app survey score from the children using AV1. Our goal is to increase the number of children that say that they agree/strongly agree to the statement “My AV1 robot has made me feel less lonely” with 60% within 5 years.

Lastly, in order to measure whether we are increasing the longevity and reusability of the AV1 robot, we are measuring the ratio of AV1s produced to the number of beneficiaries. This is in line with circular economy principles, and in practice it means that for every 1 AV1 robot produced, we would like to see it used by more than 1 user, ideally 3-5 within its lifetime. This impact measurement is linked to the UN SDG 12, because it aims to a) achieve efficient use of natural resources, b) reduce waste generation through prevention, reduction, recycling and reuse, c) adopt sustainable business practices, and d) integrate sustainability information into the reporting cycle.

Our solution: we provide an AV1 robot, and we onboard the school on how to use it effectively.

This leads to two potential outputs. 1) The children and young person’s (CYP’s) access to remote education service delivery. 2) The CYP’s access to social contact with peers. These are only potential outcomes, because it depends on the health of an AV1 user on any given day, a factor which is out of our control.

There are at least four short term outcomes. 1) The child feels included and remembered. Even if they are not well enough to use the robot, the mere act of having it can have a positive effect on wellbeing and sense of security. 2) There is increased communication between the parents and school, due to the need to coordinate the logistics around the robot. Often school staff retract, not wanting to disturb parents during a difficult time, when in fact parents often want more contact with the school. 3) The robot arrangements prompt official recognition of a child not in education. There are thousands of invisible children who slip through the cracks, and therefore do not receive the remote education they are entitled to. 4) With the robot, even if not actively used, there is a physical reminder of the absent child. This prompts the teacher, as well as the students, to keep in touch and send home worksheets.

If the child is well enough to use the AV1 robot, there are at least 4 further, or mid term outcomes. 1) The child may experience better social connections with their peers. Although the classmates may have had the chance to send messages through other mediums, oftentimes students may be initially reluctant because they are unsure of what to say. The AV1 helps to break the ice and provides a fun way to interact with one another. In a survey of AV1 users, two thirds of the children agree or strongly agree that their AV1-robot has made it easier to stay in contact with their classmates. 2) The AV1 user may experience improved confidence, wellbeing, and happiness. The AV1 does not show the face of the child which can help to ensure they use it regardless of whether they are looking their best or not. The classmates also love to be in charge of the robot, which can make the child feel a real boost of belonging. In a survey of AV1 users, more than two thirds of the children agree or strongly agree that AV1 has made them feel like their classmates remember them. And two thirds of the children agree or strongly agree that AV1 has made them feel more included in things happening at school. Nearly half of the children agree or strongly agree that AV1 has made them feel less lonely. 3) The child may feel more engaged in learning. They feel a part of the social group, and the robot provides a more interactive way to learn than a regular video call, which in turn can boost their motivation and their sense of the possible. In a survey of AV1 users, more than two thirds of the children agree or strongly agree that their AV1 has made it easier to keep up with school work. According to results from a Department for Education study, 75% of students who used AV1 engaged more with learning. 4) AV1 can make for a speedier return to school in person. By maintaining contact with the classroom the child is less likely to build up anxiety about returning. In addition some paediatricians have posited that improved wellbeing can have a positive impact on the healing process. According to results from a Department for Education study, 50% of students who used AV1 returned to mainstream school at a quicker rate.

In turn, there are 4 further potential long term outcomes. 1) The child, regardless of their absence from school, has the chance to hone their social skills and grow their self esteem. In addition, children who receive traditional home education do not often get the chance to go on school trips, or explore subjects like foreign languages, drama or art, so AV1 can also help to build their interests and personality. 2) The child has the potential to attain their school qualifications, such as the 5 GCSEs critical for post-16 studies. AV1 user Zoe, aged 16, was able to take 5 GCSEs, which according to her mum was “so much better than we ever dared to hope”. 3) The child is more likely to have hopes for the future and feel they can construct plans, such as continuing their studies at college or university, in the knowledge that their robot can help them should their health issues persist. 4) All in all this means that they will be less likely to rely on the welfare state, be it for unemployment benefits, mental health support, or other. They are more likely to thrive independently, regardless of their period of ill health. This means cost savings not just for the local authority and school in terms of less home tuition required, but also longer term for the government.

AV1s technical stack and main programming languages
AV1 run on a Variscite DART-module and are built using Yocto, an open source project that is widely used to develop Linux-based embedded IoT-software. The main programming languages used on the AV1 robot are C and Go. 

All of our apps are developed using React Native and Redux, JavaScript-based framework, which compiles and builds native applications for iOS and Android.

Our web-based applications are built using React, a JavaScript-based framework. Our backend runs on AWS on a Kubernetes cluster. While Go is the primary programming language used on our backend services, some JavaScript (Node) is still in use for certain packages and frameworks. For video streaming we use WebRTC, and for client-backend connections we use gRPC.

How the connection is established
In order to establish the connection between the AV1 and the mobile end device on which the corresponding app is running, the respective IP addresses must be transmitted once to an AWS server. 

These IP addresses are only transferred from the app to the AV1 via the servers of No Isolation and vice versa. They do not touch any permanent storage while being transferred, only volatile / volatile storage. The stream or communication is transmitted over a direct, end-to-end encrypted connection between the AV1 and the end device, with no further involvement from AWS. There is no intermediate storage of the stream.

At No Isolation, we are committed to equality of opportunity for all. As a company working to eradicate loneliness we feel it is important that our team reflects a wide range of perspectives, experiences, and backgrounds so that we can better achieve our mission. We welcome all regardless of race, religion, gender identity, sexual orientation, age, disability, social background, or any other protected class. 

From a recruitment perspective, we make the contents of our job postings as accessible as possible. Our internal recruitment team is as diverse as possible, and we score candidates in their competence and experience to avoid bias. For interviews, we will make necessary adjustments based on needs, for example by giving more time to complete assessments or providing an interpreter. 

Our offices are located in Norway, UK and Germany. But we have on several occasions hired employees outside Europe and enabled their relocation (with family) to one of these countries. Our team consists of 60 employees from 13 countries around the world. Of our employees 27 identify as female, 29 identify as male, and 4 do not wish to specify this. 

Our offices are wheelchair accessible, as required by some of our employees. Employees can work from home, which improves the work-life-balance for individuals who are family carers and/or parents.

Our business model: We have explored and made many iterations to our business model since 2017. Not surprisingly, most new markets have unique characteristics that make it necessary to finetune our ways of working. Today, we offer both short-term and long-term rental models, along with hardware purchase + subscription service packages. 

Our customers: The typical AV1 customer is a school board, governmental institution, insurance company, non-governmental organisation, a hospital system or a hospital school, and researchers.

Our value proposition: The value proposition for the child is always the same; to reconnect them with peers at their regular school and enable their participation in ordinary education on their own terms. The disruption to the social and academic lives of children with chronic conditions should be reduced as much as possible.

The value proposition for customers varies by segment. Schools and school councils acquire AV1 to increase the child’s attendance, improve the child’s well-being and mental health, and improve the child’s relationship with teachers and classmates. Moreover, AV1 ensures greater progress in lessons, quicker date of return to mainstream education and helps avoid referrals to alternative education provision or hospital schools. Costs are also a factor, with the Department for Education estimating that AV1 can give a saving of £224,873 per pupil.

The main value proposition for insurance companies is that it helps improve patient outcomes and the health of children with long-term illness, and it is also considered a competitive advantage vis-a-vis other competing insurance companies.

The main value proposition for Non-governmental organisations is to improve the patient outcomes and the health of children with specific diagnoses, and increase awareness and raise interest in their cause.

The main value proposition for Hospital systems/hospitals is the ability to reconnect children being treated at their facilities with the class from their regular school, to better access social support from peers and improve the child's mental well-being. Some hospital schools also have limited availability of subjects offered, and using AV1 allows the child to access all subjects offered at their regular school. 

No Isolation is currently scaling up funded by capital raised in 2021. We also fund our operations by selling our AV1 robots, by NGO donations, and R&D grants from national and EU funding mechanisms. In the longer term our sales revenue shall cover our operational/scaling expenses.

-