Families, Adolescents & Children Teamwork Study 2

Ipswich Paediatric Diabetes Team

HR Murphy, C Wadham, AJ Byard, J Almond, TC Skinner, J Hassler-Hurst, J Buck, S Cradock, A Scott, G Rayman

FACTS Evidence base

Parent and child behaviours for optimal self-care 1-2 years after diagnosis as HbA1c

(Anderson BJ, 1997)

Parental involvement most important predictor of positive adolescent outcomes (Anderson BJ, 1999)

3 x teamwork intervention studies with consistently beneficial results (Anderson BJ 1999, Laffel L 2003, Svoren 2003)

Background…..

Pilot study completed 2004– 78 adolescents FACTS vs Standard outpatient

care

Practice: 4 group sessions 2 skills session and 2 focused on family

responsibility and diabetes communication

Statistics....

Larger RCT - commenced 2007

300 adolescents

East - Ipswich - Norwich - Peterborough

Midlands - Coventry - Leicester - Nuneaton

South - Poole - Portsmouth

Study design…

Meets NICE structured education recommendations

Increased contact time- 6 group sessions, 60 – 90 mins duration, monthly

T1DM 11 – 16 yr olds, age-banded

Parents involved

Local educators Facilitated not taught

Course content…..

Skills training BG monitoring, insulins, hypoglycaemia, exercise,

healthy eating, sick days, etc

Adolescent development…..

Physical / psychological development Parent / child responsibility Dependence / interdependence /

independence

Communication skills….

Modelling Discussion Practice Teamwork Interdependence

Conflict resolution…

Conflict resolution skills– Schedule arguments– Stay on topic– I NOT U– Never say Never– Shut Up– Mistakes Happen

Initial sessions….

Initial sessions….

BG monitoring/communication

‘High’ or ‘Low’ blood

sugarsParents

worry about complicatio

ns

Parents may accuse and

criticise

Kids feel discouraged and

blamed

Kids don’t check or find it hard to tell the

truth

Families feel frustrated and discouraged

Avoiding a Vicious Cycle

Helping families recognise and break this cycle!

Finally….