Implementing an Integrated Psychology,Social Services,and Pediatric Diabetes Clinic

Abstract

Objective:

Integrated behavioral health services are rarely implemented as a shared space practice in pediatric diabetes specialty clinics. This paper outlines the clinical outcomes, lessons learned, facilitators, and barriers for supporting youth with diabetes and behavioral health issues whose hemoglobin A1c (A1c) was higher than the target range and their families.

Methods:

Using the Iowa Model of implementation, we redesigned the “Regular Engagement And Connection for Health” (REACH) program to integrate health psychology and social services in a shared space clinic for monthly or bimonthly diabetes visits (REACH+). This clinic focused on partnering with families, screening for behavioral and social determinants of health (SDOH), and identifying goals to provide holistic care. This paper presents program evaluation data from the first 50 youth–parent dyads.

Results:

A team in which all roles were respected and valued was critical to successfully implementing REACH+. Youth in the REACH+ clinic decreased their A1c, emergency room visits, and hospitalizations. Forty percent of youth returned to the standard diabetes clinic. Parents reported fewer resource needs associated with SDOH.

Conclusions:

A structured implementation process for the planning, delivery, and evaluation of a fully integrated shared space pediatric diabetes clinic promoted team cohesion, consensus, and ongoing administrative support along with positive patient and family outcomes.

Implications for Impact Statement

Using an implementation process to build a shared space healthcare team, including psychology and social services, was key to supporting patient and family health outcomes for youth with diabetes. Outcomes included improved A1c, and fewer emergency health and resource needs. Forty percent of youth returned to standard diabetes care.

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References

American Diabetes Association . (2017). 1. Promoting health and reducing disparities in populations. Diabetes Care, 40(Suppl 1), S6–S10. 10.2337/dc17-S004

American Psychological Association . (2014). Briefing series on the role of psychology in health care. https://www.apa.org/health/briefs/integrated-healthcare

Brodar

K. E.

Davis

E. M.

Lynn

Starr-Glass

Lui

Sanchez

, & Delamater

A. M.

(2021). Comprehensive psychosocial screening in a pediatric diabetes clinic. Pediatric Diabetes, 22(4), 656–666. 10.1111/pedi.13193

Iowa Model Collaborative Buckwalter

K. C.

Cullen

Hanrahan

Kleiber

McCarthy

A. M.

Rakel

Steelman

Tripp-Reimer

Tucker

, & Authored on behalf of the Iowa Model Collaborative . (2017). Iowa model of evidence-based practice: Revisions and validation. Worldviews on Evidence-Based Nursing, 14(3), 175–182. 10.1111/wvn.12223

Caccavale

L. J.

Bernstein

Yarbro

J. L.

Rushton

Gelfand

K. M.

, & Schwimmer

B. A.

(2020). Impact and cost-effectiveness of integrated psychology services in a pediatric endocrinology clinic. Journal of Clinical Psychology in Medical Settings, 27(3), 615–621. 10.1007/s10880-019-09645-z

Cantor

M. N.

, & Thorpe

(2018). Integrating data on social determinants of health into electronic health records. Health Affairs, 37(4), 585–590. 10.1377/hlthaff.2017.1252

Delamater

A. M.

de Wit

McDarby

Malik

J. A.

Hilliard

M. E.

Northam

, & Acerini

C. L.

(2018). ISPAD Clinical Practice Consensus Guidelines 2018: Psychological care of children and adolescents with type 1 diabetes. Pediatric Diabetes, 19(Suppl 27), 237–249. 10.1111/pedi.12736

Dhaliwal

Pereira

R. I.

Diaz-Thomas

A. M.

Powe

C. E.

Yanes Cardozo

L. L.

, & Joseph

J. J.

(2022). Eradicating racism: An endocrine society policy perspective. The Journal of Clinical Endocrinology and Metabolism, 107(5), 1205–1215. 10.1210/clinem/dgab896

Doherty

W. J.

McDaniel

S. H.

, & Baird

M. A.

(1996). Five levels of primary care/behavioral healthcare collaboration. Behavioral Healthcare Tomorrow, 5(5), 25–27.

10.

American Diabetes Association Professional Practice Committee Draznin

Aroda

V. R.

Bakris

Benson

Brown

F. M.

Freeman

Green

Huang

Isaacs

Kahan

Leon

Lyons

S. K.

Peters

A. L.

Prahalad

Reusch

Young-Hyman

Das

, & Kosiborod

(2022). 14. Children and adolescents: Standards of Medical Care In Diabetes—2022. Diabetes Care, 45(Supplement_1), S208–S231. 10.2337/dc22-S014

11.

Eilander

Snoek

F. J.

Rotteveel

Aanstoot

H. J.

Bakker-van Waarde

W. M.

Houdijk

Nuboer

Winterdijk

, & de Wit

(2017). Parental diabetes behaviors and distress are related to glycemic control in youth with type 1 diabetes: Longitudinal data from the DINO study. Journal of Diabetes Research, 2017, Article 1462064. 10.1155/2017/1462064

12.

Everett

E. M.

, & Wisk

L. E.

(2022). Relationships between socioeconomic status, insurance coverage for diabetes technology and adverse health in patients with type 1 diabetes. Journal of Diabetes Science and Technology, 16(4), 825–833. 10.1177/19322968211050649

13.

Fisher

Glasgow

R. E.

Mullan

J. T.

Skaff

M. M.

, & Polonsky

W. H.

(2008). Development of a brief diabetes distress screening instrument. Annals of Family Medicine, 6(3), 246–252. 10.1370/afm.842

14.

Harris

P. A.

Taylor

Minor

B. L.

Elliott

Fernandez

O’Neal

McLeod

Delacqua

Kirby

Duda

S. N.

, & the REDCap Consortium . (2019). The REDCap Consortium: Building an international community of software partners. Journal of Biomedical Informatics, 95, Article 103208. 10.1016/j.jbi.2019.103208

15.

Hilliard

M. E.

Y. P.

Rausch

Dolan

L. M.

, & Hood

K. K.

(2013). Predictors of deteriorations in diabetes management and control in adolescents with type 1 diabetes. Journal of Adolescent Health, 52(1), 28–34. 10.1016/j.jadohealth.2012.05.009

16.

Jerofke-Owen

T. A.

McAndrew

N. S.

Gralton

K. S.

Totka

J. P.

Weiss

M. E.

Fial

A. V.

, & Sawin

K. J.

(2021). Engagement of families in the care of hospitalized pediatric patients: A scoping review. Journal of Family Nursing, 28(2), 151–171. 10.1177/10748407211048894

17.

Kaitz

J. E.

, & Ray

(2021) Psychologist and physician inter-professional collaborative experiences in primary care integration. Journal of Clinical Psychology in Medical Settings, 28(3), 436–446. 10.1007/s10880-020-09733-5

18.

Kroenke

Spitzer

R. L.

, & Williams

J. B.

(2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16(9), 606–613. 10.1046/j.1525-1497.2001.016009606

19.

Miller

G. F.

Coffield

Leroy

, & Wallin

(2016). Prevalence and costs of five chronic conditions in children. The Journal of School Nursing, 32(5), 357–364. 10.1177/1059840516641190

20.

Mohanty

S. A.

, & Fulmer

(2022, June 13). Person-driven outcome measures health and achieves equitable outcomes. Health Affairs Forefront. 10.1377/forefront.20220609.309858

21.

Mulvaney

S. A.

Hood

K. K.

Schlundt

D. G.

Osborn

C. Y.

Johnson

K. B.

Rothman

R. L.

, & Wallston

K. A.

(2011). Development and initial validation of the barriers to diabetes adherence measure for adolescents. Diabetes Research and Clinical Practice, 94(1), 77–83. 10.1016/j.diabres.2011.06.010

22.

Nambam

Silverstein

Cheng

Ruedy

K. J.

Beck

R. W.

Paul Wadwa

Klingensmith

Willi

S. M.

Wood

J. R.

Bacha

Thomas

I. H.

Tamborlane

W. V.

, & Pediatric Diabetes Consortium . (2017). A cross-sectional view of the current state of treatment of youth with type 2 diabetes in the USA: Enrollment data from the Pediatric Diabetes Consortium Type 2 Diabetes Registry. Pediatric Diabetes, 18(3), 222–229. 10.1111/pedi.12377

23.

Perfetto

E. M.

Love

T. R.

Oehrlein

E. M.

Schoch

S. C.

Bright

Kennedy

, & Schrandt

(2022, June 14). A blueprint to advance patient-centered core impact sets. Health Affairs Forefront. 10.1377/forefront.20220610.963313

24.

Price

Beidas

R. S.

Wolk

C. B.

Genuario

, & Kazak

A. E.

(2019). Implementation science in pediatric psychology: The example of type 1 diabetes. Journal of Pediatric Psychology, 44(9), 1068–1073. 10.1093/jpepsy/jsz030

25.

Rao

, & Jensen

E. T.

(2021). Type 2 diabetes in youth. Global Pediatric Health, 7, 1–7. 10.1177/2333794X20981343

26.

Redondo

M. J.

Libman

Maahs

D. M.

Lyons

S. K.

Saraco

Reusch

Rodriguez

, & DiMeglio

L. A.

(2021). The evolution of hemoglobin A1c targets for youth with type 1 diabetes: Rationale and supporting evidence. Diabetes Care, 44(2), 301–312. 10.2337/dc20-1978

27.

The TODAY Study Group . (2020). Health care coverage and glycemic control in young adults with youth-onset type 2 diabetes: Results from the TODAY2 study. Diabetes Care, 43(10), 2469–2477. 10.2337/dc20-0760

28.

Urbina

E. M.

Isom

Bell

R. A.

Bowlby

D. A.

D’Agostino

Jr. Daniels

S. R.

Dolan

L. M.

Imperatore

Marcovina

S. M.

Merchant

A. T.

Reynolds

Shah

A. S.

Wadwa

R. P.

Dabelea

, & SEARCH for Diabetes in Youth Study Group . (2019). The burden of cardiovascular risk factors over time and arterial stiffness in youth with type 1 diabetes mellitus: The SEARCH for diabetes in youth study. Journal of the American Heart Association, 8(13), Article e010150. 10.1161/JAHA.118.010150

29.

Varni

J. W.

Limbers

C. A.

, & Burwinkle

T. M.

(2007). Impaired health-related quality of life in children and adolescents with chronic conditions: A comparative analysis of 10 disease clusters and 33 disease categories/severities utilizing the PedsQL 4.0 Generic Core Scales. Health and Quality of Life Outcomes, 5(1), Article 43. 10.1186/1477-7525-5-43

30.

Varni

J. W.

Sherman

S. A.

Burwinkle

T. M.

Dickinson

P. E.

, & Dixon

(2004). The PedsQL family impact module: Preliminary reliability and validity. Health and Quality of Life Outcomes, 2(1), Article 55. 10.1186/1477-7525-2-55

31.

Wolfgram

P. M.

Zhang

Simpson

, & Fiallo-Scharer

(2020). Clinical associations of quarterly Patient Health Questionnaire-9 depression screening results in adolescents with type 1 diabetes. Pediatric Diabetes, 21(5), 871–877. 10.1111/pedi.13017