Engaging Families to Improve Health Outcomes in Diabetes

CareMax Zubatsky, PhD, LMFT

St. Louis University

John Rolland, MD, MPHUniversity of Chicago

Tai Mendenhall, PhD, LMFTUniversity of Minnesota

Collaborative Family Healthcare Association 16th Annual ConferenceOctober 16-18, 2014 Washington, DC U.S.A.

Session # A1bOctober 17, 2014

Faculty Disclosure

We have not had any relevant financial relationships during the past 12 months.

Learning Objectives

At the conclusion of this session, the participant will be able to:

1. Identify and define specific ways that professionals can engage with families and patients living with diabetes outside of primary care settings.

2. Describe how collaborative partnerships with patients and families can lead to improved health outcomes and reduced healthcare costs.

3. Apply these clinical principles across one’s own professional and community-based environments and with diverse disease populations.

Bibliography / ReferencesDelamater, A.M., et al. (2001). Psychosocial Therapies in Diabetes: Report of the Psychosocial

Therapies Working Group. Diabetes Care, 24(7): 1286-1292.

Mendenhall, T.J., Berge, J.M., Harper, P., GreenCrow, B., LittleWalker, N., WhiteEagle, S., & BrownOwl, S. (2010). The Family Education Diabetes Series (FEDS): community-based participatory research with a midwestern American Indian community. Nursing Inquiry, 17(4): 359-372.

Rolland, J. (2015, in press). Treating Illness and Disability in Families: An Integrative Model. New York: Guilford.

Rolland, J. (1994). Families, Illness, & Disability: An Integrative Treatment Model. New York: Basic Books.

Rolland, J.S. (2012). Mastering Family Challenges: Coping with Serious Illness and Disability. In F. Walsh (Ed.) Normal Family Processes. 4th Edition. New York: Guilford. Chinese edition Shanghai: (2013)

Rolland, J.S. & Walsh, F. (2006) Facilitating family resilience with childhood illness and disability. Current Opinion in Pediatrics, 18:527-538.

Rolland, J.S. & Walsh, F.W. (2005). Systemic training for healthcare professionals: The Chicago Center for Family Health Approach. Family Process, vol 44, no 3, 283-301.

Rolland, J.S. Chronic Physical and Psychiatric Illness and the Family Life Cycle. (2014). In M. McGoldrick, N. Garcia-Preto, & E. Carter (Eds.), The Expanded Family Life Cycle: Family, and Social Perspectives. 5th edition. Boston: Allyn & Bacon.

Learning Assessment

• A learning assessment is required for CE credit.

• A question and answer period will be conducted at the end of this presentation.

Engaging Families to Improve Health Outcomes in

Diabetes Care:

Chicago Center for Family Health & University of Chicago Collaboration

John S. Rolland, M.D., MPHUniversity of Chicago Pritzker School of Medicine

jrolland@uchicago.edu

Chicago Center for Family Healthwww.ccfhchicago.org

Chicago Center for Family Health

• Family systems-oriented institute. Non-profit independent affiliate of the University of Chicago

• Provides specialized training & services to promote healthy family functioning and adaptation to stressful life challenges

• Innovative community-based, collaborative, resilience-oriented practice model to strengthen families at risk, in crisis, or facing persistent challenges

• Promotes systems-based family-centered collaborative healthcare

Basic Premises:

• Family, broadly defined, as the psychological and caregiving focal point and as a key resource and partner in care

• Comprehensive biopsychosocial model for healthcare delivery from the time of diagnosis

• The behavioral component addresses both patients’ and family members’ needs using a developmental, life-span model that is culturally sensitive

• Fuller integration of the biomedical and psychosocial aspects of care directly in healthcare settings.

Family Systems Illness Model in Healthcare

• Collaborative ApproachPatient – Family - Healthcare Team – Community

• Family Resilience - basedShift from Deficit, Problem Focus toStrengths & Resources for Positive Patient /

Family Adaptation • Developmental, life-span View:

Illness – Individual - Family • Attuned to socio-economic, cultural, spiritual

diversity & varied family forms

Overall Design: Four Components

1) Family-centered clinical & psychoeducational services

2) Professional education & development

3) Community education & outreach

4) Family resources

Component 1Family-Centered

Clinical & Psychoeducational Services

• Routine screening family consultation & brief psychological screening of the patient at time of diagnosis or entry into the Diabetes Center.

• Identify & Refer complex or “high risk” cases

• Periodic family psychosocial “check-ups” & consultations

-- at key diabetes-related transitions -- disruptive individual and family

transitions

Routine Screening & Consultation

Benefits• Engages patient and their families

• Provides orientation & psychoeducation to treatment plans and family’s role

• identifies family strengths as a resource for optimal diabetes care

• Facilitates early identification of high-risk cases

Periodic Psychosocial ‘check-ups’ & Consultations

• Available at key diabetes-related or disruptive individual/family transitions.

• Address illness and management complications that frequently arise at stressful transitions such as starting a family, transitioning to adulthood, job loss, loss of a loved one, divorce and remarriage

Psychoeducational Workshop Days

• Initial workshop for newly diagnosed patients and their families

• Topical workshops for major life transitions (transition to adulthood, early marriage) and family challenges (communication/problem-solving, caregiving).

• Format: Large group presentation & discussion

Facilitated break-out sessions for groups of families.

Multiple Family Discussion Groups & Educational Days

• Address Key psychosocial challenges

isolation and support & networking of families dealing with similar issues.

• Provide information, guidelines to reduce stress, avert medical crises. Combined with facilitated group discussion

• Draw out strengths, resources to live well with diabetes

Component 2:Professional Education and Development

• Continuing Education programs for physicians, nurses, social workers, dietitians and other allied health professionals

• Psychosocial Rounds with collaborative presentation and discussion of complex cases

• Intensive training for core Diabetes Center team members

Component 3:

Community Education and Outreach

• Free educational events offered to the consumer community

 

Component 4:

Family Resources

• Database to link families in the program

• Resource to families:• with a newly diagnosed member • those going through a difficult

transition such as starting a family or launching to adulthood, independent living.

Mental Health Issues in Diabetes National Initiative

Mission

Create a new paradigm of standardized treatment for diabetes in a “Team Approach” which will combine “Medical Treatment” and “Mental Health Care” merged in a new paradigm of care for professionals, patients and families throughout the world.

John S. Rolland, M.D., MPH

University of Chicago Pritzker School of Medicinejrolland@uchicago.edu

Chicago Center for Family Healthwww.ccfhchicago.org

312-372-4731

Citizen Health Care• Citizen Health Care (CHC) is a way

to engage patients, families, and communities as co-producers of health and health care

• CHC encompasses an identity-shift for professionals (from “expert” to “citizen”)

• Core principles and planning strategies permeate projects, but no two projects look wholly alike

Family Diabetes / Education Series

(the “FEDS”)• Members of the Native American

community who have lived experience with diabetes (as patients or family members) working in partnership with providers in the provision of education and support in culturally appropriate ways

• Designed and implemented through a democratic and collaborative partnership between patients, family members, and providers

FEDS / Introduction

• Engages low-income, urban-dwelling AIs and their families in an active forum of education, fellowship, and support

• Participants include patients and family members, medical and behavioral health providers, and tribal elders

FEDS / Meetings

• Meetings start with members conducting foot checks and recording each other’s weight/ BMI, blood pressure, and blood sugar

• Meals consistent with AI culture and traditions are prepared and shared communally, along with discussions about ingredients and indicated portion sizes

FEDS / Education

• Educational forums take place in the contexts of talking circles, small and large group discussions, and a variety of lively activities (e.g., traditional music, dancing and aerobics, impromptu theater/role-plays)

• Forums encompass active collaboration between community leaders and Western providers

FEDS / Educational Topics, con't

● Diabetes in the AI Community

● Dietary Guidelines & Portion Sizes

● Exercise & Physical Activity

● Obesity & Weight Control

● Foot Care & Wound Care

● Blood Glucose Monitoring & Control

● Eyes and Teeth: Dental Care / Retinopathy

FEDS / Educational Topics, con't

● Blood Pressure & Cholesterol● Heart Disease & Stroke● Stress Management & Strategies● Medical Services & Supplies● Working with your Doctors● Sticking with it: Staying Motivated

& Family/Social Support● Review: Putting it all Together

Targeted Activities to Engage Youth

• Family Education Diabetes Series

• East Metro Diabetes Initiative

• St. Paul Public Schools / Indian Education

Targeted Activities to Engage Youth• East Metro Diabetes Initiative

– Includes FEDS, Ain Dah Yung Center, St. Paul Public Schools, and American Indian Family Center

• Community Gatherings and Events• Community Theater• Community Gym• Physical Activity Kits

Targeted Activities to Engage Youth

• St. Paul Public Schools / Indian Education– Diabetes Education in Tribal Schools– K–12 multidisciplinary units – Enhance understanding and appreciation of the problems

of diabetes in AI communities– Empower students to make healthy lifestyle choices– Curriculum is based on national education standards

(aligned with appropriate and engaging cultural content)

Results (so far)

• Increased participation in events and activities (attendance & sign-in)

• Increased engagement in physical activity (frequency, duration)

• Improved diet• Reduced weight and BMI

The Use of Groups for Diabetes Care

Max Zubatsky, PhD, LMFT Department of Family and Community Medicine St. Louis University

Questions for Improving Diabetes Care for Families

• How do we address questions not answered fully in typical primary care visits (e.g.: medication adherence, eating challenges, mental health issues, caregiving issues)?

• How do we connect providers with families outside of routine appointments?

• How can families with diabetes connect with other families in the community?

Advantages of Multifamily Groups for Diabetes Care

• Combines educational and behavioral interventions

• A way of developing an alliance between consumers, families and practitioners

• Gathering perspectives of the disease from a variety of members

SLU Care Clinics Tertiary Care

KICK Diabetes Program

(St. Louis Regional Health Community

Commission)

Multifamily Groups at The Center for Counseling and Family Therapy

Referral Stream for Multifamily Groups at SLU

Proposed Protocol for the Groups• Two hour groups, consisting of 3-4 families per

group• One MedFT, One FM Resident, One Pharmacist• Patients are children with diabetes (ages 8-17)• One hour of educational topics, one hour of

behavioral interventions (joining, experiences of the illness, family communication, parenting)

• Outcome areas: medication adherence, A1c levels, family support, stigma reduction

Closing Points• More strategies and services need to be

implemented to address the family level in diabetes care

• Families need more resources (medical, mental health, community) after the initial diagnosis

• Patients and families need to be seen as “co-producers” of healthcare

Session Evaluation

Please complete and return theevaluation form to the classroom

monitor before leaving this session.

Thank you!