@article{340c5f11af6646ddb5d1b22fa0d53e95,
title = "All together: Integrated care for youth with type 1 diabetes: Integrated care for youth with Type 1 Diabetes",
abstract = "Objective: We describe the implementation and evaluation of an integrated, stepped care model aimed to identify and address the concerns of adolescents with type 1 diabetes (T1D) associated with diabetes-related quality of life (DRQoL), emotional well-being, and depression. Research Design and Methods: The care model with 4 steps: (1) Systematic identification and discussion of concerns salient to adolescents; (2) Secondary screening for depressive symptoms when indicated; (3) Developing collaborative treatment plans with joint physical and mental health goals; and (4) Psychiatric assessment and embedded mental health treatment; was implemented into an ambulatory pediatric diabetes clinic and evaluated using quantitative and qualitative methods. Results: There were 236 adolescents (aged 13–18 years) with T1D that were enrolled in the care model. On average adolescents identified three concerns associated with their DRQoL and 25% indicated low emotional well-being. Fifteen adolescents received a psychiatric assessment and embedded mental health treatment. Both adolescents and caregivers were appreciative of a broader, more holistic approach to their diabetes care and to the greater focus of the care model on adolescents, who were encouraged to self-direct the conversation. Parents also appreciated the extra level of support and the ability to receive mental health care for their adolescents from their own diabetes care team. Conclusion: The initial findings from this project indicate the acceptability and, to limited extent, the feasibility of an integrated stepped care model embedded in an ambulatory pediatric diabetes clinic led by an interdisciplinary care team. The care model facilitated the identification and discussion of concerns salient to youth and provided a more holistic approach.",
keywords = "adolescents, integrated care, mental health, type 1 diabetes, youth",
author = "Judith Versloot and Amna Ali and Minotti, {Simona C.} and Julia Ma and Jane Sandercock and Michelle Marcinow and Daphne Lok and Deepy Sur and {de Wit}, Maartje and Elizabeth Mansfield and Sheryl Parks and Ian Zenlea",
note = "Funding Information: The authors acknowledge our original working group members: Rayzel Shulan, MD, Ph.D., David Daien, MD, Rose Geist, MD, Alison Freeland, MD. We would also like to acknowledge Monidipa Ravi, MD, our consulting psychiatrist at SickKids and Angelo Simone, MD, who was our subject matter expert on the project and the diabetes care team at Trillium Health Partners including Elaine Wilson and Leanne Montgomery. This work is supported by the Medical Psychiatry Alliance, a collaborative health partnership of the Centre for Addiction and Mental Health, The Hospital for Sick Children, Trillium Health Partners, and the University of Toronto, as well as the Ontario Ministry of Health and Long-Term Care and an anonymous donor. Funding Information: The implementation of the Care Model was an iterative process and several learnings emerged. Having the adolescents complete the screening measures in the clinic expectedly impacted clinic flow. To reduce the impact on clinic flow in the future, an online platform could be sought where the adolescents fill out the screening measures ahead of the appointment. Due to the high volumes of patients seen in the clinic, nearly a year of data collection was required before all eligible adolescents had filled out the MY‐Q questionnaire at least once. Due to impacts on clinic workflow and clinician workloads, it was only possible to incorporate one MY‐Q per year into patient visits and not more frequently as had been planned. Furthermore, funding from the pilot project supported additional administrative support and augmented work hours for the social worker, nurses, and physicians. To ensure the sustainability of the model, consideration should be given to ongoing training, clinic flow and workload management strategies, and mitigation plans for staff turnover. Sustainability would also require ongoing sponsorship from hospital leadership to ensure the availability of funds. An economic analysis might be helpful to gain insights into the direct and indirect costs of such a Care Model. Publisher Copyright: {\textcopyright} 2021 The Authors. Pediatric Diabetes published by John Wiley & Sons Ltd.",
year = "2021",
month = sep,
day = "1",
doi = "https://doi.org/10.1111/pedi.13242",
language = "English",
volume = "22",
pages = "889--899",
journal = "Pediatric diabetes",
issn = "1399-543X",
publisher = "Blackwell Munksgaard",
number = "6",
}