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Psychosocial screening of youth with type 1 diabetes at the UMass Memorial Diabetes Center of Excellence

Dr. Barry-Menkhaus and Dr. MacGregor

The American Diabetes Association continues to recommend screening people living with type 1 diabetes for psychosocial health concerns: mental; emotional; and social, however, there are many variables to consider about how to go about it. The UMass Memorial Diabetes Center of Excellence (DCOE) is one of few diabetes clinics in the U.S. which currently employs multiple health psychologists on the diabetes care team.

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A successful psychosocial screening process for youth living with type 1 diabetes was developed and implemented at the UMass Memorial DCOE.  Results were published in the Journal of Pediatric Psychology.

Developing a psychosocial screening process at the UMass Memorial Diabetes Center of Excellence pediatric clinic

Diabetes care clinics interested in screening patients for psychosocial issues must first decide who to screen, how often, and pinpoint which of the many potential issues to evaluate. These difficulties include stress, fear of hypoglycemia and/or needles, depression, anxiety, burnout, eating disorders, diabetes-related family conflict, etc. Past studies have proven that such issues often result in difficulties with diabetes self-management and elevated A1c, which can lead to serious short-term and long-term health complications. It’s also well documented that psychosocial and mental health concerns can often be improved with behavioral health treatment, especially when identified early.

Pediatric diabetes care clinics must determine who to screen in addition to deciding what to measure, how to collect that information and how often. They can ask parents about their child’s psychosocial health, ask children about their own psychosocial health, or screen both.

The process must be carefully developed to consider patient needs, workflow and logistics in order to effectively administer the questionnaires. The clinic must also ensure appropriate staffing to allow health psychologists, social workers, diabetes educators, and other members of the care team availability to address any patient issues uncovered while screening.          

Implementing the program

The pediatric diabetes care team at UMass Memorial worked together to develop a successful screening program. The health psychologists, social worker, endocrinologists, dietitian, certified diabetes educators and child life specialist evaluated data from the previous year’s electronic patient records in order to prioritize their many screening options. Youth depression and anxiety were selected as the priority issues. Nationally, increased rates of depression and anxiety disorders in young people with T1D have been associated with negative health outcomes. The team decided to use paper-pencil questionnaires to screen children living with diabetes ages 8 and older, as well as their parents. Screenings were administered at every office visit because new problems and circumstances may arise for patients between quarterly visits.

Results from the pilot screening program

There’s plenty of evidence to suggest why systematic psychosocial screening in pediatric diabetes care is important. Results from the initial screening program at the UMass DCOE suggest there’s a benefit to involve both youth as well as their parents in the process.    

“There was about an 80% overlap in the answers provided by the young people and their parents, however approximately 20% of unique data uncovered depression and anxiety issues in our patients which would have otherwise gone undetected,” said Samantha A. Barry-Menkhaus, PhD, a health psychologist who led the screening program at the UMass DCOE. 

“In order for the screening to be beneficial, the workflow of the clinic must include a follow-up plan to close the loop on screening results, further assess identified difficulties, and provide people with the behavioral and emotional care they need to address their individual concerns,” she added.

Screening quarterly instead of once a year allowed the care team to detect problems that otherwise would not have been identified and dealt with for another three to nine months. Those patients were able to meet with a health psychologist and address their issues immediately.  

While the screening program was implemented and executed to improve clinical care and patient outcomes, reviewing the data retrospectively provided important statistics. Not only did the UMass DCOE measure how many patients were helped as a result of the program, but other diabetes clinics can also utilize that data to create their own screening program.

“It’s a simple form for people to fill out, but it’s a complex process,” said Dr. Barry. “We anticipate that these results will help inform future screening research and program development, both at UMass Memorial as well as other health care centers who will hopefully participate in this rapidly advancing area of diabetes care.”

While screening for depression and anxiety were prioritized by the UMass DCOE, those are only two of the many issues that the American Diabetes Association recommends screening for. Program developers should evaluate their own clinic’s priorities, along with available data, and consider screening for the many other psychosocial areas.

Read the full article published in Journal of Pediatric Psychology.

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