Using the Delivery of Education to Diminish Barriers to Diabetes Treatment Dave Joffe, BSPharm, CDE, Editor in Chief April Steen, LCSW, MSW Type 1 Diabetes and Psychoeducation Part 2 of 3

The Child Emotional – –Grief – –Fear – –Guilt – –Anger – –Denial – –Resentment – –Depression Social –Stigmatized –Teased –Bullied –Withdrawn

The Child Don’t hide anything when telling the child about his/her diagnosis – –This will help the child accept the diagnosis and lead to better outcomes Assure the child it was not his/her fault – –Give examples of role models who have diabetes (Nick Jonas, Randy Jackson,…) Encourage the child to tell his/her friends – –Offer to help explain it to the child’s friends and their parents Do not force the child to go to camp or support groups – –Strongly encourage it and have them talk to others who have had a good experience Encourage the child to ask questions and to show emotions

Siblings Emotional   Anger   Resentment   Pity/Sadness   Guilt   Fear   Jealousy   Embarrassment

Siblings Educate the siblings about diabetes and do not hide anything – –They are not contagious, they did not do anything wrong, etc. Have open discussions about feelings and encourage questions Spend special time with each child individually – –Dedicate one night of the week to each child Let them know their sibling with diabetes is going to need a lot of support, love, and understanding –Include siblings with monitoring/management of the child’s diabetes

Peers/Friends Misunderstandings and misconceptions due to lack of knowledge –Peers may feel the child may not be able to do everything they can do (play sports, run around, have desserts, etc.) Awkward –Others may not know what to say or how to act around them Over-protective –Friends may be very “watchful” as to what the child eats and how often they test and “report” back to the parent Defiant –Some may tell the child it is not necessary to test or make it sound “un-cool” to eat a special diet causing the child to be defiant

Peers/Friends If the child is nervous about telling peers, help him/her decide who to tell and what to say – –Role play and act out scenarios Speak with the teacher and set aside an afternoon to talk to your child’s class about diabetes and explain what they may see Tell close family, friends, and relatives as well as anyone else who may care for the child – –Educate on snacks, meals and signs/symptoms of hyper- and hypoglycemia Tell the parents to advise of the importance of eating correctly and monitoring blood sugar

Parents Emotional – –Grief – –Fear – –Guilt – –Anger – –Denial – –Resentment – –Depression Economical –Doctors bills –Medications –Testing supplies Social –Speaking to teachers –Telling friends and family

Parents Educate parents on the disease state and assure them it was nothing that they have done to cause it Encourage parents to write down questions Direct the parents to a support group Suggest family counseling Encourage the parents not have different expectations of the child diagnosed with diabetes Advise that at first there will be minor changes but over time it will become part of their daily routine

Parent and Child Education Education is a contributing factor to the emotional impact disease can have on a family Consider initially & periodically meeting with parents separate from the child – –Parents can help the doctor with ways to educate their child – –Parents may have issues they would like to discuss Talk with the family about myths associated with childhood diabetes – –Help to relieve some of the stigma associated with diabetes Have someone sufficient in diabetes education available to the family for any questions

Parent Education Explain the feelings children might have in dealing with diabetes & how these feelings may change with age Help parents establish the amount of involvement they should have when it comes to their child’s diabetes care – –Generally the amount of involvement should correlate with the age & maturity of the child Stress to parents the importance of taking care of themselves & allowing others to help

Tips for Parents Acknowledge the child’s feelings Encourage the child to play an active role in their health care Emphasize independence Help the child find strengths Focus on friendships Talk about ways to cope with bullying Clarify any misconceptions he/she may have Get in touch with other families & children who have diabetes