1. Families, Adolescents & Children Teamwork Study 2 Ipswich Paediatric Diabetes Team HR Murphy, C Wadham, AJ Byard, J Almond, TC Skinner, J Hassler-Hurst, J Buck, S Cradock, A Scott, G Rayman

2. FACTS Evidence base  Parent and child behaviours for optimal self- care  1-2 years after diagnosis as HbA1c  (Anderson BJ, 1997)  Parental involvement most important predictor of positive adolescent outcomes (Anderson BJ, 1999)  3 x teamwork intervention studies with consistently beneficial results (Anderson BJ 1999, Laffel L 2003, Svoren 2003)

3. Background …..  Pilot study completed 2004 –78 adolescents FACTS vs Standard outpatient care Practice:  4 group sessions  2 skills session and 2 focused on family responsibility and diabetes communication

4. Statistics....

5. Larger RCT - commenced 2007  300 adolescents  East - Ipswich - Norwich - Peterborough  Midlands - Coventry - Leicester - Nuneaton  South - Poole - Portsmouth

6. Study design …  Meets NICE structured education recommendations  Increased contact time - 6 group sessions, 60 – 90 mins duration, monthly  T1DM 11 – 16 yr olds, age-banded  Parents involved  Local educators  Facilitated not taught

7. Course content …..  Skills training BG monitoring, insulins, hypoglycaemia, exercise, healthy eating, sick days, etc

8. Adolescent development …..  Physical / psychological development  Parent / child responsibility  Dependence / interdependence / independence

9. Communication skills ….  Modelling  Discussion  Practice  Teamwork  Interdependence

10. Conflict resolution …  Conflict resolution skills –Schedule arguments –Stay on topic –I NOT U –Never say Never –Shut Up –Mistakes Happen

11. Initial sessions ….

13. BG monitoring/communication ‘ High’ or ‘Low’ blood sugars Parents worry about complications Parents may accuse and criticise Kids feel discouraged and blamed Kids don’t check or find it hard to tell the truth Families feel frustrated and discouraged Avoiding a Vicious Cycle Helping families recognise and break this cycle!

14. Finally ….