1. New Beginnings A Discussion Guide for Living Well With Diabetes

2. BACKGROUND

3. Focused on helping African Americans with diabetes and their families manage the emotional impact of diabetes.

4. Why African Americans? African Americans are more likely to be diagnosed with diabetes than many other groups. Emotional health is an important part of living with diabetes. New Beginnings is tailored to meet the needs of African Americans with diabetes. CDC, 2011

5. The Emotional Impact of Diabetes Diabetes is a 24/7 condition. People with diabetes are responsible for managing their health over their lifespan. People with diabtes may also be dealing with other health issues. Diabetes can lead to changes that affect mood and self-care behaviors. Every day challenges can make it difficult to manage diabetes. “It takes a lot of discipline to get diabetes under control. But the first thing you have to do is accept that you have diabetes and you have to make up your mind you’re going to do whatever it takes…to get this disease under control because if you don’t control this disease, it is going to take charge of you.” - Yvonne

6. Diabetes Affects the Entire Family People with diabetes have to make changes that may affect others in the household. Family members may have to help care for the person with diabetes. Family members may be dealing with their own health challenges. “…it really does not work if you’re making separate meals.. We have to eat as a family. We have to support one another as a family and if it really is in sickness and in health then you become one and you eat the same foods.” - Jaquie

7. The Importance of Family and Social Support Social or family support can have a negative or positive impact on the person with diabetes. African Americans with diabetes may rely more on family and social support than other populations. A lack of social support may have a worse impact on African Americans than other groups. Social support can be an important part of improving quality of life. “Communication and talking to each other and talking about the emotional part of living with diabetes helps to alleviate some of the frustration and the denial. A lot of us get to the point…we don’t want to deal with it, but it’s something that we all have to deal with, whether we like it or not, its there.” - LyCynthia Ford, M., Tiley, B., & McDonald, P. (1998) Tang, T., Brown, M., Funnell, M., and Anderson, R. (2008)

8. A Word About Stigma It is often difficult for many groups to discuss issues of emotional and mental health. African Americans may be more likely to perceive a stigma attached to mental health. African Americans may not feel comfortable discussing personal matters with those outside of their family or cultural group. African Americans may be more likely to rely on spiritual or family support. Ford, M., Tiley, B., & McDonald, P. (1998)

9. Goals of New Beginnings Help African Americans with diabetes: –Manage the emotional impact of diabetes. –Build positive supportive relationships with family and health care providers. –Develop skills for Goal setting Problem solving Positive coping Improved self-efficacy Health literacy

10. New Beginnings Lead discussions about the emotional side of living with diabetes. Help people with diabetes and their loved ones: –Develop goal setting, positive coping, and problem solving skills. –Identify family and social support needs. –Learn positive communication skills.

11. Storytelling in New Beginnings Uses the stories of people with diabetes and their families to stimulate discussion. Stories help: –Open conversations –Model skills and behaviors –Increase retention of information –Overcome barriers to discussing personal information –Bridge cultural divides

12. What’s New in New Beginnings Shorter and more flexible. New stories and story formats. More focused on behavioral outcomes. –Activities address multiple learning styles. New module on emergency preparedness. New implementation support resources. –Planning, evaluation and promotion tools –Training programs (continuing education available)

13. New Beginnings Modules ModuleTopics Covered Module 1. Overview: Living Well With Diabetes  Diabetes ABCs  Managing diabetes  Supporting a loved one with diabetes Module 2. Know Your ABCs  Diabetes ABCs  Managing diabetes  Goal setting Module 3. Healthy Coping  Emotional coping  Depression  Providing emotional support Module 4. Overcoming Self-Doubt  Building self-confidence and reducing self-doubt  Goal setting Module 5. Managing Stress  Stress management Module 6. Problem Solving and Emergency Preparedness  Problem solving  Emergency preparedness Module 7. Children and Family: How Can They Understand?  Communicating with children and family members  Building social support Module 8. Working With Your Doctor  Preparing for health care visits  Roles for family caretakers

14. Connecting Threads

15. Who should participate in New Beginnings sessions? People with diabetes Family members –Spouses, partners and other loved ones –Children (12 and over) –Close friends People who are not African American

16. Who Can Use the Guide? Diabetes Educators Health Educators Community Health Workers Health Ministers Support group leaders People with training or experience leading group discussions Medical advice is not offered during New Beginnings sessions.

17. Where Can the Guide be Used? Any setting with: –Privacy –Comfortable seating –Equipment for showing or playing the stories Discussions are designed for groups of up to 10 people –Can be incorporated into existing education programs –Can be used in one-on-one patient counseling –Can as a part of large group panel discussions

18. ROLES FOR DIABETES EDUCATORS

19. New Beginnings and Diabetes Self- Management Education In addition to self-care behaviors diabetes self-management education should include: Funnell, et. al., 2007 –Goal setting –Problem solving –Developing strategies to support emotional well- being and health, and behavior change

20. New Beginnings and AADE 7 Self-Care Behaviors™ Healthy eating Being active Monitoring Taking medication Problem solving Reducing risks Healthy coping New Beginnings addresses problem solving and healthy coping directly Other knowledge and skills support adoption of the other self-care behaviors http://www.diabeteseducator.org/ProfessionalResources/AADE7/

21. Roles for Diabetes Educators Facilitators Supervisors/Advisors Evaluators and researchers

22. ROLES FOR COMMUNITY BASED ORGANIZATIONS

23. Who has a role in supporting people with diabetes? Faith communities Worksites Social, civic and service organizations

24. Roles for Faith-Communities Faith communities focus on core values and skills important to behavior change. –Help link deeper values to health choices. –Provide support to overcome denial. –Support improved family communication and relationships. Offer New Beginnings to members and the larger community Partner with health and community organizations to support educational activities

25. Roles for Worksites Improved diabetes management can result in: –Increased productivity –Less absenteeism –Lower medical costs –Healthier employees and retirees Offer groups to employees with diabetes or those who have family members with diabetes. Partner with health and community based organizations.

26. Is Your Organization Ready for a Diabetes Support Group? Support groups –Meetings of people with something in common. –Focus on learning coping skills and strategies. Support groups are not group therapy and are not used to diagnose or treat an illness.

27. Is Your Organization Ready for New Beginnings? Would the members of your community benefit from a diabetes support group? Does your community have people who could organize and lead a support group? Does your organizations have the resources to support a group?

28. Other Ways to Support New Beginnings Offer your space for New Beginnings groups led by diabetes or health educators Refer your members to New Beginnings or diabetes education groups going on in your community Partner with diabetes education or health education programs to help make them more culturally relevant to your community

29. GETTING STARTED WITH NEW BEGINNINGS

30. Decide How You Will Use the Guide What are the needs of your participants? Will you integrate into existing groups or create a stand-alone program? How often will your group meet?

31. Review the Modules Each Module follows the same format: –Background –Objectives –Suggested materials Stories Handouts Equipment –Group Discussion –Exercises –Homework –Expand this Module section

32. Review the Modules – Background and Objectives Background information and summary of key points. Knowledge and skills participants should gain from the module. –Based on behavior

33. Review the Modules - Stories Most of the stories are told by real people with diabetes. –The stories are discussion aids and not intended to offer advice or recommendations. Each module offers multiple story options. –Pick the story that meets the needs of your group. –Use your own stories. The stories come in multiple formats. –Audio, video and print

34. Review the Modules – Group Discussions Part 1: The person with diabetes Part 2: Family support and/or skill building Discussion Format in the Guide

35. Review the Modules - Exercises Each module has 2 – 3 exercises that can be included in the session. –Think about how to use what has been discussed. –Practice new skills. –Plan to make behavior changes. Each module includes a “think-pair-share” activity. Optional homework exercises.

36. Review the Modules – Expand this Section Additional resources. Additional handouts, videos and other materials.

37. Adapting the Modules Make the sessions longer or shorter. Combine different modules. Add additional content from the connecting threads session. Use different stories. Present the modules in any order that makes sense for your group.

38. Adapting the Modules When adapting the guide remember to: –Keep the needs, culture and beliefs of your participants in mind. –Keep the focus on participants’ experiences living with diabetes. –Keep the focus on behavior change.

39. Getting Ready for a Session Review the discussion questions. –Focus on questions that will be most relevant to your group. Review the exercises. Review the Connecting Threads section for additional questions or exercises. Review the homework if appropriate. Use the “Session Plan Template” to organize your session. Prepare handouts worksheets and evaluations for your session.

40. Getting Ready for a Session - Handouts Print and copy all of the handouts in the guide. Order handouts from National Diabetes Education Program or the organizations listed. –Allow time for delivery. Worksheets can be edited to meet the needs of your group.

41. Evaluating New Beginnings Session tracking tool Participant evaluation form Outcome evaluation

42. Building Trust and Maintaining Privacy New Beginnings sessions should be a safe space that is: –Free of judgment –Private

43. Building Trust and Maintaining Privacy During the first session ask the group to establish ground rules that cover: –Sharing information –Respect –Privacy –Other issues

44. New Beginnings Promotional Tools Flyer Postcard Recruitment letter Slides

45. For More Information about New Beginnings visit: www.cdc.gov/diabetes/ndep/new- beginnings.htm Scan this code with your mobile device to go to the New Beginnings website.

46. For more information call 1-800-CDC-INFO (800-232-4636) TTY 1-(888) 232-6348 Or Visit www.cdc.gov/info To order resources, visit www.cdc.gov/diabetes/ndep