Sayaka Hino, MPH Candidate
In the United States from 2001-2009, the number of youth diagnosed with Type 1 diabetes increased by 23% and with Type 2 diabetes by 21%. With the rising prevalence of diabetes in youth, it is increasingly important to find effective ways to help children and adolescents manage their diabetes. One way to reach a large number of youth is through diabetes camps. This blog highlights its effectiveness and discusses the importance of ongoing support for diabetes camps.
Diabetes camps provide a valuable time for adolescents with diabetes to exchange peer support and to learn and practice diabetes self-management skills. Camps are quite popular in the U.S. and worldwide – in 2011, about 30,000 children attended diabetes camps in the U.S. (ADA, 2012). Diabetes camps are effective at improving knowledge of diabetes self-care, but the case is weaker for their effectiveness at reducing HbA1c, particularly over a sustained period of time (Mancuso & Caruso-Nicoletti, 2003; Santiprabhob et al., 2012). Since diabetes camps have the potential to initiate a lifetime of healthy self-management behaviors, it’s incredibly important to find out how these camps can sustain their impacts over time.
Ongoing Support to Maintain Behavior Change and Health Outcomes
Past studies have found that HbA1c goes down in the time period immediately after camp but this impact diminishes in the months and years that follow (Misuraca et al., 1996). These results are typical of behavioral interventions that find a slow return to baseline after program completion. How can the four key functions of peer support be useful in addressing this frequently occurring problem? A look at diabetes camps reveals that while they do a great job of providing assistance in daily management, social and emotional support, and linkage to clinical care, one key function is missing – ongoing support, extended over time.
According to the American Diabetes Association’s statement on diabetes camps, camps do provide assistance in daily management, social and emotional support, and linkages to clinical care, which are credited with decreased HbA1c during and immediately after camp. However, a study conducted by Misuraca and colleagues found that this reduction in HbA1c was sustained after 6 months only for individuals who attended monthly meetings after camp, but not for those who didn’t attend meetings. The monthly meetings reinforced and extended the camp’s impacts, helping individuals maintain clinical outcomes. This suggests that ongoing support is one area that could improve the outcomes for children and adolescents attending these camps, some of which only last a few days.
Approaches to Ongoing Support for Youth
There is a potential for camps to introduce ongoing support throughout the year in addition to the already-popular summer camps. Several camps have begun holding weekend trips for campers who wish to reunite with their friends during the year, which is one way to provide ongoing support. Another route for smaller camps that may not have the capacity to hold more camps is to create online forums for participants who wish to reconnect. Given the popularity and frequent use of the internet among younger generations, this could be a cost-effective, low-maintenance way to support campers throughout the year if physical get-togethers are not feasible. Promoting pen pals is another low-cost way to increase the ongoing support received by camp attendees after end of camp. Whichever way camps choose to do it, ongoing support throughout the year is one way that could effectively improve clinical outcomes for youth with diabetes in addition to the increase in knowledge and self-management skills they receive during camp.
American Diabetes Association (2012), Diabetes Management at Camps for Children with Diabetes. Diabetes Care, 35 (Suppl 1) S72-S75. doi: 10.2337/dc12-s072. http://care.diabetesjournals.org/content/35/Supplement_1/S72.full
Mancuso, M. & Caruso-Nicoletti, M. (2003) Summer camps and quality of life in children and adolescents with type 1 diabetes. Acta Biomedica Ateneo Parmense, 74(Suppl. 1): 35–37.
Santiprabhob J., Kiattisakthavee P., Likitmaskul S. et al. (2012). Glycemic control, quality of life and self-care behavior among adolescents with type 1 diabetes who attended a diabetes camp. Southeast Journal of Tropical Medicine and Public Health, 43(1): 172-184.
Misuraca, A., Di Gennaro, M., Lioniello, M., Duval, M., Aloi, G. (1996). Summer camps for diabetic children: an experience in Campania, Italy. Diabetes Research and Clinical Practice, 32(1-2): 91-6.
Patrick Yao Tang, MPH
The first meeting of the National Peer Support Collaborative Learning Network represents Peers for Progress’ commitment to promoting and advancing peer support in the U.S. by bringing together national experts in peer support, community health, and family medicine. From November 12-13 in Washington, D.C., Peers for Progress and the National Council of La Raza (NCLR) hosted work group meetings, networking sessions, and forum discussions to generate ideas for priority areas for the Network in 2014.
- Key opinion leaders
- Experts in the field, including researchers
- Leaders of peer support programs and organizations
- Network members
- NCLR Affiliates
- Stakeholders representing community-based organizations, health care organizations, insurance groups and government agencies
On the afternoon of November 12th, representatives of six work groups met to discuss their projects, share lessons learned, and formulate next steps for dissemination. For many work groups members, this was their first time meeting each other in person after collaborating for months over email and telephone. One of the objectives for this session was to gather feedback from work groups members to improve the collaborative experience next year.
That night, we moved to the historic Mayflower Hotel for a reception, dinner, and group discussion. Janet Murguía, President and CEO of NCLR, delivered the welcoming remarks to a room full of captivated attendees. Craig Doane, Executive Director of the American Academy of Family Physicians Foundation, and Delia Pompa, Senior VP of Programs at NCLR, opened the post-dinner discussion.
Even at the end of a long day, the attendees were able to muster up a great deal of energy during the post-dinner discussion. Attendees never hesitated to speak up and share their opinions. Without a single lull in the conversation, our moderator had to cut the discussion short in order to let people get some rest. I got the feeling that the attendees could have stayed up talking all night if we hadn’t adjourned at a reasonable hour.
The next morning, Ed Fisher, Global Director of Peers for Progress, launched the second day with an overview of peer support and the National Peer Support Collaborative Learning Network. From there, we dove into three open forum discussions on 1) Peer Support and Behavioral Health, 2) Audiences and Communities, and 3) Organizational and Systems Issues. The cross-cutting themes were health care reform and other funding sources for peer support, advocacy, preserving peer support as a humanizing force in a system oriented toward objective and financial outcomes, and retention, certification, quality improvement, and related issues in peer support programs.
As the microphone passed from one speaker to the next, we seemed to cover the entire spectrum of perspectives in the field of peer support. Some attendees were interested in the potential of peer support for primary prevention; how do we reach those who are not yet sick? In the discussion about program evaluation, participants wanted to move the field from a research-based approach to a quality improvement approach that will lead to lasting community benefits. In the context of health reform, a few attendees kept our eyes on the prize, reminding us that care integration is not the ultimate goal – providing comprehensive, whole person, family-focused care is what we should be striving for.
One question that stuck with me, personally, is this: Is peer support inherently disruptive and fundamentally transformative with respect to health care system, or will it conform to the existing paradigm of health care in the United States? Will peer support transform health care from within someday?
We hope that participants left the meeting with fresh ideas and a renewed sense of purpose. Our staff certainly felt the enthusiasm and brought it back with us to our offices in Chapel Hill. Check back soon for the final meeting report to see our plans for the Network in 2014. As always, we invite everyone in the Network to send us your opinions and feedback.
What participants had to say:
“Fantastic, timely gathering”
“Thought-provoking and positive atmosphere”
“What I liked most was that the meeting utilized every participant’s diverse experience to set goals for future work”
Clayton Velicer, MPH
In honor of Veterans Day, we would like to draw your attention to some of the recent advances in peer support for veterans. In April, our blog highlighted the buddy-to-buddy program at the University of Michigan that uses military culture to change the culture of treatment avoidance as part of mental health care. More recently, we highlighted the national implementation of peer support programs for veterans including increased funding for veteran peer support services in New York and Texas, as well as an article assessing the Department of Veterans Affairs’ (VA) initiative to expand its workforce of peer specialists. At that time, the program had made substantial progress in reaching the mandate of hiring 800 peer support specialists for 2012. Last week, the Department of Defense announced that this goal had been reached. The VA’s Undersecretary for Health, Dr. Robert Preztal, stated:
“We are proud to have exceeded the hiring goal established by the president in his executive order… We are well on the way to have all of these new hires trained by the end of the calendar year.”
Every VA medical center throughout the country and all community-based outpatient clinics with more than 10,000 enrollees now have peer support specialists and apprentices on staff. Building on this great news, we are sharing 3 news briefs for peer support for veterans and active military:
1) The Valor Act 2 will offer a variety of benefits to veterans, and currently has two different versions being worked on in the House and Senate. When discussing the proposed bill, Massachusetts state senator, Bruce Tar, stated, “When presented in the emergency room, we want to connect peer counselors and peer support with people who end up in a facility with a threat of suicide… We need to try to look out for information to help them and let them know the services are there before that eleventh hour.”
2) The USA Today published an article this week discussing the affect of unfair stereotypes and stigma surrounding mental health on the hiring of returning veterans. The article highlights VA Medical Center’s Compensated Work Therapy program that employs peer support specialists to help other veterans recover from mental illness. Tony Zipple, president and chief executive of Seven Counties Services in Louisville states: “A very, very large cross-section of the general population has some combination of these same conditions [mental health conditions including depression and PTSD] as well. If you said we’re not going to hire anybody that has an issue with depression and takes an antidepressant, you’d have big chunks of the population that would never work again.” The article promotes better understanding of mental health conditions and providing better resources for returning veterans.
3) The Huffington Post also featured a blog for Veterans Day by James Knickman, president of the New York State Health Foundation that described 4 keys factors to ensure that every community serves its veterans well. These 4 factors are:
1. Energy and action by a range of community stakeholders including health care providers, academic institutions, social service agencies, community-based organizations, businesses, philanthropic organizations and government.
2. Local leadership: This includes a broad network of people, but Knickman provides the example of a community-based organization like Veterans Outreach centers as being capable of serving as a resource hub for returning veterans.
3. Local funders: Knickman highlights how in his state, the Robin Hood Foundation, local businesses and individual funders came together to build community capacity to meet the needs of returning veterans and their families.
4. Sustained leadership from elected officials: Knickman points out that support from government is critical even in the presence of local funders and community support because the VA runs so many critical programs. He also calls on elected officials to push the VA to recognize the larger roles that can be played by non-VA community-based providers to work together.
These 3 news briefs represent just a small weekly sampling of the ongoing discussion of providing support for veterans and active military members. We believe peer support can continue to play a critical role in providing support for the unique needs of veterans and military members and encourage our readers to continue to share news stories, resources and general thoughts on this critical topic.