Commentary: Applying Positive Development Principles to Group Interventions for the Promotion of Family Resilience in Pediatric Psychology

As described in the call for this special issue, resilience is often defined as “achieving one or more positive outcomes despite exposure to significant risk or adversity” (Hilliard, Harris, & Weissberg-Benchell, 2012, p. 739). Resilience is particularly relevant to pediatric psychology, as youth and their families are tasked with overcoming risk factors simply by the nature of a child’s diagnosis of a disease/chronic illness and subsequent medical management demands. In addition to identifying key resilience factors within this population, it is critical to develop empirically supported clinical interventions to promote healthy biological, psychological, and social development; reduce youth psychopathology; and enhance optimal health outcomes. Although conceptually similar to the classic resilience/risk models, the positive development approach offers a distinct theoretical framework that can be used successfully in intervention development. This article describes exemplars of both resilience and positive development interventions for youth with Type 1 diabetes (T1D) and their families

Behavioral Factors Influencing Health Outcomes in Youth with Type 1 Diabetes

The Pediatric Self-Management Model provides an overview of how behavioral factors influence children’s chronic medical illnesses. This general framework is used to organize the present review of how self-management behaviors, contextual factors, and processes impact health outcomes for adolescent youth with type 1 diabetes. Adherence has been widely studied in the diabetes literature, and there are consistent findings demonstrating associations between aspects of self-management, adherence, and metabolic control, yet there are still equivocal approaches to adherence assessment methodology (e.g. global versus specific measures). Metabolic control is a hallmark health outcome for youth with type 1 diabetes, but additional outcomes need to be further explored. Future research should utilize the Pediatric Self-Management Model’s operational definitions to guide empirically-supported interventions for youth with type 1 diabetes

Exploratory analysis of the relationships among different methods of assessing adherence and glycemic control in youth with type 1 diabetes mellitus

Objectives: The present study examined four methods of assessing diabetes adherence (self-report, diary measure, electronic monitoring, and provider rating) within a population of youth with Type I Diabetes Mellitus (T1DM). Methods: Comparisons were conducted among the four methods of assessing diabetes adherence. Associations among the seven different measures of blood glucose monitoring (BGM) and HbA1c were examined. An exploratory stepwise regression analysis was conducted to determine the best predictors of glycemic control (i.e., Hemoglobin A1c; HbA1c) while controlling for relevant demographic variables. Results: The adherence measures appeared to be interrelated. The relationships between many of the BGM measures and HbA1c demonstrated a medium effect size. The Self Care Inventory (SCI) adjusted global score was the strongest predictor of HbA1c, even after taking the demographic variables into account. Conclusions: The SCI is a robust, easy-to-use, and cost-efficient measure of adherence that has a strong relationship to HbA1c. Demographic variables are important to examine within the context of different methods of assessing adherence. The research methodology utilized to assess both general diabetes adherence and more specific behavioral measurements of BGM should be clearly documented in future studies to ensure accurate interpretation of results. (PsycINFO Database Record (c) 2011 APA, all rights reserved

Effectiveness of Groups for Adolescents With Type 1 Diabetes Mellitus and Their Parents

Peer- and family-based group therapies have been used as separate interventions to improve adjustment and self-management among youth with Type 1 diabetes mellitus. This study replicates a treatment protocol that combined these two types of diabetes management groups, while also using a wait-list control design methodology within an outpatient mental health clinic setting. General psychosocial and diabetes-related variables were assessed at baseline, immediately posttreatment, and 4 months posttreatment. Youths’ medical information, including metabolic control values, was extracted from medical charts for the 6 months prior to baseline and 6 months after treatment ended. At 4 months posttreatment, parents and youth reported increased parent responsibility, and parents reported improved youth diabetes-specific quality of life. Although there were no statistically significant changes in hemoglobin A1c values and health care utilization frequency from 6 months prior to and 6 months posttreatment, other psychosocial changes (i.e., increases in parent responsibility and diabetes-specific quality of life) were documented. Therefore, this treatment was found to be a promising intervention for use in an outpatient clinical setting to aid in improving the psychosocial functioning of youth with Type 1 diabetes mellitus

Use of an Observational Coding System with Families of Adolescents: Psychometric Properties among Pediatric and Healthy Populations

Objective: To examine reliability and validity data for the Family Interaction Macro-coding System (FIMS) with adolescents with spina bifida (SB), adolescents with type 1 diabetes mellitus (T1DM), and healthy adolescents and their families.Methods: Sixty-eight families of children with SB, 58 families of adolescents with T1DM, and 68 families in a healthy comparison group completed family interaction tasks and self-report questionnaires. Trained coders rated family interactions using the FIMS.Results: Acceptable interrater and scale reliabilities were obtained for FIMS items and subscales. Observed FIMS parental acceptance, parental behavioral control, parental psychological control, family cohesion, and family conflict scores demonstrated convergent validity with conceptually similar self-report measures.Conclusions: Preliminary evidence supports the use of the FIMS with families of youths with SB and T1DM and healthy youths. Future research on overall family functioning may be enhanced by use of the FIMS

Kicking in Diabetes Support (KIDS) Intervention Effects: Parent Reports of Diabetes Management

Objectives: The Kicking In Diabetes Support (KIDS) Project is a semistructured multifamily group therapy (MGT) intervention for adolescents who have type 1 diabetes (T1D) and their parents, which incorporates both peer support and family systems processes to improve diabetes management skills. The purpose of the present study was to evaluate the clinical utility of this intervention by examining parent perspectives and health-related outcomes. Methods: Adolescents and their parents participated in the 8-session (6 core sessions and 2 booster follow-up sessions at 2 and 4 months) intervention in 1 of 8 waves of the group administration over a four-year period. Parents completed self-report measures (e.g., readiness to change behaviors, self-management, and responsibility in T1D management) at baseline, posttreatment, and follow-up. A medical chart review documented health care utilization and hemoglobin A1c (HbA1c) levels. Results: Of the 38 families that completed baseline assessments, 20 families had parent self-report measures for all 3 timepoints. There were significant improvements in parents’ reports of readiness to change behaviors and self-management. There was variability in reports of parent-adolescent division of T1D responsibility across the 3 timepoints. In addition, adolescent HbA1c levels, the number of clinic visits, and emergency room utilization were significantly reduced over time. Conclusions: The results of this study suggest that parents are amenable to a MGT intervention for adolescents with T1D conducted in a clinical setting. Further, there are sustained improvements in the parent–child interactional processes related to T1D management, glycemic levels, and health care utilization during an often-difficult developmental period

Assessing readiness to change the balance of responsibility for managing type 1 diabetes mellitus: Adolescent mother, and father perspectives

Kaugars AS, Kichler JC, Alemzadeh R. Assessing readiness to change the balance of responsibility for managing type 1 diabetes mellitus: adolescent, mother, and father perspectives. Objective: This study examined the reliability and validity of items assessing adolescent and parent readiness to change the balance of responsibility for managing type 1 diabetes mellitus (T1DM). Methods: Sixty-nine adolescents with T1DM and their caregivers completed questionnaires assessing readiness to change the balance of responsibility, division of responsibility for diabetes management tasks, self-efficacy, and parenting stress. Stages of change classifications were determined for individual respondents and families. Results: Participant inclusion in the different readiness to change classifications was associated with the variability in scores for indices of responsibility, self-efficacy, and parenting stress. Adolescent, maternal, and paternal characteristics accounted for differing amounts of variance in predicting readiness to change the balance of responsibility scores. Conclusions: Individual assessment of youth and caregivers\u27 readiness to change the balance of responsibility for diabetes management tasks may be beneficial to providers during the youths\u27 transition from adolescence to young adulthood