Integration of psychological support into paediatric Type 1 diabetes services in Australia: reality or myth?

Ann Carrigan, Nehal Singh, Elizabeth Davis, Timothy Jones, Jeffrey Braithwaite, Yvonne Zurynski

Research output: Contribution to journalMeeting abstractpeer-review

Abstract

Context: Type 1 diabetes (T1D) is a chronic, incurable condition that is typically diagnosed in childhood. In 2021, there were around 8.4. million individuals living with T1D and of these, 18% were aged < 20 years. Successful health and psychosocial outcomes require education and support from a multidisciplinary team (MDT). The 2022 International Society for Pediatric and Adolescent Diabetes guidelines (ISPAD), state that psychologists are essential members of MDTs for children living with T1D. Individuals and their families who live with diabetes often find the management and navigation of their treatment stressful. Additionally, there are increased rates of psychological pathologies such as eating disorders, depression and anxiety among adolescents with T1D compared with non-diabetic peers.

Problem: Psychosocial support for individuals living with T1D, and their caregivers, ideally with proactive approach is needed. However, despite this understanding, it is not known whether psychologists are embedded in MDTs in an Australian context.

Aim: To identify what is working well, and the gaps and needs in care delivery as viewed by T1D healthcare providers throughout Australia.

Engagement: A survey was developed using a co-design approach that involved providers and consumers across Australia who offer T1D services to children and young adults or who receive T1D care. A working group was established to ensure that the survey items were relevant and addressed topics such as clinic setting, service description and level of psychological support.

What did we do? Using a mixed methods design, providers were invited to complete an online survey describing their service and follow up semi-structured interviews. The interviews were conducted by experienced researchers, audio recorded and transcribed. Interview transcripts were deductively thematically analysed, and the main themes were synthesised by two analysts.

Results: Twenty-two representatives from services in metropolitan (n=16) and regional areas (n=6) completed the survey and seven participated in an interview. Service MDT members were diverse comprising physicians, diabetes educators, and dieticians. However, for access to an integrated psychologist, four reported having access, nine referred out and five reported no access. Several themes emerged from the qualitative interview data supporting these survey findings; while six services reported adequate medical support and cohesive teams, all reported limited access to psychologists to support diabetes management. Three highlighted the need for early proactive mental health support for families at the newly diagnosed stage.

Impact and learning for an international audience: Although adequate medical services and team cohesiveness were reported, there is a clear gap between the 2022 ISPAD guidelines and diabetes specific, psychological services integrated in patient care. It is critical that this gap is addressed so that the psychological distress and burden can be reduced in children and their caregivers.

Next steps: Knowing that there is a dearth of psychologists globally, designing and implementing a model of care that leverages available resources and team members, by offering education and up-skilling in diabetes-related psychological support, as well as established referral pathways to local peer-support services in the community, will be key to bridging this gap.
Original languageEnglish
Article number189
Number of pages2
JournalInternational Journal of Integrated Care
Volume24
Issue numberS1
DOIs
Publication statusPublished - 30 Jul 2024
Event3rd Asia Pacific conference on Integrated Care : APIC3 - Sydney , Australia
Duration: 13 Nov 202315 Nov 2023

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