Presentation on theme: "The KICk-OFF study (Kids In Control Of Food) Progress towards a structured education programme Julie Knowles/Dr Kath Price Sheffield Children’s."— Presentation transcript:
1The KICk-OFF study (Kids In Control Of Food) Progress towards a structured education programme Julie Knowles/Dr Kath Price Sheffield Children’s NHS Trust
2Diabetes UK and Department of Health 2005 Recommendations/guidelinesDiabetes NSF 2001NICE 2004 and 2004Evidence basedClear aims and objectivesTo meet personal learning needsTrained educatorsStructuredQuality assured and auditedDiabetes UK and Department of Health 2005DUK and DH highlighted a gap in the delivery of such education to children and adolescents and now provides quality standards for education programmes ………………….
3DAFNE – Dose Adjustment for Normal Eating for Adults 5 day structured training programme4-5 injections a day4-5 blood tests a dayFree dietInsulin dose to match carbohydrate intakeReduce HbA1cImproved QOLDH has highlighted one programme that meets the criteria for type 1 diabetes …………
4Paediatric KICk-OFF course research project Phase 1 – Development of a curriculumFunded by Sheffield Children’s AppealPhase 2 – Pilot courses, refinement ofcurriculumGrant from DUKPhase 3 - Multicentre Randomised Control TrialTo be funded by DUK awaiting confirmation of start date
5Development of the KICk-OFF curriculum PDNS survey (Autumn 2002)Focus groups(Jan Comparing currenteducation programmes with DAFNE )Lubeck, Germany (Jan. 2004)School teachers
6Working with school teachers DAFNE to KICk-OFFNational schools curriculum“Intellectual development” - growth in pupils knowledge understanding and skill“ Social development” - growth in self esteem, self confidence, greater maturityOffice For Standards in Education (OFSTED)Is it clear what the purpose of the lesson is?Has the lesson taken into account the learnersneeds?
7Working with school teachers Style of teaching (observation)Lesson planningSpecific teaching skillsPresentationSetting boundaries/learning environmentReading age
8Introduction to the course MondayTuesdayWednesdayThursdayFridayIntroduction to the courseWhat is diabetes?Group discussesblood sugar levelsHypoglycaemiaDiscuss overnightblood sugar levels.How to adjust insulinDiscuss blood sugarlevelsHealthy eating/weightcontrolSweets, treats andsnacks[Friends invited]Discuss overnight blood sugarlevels.Friends recap what is diabetesEveryone discusses usingKick-Off in schoolBreakSigns and symptoms,InsulinTypes of food and CP’sCP booklet and diaryInsulin/CHO relationshipHypoglycaemia andKick-off treatmentCP/insulin ratioWork out CP’s forpacked lunchHow to manageillness usingKICkOFF guidelinesAlcohol and socialissuesPoster displayExercise [theory]Managing hypos in and out ofschoolPuberty awareness and controlWhat happens next?Follow-up after the courseDiscuss school packsRecap weeks learning objectivesEvaluationLunchPacked lunchLunch - buffetInsulin/CHOcontinuedCorrection doseMonitoringPracticing countinggrams of CHO +practicalDiabetes and longterm healthdiscussionHealthy lifestyle vsunhealthyExercisePractical session.Parents will discuss follow-upcare, discussion about the weekand continued supportChildren do fun activityMillionaire gameRecapping the daysobjectivesPlan evening insulin dose.Personal interviewsPractical session continuedQuizPrepare food forparentsRecap objectives ofthe dayPlan evening insulin doseStudents to planevening insulin doseFree session for guestspeaker or otheractivityContinuedPresentation of quiz winnersFinish
9Day 2, session 2. Counting grams of carbohydrate TUESDAYSession 2:-Counting grams of carbohydrate Practical sessionLearning ObjectivesContinue with carbohydrate and insulin ratiosContinuing with learning the skills for counting grams of carbohydrateMaterialsScalesFood ingredientsRecipesFlip chartPensDiariesWork sheetsCalculatorsPlatesKitchen equipmentDigital scalesPots and pansBaking tinsWashing up materials(tea towels, cloths, washing up liquid)
10Group to split into pairs and they are each given a recipe Response: EducatorDietitian and nursePreparationTransport children to school cookery room. Set up the work stations with foods needed for recipes.TIMEEDUCATORACTIVITYSTUDENTMATERIALS11amExplain:-This session is a practical session to learn how to work out how much CHO is in the food you prepare.Group to split into pairs and they are each given a recipeResponse:Split into pairs but not the same pairs as the morningFollow recipesTidy up after the food is preparedComplete work sheet4 recipes forfruit muffinsfruit scones jam and butterscalesPaper platesingredientsutensilsCalculatorsPensFlip chartsWorksheet for estimating CP’s in rice, pasta, potato, cereals.
11Pilot Study 2004 8 per course, 11-13 and 14-16 yr 2 research educators and 1 localeducator3 Paediatric centres Sheffield,Manchester and DerbyTraining the trainers courseSheffield Hallam University3 days (2 theory, 1 practical)
12EVALUATION Teaching, curriculum, course format : independent peer reviewinterviewdaily feedback questionnaireEffectiveness:HbA1c pre course , 3 and 6 monthshypoglycaemia ratesBMIPsychological outcome at 0, 2 weeks, 3 and 6 monthsQoLSatisfaction with treatmentfamily conflictself management responsibilityself efficacy
14Table 1. Mean HbA1c Values Over Time Baseline3-months6-monthsMean (sd)8.58 (1.80)8.72 (1.98)8.69 (1.98)More mild hypo’sNo more moderate or severe hypo episodesNo significant change BMI
15QOL: Diabetes QOL: Generic Children F(3,81)=8.00,p=.0001*** Parents
16Psychosocial Outcomes for child and parent Satisfaction with Treatment:Greater satisfaction with diabetes treatment after the course.Self-Efficacy:Children more confident managing their diabetes after the course.Family Conflict:no significant change (minimal before and after course).Parent-child Responsibility:more responsibility for managing diabetes after the course.Coping with Diabetes:more able to cope after the course.
17Changes to the course: Venue Timings of difficult sessions- in the first 2 sessionsMore practical sessionsSpecific parent teaching – 1 day teaching courseImproved school supportFollow-upInteractive bookletMore CHO/Ratio practice5 day skills training programme for educators
18Multi-centre cluster randomised controlled trial comparing intensive education with standard education in year olds onintensive insulin therapy.Sponsored by DUK36 UK paediatric diabetes clinics (576 total participants)18 intervention/18 control – both using MDI2 year follow-upControl group receives skills training course and KICk-OFF curriculumOutcomes measured at 0, 6, 12, 24 months:-HbA1cPsychological outcomesHypoglycaemia episodesDKABMIDiet related behaviours