Preface

Living with a complex chronic health condition like type 1 diabetes (T1D) is complicated, expensive, and burdensome. Most people live long, happy, healthy, satisfying lives with T1D, yet there is a large body of evidence (from research, clinical practice, and personal experience) that mental health concerns and behavioral challenges are common and interfere with self-management, quality of life, and health. Although the American Diabetes Association and other professional diabetes organizations recommend integrated mental and behavioral health support as part of routine diabetes care, there are not enough professionals in these fields who have knowledge of the complex interplays between diabetes and psychosocial factors to meet the needs of the large and growing population of people with T1D, and their families.

To address this shortage, one of us (Marisa) was a member of the steering committee to develop and implement a structured educational program through the American Diabetes Association for licensed mental health professionals to learn about diabetes. The American Diabetes Association’s Diabetes Education 101 for the Behavioral Health Provider Program, which provides mental health professionals with the knowledge they need to deliver assessment and intervention to individuals with T1D, as well as members of their families and extended social support networks, is now available as a video-on-demand program. This online program offers continuing education credits (https://professional.diabetes.org/meetings/mental-health-provider-diabetes-education-video-demand-program). While serving as speakers for several in-person workshops, we recognized the need for a workbook to supplement this program, which mental health clinicians and therapists could use to guide their care of young people with T1D. We enlisted a team of pediatric psychologists with expertise in T1D to contribute to the content of this resource, and together we created a brief, practical workbook that summarizes the key clinical, mental, and behavioral health concerns of pediatric T1D, spanning early childhood through early adulthood, and provides techniques and tools for implementation in practice. The prevalence of type 2 diabetes (T2D) in pediatrics has been increasing, and although this book does not specifically focus on the concerns of patients with T2D, many of the concepts apply. We are pleased to provide this workbook for mental health providers that contains content specific to T1D.

This workbook is structured into eight chapters: 1) Overview of T1D; 2) Language and communication about T1D; 3) Challenges associated with a new T1D diagnosis; 4) Approaches to addressing T1D self-management challenges; 5) Emotions associated with T1D; 6) Mood concerns and T1D; 7) T1D-related worries and anxiety; and 8) Additional considerations. Each chapter includes a brief introduction to the chapter topic based on scientific evidence and our clinical and research experiences along with those of our coauthors. We are all licensed clinical psychologists with research and clinical expertise in T1D. Embedded throughout the introductory text are tables, figures, and content examples. At the end of each section within a chapter are customizable worksheets to be used as part of a therapy session. Worksheets make sessions with child and adolescent patients more engaging and encourage creativity and communication. Downloadable PDF versions of these worksheets are available free of charge on the American Diabetes Association’s website, ShopDiabetes.org.

We also provide a resources section that includes information on organizations, books, and websites that we find to be helpful for us and the individuals and families with whom we work. Throughout the workbook, we incorporate content related to family dynamics, child and adolescent development, and diversity, cultural, and systems factors that may influence the topics and your provision of mental and behavioral healthcare. We include the best available research in the field, which we acknowledge is limited by underrepresentation of youth and families from racially and ethnically minoritized groups or from low socioeconomic backgrounds. We recognize that access to high-quality healthcare for diabetes is a privilege that not all people with T1D have, especially with the high costs of insulin, inequitable coverage of diabetes management devices, and bias throughout the healthcare system. Access to a mental health professional who has received education about T1D is even less common, especially because insurance coverage of mental healthcare is highly variable across states and often inadequate. Our hope is that changes in the healthcare system, policies, and society reduce systemic barriers to the most effective medical and mental healthcare for all people, including youth with T1D, as well as their families.

Kimberly A. Driscoll, PhD

Director of Behavioral Science Research,

University of Florida Diabetes Institute, Gainesville, FL;

Department of Clinical and Health Psychology,

University of Florida, Gainesville, FL,

Marisa E. Hilliard, PhD

Baylor College of Medicine and Texas Children’s Hospital,

Department of Pediatrics, Division of Psychology, Houston, TX