553-P: The Type 1 Diabetes High-Fidelity Wraparound (T1D HFW) Program: An Option for the Management of High-Risk Youth?

Despite advances in management, many young adolescents with T1D continue to struggle. Psychosocial factors play a major role. The T1D HFW Program is an innovative strategy to improve the adherence to medical regimens, including self-management and self-efficacy in high-risk youth. It is based on HFW, an evidence-based behavioral health concept described as a structured, team-based and individualized process that includes members who have experience either living with or raising a child with T1D. The aim of this pilot study is to test the feasibility and impact of this intervention in youth 11 to 16 years with T1D followed in a large academic diabetes center who are struggling with their management as defined by poor glycemic control and/or repeated emergency room visits and/or hospitalizations. Outcomes include assessment for behavioral, psychosocial and diabetes related measures with validated instruments. Seventeen youth enrolled and participated so far (58% females, 58% Caucasian, 23% African American, mean age 14±1.4 years, T1D duration 7.5±3.5 years, HbA1c at entry 10.3±2.3%, 65% with a deterioration in HbA1c, 45% prior diabetes related hospitalizations). A significant percent (57%) reported at least one traumatic experience including bullying (66%), witnessing violence (50%), physical/emotional abuse (33%). To date, eight families have transitioned out of the program after a mean of 6.5 months with 62.5% showing improvement and 25% no deterioration in HbA1c. Youth scoring positive for moderate depression on the PHQ-9 went from 27% to 9%. 1/3 of youth indicated positive results for generalized anxiety by the Screen for Child Anxiety Disorders (SCARED) with no change upon finishing the program. 60% of caregivers indicated a positive score on the Diabetes Distress Scale at start, which decreased to 20%. The T1D HFW program through personalized plans with identified support systems may be a promising strategy for youth struggling with T1D.