Experiencia Educativa Inglesa

The KICk-OFF study (Kids In Control Of Food) Progress towards a structured education programme Julie Knowles/Dr Kath Price Sheffield Children’s NHS Trust

Diabetes UK and Department of Health 2005

Evidence based

Clear aims and objectives

To meet personal learning needs

Trained educators

Structured

Quality assured and audited

Recommendations/guidelines Diabetes NSF 2001 NICE 2004 and 2004

DAFNE – Dose Adjustment for Normal Eating for Adults

5 day structured training programme

4-5 injections a day

4-5 blood tests a day

Free diet

Insulin dose to match carbohydrate intake

Reduce HbA1c

Improved QOL

Paediatric KICk-OFF course research project Phase 1 – 2002 -Development of a curriculum Funded by Sheffield Children’s Appeal Phase 2 – 2004 - Pilot courses, refinement of curriculum Grant from DUK Phase 3 - Multicentre Randomised Control Trial To be funded by DUK awaiting confirmation of start date

Development of the KICk-OFF curriculum

PDNS survey (Autumn 2002)

Focus groups

(Jan. 2003 Comparing current

education programmes with DAFNE )

Lubeck, Germany (Jan. 2004)

School teachers

Working with school teachers

DAFNE to KICk-OFF

National schools curriculum

“ Intellectual development” - growth in pupils knowledge understanding and skill

“ Social development” - growth in self esteem, self confidence, greater maturity

Office For Standards in Education (OFSTED)

Is it clear what the purpose of the lesson is?

Has the lesson taken into account the learners

needs?

Working with school teachers

Style of teaching (observation)

Lesson planning

Specific teaching skills

Presentation

Setting boundaries/learning environment

Reading age

Monday Tuesday Wednesday Thursday Friday Introduction to the course What is diabetes? Group discusses blood sugar levels Hypoglycaemia Discuss overnight blood sugar levels. How to adjust insulin Discuss blood sugar levels Healthy eating/weight control Sweets, treats and snacks [Friends invited] Discuss overnight blood sugar levels. Friends recap what is diabetes Everyone discusses using Kick-Off in school Break Break Break Break Break Signs and symptoms, Insulin Types of food and CP’s CP booklet and diary Insulin/CHO relationship Hypoglycaemia and Kick-off treatment CP/insulin ratio Work out CP’s for packed lunch How to manage illness using KICkOFF guidelines Alcohol and social issues Poster display Exercise [theory] Managing hypos in and out of school Puberty awareness and control What happens next? Follow-up after the course Discuss school packs Recap weeks learning objectives Evaluation Lunch Packed lunch Lunch Lunch Lunch - buffet Insulin/CHO continued Correction dose Monitoring Practicing counting grams of CHO + practical Diabetes and long term health discussion Healthy lifestyle vs unhealthy Exercise Practical session. Parents will discuss follow-up care, discussion about the week and continued support Children do fun activity Break Break Break Break Millionaire game Recapping the days objectives Plan evening insulin dose. Personal interviews Practical session continued Quiz Prepare food for parents Recap objectives of the day Plan evening insulin dose Quiz Students to plan evening insulin dose Quiz Free session for guest speaker or other activity Continued Presentation of quiz winners Finish

Day 2, session 2. Counting grams of carbohydrate

TUESDAY

Session 2:-

Counting grams of carbohydrate

 Practical session

Learning Objectives

Continue with carbohydrate and insulin ratios

Continuing with learning the skills for counting grams of carbohydrate

Materials

Scales

Food ingredients

Recipes

Flip chart

Pens

Diaries

Work sheets

Calculators

Plates

Kitchen equipment

Digital scales

Pots and pans

Baking tins

Washing up materials

(tea towels, cloths, washing up liquid)

Educator Dietitian and nurse Preparation Transport children to school cookery room. Set up the work stations with foods needed for recipes. TIME EDUCATOR ACTIVITY STUDENT ACTIVITY MATERIALS 11am Explain:- 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 recipe

Response:

Split into pairs but not the same pairs as the morning

Follow recipes

Tidy up after the food is prepared

Complete work sheet

4 recipes for fruit muffins fruit scones jam and butter scales Paper plates ingredients utensils Calculators Pens Flip charts Worksheet for estimating CP’s in rice, pasta, potato, cereals.

Pilot Study 2004

8 per course, 11-13 and 14-16 yr

2 research educators and 1 local

educator

3 Paediatric centres Sheffield,

Manchester and Derby

Training the trainers course

Sheffield Hallam University

3 days (2 theory, 1 practical)

independent peer review

interview

daily feedback questionnaire

EVALUATION Effectiveness : Teaching, curriculum, course format :

HbA1c pre course , 3 and 6 months

hypoglycaemia rates

BMI

Psychological outcome at 0, 2 weeks, 3 and 6 months

QoL

Satisfaction with treatment

family conflict

self management responsibility

self efficacy

Table 1. Mean HbA1c Values Over Time More mild hypo’s No more moderate or severe hypo episodes No significant change BMI Baseline 3-months 6-months Mean (sd) 8.58 (1.80) 8.72 (1.98) 8.69 (1.98)

QOL: Generic

Children

F(3,81)=8.00,p=.0001 ***

Parents

F(3,81)=6.14, p=.001**

QOL: Diabetes Children F(3,81)=9.25, p=.0001 *** Parents F(3,81)=4.56, p=.005 **

Psychosocial 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.

Changes to the course: