Summary

The FRED workshop is a multidisciplinary initiative designed to empower self management among patients with type 1 diabetes, and their parents. It deals with all aspects of living with diabetes every day, ranging from psychological issues, to exercise, to self dose adjustment. It is delivered using a unique format which consists of variations of group participation combining young people independently from their parents as well as combined sessions with parents and parents independently from their children.

Innovation

This workshop is particularly innovative because of the multifaceted team approach to empower self-management of type 1 diabetes. This is achieved through practical learning with real life scenarios to embed the structured information that is also provided. In addition attendance is improved on past similar initiatives because of the team approach and attitude towards ensuring that patients realise the benefits of attending. Furthermore, the provision of lunch, without the educators present, provides an opportunity for families to build supportive relationships. The workshop aims are as follows:

• Food - practical carbohydrate counting with real foods and tips for easier carb counting when eating out. This section includes introducing the young people to alternative low carbohydrate snacks that they may not have tried before, with the option of tasting these as a group
• Relationships - exploring young people’s relationships with diabetes through externalisation. Supporting parents to reflect on how they talk with their children about diabetes and encouraging a positive approach to communication. This section includes providing the opportunity for peer support, both for the parents and young people each independently
• Exercise-– understanding the physiological impact of exercise on the body and how this impacts blood glucose levels. This section discusses the complexity of different activities such as anaerobic, aerobic, mixed and competitive, including increasing awareness of the impact of more everyday activities such as shopping or playing
• Diabetes - empowering families to safely adjust their basal insulin and insulin carbohydrate ratios by using Diasend or a diary. This section uses real-life data and examples that are discussed in small groups and then by the group as a whole. Participants are encouraged to ask questions of the ‘data’ and to suggest what insulin changes may be required.

Results

The pre- and post-questionnaires showed that all participants increased their diabetes knowledge by attending the workshop. Formal and informal feedback was very positive.

Dissemination and Sustainability

The project has already proved its sustainability and is now embedded in our service structure. It is run four times a year, with the dates set at least a year in advance. The team has already successfully run four workshops, with a further four booked for the year ahead. With the workshop material already designed and the well-structured lesson plans, additional time and resources are not needed. The workshop is highly reproducible in other services: there are lesson plans, resource lists and a well-defined structure for implementation.
There is scope for the design to be used to format a FRED 2 workshop for type 2 patients with the topics being adjusted to be more specific to the aims and education of those with type 2 diabetes.

Method

Planning commenced eight weeks prior to the first workshop. Dates were set every three months for 18 months, with rooms booked at the start, and continue to be booked 12-18 months ahead. We alternate between term time and holiday time to accommodate families with other children and young people who are studying. A pre- and post-event questionnaire was designed to include a feedback form. Lesson plans were developed, to include a list of resources needed for each activity. Team members allocated themselves to each session in advance and the timetable was developed. Fliers were designed and given to all newly diagnosed families, as well as those families identified from clinic as being likely to benefit from FRED, with particular focus on those children who were diagnosed young and are now ready to be moving towards independence with their diabetes. Families are strongly advised to attend as opposed to just being ‘invited’. Participants are asked to telephone to confirm their attendance. Attendance is not limited to parents - all significant carers are invited to attend, which can include older siblings, aunts, uncles, grandparents and even neighbours. Attendance is limited to those over 10 years old, although parents of younger children do attend. Participants are asked to complete a short quiz before, and again after the workshop so that we can monitor learning. At the event we have a team approach to preparing the rooms and welcoming the families. We hold a post-FRED meeting the week following the workshop for an hour to review the day, making any changes that are needed to continue improving the programme and to review the feedback.