Summary
The transition from primary to secondary school can be a time of great change for children and young people (CYP) with type 1 diabetes. They often go from a smaller, supportive environment to a setting where they are expected to manage their diabetes independently. This module was developed to help equip CYP for this transition. It is a group session for CYP who are in school year 6, designed to be interactive and enable them to problem-solve different scenarios. Part of the Structured Education Reassuring Empowering and Nurturing (SEREN) programme, the module is Quality Institute for Self Management Education and Training (QISMET) accredited and includes detailed educator curricula, interactive resources and quality assurance.
Innovation
Before the module was launched, most teams in Wales offered a session to CYP to prepare them for the transition to secondary school, but delivery was variable and unstructured. The SEREN group decided to develop a new All Wales resource. The working group included dietitians, nurses, doctors and a psychologist, plus parent representatives. They pooled existing resources and good practice from across Wales to develop the module in line with the other SEREN modules. Interactive resources were developed to facilitate activities in a non-didactic manner, enabling the CYP to problem-solve and encouraging discussion. The educator curriculum took the same format as the SEREN Diabetes at Diagnosis module. It contained learning objectives and outcomes, lesson plans, plus notes and tips for delivery. The half-day session could be delivered outside the hospital setting and could include a fun activity to encourage peer support. The module contains a quality assurance (QA) process enabling peer review of delivery to maintain high standards and equity of care across Wales. The child-friendly images are consistent with other SEREN branding. Resources include flash cards, a generic school map and games. The activities encourage CYP to apply existing experience and knowledge in different scenarios, problemsolve and increase confidence in self management. Older ‘diabetes ambassadors’ can share their experiences. The module is QISMET-accredited, which noted: a comprehensive programme available to every child in year 6 in Wales; an excellent, evidence-based and professionally produced curriculum handbook for HCPs with an outstanding ‘Group Facilitation Skills Guide’, plus positive feedback and evaluation.
Equality, Diversity and Variation
All of the resources are child-focused and interactive, with few worksheets. They are designed for a range of learning styles and can be adapted to individual needs. The facilitation skills guide includes information and tips on increasing accessibility to CYP. The resources are in English and Welsh and can be used with children for whom English (or Welsh) is not their first language. The plan is to supply them in other languages. There are clear aims and objectives and the curriculum reduces variation across diabetes teams. The QA component ensures standard delivery. All staff in Wales must attend SEREN programme training, including the group modules and use of the curriculum. All teams now offer this module, providing equity of care. The images are diverse and include cartoon images of CYP from different ethnic backgrounds and appearances. During the COVID-19 pandemic, the resources were provided virtually to ensure accessibility. Topics covered include: hopes and fears; high and low blood glucose; carbohydrate counting; mishaps – when things don’t go to plan; where is school to look after your diabetes; telling new people about diabetes, and dealing with other people’s unhelpful comments about diabetes.
Results
Since it was launched in 2019, the SEREN ‘Moving to year 7’ module has been delivered by all health boards across Wales. At least 200 CYP have attended a session. Diabetes teams have given positive feedback and say the CYP benefit enormously. The CYP all reported that they learned something useful and parents gave positive feedback. The main change since the launch is that all children in Wales are now offered the same education at this transition stage. The interactive nature of the activities builds confidence by encouraging them to problem-solve in a safe and supportive environment. Development of the programme was funded by the Welsh government via the All Wales Diabetes Implementation Group. Other paediatric diabetes teams across the UK have purchased the module and other SEREN resources, with income generated used to develop further modules. There has been interest from other countries. The vision is to make the programme self-sustainable and free for CYP in Wales through overseas sales. Delivering group sessions is cost effective and having a standard module available with evidence-based resources means that teams do not have to develop their own. ‘Moving to year 7’ aims to empower young people and increase self confidence to manage their condition, thereby reducing the burden on healthcare systems throughout their lifetimes.
User Feedback
Feedback was provided via Google Forms and a QR code for CYP to access the form at the end of their session. This was completed in participants’ own time to minimise risk of bias. The CYP were asked to record two things that they had learned. Feedback is reviewed annually and, although all feedback has thus far been positive, appropriate changes can be made. All SEREN modules are reviewed every five years, or sooner if there are significant changes to clinical guidelines. HCPs who have delivered the session report that they enjoy delivering the session and find it a valuable use of time.
Dissemination and Sustainability
SEREN is an All Wales programme. In addition, 11 paediatric teams in England have purchased the ‘Moving to year 7’ resources. The module is adaptable and could be delivered by other centres across the UK. It is now embedded in clinical practice across Wales. Feedback from educators and users has been positive. All children with type 1 diabetes living in Wales can now attend the structured session to support self management. The skills learned are usable in all areas of their lives. The success of the group sessions has led to the development of further SEREN group modules. Resources could be adapted by other services and conditions.
