Summary
STEPPS (Structured Training and Education with Psychological and Peer Support) is an NHS multidisciplinary initiative co-developed by Southport and Ormskirk Paediatric Diabetes Team (MWL) and Psychology (Mercycare) to transform structured education for children and young people (CYP) with type 1 diabetes. Delivered in school and bespoke settings, combining age-appropriate structured learning with psychological tools and peer-led support, STEPPS empowers CYP to improve self-management and quality of life. It targets glycaemic control, emotional resilience, and social confidence, demonstrating improved engagement, reduced HbA1c, and enhanced team–family relationships. STEPPS is sustainable, reproducible, and centred on equity, motivation, and holistic care.
Innovation/Novel approach to an existing problem
Traditional delivery models have failed to address the full needs of CYP, especially in relation to psychological well-being, school integration, and peer support. The STEPPS programme was developed in direct response to these gaps, creating an innovative, multidisciplinary approach to education that integrates psychology, peer learning, and school-based access. CYP and families had reported feeling isolated and misunderstood at school, and disengaged from traditional education sessions. Glycaemic targets were not being met consistently, and psychological distress was under-recognised and under-addressed. STEPPS embeds education in CYP environments, including school-based sessions and small-group formats to maximise peer interaction and engagement. Psychological techniques such as motivational interviewing, solution-focused brief therapy (SFBT), and behavioural family therapy are included. These allow learning to be tailored, empowering, and responsive to emotional needs. The programme is led by a multi-professional team, including paediatric diabetes nurses, dietitians, psychologists, and a patient advocate. A unique feature is the ‘whole team voice’ approach, ensuring consistent messaging and reinforcement of concepts. Educational content is developmentally appropriate, interactive, and supported by visual aids and lived experience sharing from peers and young mentors. There is a robust documentation process with risk assessments for school settings and home visits. Training in safeguarding, psychological first aid, and trauma-informed care is provided to all team members.
Equality, Diversity and Variation
A cornerstone of STEPPS is its commitment to reducing inequalities and delivering equitable, person-centred care. It was designed to address barriers related to access, appropriateness, and individual need, particularly in underserved or marginalised groups. STEPPS sessions were held in schools, homes, or virtually, giving families more control and reducing logistical barriers. For non-English-speaking families, interpreters were made available, and all resources were adapted to be culturally relevant and sensitive. Sessions covering sensitive subjects eg puberty or relationships were adapted to be developmentally appropriate, and when necessary, delivered one-to-one. STEPPS personalises approaches for neurodiversity, including sensory-friendly materials, visual communication, and smaller or adapted sessions. The ‘Geeks Club’ offers a supportive space for neurodiverse CYP to meet others, build peer relationships, and improve self-management. HbA1c outcomes and clinic attendance have improved across the cohort. CYP helped redesign content, suggesting more visual tools, interactive formats, and greater peer input.
Impact to Patient Care
STEPPS has delivered clear, measurable improvements in patient experience, engagement, emotional well-being, self-management, and clinical outcomes. Sessions are interactive, age-appropriate, and consistently delivered by a multidisciplinary team of psychologists, educators, dietitians, and nurses. Children and families report feeling empowered, listened to, and better equipped to manage diabetes. Children not only learn the mechanics of diabetes management but also to reflect on feelings regarding living with the condition. Through interactive activities, goal-setting, and repeated reinforcement of key learning objectives, participants build a strong foundation in essential skills like carbohydrate counting, insulin dosing, recognising and treating hypoglycaemia, sick day rules, ketone testing, and emergency response. More importantly, children are supported to integrate diabetes into their daily lives, making thoughtful decisions based on understanding. Follow-up reviews reveal that CYP can articulate their blood glucose trends, troubleshoot common problems, and feel confident in their management.
Results
The STEPPS programme has been in place for over 12 months, with robust evaluation demonstrating positive outcomes across clinical markers, patient experience, engagement, and service efficiency. The programme’s success has been measured through qualitative and quantitative data. Over the past year, 98.6% of eligible CYP (n=74) agreed to participate in school-based or home STEPPS sessions. The model facilitated delivery of structured education to hard-to-reach groups, resulting in a 50% reduction in missed appointments. DNA rates fell from 22% to 11%, with even greater improvement (5%) among children under 10. Clinical outcomes also improved: HbA1c median decreased from 66 to 62 mmol/mol, with 35% of patients achieving HbA1c <58 mmol/mol, outperforming national averages. Time-in-range improved in hybrid closed loop users, attributed to enhanced understanding and motivation. Hospital admissions for diabetes-related issues declined, with a 1.8-day reduction in average length of stay per admission. These improvements were sustained beyond the initial six-month pilot, demonstrating lasting behavioural and clinical changes. STEPPS has shifted the narrative from prescriptive education to empowering conversations. By using techniques such as motivational interviewing and solution-focused brief therapy, CYP feel seen, heard, and involved in their care. Patient-reported outcomes indicate increased confidence in diabetes management, stronger peer relationships, and better emotional regulation. Parents describe STEPPS as transformative. Staff also report more meaningful relationships with families and better continuity of care. The co-produced nature of STEPPS, with input from CYP and families, ensures ongoing relevance and responsiveness to need. STEPPS is a low-cost, high-impact initiative. It is embedded within the existing multidisciplinary diabetes team and uses school or home settings, reducing the need for additional clinic time or travel reimbursement. Implementation costs were limited to staff time for coordination and training in psychological approaches. STEPPS has proven effectiveness, high acceptability, and is both cost-efficient and scalable.
User Feedback
User feedback has been integral to the design, delivery and ongoing development of STEPPS. Feedback has been collected through verbal discussions, session evaluations, anonymous questionnaires, and structured debriefs with CYP and parents. The team routinely collects qualitative reflections from staff. The school-based model and peer sessions dramatically improved CYP engagement. Parents consistently report increased confidence in their children and greater trust in the diabetes team, and the value of school sessions involving teachers, which helped reduce stigma and improve daily diabetes support. The MDT expressed increased satisfaction and connection with patients plus improved team cohesion. Feedback directly informs improvements, such as the development of STEPPS Junior for primary school-aged CYP.
