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Use of Multisystemic Therapy to Improve Regimen Adherence Among Adolescents with Type 1 Diabetes in Poor Metabolic Control: A Pilot Investigation

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Abstract

The purpose of the current study was to conduct a pilot investigation to determine the effectiveness of Multisystemic Therapy (MST) for improving regimen adherence and metabolic control among adolescents with poorly controlled Type 1 diabetes. Thirty-one adolescents were randomly assigned to either MST or a control condition. MST treatment lasted approximately six months. Data were collected at study entry and at a six-month posttest. Twenty-five adolescents completed the study. Adolescents who received MST had significantly improved adherence to blood glucose testing and metabolic control from study entry to the six-month posttest, whereas controls did not. Adolescents receiving MST also had a decreased number of inpatient admissions at the six-month posttest. Improvements in metabolic control were related to improvements in parent report of adolescent adherence. Results suggest that MST holds promise as an intervention for improving adherence behavior and health outcomes among adolescents in poor metabolic control.

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REFERENCES

  • Anderson, B. J., Brackett, J., Ho, J., & Laffel, L. M. (2000). An inter-vention to promote family teamwork in diabetes management tasks: Relationships among parental involvement, adherence to blood glucose monitoring and glycemic control in young adolescents with Type 1 diabetes. In D. Drotar (Ed.), Promoting adherence to medical treatment in chronic childhood illness: Concepts, methods and interventions (pp. 347–366). Erlbaum: Mahwah, NJ.

    Google Scholar 

  • Anderson, B. J., Ho, J., Brackett, J., Finkelstein, D., & Laffel, L. (1997). Parental involvement in diabetes management tasks: Relationship to blood glucose monitoring and metabolic con-trol in young adolescents with insulin-dependent diabetes mel-litus. Journal of Pediatrics, 130, 257–265.

    Google Scholar 

  • Auslander, W. F., Thompson, S., Dreitzer-White, N. H., & Santiago, J. V. (1997). Disparity in glycemic control and adherence between African-American and Caucasian youths with diabetes. Diabetes Care, 20, 1569–1574.

    Google Scholar 

  • Bauman, L. (2000). A patient-centered approach to adherence: Risks for non-adherence. In D. Drotar (Ed.), Promoting adherence to medical treatment in chronic childhood illness: Concepts, methods and interventions (pp. 71–94). Erlbaum: Mahwah, NJ.

    Google Scholar 

  • Bennett-Johnson, S., Kelly, M., Henretta, J., Cunningham, W. R., Tomer, A., & Silverstein, J. H. (1992). A longitudinal analysis of adherence and health status in childhood diabetes. Journal of Pediatric Psychology, 17, 537–553.

    Google Scholar 

  • Borduin, C. M., Mann, B. J., Cone, L. T., Henggeler, S. W., Fucci, B. R., Blaske, D. M., et al. (1995). Multisystemic treatment of serious juvenile offenders: Long-term prevention of criminality and violence. Journal of Consulting and Clinical Psychology, 63, 569–578.

    Google Scholar 

  • Bronfenbrenner, U. (1979). The ecology of human development. Cambridge, MA: Harvard University Press.

    Google Scholar 

  • Burkhardt, P. V., Dunbar-Jacob, J., & Rohay, J. M. (2001). Accuracy of children's self-reported adherence to treatment. Journal of Nursing Scholarship, 33, 27–32.

    Google Scholar 

  • Ceccoli, V. (1992). Developing group treatment for a pediatric dia-betic population: The Bellevue Experiment. Journal of Child and Adolescent Group Therapy, 2, 67–76.

    Google Scholar 

  • Cohen, J. (1988). Statistical power analyses for the behavioral sciences. Hillsdale, NJ: Erlbaum.

    Google Scholar 

  • Delamater, A. M., Albrecht, D. R., Postellon, D. C., & Gutai, J. P. (1991). Racial differences in metabolic control of children and adolescents with Type 1 diabetes mellitus. Diabetes Care, 14, 20–25.

    Google Scholar 

  • Delamater, A. M., Shaw, K., Applegate, E. B., Pratt, I., Eidson, M., Lancelott, G., et al. (1999). Risk for metabolic control problems in minority youth with diabetes. Diabetes Care, 22, 700–705.

    Google Scholar 

  • Diabetes Control & Complications Trial Research Group. (1993). The effect of intensive treatment of diabetes on the develop-ment and progression of long-term complications in insulin-dependent diabetes mellitus. The New England Journal of Medicine, 329, 977–986.

    Google Scholar 

  • Diabetes Control & Complications Trial Group. (1994). Effects of intensive treatment on the development and progression of long-term complications in adolescents with insulin dependent diabetes mellitus: Diabetes Control and Complications Trial. Journal of Pediatrics, 125, 177–187.

    Google Scholar 

  • Ellis, D. A., Naar-King, S., Frey, M. A., Rowland, M., & Greger, N. (2003). Case study: Feasibility of Multisystemic Therapy as a treatment for urban adolescents with poorly controlled Type 1 diabetes. Journal of Pediatric Psychology, 28, 287–294.

    Google Scholar 

  • Freund, A., Johnson, S. B., Silverstein, J., & Thomas, J. (1991). As-sessing daily management of childhood diabetes using 24-hour recall interviews: Reliability and stability. Health Psychology, 10, 200–208.

    Google Scholar 

  • Frey, M. A., & Denyes, M. J. (1989). Health and illness self-care in adolescents with IDDM: Atest of Orem's theory. Advances in Nursing Sciences, 12, 67–75.

    Google Scholar 

  • Frey, M. A., Ellis, D., Naar-King, S., & Greger, N. (2004). Diabetes management in adolescents in poor metabolic control. Diabetes Educator, 30, 647–657.

    Google Scholar 

  • Glasgow, R., & Anderson, B. (1995). Future directions for research on pediatric chronic disease management: Lessons from diabetes. Journal of Pediatric Psychology, 20, 389–402.

    Google Scholar 

  • Glasgow, R., Fisher, E., Anderson, B., LaGreca, A., Marrero, D., Johnson, S. B., et al. (1999). Behavioral science in diabetes: Contributions and opportunities. Diabetes Care, 22, 832–843.

    Google Scholar 

  • Grey, M., Boland, E. A., Davidson, M., Li, J., & Tamborland, W. V.(2000). Coping skills training for youth with diabetes mellitus has long lasting effects on metabolic control and quality of life. Journal of Pediatrics, 137, 107–113.

    Google Scholar 

  • Hanson, C. L. (1990) Understanding Insulin-Dependent Diabetes Mellitus (IDDM) and treating children with IDDM and their families. In S. W. Henggeler & C. M. Borduin (Eds.), Family therapy and beyond (pp. 278–320). Pacific Grove, CA: Brooks/Cole.

    Google Scholar 

  • Harris, M., & Mertlich, D. (2003). Piloting home-based behavioral family systems therapy for adolescents with poorly controlled diabetes. Children's Health Care, 32, 65–79.

    Google Scholar 

  • Henggeler, S. W. (1999). Multisystemic Therapy: An overview of clinical procedures, outcomes and policy implications. Child Psychology and Psychiatry Review, 4, 2–10.

    Google Scholar 

  • Henggeler, S. W., & Borduin, C. (1992). Multisystemic Therapy ad-herence scales. Unpublished manuscript, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina.

  • Henggeler, S. W., Clingempeel, W. G., Brondino, M. J., & Pickrel, S. G. (2002). Four year follow-up of Multisystemic Therapy with substance-abusing and substance-dependent juvenile of-fenders. Journal of the American Academy of Child and Adolescent Psychiatry, 4, 868–874.

    Google Scholar 

  • Henggeler, S. W., Melton, G. B., & Smith, L. A. (1992). Family preservation using multisystemic therapy: An effective alter-native to incarcerating serious juvenile offenders. Journal of Consulting and Clinical Psychology, 60, 953–961.

    Google Scholar 

  • Henggeler, S. W., Rowland, M. R., Randall, J., Ward, D., Pickrel, S. G., Cunningham, P. B., et al. (1999). Home-based multisys-temic therapy as an alternative to the hospitalization of youth in psychiatric crisis: Clinical outcomes. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 1331–1339.

    Google Scholar 

  • Henggeler, S. W., & Schoenwald, S. K. (1998) The MST supervi-sory manual: Promoting quality assurance at the clinical level. Charleston, SC: MST Services.

    Google Scholar 

  • Henggeler, S. W., Schoenwald, S. K., Borduin, C. M., Rowland, M. D., & Cunningham, P. B. (1998). Multisystemic treatment of antisocial behavior in children and adolescents. New York: Guilford Press.

    Google Scholar 

  • Johnson, S. B., Silverstein, J., Rosenbloom, A., Carter, R., & Cunningham, W. (1986). Assessing daily management in childhood diabetes. Health Psychology, 5, 545–564.

    Google Scholar 

  • Kovacs, M., Goldston, D., Obrosky, S., & Iyengar, S. (1992). Prevalence and predictors of pervasive noncompliance among youth with insulin-dependent diabetes mellitus. Journal of the American Academy of Child and Adolescent Psychiatry, 31, 1112–1120.

    Google Scholar 

  • LaGreca, A. M., & Bearman, K. J. (2001). Commentary: If an apple a day keeps the doctor away, why is adherence so darn hard? Journal of Pediatric Psychology, 26, 279–282.

    Google Scholar 

  • LaGreca, A., & Schuman, W. B. (1995). Adherence to prescribed medical regimens. In M. C. Roberts (Ed.), Handbook of pediatric psychology (pp. 55–83). New York: Guilford.

    Google Scholar 

  • Levine, B. S., Anderson, B. J., Butler, D. A., Antisdel, J. E., Brackett, J., & Laffel, M. B. (2001). Predictors of glycemic control and short-term adverse outcomes in youth with type 1 diabetes. Journal of Pediatrics, 139, 197–203.

    Google Scholar 

  • Liss, D. S., Waller, D. A., Kennard, B. D., McIntyre, D., Capra, P., & Stevens, J. (1998). Psychiatric illness and family support in children and adolescents with diabetic ketoacidosis. Journal of the American Academy of Child and Adolescent Psychiatry, 37, 536–544.

    Google Scholar 

  • Orr, D. P., Golden, M. P., Myers, G., & Marrero, S. D. (1983). Characteristics of adolescents with poorly controlled diabetes referred to a tertiary care center. Diabetes Care, 6, 170–175.

    Google Scholar 

  • Rewers, A., Chase, H. P., Mackenzie, T., Walravens, P., Roback, M., Rewers, M., et al. (2002). Predictors of acute complications in children with Type 1 diabetes. Journal of the American Medical Association, 287, 2511–2518.

    Google Scholar 

  • Rogosa, D., & Saner, H. (1995). Longitudinal data analysis examples with random coefficient models. Journal of Educational and Behavioral Statistics, 20, 149–170.

    Google Scholar 

  • Schilling, L. S., Grey, M., & Knafl, K. A. (2002). A review of self-management in type-1 diabetes by youth and their parents. The Diabetes Educator, 28, 796–808.

    Google Scholar 

  • Schoenwald, S. K. (1998). Multisystemic Therapy consultation guidelines. Charleston, SC: MST Services.

    Google Scholar 

  • Schoenwald, S., Ward, D. M., Henggeler, S. W., Pickrel, S. G., & Patel, H. (1996). Multisystemic Therapy treatment of substance abusing or dependent adolescent offenders: Costs of reducing incarceration, inpatient and residential placement. Journal of Child and Family Studies, 5, 431–444.

    Google Scholar 

  • Schoenwald, S., Ward, D. M., Henggeler, S. W., & Rowland, M. D. (2000). Multisystemic therapy versus hospitalization for crisis stabilization of youth: Placement outcomes 4 months post-referral. Mental Health Services Research, 2, 3–12.

    Google Scholar 

  • Silverman, A. H., Hains, A. A., Davies, W. H., & Parton, E. (2003). A cognitive-behavioral adherence intervention for adolescents with Type 1 diabetes. Journal of Clinical Psychology in Medical Settings, 10, 119–127.

    Google Scholar 

  • Snoek, F. J., VanderVen, N. C. W., & Lubach, C. (1999). Cognitive-behavioral group training for poorly controlled Type 1 diabetes patients: A psychoeducational approach. Diabetes Spectrum, 12, 147–151.

    Google Scholar 

  • Wysocki, T., Harris, M., Greco, P., Bubb, J., Danda, C. E., Harvey, L. M., et al. (2000). Randomized controlled trial of behavior therapy for families of adolescents with insulin dependent diabetes mellitus. Journal of Pediatric Psychology, 25, 23–33.

    Google Scholar 

  • Wysocki, T., Hough, B. S., Ward, K. M., & Green, L. B. (1992). Di-abetes mellitus and the transition to adulthood: Adjustment, self-care and health status. Developmental and Behavioral Pediatrics, 13, 194–201.

    Google Scholar 

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Ellis, D.A., Naar-King, S., Frey, M. et al. Use of Multisystemic Therapy to Improve Regimen Adherence Among Adolescents with Type 1 Diabetes in Poor Metabolic Control: A Pilot Investigation. Journal of Clinical Psychology in Medical Settings 11, 315–324 (2004). https://doi.org/10.1023/B:JOCS.0000045351.98563.4d

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  • DOI: https://doi.org/10.1023/B:JOCS.0000045351.98563.4d

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