Download Shelagh Watts Engaging young people to attend a Transition Clinic

Engaging young people to
attend a Transition Clinic –
an idea in action –
Dr Shelagh Watts & Dr Emily Betts,
Clinical Psychologists, Buckinghamshire
Hospitals NHS Trust
Transition in Diabetes
 BPT means that is recognised that young people are just as in
need of focussed care up to 19 years
 Data clear that YP need care as metabolic control deteriorates
and patients are lost to follow up in this group (Pacaud et al
2005)
 Data shows engagement in a clinic is as much about the
therapeutic relationship than other factors,(Allen
2010;Watanabe 2010),non judgemental, honesty & knowledge
 Need to keep sight of patients
 Model of clinic needed that nurtures and develops their
autonomy, not just letting them go
Bucks Hospital Trust Young Persons
Clinic & Transition Clinic
 Patients seen in their own allocated clinic 16-21yrs by Adult
Team
 YP seen on their own
 Opportunities for discussion with MDT about age related
lifestyle issues; driving/university life/alcohol.
BUT Low attendance rate and a feeling that YP not engaged
with clinic and staff; are they missing the structure,
expectations & familiarity of paediatric input?
YP Business Meetings
MDT including psychology
 How to engage the YP in the clinic- particularly in the first
year of transition 16/17 years to set up expectations of clinic
care
 Hospital environment poor, no grouped set of clinic rooms
or user friendly waiting area
 Model of care? with/without parents, paediatric team and/or
adult team, seen by team or individual professionals ?
 Need to do SOMETHING to get going
 Education Workshop for new group of 16yr olds transferring
to the YP/transition clinic?
 Small YP survey suggested YP feeling scrutinised in clinic &
wanting more information but not adverse to meeting other YP.
AIM to change Young Persons perceptions of their clinic
appointments through the workshop attendance.
From
To
How could this work?
Planning
 Agenda to introduce /familiarise YP to the clinic staff and
environment
 Allow YP to be apart from their parents
 Raise topics that could be discussed in future clinics
 Reassure parents about the next level of care
 Encourage YP to communicate with each other
Confidence and technique for marketing the workshop
borrowed from Paediatric Diabetes
Previous Experience from Paediatrics
 All MDT involved in delivery of workshop
 Message of importance and expectation
‘first Transition Clinic appointment’
 Timing important, eg at a transition point when wanting
information
 Small groups that move from topic to topic
 Take away information
 Numbers- expect 50% attendance .
 Transition clinic; 17 families with 16 yr olds invited –all due
to move up to clinic in the next 3-6 months –.
Format with the ‘communication’
Agenda
1. Introduction to families and agenda setting
2. Young Peoples Groups
 Hospital walk about (reduce worries about finding
the place, talk to staff and each other)
 Biology lesson/information packs (meet staff & give
structure that allows group discussion)
 Myth Busting (peer group and staff/YP discussion)
3. Parents discussion. Reassure in the consistency of
care offered across the clinics.
Reality on the Day
 Facilities far from ideal- borrowed Staff Education centre,
lookouts needed to find families
 Performance Anxiety of Staff
 Doubts about the agenda
ON THE SPOT
 Numbers attending 8 YP 10 parents – rejig groups
 House keeping, refreshments!
 Parents Group 50/50 mum/dad
 Reluctance to finish by parents and YP- no break out space
Workshops
 Introduction (to team and agenda for the session)
 Orientation (to the hospital and adult Diabetes Centre)
Would this be difficult to engage the young people in?
 Biology (overview of diabetic patient vs. non diabetic
patient). Previously used in groups with success.
 Myth busting (range of diabetes “myths” developed by
staff). Encouraged the young people to vote true or false
and facilitated discussions. Eg ‘My BG levels affect my mood &
concentration, I have to do a BG test whenever I drive, insulin makes
you fat; my diabetes won’t be affected if I take drugs’
Evaluation
 Designed brief evaluation form
 Completed after the session-just by patients
 Rated venue, each workshop and meeting other
young people.
 Given room for comments on what was helpful/not
necessary
Patient Feedback
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Venue - “good” by all 8 patients
Orientation – range 6-10 in the “very useful” range.
Basic biology – range 7-10 in the “very useful” range.
Myth busting – range 7-10 in the “very useful” range.
Meeting other young people – range 8-10
Patient Feedback
 What did you find helpful about the afternoon?
 “Meeting the team, learning about the changes”
 “I found the discussions with the team and doctors useful for
understanding the transition and more about adult life with
diabetes”
 “Meeting new team and finding out where I need to go”
 “Hearing other people’s opinions and facts on diabetes-helped to
give a better insight”
 “Understanding which myths were true and false”
 “Socialising with the staff and other young people”
 “Myth busting and getting to talk to other people the same age”
 “Knowing about some things I didn’t know!
 Was there anything you thought that wasn’t necessary today?
“no” or no comment
 Any other comments? None
Parent’s feedback
 Unplanned group discussion with parents occurred –
psychological discussion about keeping their children on
board with diabetes care.
 At times it was very emotional, but different members of
the team available to facilitate the discussion
(Psychologist, Dietician and Medic).
 Could the clinics be held on another day?
Most felt this was a really useful session for them as well as
their child.
Team debrief and reflections
 This was the first info session we had run for new patients
transitioning from paediatrics.
 Overall felt beneficial- the families were as anxious as staff about
transition
 We need an additional activity to take place during the orientation
slot as this was completed very quickly.
 Has enabled a trial of a more flexible model of care in clinic – All
patients have turned up so far!
 Further plans about communicating with this group using Assistive
Technology
 We will review the leaflets in the pack
 When is the ideal time to run this session?
 Doing Something better than talking about it!