Implementing an Integrated Psychology, Social Services, and Pediatric Diabetes Clinic

Objective: Integrated behavioral health services are rarely implemented as a shared space practice in pediatric diabetes specialty clinics. This paper outlines the clinical outcomes, lessons learned, facilitators, and barriers for supporting youth with diabetes and behavioral health issues whose hemoglobin A1c (A1c) was higher than the target range and their families. Methods: Using the Iowa Model of implementation, we redesigned the "Regular Engagement And Connection for Health" (REACH) program to integrate health psychology and social services in a shared space clinic for monthly or bimonthly diabetes visits (REACH+). This clinic focused on partnering with families, screening for behavioral and social determinants of health (SDOH), and identifying goals to provide holistic care. This paper presents program evaluation data from the first 50 youth-parent dyads. Results: A team in which all roles were respected and valued was critical to successfully implementing REACH+. Youth in the REACH+ clinic decreased their A1c, emergency room visits, and hospitalizations. Forty percent of youth returned to the standard diabetes clinic. Parents reported fewer resource needs associated with SDOH. Conclusions: A structured implementation process for the planning, delivery, and evaluation of a fully integrated shared space pediatric diabetes clinic promoted team cohesion, consensus, and ongoing administrative support along with positive patient and family outcomes. Implications for Impact Statement Using an implementation process to build a shared space healthcare team, including psychology and social services, was key to supporting patient and family health outcomes for youth with diabetes. Outcomes included improved A1c, and fewer emergency health and resource needs. Forty percent of youth returned to standard diabetes care.