Innovative Approaches to Diabetes Education for AdolescentsMarcia Frank RN, MHSc, CDEThe Hospital for Sick ChildrenToronto, Canada

Session ObjectivesExamine rational for using innovative approaches and specifically creative arts in diabetes education Explore the impact of the use of arts in diabetes educationProvide examples of how innovative approaches and the arts are used in diabetes educationExamine the feasibility of using the arts more routinely in our practiceLearn more innovative approaches from session participants

Toronto SickKids Hospital

SickKids Diabetes Service1100 children/teensCulturally diverseWell established team

Value of creative arts in diabetes educationCuts across racial, cultural, social, educational, and economic barriersReduces the distance between teacher and learnerBridges experience and understandingInvolves affective and cognitive domains of learningMakes abstract concepts, concreteProvides a means for everyone to learn

Evidence of the effectiveness of the arts in health interventionsHelps to manage pain and side effectsReduces stress and anxietyHelps coming to terms with distressing eventsIncreases well-being and self-esteemEnhances patient /provider communication across social and ethnic groups Rosalia Staricoff 2004 www.artscouncil.org.uk

The quilt as the framework for my practice

The quilt as my framework of practiceEach has a unique history, experiences,characteristics and relationships

The quilt as my framework of practiceDiabetes: the patch that nobody asked for and nobody wants

The quilt as my framework of practiceDiabetes in its place

HSC

The Power of the Story

What could you possibly know? You dont have diabetes!

Conversation MapsTM Created by in collaboration with IDF and sponsored by Lilly

Conversation Map TM

Comic Relief and co-operationThe nose&

Survivor

Diabetes: the meaning, the emotions, the work, the support.What would you like to talk about today?

Hospital for Sick ChildrenAnnual Family Diabetes Daywith Sherman and the Never Ready for Prime time PlayersThe diabetes team

Art created by children in our clinic

High RopesLearning TrustBuilding Self-Esteem

Bunny therapy and hugs

Writing Keeping a journalThe role of a writer isnot to say what weall can say, but what we are unable to say. ~Anas Nin

Musiccommunicationrelaxationprevention

Key MessagesDiabetes care, education and support are inseparableAll diabetes health care professionals are diabetes educatorsThe relationship is critical to effective educationThe use of creative arts and other novel approaches can make diabetes education more meaningful

More meaningful education can result in:Better relationshipsImproved communicationBetter problem-solvingImproved self-efficacyImproved QoLBetter coping with the stress and work of diabetes

More Meaningful Education Can Result in:Better relationshipsImproved communicationBetter problem-solvingImproved self-efficacyImproved QoLBetter coping with the stress and work of diabetesAnd hopefully, improved metabolic control

*Thank you anne and good morning friends and colleagues.The purpose of diabetes education is to provide individuals who live with diabetes with the knowledge and skills they require to manage their diabetes well day by day and remain healthy. The use of music and drama and story and writing has wonderful potential to bring diabetes education to lifeto make it meaningful and accessible to all who participate and I include here the diabetes educator herself.*In the next short while, Id like us to briefly consider why we should use the arts in diabetes education.And review the impact of the use of the arts in health (if not diabetes) educationId like to spend most of the time providing you with examples from my own experience of how stories and drama and music and writing are used in diabetes education. Tell you up front, I am not an artist. I am not a therapist. I do not come from a place where our children with diabetes are offered any formal programs of music therapy, art therapy, terapeutic writing etcBut I do incorporate some of these things into my daily practice.Finally,Ill leave you with a challenge which is to share examples of how you use the arts in daily practice because I assure you, as soon as I start to tell you my stories, yours will bubble up too!But before we go any further I have to just tell you about my frame of reference. First, I am a pediatric diabetes nurse, but my population is primarly adolescents, particularly those who struggle the most to achieve safe control even to get the A1c under 10. Second, I stongly believe that Next slide.*

Education is an INTEGRAL part of care and cannot be separated from clinical care and and psychosocial support. They are inextricalbly bound.

Indeed, in my mind where they intersect is the yin and the yang, the art and the science of diabetes education.

Finally, my definition of diabetes educators includes all those who are clinically involved with the individual with diabetes

*So keeping that in mind, ..WHY SHOULD WE USE CREATIVE ARTS IN DIABETES EDUCATION?Well first of all it has great potential to make learning about diabetes accessible to every one. If you think about it., the arts are languages that most people speak. They cut across racial, cultural, social educational and economic barriers. And the message sticks. Think about role play or theatre for example. The use of these strategies encompass a whole lot of principles of adult educaton paticipation, collaboration, humor, and respect, It creates 2 way communication and involves both the affective and cognitive domains of learning, And usually we break away from using medidcal jargon, which reduces the distance between health care providers and patients.. And our somewhat self-conscious efforts at acting further reduce the distance.One of my favourite art forms is the writing and telling of narritives or stories. Narratives are always told in the first person. Key to writing and telling the narrative is capturing the context of the situation the details of the setting, We ask individuals to think about where was I and what did I see smell, hear and feel, what were he details of the interaction and what did I think do and say next. When stories are written and told in this amount of detail we are better able to confront ourselves in action as we question our personal beliefs and the assumptions that are connected to it. When stories are written in this amount of detail, its more possible to confront ourselves in action as we question our values and beliefs and examine our stories inconsistencies. Once people get that far there is a chance to change to write the story a different way*Is there any evidence that art is effective in diabetes education. Well in order to understand the impact we had to look more broadly that is the effectiveness of art as a health intervention. In the UK, Rosalia Staricoff did a very thorough review of the medical literature between 1990 and 2004 on the relationship of Arts and the Humanities to and health care and on HealthAnd a number of positive outcomes were observed. You can see some of them here. Clearly of these things are relevant and important to those who live with diabetes and their families*While I am not an artist yet. I think there is an artist in me trying to get out I do love texture and textile. I have grown to really love all kinds of quilts and find craz;y quilts most interesting. For me crazy quilts have become very symbolic , beautifully representing the framework for my practice. The quilt is the fabric of each person I meet. Quilts are unique and patch represents something about that individual..*Each has a unique history, experiences, characteristics and relationships.And while some people like certain patches better than others they are generally very happy with the whole quilt that they have or shall I say are.

*Then along comes diabetes, a patch that nobody asked for and nobody wants. Its back and ugly and doesnt fit into the rest of the quilt.Our job as diabetes educators is to get to know that individual and many of those other patches and help them learn how to carefully fit and sew that patch into the quilt. If the person with diabetes is unable to do what it takes to fit diabetes into his life then the diabetes patch is likely to just stay out there, flapping in the wind and drawing more attention to itself. Furthermore if the stitching is sloppy, then over time the edges may get frayed and affect the integrity of the rest of the patches closest to it health, family relationships, work, school, friends.*For the first while it is natural that diabetes is front line and centre. But over time individuals and families learn to put diabetes in its place not the favourite patch but manages to fit. When people come to clinic, we ask them to take out that diabetes patch and put it on the table to that we can take a close look at it and make sure that the stitching is intact and there are no freyed edges or little tears. We also have to explore the patches around it because if the integrity of the nearby patches is compromised then the diabetes will be affected too.Every quilt has a story as does every person*Anyone who was at the socratic discussion yesterday morning surely had to be affected by the power of the written or told story.As a large referral centre, we see quite a few children and teens who have previously diagnosed diabetes but come for assessment and management because they are struggling with achieving safe metabolic control.Rather than asking a series of questions that will give me historical information about the onset of the diabetes often a number of years ago, I ask one question, and it is so powerful. That is.. I am wondering if you can tell me the story about when you first got diabetes. What follows is incredibly revealing, Its often laden with emotion and tends to seal my relationship with the family.This is usually very therapeutic for the teen and parents as they come to know and understand each other better. Recently one teen said you cried? Dad cried? I didnt know that.*Just recently, I was sitting in my office and just finishing my visit with this young lady who here looks very sweet and pleasant but when we see her she is frequently very loud and oppositional.She refused to have her A1c done on the 2 previous occasions and I was about to request that we do it today. I turned away from her to reach for the requisition and I saw my opportunity. Halloween is just around the corner and my new nose and glasses sat by the telephone. Still looking away from her I put the glasses on and suggested the A1c. As she started her rant I looked at her and said come on Sheila work with me. She burst into laughter and then handed over her finger.*Amanda I used colourful images so that the children could connect more easily with the concept of having diabetes. The four faces represent the basic moods that this illness can bring. They are place in a circle with arrows facing both directions. The arrows go both ways to symbolize that the emotions can also go either way. Happy, confused, sad, neutral and vice versa. The looney tunes characters symbolize a family member or friend that is there to support you. The abnormally large vial and syringe represent how large or how heavy the burden can feel. The water stands for the fact that we are all trying to stay afloat, and we need each others support to do that.*OK - talking about looney tunesId like you to meet my colleagues on the diabetes team. Some are here today.In fact 2 are chairing a session down the hall.For many years we incorporated a skit into our family diabetes day update.Every one on the team participated and we made absolute fools of ourselves and the families love it.It usually introduces a theme or a topic. We usually make a point that noone forgets and it definitelly reduces the distance between provider and patient.And its fun.*As part of our family diabetes day we do have a full day creative arts program, which is planned by a volunteer who is very well connected to the arts community. These canvasses represent just a small percentage of the art that comes out of that day.These tend to be among our favourite pieces to bring out for group sessions to provoke discussion and problem solving.****