Published on January 17, 2008
Diabetes & Family Dynamics: Exploringa Seamless Approach to Management for Type 1 & Type 2: Diabetes & Family Dynamics: Exploring a Seamless Approach to Management for Type 1 & Type 2 June 7, 2007 Eddie Hill – Old Dominion University [email protected] Ron Ramsing – Western Kentucky University [email protected] Objectives:: Objectives: Become more familiar with current issues Explore a simile Determine aspects of Positive Youth Development Discover Recreation as a modality for change Discuss different approaches to parenting Increase awareness of Self-Determination Theory and its use in Parenting Review research findings What We Know: What We Know Remembering our youth The summers Friends & family Joy Freedom & fun Firsts Heart break Camp Two perspectives Adolescent Adult Diametrically opposed? The lens Transitional period Social challenges Emotional tribulations Independence Skill acquisition Risk taking Coming into one’s self Challenging Times: Challenging Times Complex world Free & leisure time opportunities Sedentary lifestyles & obesity Risk Taking Peer influence Media influences & consumption Exacerbating the Issue: Exacerbating the Issue Normal growth & development Psychological characteristics Family dynamics Providing care outside of the home Perceptions School settings More testing = more severe Camps (Halvorson, Yasuda, Carpenter, & Kaiserman, 2005) Slide6: Maybe, working with youth requires a different approach than younger children or adults! (Harris, 2006) A Simile: A Simile Dogs are like children Dependent on others People oriented Respond to discipline Willing to try new things Enjoy affection Anywhere any time Thinking like a dog Fun but not beneficial for outcome Cats are like youth Independent Require solitude Coaxing is necessary Tough to discipline Enjoy affection On their own terms Thinking like a cat Critical for outcomes Harris, 2006 Positive Youth Development: Positive Youth Development Positive Youth Development (PYD) Positive contributors; not burdens to be managed (Damon, 2004) Problem free is not fully prepared, and fully prepared is not fully engaged (Pittman, 2003) Resilience Protective factors Developmental assets Environments: Environments Mental & Emotional Well-being Emotionally positive and warm Develop adolescent autonomy Positive experiences in one area (e.g. family, peers, school, community) may lessen the effect of negative experiences in other areas Zaff, Calkins, Breidges, & Margie, 2003 National Research council and Institute of Medicine (2002) Toward Adulthood: Toward Adulthood Achievement of developmental outcomes Learn to be productive Connect with adults & peers Navigate through diverse settings Availability of supports and opportunities Relationships with adults and peers Challenging activities and learning experiences Meaningful opportunity for involvement and membership Gambone, Klem, & Connell, 2002 Our Focus: Our Focus Enhance quality of life Socialization Support Relationships Relatedness Competence Accessibility Autonomy Excellence Skill development Recreation as a modality for change Holistic Approach to Motivation: Holistic Approach to Motivation All stakeholders & players Focused on youth as contributor not burden Multidisciplinary Youth Parents Counselors Health care teams Schools/nurses Diabetes educators Significant others Camp Works: Camp Works Rich history Limited research but still fun Anecdotal evidence Expectations have changed Camp Research: Camp Research Quantitative & Qualitative Findings Support for theory-based therapeutic camping Adolescents with disabilities and illnesses Increase resiliency, self-esteem, self-image, autonomy, and self-determined behaviors National Parks and Recreation Association (NRPA) “Benefits are Endless” Redefinition and repositioning Three concepts emerge Programming, Management, and Awareness. Benefits Based Programming (BBP) focuses on intentional recreation programming. Benefits-Based Programming: Benefits-Based Programming Engineering theory-based experiences WITH specific, targeted outcomes (Hurtes, Allen & Stevens, 2000) 4 step process Benefits-Based Programming: Benefits-Based Programming Identify meaningful outcome-oriented goals Program components intentionally structured to address the stated goals Assess progress toward desired goal essential Disseminate and publicize formative and summative findings The Theoretical Framework Self-Determination Theory: The Theoretical Framework Self-Determination Theory An approach to human motivation that emphasizes the importance of internalized behavior (Ryan, Kuhl, & Deci, 1997). Needs Competence Autonomy Relatedness Role of Autonomy Supportive Environments Choice Provision Rationale Provision Perspective taking Autonomy Supportive Environments: Autonomy Supportive Environments Choice provision (at the parents’/practitioners’ discretion) offers ownership to the individual making the decision. Perspective taking provides a sense of understanding, empathy, and acknowledgement of feelings from a participants’ viewpoint. Rationale provision provides justification for youth when restrictions are necessary. Research has shown that providing an autonomy supportive environment significantly promoted healthier behavior in persons with type 1 diabetes (e.g., Sheldon et al.). Slide20: Self-Determination Continuum Type of Motivation Extrinsic Motivation Intrinsic Motivation External Introjected Identified Internalized Intrinsic Regulation Regulation Regulation Regulation Regulation Deci & Ryan, 2002 What can families do…How does one motivate within families?: What can families do…How does one motivate within families? The Theoretical Framework Self-Determination Theory: The Theoretical Framework Self-Determination Theory Choice Provision Rationale Provision Autonomy Competence Relatedness Perspective taking Autonomy Supportive The Theoretical Framework Self-Determination Theory: The Theoretical Framework Self-Determination Theory Origination… A theoretical framework used in research. Sports School Healthcare Diabetes Management Work Parenting SDT in Parenting: SDT in Parenting Controlling parents are likely to create a higher perceived locus of causality. learned helplessness, lower intrinsic motivation, and greater lack of initiative. Studies have shown that using an AS approach in parenting may increase a child’s self-perception of competence. Sense of choice indicates parents have confidence and value what he or she thinks. Increased connectedness to the parents. More authentic relationship versus a controlling parental relationship. (Grolnick & Apostoleris, 2002). Family Recreation: Family Recreation Family systems framework (Covey, Covey, & Taylor, 2006). Dynamic and complex unit where family members influence, influenced by one another, and influenced by the surroundings. Can strengthen internal relationships, learn from one another and participate in healthy activities as a unit. Research on diabetes camps is becoming more apparent (e.g., Hill, Ramsing, Hill, 2007) Enhance communication and trust among family members. Teachable moments under the guidance of recreation and healthcare professionals. Allows for “practice” of positive parenting (e.g., autonomy supportive environments). Let’s see what you remember : Let’s see what you remember Slide27: PYD Diabetes 101 Diabetes 201 Physical Activity Benefits of Recreation SDT $100 $100 $100 $100 $100 $100 $200 $200 $200 $200 $200 $200 $300 $300 $300 $300 $300 $300 $500 $500 $500 $500 $500 $500 Our Research: Our Research Utilizing this Approach at Diabetes Camp Wilderness Camp Residential Camp Family Camp Day Camp Slide29: Measurement: HCCQ-M Autonomy support measured through the Health Care Climate Questionnaire. Autonomy Support Operationalized Environments needed for individuals to take ownership of their behavior and to provide choice, perspective taking, and rationale giving. Slide30: Measurement: Adolescents' Autonomy Support Scale Not only the degree, but the level of helpfulness of AS was measured by this scale (Diet, Exercise and Insulin) Emerging Themes: Emerging Themes Recreation program targeting internalized diabetes management was promising. Higher levels of autonomy support from the parents Increased Diabetes competence Increased Social/Relatedness Camp Satisfaction Meeting other kids with diabetes Emerging Themes continued: Emerging Themes continued Nature of competition Instructional approach Activity type Females negatively influenced by competition Leader-centered instruction negatively influenced males and females Slide33: Discussion Similar perceptions of AS among campers, parents, and counselors on what is necessary for diabetes support and management. Implications As diabetes camps become more outcome-based, diabetes management strategies can be taught in exciting and educational ways where adolescents with diabetes and their parents benefit from the camp experience. Holistic Approach...: Holistic Approach... Training Autonomy Support Self-determination Example CHKD/ODU Teen Support Group Future Partnering for the Future: Partnering for the Future Multifaceted Outcome-based Benefits-driven Evaluation National and international components Holistic Approach: Holistic Approach Adolescent with T1 diabetes Diabetes Educators School Nurse, Teacher, or other Academic stakeholder Parents &/or guardians Extended family (grandparents, Uncles, aunts, etc.) Camp counselors, Director, CIT, Support staff Treatment team (RN, PA, RD, MD) Thank you!: Thank you! Questions, comments, suggestions, or other thoughts?