Abstract
Youth with type 1 diabetes (T1D) are tasked with managing their diabetes across complex systems (e.g., family, school, and medical systems), and their diabetes is often impacted by functioning within and across these systems. To effectively intervene, providers must first identify the system or systems in which risk factors exist for any given youth and then subsequently choose a relevant intervention. This chapter examines the state of the literature with regard to behavioral interventions, exploring both single system and multisystem approaches. As this chapter demonstrates, the overwhelming majority of interventions developed for youth with T1D address problems within a single system. However, youth with a combination of risk factors across a number of systems are a particularly vulnerable group, and improvements to outcomes within this group are essential to population health improvements and overall cost savings in pediatric diabetes care. While not yet standard care, there are several intensive, multisystem interventions that have demonstrated success with high-need, high-cost youth with T1D. As such, a case example is presented in order to demonstrate the utility of one multisystem intervention, Novel Interventions in Children’s Healthcare (NICH), and the barriers to implementing such interventions within our current healthcare model are discussed.
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References
AAFP. (2017). MACRAnyms: Acronyms and terms related to MACRA.
Agarwal, S., Raymond, J., Schutta, M., Cardillo, S., Miller, V., & Long, J. (2017). An adult health care-based pediatric to adult transition program for emerging adults with type 1 diabetes. Diabetes Educator, 43, 87–96.
Aiken, L. H., Sermeus, W., Van den Heede, K., Sloane, D. M., Busse, R., Mckee, M., … Kutney-Lee, A. (2012). Patient safety, satisfaction, and quality of hospital care: Cross sectional surveys of nurses and patients in 12 countries in Europe and the United States. BMJ, 344, e1717.
American Diabetes, A., Clarke, W., Deeb, L. C., Jameson, P., Kaufman, F., Klingensmith, G., … Siminerio, L. M. (2012). Diabetes care in the school and day care setting. Diabetes Care, 35(Suppl 1), S76–S80. https://doi.org/10.2337/dc12-s076
Anderson, R. J., Grigsby, A., Freedland, K. E., de Groot, M., McGill, J. B., Clouse, R. E., & Lustman, P. J. (2002). Anxiety and poor glycemic control: A meta-analytic review of the literature. International Journal of Psychiatry in Medicine, 32, 235–247.
Barkin, S., Balkrishnan, R., Manuel, J., & Hall, M. (2003). Effect of language immersion on commu- nication with Latino patients. North Carolina Medical Journal, 64(6), 258–262.
Barry, S. A., Teplitsky, L., Wagner, D. V., Shah, A., Rogers, B. T., & Harris, M. A. (2017). Partnering with insurers in caring for the most vulnerable youth with diabetes: NICH as an integrator. Current Diabetes Reports, 17, 26.
Bindman, A. B., Grumbach, K., Osmond, D., Komaromy, M., Vranizan, K., Lurie, N., … Stewart, A. (1995). Preventable hospitalizations and access to health care. JAMA, 274(4), 305–311.
Bloomgarden, Z. T., Karmally, W., Metzger, M. J., Brothers, M., Nechemias, C., Bookman, J., … Brown, W. V. (1987). Randomized, controlled trial of diabetic patient education: Improved knowledge without improved metabolic status. Diabetes Care, 10, 263–272.
Blumenthal, D., Chernof, B., Fulmer, T., Lumpkin, J., & Selberg, J. (2016). Caring for high-need, high-cost patients - an urgent priority. The New England Journal of Medicine, 375(10), 909–911. https://doi.org/10.1056/NEJMp1608511
Brown, R. (2002). Society of pediatric psychology presidential address: Toward a social ecology of pediatric psychology. Journal of Pediatric Psychology, 27, 191–201.
Cameron, F. J., Skinner, T. C., de Beaufort, C. E., Hoey, H., Swift, P. G., Aanstoot, H., … Hvidoere Study Group on Childhood, D. (2008). Are family factors universally related to metabolic outcomes in adolescents with type 1 diabetes? Diabetic Medicine, 25(4), 463–468. https://doi.org/10.1111/j.1464-5491.2008.02399.x
Carcone, A. I., Ellis, D. A., Chen, X., Naar, S., Cunningham, P. B., & Moltz, K. (2015). Multisystemic therapy improves the patient-provider relationship in families of adolescents with poorly controlled insulin dependent diabetes. Journal of Clinical Psychology in Medical Settings, 22, 169–178.
Centers for Medicare and Medicaid Services (CMS). (2015). Better care. Smarter spending. Healthier people: Paying providers for value, not volume. https://www.cms.gov/newsroom/mediareleasedatabase/fact-sheets/2015-fact-sheets-items/2015-01-26-3.html. Accessed 23 Apr 2017.
Centers for Medicare and Medicaid Services (CMS), HHS. (2016). Medicare program; merit-based incentive payment system (MIPS) and alternative payment model (APM) incentive under the physician fee schedule, and criteria for physician-focused payment models. Final rule with comment period.
Channon, S., Lowes, L., Gregory, J., Grey, L., & Sullivan-Bolyai, S. (2016). Feasibility of parent-to-parent support in recently diagnosed childhood Diabetes: The PLUS study. Diabetes Educator, 42, 462–469.
Clay, D., Mordhorst, M., & Lehn, L. (2002). Empirically supported treatments in pediatric psychology: Where is the diversity? Journal of Pediatric Psychology, 27(4), 325–337.
Cohen, D. M., Lumley, M. A., Naar-King, S., Partridge, T., & Cakan, N. (2004). Child behavior problems and family functioning as predictors of adherence and glycemic control in economically disadvantaged children with type 1 diabetes: A prospective study. Journal of Pediatric Psychology, 29, 171–184.
Cook, S., Herold, K., Edidin, D. V., & Briars, R. (2002). Increasing problem solving in adolescents with type 1 diabetes: The choices diabetes program. The Diabetes Educator, 28(1), 115–124. https://doi.org/10.1177/014572170202800113
Danne, T., Mortensen, H. B., Hougaard, P., Lynggaard, H., Aanstoot, H., Chiarelli, F., … Aman, J. (2001). Persistent differences among centers over 3 years in glycemic control and hypoglycemia in a study of 3,085 children and adolescents with type 1 diabetes from the Hvidøre Study Group. Diabetes Care, 24, 1342–1347.
Dopp, A. R., Borduin, C. M., Wagner, D. V., & Sawyer, A. M. (2014). The economic impact of multisystemic therapy through midlife: A cost-benefit analysis with serious juvenile offenders and their siblings. Journal of Consulting and Clinical Psychology, 82, 694–705.
Drew, L. M., Berg, C., King, P., Verdant, C., Griffith, K., Butler, J., & Wiebe, D. J. (2011). Depleted parental psychological resources as mediators of the association of income with adherence and metabolic control. Journal of Family Psychology, 25, 751.
Duke, D. C., Wagner, D. V., Ulrich, J., Freeman, K. A., & Harris, M. A. (2016). Videoconferencing for teens with diabetes: Family matters. Journal of Diabetes Science and Technology, 10, 816–823.
Ellis, D., Naar-King, S., Templin, T., Frey, M., Cunningham, P., Sheidow, A., … Idalski, A. (2008). Multisystemic therapy for adolescents with poorly controlled type 1 diabetes: Reduced diabetic ketoacidosis admissions and related costs over 24 months. Diabetes Care, 31(9), 1746–1747. https://doi.org/10.2337/dc07-2094
Ellis, D. A., Frey, M. A., Naar-King, S., Templin, T., Cunningham, P. B., & Cakan, N. (2005). The effects of multisystemic therapy on diabetes stress among adolescents with chronically poorly controlled type 1 diabetes: Findings from a randomized, controlled trial. Pediatrics, 116, e826–e832.
Ellis, D. A., Naar-King, S., Frey, M., Templin, T., Rowland, M., & Cakan, N. (2005). Multisystemic treatment of poorly controlled type 1 diabetes: Effects on medical resource utilization. Journal of Pediatric Psychology, 30(8), 656–666. https://doi.org/10.1093/jpepsy/jsi052
Ellis, D. A., Naar-King, S., Frey, M., Templin, T., Rowland, M., & Greger, N. (2004). 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.
Ellis, D. A., Templin, T., Naar-King, S., Frey, M. A., Cunningham, P. B., Podolski, C. L., & Cakan, N. (2007). Multisystemic therapy for adolescents with poorly controlled type 1 diabetes: Stability of treatment effects in a randomized controlled trial. Journal of Consulting and Clinical Psychology, 75, 168–174.
Gesteland, H. M., Sims, S., & Lindsay, R. N. (1989). Evaluation of two approaches to educating elementary schoolteachers about insulin-dependent diabetes mellitus. The Diabetes Educator, 15, 510–513.
Gill, G., Nayak, A. U., Wilkins, J., Hankey, J., Raffeeg, P., Varughese, G. I., & Varadhan, L. (2014). Challenges of emerging adulthood-transition from paediatric to adult diabetes. World Journal of Diabetes, 5, 630.
Greco, P., Pendley, J. S., McDonell, K., & Reeves, G. (2001). A peer group intervention for adolescents with type 1 diabetes and their best friends. Journal of Pediatric Psychology, 26, 485–490.
Grey, M., Boland, E. A., Davidson, M., Li, J., & Tamborlane, W. V. (2000). Coping skills training for youth with diabetes mellitus has long-lasting effects on metabolic control and quality of life. The Journal of Pediatrics, 137, 107–113.
Group, D. C. a. C. T. R. (1993). The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. New England Journal of Medicine, 329, 977–986.
Hanson, C., Henggeler, S. W., Harris, M., Mitchell, K., Carle, D., & Burghen, G. (1988). Associations between family members’ perceptions of the health care system and the health of youths with insulin-dependent diabetes mellitus. Journal of Pediatric Psychology, 13, 543–554.
Harris, M., Hood, K., & Weissberg-Benchell, J. (2014). Teens with diabetes: A clinician’s guide. Alexandria, Egypt: American Diabetes Association.
Harris, M., Wagner, D., & Dukhovny, D. (2016). Commentary: Demon$trating (our) value. Journal of Pediatric Psychology, 41, 898–901.
Harris, M. A. (2017). Systems challenges in paying for services for youth with medical complexity: Apms and bundled payments. In M. A. Harris (chair), Collaborative efforts in treating youth with medical complexity: Systems autopsies. Symposium presented at Society of Pediatric Psychology Annual Conference, Portland, OR.
Harris, M. A., Freeman, K. A., & Duke, D. C. (2015). Seeing is believing: Using skype to improve diabetes outcomes in youth. Diabetes Care, 38(8), 1427–1434.
Harris, M. A., Spiro, K., Heywood, M., Wagner, D. V., Hoehn, D., Hatten, A., & Labby, D. (2013). Novel interventions in Children’s Health Care (NICH): Innovative treatment for youth with complex medical conditions. Clinical Practice in Pediatric Psychology, 1(2), 137–145.
Hayes-Bohn, R., Neumark-Sztainer, D., Mellin, A., & Patterson, J. (2004). Adolescent and parent assessments of diabetes mellitus management at school. Journal of School Health, 74, 166–169.
Health, O. o. M. (2000). Assessment of state minority health infrastructure and capacity to address issues of health dis- parity: Final report. Retrieved from http://minorityhealth.hhs.gov/Assets/pdf/Checked/1/OMHHealthDisparityFRSept00.pdf
Hilliard, M. E., Wu, Y. P., Rausch, J., Dolan, L. M., & Hood, K. K. (2013). Predictors of deteriorations in diabetes management and control in adolescents with type 1 diabetes. Journal of Adolescent Health, 52, 28–34.
Hodges, L. C., & Parker, J. (1987). Concerns of parents with diabetic children. Pediatric Nursing, 13(1), 22–24, 68.
Hood, K. K., Rohan, J. M., Peterson, C. M., & Drotar, D. (2010). Interventions with adherence-promoting components in pediatric type 1 diabetes. Diabetes Care, 33, 1658–1664.
Huang, Y., Wei, X., Wu, T., Chen, R., & Guo, A. (2013). Collaborative care for patients with depression and diabetes mellitus: A systematic review and meta-analysis. BMC Psychiatry, 13(1), 1.
Jacobs, E. A., Lauderdale, D. S., Metltzer, D., Shorev, J. M., Levinson, W., & Thisted, R. A. (2001). Impact of interpreter services on delivery of health care to limited–English-proficient patients. Journal of General Internal Medicine, 16, 468–474.
Jacobson, A. M., Hauser, S. T., Layori, P., Willett, J. B., Cole, C. F., Wolfsdorf, J. I., … Wertlieb, D. (1994). Family environment and glycemic control: A four-year prospective study of children and adolescents with insulin-dependent diabetes mellitus. Psychosomatic Medicine, 56, 401–409.
Jacobson, A. M., Hauser, S. T., Willett, J., Wolfsdorf, J. I., & Herman, L. (1997). Consequences of irregular versus continuous medical follow-up in children and adolescents with insulin-dependent diabetes mellitus. The Journal of Pediatrics, 131, 727–733.
Jarrett, L., Hillam, K., Bartsch, C., & Lindsay, R. (1993). The effectiveness of parents teaching elementary school teachers about diabetes mellitus. The Diabetes Educator, 19, 193–197.
Katz, M. L., Volkening, L. K., Butler, D. A., Anderson, B. J., & Laffel, L. M. (2014). Family-based psychoeducation and care ambassador intervention to improve glycemic control in youth with type 1 diabetes: A randomized trial. Pediatric Diabetes, 15, 142–150.
Kaufman, F. R., Halvorson, M., & Carpenter, S. (1999). Association between diabetes control and visits to a multidisciplinary pediatric diabetes clinic. Pediatrics, 103, 948–951.
Kay, M., Santos, J., & Tarkane, M. (2011). mHealth: New horizons for health through mobile technologies. Geneva, Switzerland: World Health Organziation.
Kichler, J. C., Kaugars, A. S., Marik, P., Nabors, L., & Alemzadeh, R. (2013). Effectiveness of groups for adolescents with type 1 diabetes mellitus and their parents. Families, Systems & Health, 31, 280–293.
Lancaster, B. M., Gadaire, D. M., Holman, K., & LeBlanc, L. A. (2015). Association between diabetes treatment adherence and parent–child agreement regarding treatment responsibilities. Families, Systems & Health, 33, 120.
Leonard, B. J., Jang, Y. P., Savik, K., Plumbo, P. M., & Christensen, R. (2002). Psychosocial factors associated with levels of metabolic control in youth with type 1 diabetes. Journal of Pediatric Nursing, 17, 28–37.
Li, C., Xu, D., Hu, M., Tan, Y., Zhang, P., Li, G., & Chen, L. (2017). A systematic review and meta-analysis of randomized controlled trials of cognitive behavior therapy for patients with diabetes and depression. Journal of Psychosomatic Research, 95, 44–54. https://doi.org/10.1016/j.jpsychores.2017.02.006
Lindsay, R. (1987). Elementary schoolteachers’ understanding of diabetes. The Diabetes Educator, 13, 312–314.
Lotstein, D. S., Seid, M., Klingensmith, G., Case, D., Lawrence, J. M., Pihoker, C., … Group, S. f. D. i. Y. S. (2013). Transition from pediatric to adult care for youth diagnosed with type 1 diabetes in adolescence. Pediatrics, 131(4), e1062–e1070. https://doi.org/10.1542/peds.2012-1450
Murphy, H. R., Rayman, G., & Skinner, T. C. (2006). Psycho-educational interventions for children and young people with type 1 diabetes. Diabetic Medicine, 23, 935–943.
Murphy, H. R., Wadham, C., Hassler-Hurst, J., Rayman, G., & Skinner, T. C. (2012). Randomized trial of a diabetes self-management education and family teamwork intervention in adolescents with type 1 diabetes. Diabetic Medicine, 29(8), e249–e254.
Murphy, H. R., Wadham, C., Rayman, G., & Skinner, T. C. (2007). Approaches to integrating paediatric diabetes care and structured education: Experiences for the Families, Adolescents, and Children’s Teamwork Study (FACTS). Diabetic Medicine, 24, 1261–1268.
Naar-King, S., Ellis, D. A., Idalski, A., Frey, M. A., & Cunningham, P. (2007). Multisystemic therapy decreases parental overestimation of adolescent responsibility for type 1 diabetes management in urban youth. Families, Systems & Health, 25, 178–189.
Naar-King, S., Podolski, C. L., Ellis, D. A., Frey, M. A., & Templin, T. (2006). Social ecological model of illness management in high-risk youths with type 1 diabetes. Journal of Consulting and Clinical Psychology, 74(4), 785.
Nabors, L., Lehmkuhl, H., Christos, N., & Andreone, T. L. (2003). Children with Diabetes: Perceptions of supports for self-management at school. Journal of School Health, 73, 216–221.
Nansel, T. R., Anderson, B. J., Laffel, L. M. B., Simons-Morton, B. G., Weissberg-Benchell, J., Wysocki, T., … Lochrie, A. S. (2009). A multi-site trial of a clinic-integrated intervention for promoting family management of pediatric type 1 diabetes: Feasibility and design. Pediatric Diabetes, 10, 105–115.
Nansel, T. R., Iannotti, R. J., & Liu, A. (2012). Clinic-integrated behavioral interventions for families of youth with type 1 diabetes: Randomized clinical trial. Pediatrics, 129, e866–e873.
Peitte, J. D., Richardson, C., & Valenstein, M. (2004). Addressing the needs of patients with multiple chronic illnesses: The case of diabetes and depression. Journal of Managed Care, 10, 152–162.
Peña Dolhun, E., Muñoz, C., & Grumbach, K. (2003). Cross-cultural education in U.S. medical schools: Development of an assessment tool. Academic Medicine, 78(6), 615–622.
Pendley, J. S., Kasmen, L. J., Miller, D. L., Donze, J., Swenson, C., & Reeves, G. (2002). Peer and family support in children and adolescents with type 1 diabetes. Journal of Pediatric Psychology, 27, 429–438.
Peters, A., Laffel, L., & Group, A. D. A. T. W. (2011). Diabetes care for emerging adults: Recommendations for transition from pediatric to adult diabetes care systems. Diabetes Care, 34, 2477–2485.
Prieto, L. R., Miller, D. S., Gayowski, T., & Marino, I. R. (1997). Multicultural issues in organ transplantation: The influence of patients’ cultural perspectives on compliance with treatment. Clinical Transplantation, 11(6), 529–535.
Quittner, A. L., Espelage, D. L., Ievers-Landis, C., & Drotar, D. (2000). Measuring adherence to medical treatments in childhood chronic illness: Considering multiple methods and sources of information. Journal of Clinical Psychology in Medical Settings, 7, 41–54.
Rewers, A., Chase, H., Mackenzie, T., Walravens, P., Roback, M., Rewers, M., … Klingensmith, G. (2002). Predictors of acute complications in children with type 1 diabetes. JAMA, 287(19), 2511–2518.
Riley, A. R., Duke, D. C., Freeman, K. A., Hood, K. K., & Harris, M. A. (2015). Depressive symptoms in a trial behavioral family systems therapy for diabetes: A post hoc analysis of change. Diabetes Care, 38(8), 1435–1440. https://doi.org/10.2337/dc14-2519
Ross, L. F., & Walsh, C. (2003). Minority children in pediatric research. American Journal of Law & Medicine, 29(2–3), 319–336.
Rossberg, J. I., Melle, I., Opjordsmoen, S., & Friis, S. (2008). The relationship between staff members’ working conditions and patients’ perceptions of the treatment environment. The International Journal of Social Psychiatry, 54(5), 437–446.
Rumburg, T., Lord, J., Savin, K., & Jaser, S. (2017). Maternal diabetes distress is linked to maternal depressive symptoms and adolescents’ glycemic control. Pediatric Diabetes, 18, 67–70.
Schoenwald, S. K., 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(4), 431–444.
Sheehan, A. M., While, A. E., & Coyne, I. (2015). The experiences and impact of transition from child to adult healthcare services for young people with type 1 diabetes: A systematic review. Diabetic Medicine, 32, 440–458.
Shilling, V., Morris, C., Thompson-Coon, J., Ukoumunne, O., Rogers, M., & Logan, S. (2013). Peer support for parents of children with chronic disabling conditions: A systematic review of quantitative and qualitative studies. Developmental Medicine and Child Neurology, 55(7), 602–609. https://doi.org/10.1111/dmcn.12091
Siminerio, L. M., & Koerbel, G. (2000). A diabetes education program for school personnel. Practical Diabetes, 17, 174–177.
Stallwood, L. (2005). Influence of caregiver stress and coping on glycemic control of young children with diabetes. Journal of Pediatric Health Care, 19(5), 293.
Stanger, C., Ryan, S. R., Delhey, L. M., Thrailkill, K., Li, Z., Li, Z., & Budney, A. J. (2013). A multicomponent motivational intervention to improve adherence among adolescents with poorly controlled type 1 diabetes: A pilot study. Journal of Pediatric Psychology, 38, 629–637.
TeleGeography. (2015). Global mobile subscribers surpass 7 Billion. TeleGeography: Authoritative Telecom Data. Retrieved from https://www.telegeography.com/products/commsupdate/articles/2015/07/28/global-mobile-subscribers-surpass-seven-billion/
Thom, D. H., Tirado, M. D., Woon, T. L., & McBride, M. R. (2006). Development and evaluation of a cultural competency training curriculum. BMC Medical Education, 6, 38. https://doi.org/10.1186/1472-6920-6-38
Vanelli, M., Chiari, G., Ghizzoni, L., Costi, G., Giacalone, T., & Chiarelli, F. (1999). Effectiveness of a prevention program for diabetic ketoacidosis in children. An 8-year study in schools and private practices. Diabetes Care, 22, 7–9.
Wagner, D. V., Barry, S., Teplitsky, L., Sheffield, A., Stoeckel, M., Ogden, J. D., … Harris, M. A. (2016). Texting adolescents in repeat DKA and their caregivers. Journal of Diabetes Science and Technology, 10(4), 831–839.
Wagner, D. V., Barry, S. A., Stoeckel, M., Teplitsky, L., & Harris, M. A. (2017). NICH at its best for diabetes at its worst: Texting teens and their caregivers for better outcomes. Journal of Diabetes Science and Technology. https://doi.org/10.1177/1932296817695337
Wagner, D. V., Stoeckel, M., Tudor, M. E., & Harris, M. A. (2015). Treating the most vulnerable and costly in diabetes. Current Diabetes Reports, 15, 32.
Wagner, J., Heapy, A., James, A., & Abbott, G. (2006). Brief report: Glycemic control, quality of life, and school experiences among students with diabetes. Journal of Pediatric Psychology, 31(8), 764–769.
Whittemore, R., Jaser, S., Chao, A., Jang, M., & Grey, M. (2012). Psychological experience of parents of children with type 1 diabetes: A systematic mixed-studies review. The Diabetes Educator, 38, 562–579.
Willi, S., Miller, K., DiMeglio, L., Klingensmith, G. J., Simmons, J., Tamborlane, W., … Lipman, T. (2015). Racial-ethnic disparities in management and outcomes among children with type 1 diabetes. Pediatrics, 135(3), 424–434.
Wolff, H. (2014). School advisory toolkit for families.
Wood, J. R., Miller, K. M., Maahs, D. M., Beck, R. W., DiMeglio, L. A., Libman, I. M., … Woerner, S. E. (2013). Most youth with type 1 diabetes in the T1D exchange clinic registry do not meet American Diabetes Association or International Society for Pediatric and Adolescent Diabetes clinical guidelines. Diabetes Care, 36, 2035–2037.
Wysocki, T., Harris, M. A., Buckloh, L. M., Mertlich, D., Lochrie, A. S., Mauras, N., & White, N. H. (2007). Randomized trial of behavioral family systems therapy for diabetes. Diabetes Care, 30, 555–560.
Wysocki, T., Harris, M. A., Buckloh, L. M., Mertlich, D., Lochrie, A. S., Taylor, A., … White, N. H. (2006). Effects of behavioral family systems therapy for diabetes on adolescents’ family relationships, treatment adherence, and metabolic control. Journal of Pediatric Psychology, 31, 928–938.
Wysocki, T., Meinhold, P., Cox, D., & Clarke, W. (1990). Survey of diabetes professionals regarding developmental charges in diabetes self-care. Diabetes Care, 13(1), 65–68.
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Barry-Menkhaus, S.A., Koskela, N., Wagner, D.V., Burch, R., Harris, M.A. (2020). System Overload: Interventions that Target the Multiple Systems in which Youth with Type 1 Diabetes Live. In: Delamater, A., Marrero, D. (eds) Behavioral Diabetes. Springer, Cham. https://doi.org/10.1007/978-3-030-33286-0_11
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