Multisystemic Therapy Improves the Patient-Provider Relationship in Families of Adolescents with Poorly Controlled Insulin Dependent Diabetes
The purpose of this study was to determine if multisystemic therapy (MST), an intensive, home and community-based family treatment, significantly improved patient-provider relationships in families where youth had chronic poor glycemic control. One hundred forty-six adolescents with type 1 or 2 diabetes in chronic poor glycemic control (HbA1c ≥8 %) and their primary caregivers were randomly assigned to MST or a telephone support condition. Caregiver perceptions of their relationship with the diabetes multidisciplinary medical team were assessed at baseline and treatment termination with the Measure of Process of Care-20. At treatment termination, MST families reported significant improvement on the Coordinated and Comprehensive Care scale and marginally significant improvement on the Respectful and Supportive Care scale. Improvements on the Enabling and Partnership and Providing Specific Information scales were not significant. Results suggest MST improves the ability of the families and the diabetes treatment providers to work together.
KeywordsFamily therapy Health care services Diabetes Randomized controlled trial
The authors would like to acknowledge the National Institute of Diabetes, Digestive, and Kidney Diseases’ support of this research (Grant Number R01 DK59067, Deborah Ellis, PI) and Yuanjing Ren for her assistance with preparation of data for use in the analyses.
Conflict of interest
Author Phillippe B, Cunningham is a board member of Evidence Based Services, which has a licensing agreement with MST Services, LLC, for dissemination of Multisystemic Therapy treatment technology. Authors April Idalski Carcone, Xinguang Chen, Deborah A. Ellis, Sylvie Naar and Kathleen Moltz declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent Statement
All procedures performed with human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Research assistants obtained informed consent and assent via home-based consent procedures.
- Ellis, D. A., Frey, M. A., Naar-King, S., Templin, T., Cunningham, P. B., & Cakan, N. (2005a). 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(6), e826–e832. doi: 10.1542/peds.2005-0638.CrossRefPubMedGoogle Scholar
- Ellis, D. A., Frey, M. A., Naar-King, S., Templin, T., Cunningham, P. B., & Cakan, N. (2005b). Use of multisystemic therapy to improve regimen adherence among adolescents with type 1 diabetes in chronic poor metabolic control: A randomized controlled trial. San Diego, CA: Paper presented at the Diabetes Care.Google Scholar
- Ellis, D. A., Frey, M. A., Naar-King, S., Templin, T., Cunningham, P. B., & Cakan, N. (2005c). Use of multisystemic therapy to improve regimen adherence among adolescents with type 1 diabetes in chronic poor metabolic control: A randomized controlled trial. Diabetes Care, 28(7), 1604–1610.CrossRefPubMedGoogle Scholar
- Ellis, D. A., Naar-King, S., Chen, X., Moltz, K., Cunningham, P., & Idalski-Carcone, A. (2012). Multisystemic therapy compared to telephone support for youth with poorly controlled diabetes: Findings from a randomized controlled trial. Annals of Behavioral Medicine, 44(2), 1–9. doi: 10.1007/s12160-012-9378-1.CrossRefGoogle Scholar
- Ellis, D. A., 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.Google Scholar
- 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 I diabetes: Stability of treatment effects in a randomized controlled trial. Journal of Consulting and Clinical Psychology, 75(1), 168. doi: 10.1037/0022-006X.75.1.168.
- Ellis, D. A., Yopp, J., Templin, T., Naar-King, S., Frey, M. A., Cunningham, P. B.,…Niec, L. N. (2006). Family mediators and moderators of treatment outcomes among youths with poorly controlled Type 1 diabetes: Results from a randomized controlled trial. Journal of Pediatric Psychology, 32(2), 194–205. doi: 10.1093/jpepsy/jsj116.
- Hanson, C. L., Henggeler, S. W., Harris, M. A., Mitchell, K. A., Carle, D. L., & Burghen, G. A. (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(4), 543–554.CrossRefPubMedGoogle Scholar
- Henggeler, S. W., Halliday-Boykins, C. A., Cunningham, P. B., Randall, J., Shapiro, S. B., & Chapman, J. E. (2006). Juvenile drug court: Enhancing outcomes by integrating evidence-based treatments. Journal of Consulting and Clinical Psychology, 74(1), 42–54. doi: 10.1037/0022-006X.74.1.42.CrossRefPubMedGoogle Scholar
- Henggeler, S. W., Schoenwald, S. K., Borduin, C. M., Rowland, M. D., & Cunningham, P. B. (2009). Multisystemic therapy for antisocial behavior in children and adolescents (2nd ed.). New York: Guilford Press.Google Scholar
- Jacobson, A. M. M. D., Hauser, S. T. M. D. P., Willett, J. P., Wolfsdorf, J. I. M. D. B., & Herman, L. B. A. (1997). Consequences of irregular versus continuous medical follow-up in children and adolescents with insulin-dependent diabetes mellitus. Journal of Pediatrics, 131(5), 727–733.CrossRefPubMedGoogle Scholar
- Kovacs, M., Goldston, D., Obrosky, S., & Iyengar, S. (1992). Prevalence and predictors of pervasive noncompliance with medical treatment among youths with insulin-dependent diabetes mellitus. Journal of the American Academy of Child and Adolescent Psychiatry, 31(6), 1112.CrossRefPubMedGoogle Scholar
- La Greca, A. M., Bearman, K. J., & Roberts, M. (2003). Adherence to pediatric treatment regimens. Handbook of Pediatric Psychology, 3, 119–140.Google Scholar
- Liss, D. S. P. D., Waller, D. A. M. D., Kennard, B. D. P. D., McIntire, D. P. D., Capra, P. P. D., & Stephens, J. P. D. (1998). Psychiatric illness and family support in children and adolescents with diabetic ketoacidosis: A controlled study. Journal of the American Academy of Child and Adolescent Psychiatry, 37(5), 536–544.CrossRefPubMedGoogle Scholar
- 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(2), 178(112. doi: 10.1037/1091-75126.96.36.199.CrossRefGoogle Scholar
- Naar-King, S., Ellis, D., Kolmodin, K., Cunningham, P., & Secord, E. (2009). Feasibility of adapting multisystemic therapy to improve illness management behaviors and reduce asthma morbidity in high risk African American youth: A case series. Journal of Child and Family Studies, 18(5), 564–573.CrossRefGoogle Scholar
- Patterson, C. H. (1979). Rogerian counseling. Basic handbook of child psychiatry: Therapeutic interventions, 3, 203–215.Google Scholar
- Silverstein, J., Klingensmith, G., Copeland, K., Plotnick, L., Kaufman, F., Laffel, L.,…Clark, N. (2005). Care of children and adolescents with type 1 diabetes: A statement of the American Diabetes Association. Diabetes Care, 28(1), 186.Google Scholar
- Young, B., Dixon-Woods, M., Windridge, K. C., & Heney, D. (2003). Managing communication with young people who have a potentially life threatening chronic illness: Qualitative study of patients and parents. British Medical Journal, 326(7384), 305–309. doi: 10.1136/bmj.326.7384.305.PubMedCentralCrossRefPubMedGoogle Scholar