Volume 2: Special Issue, November 2005
COMMUNITY CASE STUDY
|View the Children with Diabetes: A Resource Guide for Wisconsin Schools and Families Table of Contents (PDF 107K)|
The initial group of 48 partners organized into subgroups to draft individual sections of the resource guide. The final guide includes information on disease management, legal issues, diabetes management and monitoring forms, and tools such as field trip tips and suggested agendas for planning meetings. It also describes the roles of parents, school nurses, teachers, coaches, administrators, food-service staff, and bus drivers (Sidebar).
Of special significance to the workgroup was the acknowledgment that Wisconsin public school districts are not required to employ a school nurse. The lack of school nurses underscores the importance of having academic and administrative staff members who understand diabetes and how best to assist children with blood glucose monitoring and medication administration, including managing glucose levels that are outside of target ranges (2). In a “Tools and Information” section of the resource guide, the workgroup addresses 28 frequently asked questions about roles and responsibilities related to nursing procedures and health-related activities.
An additional subgroup was formed to plan promotion, distribution, and training for the resource guide. To assist with promotion and training, the WDPCP contracted with a certified diabetes educator who had strong experience working with adolescents and their schools. The WDPCP staff and the diabetes educator developed a training program for school professionals. Suggestions for training content and target audience groups were solicited from workgroup members. Between June 2002 and April 2003, participants traveled to a central location, such as the regional Cooperative Education Service Association (CESA) building or a conference center, for in-person presentations conducted by the diabetes educator that included hands-on exercises and equipment samples. The training sessions provided an overview of diabetes in school-aged children and addressed disease management, nutritional considerations, laws, and policy issues. They were conducted during the school day and ranged from half-day sessions for some large school districts and CESA districts to hour-long breakout sessions at statewide conferences of school professionals. The diabetes educator conducted 21 total sessions for 762 school and support staff (Table 2).
Workgroup members also obtained endorsement of the resource guide from their own organizations and promoted it through their organizations’ newsletters, Web sites, and electronic mailing lists. The WDPCP provided sample newsletter articles and Web site links to workgroup members.
The WDPCP evaluated Children with Diabetes: A Resource Guide for Wisconsin Schools and Families in the following four ways: 1) by asking all training session attendees to complete an evaluation; 2) by tracking promotional efforts such as exhibit booths and news postings through verbal, written, and e-mail reports from workgroup members and other WDPCP partner organizations; 3) by including an evaluation form with every resource guide distributed; and 4) by conducting a follow-up survey among resource guide recipients on the impact of the resource guide on school policies.
Of the 762 people who attended training sessions, 631 (83%) completed the evaluation form (Appendix A). The majority of evaluation participants were school nurses (n = 243); the second largest group was food-service workers (n = 150). Of the 631 evaluation participants, 459 (73%) stated that they had worked with a child with diabetes in the school setting; 143 (23%) had not worked with a child with diabetes; 15 (2%) did not know if they had; and 14 (2%) did not respond to the question.
On questions about the training session’s content, quality, organization, and appropriateness, responses averaged 4.42 points on a scale of 1 (poor) to 5 (excellent). Four questions targeted the value of the training; respondents rated the sessions an average of 3.76 points on a scale of 1 (strongly disagree) to 4 (strongly agree) for these questions.
Open-ended questions allowed respondents to share information about the aspect of the training that was most helpful and least helpful, and about any change they would suggest to improve the training. Revisions to the training format (e.g., increased length, increased networking opportunities, more information on certain subjects) were made to subsequent sessions based on these responses. Responses were not tracked by length of training attended, so no comparisons can be made between the impact of the 1-hour sessions and the longer sessions.
Workgroup members have reported activities such as giving presentations to their organization, distributing order forms or resource guides to colleagues, providing exhibits or announcements at conferences, offering Web site links, publishing newsletter articles, and mailing promotional materials. We counted five direct mailings, eight Web site postings, 14 electronic mailing list or newsletter articles, and 33 face-to-face presentations.
Evaluation information on promotional activities provided by workgroup members was sparse: only 25 reports of promotional activities were received. We expected the difference in response rates between the onsite training evaluations and the mailed or faxed reporting of promotional activities through Report of Action forms (Appendix B). The low response rate, however, limits the ability to draw conclusions about the effectiveness of the promotional efforts. For future efforts, we will consider sending a subsequent mailing requesting feedback in exchange for an incentive gift to raise response rates.
More than 9713 resource guides were distributed. A sample of guides included an evaluation form (Appendix C). Only 58 recipients of the resource guide returned evaluation forms; 57 of these respondents indicated they would recommend the guide to others.
A follow-up survey was sent to 1359 individuals for whom we had mailing addresses and who had received the resource guide. This impact survey sought to determine the number of schools that have made changes to improve the school environment for children with diabetes and what those changes are (Appendix D). Preliminary results indicate that of the 331 respondents, 34 (10%) reported that they frequently referred to the resource guide, 73 (22%) referred to it several times, 158 (48%) referred to it a few times, and 63 (19%) never referred to it. Of the survey respondents, 13 (4%) reported that they frequently referred parents, colleagues, or both to the resource guide, 59 (18%) referred others several times, 143 (43%) referred others a few times, and 109 (33%) never referred others.
The survey’s open-ended questions demonstrate that policy and procedure changes have occurred in schools that received the resource guide. Following are examples of the changes noted by respondents: incorporating healthy snacks into the school day, eliminating soda machines and the sale of candy during the school day, modifying field trip procedures, providing information on the carbohydrate content of cafeteria items, and allowing blood glucose tests in the classroom. The impact survey also indicated that schools have made changes to improve the school environment for children with other chronic conditions, such as asthma and seizure disorders.
We plan to provide updates to the resource guide. We will update information on the types of insulin and insulin-delivery systems that youths are using because this information becomes outdated quickly. We produced the resource guide in a loose-leaf notebook using 3-hole–punched paper to allow for periodic updates and addition of local information. New information will be based on feedback from resource guide recipients and on new developments in diabetes-care practices, equipment, and school policy. We anticipate an expanded discussion of the incidence and management of type 2 diabetes in youths.
The development and implementation of the Children with Diabetes: A Resource Guide for Wisconsin Schools and Families was a valuable process that brought a needed reference to schools throughout Wisconsin and assisted schools in making changes to improve the school environment for children with diabetes. This model of establishing new partnerships to create a useful document with accompanying training sessions can be replicated in other states to accomplish similar goals. Bringing individuals and organizations into the development process increased the support for the resource guide and greatly enhanced the reach of our implementation efforts. Although there was a strong advantage to incorporating Wisconsin-specific information into the resource guide, it is not necessary for every state to develop its own guide. Since we developed the Wisconsin resource guide, the National Diabetes Education Program (NDEP) released Helping the Student with Diabetes Succeed: A Guide for School Personnel. This document, published in 2003, includes a diabetes primer and glossary; action steps for key school personnel, parents, and students; sample medical management and emergency action plans; review of school responsibilities under federal laws; and copier-ready handouts (12). Localities can review the national resource as well as consult with their state’s department of education for information on how state laws may affect diabetes care.
When the need for a Wisconsin resource guide became apparent, the NDEP guide was not yet available, thus leading partners to create the Wisconsin guide. Furthermore, the WDPCP successfully developed and implemented the Wisconsin Essential Diabetes Mellitus Care Guidelines and believed that the creation and implementation of the resource guide would have similar success. It was also important to our partners to create a guide that was applicable to the residents and laws of Wisconsin.
Although the resource guide cannot directly change the day-to-day practice within every school, it can be used as a resource for school personnel. The resource guide helps to identify concrete solutions to deliver the best diabetes management care in schools.
We continue to work with school professionals and parents to improve the school environment for children with or at risk for diabetes. The WDPCP staff regularly provides updates on diabetes-related research findings, medications, and equipment. We also work with statewide and local groups targeting physical activity and nutrition in the schools to enhance diabetes management for children already diagnosed and to improve the environment for those at risk of developing type 2 diabetes. These efforts, and those of collaborating organizations supported by the resource guide, can lead to improved understanding between youths with diabetes and the adults in positions to help them. This improved partnership will enhance the school environment for these youths and potentially lead to improved glycemic control and reduced long-term complications.
This article was supported by Grant/Cooperative Agreement Number U32/CCU522717 from the Centers for Disease Control and Prevention (CDC). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the CDC. The authors express gratitude for the support and guidance of Pat Zapp, former director of the Wisconsin Diabetes Prevention and Control Program. Appreciation is also extended to Kelly Stolzmann, student intern with the program, for her analysis of the impact survey results.
Corresponding Author: Angela Nimsgern, MPH, Wisconsin Department of Health and Family Services, Division of Public Health, Northern Region, Diabetes Prevention and Control Program, 1853 N Stevens St, Rhinelander, WI 54501. Telephone: 715-365-2721. E-mail: email@example.com.
Author Affiliations: Jenny Camponeschi, MS, Wisconsin Department of Health and Family Services, Division of Public Health, Diabetes Prevention and Control Program, Madison, Wisc.
*URLs for nonfederal organizations are provided solely as a service to our users. URLs do not constitute an endorsement of any organization by CDC or the federal government, and none should be inferred. CDC is not responsible for the content of Web pages found at these URLs.
Table 1. Workgroup Partners, Children with Diabetes: A Resource Guide for Wisconsin Schools and Families
Table 2. Implementation and Promotion Events for Children with Diabetes: A Resource Guide for Wisconsin Schools and Families
Children with Diabetes: A Resource Guide for Wisconsin
Schools and Families
Thank you for attending the “Caring for a Child with Diabetes in Your
Please identify your role in working with children with diabetes in the
Have you worked with a child that has diabetes in the school setting?
(15) What aspect of this training was most helpful? ________________________________________
(16) What aspect of this training was least helpful? ________________________________________
(17) What change(s) would you make to this training? ________________________________________
B: REPORT OF ACTION
|Date||Description of Activity||In-kind Contribution (Estimate)|
Thank you for taking the time to complete this Report of Action. Please return this form to the Wisconsin Diabetes Prevention and Control Program in the enclosed envelope or fax to (608) 266-8925. If you have questions, please contact Judy Wing at (608) 261-6855. Thank you!
Children with Diabetes: A Resource Guide for Wisconsin Schools and Families
Evaluation of Resource Guide
Please help us improve future versions of the resource guide by sharing your comments.
Please identify your role in working with children with diabetes in the school setting:
(Check all that apply)
Food Service Worker
Physical Education Teacher
Other (please specify) ______________________________
Have you worked with a child with diabetes in the school setting?
Don’t know/not sure
|Strongly Agree||Partially Agree||Partially Disagree||Strongly Disagree||Not Applicable|
|I was able to find the information that I needed in the resource guide||5||4||3||2||1|
|The information I was looking for in the resource guide was easy to find||5||4||3||2||1|
|I learned something new from the resource guide||5||4||3||2||1|
|The resource guide is a good source for future questions or concerns I might have about a child with diabetes||5||4||3||2||1|
|The resource guide is a good source of information even if I do not have a specific question about a child with diabetes||5||4||3||2||1|
|I expect to use the resource guide again in the future||5||4||3||2||1|
|If a colleague mentioned he/she knew a child with diabetes, I would refer him/her to this guide as a resource||5||4||3||2||1|
(8) What part(s) of this resource guide was most helpful? ________________________________________
(9) What part(s) of this resource guide was least helpful? ________________________________________
(10) What change(s) would you make to this resource guide? ________________________________________
(11) Thinking of your needs or interests, what topics would you recommend for future editions of this resource guide and/or Diabetes in the School Setting professional or public awareness activities? ________________________________________
(12) Would you recommend this resource guide to others?
Yes No Don’t know/not sure
Thank you for taking the time to complete this evaluation.
Please fax this completed evaluation to (608) 266-8925
or mail to Judy Wing, Diabetes Control Program, 1 W Wilson, PO Box 2659, Madison, WI 53701-2659.
Children with Diabetes: A Resource Guide for Wisconsin Schools and Families
In the past, you received a copy of Children with Diabetes: A Resource Guide for Wisconsin Schools and Families. The guide will be updated in 2005. The Wisconsin Diabetes Prevention and Control Program would like to learn how this guide is being used, what policy changes (if any) have been made, and suggestions on how to improve or expand the guide. Please take a few moments to complete this brief survey and return it by July 1, 2005.
In appreciation for completing the survey you will be sent a pedometer and a copy of the updated Essential Diabetes Mellitus Care Guidelines. Also, we will notify you by e-mail when the revised resource guide is available.
1. What type of organization do you represent?
2. What is your role within this organization? ________________________________________
3. Do you still have your copy of the Children with Diabetes Resource Guide?
4. How often have you referred to the Children with Diabetes Resource Guide?
5. How often have you referred colleagues/parents to the Children with Diabetes Resource Guide?
6. Did you attend a Diabetes Prevention and Control Program or Cooperative Educational Service Agency-sponsored training regarding the Children with Diabetes Resource Guide?
7. Did you attend any educational training sessions on diabetes in the schools at a statewide professional conference in the past year?
8. How has the Children with Diabetes Resource Guide been used in your organization? ________________________________________
9. Please identify all areas where policy or procedure changes have been made to improve the school environment for children with diabetes.
10. What is total estimated enrollment of school(s) implementing these changes?
11. What changes (if any) have been made that improve the school environment for children with other health conditions (e.g., asthma, seizure disorders) as a result of information in the Children with Diabetes Resource Guide? ________________________________________
12. Please rate the usefulness of each section of the Children with Diabetes Resource Guide by indicating your response below.
|Extremely Useful||Somewhat Useful||Not Useful||No Opinion/Not Used|
|American Diabetes Association Position Statement||3||2||1||N/A|
|Diabetes General Information||3||2||1||N/A|
|Tools and Information for Parents/Guardians||3||2||1||N/A|
|Tools and Information for School Nurses, Parents/Guardians and School Staff||3||2||1||N/A|
|Tools and Information for Teachers, Coaches, Administrators, School Staff, and Bus Drivers||3||2||1||N/A|
13. What technical assistance is needed for schools to further implement changes based on the information in the Children with Diabetes Resource Guide?
14. What additional training about diabetes (if any) would be beneficial to your school or to you personally?
15. The guide will be updated in 2005. Please suggest any changes or additions that would make it more helpful/useful.
Thank you for taking the time to complete this survey! Fax this form (please remember all pages) to Judy Wing at the Diabetes Prevention and Control Program at (608) 266-8925.
Please fill out your contact information below. This information will remain confidential and will only be used to send the aforementioned materials.
E-mail Address _____________________________
For more information on the Wisconsin Diabetes Prevention and Control Program, please visit our Web site at: http://dhfs.wisconsin.gov/health/diabetes/ or call (608) 261-6855.
The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
This page last reviewed March 30, 2012