School-Partnered Collaborative Care (SPACE) for Pediatric Type 1 Diabetes

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Project Summary Despite modern treatment advances over the last several decades, most youth with type 1 diabetes (T1D) fail to meet recommended targets for glycemic control as measured by hemoglobin A1c. As glycemic control remains the single most important predictor for long term outcomes, adjunctive interventions are needed. One approach is to bolster multidisciplinary care delivery, the traditionally hospital-based management approach for T1D, through partnering with community organizations that support youth and families where they live. The school setting provides such an opportunity, as children spend nearly half their weekday waking hours there under the care of school nurses, providing a consistent and supervised environment. Though limited in their design, prior studies of T1D school-centered interventions have suggested a benefit to enhancing school- provider collaboration for management. Yet, this relationship remains sub-optimal. Our prior work has identified that school nurses feel they make valuable contributions for T1D which are often unrecognized, and providers desire more feedback from school health staff. Enhancing this partnership may be accomplished through a Collaborative Care Model, previously studied for mental health conditions in primary care and school. Adapting this model for T1D may offer a systems-based approach to support school nurses, youth with T1D, and their families. The overall objective of this mentored K23 award is to develop and pilot test a School-PArtnered Collaborative carE (SPACE) intervention for T1D. Dr. March will discover the contextual factors affecting implementation of school-based collaborative care using mixed methods (Aim 1), design the SPACE for T1D intervention through an iterative, community-partnered process (sub-Aim 2A), select valid measures to evaluate SPACE with parents of children with T1D (sub-Aim 2B), and test the SPACE for T1D intervention in a pilot cluster-randomized controlled trial with the primary outcome of feasibility (Aim 3). Secondary outcomes will address other implementation-focused measures (e.g., acceptability, usability, etc.), and an exploratory goal will be to descriptively assess candidate outcomes for a future fully powered trial. Paired training activities are cohesive with each research Aim and include to advance understanding in applied implementation science principles, develop skills in user-centered design, and cultivate competences in clinical trials. These studies will provide preliminary data to support future R-level studies examining factors affecting implementation of T1D interventions in schools nationally and testing the SPACE intervention in a fully powered, cluster-randomized, hybrid implementation-effectiveness trial. In addition, cross-disciplinary mentorship and career development activities will foster Dr. March’s transition to independent funding mechanisms. By completing this K23, Dr. March will have the training, experience, and preliminary data needed to become an independent physician- scientist leading studies aligned with NIDDK’s strategic mission to advance stakeholder-engaged research which disseminates and implements evidence-based treatments in community settings.