The objective of the present study is to determine the feasibility of using Multisystemic Therapy (MST) to improve the treatment of adherence and metabolic control of urban adolescents with insulin dependent diabetes mellitus (IDDM) and a glycosylated hemoglobin (GHb) of 14% or above. Multisystemic Therapy, a flexible and home-based therapeutic intervention originally designed for use with mental health populations, seems to be a promising approach to providing diabetic adolescents with the ability to engage in consistent and attentive illness management. Feasibility will be assessed based upon ability to recruit families to participate in the intervention, to develop a treatment plan, to implement and complete treatment and upon evaluation of cost effectiveness of the intervention. Additional study aims are to determine if MST improves knowledge of diabetic regimen and family interactions related to diabetic care, decreases diabetes-related life stress and improves overall quality of life. The experimental design for the present study is a randomized clinical trial examining the utility of MST. The study will use a sample of 40 adolescents, 20 of who will receive MST plus standard care and 20 of whom will receive only standard care of their IDDM (control condition). Families will complete an initial data collection session (baseline) which will be repeated six months and nine months after study treatment entry. Study hypotheses of better outcomes in the MST vs. control group will be tested using repeated measures analysis of variance and Dunnet's test for post-hoc comparisons. The costs of the intervention will be assessed from a government or third party payer (i.e. insurance) perspective, where the cost of implementing the intervention is compared to the benefits or cost offsets of the intervention. If successful, this intervention will provide immediate assistance to a vulnerable population at high risk for diabetes complications and decreased quality of life.
| Ellis, Deborah A; Naar-King, Sylvie; Frey, Maureen et al. (2005) Multisystemic treatment of poorly controlled type 1 diabetes: effects on medical resource utilization. J Pediatr Psychol 30:656-66 |
