DiSH-MT: Supporting Students with Diabetes and their Mental Health
The October DiSH-MT session covered current mental health trends in youth with diabetes, discussed school-specific factors that lead to extra stress and burnout, and shared ways that school nurses and other school health personnel can help support youth with diabetes in handling this chronic disease while living and thriving alongside their peers.
Even when a student appears to be handling their diabetes well, remember that there is still a high chance of diabetes distress occurring. Routine check-ins with a student with diabetes are helpful and usually welcomed.
It is important to help all school staff that work with a student with diabetes, including teachers, coaches, substitutes and others are aware of the student’s diabetes care needs including school accommodations.
Focus on reducing risk of burnout and prevention of crisis by maintaining consistent communication with the student, family, and school. With this, everyone can feel more supported.
When a student with diabetes has an acute crisis or challenging behavior, after ensuring safety and immediate needs, focus on strengthening the communication between the systems (school, family, student) and sorting out what areas are in need of more support.
What school health personnel should know when considering increasing care for students with diabetes?
Early middle school years: Building and strengthening connections with students is helpful: it may be a key time to establish a routine check-in with students with diabetes.
Stay positive, praise small wins, and show them that you really care: Empathy for how difficult it is to be a teenager and then even harder with managing diabetes 24/7. Fear is not a good motivator. Most students know about all the bad things that can happen and complications of diabetes, and reminding them of this doesn’t usually help. Fear tactics tend to make things harder and do not improve behaviors.
The more supported and connected a student feels, the more likely they are to have positive outcomes.
Students may not feel comfortable asking for additional accommodations, so they may need advocacy from you and other school staff (coaches, teachers, aides) to make sure their school experience includes meeting their diabetes needs.
Ask students how you can help them, but also give examples of how you can assist and available resources, as they may not know.
Release of information form (ROI) from parents can be difficult to get for school nurses (especially in high schools). Could this be assisted through diabetes clinics?
Probably! Call the student’s clinic to see if they can have one signed at the next visit. If you have the form that’s needed, feel free to fax it to the clinic. Some diabetes programs are also integrating that language into their consent forms and then including the school nurse as a part of the student’s diabetes care team. Don’t hesitate to reach out to the student’s diabetes provider team to find ways to integrate or have the clinical diabetes care team stress the importance of signing forms.
How can I help a student with T1D who has burnout, diabetes distress behaviors, and recently some worrisome behaviors that seemed like a suicide attempt, although the student denied suicidal ideation?
There are two parts to think about – acute crisis and safety if a student shows signs of suicidal ideation, and then how to help with worsening diabetes distress and burnout.
Crisis – – if a student seems actively suicidal, get them to emergency care immediately (e.g. call a crisis line – 1(800) 273-8255 – or 911). If not in crisis but still high concerns, ensure there is a safe plan and that their healthcare team is engaged and actively involved.
Prevention – – using the same strategies we reviewed above, but with an added lens for watching for risky behaviors and expressions. Continue to prioritize building trusting and caring relationship with the student rather than perfecting diabetes skills (within safe practice). Provide regular check-ins, open and supportive communication with the student, their family and clinic team. Have a low threshold to ask for help for other professionals rather than handling this on your own.
Register for the next DiSH-MT session! We look forward to seeing you in November, which is Diabetes Awareness Month! The topic of the session will be Diabetes Sick Days, presented by Nathan Bingham, MD, PhD - pediatric endocrinologist for Logan Health Children’s.