Read the case study below and answer the following questions…
Read the case study below and answer the following questions (Aim for 700 words or less). Case Study: “Cameron Diaz is a 14-year-old female diagnosed with type 1 diabetes (T1D) when she was 12-years-old. She lives at home with her mother, father, and 11-year-old sister. Her pediatric endocrinologist referred her to the psychology team within the T1D outpatient clinic due to suboptimal adherence and suboptimal glycemic control (HbA1c = 10.2%). At the time of referral, Caroline used an insulin pump and continuous glucose monitor. Cameron was treated for diabetic ketoacidosis as an inpatient three separate times since diagnosis, two of which occurred during the six months preceding her referral to the psychology team. During Cameron’s inpatient stays, the hospital did not have psychology staff on board. This limited Cameron’s providers from conducting a thorough assessment of adherence-related behaviors. Cameron’s mother was frequently hostile with Cameron in front of the medical team, stating that Cameron “just doesn’t do what she knows she has to do . . . she doesn’t believe it will benefit her health.” Cameron’s mother explained that Cameron shares her blood glucose values with her via a smartphone app, but that this data often leads to fighting in the home whenever Cameron’s blood glucose levels go too high. Cameron reported that her mother often “nags” her about her glucose levels, and at times, she has torn off her devices so that her mother could not monitor her behavior. Given Cameron’s mother works 14-hour days, she is not always there to monitor Cameron; she reported that she feels extremely afraid when she cannot see Cameron’s numbers. This fear results in greater nagging and conflict. Further, Cameron’s mother worries about Cameron when she is at school because there is no school nurse trained in T1D management. Unfortunately, upon leaving the hospital, Cameron’s health insurance did not accept referrals to behavioral health. Thus, it took five weeks for an application to be approved for the family to be seen via grant funding by the psychology team. When she finally met with psychology, Caroline described feeling “sick of diabetes” and deciding to take a “vacation” from T1D self-management. She explained that this means “ignoring” her T1D and eating like a “normal” person who does not require insulin, and stopping exercise altogether. She described that she feels guilty and lies to her parents about her blood glucose values to avoid disappointing them. Consuming carbohydrates without administering insulin leads to very high hyperglycemia. Secretly, Cameron appreciated this because high hyperglycemia meant her cells would start starving, and she would lose weight despite eating whatever she wanted. Cameron thought back to her weight loss at diagnosis when she was 12-years-old and appreciated how her body looked then. She revealed that she sometimes restricts insulin in order to lose weight and have a better body image. Female sex, and adolescent age, are both linked to increased risk of eating disordered behavior in T1D. At the introduction of therapy, Cameron was administered the Barriers to Diabetes Adherence scale to report on perceived barriers to self-management. Her score was elevated; she noted feeling burned out with diabetes, stated she doesn’t like to take time out of other activities to engage in self-management tasks, felt she did not have people in her life who understand diabetes, feels embarrassed talking about diabetes in front of others or performing regimen tasks, and often forgets to carry her supplies. Initial sessions focused on rapport building and gathering information for case conceptualization. A problem-solving therapy approach was used to improve adherence. Given the extensive history of parent-child conflict about T1D management, initial sessions focused on building adaptive communication practices to replace the maladaptive patterns that had developed. Several weeks were spent using problem-solving therapy to develop, implement, and refine adherence plans that both Cameron and her mother could agree upon. One specific strategy used to reduce the conflict about reminders to check blood glucose and give insulin was replacing phone calls and verbal reminders with emojis as Cameron found this less intrusive. Throughout the process, Cameron’s mother was provided with psychoeducation regarding effective strategies to help shape desired behaviors. Lastly, Cameron was provided skills to maintain a healthy exercise program to maintain her weight without the need to restrict insulin. The percentage of time her blood glucose was “in-range” (assessed by continuous glucose monitor downloads) and insulin boluses administered (assessed insulin pump downloads) increased during therapy. Simultaneously, Cameron’s HbA1c declined to 8.2% during approximately 12 weeks reflecting a 2% change. Cameron was re-administered the Barriers to Diabetes Adherence scale to assess barriers to self-management. Her score was much lower at the end of treatment, indicating fewer perceived barriers. These data support that the increase in self- management behaviors was key to improving HbA1c. In order to help maintain these changes, Cameron was linked to other adolescents living with T1D in her community to provide social support and peer modeling, given these components had been lacking for her prior to intervention.” Your Task: Describe self-management tasks related to management of type 1 diabetes. Briefly describe the Case Study presented (patient demographics, state of condition, history of care). What individual, family, community, and healthcare system level influencing factors were discussed? Discuss the presented barriers to adherence and self-management within these influencing factors. What was the role of the pediatric psychologist? What did the intervention involve? If there was a psychological component, describe it. How was the effect of the intervention measured or assessed? What resilience factors could help Cameron continue to do well? (think hypothetically).