Exeter and Young Person’s Paediatric Diabetes service developed two structured education programmes, Cook and Eat Family Fun (pre-school and primary age) and Cook and Eat Fun! (secondary age) to actively learn carbohydrate counting skills in a real-life setting. The learning outcomes are age appropriate and achievable for young people and young people are invited to annual sessions to build up their knowledge and understanding. Sessions are funded by schools, supermarket donations and grants from charitable trusts.
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Inspired by the Sheffield Teaching skills for Healthcare Professionals we looked for novel ways to educate children and young people about food. We developed two programmes: Cook and Eat Family Fun (pre-school and primary age) and Cook and Eat Fun! (secondary age) to actively learn carbohydrate counting skills in a real-life setting. We aim to provide a number of experiences to engage all learning styles, such as giving young people the food packets and ingredients (tactual), cooking (kinaesthetic), using pictures on cooking instructions (visual), giving spoken instructions and having group discussions (aural). The primary aims for the sessions were:
- To meet other young people with diabetes
- To cook healthy food
- To carbohydrate count the food made.
The initial pilot sessions were held in a secondary school in Exmouth (seven children with type 1 attending) in 2013/14. All the young people found basic maths difficult so modifications were made during the programme to simplify the task. These sessions were then repeated in the same school in the following school year 2014/15 and further modifications were made to reduce the complexity of carbohydrate counting and shifted the focus on assessing abilities. Following the success of Cook and Eat in secondary schools a primary (and pre-school) version was developed. These sessions started in summer 2015. All sessions are held in the summer holidays and last for two hours. For Cook and Eat Family Fun, siblings and parents are also invited. Recipes are quick and technically easy to prepare so that even the youngest can take part in cooking. We use food technology rooms in secondary schools in Honiton and Exeter to host the sessions. Invitations are sent out to the young person 3-4 weeks prior to the sessions. Parents attend with their children so consent is not required. After the introductions and initial icebreaker (a game) the plan for the session is outlined. The CYPs are given a recipe to follow. We prepare and cook a sweet and a savoury option then carbohydrate count, blood glucose test and administer insulin before all eating together. Cook and Eat Fun! sessions occur in the CYPs own school or in half term at a central school. CYPs attend without parents and (since the 2016/17 academic year) they can invite a friend to attend with them. Invitations are sent out to the young person 3-4 weeks prior to the sessions. Parents reply by text or email with consent for them to attend, whether the child is able to walk home from the sessions alone and a mobile number for the parent in case of emergencies. A text message is sent to the parents if the child has not attended within the first 15 minutes of the session. Parents also inform the dietician of any dietary requirements so that recipes can be adapted for dietary exclusions. After the quiz we cook and carbohydrate count a savoury option (week one) and a sweet option (week two). The young people may then inject insulin and eat the food if they wish.
There was an improvement in knowledge in 2016-17. 77% (up from 55% last year) of young people were able to correctly identify foods containing carbohydrate (from a list of eight). 91% (85%) were able to correctly read the carbohydrate value on a Carbs and Cals picture. After the CYPs have finished cooking the facilitators are able to watch them problem solve as a group to work out carbs. It allows assessment of numeracy capabilities, identify those who regularly carbohydrate count at home themselves or with help. Older/more able pupils will help less able/young pupils (peer support). As the sessions progressed we found that pupils do not read the recipe but ask at each stage what they need to do so we moved towards pictorial forms for recipes.
Sustainability and Spread
Schools find the ingredients using pupil premium for their own pupils and allow use of the venue free of charge. We were successful in obtaining grant funding from The Norman Charitable Trust for four years of Cook and Eat provision (£2,000) and we received donations from Tesco, Sainsbury’s and Morrisons towards ingredient costs for the Cook and Eat Family Fun. The same recipes are cooked throughout the whole school year (or summer holiday) so the facilitators are repeating the session in each session or school. This reduces the preparation time and non-perishable ingredients can be transferred to the next session. We have already received an offer of financial support from the local CYP with diabetes support group. The school sessions are free and there is capacity for more schools to be included. The Cook and Eat programme is easily reproducible by other diabetes teams. We have clearly written lesson plans, recipes and risk assessments. These tried and tested resources have been shared with other teams in the UK.
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