The COVID-19 pandemic disrupted the lives of young people living with type 1 diabetes, with limited or no face-to-face contact with healthcare teams. The Tree of Life groups (QiC finalist 2013) had been run in person at UCLH since 2010, helping young people to develop positive views of themselves, connect with others and improve diabetes management. The groups were adapted to be delivered online, focusing on fun and creative ways of connecting young people with each other. Between July 2020 and June 2021, three Tree of Life groups, one ‘peer trainer’ event and a professional training event were held virtually.
The Tree of Life enables young people to share problems and solutions in ways that make them stronger by connecting with their strengths, abilities, hopes and dreams for the future. It has been used across multiple cultures, settings, and ages. Additionally, young people can become ‘peer trainers’ who facilitate groups. A sense of safety and connection between participants is crucial. When planning the online version of the group, it was important to find fun and creative ways of connecting young people with each other. This meant creating opportunities for the ‘social micro-interactions’ that can be lost when not meeting face to face; not ‘getting locked up in the screen’, and involving an art therapist to co-facilitate a peer trainer event. Young people were involved in the adaption and development of the online group, which was adjusted according to their feedback. Packs were sent in the post to ensure everyone had all the materials they needed, as well as to create excitement and intrigue. All groups were evaluated with telephone feedback calls/questionnaires, to make comparisons with outcome data from the face-to-face group.
Equality, Diversity and Variation
UCLH paediatric and adolescent diabetes service has many patients who live a long distance from the hospital. For some, attending a group at 10am was costly, and potentially a barrier to accessing group support. Zoom was used to run Tree of Life online groups, allowing young people to join from home, without any travel time. This made it easier for many to attend. Across the country there is significant variation in provision and access to psychological support. The Tree of Life online group is available to any young person under the service aged over 12 years (two online groups are available for younger children). They do not need to have been referred to psychology. The group is promoted by the diabetes team, on the team website and via the DigiBete website. The format was developed in collaboration with peer trainers and adapted based on attendee feedback. Participants are called prior to the group so any additional support can be put in place, plus it helps put the young person at ease. The Tree of Life has been developed and used in multiple cultures and settings.
Three online Tree of Life groups were run between July 2020 and February 2021, attended by 21 young people aged 12-19. The group initially ran as two half days but, based on feedback, changed to a one-day group. Some key adaptations included taking time before the groups to speak to each participant to ensure they were comfortable attending and using the technology. Emails helped young people know how to attend and what to expect. Packs were sent in the post with pens, paper, fruit stickers and a welcome letter. Another adaptation was to allow lots of time to create connections. Peer trainers helped facilitate ice breakers, including scavenger hunts, sharing important objects, and using small breakout rooms. Young people drew their own trees to share on screen for others to discuss. Online white boards and screen sharing of slides helped document and capture the ideas and wisdom shared by the group on responding to the challenges diabetes could bring. One peer trainer online event was run, attended by 13 young people who were, or wanted to become, a Tree of Life peer trainer. Packs of art and craft materials were sent out and an art therapist co-facilitated the day where young people made their own trees and origami birds.
Online attendees rated the groups as: 9.5/10 – likely to recommend to a friend (face-to-face 9.16); 8.5/10 – usefulness of sharing experiences (face-to-face 9.19). Qualitative data from the online groups indicated similar themes to the face-to-face groups. Young people generally found the online platform accessible but a few had connection problems. Overall, the online group had similar positive feedback to the face-to-face group. Most said they did not mind if future groups were face-to-face or online, or felt both options should be offered. Learnings were disseminated via three online training session about creative approaches to running groups online. The training for paediatric psychologists in Scotland was rated as 9.5/10 to recommend to a friend and 4.7/5 overall. An article on keeping young people connected through online groups was published and a further article was being written on adapting the Tree of Life.
Dissemination and Sustainability
As detailed above, learnings in moving to online service delivery have been shared with other paediatric services, which will benefit many young people living with type 1 diabetes, and other health conditions. The Tree of Life peer trainer programme enabled young people to stay part of a community after attending a group, and the online platform seemed to make this even more accessible. The peer trainers wanted to meet more often and another event has been organised. This experience has encouraged the development of new online groups, including a pilot group called DiaMeetes, for 9-11 year olds, which had a positive reception and will be run again.
Following the Tree of Life groups young people were contacted to complete a questionnaire over the telephone by members of the psychology team who were not the lead facilitators (to reduce bias) and to share feedback on the day. Feedback was positive, with young people feeling more confident and supported with their diabetes.
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