SEREN Connect is a comprehensive education programme to address a long-standing gap in service provisions for Young Adults (YA) living with type 1 diabetes (T1D). It helps teams to support every child with diabetes in Wales. The transition from young person to young adult and the difficulties of trying to self-manage health is hard at this notoriously turbulent time. SEREN Connect provides tools for all healthcare professionals (HCPs) to deliver information on age-appropriate topics that directly or indirectly impact the lives of YA living with T1D. It aims to influence and improve services across Wales, via paediatric and adult colleagues.
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Early ‘wants’ from developing this project were mixed with ‘needs’ from national guidance and existing good practice to create a programme that could: be co-delivered by both paediatric and adult colleagues; be delivered in a group setting (but also be useful where YA do not attend); be suitable for all YA, irrespective of length of diagnosis; be as inclusive as possible to all YA; create a safe space for YA to discuss T1D from their point of view; include elements of peer support; be replicable in every service across Wales; and feel safe and manageable to deliver for diabetes colleagues. Conversations were held with the SEREN Education Group (All Wales representation of multidisciplinary team of consultants, diabetes specialist nurses, dieticians, a clinical psychologist, parent representatives, and lived experience of diabetes). As SEREN is a paediatric programme, wider representation was needed so a sub-group was formed with extended invitations to adult colleagues and YA living with diabetes to focus on the development of the programme. Some YA who gave initial comments formed a virtual YA feedback panel. They were invited to comment on all resource development. The views and representation of minority groups and communities, including LGBT+, ethnic minorities, religions, and Welsh speaking communities meant that the programme was written to be as inclusive as possible. This led to the creation of various resources published in 2019, including a SEREN Connect Curriculum and facilitator guide front cover with artwork based on YAs’ input, a SEREN Connect A4 box file containing a copy of the curriculum and facilitator guide and all resource cards needed for all four group sessions, plus SEREN Connect booklets suitable for use with young people from Year 9 onwards. These are also given out at SEREN Connect group sessions and/or appropriate for any YA diagnosed with diabetes who does not receive care in paediatrics. The difference between SEREN Connect and existing diabetes education programmes is that it offers additional elements beyond health education that YA need, with the aim of developing self-confidence, encouraging team building and promoting resilience and independence. This is difficult to achieve in a traditional diabetes clinic set-up. It puts the person at the forefront of diabetes care. Having all resources on hand in the delivery box allows flexibility when encouraging uptake of group sessions; they do not need to take place in a hospital setting.
SEREN Connect has been designed to be flexible. Elements of the programme can be introduced to YA when they are most needed. This can take the form of one-to-one consultations to discuss topics such as alcohol and/or sex/relationships from Year 9+ (13yrs); group sessions of 16-18-year-olds to build further knowledge with peers guided by HCPs ; when a young adult is newly diagnosed and may already be driving/drinking/sexually active/at university or working. The programme has enabled paediatric and adult colleagues to work together for the first time, with meetings to discuss reconfiguring existing services to accommodate the delivery of SEREN Connect. Some health boards have established a working group for transitional care, with SEREN Connect delivery on the agenda at each meeting. YA have been developing a rapport with adult teams before their care transfers to adult services. SEREN Connect resources have been taken up in all seven health boards and are being used with YA aged 14-25, and beyond.
Sustainability and Spread
There is a commitment in the Diabetes Delivery Plan for NHS Wales’ services to deliver SEREN Connect. While there is no updated delivery plan post 2021, it is anticipated that SEREN Connect will be included as a recommendation. Since it was launched, every health board has nominated a paediatric and adult lead to coordinate delivery. Beyond delivery to HCPs, SEREN Connect has been included in an e-learning module for Swansea University’s MSc Diabetes Practice. Electronic versions of a booklet trialled with YA received positive feedback and these have been circulated to diabetes teams since June 2020. Young people in Wales can access the booklet via the Digibete App (which is free to all families living with diabetes in Wales). A lack of age-appropriate information on T1D and foot care or eye care in Wales resulted in new resources being created as part of the programme. The national podiatry network and Diabetes Eye Screening Wales gave input. SEREN Connect is in demand with YA services beyond diabetes clinics, including Primary Care. There has been interest from several trusts in England, including CYPDN West Midlands, CYPDN South West Network and CYPDN Thames Valley, and areas of Somerset, London, the Isle of Wight and Northern Ireland. The programme has been presented at several conferences. In 2020, national discussions have been held regarding taking SEREN Connect group sessions online. A virtual session, trialled by a health board in May, was positively received, so the ‘next steps’ will be to enable more options for engagement.
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