• Fresh Views

    Flipping the Paradigm: Applying a Solution-Focused Approach to Healthy Eating

    Problem talk creates problems, Solution talk creates solutions. – Steve de Shazer

    Tasty, healthy grilled mussels in garlic and lemon

    We are excited to launch into a 7-week series on applying a solution-focused approach to the AADE7 Self-Care Behaviors for managing diabetes. As you probably know, the AADE7 is a framework for organizing diabetes self-management education and support and for identifying key areas that may require behavioral changes to manage diabetes.  The 7 categories are:

    For those of you that follow our blog, you know that we are passionate about flipping the conversation from a “problem focused” (traditional medical) approach to a solution-focused conversation. We are advocates for the use of person-first, empowering language when speaking with and in reference to people with diabetes. #LanguageMatters in diabetes care and education; problem centered talk can make speaking about and managing diabetes more challenging.

    Each of the next seven weeks, we will focus on one of the above self-care behaviors and provide 3 practical illustrations of how to flip the conversation around it to solution-focused talk.

    AADE7 Self Care Behavior #1: Healthy Eating 

    “What can I eat?” is the #1 question asked by people with diabetes when they are diagnosed. Without a doubt it can be a confusing, challenging, and sensitive ongoing area of diabetes management. 

    Often the healthy eating discussion focuses on foods to avoid and “what went wrong” when blood glucose was out of range. The conversation continues with discussion on how to prevent that from happening again. This approach to eating can be painful and result in feelings of blame and shame. A solution-focused approach changes the dynamics of the conversation.  It helps flip the focus to what is working well and building upon existing strengths.

    Instead of focusing on what is not working well or what is “wrong”, here are 3 illustrations of how to flip the conversation:

    Try this: I noticed that you are drinking sweet tea or soda only three times a week now instead of every day. How have you been able to do that? 

    Instead of this: Are you still drinking sweet tea and soda? 

    Try this: I hear you saying that you’d like to lose 20 more pounds. I’m noticing you are down 5 pounds since we last met. I’m really proud of you. What do you think helped you lose those 5 pounds? 

    Instead of this: I hear you saying that you’d like to 20 more pounds. I see you’ve only lost 5 pounds. What have you been eating?

    Try this: We’ve been talking about trying to work in more non starchy vegetables at dinner to help fill you up without raising your blood glucose. How many days a week do you think it’s reasonable to start with? On a scale of 0-10, where 0 is not all and 10 is I can definitely do this, where would you rate yourself? 

    Instead of this: We’ve talked about trying to work in more non starchy vegetables to help fill you up. I want you to eat one at lunch and dinner every day. 

    Be a think partner

    During a solution focused conversation, the diabetes care and education specialist acts as the “think partner” in developing solutions by asking questions and helping the person with diabetes to use their own personal strengths to create solutions that work for them. 

    When you meet again, here are 3 follow-up questions to try:

    • What’s been better since our last session?
    • What skills did you draw upon to make changes?
    • What do you know about yourself that lets you know you can achieve what you want?

    We’ll challenge you each week to try incorporating some flips into your conversations and let us know what impact they have.

    Join us next week as we discuss a solution focused-approach to Being Active!

    We welcome anyone interested in our approach to Subscribe to our blog and we’ll email you when a new post is published!

    If you are a health care professional and interested in learning more about our solution-focused practice and approach, when you subscribe to our blog, we’ll send you in return a FREE resource of 10 Solution-Focused Questions to start a solution-focused discussion with your clients. 

    Follow us on Twitter and Instagram @AFreshPOVforYou

  • Fresh Views

    Seeing with new eyes: Perceptions of life with diabetes

    The real voyage of discovery consists not in seeking new landscapes, but in having new eyes. – Marcel Proust 

    A view of La Sagrada Familia through an arch on the roof of Casa Mila in Barcelona, Spain

    #EASD2019 is a wrap! Hi this is Deb this week. I represented @AFreshPOVforYou at the 55th Annual Meeting of the European Association for the Study of Diabetes (EASD) conference in Barcelona where I was excited to share the results of our study (more about that below). I learned much at the meeting, connected with friends and colleagues, and met Twitter followers in person for the first time! I also had time to do a little sightseeing and take in the food and culture of Barcelona!

    Front entry of the EASD 2019 meeting, Barcelona

    Our abstract, Perceptions of life with diabetes revealed through a solution focused brief therapy exercise via Twitter, was presented on the final day of the conference in a very large room. Often many people leave for home the last day of the conference so I feared the room would be empty, but it was not! Given that this was the only session addressing the psychology of diabetes, there was a great crowd. The presentation focused on the use of the Miracle Question, a solution-focused tool, to help people overcome challenges by using “solution talk” rather than “problem talk.” We wrote about it in our blog post about our AADE presentation here and here describing our World Diabetes Day 2018 #DSMA Twitter chat.

    I try to start all of my presentations with a slide reminding the audience (or sometimes educating them for the first time) that #LanguageMatters when speaking with or about people with diabetes. You can read our past blog posts related to this here and here.

    #LanguageMatters slide

    I asked for a show of hands to see how many in the room were familiar with the Miracle Question approach. I only saw one hand raised. Since this was a 15-minute research presentation, it was hard to cover a lot of the background, so the focus was on the study outcomes. It was exciting to see lots of Tweets about the presentation and that the concept of a solution-focused approach was being spread across the Twitterverse. You can read the full abstract here

    We have submitted the complete data to be published (fingers crossed that happens soon!). However, in brief, when we employed the Miracle Question approach during a Twitter chat there were five themes that evolved.  That means that these were the most common threads, thoughts, comments that were expressed by those who participated in the chat. The themes were: more of living life; laughter and humor; self-compassion; resilience; and support.  

    Deb at the podium presentation

    There were several questions at the end of the session and many people came up to talk about the approach. In fact, several researchers shared with me about their research and how they could see incorporating a solution-focused approach into their research study.  It was very exciting to see the interest in this tool.

    Most of the comments and questions were positive. Interestingly, one questioned the value of having people “think less” about their diabetes, and worried that diabetes management would be hurt. I responded by saying that Dana Lewis (creator of Open APS) might disagree. When I heard her speak earlier in the conference she indicated that with her Open APS system, she thinks less about diabetes, including not having to bolus when she eats carbs.The theme of “more of living life” meant different things for different people.  The Grumpy Pumper (Chris Aldred) commented, “For me, the issue isn’t how often I think about my diabetes, it’s the type of thoughts. Looping hasn’t made me think less, but my thoughts are more positive because I’m seeing the results I want.”  This was a great perspective. The overarching message was that they wanted to focus on the positive aspects of life.

    It’s important to acknowledge that people engaged in a diabetes Twitter chat are likely very engaged in their diabetes management. There was a question if the process would still be successful in others. We agree that we have the same questions and hope to conduct additional research in this area in the future.  

    We also had a Diabetes Online Community (DOC) advocate @Blue_sugar_cube reach out and ask how she and the DOC could get involved with our work. That was exciting! As well as seeing a few new subscribers to our blog!

    And lastly, a big thanks to @WeRateTalks on Twitter who gave our talk an 11/10!  Wow! We were honored!

    We’ll be seeing some of these diabetes friends in Busan, South Korea for the International Diabetes Federation Congress where Deb will be speaking on two panels, one on #LanguageMatters and one on digital health. 

    Kellie, Karen, Grumpy, Renza, Deb and Donna at the end of our presentation

    By sharing a solution-focused approach to diabetes management with a worldwide audience we hoped to inspire people to think differently and consider incorporating a solution- focused approach in their practice.

    We began this post with the quote, The real voyage of discovery consists not in seeking new landscapes, but in having new eyes by Marcel Proust . We’d like to encourage health care professionals to “have new eyes” when they think about diabetes management, and be open to new tools and solutions. 

    If you’re a researcher and would like us to consult on a future research grant, please reach out – we’d love to chat!

    We welcome anyone interested in our approach to Subscribe to our blog and we’ll email you when a new post is published!

    If you are a health care professional and interested in learning more about our solution-focused practice and approach, when you subscribe to our blog, we’ll send you in return a FREE resource of 10 Solution-Focused Questions to start a solution-focused discussion with your clients. 

    Follow us on Twitter and Instagram @AFreshPOVforYou

    Disclaimer: A Fresh POV for You is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to amazon.com. 

  • Fresh Views

    #AADE19 Sessions (Part 2)

    More Behavioral Health, Language, Peer Support, Tech & Social Media 

    The long awaited #AADE19 Annual Meeting in Houston August 9-12 is here! Tomorrow we’ll be on a plane headed to Houston to join more than 3700 diabetes educators and other healthcare professionals at the American Association of Diabetes Educators (AADE) Annual Conference. It is the premier educational and networking event for diabetes educators. Can you tell we’re excited??

    Tami and Deb at AADE a couple years back, with now AADE President Karen Kemmis

    Last week we shared the sessions that peaked our interest to catch on Friday. And today we’re sharing a look at the sessions we’ve highlighted in our online planner for Saturday-Monday.  As you will see, many overlap. So much great content, so little time to catch it all!. So, if you’re joining us in Houston and haven’t had a chance to look at sessions yet, here’s a glance at the top twelve we’re excited about and which again focus on behavioral health, how to impact behavior change, and the use of peer support. To keep it simple, we pulled out the session descriptions for you and reviewed uploaded slides when available. You can find all of this information in the Online Planner.  

    Saturday August 10, 2019

    S03 – 9:15-10:15 am AADE’s Practical Approach to Mental Health for the Diabetes Specialist by Shannon Eaves, Jasmine Gonzalvo, Jay Hamm, & Cynthia E. Muñoz

    Description:

    The AADE practice paper A Practical Approach to Mental Health for the Diabetes Educator describes common psychosocial considerations in people with diabetes (e.g. depression, anxiety, diabetes distress, disordered eating, etc.), the pharmacological impact of relevant medications, appropriate assessment and referral strategies, and effective communication practices. During this presentation, the authors of the paper will review the content of the paper and expand on specific aspects, including clinical scenarios to highlight real world implementation of the assessment and referral recommendations.

    Our take away:

    The dynamic duo of Jasmine Gonzalvo and Jay Hamm are two of the speakers on this panel who will review the practice paper findings and discuss medication therapy. We predict this session will be well attended. 

    S16A – 1:00pm-1:30pm Online and In-Person Peer Support for Underserved Populations by Michelle Litchman, Cherise Shockley and Heather Walker

    Description:

    Support for individuals with diabetes is recommended per the 2017 DSMES National Standards; however, it is not always easy to identify support resources, especially for underserved populations. In this session, online and in-person support specific to those with different ethnic, language, abilities and diabetes type will be discussed. This session will provide diabetes specialists with tools for identifying, creating, and referring to support resources.

    Our take away:

    This team is well known in the diabetes support space and we look forward to learning from them.

    S16B – 1:30-2:00 pm Create Lasting Behavioral Change in African Americans with Diabetes by Sharon Evette

    Description:

    African Americans have one of the highest rates of diabetes in the US. Diabetes specialists play a significant role in addressing cultural barriers which enable diabetes self-care. The Change Model addresses the person’s level of growth by helping them identify goals and develop strategies for long term self-care behavior change.

    Our take away:

    We’re interested in learning about their process. In the 7-step process of change they describe, step 2 is establishing a “vision” which is in alignment with what we are trying to do here @AFreshPOVforYou , and aligns with the Miracle Question exercise we’ll present on Friday.  If you’d like to read more about the Miracle Question, we are fans of this book

    S21A – 3:15-3:45 pm Making Space for Lurkers in Peer Support: A Community-Supported Approach to Engagement by Anna Norton and Heather Walker

    Description:

    Peer support in diabetes has been shown to positively impact the health of those who actively participate; however, only one recent study points to the power of a lurker. In this session, the role of the lurker will be introduced and highlighted in the context of diverse populations. The session will conclude with strategies to include underserved and low-income adults generally not reached through traditional peer support programs.

    Our take away:

    These powerhouse women are strong advocates of peer support and are fantastic speakers. We love the concept of lurkers as being truly a part of the community, learning and engaging in a way that works for them. Not everyone has the same needs, desires and abilities. We support all.

    S28-4:30-5:30 Beyond Coping: Raise Your Spirits, Not Your Blood Sugar, by Maggie Hunts

    Description:

    This interactive and musical presentation incorporates key methodologies to improving diabetes care for the specialists and the person with diabetes. Be uplifted by musical parodies about living with diabetes, as you learn key ways to reach individuals.

    Our take away:

    While this presentation seems like it will be a lot of fun, we were attracted to the solution focused approach described in the slide deck. She emphasizes starting with “wins” to build on what’s working and to teach seeing “victories” no matter how small. Love this! Tami will catch this one since Deb will be presenting another session at the same time.

    S25 – 4:30-5:30 pm Use of Social Media and Peer Support in Diabetes Care: A Panel from AADE Project Leaders by Deborah Greenwood, Ashley Ng, Michelle Litchman and Hope Warshaw

    Description:

    This panel presentation will share findings, tools, tips and practice pearls from publications in a special edition of the Journal of Diabetes Science and Technology focusing on social media and peer support in diabetes. Three projects, which will be highlighted, had support from AADE. These include the online peer support community scoping review, the peer support communities initiative and iDOCr council. Join us to learn how to incorporate a variety of peer support and social media components to improve outcomes.

    Our take away:

    Deb was a special section editor for these journal issues and will share with other authors on the panel some learnings about the benefits of social media in diabetes care and education.

    Sunday August 11, 2019

    D01 – 9:15-10:15 am Tic-Tac-Tech: An Expert Panel on the Game of Integrating Technology into Practice by Crystal Broj, Kelly Close, Jasmine Gonzalvo and Deborah Greenwood

    Description:

    The panel discussion will focus on technology and its evolution in diabetes care. Real world case studies will demonstrate how educators can integrate new technologies into practice and work flow to ultimately produce improved outcomes.

    Our take away:

    Deb will be speaking on a panel with other tech savvy individuals in the diabetes space. The team hopes to generate a lot of discussion and conversation with the audience. So please join us if you would like to talk tech!

    D11 – 10:30-11:30 am No One Understands Me!; Helping People Live Well with Diabetes by Ann Constance and Cecelia Sauter

    Description:

    Only 32% of people with diabetes reported recently being asked about their emotional well-being by a member of their health care team.This interactive session will discuss new evidence about the negative effects of diabetes-related distress. It will explore effective and practical strategies diabetes specialists can incorporate into care delivery models to address emotional well being.

    Our take away:

    The Empowerment model will be employed in this presentation, helping people use their “own innate ability to gain mastery over their chronic disease.” Their slides describe very solution focused approaches to practice including focusing on goals and NOT solving problems for the individual, but listening to them and supporting them in their efforts.

    Next is a description of a two-session series on diabetes distress in the afternoon.

    D15A – 1:30-2pm Interventions to Help Overcome the Impact of Diabetes Distress by Eliot LeBow

    Description:

    Diabetes distress can impact a person’s life and diabetes self-management.This presentation orients educators to the underlying causes of diabetes distress, the symptoms, and the impact on peoples’ lives. Validated resources will be provided to help attendees understand and decipher the differences between diabetes distress and clinical depression. Interventions to help overcome the impact of diabetes distress will be reviewed.

    Our take away:

    We’re interested in the concept of “micro-trauma” as a factor in diabetes distress and look forward to learning more.

    D15B – 2:00-2:30 pm Diabetes Distress and Burnout: Helping Youth and Families Live Well with Diabetes by Rebecca Butler, Katherine Gallagher and Amber Smith

    Description:

    Most people with diabetes will experience diabetes distress at some points during their life. The emotional side of diabetes is often the area where providers spend the least amount of time, but it is one of the most important things to address to help people succeed. The goal of this presentation is to help diabetes specialists learn to recognize when people may be exhibiting diabetes distress and to provide tools to empower them to provide emotional support.

    Our take away:

    There are some great solution focused approaches to practice in this slide deck, including providing 3 behavior praises for every one correction and for parents and providers to notice what the kids did WELL!  Also, there’s great inclusion of using empowering language.

    D22 – 2:45-3:45 pm Mind, Body, History: Listening, Eliciting, Responding to the Whole Story of the Person with Diabetes by Marina Tsaplina

    Description:

    Behind the complexities of diabetes management, is a human being with a lived history that shapes their diabetes story. Narrative medicine understands that illness unfolds in stories and that a competent diabetes specialist must be trained in the physiology of the body and appropriate treatments, but also in narrative competence, humility and mind-body practice to serve people with diabetes across cultural, racial, and economic inequities. We invite you to participate in a workshop that incorporates theater, narrative medicine, and mindfulness to strengthen your practice of delivering compassionate, whole-person diabetes care.

    Our take away:

    While there were no slides to review, this interactive session by Marina Tsaplina will discuss building a therapeutic relationship with clients, an important concept to us, and in any solution focused approach.  

    Monday August 12, 2019

    M12 – 10:45-11:45 AM Not the Word Police: What the Language Movement is Really About by Jane K. Dickinson

    Description:

    The 2019 Diabetes Educator of the Year will present a deeper dive into the language movement in diabetes. Why are we trying to change the language around diabetes, why does it matter, and how can we do it effectively? We will discuss what the language movement is not, and have some hands on practice with replacing unhelpful messages.

    Our take away:

    Dr. Jane K. Dickinson will work through some examples of how to change practice and use person first, empowering language that does not stigmatize, shame and blame. Hooray! 

    So many fabulous speakers, topics, panels and presentations are ahead of us! Not to mention all of the great posters that will be presented as well. Join us in tweeting using the #AADE19 hashtag – share what you are learning along with others in your network. While we love the learning, we are also excited to connect with dear friends and colleagues, laugh a little (or maybe a lot), enjoy an adult beverage (or two) and dance at Sunday night’s classic celebration!  

    Please find us and say hello at the meeting! We love meeting our “online friends” when we are at in-person at conferences! We plan to share our highlights in a future blog, so stay tuned!  Hope to see you in Houston! 

    2019 AADE President, Karen Kemmis and Past President Donna Ryan at last year’s AADE Celebration!

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    Follow us on Twitter and Instagram @AFreshPOVforYou

    Disclaimer: A Fresh POV for You is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to amazon.com.

  • Fresh Views

    Highlights from American Diabetes Association Scientific Sessions (Part 1): Focus on Behavioral Health

    “Wellness is the complete integration of body, mind and spirit – the realization that everything we do, think, feel and believe has an effect on our state of well-being.” ~ Greg Anderson

    Tami, Mike, Deb and Mark enjoying the “Fresh Views” in Marseilles, France

    We’ve just returned from a relaxing vacation in the South of France where we imprinted enough “fresh views” to last us quite a while! But we are quickly back to work, with the first stop post vacation at The American Diabetes Association Scientific Sessions in San Francisco. A Fresh POV for You attended some inspiring sessions, particularly those focused around behavioral health. (If you’ve been following our blog, you know that’s a special interest of ours.) We thought we’d share highlights from several that were particularly impactful.

    Highlight #1

    One of the most rewarding presentations was the Richard R. Rubin Award lecture, presented by Dr. Frank J. Snoek, PhD. The award recognizes an individual who has contributed to the science of the behavioral aspects of living with diabetes. Dr. Snoek’s talk  #DiabetesPsychologyMatters focused on the important connection between behavior change and mental health. As one of his slides depicted…they are two sides of the same coin!

    Dr. Snoek noted that one goal is to shift the burden of diabetes distress, so that higher distress can be moved down to moderate, and moderate moved down to low. He also indicated that a single high score on a distress scale does not mean that an individual needs professional help, or is in a maladaptive situation. Everyone with diabetes experiences diabetes distress at some point and at some level.

    Additionally, he discussed the correlation between mood and behavior, an area of significant interest to us at A Fresh POV for You. He described that when someone actually feels good, they are able to shift their priorities towards less pleasant activities that might help them achieve more long term goals. However, when someone has a low mood, they tend to seek short term rewards to help them feel better in the present.

    Overall he emphasized the need to enhance access to care and specifically called out what he described as “indirect interventions” –  including Diabetes Self Management Education and Support (DSMES), psycho-education as well as internet/mobile interventions. Specifically, he called for incorporating behavioral techniques along with existing pure “education” practices.

    Photo of Frank Snoek’s slide at ADA Scientific Sessions showing the indirect psychological support that can be provided by nurses, diabetes educators, etc.

    We believe that by incorporating Solution-Focused Brief Therapy (SFBT) techniques and counseling approaches, diabetes educators can address the needs of people living with diabetes, incorporating “two sides of the same coin”. Addressing both the self-management education and support needed for behavior change, while at the same time, addressing mental health concerns, such as diabetes distress. In essence, we can “fill the gap” that exists in access to psychological care. Overall this lecture solidified our efforts in moving this approach forward within the diabetes community.

    Highlight #2

    Another impactful session focused on complications associated with diabetes. The emotional toll of diabetes complications-What have we done for them lately.  The panel was moderated by Dr. Korey Hood, a behavioral scientist. Panelists included Chris Aldred (aka The Grumpy Pumper), Kerri Sparling (Six Until Me), Matthew Heywood, and Ina Mendoza. They spoke frankly and candidly about their experiences living with diabetes complications. Managing diabetes is tiring enough, then add a complication, and it becomes so much more complex. Much of the discussion addressed the stigma associated with diabetes complications and how the panelists were/are often told that they “should have done better”. Ouch.  #LanguageMatters when talking about complications. Making people often feel “less than” when they have a complication.  Where is the compassion in care?

    One question from the audience was, “What can we do to make this better?” So, A Fresh POV for You posed an answer to consider….”How about incorporating a more solution-focused approach into practice?  With focus on the solutions and strengths an individual has to help move them forward, rather than focusing on past problems and trying to identify why they occurred.” We know that no matter how much effort goes into managing diabetes, sometimes people still get complications. We also referred to Adam Brown’s Book, Bright Spots and Landmines,, featured in one of our  April blog posts. Focusing on “bright spots” are similar to focusing on the “exceptions” or the things that are going well used in a solution-focused approach.  

    We look forward to sharing more of these concepts in our presentation at the American Diabetes Association Annual Meeting in Houston in August,  Applying the Miracle Question in Diabetes Care.. In fact, here we are finalizing our slides before the deadline while in Marseilles, France.

    What deadlines look like on vacation!

    Highlight #3

    Stigma was a theme common through many of the behavioral health sessions. As recipient of the Outstanding Educator in Diabetes Award, Virginia Valentine, shared a moving presentation, The most important thing we give to people is…Hope: Overcoming stigma in diabetes and obesity,. She explained that the stigma associated with diabetes causes blame and shame, and that “Shame is the intensely painful feeling or experience of believing that we are flawed and therefore unworthy of being loved or belonging.”-Brene Brown. She reminded the audience that “the only thing people with diabetes did wrong is when they picked their grandparents.”  She ended her presentation with a review of the language guidelines that foster person-first, strength based language.

    Highlight #4

    Finally, there was the session on #LanguageMatters- Strategies to Improve Communications in Diabetes Care. Jane K Dickinson, and Joe Solowiejczyk, both healthcare providers and people living with diabetes, gave their perspectives on the use of language. Notably, Jane was the lead author on the publication , The Use of Language in Diabetes Care and Education (we’ve written about #languageMatters in the past here). Then Kevin Joiner connected the dots between the stigma associated with language when engaging in a healthcare discussion. Finally, Dr. Jane Speight, lead author of the Australian Position Paper, A New Language for Diabetes, helped to identify strategies for healthcare providers to communicate more effectively with people living with diabetes. We were excited to see them show the Telly Award Winning #LanguageMatters video that was co-designed with the #DOC and released last year at the AADE meeting, Changing the Conversation.

    Deb watching the Changing the Conversation #LanguageMatters video at the #ADA2019 meeting (Photo credit Renza Scibilia)

    Check back July 10th as we share another big highlight from ADA Scientific Sessions,  discussion of the recently published “Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report”.

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