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Living a Balanced Life with Diabetes: An Introductory Webinar

September 21, 2019


Thank you for joining
today’s introductory webinar, Living a Balanced
Life with Diabetes. This webinar
is sponsored by the National
Diabetes Education Program, which is a joint
program from the Centers for Disease
Control and Prevention and the National
Institutes of Health. Our two speakers today
are Ms. Shondra McCage and Dr. Michelle Owens-Gary. Shondra McCage is
a Health Promotion Specialist and Program Manager
for the Chickasaw Nation Diabetes Care Center. She earned her MPH at
the University of Oklahoma Health Science Center. She serves as chair for the
American Diabetes Association’s Native American Initiative
Sub-Committee and is also a member of the National
Diabetes Education Program’s American Indian/Alaska
Native stakeholder group. Dr. Michelle Owens-Gary
is a Behavioral Scientist in the Division of
Diabetes Translation at the Centers for Disease
Control and Prevention. At CDC, Dr. Owens-Gary
serves as the team leader of the National Public
Health Initiative on Diabetes and Women’s Health
and is also a staff member for the National
Diabetes Education Program, where she works on
tasks to address diabetes for American
Indians/Alaska Natives, women’s health,
and mental health. She is a licensed psychologist
who earned a Ph.D. degree at the University
of Massachusetts Boston. Shondra, you can proceed. I just wanted to thank
everyone for joining us today. As he mentioned, I am Shon
McCage and I will be covering the first half of
this presentation, and then Dr.
Owens-Gary will cover the second half
of the presentation. We will go ahead
and get started. Our outline
for today is we will cover the burden
of diabetes in Indian country; we will highlight
how depression impacts American Indians
and Alaska Natives. We will describe the
association between diabetes and depression and
why we developed the toolkit, components of
the toolkit, and also how the toolkit can be
used in various settings, and then we will also discuss promotion and
evaluation of this toolkit. I would like to discuss a bit
of the background information related to
diabetes and depression. Diabetes and depression
are two illnesses that are very common and
often occur together. People with diabetes
are twice as likely as people without
diabetes to be depressed. The reason why depression
and diabetes is so concerning is that
diabetes can worsen when depression occurs with it. Depression is associated
with poor glycemic control, and this also increases
the risk of complications and mortality in
people with diabetes. American Indian and Alaska
Native people with diabetes are at particularly
high risk for depression. This is just a few
statistics from the 2007 Report to Congress
by the Indian Health Service. Of course, American
Indians, Alaska Natives we know have the highest age-adjusted
rate of diagnosed diabetes, at 16.3 percent among all
U.S. racial and ethnic groups. Then, in some
communities, the prevalence rate has been known to be
as high as 60 percent. Also, just a few
more health statistics, the likelihood–American Indians, Alaska Natives are over two times
more likely to have diabetes compared to non-Hispanic whites. Then, the death rate due to
diabetes is three times higher for American
Indian, Alaska Natives, compared to the
general U.S. population. This slide continues
to show some of the statistics we were talking
about showing the prevalence of depression
among adults with diabetes. This data was obtained from
a 2006 behavioral risk factor surveillance system. You can see here that the
light blue chart shows that major depression alone, and then the major
and minor depression together is indicated by
the dark blue bar. You can see here of course
that American Indian and Alaska Natives are two to
three times more likely to have major and
minor depression, compared with
non-Hispanic whites. Individuals who are
depressed may have more difficulty following the
medical treatment that their healthcare team
has established for them. Therefore,
depression can result in poor physical and mental
functioning and, of course, when this occurs
we know that these people are less likely to
maintain physical activity or to practice trying
to eat a healthy diet. Just an example,
depressed people may not take their medication as prescribed
or monitor their blood sugars. We all know what kind
of implications that can have. Untreated depression
in diabetes can result in some of the concerns
that I was mentioning with hyperglycemia
or high blood sugars, poor metabolic control, a decreased quality of life, increased
healthcare usage and cost, and also increased
risk of mortality. Also, of course,
our major concerns are untreated
depression can result in diabetes-related complications, and these of course include heart disease, blindness, amputations,
erectile dysfunction, stroke, and kidney disease. Along with depression
some of our patients may also deal with
issues such as denial, anger, and grief. Some of these people
have a difficult time accepting that they
have a chronic illness. Others may become angry or upset
that they developed diabetes. These and other
psychosocial issues are often overlooked in
clinical settings, and they may not be talked about
by our patients unless the healthcare provider
may raise the issue. There can be many
reasons, of course, why depression is overlooked
in the clinical setting or not discussed
by the patient, and of course we
all know that some of this may be due to stigma
that is associated with depression, and so we
realize that it is often hard for people to talk
about being depressed, and people worry about
how others will react or react to them
if they mention this. What we want to know is
that you are able to let your patients know that
this is very common among people with diabetes; it is not a sign of weakness
to be feeling depressed. It is so important
that they try to get help and also that there
is treatment available. Now of course when I say that
there is treatment available, some of you
may have cringed, because I know even in my world, behavioral
healthcare can be an issue, and it is challenging
to get access to care. Some of you may struggle
with that in your areas, but people who are
eligible for care at IHS, tribal, or
urban facilities, they can contact any
clinic nearby, and HRSA, which is the Health Resources
and Services Administration, has information about
federally funded health centers that offer care for
people without health insurance, and you can see
here on the screen that they did list the
website for that. I would encourage you,
after the webinar maybe, you can go online and go
to that website and see what is available and just
as other resources that you can use to
help your patients. The NDEP, in collaboration with the Association of
American Indian Physicians, they spoke with
several healthcare providers about the needs
in our communities and how we can
address psychosocial issues. It was overwhelming that
of course what came up, time and time again, was
that healthcare providers needed resources to help
them increase their own skills in reaching out
to patients concerning psychosocial issues
and emotional concerns. Our healthcare
providers needed materials to help raise awareness
about the risk of depression in American Indian
and Alaska Native people, and as a way of
increasing opportunities for early treatment in
these high-risk individuals. The NDEP’s American Indian/Alaska Native stakeholder group
focuses on efforts to increase awareness of diabetes
prevention and control in American Indian and
Alaska Native communities, and we also identify
depression in diabetes as a
priority issue that needed to be
addressed in Indian country. The main objective
when creating this toolkit was to raise awareness about
social and psychosocial issues and also to provide culturally
appropriate resources. Our toolkit has components
that were developed or included to be used directly by healthcare professionals, but there are also materials
that healthcare professionals can share with
patients who have depression or other
psychosocial concerns. To use the toolkit,
healthcare professionals must be able to
recognize depressive symptoms, familiar with how
to use screening tools, and the main
screening tool we use is the patient
health questionnaire. Patient health
questionnaire nine, you may have heard of this as
PHQ9, to assess depression and also aware of
available community resources to address diabetes and
mental health concerns. Now we can take a look
at the different components that are part
of this toolkit, and on the slide
you are seeing here of course shows the disks
with these materials that you are able to download,
and then also is a magnet with information
and hotline numbers. Michelle, I think, did you
mention too the use of the magnet was really
a popular idea, and people really
liked the use of magnets. People really do
like the use of the magnet, mainly because it is
an easily accessible tool that providers can
hand out to their patients, and the number is available
right there for people to use, especially if there
is a need for an emergency. I’m not familiar. I don’t know if some
of you on the call today have seen the toolkit or
if you just heard of this? I hope you have seen it. If you haven’t,
some of the components inside the toolkit
include the Indian health diabetes best
practices on depression care, of course the
depression screening tools, there is a resource list
that, Using Our Wit and Wisdom, there is the
book and the audio CD. There are also tip sheets
for American Indian and Alaska Natives,
like we just discussed, the suicide prevention
hotline magnet, and then also articles from the Health
for Native Life magazine. Some of you, I know,
may be familiar with these; they have really
good articles in them, and our patients
really like them. The toolkit components, when
we were developing this toolkit, they wanted to
be sure these were things you would
be able to use, and of course so
you are able to copy. These can be copied for
multiple patients or co-brand; you could put your
own organization’s logo on these materials or
use with other NDEP resources. We really wanted
you to tailor it to meet your needs
for your patients. Sometimes they are more
likely to grab something that has a more
familiar logo, your program
or your tribal seal, or something along
these lines, versus something they may not be
familiar and know what NDEP is. We do encourage people
who are going to be using these to tailor it and have it special
for them and their patients. Now we will look more
at the toolkit components that are specifically for
the healthcare professionals, and this includes the Indian health diabetes best practice on depression care, the depression screening tool, and the resource list. First up is, of course, the best practices on depression care. Once again, some of
you may have seen this and/or be familiar with it. This slide
shows the web link that can take you
to this resource. This comes from the
Indian Health Service. You can click on the
division of diabetes treatment and prevention, and you can
get to these resources here. The purpose of
having the best practice on depression care
in to this toolkit was because it really
provides a good guidance for programs that seek to
improve the individual’s diabetes and mental
health status and to enhance the delivery of
effective diabetes care. It describes depression
screening and treatment options, and this best
practice report can be used for any individual with either
Type 1 or Type 2 diabetes. It also provides
eight key recommendations for depression
screening treatment and care, and it
provides suggestions on how to implement
these recommendations. For example, the
key recommendation two says to screen for depression
in all patients with diabetes. Well, how would
you implement that? Well, it gives
you suggestions, you can screen
for depression, and you can use
the screening tool such as the PHQ9 that
we discussed earlier. Then next we are
going to go into discussing more of the
screening tools, and Michelle, she will finish out the
remainder of the presentation. Good afternoon everyone. This is Dr.
Michelle Owens-Gary, as Shon just
mentioned, I will spend the rest of the time
discussing the screening tools and other materials
that are in the toolkit. The next section we will
talk about the toolkit, “Living a Balanced
Life with Diabetes,” looking at two
depression screening tools, and there is a
patient health questionnaire that Shon talked
about, and there is also a depression checklist
which was developed by NDEP’s
psychosocial sub-committee. Here, you see a screen shot of the patient health
questionnaire nine. The patient health
questionnaire nine is a self-administered tool that
assesses depressive symptoms. It is in the public domain, so that means that
anyone can use it. It is available online. You can also order hard
copies from a website; you can Google it and
find more information about the patient health
questionnaire nine. The patient health
questionnaire nine can be used by
healthcare professionals who see diabetes patients. It can be filled out by
the person with diabetes and then reviewed by
the healthcare provider to see whether or not the
patient has depressive symptoms. The PHQ9 is a
helpful tool to help healthcare
providers to determine what the next
steps should be, such as, is there a need for
local resources if the patient is indeed showing
depressive symptoms? The PHQ9 has nine
questions that look at topics related to a person
losing interest in things, a person feeling
down or depressed, having trouble sleeping,
feeling tired or lacking energy, having a change
in one’s appetite, feeling bad about one’s self,
having trouble concentrating, moving or speaking slowly, or having thoughts of hurting
one’s self, or even death. When the
PHQ9 is scored, the items are all scored
from either zero to three. A total score from
zero to four means that the patient may not need
depression treatment. If a healthcare
provider finds that the patient scores
between five to 14, the healthcare provider should
then consider clinical judgment in deciding whether or not
the patient needs treatment. Then greater than 15 means
that the healthcare provider should definitely consider
treatment for depression using
anti-depressants, psychotherapy, or a combination of
medicines and therapy. Once the results
have been scored and tallied, the result should then
be shared with the patient, and then the healthcare
provider should make appropriate
referrals for treatment, if that is indeed necessary. As I mentioned, the NDEP created
the depression checklist. This slide shows you
a screen shot of that checklist, and it was created
to be a part of the toolkit. The checklist
helps us determine if depressive
symptoms are present, and it also
provides resources for additional information related to emotional issues. The checklist can
be given to a patient who completes the PHQ9; it also provides the
patient with tips on how to get help to cope
with his or her feelings. And the depression
checklist provides additional
information about diabetes, as well as about depression. This slide shows
the resource list that is a part
of the toolkit. The resource list provides
information about health, nutrition, physical
activity, and other topics for American Indians
and Alaska Native people. It provides resources
for healthcare professionals to obtain training
related to behavioral health; it also has information
for healthcare providers in terms of
information they can share with their patients
about behavioral change. Then it also has
information to help the patients find the nearest
healthcare facility, if there is a
need for that. So along with the screening tools and the resource list, the toolkit also
contains several other products that can be given to
American Indian/Alaska Native patients with diabetes,
as well as their loved ones. These other components
include the book and audio CD that is called
“Using Our Wit and Wisdom,” new tips sheets for American
Indians and Alaska Natives. As Shon mentioned, a suicide
prevention hotline magnet and also Indian Health for Native Life magazine articles. Now let’s look at “Using
our Wit and Wisdom” book that was written
by Barbara Mora. The book has many topics
that relate to diabetes, and controlling
diabetes for American Indians and Alaska Natives. The “Wit and Wisdom” book
and audio CD highlight successes and challenges
a person may experience while living with
diabetes, and it’s all discussed from a
personal perspective from that of
Barbara Mora’s experience. It is told by
the author but it also provides examples of
how to live a positive life and how to cope
with diabetes. The book chapters
can be used in a group setting to address
different issues related to myths about diabetes, accepting the
diagnosis of diabetes, dealing with
diabetes on a daily basis, and also
obtaining support to cope with diabetes
and emotional feelings. The book chapters can
also be used in a group setting with other
toolkit materials. In using the book, you can
also combine a discussion with a tip sheet, and
there are four tips sheets that are listed that
can be used with the book, and that includes
resources to help a loved one deal with diabetes; that is one tip sheet that
we will discuss in a minute. Another tip
sheet is called “Tips for Taking
Care of Yourself,” and that deals
with self- esteem. “Tips for American
Indian/Alaska Native Teens” and also the book can be used
with a tip sheet that is called “Diabetes, Stress
and Healthy Food Choices.” There are also a whole
host of NDEP resources that the book
could be combined with in a diabetes support
group, such as four steps and also other American
Indian/Alaska Native materials that NDEP
has produced. To learn more about
NDEP resources and tools, please feel free
to visit our website, and that is
www.yourdiabetesinfo.org. An environmental
scan was conducted to determine what tip sheets
and patient education materials currently existed
for people with diabetes, American Indians
and Alaska Natives, and also for
psychosocial issues. Based on this environmental
scan and feedback from the American Indian/Alaska
Native stakeholder group, several tip sheets
were developed for this toolkit. The tip sheets cover
psychosocial issues that many people
with diabetes experience, including depression,
self-esteem, stress and coping, and healthy eating, and
also tobacco and alcohol use. There is also a tip sheet
that helps family members to learn more
about diabetes so that they can care
for their loved one. All of the tip sheets
provide online resources, with some resources
that are specifically for American Indians
and Alaska Natives. A tip sheet for American
Indian/Alaska Native teens was created
for this toolkit. This tip sheet focuses
on stressors that teens may experience in having
diabetes in their youth, particularly as they try
to deal with other life issues, like school, family,
and relationships. It helps teens
realize that it is normal to have concerns
about feeling sad when they think
about having diabetes. It also lets them know
that they are not alone in dealing with
diabetes and that they should talk with others when they are feeling stressed to find new
solutions for their concerns. The tip sheet also
provides a checklist for teens to think about how
they have been feeling about having
diabetes, and to also see if there have been
any major changes in their life, such as
getting poor grades, having no interest
in things they once enjoyed, or just feeling
tired all the time. It also encourages teens to
talk to their healthcare team, their spiritual counselor,
their parents, or others that they trust to
get help and support. The tip sheet on
self-esteem is called “Tips for Taking
Care of Yourself.” It acknowledges that diabetes
and everyday life events can sometimes be tough. It encourages
people with diabetes to get the
support that they need to deal with diabetes
as well as other life issues. Some of the tips to
increase self-esteem include talking about
problems with elders and seeking out their
wisdom, learning something new, like reading about
the tribe’s history and sharing what you
have learned with others. Doing something nice
for others by helping out in your community,
and making a list of your strengths
and accomplishments, listing what you
do well and your successes. Another tip sheet, “Dealing With Stress and
Making Healthy Food Choices,” highlights ways
that people with diabetes can make
healthy food choices, even while
dealing with stress. It emphasizes how people
handle stress in different ways. Some people may turn to
food to cope with stress, and others may avoid
food and not want to eat when they are
dealing with stress. It also provides some
tips on how to handle stress, and that includes talking
to an elder about concerns, being around others
and not isolating one’s self, making sure that
they have fun with others, taking
a nature walk, learning a new activity like
fishing or horseback riding, or other enjoyable events. It also talks about
healthy ways to reduce stress by being
physically active and talking to
people that they trust. On the tip sheet,
it also talks about tips that can help
people with diabetes make healthy food
choices, such as eating a colorful variety
of fruits and vegetables, choosing whole grain foods, limiting solid fats and sugars, and eating a healthy
snack between meals. Within the toolkit
there is another tip sheet that focuses on
tobacco and alcohol use for people
with diabetes. This tip sheet provides
tips on how to handle stress without
tobacco or alcohol. It talks about
the complications that can occur, and it
encourages people with diabetes to find help
and support so they can quit
smoking or using alcohol. The tip sheet acknowledges
that quitting is tough, and it also gives suggestions
for quitting successfully. It also gives information
about staying focused and finding new
activities to do instead of using
tobacco or alcohol. It also highlights
the benefits of not using
tobacco or alcohol, which can include improvement
in health and energy, feeling and
looking better, improvements in taste and
smell, and also saving money. The toolkit has a tip
sheet for family members who are helping a loved
one to cope with diabetes. This tip sheet has
three main messages: learn about diabetes,
talk about diabetes, and be active together. It encourages family members
to learn all that they can about diabetes, so
they can be a support for their loved
ones, helping them with their
medication and daily tasks that are needed for
diabetes self-care. Shon, I know that you
have used the tip sheets, many of them,
in your diabetes center. Could you talk a bit
about how you’ve used them and any
responses you’ve gotten from patients
in your center? Yes, we made a lot
of copies of these, as we mentioned, you
are able to copy these. Of course we put them–
we have these magazine racks that we have in the
patient rooms, and we just put some of these
tip sheets in there. We really left them in
there for the provider to use to give
them, but often while they are
in there waiting, they will pick up these materials and read them, and actually, a couple
of stories, our providers have mentioned that
really encouraged the patient to come forth to the
provider and ask questions, and we were able to help get
them treatment and refer them to our behavioral
health department. Anywhere patients gather that
they may have some downtime: exam rooms, your
lobbies, places like that. Sometimes, just
having these copies there and available, they
may not have picked them up anywhere else if someone
handed it to them to read, but when you are sitting
there kind of bored and waiting, they will thumb
through this material, and I think it sparks
something from within, and seeing these things
that they may approach to either go get
help or talk to their provider more willingly
about these issues. Thank you Shon for
sharing that message. As we’ve talked,
we mentioned that the components of the
toolkit also include a suicide
prevention hotline magnet, and the magnet
provides the phone numbers of suicide
prevention hotlines, where one of
the phone numbers was created
especially for Native youth. Some people may wonder why
is a magnet so important. There are data that have
been collected from the National Suicide
Prevention Lifeline, from April 2010 to January
2012, which indicates that persons who called the National
Suicide Prevention Hotline, they heard about the
actual national hotline through distribution of
magnets, brochures, and posters. So, the magnets really
are helping people to learn about resources and
support that are out there and they have helped
people to get connected to those resources. Seeing a hotline number
on a magnet was one of the top ten ways in which callers
learned about this resource. Providing the
hotline number on a magnet provides an easily
accessible product for people to use and to locate
when they are in a crisis. In discussing
suicidal ideation, it is also important
for us to mention that if you are
with a patient who expresses
suicidal thoughts that the patient should go to
the nearest emergency room and he or she can also call
the National Suicide Hotline number for more information
and also for more support. The toolkit also has
four magazine articles from IHS’s magazine, Health for Native Life. They focus on
anger, denial, grief, and a positive attitude
when dealing with diabetes. Partners have
mentioned to us that having real life
stories about how American Indians and Alaska
Natives cope with diabetes can help others to
learn how to deal with their own
situations. Having the
“Wit and Wisdom” book and these magazine
articles together in the toolkit can help a patient
see themselves in the stories and they also
provide them with new ways of looking at diabetes
and psychosocial issues that are
associated with diabetes. The IHS’s Health
for Native magazine articles promote wellness
and prevention of diabetes in American Indians
and Alaska Natives. They were
developed by IHS’s Division of Diabetes Treatment and Prevention, in partnership with the Tribal
Leaders Diabetes Committee. The magazine
articles can be provided to patients with diabetes as an
additional resource information. They can also be used
as a part of a discussion in a
support group. Here is one of the articles
that is included in the toolkit; the article
is entitled, “What Does Anger Have to
Do With Weight Loss?” The article talks
about a man’s journey from losing
everything in his life: his children, his
wife, his job, and his health. It tells his story
of coming to terms with anger issues and denial
about what was happening to him. He explains how now he
wants to help make an impact on others who are
where he once was, being angry. Another article in
the toolkit is called “Denial and Being
Well with Diabetes.” It highlights a man’s struggle
with breaking out of denial about his
diabetes. It also talked about when
the denial begins to fade, he is able to take
control of his life and also manage
his diabetes. A third article
in the toolkit is called “Grief
and Getting Fit.” It focuses on the grief
of losing one’s language, culture, pride, and all
that have been dear to Native people
for generations. It talks about
grief as a first step to taking control
and getting fit, and it also talks
about a ceremony for healing. The fourth article in
the toolkit is called “A Positive Spin,”
and it talks about a woman who looked at the positives instead of the negatives. It talks about diabetes
as being a positive thing; it talks about how
being happy and positive can help you see things
that you do have in life. It encourages the reader
to make a list of things that are going well
and what they can do to help them deal
with their diabetes. Shon, I know you
mentioned that you have used the magazine articles as
well in the diabetes center. Can you just share a
couple of stories about that? Yes, we’ve
actually used them in a couple of
different ways. We do have a
behavioral health counselor; we offer a diabetes
education class on Tuesdays, which we have
one going today. Our behavioral health
counselor actually uses the “Denial and Being
Well with Diabetes,” sharing his
example and his story. She uses that and passes
that out in our education class, and the patients are able
to identify with this patient and his story. Then, also, we just make
several copies of these, and we’ve used
them at health fairs just to have out
that we distribute out. Sometimes we do get
asked–it kind of depends on your
audience too. We go and talk at
some of our senior sites and different places
around our nation. Sometimes we take copies
of these and we put them in their
goody bags. There are lots of ways you
can distribute these out there and get them out to the
patients to be helpful. Thank you, Shon. This webinar
has provided you with an overview of
the toolkit components and how they can be used
with a patient with diabetes, as well as with his
or her loved ones. In disseminating
the toolkit, NDEP’s American Indian/Alaska Native
stakeholder group members have promoted the
toolkit through many national, local, and
regional conferences, through partner
meetings, newsletters, partner
organizations List Serve, as well as
their own website. We’d appreciate any
suggestions that you have to reach
people like you who would be
interested in using the toolkit with American Indians
and Alaska Natives. We’d like to now
acknowledge all of the hard work of the NDEP
American Indian/Alaska Native stakeholder group members
on the next few slides. If you would like to
learn more about the toolkit, or to even request your
own copy of the toolkit for use with American
Indian/Alaska Native communities that you serve,
please feel free to email
[email protected], or you can call
1-888-693-6337. If you would also like
to learn more about the toolkit, you can also visit
NDEP’s website, and that is
www.yourdiabetesinfo.org. I also wanted
to let you know that NDEP has a
wonderful resource that is called Health Sense;
it’s a resource to help patients learn more about making
and sustaining behavior change. So healthcare providers
can go on this website to learn more about tools and
products that currently exist that focus on
behavior change, and we’d like
to encourage you to use this website
to learn more about behavior change
and diabetes care. You can go to
NDEP’s website, again, it’s listed
there for you; it is ndep.nih.gov/resources/dia betes-healthsense/index.aspx. Also, if you would like
to help us promote and/or evaluate the
toolkit, you can also email us at
[email protected] Before we go to
the questions segment of the webinar, I
wanted to let you all know that there is a
short survey about the webinar experience
that you’ve had. It will be made available
at the very end of the webinar. Operator, we are now
ready for questions. Thank you. Ladies and gentleman,
if you would like to register a question,
please press the one, followed by the
four on your telephone. You will hear
a three tone prompt to acknowledge
your request. If your question
has been answered and you would like to
withdraw your registration, please press the one
followed, by the three, or please use
the chat feature located in the lower
left corner of your screen. One moment please for
our first question. I do have one
question here from the chat, and the question is:
Our teens are dealing with a lot of different
issues all at the same time, not just dealing
with diabetes. What else can you
recommend that we use to teach them about diabetes
and dealing with life changes? The National
Diabetes Education Program has several products
for teens who have diabetes, or even those who are
at risk for diabetes, and they focus on healthy
eating, physical activity, and coping with stress. Please feel free
to visit NDEP’s website for these free
materials, and the website is www.yourdiabetesinfo.org. There is another
question from the chat, and that
question is: Can we obtain a copy
of the presentation? This presentation will be
archived on NDEP’s webpage, so we will be posting
this within the next few months. Please feel free to look for
the webinar on NDEP’s webpage. Again, that is
www.yourdiabetesinfo.org. Is there a
question from the phone? There are no
questions on the phone lines at this time,
however ladies and gentleman, as a reminder, to
register a question please press the
one followed the four on your telephone keypad. There is another
question from the chat, and that says, can
you get multiple magnets outside of or in
addition to the toolkit? The magnets–there are 25
magnets included in the toolkit, so when you
order the toolkit, you will get all
of the components that we talked about, plus
25 magnets for distribution. At this time, the
magnets are not available outside of the toolkit,
but you would just need to order a copy of
the toolkit itself. And I should mention
that the toolkit is free, limited to two copies. Another question
on the chat says: Are there any materials
that are short enough and can be
translated to use as PSAs for tribal
radio stations? NDEP has several materials
that are geared towards different audiences,
different age groups for healthcare providers;
it really depends on the group that you are trying
to focus on for your PSA. I would encourage you
to visit NDEP’s website and also you could use
materials in the toolkit itself to modify for
your own use. We just encourage you
to not change the content, as the content for the
toolkit has been approved by CDC as well as by NIH. Michelle, this is
Shon real quick, There are some PSAs
on the NDEP website, not particularly
pertaining to this toolkit. But there are some out
there regarding diabetes and diabetes prevention,
because we have used them on our radio station,
our tribal radio station. Is there a
question from the phone? There are no phone
questions at this time. I do have
another chat question, and the question is: Is
the PHQ2 no longer used? The PHQ2 is
currently being used, but for this toolkit
we have the PHQ9 available. You could also use the
PHQ2 if that was something that you
wanted to use; it is a shorter
version of the PHQ9. It just has
two questions. Another question
from the chat: Are there CEs,
continuing education, for this? Currently there are no
continuing education credits for this webinar. There is a question
from the chat as well: Will the toolkit have any
local resources listed available for our clients, or
are all of the resources national and web-based? There are some
materials in the toolkit that are
local resources; it just depends
on the materials that we were able to find
in our environmental scan. If they were listed
online, we looked for materials that we felt could be
included into the toolkit. Some materials are
local, and some materials are also national resources
that we were able to locate. Let me just
check and see if there are any
questions on the phone. There are no phone
questions at this time. However, ladies and
gentleman, as a reminder to register for
questions, please press the one, followed by the four on
your telephone keypad. There are still no phone
questions at this time. Michelle, this is Shon. That was a very good
question someone asked about the magnets,
and I think that’s not a question that
has come up before, that we would really
like to get your feedback on whether you want more
specific parts of the toolkit. We can collect this and
definitely be thinking about making–being able
to order specific pieces, I guess of the toolkit. So, we would really
appreciate your feedback, and to please stay on the
line and finish the survey once the
webinar is completed. Thank you. Someone else asked
a question about, can you explain a
bit more about how the toolkit can be
used in a group setting. As Shon and I
talked about, many of the toolkit components can
be used in a group setting. So if you do have a
diabetes support group, or you are working with
a church organization or even an
organization in the community, if you are focusing
on topics related to diabetes such as alcohol or
tobacco use, self-esteem, healthy eating,
or even providing support for the loved one, because
they also experience stress when they are caring
for someone with diabetes. Many of the
components of the toolkit, including the tip sheets
and the “Wit and Wisdom” book, could be used for those
types of discussions. We encourage you just to
look through the toolkit, learn more about the
different components, and see how they might
fit with your audience that you are working with. Someone else
asked a question: We only received one
copy of each tip sheet, so it is okay to make copies of the tip sheets
to give out to more people. The tip sheets
were designed so they are
printer friendly, so they should print
well when they are copied. All of the materials
in the toolkit are also, as I mentioned, in
the public domain, so you can make as
many copies as you need. Even though you only received
one copy of each tip sheet, you can
definitely reprint them, copy them, and
as Shon mentioned, put your logo
on them as well. Another question from the
chat asked about the toolkit: Does it touch on
components of the medicine wheel to incorporate
balance in their lives? The medicine wheel
would be a great resource to also include
in the discussion if you are
using the toolkit, because the
toolkit discusses different issues related
to psychosocial concerns, stress, healthy eating,
choosing healthy foods, and managing one’s life,
even when just dealing with the daily demands of
diabetes–a medicine wheel would also help and add
to what is in the toolkit. So it’s a nice
complement to each other. We definitely would
encourage you to use a medicine wheel to
discuss the whole issue regarding
balance in one’s life. Are there any
questions from the phone? There are no
questions on the phone line. There is another question
in the chat and that is: Can NDEP provide
training to our hospital on this
toolkit? As I
mentioned earlier, the webinar
will be recorded and it will be
archived on NDEP’s website. Unfortunately, we don’t
have the manpower to do individual training, but we
are available for a consultation and also for technical
assistance if that is needed. You can feel free to
look for the webinar, the recording of the
webinar on our website, and that is: yourdiabetesinfo.org. If you need consultation
or TA, you can also email us at [email protected] Another chat
question says: Are you familiar with the
CES depression questionnaire to assess
depression? We are familiar with
the CES depression questionnaire to assess
depression. We didn’t use that in
the toolkit just because we wanted a product that
was a little bit shorter and concise and focused
on some of the topics that we mentioned
throughout the entire toolkit. So, focusing
on loss of interest, not being able to concentrate,
stress, suicidal thoughts, and also
thoughts about death. That’s really what is
covered in the PHQ9. Same question
is asking about, do you recommend
changing it to the PHQ9? The PHQ9 is just one
tool that is out there for depressive symptoms
to assess depressive symptoms. If someone wanted to use the
CES 9, that is highly validated and highly reliable,
so you could use either one; it is just that
we chose the PHQ9 to be a part
of this toolkit. Let me stop and see if
there are any questions on the phone
at this point. There are no questions
on the phone line at this time. This now
concludes the webinar. There will be a
survey at the very end; we thank you for
joining us today. Michelle, this is
Shon again, could we go back to the slide with
our contact information? There, thank you. Again, you see the
email to order the toolkit. Also, if you have
questions about NDEP or any of its products, feel
free to call the 1-888 number,
938
00:52:18,401
and then you can also
go to the NDEP website.

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