Objective: The ISPAD recommends routine, comprehensive psychosocial screening for adolescents with diabetes. However, few clinics have implemented procedures consistent with these guidelines. This study describes the results of a universal, comprehensive psychosocial screening program in an integrated pediatric diabetes clinic located within an academic medical center.Research Design and Methods: Participants included 232 ethnically diverse adolescents with type 1 diabetes (55.5% female; M age = 14.85; 58.5% Hispanic; 20% Black). Adolescents completed screening measures on iPads in the waiting room before their medical visit. The proportion of adolescents screening positive on each psychosocial measure was assessed, and regression analyses evaluated how psychosocial variables accounted for variance in insulin non-adherence and glycemic control (measured by A1c).Results: Psychosocial concerns were common and ranged from 7% of adolescents screening positive for disordered eating and suicide risk to 52% screening positive for low motivation to manage diabetes. A1c and insulin non-adherence were positively correlated with suicide risk, depressive symptoms, anxiety, disordered eating, diabetes stress, blood glucose monitoring stress, family conflict, and total number of elevations, and negatively correlated with intrinsic motivation. Insulin non-adherence, disordered eating, diabetes stress, and family conflict uniquely predicted A1c. Age, motivation, and family conflict uniquely predicted insulin non-adherence. Eightythree percent of eligible youth completed the screener. Referrals by physicians to the team psychologist increased by 25% after the screening program was implemented.Conclusions: Comprehensive psychosocial screening can be effectively implemented as part of routine pediatric diabetes care and can identify adolescents in need of additional supports.

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Health agencies call for the immediate mobilization of existing interventions in response to numerous child and family mental health concerns that have arisen as result of the COVID-19 pandemic. Answering this call, this pilot study describes the rapid, full-scale change from a primarily clinic-based Parent–Child Interaction Therapy (PCIT) model to a virtual service model (i.e., I-PCIT) in an academic and community-based program in Miami, Florida. First, we describe the virtual service training model our program developed and its implementation with 17 therapists ( M Age = 32.35, 88.2% female, 47.1% Hispanic) to enable our clinic to shift from providing virtual services to a small portion of the families served (29.1%) to all of the families served. Second, we examine the effect of I-PCIT on child and caregiver outcomes during the 2-month stay-at-home period between March 16, 2020, and May 16, 2020, in 86 families ( M ChildAge = 4.75, 71% Hispanic). Due to the rapid nature of the current study, all active participants were transferred to virtual services, and therefore there was no comparison or control group, and outcomes represent the most recently available scores and not treatment completion. Results reveal that I-PCIT reduced child externalizing and internalizing problems and caregiver stress, and increased parenting skills and child compliance with medium to large effects even in the midst of the COVID-19 pandemic. Finally, the study examined components of our virtual service training model associated with the greatest improvements in child and caregiver outcomes. Preliminary findings revealed that locally and collaboratively developed strategies (e.g., online communities of practice, training videos and guides) had the strongest association with child and caregiver outcomes. Implications for virtual service delivery, implementation, and practice in the midst of the COVID-19 pandemic are discussed.

Objective: Psychosocial concerns are common among youth with Type I diabetes; psychosocial screening and integrated care models can address these concerns. Medical providers are key stakeholders, but their perspectives on the role of mental health within pediatric diabetes care represent a gap in the literature. This study aimed to describe pediatric diabetes care providers' views on the relationship between psychosocial stress and diabetes, their experiences with psychosocial screening and psychological consultation within their clinic, and their suggestions for mental health professionals working with youth who have diabetes. Method: All endocrinologists, fellows, and diabetes educators involved with psychosocial screening and psychology consultations (N = 7; 71.4% female, 42.9% Hispanic/Latinx White, 28.6% Non-Hispanic/Latinx White, 28.6% Asian) at a single outpatient pediatric diabetes clinic participated in semistructured interviews. Qualitative data were analyzed via thematic content analysis. Results: Providers described a bidirectional relationship between psychosocial stress and diabetes management. They expressed positive views of psychosocial screening and the clinic's integrated psychology team, which allow them to focus on the medical aspect of care and gain comfort with mental health. Providers offered suggestions to improve coordination and communication with mental health professionals. Conclusions: Pediatric diabetes care providers valued psychosocial screening and benefited from collaboration with the clinic psychology team. Clinics without access to mental health professionals may struggle to sustain screening practices. Eliciting medical providers' opinions and using other implementation science strategies are important for incorporating psychosocial screening and intervention within pediatric diabetes clinics, especially for clinics with unique models for psychological services. Kaitlyn E. Brodar https://orcid.

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