Family functioning and adherence behaviors are strongly related to a child's health status. Assessment of diabetes-specific family functioning, in addition to adherence, is an important factor in understanding metabolic control.

Five adolescents with diabetes participated in an intensive outpatient treatment programme designed to improve adherence to their regimen and improve metabolic control. Families reported blood sugar levels, injections and food intake daily by telephone. After four weeks they were offered a video-phone. Nine subjects were recruited but four of them dropped out. Of the remaining five, one subject used a video-phone and one subject reported blood sugar results by email. Most of the children improved their metabolic control and all five subjects showed reduced HbA(1c) levels during the three months of the study. The use of telehealth facilitated the treatment of adolescents with poor glycaemic control.

The objective of this study was to review the process of psychology consultation with an outpatient pediatric diabetes service, and provide data regarding assessment and outcome. The purpose was to demonstrate that the inclusion of psychology in the care of the child would enhance the effectiveness of treatment delivery. Over a one-year period, 91 psychological consultations were reviewed for information related to reasons for referral, diagnosis, and treatment. Processes of assessment and collaboration are described. Nearly half of all the participants that were referred for a consultation met the criteria for a psychiatric disorder, including Attention-Deficit Hyperactivity Disorder, mood disorder or anxiety. Paired t-tests revealed significant improvement in metabolic control from referral to the next clinic appointment. Psychological consultation appears to have a positive impact on selected health outcomes. Given the large number of children with psychiatric disorder, psychological intervention may facilitate adherence and reduce complications associated with poor metabolic control.

An educational Website was designed by the Florida Initiative in Telehealth and Education group, and an online diabetes education test was developed using a sample of 60 children and young adults aged 8-22 years, all of whom had diabetes. The 31 items were analysed for item difficulty. Eight test items were eliminated as being unsuitable. The test was then used in 67 prospective diabetes counsellors (23 men, 44 women) who volunteered for a summer camp. Camp counsellors ranged in age from 17 to 33 years (mean 22 years, SD 3). The counsellors' mean pre-test scores were 80% and their mean post-test scores were 92%. There was a significant improvement (P=0.001) of approximately 1.25 questions from pre- to post-test. This supports the use of the online educational Website for training individuals working with children with diabetes. The Website may prove to be useful for online education in other areas of diabetes management.

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