In the United States, an estimated 9.4% of the adult population has diabetes, and diabetes is the seventh leading cause of death (Statistics, 2018). In addition, about 33% of adults have prediabetes and are at-risk for developing type 2 diabetes (Statistics, 2018). Individuals who have experienced four or more Adverse Childhood Experiences (ACEs) have a 1.6 odds ratio for developing diabetes compared to their counterparts who have no history of ACEs (Felitti,1998). Type 2 diabetes is preventable through lifestyle modifications, and it is essential to ensure that there are trauma-informed type 2 diabetes prevention programs in order to address the public health issues of both diabetes and ACEs (Diagnosing Diabetes, n.d.).
The proposed type 2 diabetes prevention program is targeted towards adults in Alachua County, FL who have experienced at least one ACE and are at-risk for developing type 2 diabetes. This multi-component intervention will be administered by a multidisciplinary team consisting of individuals, including members of the target population, who are well-versed in their respective fields, as well as in trauma-informed approaches. Program components will address various levels of the CDC’s social ecological model as well as multiple dimensions of wellness. Program activities will include weekly blood glucose screenings, weekly outings to state parks, and biweekly cooking classes.
LEVELS OF THE SOCIAL ECOLOGICAL MODEL
Project activities, such as education about blood glucose levels, at the individual level will provide participants with knowledge and skills, which will empower them and help them make lifestyle improvements. This project will go beyond the scope of focusing solely on the individual level of the social ecological model, as it will include the relationship level through cooking classes. Lifestyle changes can be difficult to implement and including family members in the cooking classes will serve to increase buy-in and support from the whole family. In addition, a community component of the program will be addressed through the outings in nature. These outings will connect individuals with similar experiences and will serve as a catalyst for program participants to develop social ties and strengthen their social networks (Centers for Disease Control and Prevention, 2019).
TRAUMA-INFORMED PRINCIPLES
The principle of safety will be incorporated into the project by ensuring that all settings where the project will be implemented are physically safe and welcoming. Project staff will provide program participants with all information relevant to the program and will take the time to listen to the participants in order to establish trustworthiness and transparency. The principle of peer support will be incorporated into the project through the group outings in nature, which will allow program participants time to interact and develop relationships with one another. This project places a strong emphasis on the importance of all project staff undergoing trainings to become trauma-informed, which addresses the SAMHSA principle of collaboration and mutuality. Empowerment, voice, and choice will be incorporated into the program by empowering program participants to make changes to their lifestyles and by letting program participants decide which recipes they would like to learn how to make during the cooking classes. Cultural, historical, and gender issues will be addressed through culturally competent diabetes education, as well as though collaborative development of ground rules by the project staff and program participants, which will emphasize the importance of respect for everyone involved in the program (Substance Abuse and Mental Health Services Administration, 2014).
PUBLIC HEALTH FRAMEWORK
Overall, the program aligns with the secondary prevention level, as the target audience for the program is individuals who have prediabetes and are at-risk for developing type 2 diabetes. The program activities strive to prevent the development of type 2 diabetes among the program population. If any participants develop type 2 diabetes, routine blood glucose screenings will detect type 2 diabetes early-on, and the focus will shift to tertiary prevention of diabetes complications for those participants. In addition, this program recognizes that health is more than just the absence of illness or disease. Both physical and emotional dimensions of wellness are addressed through program activities (Philanthropy Network Greater Philadelphia, 2016).
References
Centers for Disease Control and Prevention (2019). The Social-Ecological Model: A Framework for Prevention. Retrieved February 28, 2019, from https://www.cdc.gov/violencepr...ecologicalmodel.html
Diagnosing Diabetes and Learning About Prediabetes (n.d.). Retrieved February 14, 2019, from http://www.diabetes.org/are-you-at-risk/prediabetes/
Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., & Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American journal of preventive medicine, 14(4), 245-258.
Philanthropy Network Greater Philadelphia, Thomas Scattergood Behavioral Health Foundation, and United Way of Greater Philadelphia and Southern New Jersey (2016). Trauma Informed Philanthropy: A Funder’s Resource Guide for Supporting Trauma-Informed Practice in the Delaware Valley.
Statistics About Diabetes. (2018). Retrieved February 14, 2019, from http://www.diabetes.org/diabet...tics/?loc=db-slabnav
Substance Abuse and Mental Health Services Administration. SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach. HHS Publication No. (SMA) 14-4884. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2014.
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