PROJECT SUMMARY/ABSTRACT Type 1 diabetes (T1D) is one of the most prevalent pediatric chronic illnesses and requires a complex treatment regimen. Youth with T1D, particularly those from ethnic minority and lower income backgrounds, struggle to adhere to treatment demands; fewer than 30% achieve recommended levels of glycemic control. Youth with poorly controlled T1D are at risk for health complications. Behavioral Family Systems Therapy for Diabetes (BFST-D), a family-based behavioral intervention, is efficacious in improving health outcomes for youth with T1D and initial effectiveness data suggest a brief version of BFST-D (bBFST-D) is associated with improved glycemic control when delivered as part of standard care. However, few receive these services, particularly those most at-risk, which complicates further evaluation of bBFST-D effectiveness when delivered as part of standard care. Increasing the uptake of bBFST-D may lead to improved overall health of this population. Implementation strategies are methods for integrating evidence-based practices into standard care. The proposed K23 career development award aims to address these gaps in research and provides the means by which Dr. Julia Price will complete scholarly training and practical experience to become an independent investigator in pediatric T1D. The proposed study will develop a toolkit of implementation strategies to increase the reach of bBFST-D by first conducting qualitative interviews with stakeholder groups to identify barriers and facilitators of this care (Aim 1). The Consolidated Framework for Implementation Research (CFIR) will guide these interviews. Second, using results from Aim 1 and drawing from literature identifying conceptually unique implementation strategies, a toolkit of implementation strategies will be developed (Aim 2). Iterative feedback from a Diabetes Advisory Board comprised of stakeholders will facilitate this development process and support identification of three implementation strategies to pilot. Third, the feasibility and acceptability of the selected strategies will be evaluated through a single-case experiment at the PIs institution, and exploratory outcomes (effectiveness of these strategies, change in patient health outcomes among those attending bBFST-D as part of standard care) will also be examined (Aim 3). To explore potential healthcare disparities, provider referral patterns across youth demographic variables will be examined. Through a combination of formal didactics and direct mentored training experiences with her mentoring team (Drs. Kazak, Deatrick, Haire-Joshu, Bunnell, Wysocki), Dr. Price will acquire skills and expertise in the following areas: 1) mixed methods research, 2) implementation science, 3) optimizing electronic health record use for research and for implementing evidence- based healthcare, and 4) designing and conducting clinical trials. Nemours, a national leader in pediatric T1D behavioral research and health informatics, will provide Dr. Price with the ideal environment to successfully complete the proposed project and achieve her goals of becoming an independent investigator and applying for R01 funding to conduct a large multisite randomized hybrid implementation-effectiveness trial of bBFST-D.

NARRATIVE Youth with type 1 diabetes (T1D), particularly those from ethnic minority and lower financial resource backgrounds, exhibit significant difficulty adhering to the complicated treatment regimen for T1D, placing them at risk for adverse acute and long-term health outcomes. Although evidence-based behavioral interventions are efficacious at improving health outcomes for youth with T1D, few families receive this care. Effective implementation strategies, or methods for increasing the integration of behavioral intervention into standard care for youth with T1D, and additional data supporting effectiveness of this intervention when delivered as part of standard care can contribute meaningfully to improving the overall health of youth with T1D.