5.9.4 Service Delivery

Scope of Services

Up to 15 hours of individual and group diabetes self-management education services can be approved, including skills training. Additional hours must be approved by the field director and discussed with the diabetes program specialist (DPS).

Self-management of diabetes is an important component of an education plan. The education plan must be customized for each consumer

  • age;
  • schedule;
  • physical activity;
  • eating patterns;
  • cultural factors;
  • personality; and
  • diabetes-related complications or other medical conditions (ADA, 2003e).

Diabetes self-management education services include:

  • an initial assessment (up to two hours);
  • skills training on diabetes self-management (up to 12 hours); and
  • a post training assessment (up to one hour).

Individual skills training on diabetes self-management is divided into short segments (ideally two-hour blocks) to reduce travel costs and ensure that the consumer maintains the physical and intellectual stamina needed to benefit from the skills training.

Group sessions (that is, sessions for two or more consumers at a time) can be cost effective. Service providers are encouraged to coordinate group skills training sessions when they will benefit the instruction process and better meet the needs of the consumer. Approval must be obtained from the referring case manager before skills training begins.

If group skills training sessions are conducted, the initial assessment and post training assessment must be conducted individually, so that a consumer’s health information and other concerns may be addressed privately.

Providers of diabetes education are reimbursed only for the time spent teaching consumers about diabetes.

Providers are not reimbursed for:

  • travel time;
  • planning time;
  • office interaction time; or
  • time spent completing and submitting the required paperwork.

Note: If diabetes self-management education services take more or less than the recommended amount of time (for instance, if an assessment takes more than two hours), the service provider: must document the exceptions to the recommended amount of time; and include the documentation in the report before DARS will consider payment.

The required documentation must be submitted within 35 calendar days of the date that any diabetes self-management education service is provided, including initial assessment, skills training, and post training assessment.

Service providers are strongly encouraged to call or email the consumer's vocational rehabilitation counselor (VRC) or independent living worker (ILW) immediately when situations arise that affect the consumer's health or ability to participate in skills training on diabetes self-management.


Assessing Diabetes Self-Management Education Service

The service provider ensures that the individualized education plan (including the initial assessment, instructional and skills training methods, and teaching materials) is appropriate for each consumer, based on the consumer's:

  • age;
  • type of diabetes (type I or II) and duration;
  • cultural influences; and
  • learning abilities.


The Initial Assessment

The initial assessment for each consumer must include the consumer's:

  • relevant medical history;
  • cultural influences;
  • health beliefs and attitudes;
  • diabetes knowledge;
  • self-management skills and behaviors;
  • readiness to learn;
  • cognitive ability;
  • physical limitations;
  • level of family support;
  • financial status; and
  • any employment issues related to diabetes.

As part of the initial assessment, the service provider recommends the specific skills training that the consumer may need.

The training may include information on:

  • the pathophysiology of diabetes (an overview);
  • nutrition;
  • exercise and activity;
  • blood glucose monitoring and use of monitoring results;
  • diabetes-related complications;
  • management of sick days;
  • medical treatment;
  • medication;
  • foot, skin, and dental care;
  • preconception care, pregnancy, and gestational diabetes;
  • insulin;
  • use of the health care system;
  • community resources;
  • stress and psychosocial adjustment;
  • goal setting; and
  • employment aspects and/or barriers related to diabetes.


Blood Glucose Meter

For the purpose of assessing consumers and providing them with skills training, service providers may use the talking blood glucose meter recommended by DBS. If the provider recommends using another talking meter, the diabetes program specialist must approve it before skills training occurs.

If DBS changes its recommendation on a talking blood glucose meter, the service provider has 90 calendar days after being notified about the change to obtain the new talking blood glucose meter.

The consumer’s vocational rehabilitation counselor (VCR) or independent living worker (ILW) is responsible for approving the purchase of the recommended equipment or supplies.


Skills Training for Diabetes Self-Management

The number of skills training hours recommended for individual diabetes self-management is based on:

  • the initial assessment; and
  • the topics covered that are related to the consumer’s vocational and independent living goals.

Skills training on diabetes self-management must include:

  • goals for behavioral change; and
  • participation in healthy lifestyle changes.

A copy of the current DARS diabetes education materials is provided to the consumer in his or her preferred medium (for example, large print, CD, and so on).

Other education materials, resources and referrals are documented on the required forms.

Diabetes self-management education is primarily intended to:

  • provide knowledge and skills training; and
  • help the consumer identify barriers, solve problems, and develop coping skills to achieve effective self-care and behavior change.

The initial assessment and subsequent skills training on diabetes self-management is based on the seven self-care behaviors identified by the American Association of Diabetes Educators.

The AADE’s seven self-care behaviors (known as AADE7) are:

  • healthy eating;
  • being active;
  • monitoring;
  • taking medications;
  • healthy coping;
  • problem solving; and
  • reducing risk.


Group Training

Skills training for diabetes self-management can be provided:

  • in a group of two or more consumers; or
  • as a combination of one-on-one and group training sessions.

In most cases, the training should not exceed 15 hours, total.

Individual skills training for diabetes self-management may be authorized, if group training cannot be scheduled in a timely manner.

The initial assessment and subsequent skills training are usually conducted in the consumer's home. If the skills training is conducted in a group and meets outside the consumer's home, the training and payment are different. Contact the DARS regional program support specialist (RPSS) for more information.


Post-Training Assessment

Post-training (follow-up) assessments are conducted by the service provider at least one month (30 calendar days) after the skills training is completed.

As part of the post training assessment, the service provider:

  • reviews the skills training provided; and
  • reinforces the behavioral changes.

If a post-training assessment is provided before one month (30 calendar days) after the skills training is completed, the service provider must secure approval from the referring case manager.