System overload: Interventions that target the multiple systems in which youth with type 1 diabetes live

Youth with type 1 diabetes (T1D) are tasked with managing their diabetes across complex systems (e.g., family, school, and medical systems), and their diabetes is often impacted by functioning within and across these systems. To effectively intervene, providers must first identify the system or systems in which risk factors exist for any given youth and then subsequently choose a relevant intervention. This chapter examines the state of the literature with regard to behavioral interventions, exploring both single system and multisystem approaches. As this chapter demonstrates, the overwhelming majority of interventions developed for youth with T1D address problems within a single system. However, youth with a combination of risk factors across a number of systems are a particularly vulnerable group, and improvements to outcomes within this group are essential to population health improvements and overall cost savings in pediatric diabetes care. While not yet standard care, there are several intensive, multisystem interventions that have demonstrated success with high-need, high-cost youth with T1D. As such, a case example is presented in order to demonstrate the utility of one multisystem intervention, Novel Interventions in Children’s Healthcare (NICH), and the barriers to implementing such interventions within our current healthcare model are discussed.