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13 Responses

  1. Bernard Farrell
    Bernard Farrell September 29, 2011 at 6:17 am | | Reply

    Glad to see the introduction of a Level 1 category. Has AADE opened up access to more of their publications? As the number of people with diabetes continues to increase and the ratio of diabetics to endos gets worse, CDEs are going to be crucial in the next decade or so. Especially CDEs associated with groups of internists. Any progress on better reimbursement for CDE appointments? That seems to be a remaining roadblock in many places.

  2. Mary Dexter
    Mary Dexter September 29, 2011 at 7:02 am | | Reply

    I would like more information on the Level 1 category. How and where does one get the training? What are the prerequisites?

  3. Scott S
    Scott S September 29, 2011 at 7:41 am | | Reply

    Call me a skeptic when it comes to the AADE: this is a group that works to promote its own interests, which means keeping as many out of the profession as possible. Patients would be served best if there was an alternative to the current certification process, meaning a rival “certification” board existed, just don’t expect the AADE to promote such a thing.

  4. Scott S
    Scott S September 29, 2011 at 8:08 am | | Reply

    Call me a skeptic when it comes to the AADE: this is a group that works to promote its own interests, which means keeping as many out of the profession as possible. Patients would be served best if there was an alternative to the current certification process, meaning a rival “certification” board existed, just don’t expect the AADE to promote such a thing.

  5. Lee Ann Thill
    Lee Ann Thill September 29, 2011 at 11:46 am | | Reply

    This is mostly a rant, but I’ll preface by saying it’s encouraging to see that they’re trying to expand the profession, thus expanding patient access. I understand those kinds of changes take time to structure and implement.

    However, I still have a bee in my bonnet that social workers and psychologists can get certified, but other masters level mental health professionals can’t. I chatted with a couple of psychologists who are CDE’s over the summer, and if I recall correctly, one of them told me how many psychologists actually hold the CDE credential, and I was appalled at how low the number was, I think well below 20… 20! (I don’t know where to verify that number, and I’m drawing from memory of a conversation, so that might not be accurate.) That despite the fact that successful medical outcomes are not only contingent on patients having a solid knowledge base, but also following through on management-related behaviors. Diabetes is obviously a medical condition, but the nature of management may as well make it a behavioral health condition. I’ve ranted about this all over the interwebz on many occasions (as you DM ladies know!), but it burns me up every time the issue comes up. Furthermore, CDE’s are in the early process of establishing state licensure which will allow for reimbursement, but many mental health providers already have state licensure that means patients can get reimbursed for the services they receive. If the CDE standards were expanded to better integrate mental health care, many patients could get the behavioral health support they need, the diabetes education they need, and they could get reimbursed. It’s so frustrating to me, it makes my head spin.

    All of that being said, thanks for the update. I hope AADE and NCBDE continue their efforts to expand access of much needed services to patients, even beyond the successful implementation of the initiatives outlined here. I’m a big fan of creative thinking, and that’s going to be instrumental in alleviating the disconnect between who needs diabetes education and who’s getting it.

  6. riva
    riva September 29, 2011 at 2:38 pm | | Reply

    It’s very interesting what Lee Ann said because it turns diabetes around. Most look at diabetes as a medical condition and then bemoan that patients don’t change their behavior. But if we look at it as Lee Ann said, as “a behavioral health condition” then we have a whole different starting point for qualified professionals to enter the field and a different concentration in training.

    Currently, very few GPs, endos, nurses and even CDEs have behavioral change skills and so after they tell patients what meds to take, they think they’re done. Patients go home, have trouble doing what they’ve been told and get complications. But if we started from the point of view that diabetes is a behavioral condition, professionals would get trained to help patients make the necessary changes to support their self-management and their health.

    But it will take a whole different model for the AADE to see it that way let alone turn the ship around.

  7. Jacquie
    Jacquie September 29, 2011 at 2:43 pm | | Reply

    I was in the same conversation as Lee Ann (I think), and I believe the number given was 12. Twelve psychologists in the whole country who are certified CDEs.

    And unless I missed it, the career path doesn’t seem to be laid out here, does it?

    I love my CDE, and wish hundreds more just like her were available to all in D-land. Can the AADE invent a cloning machine?

  8. Donna Tomky
    Donna Tomky September 29, 2011 at 11:02 pm | | Reply

    Thank you for the questions. I?ll try to answer them here:

    Bernard: While some of our publications are for members only, there are also many that are available to everyone. We agree that diabetes educators need to be in many different practice settings and we?re noticing that more are partnering with PCPs and providing care in the physician office, community centers, and non-traditional settings. Reimbursement for diabetes education went up 44% ($12.99 to $18.69) for group classes in 2011, which is a positive step in the right direction!

    Mary: At this time there is no formal training for Level 1 educators but you may want to check out our online Fundamentals of Diabetes Care course (https://www.diabeteseducator.org/ProfessionalResources/products/fundamentals.html), which is free and meant for healthcare technicians and others interested in the practice of diabetes education. We?re also in the process of developing resources to help facilitate a career path for the beginning levels so stay tuned.

    Lee Ann and Riva: Please review AADE’s position statement on AADE7 Self-Care Behaviors (http://www.diabeteseducator.org/export/sites/aade/_resources/pdf/research/AADE7_Position_Statement_version_2011_update.pdf) to learn more about the changing paradigm of DSME/T. We recognize that behavior change is the key outcome of DSME/T and encourage all diabetes educators to use interventions for facilitating healthy self-care behaviors in their practice. We have learned and continue to learn from behavioral health specialists and would encourage more to join AADE to enrich our multi-discipline organization.

  9. Donna Tomky
    Donna Tomky September 30, 2011 at 7:45 am | | Reply

    Thank you all for your comments and questions. l will try to answer them here:

    Bernard: While some of our publications are for members only, there are also many that are available to everyone. We agree that diabetes educators need to be in many different practice settings and we’re pleased to see that they are increasingly partnering with PCPs and providing care in the physician office, community centers, and non-traditional settings. Reimbursement for diabetes education went up 44% ($12.99 to $18.69) for group classes in 2011, which is a positive step in the right direction!

    Mary: At this time there is no formal training for Level 1 educators but you may want to check out our online Fundamentals of Diabetes Care course (https://www.diabeteseducator.org/ProfessionalResources/products/fundamentals.html), which is free and meant for healthcare technicians and others interested in the practice of diabetes education. We’re also in the process of developing resources to help facilitate a career path for the beginning levels so stay tuned.

    Lee Ann and Riva: Thank you so much for speaking up for mental health professionals. AADE recognizes that behavior change is the key outcome of diabetes education and believes that the emotional impact of diabetes needs to be cared for in addition to the physical. That’s why we include Healthy Coping and Problem Solving as two of our AADE7 Self Care Behaviors. We have a updated position statement on the AADE7 if you are interested: (http://www.diabeteseducator.org/export/sites/aade/_resources/pdf/research/AADE7_Position_Statement_version_2011_update.pdf). Over the past several years, we’ve developed curricula around behavior change, created tools for measuring it and incorporate it as an outcome in all our demonstration projects. I don’t know exactly what NCBDE’s requirements are for mental health professionals wanting to become a CDE, but I do know that we have learned and continue to learn from behavioral health specialists and would encourage more to join AADE to enrich our multi-discipline organization.

    Again, thank you for the feedback.

  10. AngelaC
    AngelaC October 2, 2011 at 3:41 pm | | Reply

    @LeeAnn: Just a quick note on the issue of clinical psychologists and why there are so few — and virtually none at the MA/MS level.

    If you read the eligibility requirements for initial certification 2011 as found on the National Certification Board for Diabetes Educators page(http://www.ncbde.org/eligibility.cfm), qualification 1a reads:

    1.Discipline
    A.Clinical psychologist, registered nurse, occupational therapist, optometrist, pharmacist, physical therapist, physician (M.D. or D.O.), or podiatrist holding a current, active, unrestricted license from the United States or its territories.

    Most people understand “clinical psychologist” to mean someone who works with people who have moderate to severe behavioral, emotional and mental issues (exceedingly basic, I know, but please bear with me). For decades, there have been a number of MA/MS-level programs in clinical psychology that led to students becoming licensed clinical psychologists without having to obtain a doctoral degree. By the late 1980s, though, that changed. Prozac was new on the market and both psychiatrists (MDs with specialized training in psychiatric disorders) and psychologists recognized that a new era in the treatment of many mental disorders had arrived — the era of prescription meds. At that time, licensed psychologists, counselors, social workers, etc, did not have prescription privileges. Members of the American Psychological Association thought it was wrong and began to wage a long war to allow prescription privileges. I was an undergrad psychology major at the time and I remember my department chairman telling me and my classmates that if we intended to work in the mental health field, we needed to be willing to obtain a PhD, since by 1990, no one with a master’s degree in a mental health field would be allowed to sit for the psychologist-licensing exam in Pennsylvania. These same changes have been enacted throughout the country, and it was due at least in part to the push to obtain prescription privileges. The APA could tell states and the federal government that the only people who could call themselves “psychologists” or “clinical psychologists” were people with a doctoral degree, thousands of hours of internships, (and now) post-doc work — giving clinical psychologists comparable training to psychiatrists. I’ve done some research on the current state of affairs and there is only one state in the union that allows people to be licensed as psychologists with only a master’s degree: Vermont. Other states that do allow people to practice psychology do not grant MA/MS holders a full license. These licenses are “Associate” or “Assistant” psychologist licenses and requre the holder to be supervised under a licensed, doctoral-level psychologist. They are NOT clinical psychologists and are not allowed to call themselves by such a title.

    Are there still some MA level clinical psychologists out there? Yes, there are, though many of them were “grandfathered” into the current licensing rules. For the most part, though, clinical psychology MA programs have had to change. People coming out of those programs are often encouraged to sit for the LMSW tests — if their states allow them to do so. They are also allowed to work under terms such as “behavioral therapist”, “mobile therapist”, occassionally couselor, but almost never are they allowed to work under the term “clinical psychologist” or even simply “psychologist”.

    Therefore, under the rules for the CDE exam, virtually no one with a Master’s degree in psychology would be allowed to sit for it. Even certain doctoral degree holders might not be allowed to sit for the exam, such as those receiving their PhDs in Health Psychology, if it does not have the backing clinical internships, APA or CPA certification, post-doc positions, and a host of other hoops through which the candidate for psychology licensing must jump. To me, that is simply a waste of potential talent. In reality, when it comes to the mental health arena, there are only two groups who are allowed to play: PhD/PsyD/EdD clinical psychologists and MSWs. The rest of us with backgrounds in, oh, say, LEARNING SCIENCES (c’est MOI, and isn’t that what diabetes EDUCATION is supposed to be about — LEARNING??) or Art Therapy (c’est toi!!) aren’t welcome at the table.

    IMO, the diabetes education industry is not taking advantage of the intellectual and clinical resources that are out there, despite the growing shortage of trained professionals and the exploding patient population. By only accepting only those with very specific backgrounds, the AADE and the NCBDE are ensuring that more people with diabetes will not know how to manage their diabetes. I do agree with you, Lee Ann. Things need to change!! (Ok, so it wasn’t quick, but this was my rant!)

  11. Berit Bagley
    Berit Bagley November 2, 2011 at 9:37 am | | Reply

    Enjoyed the article, I am a diabetes educator in utah

  12. Janet Tennison
    Janet Tennison November 2, 2011 at 9:44 am | | Reply

    Sitting here listening to Amy at conference. Awesome stuff!

  13. mv
    mv April 17, 2014 at 7:50 pm | | Reply

    It’s really a shame. I am a member of the AADE, I’m a licensed and certified nurse practitioner…yet I cannot qualify to sit for the CDE. Yes, I have years of experience working with diabetic patients…easily half the patients I saw in practice had diabetes. However, unless your practice hours occurred over the year immediately preceding your application…sorry you are out of luck, you don’t qualify. Furthermore, even if I now chose to volunteer my time to obtain the required 1000 hours, well only 400 of those hours can be volunteer…the other 600 hours must be paid employment. In addition, a certain amount of continuing education hours must be earned. So it appears (and I hope I am wrong) that the AADE and the NCBDE are not interested in allowing clinicians with Masters or Doctoral degrees who have a passion for Diabetes education but who currently occupy roles in direct inpatient care, research, or education obtain the CDE credential. The qualifications are so restrictive that only folks hired into diabetes educator roles qualify…in most hospitals, that would be one or two people..to serve all the patients. Proposals of requiring licensure in some states will not relieve the problem because the “experience” requirement is equally restrictive. The language of the licensure and the certification sets the stage for claims that no one is qualified to provide diabetes education unless they have a CDE or the specific licensure. It is upsetting that rather than assuring that more diabetes education is delivered to patients who desperately need it, these organizations seem more concerned with assuring their roles as gatekeepers. Instead of assuring multiple lines of entry, they seem to become more restrictive. What is the next step? Will primary care providers who provide diabetes education now be sanctioned or threatened with legal action if they are not CDE or have a license as a “diabetes educator”? Well, I will remain a member of the AADE for now…I love diabetes education and know that it can make a real difference in patient’s lives…but I do feel like I am on the outside looking-in on that community and would like to be allowed the chance for full membership.

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