Microsoft Word - Diabetes Health Educator Toolkit_Final

Recognizing Health Education

Specialists Roles in Diabetes Prevention

and Management

A Toolkit for Diabetes Self-Management Education

Society for Public Health Education

(SOPHE)

SOPHE is a 501 (c)(3) professional organization founded in 1950 to provide global

leadership to the profession of health education and health promotion and to promote the

health of all people by: stimulating research on the theory and practice of health education;

supporting high quality performance standards for the practice of health education and health

promotion; advocating for policy and legislation surrounding health education and health

promotion; and developing and promoting standards for professional preparation of health

education professionals. SOPHE members include nearly 4,000 health education professionals

and students at the national and chapter levels, and in 25 international countries. SOPHE

members work in elementary/secondary schools, universities, voluntary organizations, health

care settings, worksites, and all levels of government agencies. SOPHE is a leading

organization committed to the field of health education and the advancement of the profession,

and continues to work as a champion for using health education specialists in community

settings to address diabetes disparities.

Acknowledgements

This toolkit was written by Bethany Anderson, MPH (c), Loma Linda University; Melanie

Sellers, MPH, Society for Public Health Education; and Nicolette Warren, MS, Society for Public

Health Education. Special thanks are also extended to SOPHE’s Sustainable Solutions for Health

Equity project, SOPHE’s chapter participation and additional reviewers who provided input

and helped to shape the document. This publication was supported by the Cooperative

Agreement Number 5U58DP002328-05 from the Centers for Disease Control and Prevention. Its

contents are solely the responsibility of the authors and do not necessarily represent the

official views of the Centers for Disease Control and Prevention.

Disclaimer: Users of this document should be aware that every funding source has different requirements governing the

appropriate use of those funds. Under U.S. law, no Federal funds are permitted to be used for lobbying or to influence,

directly or indirectly, specific pieces of pending or proposed legislation at the federal, state, or local levels. Organizations

should consult appropriate legal counsel to ensure compliance with all rules, regulations, and restriction of any funding

sources.

Introduction .................................................................................................................................................... 4

Diabetes Disparities ....................................................................................................................................... 6

What Can Be Done to Address the Problem? ................................................................................................. 7

Diabetes Self-Management Education (DSME) .............................................................................................. 9

Health Education Specialists ........................................................................................................................ 12

Diabetes Educators ...................................................................................................................................... 14

The National Certified Board of Diabetes Educators (NCBDE) Mentoring Program ..................................... 17

American Diabetes Association (ADA) Diabetes Recognition Programs...................................................... 19

American Association of Diabetes Educators (AADE) Diabetes Education Accreditation Program ............. 21

The National Diabetes Education Program (NDEP) ...................................................................................... 22

Why Become Accredited? ............................................................................................................................ 24

Action Steps ................................................................................................................................................. 26

Conclusion ................................................................................................................................................... 29

Table of Contents

Introduction

Clinical and community prevention efforts should be mutually reinforcing and

appropriate health care provided in clinical settings, recommending community-based

prevention efforts, and providing environments that enhance health. According to the Institute of

Medicine,

“It is unreasonable to expect that people will change their behavior when so many forces in the

social, cultural, and physical environment conspire against such change.”

Because of diabetes, care must address a diverse community of people needing

assistance with diabetes complications, and education, it is important for health education

specialists to be diverse in their approach as well. This toolkit is not a comprehensive list of

every diabetes education opportunity offered, but is to be used as a guide to highlight recent

changes and can be used as a starting point. This toolkit has been designed to promote health

education specialists in providing Diabetes Self-Management Education (DSME) in both clinical

and community settings. Incorporating health education specialists within the community setting

strengthens coverage for Americans and provides better opportunities for meeting healthcare

needs, thus accelerating efforts to improving the nation’s health overall.

Institute of Medicine, Division of Health Promotion and Disease “Prevention. Promoting health: Intervention

strategies from social and behavioral health research.” The National Academies Press, 2001. Print.

“Of all the forms of inequality, injustice in health care

the most shocking and inhumane.”

–Martin Luther King, Jr.

Health Disparities

In 1966, Martin Luther King said that “Of all the forms of inequality, injustice in health

care is the most shocking and inhumane.”

The burden of illness, premature death, and

disability disproportionately affects certain populations. Residents in mostly minority

communities continue to have lower socioeconomic status, greater barriers to health-care

access, and greater risks for, and burden of, disease compared with the general population

living in the same country or state.

Health disparities are contributing the health crisis of

increasing chronic diseases in America.

Chronic Diseases

According to the Centers for Disease Control and Prevention, chronic diseases are

responsible for 70% of American deaths each year.

Americans living with chronic diseases

account for 75% of the nation’s health spending.

The World Health Organization has estimated

that if the major risk factors for chronic diseases were eliminated, at least 80% of all heart

disease, stroke, and type-2 diabetes would be prevented, and more than 40% of cancer cases

would be prevented.

As the United States continues to move forward with health reform, there

is a realization in the importance of having health education specialists plays a critical role in

primary prevention and chronic disease management. This is especially true among chronic

diseases such as diabetes.

Hamilton, Nalo & Giscombé, Cheryl Woods. “Of all the forms of inequality, injustice in health care is the most

shocking and inhumane.” Human Capital Blog – Robert Wood Johnson Foundation, 21 January 2013. Web. 22 May

2014. http://www.rwjf.org/en/blogs/human-capital-blog/2013/01/_of_all_the_formsof.html

US Department of Health and Human Services. “CDC Health Disparities and Inequaliteis Report – United States,

3013.” Centers for Disease Control and Prevention, 22 November 2013. Web. 14 May 2014.

http://www.cdc.gov/mmwr/pdf/other/su6203.pdf

National Center for Chronic Disease Prevention and Health Promotion. “ The Power of Prevention – Chronic

disease… the public health challenge of the 21

century.” Centers for Disease Control and Prevention, 2009. Web.

14 May 2014. http://www.cdc.gov/chronicdisease/pdf/2009-power-of-prevention.pdf

Centers for Disease Control and Prevention. “Chronic Disease Prevention and Health Promotion.” Centers for

Disease Control and Health Promotion, 6 May 2014. Web. 14 May 2014. http://www.cdc.gov/chronicdisease/

Diabetes Disparities

While African Americans, Hispanic/Latino Americans, American Indians, Asian

mericans, and Pacific Islander Americans have lower rates of type-1 diabetes, they are at

greater risk for type-2 diabetes than Whites. Gestational diabetes affects African Americans,

Hispanic/Latino Americans, and American Indians at greater rates than other groups.

dditionally, poverty, lack of access to health care, cultural attitudes toward health care, and

behaviors are all barriers to preventive services and diabetes management care in minority

populations.

Diabetes is the leading cause of new cases of blindness; non‐ traumatic, lower‐ limb

amputations; and kidney failure among adults as well as a major cause of heart disease and

stroke.

People with diabetes can reduce diabetes complications by controlling blood glucose,

blood pressure, blood lipids, and getting timely preventive care.Diabetes is associated with

higher health care costs. For example, in 2001, 30% ofhigh

‐

cost Medicare beneficiaries (those

in the top quartile of costs) had diabetes compared to 16% of low

‐

cost beneficiaries (bottom

75%).

In 2010, over 25 million people in the United States had diabetes. If current trends

continue, 1 in 3 adults will have diabetes by the year 2050. The Centers for Medicare and

Medicaid Services (CMS) estimate of healthcare expenditures for 2010 was $2.7 trillion.

ssuming the costs of care for people with diabetes held steady, people with diabetes account

for 43% of the direct medical costs.

Centers for Disease Control and Prevention. “Groups Especially Affected by Diabetes.” Centers for Disease

Control and Prevention, 7 March 2014. Web. 12 May 2014. http://www.cdc.gov/diabetes/consumer/groups.htm

National Association of Chronic Disease Directors. “Addressing a Major Complication of Diabetes to Reduce

Health Care Costs.” Society for Public Health Education, February 2012. 14 Web. May 2014.

http://www.sophe.org/Sophe/PDF/NACDDDiabeteWhitePaper.pdf

Centers for Medicare and Medicaid Services. “National Health Expenditure Projections 2011-2021.” Centers for

Medicare and Medicaid Services, 2011. Web. 13 May 2014. http://www.cms.gov/Research-Statistics-Data-and-

Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/Downloads/Proj2011PDF.pdf

American Diabetes Association. “The Cost of Diabetes.” American Diabetes Association, 18 April 2014. Web. 13

May 2014. http://www.diabetes.org/advocacy/news-events/cost-of-diabetes.html

Of the approximately 500,000 professionals that constitute the public health workforce,

roughly 85% are employed by a government agency. They work in the 3,000 the local health

departments, 56 state and tribal agencies, and various other federal agencies such as the

Centers for Disease Control and Prevention (CDC), the Health Resources and Services

Administration (HRSA), the National Institutes of Health (NIH), and the Agency for Healthcare

Research and Quality (AHRQ). The remaining 15% of the public health workforce works in

nonprofit organizations, academia and research, hospitals, medical groups, and private

companies. The Affordable Care Act (ACA) has been designed with investments into public

health infrastructure and boosting the number of public health workers in the workforce.

Community-based programming also benefits from these investments. Programs receive

better support for their prevention efforts, health education activities, and training of health

workers. The ACA also allows investment in projected health workforce needs. These

projected needs are not just on the federal level – they trickle down to the regional, state, and

local levels as well.

It is necessary to have affordable, comprehensive training options for

Certified Diabetes Educators (CDE) at low cost using community-based adult learning

methods.

With the rollout of the ACA, the healthcare landscape is rapidly changing. Because

public health focuses on population-level health as opposed to individual, clinical health, it is

unique in comparison to other areas of healthcare. Since the mid-1970s, there have been

question surrounding the validity and need for a health education specialist. Today, we are

questioning how to better incorporate health education specialists into the primary care team.

With new funding for prevention and health promotion, new and innovative opportunities are

becoming possible for health education specialists to broaden their impact and participate in

the various new models of service delivery.

American Public Health Association, “The Affordable Care Act’s Public Health Workforce Provisions:

Opportunities and Challenges.” American Public Health Association, June 2011. Web. 14 May 2014.

http://www.apha.org/NR/rdonlyres/461D56BE-4A46-4C9F-9BA4-

9535FE370DB7/0/APHAWorkforce2011_updated.pdf

What Can Be Done to Address the Problem?

The ACA creates opportunities for health education specialists to have a more defined

role in healthcare delivery. Through the Prevention and Public Health Fund, the ACA provides

invaluable resources to support community-based strategies in preventing chronic diseases as

well as improving public health. Diabetes education is a cost effective management strategy.

An investment of $10 per person in proven community-based disease prevention programs

could yield a net savings of more than $16 billion annually within five years, a Return on

Investment (ROI) of $5.6 for every $1 invested. A 5% reduction in the obesity rate could yield

more than $600 billion in savings in health care over the next 20 years.

Every new health plan, since 2010, has included coverage of evidence-based, effective

preventive services, such as screenings for type 2 diabetes, immunizations, and mammograms,

without co-pays. Since January 1, 2011, seniors on Medicare have received many preventive

services, with no co-payments including annual wellness visits, cervical cancer screening,

diabetes screening, mammograms and important immunizations such as for the flu and

pneumonia.

De Biasi, Anne. “Sustainable Funding for Community Prevention.” Health Education Advocate, 22 February 2014.

Web. 14 May 2014. http://healtheducationadvocate.org/wp-

content/uploads/2014/03/BringingItAllTogetherADV2014KR.pdf

US Department of Health and Human Services. “Medicare Preventive Services.” HHS.gov/HealthCare, 1 May

2014. Web. 14 May 2014. http://www.hhs.gov/healthcare/prevention/seniors/medicare-preventive-services.html

Diabetes Sel

-Management Education (DSME)

DSME is the collaborative process through which people with or at risk for diabetes gain

the knowledge and skills needed to modify behavior and successfully self-manage the disease

and its related conditions. It is an interactive, ongoing process involving the person with

diabetes (or the caregiver or family) and a diabetes educator. The intervention aims to achieve

optimal health status, better quality of life and reduce the need for costly health care.

Diabetes education focuses on seven self-care behaviors that are essential for improved

health status and greater quality of life. The AADE7™ Self-Care Behaviors are:

 Healthy eating

 Being active

 Monitoring

 Taking medication

 Problem solving

 Healthy coping

 Reducing risks

In the September/October 2003 issue of The Diabetes Educator (TDE 29[5]) AADE published

its Position Statement on Standards for Outcomes Measurement of Diabetes Self-Management

Education. The Standards elaborate the five areas shown in Figure 1: DSME Outcomes

Standards and listed below:

 Behavior change is the unique outcome measurement for diabetes self-management

education.

 Seven diabetes self-care behavior measures determine the effectiveness of diabetes

self-management education at individual, participant, and population levels.

 Diabetes self-care behaviors should be evaluated at baseline and then at regular

intervals after the education program.

 The continuum of outcomes, including learning, behavioral, clinical, and health status,

should be assessed to demonstrate the interrelationship between DSME/T and behavior

change in the care of individuals with diabetes (see Figure 2: Outcomes Continuum).

 Individual patient outcomes are used to guide the intervention and improve care for that

patient. Aggregate population outcomes are used to guide programmatic services and

for continuous quality improvement activities for the DSME/T and the population it

serves.

American Association of Diabetes Educators. “AADE7 Self-Care Behaviors.” American Association of Diabetes

Educators, 2009. Web. 22 May 2014. http://www.diabeteseducator.org/ProfessionalResources/AADE7/

Mensing, Carolé, et. al., “The Diabetes Educator Career Path: Revised Levels of Practice.” American Association

of Diabetes Educators, Publication date unknown. Web. 13 May 2014.

http://www.diabeteseducator.org/export/sites/aade/_resources/pdf/general/Narrative.pdf

Diabetes Sel

-Management Education

Figure 1: DSME Outcomes Standards

Mensing, Carolé, et. al., “The Diabetes Educator Career Path: Revised Levels of Practice.” American

Association of Diabetes Educators, Publication date unknown. Web. 13 May 2014.

http://www.diabeteseducator.org/export/sites/aade/_resources/pdf/general/Narrative.pdf

Health education specialists may

play a critical role in providing

diabetes self-management

education.

Figure 2: Outcomes Continuum

American Association of Diabetes Educators. “AADE7 Self-Care Behaviors.” American Association of Diabetes

Educators, 2009. Web. 22 May 2014. http://www.diabeteseducator.org/ProfessionalResources/AADE7/

Health Education Specialists

Health education specialists are, as Tennessee senator, Bill Frist (R) states, “the workers on

the ground [who] see the needs and the gaps in care.”

The U.S. Department of Labor Bureau of

Labor Statistics (BLS) defines health educators (SOC 21-1091.00) as those who promote, maintain,

and improve individual and community health by assisting individuals and communities to adopt

healthy behaviors, collect and analyze data to identify community needs prior to planning,

implementing, monitoring, and evaluating programs designed to encourage healthy lifestyles,

policies and environments. They may also serve as a resource to assist individuals, other

professionals, or the community, and may administer fiscal resources for health education

programs.

The health education profession developed its first set of evidence-based competencies in

1998 and a certification system under the National Commission for Health Education

Credentialing (NCHEC). Since then, SOPHE has worked with NCHEC on two comprehensive

research projects to update the competencies addressing health educators’ contemporary roles

in individual- and population-based health. Health education specialists bring valuable,

complementary skills to the health care and public health teams in addressing diabetes

prevention and control.

NCHEC is the official certification body for health education specialists, which is based on

a rigorous exam. The Certified Health Education Specialist (CHES) examination is a competency-

based tool used to measure possession, application and interpretation of knowledge in the Seven

reas of Responsibility for Health Educators, delineated by A Competency-Based Framework for

ealth Education Specialists 2010. Eligibility to take the CHES examination is based on exclusive

academic qualifications. The Master Certified Health Education Specialist (MCHES) exam

eligibility includes both academic and work experience requirements. Professionals who pass

either exam and are credentialed as CHES/MCHES must complete 75 hours of approved

continuing education over 5 years to maintain their certification.

Frist, Bill. “The Case for Global Health Diplomacy.” Health Affairs Blog, 14 April 2014. Web. 13 May 2014.

http://healthaffairs.org/blog/2014/04/14/the-case-for-global-health-diplomacy/

US Bureau of Labor Statistics. “What Health Educators and Community Health Workers Do.” Occupational Outlook

andbook,

8 January 2014. Web. 13 May 2014. http://www.bls.gov/ooh/community-and-social-service/health-

educators.htm#tab-2

Society for Public Health Education. “Affordable Care Act: Opportunities and Challenges for Health Education

Specialists.” Society for Public Health Education, April 2013. Web. 14 May 2014.

http://www.sophe.org/Sophe/PDF/ACA-Opportunities-and-Challenges-for-Health-Educators-FINAL.pdf

Health Education Specialists (cont’d)

The core areas of responsibility of CHES and MCHES are:

I. Assess Needs, Assets and Capacity for Health Education

II. Plan Health Education

III. Implement Health Education

IV. Conduct Evaluation and Research Related to Health Education

V. Administer and Manage Health Education

VI. Serve as a Health Education Resource Person

II. Communicate and Advocate for Health and Health Education

It is important to note that health education competencies are designed to be generic in

nature and apply regardless of the work setting, group versus individual setting, and subject

matter. These core competencies are then integrated specifically to a subject-specific material.

The health education responsibilities and competencies are skills that can be applied to a variety

of health content areas, including diabetes.

National Commission for Health Education Credentialing, Inc. “Responsibilities and Competencies for Health

Education Specialists.” National Commission for Health Education Credentialing, Inc., 2010. Web. 14 May 2014.

http://www.nchec.org/credentialing/responsibilities/

Diabetes educators are involved in direct patient care, education of other healthcare

professionals, research, social reform and advocacy. Many diabetes educators obtain

certification in the specialty and are credentialed as a certified diabetes educator (CDE) or board

certified advanced diabetes manager (BC-ADM) and, in some cases, both. An educational

background in healthcare, considerable experience working with diabetes patients, and a

comprehensive knowledge base enable a qualified healthcare professional to take a certification

examination. It has long been AADE’s position that diabetes educators should work toward

certification in the specialty. In the U.S., the National Certification Board for Diabetes Educators

(NCBDE)

sets the criteria for CDE certification whereas the American Association of Diabetes

Educators (AADE) establishes the criteria for the BC-ADM credential.

Other countries often have

their own standards, processes, and names for the credentialed educator. Curiously, recent

surveys suggest that while certification is valued by the educator, it may no longer be required

for employment (Tobin, 2008; Zrebiec, 2009). This disturbing trend suggests that employers may

fail to understand the complexities of Diabetes Self-Management Education and Support (DSMES)

and the critical role of the credentialed diabetes educator in the delivery of comprehensive care.

Equally troubling is the notion that primary care providers may not fully appreciate the

contribution of diabetes educators in facilitating self-care management, a trend suggested by

referral patterns (AADE, 2009a; AADE 2009b; Martin et al., 2008; Martin et al., 2013; Peyrot et al.,

2009).

National Certification Board for Diabetes Educators. “Welcome to the National Certification Board for Diabetes

Educators.” National Certification Board for Diabetes Educators, 2014. Web. 14 May 2014. http://www.ncbde.org

American Association of Diabetes Educators. “American Association of Diabetes Educators.”

American Association

of Diabetes Educators,

2014. 14 May 2014. http://www.diabeteseducator.org

Diabetes Educators

(cont’d)

Certified Diabetes Educators

A Certified Diabetes Educator® (CDE®) is a health professional who possesses

comprehensive knowledge of and experience in prediabetes, diabetes prevention and

management. The CDE® educates and supports people affected by diabetes to understand and

manage the condition. The CDE® promotes self-management to achieve individualized

behavioral and treatment goals that optimize health outcomes.

Opportunities as Certified Diabetes Educators (CDE)

Starting January 1, 2014, NCBDE Board approved SOPHE’s request to recognize MCHES

credentials to be eligible to take the CDE exam. Individuals must meet the MCHES eligibility

criteria and must still fulfill NCBDE’s remaining eligibility criteria. Individuals holding the

MCHES credential must meet the Discipline requirement, and prior to applying for

certification, candidates must accrue:

1. A minimum of two (2) years, to the day of application, of practice experience as an

MCHES;

2. A minimum of 1,000 hours of DSME practice experience in the four years prior to the

date of the CDE® certification application, 400 hours of which must be in the year

immediately prior to application; and,

3. A minimum of 15 clock hours of approved continuing education applicable to diabetes,

and provided by one of NCBDE’s recognized continuing education providers, within two

years of the date of application.

In 2010, NCBDE, AADE, and the American Diabetes Association (ADA) created the

Diabetes Educator Mentorship Program as an avenue that promotes careers leading to a CDE

designation. Now MCHES credential holders are able to earn the 1,000 hours of DSME through

various offered mentorship strategies.

To find a mentor in your area, visit

http://www.ncbde.org/certification_info/mentorship-program/mentor-listing/.

National Certification Board for Diabetes Educators. “What is a CDE?” National Certification Board for Diabetes

Educators, 2014. Web. 14 May 2014. http://www.ncbde.org/certification_info/what-is-a-cde/

Harrington, Carolyn C., RD, LDN, CDE. "Ltr to Auld Re-MCHES." Letter to Elaine Auld, MPH. National

Certification Board for Diabetes Educators, 1 Mar. 2013. Web. 22 May 2014.

file:///Users/bethy/Downloads/ltr%20to%20auld%20re-mches%20credential%200227013%20_3_%20(1).pdf

National Certification Board for Diabetes Educators. “Mentorship Program.” National Certification Board for

Diabetes Educators, 2014. Web. 22 May 2014. http://www.ncbde.org/certification_info/mentorship-program/

The National Certified Board of Diabetes Educators

(NCBDE) Mentoring Program

In 2010, the NCBDE, the ADA, and the AADE created the Diabetes Educator Mentorship

Program that began in 2011. This program has been designed to promote careers that will lead to

Certified Diabetes Educator designation, thus improving access to DSME. The National

Certification Board for Diabetes Educators makes it easy to find a CDE in your area. To find a CDE

currently working in your area, visit http://www.ncbde.org/find-a-cde/.

The program works to partner healthcare professionals interested in gaining experience in

providing DSME with experienced CDE-credentialed diabetes educators. The goal is to assist

these professionals with meeting the current hours of experience practice requirement for CDE

certification. To be eligible for certification, NCBDE requires the following:

To meet the discipline licensure requirement, one must be a clinical psychologist, registered nurse

(RN), occupational therapist, optometrist, pharmacists, physical therapist, physician (MD or DO),

or podiatrist holding a current, active, unrestricted license from the US or its territories. One can

also be a dietitian or dietician nutritionist holding active registration with the Commission on

Dietetics Registration, a physician assistant (PA) holding active registration with the National

Commission on Certification on Physician Assistants, an exercise specialist holding active

certification as an American College of Sports Medicine (ACSM) Registered Clinical Exercise

Specialists, or an exercise physiologist holding an active certification as an ACSM Registered

Clinical Exercise Physiologist, a health educator holding active certification as a Master Certified

Clinical Exercise Specialist from the National Commission for Health Education Credentialing.

One can also be a health professional with a master’s degree or higher in social work from a US

college or university accredited by a nationally recognized regional accrediting body. If you do

not meet any of these licensure requirements, you can file for the NCBDE Unique Qualifications

Eligibility Pathway

http://www.ncbde.org/assets/1/7/UQPathwayAppCanonsPacket092513fillableFinal.pdf.

After meeting the discipline requirement and before applying for the examination, a

minimum of 15 clock ours of continuing education activities that are applicable to diabetes

within the two years prior to applying for certification, must be met. These continuing

education hours can be provided by the following providers:

 American Association of Diabetes Educators (AADE)

https://www.diabeteseducator.org/ProfessionalResources/products/

 American Diabetes Association (ADA)

http://professional.diabetes.org/HomeContinuingEducationAndMeetings.aspx?hsid=5

 Academy of Nutrition and Dietetics (Academy) http://www.eatright.org/cpd/

 International Diabetes Federation (IDF) http://www.idf.org/

 Accreditation Council for Pharmacy Education (ACPE) Accredited or Approved

Providers https://www.acpe-accredit.org/shared_info/providersSecure.asp

 Accreditation Council for Continuing Medical Education (ACCME) Accredited or

Approved Providers http://www.accme.org/

 American Academy of Family Physicians (AAFP) http://www.aafp.org/cme.html

 American Academy of Optometry (AAO) http://www.aaopt.org/meetings-continuing-education

 American Academy of Physician Assistants (AAPA) http://www.aapa.org/cme/

 American Association of Clinical Endocrinologists (AACE) https://www.aace.com/education

 American Association of Nurse Practitioners (AANP) http://www.aanp.org/education/continuing-

education-ce

 American College of Endocrinology (ACE) https://www.aace.com/college

 American College of Sports Medicine (ACSM) http://www.acsm.org/find-continuing-education

 American Medical Association (AMA) http://www.ama-assn.org/ama/pub/education-careers/continuing-

medical-education.page?

 American Nurses Association (ANA) http://ananursece.healthstream.com/

 American Nurses Credentialing Center (ANCC) Accredited or Approved Providers

http://www.nursecredentialing.org/

 American Occupational Therapy Association (AOTA) http://www.aota.org/Education-

Careers/Continuing-Education.aspx

 American Physical Therapy Association (APTA)

http://www.apta.org/CoursesConferences.aspx?navID=10737422670

 American Psychological Association (APA) http://www.apa.org/education/ce/

 Council on Continuing Medical Education (CCME-AOA) Approved Sponsors [American

Osteopathic Association (AOA)] http://www.osteopathic.org/inside-aoa/development/continuing-medical-

education/Pages/default.aspx

 Council on Podiatric Medical Education (CPME-APMA) Approved Sponsors

http://www.cpme.org/education/content.cfm?ItemNumber=2422

 Commission on Dietetic Registration (CDR) Accredited or Approved Providers

https://www.cdrnet.org/

 National Association of Clinical Nurse Specialists (NACNS) http://www.nacns.org/html/cont-

ed.php

 National Association of Social Workers (NASW) http://www.socialworkers.org/pdev/default.asp

 National Commission for Health Education Credentialing (NCHEC) Designated

Providers

http://www.nchec.org/ce/getcredit/

American Diabetes Association (ADA) Diabetes

Recognition Programs

Another option that addresses diabetes disparities is for organizations to become

recognized Diabetes Self-Management Education programs. Diabetes Self-Management

Education has been associated with improvement in diabetes knowledge, self-care behavior, and

clinical outcomes. The American Diabetes Association (ADA) Standards of Medical Care in

iabetes 2011 states that health management plans for people with diabetes “should recognize

diabetes self-management education (DSME) and ongoing diabetes support as an integral

component of care.” DSME is associated with improved diabetes knowledge, improved selfcare

behavior, better clinical outcomes such as lower HbA1c and lower selfreported weight, and

reduced hospitalizations, emergency room visits and medications costs.

National Certification Board for Diabetes Educators. “Recognized Provider List.” National Certification Board for

iabetes Educators,

2014. Web. 14 May 2014. http://www.ncbde.org/currently_certified/recognized-provider-list/

Continuing education activities that are provided through an accredited academic institution in

the U.S. or its territories granting degrees to professional practice are also accepted. The exam

is offered twice a year (spring and fall) to approved candidates. There are multiple testing

centers across the country, and the exams are proctored.

To become certified through ADA, you must have the following:

 Annual Quality Improvement Project

 Approved Curriculum

 Advisory Committee Meeting and meeting minutes

 All areas of Chronicle completed, communication with provider documented and DSMS

plan completed.

 Behavior goals must be set at every patient contact and reviewed at every patient

subsequent visit. Documentation in Chronicle.

 Program Coordinator must have a job description and CV

 Cost

 Chronicle Application

 Materials Needed

o Check number

o Minimum of 1 patient seen in last 3-6 months.

o 2 outcome measures for all patients

o Letter of support from sponsoring organization

o Copies of licenses, registrations, CDE credentials and certificates indicating 15-20

hours of CEUs

o Possible Audit Items

As of May 2014, you must provide $1100 for initial site and $100 for each additional site

after that. For current fees, visit

http://professional.diabetes.org/HomeDiabetesEducationAndRecognition.aspx?hsid=4.

Recognition must be within the lasts 4 years. All data is pulled from the site; documented

evidence of Sponsoring Organizational support (PDF) (e.g. letter signed by official of the

sponsoring organization responsible for the diabetes education program).

A potential CDE must have copies of active licenses, registrations (CDR cards only

required for RDs), certificates for other credentials (e.g. CDE, BC-ADM, etc.), as well as

certificates for official verification of accrued continuing education credits as applicable to the

coordinator and all active instructional staff on the application. Non –certified instructional staff

(non-CDE or BC-ADM) must provide 15 hours of qualifying CEUs for multi-discipline programs

and 20 hours for single-discipline programs.

American Diabetes Association. “Education Recognition Requirements.” American Diabetes Association, 2012.

Web. 14 May 2014. http://professional.diabetes.org/admin/UserFiles/2012%20ERP/education-recognition-

requirements-2012.pdf

Paper Audit Items: (Note all five required for new or original applicants; one randomly

assigned for renewing/additional site applicants)

 Documentation of Advisory Group activity within 12 months of application submission

date http://professional.diabetes.org/UserFiles/ERP/Annual%20Program%20Review%20-%2005-11-09.pdf

 Program Coordinator’s job description

http://professional.diabetes.org/UserFiles/ERP/Sample%20Program%20Coordinator%20Job%20Description.pdf

and resume or CV http://professional.diabetes.org/UserFiles/ERP/Resume%20Template.pdf

 A full section of one assigned content area of the curriculum

http://professional.diabetes.org/UserFiles/ERP/A%20Written%20Complete%20Curriculum.pdf

 A description of a formal CQI plan/process, using a CQI project

http://professional.diabetes.org/UserFiles/ERP/Continuous%20Quality%20Improvement%20Process.pdf

 A copy of one de-identified participant chart demonstrating the complete education

process

http://professional.diabetes.org/UserFiles/ERP/Example%20of%20a%20Complete%20Patient%20Education%20Rec

ord.pdf

American Association of Diabetes Educators (AADE)

Diabetes Education Accreditation Pro

ram

The AADE provides a program that addresses providing DSME to community members.

The AADE Diabetes Education Accreditation Program

is a multidisciplinary association of

healthcare professionals dedicated to integrating selfmanagement as a key outcome in the

care of people with diabetes and related chronic conditions, constantly working toward the

vision of optimal health and wellness for all people with diabetes and related chronic

conditions. AADE certified members are primarily diabetes educators and focus on helping

people with diabetes achieve behavior change goals, which, in turn, lead to better clinical

outcomes.

Board certification in Advanced Diabetes Management (BC-ADM) indicates achievement

of standards set by professionals in your area of practice and it demonstrates commitment to

competence in within your profession. Board certification is the process by which AADE

validates, based on predetermined standards, an individual’s knowledge, skills, and abilities

in the area of advanced diabetes management.

Rinker, Joanne. “How to Get Your Diabetes Self-Management Program Recognized by the ADA.” American

Diabetes Association, 2014. PowerPoint. 14 May 2014.

American Association of Diabetes Educators. “AADE Diabetes Education Accreditation Program.” American

Association of Diabetes Educators, 2014. Web. 26 May 2014.

http://www.diabeteseducator.org/ProfessionalResources/accred/

The AADE follows the NCBDE guidelines for becoming a CDE, but to become BC-ADM

certified, candidates must complete a different process. The BC-ADM certification validates a

healthcare professional's specialized knowledge and expertise in the management of people

ith diabetes. Practicing within their discipline's scope of practice, healthcare professionals

ho hold the BC-ADM certification credential adjust medications, treat and monitor acute and

chronic complications, provide medical nutrition therapy, help patients plan exercise

regimens, counsel patients to manage behaviors and psychosocial issues, participate in

research and mentor. The depth of knowledge and competence in advanced clinical practice

and diabetes skills affords an increased complexity of decision making which contributes to

better patient care.

As of May 2014, to become BC-ADM certified, a candidate must hold a current, active

RN, RD, RPh, PA OR MD/DO license in a state or territory of the United States or the

professional, legally-recognized equivalent in another country. You must hold a graduate

degree from an accredited program and within 48 months prior to applying for this

certification exam, complete a minimum of 500 clinical practice hours in advanced diabetes

management. For complete information about eligibility please refer to the BC-ADM

Handbook.

28, 29

The National Diabetes Education Program (NDEP)

The Centers for Disease Control and Prevention as the National Institutes of Health have

created the National Diabetes Education Program (NDEP), a joint project that conducts

consumer education campaigns targeting people with diabetes, their families, and people at

risk for diabetes.

NDEP works with partners to reduce the burden of diabetes and

prediabetes by aiding in the implementation of approaches proven to delay or prevent the

onset of type-2 diabetes and its complications.

American Association of Diabetes Educators. “Board Certified – Advanced Diabetes Management Certification.”

American Association of Diabetes Educators, 2014. Web. 14 May 2014.

http://www.diabeteseducator.org/ProfessionalResources/Certification/BC-ADM/

American Association of Diabetes Educators. “Candidtate Handbook for the American Association of Diabetes

Educators (AADE) Board Certified Advanced Diabetes Management (BC-ADM) Examination. American Association

of Diabetes Educators, November 2012. Web. 14 May 2014.

http://castleworldwide.com/aade/AppSystem/6/Public/Resource/AADE_Candidate_Handbook.pdf

Centers for Disease Control and Prevention. “About NDEP.” Centers for Disease Control and Prevention, 8 May

2014. Web. 14 May 2014. http://www.cdc.gov/diabetes/ndep/about.htm | Centers for Disease Control and

Prevention. “National Diabetes Education Program.” Centers for Disease Control and Prevention, 8 May 2014. Web.

14 May 2014. http://www.cdc.gov/Diabetes/ndep/index.htm

Boren, S.A., et. al. “Costs and Benefits Associated With Diabetes Education: A Review of the Literature.” The

iabetes Educator,

35(1). (2009). 72-96. Print.

Centers for Disease Control and Prevention. “Partnerships.” Centers for Disease Control and Prevention, 29 April

2014. Web. 14 May 2014. http://www.cdc.gov/diabetes/ndep/partnerships.htm

NDEP has a strong history of working with partners on all its activities and continues to maintain

strong networks of partners interested in diabetes education related to the following:

 African-Americans and people of African ancestry

 American Indians and Alaska Natives

 Asian-Americans, Native Hawaiians, and Pacific Islanders

 Hispanics/Latinos

 Children and adolescents

 Older adults (60 years or older)

 Businesses

 Health care providers

 Community Health Workers

 Podiatrists, pharmacists, optometrists, and dentists

Become Accredited?

The ACA is driving change in our health care system. Delivery system reforms are aimed at

making health care providers more accountable for quality and health outcomes. Financing

reforms are shifting the reimbursement system from volume-based to value-based. A highly

coordinated health care system will be critical for addressing our nation’s chronic disease

burden, which today accounts for roughly 75% of our health care spending. Evidence of

effective community-based prevention programs is mounting, and studies show that

investment in community-based prevention yields savings on a magnitude of more than 5 to

1.2. The Prevention and Public Health Fund has funded new and expanded evidence-based

community-based prevention programs, building on years of experience and activities at the

Centers for Disease Control and Prevention (CDC).

Health education specialists – particularly those employed in community-based

organizations – may consider becoming recognized for reimbursement eligibility. Uptake of

various community-based prevention programs has been hampered by a lack of

reimbursement for these activities. Public and private insurers have traditionally focused on

reimbursing services provided by licensed clinical providers in a health care setting. The

focus on population health is driving changes in the marketplace related to the need for a

broader array of health professionals to provide preventive services. The Trust for America’s

Health Healthier America 2013 report recommended that the Centers for Medicare and

Medicaid Services (CMS) “clarify states’ ability to reimburse a broader array of health

providers and pay for additional covered services” under Medicaid.

A broader array of health professionals that could be reimbursed for providing preventive

services to Medicaid beneficiaries include:

 Community Health Workers (CHW)

 Care Coordinators

 Education Counselors

 Home Visiting Staff

 Lactation Consulters

 Developmental screening

 Parenting Educators

Nemours. “Medicaid Reimbursement for Community-Based Prevention Based on Convening Held October 31,

2013.” Centers for Medicare and Medicaid Services, 16 December 2013. Web. 14 May 2014.

medicaid_and_community_prevention_final_12.20.13 (1).

Opportunities in Community Settings for Diabetes Education

The Task Force on Community Preventive Services recommends communities to have

gathering places for adults with type-2 diabetes to get self-management education.

Certified

Diabetes Educators must first define a scope of practice and create a framework for standards

and credentialing (ideally with regional coordination). Education, technical assistance, and

capacity building for employers and sites on best practices and the role of CDEs must be

provided. Overall, for a successful community diabetes education program, CDEs must create

networks among both service providers and themselves.

Medicaid Reimbursement for Community Organizations

With the rollout of the ACA, the CMS had to change its Medicaid regulations to comply with

the existing Medicaid statute. Medicaid reimbursements were previously only for preventive

services provided by a licensed practitioner. Now, reimbursement for preventive services can

be provided for non-licensed providers. Services that could potentially be reimbursed are:

 Care coordination and educational counseling

 Home visiting

 Group health education

Community-based prevention programs have not traditionally been reimbursed by health

insurers, but the CMS clarified statute in the recently issued Essential Health Benefits rule. With

the new changes, Medicaid will now allow preventive services recommended by licensed

providers to be provided, at state option, by non-licensed providers. Reimbursement for

preventive services by non-licensed providers offers a great opportunity for health education

specialists.

Action Steps

Diabetes educators and health education specialists can be found in various settings

including: hospitals, physician offices, private practices and clinics. In community settings,

they can be found in schools, community programs, research programs, insurance companies,

wellness programs, and even government agencies. The American Association of Diabetes

(AADE) Educators provides a list of diabetes education programs in the United States.

https://www.diabeteseducator.org/ProfessionalResources/accred/Programs.html

AADE also provides a way to connect with CDEs in your area.

https://nf01.diabeteseducator.org/eweb/DynamicPage.aspx?Site=AADE&WebCode=AADEDi

aEduDirectory

To address these and other issues, you can work in collaboration with other partners and

stakeholders to accomplish the following external and internal actions:

External:

1. Educate Congress and the Administration at the national and state levels to include

health education specialists in highlighting and translating public health evidence;

collecting and analyzing data; publishing and disseminating results of research;

implementing prevention strategies; conducting community outreach services; fostering

coalition building and consensus on public health initiatives; providing leadership and

training, and fostering safe and healthful environments.

2. Educate the Department of Health and Human Services and its agencies (including the

National Institutes of Health, Centers for Medicare and Medicaid Services, Centers for

Disease Control and Prevention, Food and Drug Administration, Agency for Healthcare

Research and Quality, and Health Resources and Services Administration) to provide

funding for research, identification, use of new technologies and dissemination of best

practices for improving patient centered care, including the role of health education

specialists.

3. Call for professional preparation schools and programs for health care providers, public

health, allied health, health education, and health communication to strengthen

professional preparation and training of health professionals about evidence-based

strategies for patient-centered care, including the role of health education specialists as

part of the team.

4. Educate public health and health care communities to organize and work with multi

sectoral coalitions (i.e., consumers, government, businesses, and non-profit agencies) to

help enroll uninsured consumers into health care plans by reducing individual and

structural barriers to health literacy, promoting the dissemination of accurate health

information, and involving and advocating for vulnerable populations and communities

in their right to informed health decision-making.

Internal:

1. Conduct a comprehensive community assessment to learn about existing diabetes

education resources in your area, gaps in those resources, and the self-perceived needs

of your target audience and begin organizing the human, material, and financial

resources you will need for establishing a DSME program.

2. Convene an expert panel to examine the latest research and best practices in patient-

centered health care, ACA implementation, and the roles of health education specialists

and other professionals in promoting patients and families as active participants in

decision making and treatment. Publish the findings in one of SOPHE’s journals – Health

Promotion Practice (HPP) and Health Education & Behavior (HEB).

3. Provide continuing education for national and chapter members on ACA implementation

and patient and consumer engagement as part of its national and chapter meetings and

through distance education opportunities.

4. Work with allied health education organizations in the next health education job analysis

to identify any additional knowledge and skills should be part of the core competencies

of all health education specialists in the new and evolving era of health reform.

5. Advocate for the inclusion of health education specialists when identifying personnel for

funding opportunities; job announcements; or pertinent federal/state/local legislation or

regulations. SOPHE must also advocate for the use of health education specialists as

opposed to lower cost and more narrowly trained classifications of employees.

6. Work with CMS to establish insurance codes for claiming reimbursement funds.

7. Expand outreach efforts, especially on the local and regional levels, to build

relationships with and educate payers and health providers to assure the calculations of

the bundled payments include the health educator as part of the team.

8. Use the Assets-Based Community Development (ABCD) model to begin a grassroots

community diabetes education program in your area.

For more information visit

http://www.abcdinstitute.org/

Partnership for Prevention. “Establishing a Community-Based DSME Program for Adults with Type 2 Diabetes to

Improve Glycemic Control – An Action Guide.” Partnership for Prevention, April 2008. Web. 14 May 2014.

https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=0CCsQFjAA&url

=http%3A%2F%2Fwww.prevent.org%2FdownloadStart.aspx%3Fid%3D16&ei=Bph-

U6SzEYamyAT26YGYCw&usg=AFQjCNELnp6oOjqesFUI-

of59VQaiPXX7w&sig2=augBxRBKhFXtkWzmQc4akA&bvm=bv.67720277,d.aWw

School of Education and Social Policy Northwestern University. “The Asset-Based Community Development

Institute.” ABCD Institute, 2009. Web. 30 May 2014. http://www.abcdinstitute.org/

Conclusion

Health equity can only be achieved when every person has the opportunity to “attain his or

her full health potential” and no one is “disadvantaged from achieving this potential because of

social position or other socially determined circumstances.”

Evidence exists to show that

communities that are more cohesive are more likely to maintain and sustain health, regardless

of disadvantages faced. Cohesion is seen as a health asset – measured by strong and positive

networks and their impact on a community’s wellbeing.

It is necessary for Certified Diabetes Educators and health education specialists to be a part

of the communities they serve. If under careful guidance, diabetes education can have a great

impact on more people if it is offered as a do-it-yourself option. Becoming a CDE not only helps

to accelerate the impact of the ACA to a wider audience, but it also helps to further push the

idea of DSME. This toolkit serves as a starting point for how you, a health education specialist,

can be utilized in the communities as diabetes educator. SOPHE, its leadership, chapters,

members, and organizational partners and allies offer this toolkit as a creative resource for

health education specialists to begin. Diabetes educators and health education specialists

improve the health care system and contribute to a healthier nation through Disease Self-

Management Education.

Centers for Disease Control and Prevention. “Health Equity.” Centers for Disease Control and Prevention, 12

December 2013. Web. 14 May 2014. http://www.cdc.gov/chronicdisease/healthequity/

Morgan, A., & Ziglio, E. “Revitalizing the Evidence Base for Public Health: An Assets Model.” IUHPE –Promotion &

Education Supplement; 2. (2007). 17-22.

Society for Public Health Education

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