KY Diabetes Peer-Led Self-Management Program Application Logging
Program Description
 


Developed by Stanford University’s Patient Education Research Center, the Diabetes Self-Management Program (DSME) is a six week workshop that takes place once a week for 2 ½ hours and is facilitated by two trained Peer Leaders. It is a peer-led model; at least one of the two people leading the workshop has diabetes or is a caregiver of someone with diabetes.


Subjects covered include: 1) techniques to deal with the symptoms of diabetes, fatigue, pain, hyper/hypoglycemia, stress, and emotional problems such as depression, anger, fear and frustration; 2) appropriate exercise for maintaining and improving strength and endurance; 3) healthy eating 4) appropriate use of medication; and 5) working more effectively with health care providers

Contact Information
Application Date:
First Name:
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Last Name:
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Address:
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Address 2:
City:
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Zip Code:
Type of Address:

Work Phone:
Home Phone:
Mobile Phone:
Email:
Organization You Represent:
Counties You Can Travel To:
Are you currently a certified CDSMP Lay Leader?  

Do you have diabetes?  
If Yes, Please List/Describe:

Are you a caregiver for someone with a health condition?  
If Yes, Please Specify:



What qualities do you feel you possess that would make you a good DSME Leader?


 
DSME Leader Agreement

You will be certified to teach the DSME course after meeting these requirements.

  • Attended the 4 ½ Leader Training
  • Attended the 2 day cross over training (CDSMP Master Trainers only)
  • Be associated with an entity licensed by Stanford University Patient Education Research Center to provide the DSME.
  • Commit to teach the DSME as developed by the Stanford University Patient Education Research Center, as outlined in the Leader Manual.
  • Follow recommendations from Master Trainers, based on your demonstrated practice teaching

If selected as a Kentucky leader, I agree to the following requirements.

  • Co-teach two entire 6-week Diabetes Self-Management Programs in association with the Kentucky Department for Aging & Independent Living within 12 months of this training.
  • Complete and submit necessary documentation of classes taught.



Coordinate all DSME Lay-Leader Trainings with the Department for Aging & Independent Living (DAIL) as DAIL holds the DSME License. Failure to coordinate with DAIL will jeopardize your teaching status.


Leaders are not employees of the Kentucky Department for Aging & Independent Living. The organization that employs you may compensate you for teaching the course.




I will attend all 4 1/2 days of the Leader Training or 2 days training for DSMP Cross-Training (CDSMP Master Trainers only). I agree to co-teach two entire 6-week Diabetes Disease Self-Management Programs in association with an entity licensed by Stanford University within 12 months of this training. I will teach in strict accordance with the program as written in the Leaders Manual and as taught to me at Leader Training.


Signature:
Date:
 
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