Project Summary/Abstract There is a critical need to develop innovative strategies in early adolescents with type 1 diabetes mellitus (T1DM) that develop self-efficacy and facilitate positive parental involvement. In the absence of accessible interventions, we can expect adherence to diabetes self-management tasks (like blood glucose monitoring [BGM] and BG review) to decline and glycemic control (hemoglobin A1c [HbA1c]) to deteriorate, as typically seen during adolescence. The objective of this pilot RCT is to assess the feasibility, acceptability and preliminary effects of incorporating the structured care of a pet fish into a family-based diabetes self-care routine combined with communication skills training (Routine+CC) on HbA1c, BGM frequency and BG review in early adolescents with suboptimal control of T1DM. The rationale for the intervention is based on three established principles: Social Cognitive Theory, Habit Formation Theory, and Family Systems Theory. Participants in the Routine+CC group will be given a Betta fish with supplies. Participants will be told to feed their fish in the morning/evening/bedtime and perform BGM at that time; and perform fish tank maintenance activities once a week in collaboration with their parent(s) and review their blood glucose (BG) trends with the parent at that time utilizing a collaborative communication framework. The hypothesis is Routine+CC will have high recruitment, fidelity and retention rates; and will provide activity-based cues to perform BGM and BG review, a positive competence experience that enhances self-efficacy in performing diabetes self-care tasks, and an opportunity for positive parental engagement in the youth’s diabetes care. The hypotheses will be tested by pursuing these specific aims: Aim 1: Conduct a rigorous feasibility and acceptability pilot RCT of (a) Pet Fish + Collaborative Communication (Routine+CC) (n=20) which combines routine (pairing fish care with family-based diabetes self-care tasks) and collaborative communication (family will receive training on collaborative communication skills); (b) Pet Fish (Routine) (n=20) which only has the routine; as compared to (c) Control (n=20) which is usual care. Obtain quantitative and qualitative feedback on feasibility (recruitment, fidelity, retention) and adolescent/caregiver acceptability; and Aim 2: Assess the preliminary effects of the Routine+CC intervention on HbA1c, BGM frequency and adherence to weekly BG review at intervention completion (12 weeks) plus a follow-up period (12 weeks). Examine whether Routine+CC changes the hypothesized target mechanisms (parental involvement, diabetes self-efficacy, habit strength) based on survey measures. This approach is innovative, because it proposes a novel approach for youth with TIDM that is resource-efficient and home-based, offers new concepts in habit-formation research and presents a potential benefit of pet care for children with chronic conditions. The proposed research is s...