Transcript Social Work with Children and Adolescents with Medical

SOCIAL WORK WITH
CHILDREN AND
ADOLESCENTS WITH
MEDICAL CONDITIONS
Chapter 15
Handbook of
Health Social
Work, 2nd Edition
Created by
Teri Browne
CHAPTER OBJECTIVES
 Under stand the prevalence and scope of children’s health conditions
 Under stand the influence of a child’s age and level of development on
the attribution of meaning in medical diagnosis and prognosis
 Recognize the necessar y collaboration among the family, school, and
medical setting in providing care to youth with medical conditions
 Learn of inter ventions that social workers can employ to help children
with medical conditions in hospital, home, and community
 Explore palliative care and end -of-life issues for the child, family, and
interdisciplinar y team
 Under stand issues and challenges for the social worker dealing with
youth who have medical conditions, including vicarious traumatization
 Discover resources in the community and on the Internet to help
children and families challenged by medical conditions
PREVALENCE AND SCOPE OF CHILDREN’S
HEALTH PROBLEMS
 Children with special health -care needs comprise 12.8% of all
children younger than 18 years in the United States.
 Special health-care needs may result from premature birth,
illness, or congenital causes.
 The most frequent pediatric illnesses in the United States are
Asthma, Cancer, Diabetes, Juvenile rheumatoid arthritis, and
Obesity (see Table 15.1)
DEVELOPMENTAL CONSIDERATIONS AND
CHILD AND FAMILY ATTRIBUTION OF
MEANING TO MEDICAL DIAGNOSES
 Researchers who have studied the family impact of medical
diagnoses propose a four-stage model to describe the typical
adjustment to a youth’s medical condition:
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Stage
Stage
Stage
Stage
1:
2:
3:
4:
First clue
Limbo
Reconstructing meaning
New normal
DEVELOPMENTAL CONSIDERATIONS AND
CHILD AND FAMILY ATTRIBUTION OF
MEANING TO MEDICAL DIAGNOSES
 Do all families move consistently through the four stages? If
not, what prevents them from doing so?
 Social workers who deal with children with medical
conditions must be aware that the youth’s friends will
notice and sometimes worry about their friend’s treatments.
T YPICAL RESPONSES OF CHILDREN AND
THEIR PARENTS WHEN DEALING WITH A
CHILD’S MEDICAL CONDITION
 It is important for social workers to be informed about
various illnesses so that they in turn can help to inform
parents.
 A social worker could of fer to be available to answer future
questions about the illness and its management or to act as
a go-between with other providers.
 It is critical for the social worker to maintain a relationship
with the patient and family to ensure that they understand
instructions for medications, diet, and follow -up visits.
 Internet support and information groups moderated by
social workers trained in the area of a specific disorder can
be helpful resources for those who live in rural areas or at
great distance from the treatment centers.
T YPICAL RESPONSES OF CHILDREN AND
THEIR PARENTS WHEN DEALING WITH A
CHILD’S MEDICAL CONDITION
 Parents may wonder why their child became ill and in some
cases may feel responsible.
 The child usually senses the parents’ feelings.
 Young people may be more focused on their current lives
than on the future ramifications of their illnesses.
 It is also common for young people to resist all or some of
their procedures, and parents will need help in dealing
firmly with this resistance in a manner that emphasizes
necessity.
T YPICAL RESPONSES OF CHILDREN AND
THEIR PARENTS WHEN DEALING WITH A
CHILD’S MEDICAL CONDITION
 Some adolescent survivors of cancer and their parents
report positive attitudes a year after supportive treatment.
 Posttraumatic growth: refers to positive changes in views
about oneself, others, and plans for the future following a
medical diagnosis.
COLLABORATION AMONG FAMILY, SCHOOL,
AND MEDICAL SETTING IN CARING FOR
YOUTH WITH MEDICAL CONDITIONS
 Why is it important for a social worker to facilitate connections
with the patient’s school, community, and family members
after a medical diagnosis?
 The social worker, parents, student, and nurse can collaborate
on care while protecting the privacy of the child’s medical
information.
 It is crucial for social workers to understand the legal rights of
students under federal law so that they and parents can
advocate for minor patients.
 Social workers should understand laws that assist and protect
student rights, such as: Rehabilitation Act of 1973, American
with Disabilities Act of 1990, Individuals with Disabilities
Education Act, and Family Education and Privacy Act
 Social workers can act both as educators and advocates. What
are some examples of this?
FERTILIT Y
 Certain chemotherapies and high -dose radiation therapies can
cause infertility.
 The social worker’s role is to provide the patient and his/her
family with information and resources so that they are ready
for the transition to adulthood and the obstacles that it may
bring.
 This is best done early in the diagnostic period and addressed
periodically as needed through and beyond the period of
treatment.
 Examples of fertility treatment are sperm cryopreservation,
embryo freezing, egg freezing, testicular tissue freezing, and
ovarian tissue freezing.
SELECTED INTERVENTIONS FOR SOCIAL
WORKERS WHO HELP YOUTHS WITH
MEDICAL CONDITIONS
 Factors that can make medical experiences traumatic for a
child include helplessness and vulnerability, discomfort and
pain, confusion, parental distress, and uncertainty about
outcome.
 Social work interventions should include collaboration with
the family while also giving attention to the hospitalized
patient.
 Interventions may include play and expressive therapies,
and anxiety management techniques.
INTERVENTIONS
 Play therapy: the assumption is that when the child knows
that the purpose of the play therapist’s visit is to help with
troubles and worries and that it is acceptable to either talk or
play, children will use toys to express their anxieties
symbolically.
 Often young children repeatedly use a doll or puppet to act out the
procedures that they have experienced.
 The play therapist encourages the child to verbalize the feelings and
questions of the doll patient while assuming that through this
process, the children actually are expressing their own emotions and
concerns.
 Drawings and board games can be used with older children for a
similar purpose in play therapy.
 Some hospitals also employ music therapists.
INTERVENTIONS
 Anxiety Management Techniques:
 Breathing exercises: Most children find it boring to focus on
breathing, so methods have been created to help them engage in
breathing exercises while still having fun.
 Self-control methods: “Everyone’s head is like a television set.” How
does this method work?
 Safe-place imagery: Close their eyes and think of a place where they
feel safe
PALLIATIVE CARE AND END-OF-LIFE ISSUES
 Currently only about 10% -20% of dying children receive
hospice services, and a similar number of children with life threatening conditions receive palliative care support and
interventions.
 Only 20% of American hospice programs of fer services to
children and their parents.
PALLIATIVE CARE AND END-OF-LIFE ISSUES
 When no further treatment options are available for a child, it
may be devastating to all concerned.
 How can social workers intervene?
END-OF-LIFE CARE IN THE EMERGENCY
ROOM
 Injuries include falls that cause massive traumatic head injury
or car or bicycle accidents that cause significant injury that
may result in death either during or following surgery
 Families are typically shocked
 What is the role of social workers in situations of sudden
death?
END-OF-LIFE CARE IN THE PEDIATRIC
INTENSIVE CARE UNIT
 Play therapy has been used to ease the pain of dying children
– case: 7-year-old Nathan
 This case illustrates how a child used play to prepare for his
own death and how the play therapist in her role as witness
gave the child the support and understanding he needed.
METHODS TO HELP FAMILIES AND YOUTH AT
THE END OF LIFE
 Some of the methods include:
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Acknowledging the spiritual needs of the dying person
Facilitating a life review and identify a legacy
Creating meaningful rituals
Connecting with family, friends, and community
METHODS TO HELP FAMILIES AND YOUTH AT
THE END OF LIFE
 Spiritual needs of the dying person
 Spirituality refers to the universal need to understand what lays
beyond human experience, including the meaning of life, the quest
for vision, and some kind of inspiration
METHODS TO HELP FAMILIES AND YOUTH AT
THE END OF LIFE
 Facilitating a Life Review and Identifying a Legacy
 Children, like adults, need to feel that they have made some
difference through their actions and that others will remember them
because of some of their special qualities or talents.
 A social worker can encourage/help the child create a book of
memories, which contains the activities and messages that they want
other people to think about when they remember them
 A social worker can encourage them to give this document to parents
or family
METHODS TO HELP FAMILIES AND YOUTH AT
THE END OF LIFE
 Creating Meaningful Rituals
 A ritual can be created to serve the needs of terminally ill children
(saying a prayer, singing a meaningful song)
 Pastoral care also can provide the family of a dying child with the
opportunity to express their unique rituals of grief
METHODS TO HELP FAMILIES AND YOUTH AT
THE END OF LIFE
 Connecting with family, friends, and community
 It’s important for parents and siblings to have quiet, intimate times
with a child who has a life-threatening illness. These times help
parents with the anticipatory grieving process, and they help the
child feel a sense of safety and connection.
 Social workers can encourage both the child and family to express
their love for one another with verbal assurance that they will always
remember these special moments.
ISSUES AND CHALLENGES FOR THE MEDICAL
SOCIAL WORKER
 A social worker must emphasize what the child can achieve
rather than focusing on all the limitations.
 Not all social workers will be able to function well knowing
that a certain percentage of their young clients will die over
the course of weeks or months.
 What are some methods social workers can take to deal with
stress?
VICARIOUS TRAUMATIZATION
 Refers to the experience of the helper who identifies and
empathizes with the physical or psychological pain of the
client to the extent that the practitioner becomes
traumatized.
 Often the helpers are unaware of their own traumatization.
 What are some guidelines for avoiding vicarious
traumatization? Do you agree with the guidelines provided in
the chapter?
CONCLUSION
 A strong bond often develops between the family and the social
worker, and this helping relationship may serve to assist the
family through many difficult phases of their child’s illness.
 The high level of stress associated with daily exposure to end -oflife issues may exhaust and deplete the emotional resources of
social workers.
 Hospitals and other facilities that deal with dying patients must
acknowledge the risk for their staff and provide training on
methods for coping with this inevitable component of medical
social work.
 The goal for health social workers is to feel a sense of pride and
achievement in carrying out a difficult job in a compassionate
manner that conveys meaning and dignity to children and
families who are coping with a serious medical condition.