Evidence-based Interventions for Social Work in Health Care

Marcia Egan

• Publisher: Routledge
• Year: 2009
• ISBN:
  9781135262938
• Edition: 1
• Topic: Médecine
• Subtopic: Théorie, pratique et référence de la médecine

Social work practice in health care requires that practitioners be prepared to meet the interdisciplinary and managed care demands for best practices in efficacious, time-limited, and culturally competent interventions, with populations across the lifespan. This text is designed to meet that demand for evidence-based practice.

The result of extensive systematic reviews, Evidence-based Interventions for Social Work in Health Care provides substantive in-depth knowledge of empirically based interventions specifically for major and emerging medical diseases and health conditions particularly affecting diverse, at-risk and marginalized populations. It outlines best practices for the psychosocial problems associated with the emerging chronic and major health conditions of the twenty-first century, such as paediatric asthma, Type I and Type II diabetes, obesity, paediatric cancer, and adult hypertension. The interventions discussed are detailed in terms of for whom, by whom, when, under what circumstances, for what duration, and for what level client system the intervention has proven most effective.

This invaluable text is suitable for students and will be a useful reference for practitioners specialising in social work in health settings.

1
Asthma in Childhood and Adolescence

Who is affected by pediatric asthma ?

What is asthma? What are asthma medical regimens and treatments? What are the associated family and child psychosocial stressors?

What interventions are promising for social work implementation?

• Family-focused interventions

• Child- and adolescent-focused interventions

Glossary

Scenario

Introduction

Pediatric asthma receives a great deal of attention in the research literature, possibly due to its epidemic-size prevalence, and as likely to the life threatening nature of the illness. Practitioners in a variety of settings are likely to have children and families contending with the psychosocial aspects of the illness. This chapter seeks to provide the best practices for intervening with asthmatic children and youth, and with their families. For practitioners to implement these promising interventions, however, they must understand the prevalence and the nature of the disease itself. Thus, this chapter first discusses the prevalence of pediatric asthma and characteristics of the affected population, the nature of the illness, medical regimens and treatments, and the stressors on asthmatic children and their families. Following this background, the details of the 22 studies identified in the systematic review that met the criteria of the study are explicated. The chapter concludes with an exploration of the implications for practice, and future research, a glossary of relevant terms, and a scenario for discussion.

Who is Affected by Pediatric Asthma?

Asthma is the most common chronic disease among children in the U.S. (Akinbami, 2006; American Lung Association, 2007). The Centers for Disease Control & Prevention (2006b) reported that over 9 percent (i.e., 9.4 percent), or nearly seven million children in the U.S. have a diagnosis of asthma (Akinbami, 2006; Centers for Disease Control & Prevention, 2006b). The financial direct cost for one year of health care alone for pediatric asthma is nearly 15 billion dollars annually (i.e., 14.7); medications for pediatric asthma total just over an additional six billion dollars (American Lung Association, 2007). These financial costs relate to the pattern of pediatric asthma itself, including ongoing and recurrent symptoms requiring care, and acute episodes requiring recurrent emergency department visits and hospitalizations, both characteristic of a chronic illness.

The extent of the impact of pediatric asthma cannot be over-stated. Pediatric asthma is a major reason for children’s use of acute medical care, including being the third leading cause of hospitalizations in those less than 15 years of age (American Lung Association, 2007). In 2004, nearly 200,000 hospitalizations, representing about three percent of all hospitalizations among children, and over three quarters of a million visits to emergency departments for children were due to their asthma (Akinbami, 2006; Centers for Disease Control & Prevention, 2006b). Akinbami notes that 6.5 million physician office visits and outpatient clinic visits for children in 2004 were for asthma (2006).

Behind those daunting statistics are the costs of the financial, psychosocial, and emotional sequelae of pediatric asthma for the children and their affected families. Asthma is the leading cause of school absenteeism, accounting for 14.6 million lost school days in 2002 alone (Centers for Disease Control & Prevention, 2006a; Pulcini, DeSisto, & McIntyre, 2007). Parents and caregivers miss work days due to the care needed by their asthmatic children with inestimable indirect cost, and lost wages, and the potential loss of jobs and, thereby, health care coverage due to absences from work (Lara et al., 2002).

Racial, Gender, and Economic Disparities in Asthma Prevalence

Childhood asthma is disproportionately prevalent among minority, poor and urban, and medically under-served populations in the U.S. (Akinbami, 2006; Akinbami & Schoendorf, 2002; Centers for Disease Control & Prevention, 2006a; Kaugars, Klinnert, & Bender, 2004; Lee, Parker, & DuBose, 2008; Lieu et al., 2002; Shegog, Bartholomew, Parcel, Sockrider, Masse, & Abramson, 2001). The statistics evidencing these disparities is striking. Not only are prevalence rates disparate for African American children, but also emergency department visits for asthma health care by black children is 200 percent and hospitalizations 250 percent higher compared to non-Hispanic white children (Akinbami, 2006).

The overall mortality (death) rate for children with asthma (just under 3 per million) continues to increase with consistently higher rates for boys in comparison to girls, and among African American children compared to their white, non-Hispanic white cohorts (Akinbami & Schoendorf, 2002). Most dramatically, the rate of death from asthma for black children is 500 percent higher than for white children with asthma (Akinbami, 2006).

Children from economically poor families and those in urban areas are more likely to have a diagnosis of asthma than are children from non-poor, and/or non-urban families (e.g., Akinbami & Schoendorf, 2002; Kaugars et al., 2004). Given the health care system Americans are currently enduring, it is not surprising that low-income children are treated more often in episodic care through emergency or urgent care centers, than in more preventive ongoing care (Fox, Porter, Lob, Holloman, Rocha, & Adelson, 2007). This limitation in medical care use is associated with inconsistent or inadequate maintenance of medical regimens, which often lead to increased acute episodes and the associated overuse of emergency medications without medical supervision (Fox et al., 2007).

Risk Factors for Pediatric Asthma

The medical causalities of asthma are extensively studied. And, though the exact cause or causal linkages for asthma are not yet known, research on possible links consistently evidences that:

• minority group membership,

• gender,

• and poverty,

are risk factors for developing asthma in childhood (e.g., Brown, Bakeman, Celano, Demi, Kobrynski, & Wilson, 2002). In combination, these factors are believed to interact with factors limiting access to ongoing, preventive medical care (e.g., being uninsured, under-insured and/or lacking funds to cover care and medications), resulting in the higher prevalence rates of asthma among minority children, and/or their greater use of emergency health care for asthma attacks (Akinbami & Schoendorf, 2002; Lieu et al., 2002; Pulcini et al., 2007).

What is Asthma?

Asthma is a chronic inflammatory disease of the airways (bronchial tubes). The inflammatory process causes re-current bronchospasms and increased mucus production resulting in difficulty in breathing with episodes of wheezing, shortness of breath, general chest tightness, and/or coughing, the latter occurring particularly at night or early morning (Centers for Disease Control & Prevention, 2005b; Sales, Fivush, & Teague, 2008). Acute episodes of asthma are life-threatening (Akinbami, 2006). The difficulty in breathing results from hyper-sensitivity or hyper-responsivity of the airways to asthma “triggers,” such as:

• dust,

• mites and insect dust,

• mold,

• chemicals,

• pollen,

• viral infections (e.g., common cold),

• and/or psychosocial or emotional stress.

Unfortunately, though the prevalence rates of childhood asthma have steadily risen since 1980, with resultant increased attention in medical research, the exact cause(s) of asthma remain largely unclear. Some authors (e.g., Burke, 2003; Kaugars et al., 2004; McCunney, 2005) suggest, however, that the cause of the disease is likely to be a combination or interaction of the following factors:

• genetic predisposition factors,

• environmental triggers,

• physical and psychosocial factors.

The most notable psychosocial factor is stress on the child, on the family, and/or in the interaction(s) of the child and her/his family (Sales et al., 2008; Sawyer, Spurrier, Whaites, Kennedy, Martin, & Baghurst, 2001; Wood et al., 2007). These physical and emotional stressors can also cause and/or contribute to acute episodes that can be life threatening (American Lung Association, 2007).

What is the Medical Treatment and Regimen for Pediatric Asthma?

The daily medical regimen for pediatric asthma includes vigilance for environmental triggers (dust, chemicals, etc.) and allergens (foods, animals, molds, etc.), and careful maintenance of medications. Consistent monitoring of the child’s school classroom, playground, and recreational activities for potential environmental triggers, and routine and emergency medications are necessary. When acute symptoms appear, caregivers/parents must administer emergency medications to relieve restricted breathing and wheezing, and follow up to assure that the medications relieve the acute symptoms. In general, emergency medications are delivered in the form of an inhalant, a vaporized form of medication that is inhaled by the asthmatic. In the event that these medications do not relieve the symptoms, emergency medical care must be obtained from physicians and/or emergency rooms. In sum, the regimen for care is a 24 hour, seven day a week routine where inadvertently missed, or a lack of needed medications can result in life-threatening attacks, attacks that are often rapid in their progression from acute to critical.

Stressors on the Child

Childhood asthma has multiple, complex, and extensive effects on the child with asthma and on their family/caretakers (Ng, Li, Lou, Tso, Wan, & Chan, 2008; Wade, 2000; Weil, Wade, Bauman, Lynn, Mitchell, & Lavigne, 1999). The child with asthma experiences stress from the symptoms of the disease itself, and from acute episodes, as well as from the extensive daily medical regimens required to manage the disease.

In addition to coping with directly illness-related stressors, lifestyle adaptation to the requirements of daily medications and regimens can deter the child’s achieving, and/or the timeliness of achieving their regular developmental tasks (Marsac, Funk, & Nelson, 2006; Wamboldt & Levin, 1995). Kaugars and co-authors (2004) discuss at length the complexities of asthma care and the scope of the impact of the disease on children’s lives. They note in particular the research suggesting that an early onset of asthma puts asthmatic children at greater than average risk for behavior problems, and may limit their range of coping strategies. Specifically, these research findings imply that asthmatic children, particularly early-onset (younger) children, internalize more than non-asthmatic children do, and have higher rates of anxiety disorders, most notably among children experiencing more acute attacks and hospitalizations (e.g., McQuaid, Kopel, & Nassau, 2001). In brief, the psycho-emotional climate of the family is seen as pivotal in the effective management of pediatric asthma. This latter issue further endorses the importance of effective interventions by social workers.

Family Stressors and Tasks

While the child’s stressors directly affect her/his emotional wellness, and may actually prompt acute attacks, the child’s stress also influences the emotional well-being of his/her caretakers. The result is a reciprocal cycle in the family (child<>family/parents <>child) that can have major bearing on disease outcomes, such as exacerbations of symptoms or attacks, the frequency of emergency room visits, and/or hospitalizations (Ng et al., 2008). The links between a family’s stress in managing their child’s asthma, the asthmatic child’s own stress, and the child’s acute episodes (attacks) are documented, as is the centrality of the family in effective asthma management (Svavarsdottir, McCubbin, & Kane, 2000; Wade, 2000; Weil et al., 1999; Wood et al., 2007). These interactive stressors set the context for the complexities of asthma in children.

These complexities result in daily multiple tasks for the family. The stress of these responsibilities is influenced by, and in turn, influences the child’s overall emotional well-being. In summary, the family’s psychosocial stressors are related to:

• required vigilance for the presence, and elimination of environmental triggers,

• effective management of asthma symptoms,

• maintenance of medication regimens,

• prevention of asthma attacks and acute episodes.

In sum, families’ tasks in their children’s daily lives include ongoing coordination with school personnel concerning symptoms, medications, school and playground environmental triggers and with health care providers regarding symptoms, reactions to medications, and attacks (e.g., Kaugars et al., 2004; Parker-Oliver, 2005; Shegog et al., 2001; Wade, 2000).

Coupled with the asthma-related tasks and stressors is the ongoing parental responsibility for nurturing their child’s attainment of normative developmental and the psychosocial tasks and attendant needs of their children (Parker-Oliver, 2005; Svavarsdottir et al., 2000). It was suggested early on in the literature that a family’s abilities to handle these tasks is related to...

Table of contents

• Contents
• Introduction
• 1 Asthma in Childhood and Adolescence
• 2 Diabetes
• 3 Hypertension
• 4 Obesity
• 5 Pediatric Cancer
• Afterword
• Appendix: Steps and Process of the Systematic Reviews
• References
• Index