Young patients face unique challenges during an illness and its treatment. Chronic childhood illness can be extremely disrupt

N A S W S t a n d a r d s f o r

t h e P r a c t i c e o f S o c i a l Wo r k w i t h

Adolescents

N A T I O N A L A S S O C I A T I O N O F S O C I A L W O R K E R S

N A S W S t a n d a r d s f o r

t h e P r a c t i c e o f S o c i a l Wo r k w i t h

Adolescents

National Association of Social Workers

Gary Bailey, MSW

NASW President (2003–2005)

NASW Partners in Program Planning

for Adolescent Health (PIPPAH)

Advisory Committee Standards

Task Force (2002–2003)

Marvin Hutchinson Jr., MSW, LISW

Frank Irigon, MSW

Elaine Johnson, MSW

Homer Rahn-Lopez, MSW

Rufus Sylvester Lynch, DSW, LSW

Dennis Poole, PhD

Kristine Siefert, PhD, MPH

Lann E. Thompson, EdD, LCSW, ACSW

Darrell P. Wheeler, PhD, MPH

NASW STAFF:

Elizabeth J. Clark, PhD, ACSW, MPH

NASW Executive Director

Toby Weismiller, ACSW

Director, Professional Development

& Advocacy

Tracy Whitaker, ACSW

Laurie Emmer, LICSW, LCSW-C

©2003 National Association of Social Workers All rights reserved

Contents

5 Introduction

8 Standards

8 Standard 1. Knowledge of Adolescent Development

9 Standard 2. Assessment

10 Standard 3. Knowledge of Family Dynamics

11 Standard 4. Cultural Competence

12 Standard 5. Self-Empowerment of Adolescents

13 Standard 6. Understanding Adolescents’ Needs

15 Standard 7. Multidisciplinary Case Consultation

15 Standard 8. Confidentiality

16 Standard 9. Work Environment

17 Standard 10. Advocacy

18 Standard 11. Policies for Effective Practice

20 Resources

Adopted by the NASW Board of Directors

June 28, 2003

5

Introduction

Adolescence marks an important time in the process of human development, the passage between childhood and adulthood. It is a time of tremendous opportunity and promise, when young people begin to explore their burgeoning individuality and independence and begin to think critically about themselves and the world around them. They begin to adjust and adapt to the profound biological, psychological, and social changes and challenges that are by-products of adolescence.

The manner in which adolescents navigate these changes and challenges is largely a function of interactions—both positive and negative—with families, communities, and the larger social environment. The health and well-being of our young people (and the adults they will become) are critically affected by their experiences during this developmental milestone.

Healthy adolescent development depends on safe and supportive environments that are free from violence and from the risks of physical, mental, and emotional harm environments that provide opportunities for youths to build strong and meaningful connections with their families, their schools, and their communities. Adolescents greatly benefit from engagement in activities in which their value is demonstrated and affirmed and their inherent talents, capabilities, and strengths are enhanced. Social environments that are inclusive and accepting of diversity encourage all youths to feel good about and value themselves and others around them. Equitable access to quality education, health care, employment opportunities, and social supports also are essential for ensuring positive outcomes for youths.

6

Most young people are able to navigate these adolescent years successfully with the support of caring families and communities. Far too many youths, however, experience significant challenges during this time that impede their ability to move successfully into adulthood. The healthy development of adolescents is thwarted by the invasion of drugs and violence into homes, schools, and social environments. Impoverished conditions may offer limited or no access to basic needs and present barriers for youths and their families. These barriers prevent access to adequate health care and social services, education, employment opportunities, housing, and nutrition. Youths also may be exposed to violence, abuse, bullying, harassment, and neglect in their homes, schools, and communities.

Some youths may experience alienation, disenfranchisement, and discrimination from the families, communities, and social institutions charged with supporting their development. Youths with severe health and mental health problems or disabilities, runaway and homeless youths, youths in foster care or juvenile justice systems, and gay, lesbian, bisexual, and transgender adolescents often experience alienation. These social conditions leave young people more vulnerable to health-damaging behaviors such as substance abuse, delinquent activities, unprotected sexual activity, and mental health pathology.

Social workers understand that everyone— individuals, communities, and society as a whole—reaps the benefits from investments in helping our young people achieve optimal physical and mental health. Social workers provide essential services in the environments, communities, and social systems that affect the lives of youths. To

7

meet the needs of young people, it is important for social workers to demonstrate a fundamental knowledge and understanding of adolescent development and the critical role of biopsychosocial systems.

As the largest professional organization of social workers, the National Association of Social Workers (NASW) expects social work with adolescents to be carried out by people who have the necessary competence, knowledge, and values. Thus, NASW establishes standards to define and describe professional social work practice. These Standards for the Practice of Social Work with Adolescents are designed to guide social workers in a variety of settings as they help young people become competent and healthy adults. The unique perspectives and breadth of social work practice provide systemic linkages between the social work profession and the social entities that affect adolescent development. Adequately meeting the needs of youths means engaging all systems— individual, family, and the broader community— in efforts to prevent problems and promote health and well being.

8

NASW Standards for the Practice of Social Work with Adolescents

Standard 1. Knowledge of Adolescent Development

Social workers shall demonstrate knowledge and understanding of adolescent development.

Interpretation

Essential areas of knowledge and understanding about positive adolescent development include ■ human growth and behavior, including

developmental stages, human needs, motivations, feelings, behaviors, activities of children and youths, and cultural differences

■ the role of adolescence in individuals’ social, physical, emotional, and sexual growth, including adolescents’ striving for and ambivalence about independence, competence, achievement, personal identity, and sexuality

■ the critical role of education in healthy adolescent development and the barriers to a successful educational experience

■ the necessity to recognize the needs of adolescent development

■ the impact of substance abuse and violence on adolescents’ development and on their families

■ the family, school, community, and cultural process for allowing and helping adolescents become independent

■ the importance of opportunities for adolescents to establish positive relationships with open expression of thoughts and feelings with family members, peers, and role models such as teachers, clergy, and sports team coaches

■ the significance of adolescents’ steps in establishing an identity, which may include a natural form of rebelliousness and rejection of authority.

9

Standard 2. Assessment

Social workers shall demonstrate an ability to assess adolescent services, including access to social institutions and community-based resources that provide services for adolescents and their families, and shall advocate for the development of needed resources.

Interpretation

Social workers shall possess the following fundamental knowledge and skills to work effectively with adolescents and their families: ■ the history and development of social work

and its person-in-environment perspective ■ the theory, principles, and methods of social

work, including casework, group work, community organization, administration, supervision, planning, and research

■ the influence of cultural beliefs, background, lifestyles, and ethnicity

■ the interrelationships among the individual and the family, the group, the neighborhood, the community, and social systems

■ the purpose, structure, legal mandates, and services provided by public and voluntary social welfare, child welfare, and youth services agencies; schools; and health, mental health, juvenile justice, and law enforcement organizations

■ an ability to coordinate with other professionals and community organizations and advocate for their involvement on behalf of youths

■ the political and economic factors affecting adolescents, their families, and their communities

■ multidisciplinary and team approaches for working with children and youths, and the contributions from biomedical, psychological, social sciences, legal, educational, law enforcement, and other disciplines

10

■ opportunities available to adolescents for training to increase job-related skills

■ an understanding of the importance of working with adolescents in the environments in which they feel comfortable, including nontraditional environments

■ familiarity with groups who provide peer education and improve youths’ decision making and leadership skills

■ understanding of and ability to develop a case plan jointly with youths and their families

■ an understanding of how to develop programs that provide comprehensive services to adolescents to prevent fragmentation

■ an understanding of how to develop programs that will increase the likelihood that youths will use available services for the range of issues that affect adolescents (for example, reproductive health, HIV/AIDS and other STIs, violence, and abuse).

Standard 3. Knowledge of Family Dynamics

Social workers shall demonstrate knowledge and understanding of family dynamics and systems theory.

Interpretation

NASW defines families as two or more people who consider themselves “family” and who assume obligations, functions, and responsibilities generally essential to healthy family life. Essential areas of knowledge about family dynamics include ■ family dynamics in traditional and nontraditional

families, including two-parent, single-parent, and foster and adoptive families and unrelated individuals living together as a family, and acceptance and understanding of such family constellations

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■ the impact of adolescents’ parents’ growth experiences, attitudes, and behaviors and culturally relevant ways for parents to ask for help

■ an understanding of how to bring about changes in family functioning

■ the concept of family culture, including the role of the family in meeting the changing physical, mental, spiritual, and emotional needs of adolescents

■ cultural attitudes toward the responsibilities of each family member

■ the impact of impairment and disability, including mental and emotional disabilities, chemical dependency, and abusive conditions on positive adolescent development and family dynamics

■ an understanding of changing parental roles and the diversity among those roles

■ the impact of economic, social, and cultural conditions on parental ability to meet family responsibilities.

Standard 4. Cultural Competence

Social workers shall demonstrate culturally competent service delivery.

Interpretation

The increasingly diverse population in the United States requires that social workers raise their awareness and appreciation of cultural differences. They must develop competencies that include heightened self-awareness, knowledge, and practice skills consistent with the NASW Standards for Cultural Competence in Social Work Practice (NASW, 2001).

Culturally competent social workers should be knowledgeable about the deleterious effects of racism, sexism, ageism, heterosexism or

12

homophobia, anti-Semitism, ethnocentrism, classism, and disability-based discrimination on adolescents’ lives and about the need to advocate for and with adolescents.

Social workers must recognize racial, ethnic, gender, and cultural differences that may be interpreted as barriers and develop strategies and skills to ameliorate such barriers.

Standard 5. Self-Empowerment of Adolescents

Social workers shall help adolescents achieve self- empowerment.

Interpretation

Social workers should demonstrate the necessary knowledge and skills to ensure the participation of adolescents in decisions about the programs and services designed to meet their needs. This includes ■ encouraging youths and their families to be

active participants in their case planning and service delivery

■ developing adolescent leaders to provide peer support to other adolescents and supporting their efforts

■ advocating for youth positions and roles of influence on agency boards or committees and providing training for youths to develop the skills needed to improve existing services and develop necessary services

■ working with youths and their families to help them assume responsibility for following through on a plan of action and for securing and using planned services

■ providing or brokering the training and support to help youths develop independent living skills.

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Standard 6. Understanding Adolescents’ Needs

Social workers shall advocate for an understanding of the needs of adolescents and for resources and cooperation among professionals and agencies to meet those needs.

Interpretation

Social workers who work with adolescents should respect and work to strengthen the many protective factors that are sometimes overlooked or ignored. Appropriate and effective work with adolescents requires an understanding of the developmental skills and tasks characteristic of the age, an awareness of the psychosocial and emotional phases of adolescence, and clinical knowledge of inappropriate behavior and symptoms of mental illness or stress. Social workers should be aware that adolescents’ behaviors and attitudes may provoke ambivalent or negative feelings in those who work with this age group.

Social workers need to be aware of adolescents’ multidimensional lives, regardless of service focus. This includes the family, siblings, extended family, individuals with whom the adolescent may reside, peer group, friends of the opposite sex, religious affiliation, physical and mental health, cultural and economic facts, refugee status, discrimination experiences, and exposure to violence in the community or family or from war experiences. In advocating for adolescents, social workers must work to ensure that ■ continuing education is available for

providers, professionals, and families of adolescents to develop skills and a knowledge base, to acknowledge and enhance adolescent protective and resilient factors, and to strengthen empowerment capacities and decision-making skills

14

■ community services are responsive to the mental health, physical, medical, educational, vocational and occupational training, housing, and other needs of adolescents as articulated by adolescents and their families

■ agencies provide opportunities for staff to recognize and take appropriate actions to resolve their own biases, fears, or antipathy about behaviors exhibited by adolescent clients

■ policies and programs adjust, change, or accommodate to meet the needs of adolescents in different settings and with different disabilities or mental or physical limitations

■ opportunities are provided for adolescents to discuss, learn about, and appreciate the uniqueness of different cultures, personalities, and interactions

■ knowledge is increased about medical and substance abuse issues, methods of fostering healthy attitudes, interventions, and behavior toward drug use among targeted youths

■ improved school connections are encouraged to improve academic performance, school attendance and behavior, and attitudes toward learning and achievement

■ opportunities for strong relationships with adults and peers for positive and supportive interaction are available

■ information about model programs for prevention and treatment is available

■ information is disseminated on the effects of alcohol, substance abuse, domestic and dating violence, and HIV/AIDS to families and communities

■ information, news, and updates about pressures on adolescents from different cultures, income levels, and ethnic groups are routinely provided

■ opportunities to identify and address risk-taking behavior are available in community forums

15

and parent groups, as well as with educators, juvenile justice staff, and law enforcement officials

■ opportunities for collaboration among community, religious, and athletic groups are supported

■ opportunities exist to recognize adolescent achievements.

Standard 7. Multidisciplinary Case Consultation

Social workers shall participate in multidisciplinary case consultation across agencies that provide services to adolescents.

Interpretation

To develop the most appropriate case plan with adolescents and their families, social workers must consult with other individuals, professionals, and organizations who work with adolescents without violating confidentiality.

Such consultation should include ■ joint assessment of youths’ presenting

problems, family strengths, and risk factors ■ joint assessment of the need for available

services and interventions ■ individual evaluations of adolescents’

progress and joint consultation following the evaluations

■ joint appraisal of youths’ successes and failures when the cases are closed and assessment of alternatives that were available for the case plan

■ involving adolescents and their families in care planning

Standard 8. Confidentiality

Social workers shall maintain adequate safeguards for privacy and confidentiality in their relationships with youths.

16

Interpretation

Respect for the client as a person and for his or her right to privacy underlies the social worker– client relationship. Except for federal, state, or local legal and other overriding requirements, the social worker will share information only with the informed and signed consent of the youth, the family, or both. Although assurance of confidentiality enhances the relationship and the willingness of the youth to develop and adhere to a case plan, the youth should be advised that there are circumstances in which confidentiality cannot be maintained. These situations may include ■ suspicion of child abuse or neglect, which

requires that appropriate authorities be notified ■ suspicion of danger to the youth or to others.

In all such situations, the social worker shall advise the youth of the exceptions to confidentiality and privilege, shall be prepared to share with the youth the information that is being reported, and shall appropriately address the feelings evoked.

Standard 9. Work Environment

Social workers shall assume an active role in contributing to the improvement and quality of the work environment, agency policies and practices with clients, and their own professional development.

Interpretation

Social workers are responsible, in part, for their own empowerment as staff of the organizations in which they work. As integral members of an agency, social workers who work with adolescents are to conform to the mission and expectations established by that agency. Social workers should ■ initiate action to ensure that agency policies and

practices establish reasonable expectations that allow them to perform their jobs most effectively

17

■ work for constructive change so that the work environment allows them to meet youths’ needs and derive the support needed to do so

■ be responsible for remaining prepared for their duties in the provision of social work services by seeking relevant continuing education and training programs and competent supervision

■ assume responsibility for helping their colleagues by sharing their knowledge and skills

■ document the need for changes in agency policy, practices, continuing education, and training and discuss the information with agency management.

Standard 10. Advocacy

Social work administrators in youth services agencies shall advocate for an increased under- standing of the needs of youths, policy changes and adequate resources to enable social workers to meet those needs, and appropriate working conditions for all workers.

Interpretation

To fulfill this standard, the social work admin- istrator is expected to ■ solicit and allocate program funds and

resources sufficient to respond to emergency, short-term, and longer-term needs of youths and their families

■ provide opportunities for youths to participate in the design and implementation of service programs

■ provide transportation and individual telephone lines to ensure that social work staff may help youths and their families obtain needed services that will support family functioning or contribute to the adolescent’s preparation for independence

18

■ employ sufficient staff to work with all clients and their families

■ establish and disseminate reasonable work loads for staff

■ provide appropriate and adequate supervision and opportunities for multidisciplinary consultation services

■ provide opportunities and time for staff development and continuing education on the basis of an agency assessment of training needs

■ establish a salary schedule that is appropriate with regard to the social worker’s education, work experience, and job responsibilities

■ provide liability protection for the agency and staff

■ advocate for public policies on the local, state, and national levels that support the goals and client population of the agency

■ ensure appropriate space and working environment for social work staff to work and for privacy to maintain confidentiality.

Standard 11. Policies for Effective Practice

Social work administrators in youth services agencies shall establish the environment, policies, procedures, and guidelines necessary for effective social work practice with adolescents.

Interpretation

The social work administrator is responsible for providing a supportive work environment that ensures that the staff concerns are addressed within the agency and with cooperating agencies that serve the same adolescent population. The administrator is also responsible for ensuring that the agency is responsive to the needs of the youths and their families. The policies and procedures should include

19

■ personnel and recruitment policies to ensure a diverse staff and pluralism in the agency

■ public education materials and participation in public discussions to solicit public support for the goals of the program

■ operational policies and procedures for dealing with specific issues such as suspected parental abuse, abuse in a previous residential setting, treatment of substance abuse problems, and treatment of HIV/AIDS and other STIs

■ interagency agreements to ensure collaboration among those who serve the same adolescent population

■ establishment of a safe and secure working environment, with measures to protect staff from violent youths and family members and from violence in the surrounding area

■ systematic administrative and evaluative reviews of the program and opportunities for board members (including youths) and staff to participate in the development of program policies

■ hiring professional social work staff with bachelor of social work or master of social work degrees from accredited programs, with demonstrated work skills, and with characteristics that reflect the ethnic composition of the clientele served by the agency

■ clearly written job descriptions and affirmative action and other personnel policies, including grievance procedures

■ program evaluation by youths and their families, funding sources, and other community agencies and referral sources.

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Reference

National Association of Social Workers. (2001). Standards for cultural competence in social work practice. Washington, DC: Author.

Resources

Greene, R. (2002). Resiliency. Washington, DC: NASW Press.

National Association of Social Workers. (2003). Foster care and adoption. Social work speaks: National Association of Social Workers policy statements, 2003–2006 (6th ed., pp. 144–151). Washington, DC: Author.

Van Soest, D. (1997). The global crisis of violence. Washington, DC: NASW Press.

NASW gratefully acknowledges the Health Resources and Services Administration’s Maternal and Child Health Bureau, Office of Adolescent Health, for their support of the development of these standards through the Partners in Program Planning for Adolescent Health (PIPPAH) initiative (6 U93MC 00103-07-01).

NATIONAL ASSOCIATION

OF SOCIAL WORKERS

750 First Street, NE

Suite 700

Washington, DC 20002-4241

202.408.8600

http://www.socialworkers.org

Depressive Symptoms in Children and Adolescents with Chronic Physical Illness: An Updated Meta-Analysis

Martin Pinquart, PHD, and Yuhui Shen, CAND PSYCH

Department of Psychology, Philipps University

All correspondence concerning this article should be addressed to Martin Pinquart, PHD, Department of

Psychology, Philipps University, D-35032 Marburg, Germany. E-mail: [email protected]

Received July 8, 2010; revisions received and accepted October 20, 2010

Objective To integrate results of available studies that compared levels of depressive symptoms of children

and adolescents with chronic physical illness to healthy peers or test norms. Methods Random-effects

meta-analysis was computed with 340 studies and 450 subsamples. Results Children and adolescents

with chronic illness have, on average, higher levels of depressive symptoms than their healthy peers (d¼ .19

SD units). Differences are strongest for chronic fatigue syndrome (d¼ .94), fibromyalgia (d¼ .59), cleft lip

and palate (d¼ .54), migraine/tension head ache (d¼ .51), and epilepsy (d¼ .39). Larger effect sizes were

found in studies with higher proportion of girls, with a healthy control group, from developing countries,

published before 1990, and that used parent rating or clinician ratings rather than child

ratings. Conclusions Pediatricians and others working with children with chronic illnesses should screen

children with chronic physical illness for symptoms of psychological distress and make appropriate referrals

for mental health services, when needed.

Key words chronic illness; depression; meta-analysis; psychological functioning; psychological health.

In the United States, the number of children and adoles-

cents with chronic health conditions has increased dramat-

ically in the past four decades (Perrin, Bloom, &

Gortmaker, 2007). Although results from epidemiological

studies differ considerably, an overview of articles found

that, on average, 15% of children and adolescents have a

chronic health condition (van der Lee, Mokkink,

Grootenhuis, Heymans, & Offringa, 2007).

Chronic illness is a risk factor for psychological prob-

lems, such as depressive symptoms (e.g., Bennett, 1994).

For example, the presence of physical symptoms, such as

pain and fatigue, combined with the need for disease man-

agement regimes, are likely to interfere with many aspects

of daily life, such as regular school attendance and main-

taining peer relations, and may cause frustration (e.g.,

Suris, Michaud, & Viner, 2004). Children with chronic

illness may feel different from his peers and experience

peer rejection, which may have detrimental effects on

their self-concept (e.g., Sandstrom & Schanberg, 2004).

In addition, chronic illnesses may foster inappropriate

parental attitudes and behaviors, ranging from overprotec-

tion to rejection, which may impair psychological

well-being (e.g., Holmbeck et al., 2002). In some cases,

poor prognosis may cause feelings of helplessness and

hopelessness. Finally, side effects of treatments may

cause psychological distress (e.g., Miller et al., 2008).

A meta-analysis by Bennett (1994) on 60 statistical

effects from 46 studies found that children and adolescents

with chronic medical problems have elevated levels of de-

pressive symptoms, but differences with test norms or

healthy control groups were small (mean d¼ .27 SD

units). Because (a) the number of studies has increased

considerably since this meta-analysis, (b) the effects of

chronic illness on depressive symptoms may have changed

over time, and (c) the previous meta-analysis could not test

for moderating effects of many study characteristics, the

Journal of Pediatric Psychology 36(4) pp. 375–384, 2011 doi:10.1093/jpepsy/jsq104

Advance Access publication November 18, 2010 Journal of Pediatric Psychology vol. 36 no. 4 � The Author 2010. Published by Oxford University Press on behalf of the Society of Pediatric Psychology.

All rights reserved. For permissions, please e-mail: <a href='/cdn-cgi/l/email-protection' class='__cf_email__' data-cfemail='32585d47405c535e

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