Academic journal article Health and Social Work

Fostering Resilience in Siblings of Youths with a Chronic Health Condition: A Review of the Literature

Academic journal article Health and Social Work

Fostering Resilience in Siblings of Youths with a Chronic Health Condition: A Review of the Literature

Article excerpt

Advances in medicine and technology have enabled youths with chronic health conditions to live longer and remain in the care of their families (Hollidge, 2001). Data suggest 10 to 20 million children and adolescents residing in the United States have some form of a chronic condition--a health impairment that "has lasted or is expected to last more than a defined period of time, usually three months or longer" (American Academy of Pediatrics, 1993, p. 876). Although there is literature on the impact of mental illness or life-threatening illness on siblings and the caregiving role that some adult siblings assume, the intent of the following review is to broadly capture the experience of school-age youths who have a sibling with a chronic physical (for example, spina bifida), medical (for example, diabetes), or developmental condition (for example, Down syndrome).

The increased number of youths with a chronic health condition has resulted in more opportunities for social workers and other health professionals to assist this population (Brown, Krieg, & Belluck, 1995) and a greater appreciation for the importance of family-centered assessment and intervention (Strohm, 2001). Attending to the individual strengths, capabilities, and needs of the affected youths, parents, and siblings is fundamental to helping families successfully adjust to the ongoing and often unpredictable journey of childhood chronic conditions (Bergman, Lewiston, & West, 1979).

Despite widespread agreement about viewing the impact of the child's health condition as a shared experience, data are limited on the specific risk and protective factors influencing the adjustment of siblings and perhaps most significant, how to foster resilience in this special population. Drawing on the literature related to resilience in youths and families, we aim to help prepare social workers to identify and address the needs of school-age siblings, possibly preventing the onset of psychosocial difficulties.


Social workers are uniquely prepared with the knowledge, skills, and value base to provide family-centered intervention in the context of childhood chronic health conditions (Bergman et al., 1979). An emphasis on family theory in social work education, and especially the principle that a stressor affecting the well-being of one member will likewise influence the psychosocial outcomes of other members, clearly establishes social workers as likely professionals to assist this population (Andreae, 1996). Social workers are schooled in a person-in-environment approach to understanding individual and family strengths and risks that influence psychosocial outcomes (Bronfenbrenner, 1979). By integrating ecological and developmental theories with a strengths-based approach, practitioners draw out individuals' and families' abilities, competencies, and resources (Walsh, 1998). Finally, social workers' interactions with youths and families across diverse service settings, such as hospitals and clinics, schools, and other community agencies, provide multiple opportunities for family-centered services inclusive of well siblings.


The growing body of literature on risk and resilience offers social workers and other health professionals a medium to reconceptualize the experience of families living with a child's chronic health condition from a pathological, deficit-laden perspective to a growth-enhancing, resilience lens (Walsh, 1998). This perspective affirms and builds on individual and family resources and simultaneously attends to the multiple and varied forces affecting the youth and family (Patterson, 2002). Although acknowledging that families of youths with a chronic condition may encounter major stressors and challenges, such as daily caregiving demands, financial strains, concerns about access to adequate services, and future health uncertainties, researchers and practitioners observe that some family members and the family as a whole often emerge stronger and more resourceful from their experience (Walsh, 2002). …

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