Optimal health care for children involves participation from patients, families, and health care professionals. Children’s health and well-being depend greatly on the care they receive from their families and communities (Szilagy & Schor, 1998). The needs of children and their families often include unresolved, and sometimes unidentified, social and emotional problems. Such psychosocial problems often impede access to health care delivery and create distress for children, family members, and health care providers.

Primary care providers are often the first professionals to whom families turn for psychosocial care. Providers are the first contact for as many as 85% of typical psychosocial problems (Gross, Rabinowitz, Feldman, & Boerma, 1996). As the first line of contact with patients, these providers often have the best opportunity to recognize patients with mental health problems and to treat them or refer them to specialists (Glied, 1998). For this reason, primary care clinicians need a strong awareness of the role played by social workers as well as the ability to work with these professionals. The chronic illness of a child forever changes the life of the child and the entire family. Professional social workers can work closely with pediatric health care providers to identify and treat the stresses that a chronic illness produces. This chapter provides an overview of the psychosocial issues affecting chronically ill children and their families and the roles that social workers play in providing assistance.

Social work and primary care orientations are alike in that they emphasize both continuity and comprehensiveness of care (Badger, Ackerson, Buttell, & Rand, 1997). The National Association of Social Workers maintains in its code of ethics that the primary mission of social work is “to enhance human well-being and help meet the basic needs of all people, with particular attention to the needs and empowerment of people who are vulnerable, oppressed, and living in poverty” (1996). Consistent access to social workers is a challenge, however, because no government mandate exists to provide social work services to families in need. Hospital and ambulatory care clinic settings usually employ social workers who specialize in health care. Child welfare prevention service agencies, nonprofit social service agencies, and federal and state programs also employ social workers. School districts and school health projects also use professional social workers on behalf of children. Professional social workers are those who have received a master’s degree in social work from an accredited university. Each state has individual requirements to practice, with some states requiring a license and some offering state certifications. Many trained social workers, like child psychologists and child psychiatrists, are also employed in private practice settings, and sessions can be reimbursed through insurance coverage. Professional social workers are also on panels of health maintenance organizations for mental health service coverage.

Some organizations use professional social workers as counselors to help people with chronic illnesses deal with the emotional impact of their illness. These organizations also provide information on self-help groups and political advocacy initiatives related to the illness.

As professionals, social workers provide a knowledge base in defining and handling social problems on an individual and community level, often working with others to solve problems. An interdisciplinary team is a functioning unit, composed of individuals with various and specialized training, who coordinate their activities to provide services to a client or group of clients (Ducanis & Golin, 1979). The social work assessment helps the team to gather facts and impressions about the economic, psychological, religious, and sociocultural functioning of the patient and family. Because social workers intersperse facts with a value orientation and what appears to be a subjective assessment (Mizrahi & Abramson, 1985), primary care providers may be concerned about a lack of “hard data.” The social worker incorporates the points of view of other disciplines while developing a treatment plan.

Many of the most useful skills that social workers use in a team are drawn from group training. These skills include assessing the team as a group, contracting, monitoring the team process as it occurs, dealing with conflict, and understanding professional differences (Abramson, 1990). The social worker can be an essential member of the interdisciplinary team that provides services to patients and families.