Childhood asthma is a chronic health condition that affects more than 1 million school-age children and their families. Asthma is the leading cause of school absences and accounts for a substantial amount of activity limitation in children. A small pilot study of caretakers of African American and Hispanic school-age children with asthma explored the effects of the illness on families and the coping strategies used by caretakers. Large and significant correlations were found between the perceived impact in the areas of financial burden, social and familial isolation, and personal strain. Caretakers reported using active coping, planning, religion, and acceptance of the illness most frequently. The authors suggest the value of making conceptual distinctions between the burden imposed by the illness and the coping skills used by caretakers.

The course and outcome of severe chronic illness are decisively affected by social and emotional variables. The conceptual approach of this article emphasizes an understanding of the individual, the family, and health care personnel as all facing a series of adaptive tasks in relation to the illness. Each of the three phases of the illness--the diagnostic, chronic, and end stage--poses special tasks and requires different defenses and coping capacities from the patient, family, and health care personnel. These are discussed as interdependent factors in a holistic framework.

The process of discharge planning is often impeded by disagreements among family members and others involved. A discharge plan must be negotiated to meet the varying needs of participants within the context of regulatory and organizational mandates. Under such circumstances, disagreements in decision making can be anticipated, particularly for family members, who must readjust roles and relationships in the face of the crisis of illness. Support for this conceptual formulation is found in the literature, particularly in two studies that evaluated the incidence of disagreements in discharge planning caseloads. In both studies, disagreements occurred in at least one-third of the cases, with most disagreements involving family members. Neither study found substantial disagreement among professionals. Social workers who provide discharge planning services in hospitals clearly are dealing with substantial levels of disagreements among principals in the process; in fact, disagreement needs to be accepted as a normative phenomenon in such planning. This article discusses the sources of family disagreements related to discharge planning, identifies the implications for social work practice, and uses a family systems perspective to articulate an approach to intervention.