Chronic illness affects between 10-20% of school-aged children in the United States (LeBlanc, Goldsmith, & Patel, 2003). Theoretically, the average U.S. school counselor has as many as 50-100 students living with a chronic illness in their caseload. A chronic condition poses many challenges including some of the following basic psychological issues: stress, crisis, loss and grief, body image, self-concept, stigma, uncertainty and unpredictability, and quality of life (Livneh & Antonak, 2005, p.12). The onset of illness poses dramatic changes in "an individuals' physical, psychological, social, and vocational functioning" (Whittemore & Dixon, 2008, p. 178). Students with illnesses face a unique opportunity to confront the challenges of their diseases, but also gain knowledge and insight because of those experiences to prepare them for the future. School counselors are in the position to help students' process the impact illness has on shaping their life roles during the early stages of development.
A Closer Look at Chronic Illness
LeBlanc et al. (2003) refer to chronic illness as "illnesses that require at least 6 months of continuous medical care, permanent lifestyle changes, and continuous behavioral adaptation to the unpredictable course of the illness (p.859)." There is a broad scope of childhood illnesses, some include: Asthma, Diabetes, Cerebral Palsy, Cancer, and Epilepsy. Indicators of chronic illness include anxiety, fear, worry, decreased attention or concentration, change in academic performance, irritability with support systems (e.g. friends and teachers), withdrawal or disengagement from others or activities (i.e. isolating behavior), absence from school, and increased somatic complaints (Dahlbeck & Lightsey, 2008; LeBlanc et al., 2003; Last, Stam, Onland-van Nieuwenhuizen, & Grootenhuis, 2007). Specifically, chronic illness is associated with early-onset depressive symptoms and negative social development in children, frequent hospitalizations, lifestyle changes, sometimes slow or altered physical development and appearance, and internalization of problems (LeBlanc et al.). Thus, individuals may be in constant flux due to changing physical and emotional responses, putting a strain on their educational continuity and subsequent career development. An effective career counseling approach for these students should therefore, focus on the importance and flexibility of life roles within the context of changing internal and external factors.
Approaching Career Development
Chronic illness can influence how students view themselves, particularly, how they interpret their potential to take on certain roles and responsibilities. As students navigate their illness, Super's Life-Span-Life Space Theory allows counselors to address potential life roles accounting for the student's self-perceptions of their abilities in relation to interests. Role shaping consists of personal and situational choices individuals face, suggesting a constant fluctuation of roles due to forces such as biological factors interacting with situational determinates. The counselor's goal is to help students "find ready and temporally compatible outlets in the full range of activities engaged in" (p. 287) in different settings (i.e. home, community, school, and workplace) while incorporating the reality of their illness. How roles materialize can be linked to the meaning individuals derive from their experiences with their illness.
In addition to the conceptualization of life roles, counselors can focus on the self-concept and life role navigation as a process of self-exploration. Students need to have the opportunity to explore themselves and career options before they can begin to commit to a specific plan, especially considering the unpredictable nature of choices through their experiences with their illnesses. Reflecting on (1) the adaptations they have made, (2) the reason for those changes, and (3) the impact of those changes on their present and future, students can process their reformulated self-concept(s) and life role(s) and apply it to future planning. For example, a student diagnosed with Lupus acknowledges that to minimize the symptoms of her disease, she needs to stay out of the sun and minimize stressful situations. Those adaptations help her to avoid illness flares, but change her lifestyle (i.e. having to avoiding activities that she enjoys) and alters her career interests that might not fit with her health needs.
Connecting to resources and proactive plans on how to address career issues can be accomplished through collaborative, problem-focused strategies (Melnleners, Binns, Lee, & Lower, 2003). Below are some strategies to assist counselors working with students who have a chronic illness:
The Internet: Efficient and effective means of learning about specific illnesses. Information is useful but should not be assumed correct without first checking with the student or even the school nurse. Specific Websites for chronic illness information:
2. Narrative approaches (e.g. "My Life as a Book"; Niles & Harris-Bowlsby, 2009) are useful tools when helping students tell their story while identifying transitions during the development of their illness.
3. Cognitive behavioral and psychoeducational approaches (cognitive restructuring, behavioral contracting, relaxation, modeling, role-playing) has been correlated with "positive psychological adjustment" for individuals with illnesses and disability (Dahlbeck, p. 296, 2008)
4. Creating systems to account for missed school/assignments (e.g. shorten assignments, allow extra time, possibly consider 504 accommodations), or within the school, how a child can leave the classroom to go to a designated adult (e.g. counselor or nurse) if emotional or physiologically symptoms become overwhelming.
Implications for Counselors
Navigating and understanding career development while adjusting and reshaping goals and roles due to chronic illness poses unique challenges for students and counselors. Regardless of the counseling approach, the relationship between the student and counselor is universally identified as the foundation for success. The relationship that a counselor builds with students creates the environment of trust necessary for students to confront the reality of their career development within the context of illness. Using the information and strategies presented here can help students with chronic illness navigate and recognize their unique career exploration process and opportunities for success.
Alliance for Health Reform (2008, March 28). Helping 125 million Americans: Improving care for chronic conditions. Retrieved November 9, 2008, from http://www.allhealth.org
Dahlbeck, D. T., & Lightsey, O. R. (2008). Generalized self-efficacy, coping, and self-esteem as predictors of psychological adjustment among children with disabilities or chronic illnesses. Children's Health Care, 37, 293-315.
Last, B. F., Stam, H., Onland-van Nieuwenhuizen, A., & Grootenhuis, M. A. (2007). Positive effects of a psycho-educational group intervention for children with a chronic disease: First results. Patient Education and Counseling, 65, 101-112.
LeBlanc, L. A., Goldsmith, T., & Patel, D. R. (2003). Behavioral aspects of chronic illness in children and adolescents. Pediatric Clinics of North America, 50, 859-878.
Livneh, H. & Antonak, R. F. (2005). Psychosocial adaptation to chronic illness disability: A primer for counselors. Journal of Counseling & Development, 83, 12-20.
Meuleners, L. B., Binns, C. W., Lee, A. H., Lower, A. (2002). Perceptions of the quality of life for the adolescent with a chronic illness by teachers, parents, and health professionals: A Delphi study. Child: Care, Health, & Development, 28, 341-349.
Niles, S. G. & Harris-Bowlsbey, J. (2009). Career Development Interventions in the 21st Century. Upper Saddle River, NJ: Pearson.
Super, D. E. (1980). A life-span, life-space approach to career development. Journal of Vocational Behavior, 16, 282-298.
University of Michigan (2009). YourChild Development and Behavior Resources: Children with Chronic Conditions. Retrieved September 26, 2009 from http://www.med.umich.edu/yourchild/topics/chronic.htm
Warner, L. A. (2006). Medical problems among adolescents in the U.S. mental health services: Relationship to functional impairment. The Journal of Behavioral Health Services & Research, 33, 366-379.
Whittemore, R. & Dixon, J. (2008). Chronic illness: The process of integration. Journal of Clinical Nursing, 17, 177-187.
Lindsey Nichols, M.A., M.Ed., is a Second Year Doctoral Candidate in Counselor Education at The Pennsylvania State University. A former school counselor, Lindsey is focused on counseling topics related to health and illness, including career. She presented on this topic with Dr. Hutchison at the 2009 NCDA Conference and is a member of NCDA.
Brian Hutchison, Ph.D., NCC, is an Assistant Professor at the University of Missouri - St. Louis. Brian is active in NCDA as a member of NCDA Leadership Academy 2007-09, ad hoc reviewer for the Career Development Quarterly, state contact person for Missouri, and a member of the International Career Issues Committee. He has several publications pertaining to career development and counseling and continues to pursue a research agenda focused on these areas with urban and low social class populations.