Controlled trial of social work in childhood chronic illness.

Children with chronic illnesses have a doubled risk of becoming psychosocially maladjusted, and social-work support and counselling are commonly used to reduce this secondary morbidity. A randomised controlled trial of this type of intervention was conducted in 345 children with chronic physical disorders cared for in eleven specialty clinics at a children's hospital. Four months after a six-month period of social-work services, no significant difference was found between social-work and control groups in overall prevalence of maladjustment. There was no evidence to support a preventive or therapeutic effect of social work on child behaviour disorder or social dysfunction on the principal outcome measure, the Child Behaviour Checklist. Nor was there any detectable effect on child self-esteem, on maternal psychological function, or on the impact of the child's illness on the family. Furthermore, no patient subgroup could be shown to benefit from the intervention, and restriction of the analysis to individuals who received the intervention did not alter the results.