Bridging Disciplinary Boundaries (January 11 - 14, 2007)

Purpose:   Across disciplines, family-centered care is increasingly regarded as the ideal in service provision to families with children with a chronic health condition.  Clinical work and research have historically focused, however, on the psychosocial implications for youth with spina bifida, and to a lesser degree, their parents.  Based in a risk and resilience perspective of human behavior, the purpose of this national, cross-sectional study was to advance family-centered care in spina bifida by testing an ecological model of adjustment for adolescent siblings.

Methods:  A convenience sample of 224 adolescent siblings of youth with spina bifida was recruited through the national and state chapters of the Spina Bifida Association of America and three geographically diverse spina bifida clinic sites.  Participants completed self-report surveys that used standardized instruments to explore the variables of interest.  Hierarchical regression models were run to evaluate whether a set of ecological variables (stress appraisal, warmth and conflict in the sibling relationship, satisfaction with family functioning, and experiences of peer social support) predicted self-concept, behavior difficulties and prosocial behavior, after controlling for spina bifida severity and age.  A potential moderating effect of birth order (older versus younger than child with spina bifida) and gender were also explored. 

Results:  The set of variables forming the ecological model significantly (at p < .001) predicted self-concept (R²= .56,  F= 29.57), behavior difficulties (R²= .31, F= 10.62), and prosocial behavior (R²= .23,  F= 7.07) and explained a significant amount of variance above and beyond that attributed to the control variables in self-concept (R²Δ= .53, F= 42.51), prosocial behavior (R²Δ = .22, F= 10.10), and behavior difficulties (R²Δ = .31, F= 15.73).  Divergent predictors of self-concept (stress appraisal, satisfaction with family functioning, and peer social support), behavior difficulties (conflict in the sibling relationship, satisfaction with family functioning and peer social support), and prosocial behavior (warmth in the sibling relationship) emerged, underscoring a comprehensive model of adjustment.  Also, a significant interaction effect of birth order was observed in several regression equations.  Close friend support predicted prosocial behavior only for participants younger than the child with spina bifida. Satisfaction with family functioning predicted behavior difficulties for older participants.  Regardless of birth order, greater conflict in sibling relationship was related to more behavior difficulties, but the relationship was stronger for younger participants.

Implications for Practice: The data offer several avenues for social workers to promote healthy, age-appropriate functioning in siblings, help steer those experiencing difficulty back toward more positive outcomes, and more generally, enhance family-centered services.  These data support targeted assessment and intervention around 1) clarifying and supporting sibling perception of the impact of spina bifida; 2) fostering a family milieu characterized by shared decision-making and communication sharing; 3) supporting positive sibling relations; and 4) encouraging opportunities for peer socialization. Understanding and enhancing factors related to healthy adjustment for siblings offers a critical foundation for advancing family-centered care in the context of spina bifida.