SCIENTIFIC PUBLICATIONS International Journal of Psychology: Biopsychosocial Approach 2016 / 18 ISSN 1941-7233 (Print), ISSN 2345-024X (Online) http://dx.doi.org/10.7220/2345-024X.18.5 SCHOOL COUNSELOR PREPAREDNESS FOR WORKING WITH STUDENTS & CHRONIC ILLNESS: INSIGHTS AND APPLIC ATIONS FROM A SERVICE LEARNING EXPERIENCE IN SOUTHERN AFRIC A Eric Davis University of South Florida, USA Abstract. Background. The American School Counselor Association suggests school coun- selors be prepared to deal with myriad forms of trauma in the school community. Included among these forms of trauma are students and families dealing with chronic illness. Despite this suggestion coupled with the increased rates of chronic illness among children, many school counselors may not be prepared to handle such issues due to lack of training, professional development, or culturally diverse experiences. Purpose, method. The author reviews the literature on chronic illness and school counselor preparation. To further explore this area of need, the author participated in a service learning experience in southern Africa. Results, discussion. The information and experiences are explored with discussion of insights and applications that can be utilized to address school counseling needs related to working with students and chronic illness in the United States. Keywords: illness-related trauma; school counseling; outreach INTRODUC TION School Counselor Preparedness for Working with Students & Chronic Illness: Insights and Applications from a Service Learning Experience in Southern Africa Chronic illness is defined as condition impacting normal routines for 3 months or more and can include such conditions as asthma, HIV/ AIDS, cancer, and so forth (Merianos, Vidourek, King, & Nabors, 2015). The number of children with a chronic illness has increased by more than double from 2007 to 2013 (Nutting, 2015). Despite the fact that children are significantly affected by various forms of their own or family 89 Eric Davis 90 members’ chronic illnesses and present their responses to these events often times with behavioral, academic, and emotional problems, school counselors receive minimal preparation for responding to their needs within the school setting (Crump, Rivera, London, Landau, Erlendson, & Rodriguez, 2013; Kaffenberger, 2006; Yi, Kim, Hong, & Akter, 2016). While death and illness have become increasingly common within school com- munities (Servaty-Seib & Tedrick Parikh, 2014; Senyonyi, Ochieng, & Sells, 2012), the professional development of school counselors in this area is lacking (Allen, Bunt, Bryan, Carter, Orsi, & Durkan, 2002; American School Counselors Association [ASCA], 2012; Nutting, 2015). A potentially viable option for increasing and enhancing professional opportunities and de- velopments in the counseling profession is through service learning (Ge- hlert, Graf, & Rose, 2014; Ockerman & Mason, 2012). This manuscript explores chronic illness and service learning litera- ture as related to professional school counselors. Additionally, the au- thor will share a personal narrative detailing experiences, applications, and recommendations gained during a service learning experience in South Africa and Botswana for seeking this opportunity to learn more about school counselor preparedness when working with children who are affected by chronic illness based in two objectives. The first objec- tive addresses the need to learn about the amount of preparation school counselors in South Africa and Botswana receive in the area of chronic illness as a means of comparison and collaboration for working with U. S. students. Considerations include: (a) the culturally specific needs that are addressed and (b) the ways in which school counselor-trainees gain experience and knowledge in community service learning. Additionally, the service learning experience explores the need to understand the role of teachers and other school personnel who work in partnership with school counselors. For instance, it was surmised that they might work col- laboratively toward creating a balanced school environment in which all members feel mutually respected and empowered to face the disconnec- tion, shame, and fear that are often associated with such issues as chronic illness (Jordan, 2000). The second objective addresses the need to learn about the actual interventions that were being utilized by school counse- lors and counselor-trainees when working with students facing their own chronic illness or that of a family member to enhance the training and interventions being applied in American school settings. 2016, 18, 89–104 p.International Journal of Psychology: A Biopsychosocial Approach 91 RE VIE W OF THE LITER ATURE Impact of Chronic Illness With the increase in cases of chronic illness for children in the United States, there is a need for school counselors to gain knowledge and experience in working with these students and the school stakeholders (Merianos et al., 2015; Nutting, 2015). Such issues can have major impacts on children. Dunning (2006) reports that chronic illness presents an ex- perience outside of the norm for the developmental stage of both the child and family. Resulting death may foster loss of trust in the predict- ability of events, damage to the self-image, loss of belonging, a compro- mised sense of justice, and a loss of control (Graham, 2004; Yi et al., 2016). Further, the isolation which may occur for parent and children can be a major source of suffering and can result in disconnection from significant relationships such as family and friends (Jordan, 2000; Nutting, 2015). Children may also face discrimination resulting from the stigma at- tached to such conditions as HIV/AIDS (Mbugua, 2004; Raath, 2005) as well as dealing with more complicated bereavement due to the disease (Wood, Chase & Aggleton, 2006). Factors of abuse, neglect, and depend- ence on caregivers may also create difficulty for youth facing chronic illness (Buss, Warren, & Horton, 2015). Families can also be significantly impacted by chronic illness resulting in increased stress levels related to finances, mental health, and appropriate support (Distelberg, Williams- Reade, Tapanes, Montgomery, & Pandit, 2014; Gold, Grothues, Joss- berger, Gruber, & Melter, 2014; Nabors, Bartz, Kichler, Seivers, Elkins, & Pangallo, 2013). Finally, advocacy and social justice issues such as nutri- tion, migration, availability to community, political, and medical services further the difficulties much more (Evans & Miguel, 2007; Ford & Hose- good, 2005; Kohl-Wood & Harper, 2014; Mbugua, 2004; Nutting, 2015). Schools and Chronic Illness As a result of so many children being impacted by chronic illness, schools are highly affected by these issues with 97% of school counse- lors reporting that they have worked with students addressing chronic illness (Hamlet, Gerger, & Schaefer, 2011). These youths are experiencing a wide range of issues related to the chronic illness. Children with cancer express being fearful and concerned about returning to school as well as Eric Davis 92 a sense of loss and lack of social skills (Yi et al., 2016). Children also report increased incidents of bullying, abuse, and neglect in conjunction with dealing with chronic illnesses (Buss et al., 2015; Merianos et al., 2015; Nutting, 2015). School counselors are particularly critical in addressing these areas of concern because of the role school plays in the quality of life for students and the charge for impacting the areas of academics and personal/social areas (ASCA, 2012; Crump et al., 2013). In cases where students have suffered the loss of the mother, this is a strong predictor of poor schooling outcomes as they are often behind in school, are less likely to be enrolled, and spending on school expenses is significantly lower (Case & Ardington, 2006; Evan & Miguel, 2007) with some even having denied admission to public schools (Mbugua, 2004). Additionally, orphans are more likely to be moved around significantly, living with a variety of households following the loss of parents (Ford & Hosegood, 2005). It may also be the case that orphans are under the care and supervision of older sibling or even head of the household them- selves (Case & Ardington, 2006; Raath, 2005). It is these cases in particular where a school counselor can become an advocate for the child (Bemak & Chung, 2005; Hamlet et al., 2011; Trust & Brown, 2005). The school counselor is in a unique position and can provide a voice to the student. This may require work beyond the school setting and includes such behaviors as phone calls, letters, negotiating with those in power, and being flexible and realistic in what can be accomplished (Baker & Field, 2004). These increased concerns combined with the sub- stantial increases in childhood chronic illness experiences has led to the need for more impactful and culturally training experiences for school counselors. One such option is service learning. Service Learning Service learning is defined as a non-traditional learning strategy that utilize in-depth cultural and academic experiences within a com- munity while providing needed services with reflective and evaluative components to enhance identities and knowledge related to social jus- tice and multicultural skills (Dolson-Blake, Dotson, Glass, & Liley, 2010; Gehlert et al., 2014). This identity and self-awareness is of particular in- terest considering that while school communities have become increas- ingly more diverse, the school counselor population has not. Hanson and Stone (2002) reported that 83% of school personnel graduates from 2016, 18, 89–104 p.International Journal of Psychology: A Biopsychosocial Approach 93 nationally accredited graduate programs are White. As a result, there is a consistent call for increased emphasis on multicultural competence in counselor preparation programs (Musheno & Talbert, 2002). Moreo- ver, contemporary scholars assert that advocacy skills should be incor- porated into school counselor identity (Arman & Sherer, 2002; Bemak & Chung, 2005; Howard & Solberg, 2006; Kohl-Wood & Harper, 2014; Trust & Brown, 2005), particularly for school counselors working with socially marginalized students and their families. Service learning has shown to be an effective and meaningful strategy for building skills related to multiculturalism and social justice (Koch, Ross, Wendell, & Aleksandrova- Howell, 2014; Ockerman & Mason, 2012). In particular, service learning has been shown to be effective in aiding students in working with griev- ing families and reducing stress related to death-related clinical experi- ences (Servaty-Seib & Tedrick Parikh, 2014). Because of the increased evidence of the effectiveness of service learning, the author utilized a service learning experience in southern Africa to increase exposure and knowledge of chronic illness with a so- ciety and culture that has experienced an abundance of working with students, families, and schools in the area. One of the most devastating chronic illnesses affecting the globe is HIV/AIDS with most incidences occurring in the continent of Africa. Almost 13.2 million children under the age of 15 have lost parents as a result of HIV/AIDS and this number is expected to increase to 25 million by the year 2010 (Stats of South Africa, 2012). Africa is affected most severely by this epidemic due to the fact that 95% of HIV/AIDS orphans reside on the continent (Mbugua, 2004). Schools in particular have been affected by the epidemic because of the increased incidents of children being orphaned, diagnosed with the disease, and increased academic, emotional, and behavioral school is- sues (Case & Ardington, 2006; Evans & Miguel, 2007; Otwombe, Dietrich, Laher, Hornschuh, & Nkala, 2015). The similarities of an epidemic of chronic illness in Africa and the rise of incidents in the United States was the rationale for the author’s partic- ipation in a service learning experience to learn about school counselor preparation and application of strategies for working with chronic illness in school settings. The following sections discuss what was experienced and potential interventions that were observed. Recommendations for the school counseling profession are also included. Eric Davis 94 PERSONAL NARR ATIVE As I boarded the plane for South Africa, my thoughts and feelings ran the gambit of fear, excitement, doubt, and confusion. I was not sure that I was ready to approach such a large and daunting counseling ex- perience. According to The ASCA National Model: A framework for school counseling programs (ASCA, 2012), it is the school counselor’s duty to meet the immediate needs of students necessitated by life events, situa- tions, or conditions with responsive services including individual, group, and classroom counseling as well as collaboration with parents, commu- nity members, and school personnel. Despite this statement, it is com- mon for many school counselors to feel unprepared to deal with events like chronic illness due to issues such as lack of training and experience. This was absolutely the case for me. Even though I was aware of these issues and had read several rel- evant articles, participated in numerous trainings, and responded to a limited amount of chronic illness as a school counselor, it still seemed daunting that I would soon be in South Africa and Botswana working with counselors who dealt with students facing such issues as HIV/AIDS on a daily basis. How would I handle such situations? Would I be pre- pared to discuss these issues with the counselors and students? I also wondered about how I would be perceived by the counselors, staff, and students. Would they see me as another invader who just wanted to come into the school, snap a few pictures, say a few words, and leave – never to be seen again? Would I be accepted as a colleague? These were the questions I pondered as I walked onto the high school campus in Gabarone, Botswana. I took a deep breath and prepared myself for any- thing that might happen. Fortunately, many of my fears and trepidations melted away. Upon meeting the counselors at the school, their kindness and hospitality were overwhelming. It was made clear to me that I was an honored guest and my presence was considered a gift. The campus was lovely. It was open and spread out with great courtyards, allowing students to mingle dur- ing breaks. The interactions with the students were incredible. My team member and I were allowed to conduct an impromptu session with a classroom of eleventh graders. We simply conversed about ideas that they had about the United States and the ideas we had about Botswana. 2016, 18, 89–104 p.International Journal of Psychology: A Biopsychosocial Approach 95 I was floored when hearing such questions as, “Do all of the teenagers act like Brittany Spears and Paris Hilton?” and “Are all schools in America really violent?” It was intriguing that my questions about HIV/AIDS were met with very little knowledge as most students did not mention that they had dealt with it personally. Overall, it reminded me so very much of my conversations with my own high school students. Students were mainly interested in learning about how to get to America, the best way to get into college, and what do I do for fun. It was so invigorating to converse with these young people from another continent! The conversations with the counselors were even more enlighten- ing. We began by meeting in their office with a cup of tea and some wonderful home-made bread prepared by the secretary. The counselors’ office was small and served as the school infirmary as well. However, it was welcoming and strategically placed for easy access by students and staff. We began talking and, I must admit, there was a great amount of surprise on my behalf by what was said. It was my expectation that the school counselors would be well pre- pared to handling chronic illness on a daily basis. I was incredibly mis- taken. Not only did they not deal with many cases of chronic illness, but they also confided in me that, due to a lack of training and experience, they did not feel adequately prepared to face such situations if they arose. Despite this limited amount of interactions with chronic illness, the counselors did discuss a variety of interventions that were utilized in such cases. In many of the instances, the counselors worked with stu- dents using puppets, music and dance, art, and story-telling as familiar and culturally acceptable means for working in the counseling process. The literature confirms this notion stating that many counselors feel unprepared to deal with the issue of chronic illness (Hamlet et al., 2011; Kaffenberger, 2006; Servaty-Seib & Tedrick Parikh, 2014). Despite this, school counselors are often expected to be aware of such issues as post- traumatic stress disorder (PTSD) and are often seen as the most qualified member of the school staff to recognize and provide recommendations for intervention (Marotta, 2000). Even with an awareness of this informa- tion, I was still quite unprepared to hear these statements. At this point, all of the preparation and reading came into light as my personal objec- tives for participating in this service learning experience became center stage and were thus highlighted in that moment. Eric Davis 96 The experience was further enhanced through our learning aspect of what transpired during the visit. As a part of the trip, we participated in reflective journal writing and group process of our interactions with colleagues and students. These activities aided in transferring the knowledge to a deeper level of understanding and potential application to the school settings in the United States. Recommendations based on the experiences and literature are discussed further in the following section. RECOMMENDATIONS FOR TR AINING School counselors often feel unprepared to handle chronic illness issues in the school setting, reporting a lack of communication, infor- mation, and adequate training as well as unsupportive school system policies (Kaffenberger, 2006; Otwombe et al., 2015). These concerns, echoed by the counselors in Botswana as well as personal experiences, are cursorily covered in school counselor training programs and almost completely ignored in the actual school setting. This is exemplified in the fact that almost one-third of school counselors enter the school system with no formal coursework or supervision related to crises such as chronic illness topics (Allen et al., 2002). Additionally, it is vital that po- tential issues are discussed prior to the onset of critical events to ensure that an adequate plan is in place to effectively handle chronic illness and death (Allen et al., 2002; Charkow, 1998; Crump et al., 2013; Merianos et al., 2015). Cultural Aspects of Training One aspect of training that is vital for school counselor trainees in- volves dealing with cultural aspects of chronic illness response. Training programs must take into account current social, economic, and political realities while responding to the developmental needs of future coun- selors and students in rapidly changing multicultural societies (Arman & Scherer, 2002; Dolson-Blake et al., 2010; Koch et al., 2014; Kohn-Wood & Harper, 2014). This includes educating school counselors about their duties as advocates and agents for social change as this is also an impor- tant part of the ASCA National Model (ASCA, 2012; Ockerman & Mason, 2010). 2016, 18, 89–104 p.International Journal of Psychology: A Biopsychosocial Approach 97 Working with School Stakeholders School counselor trainees must be made aware of challenges re- lated to working with parents, such as locating adequate community resources, and dealing with possible bureaucratic red tape they might face in their roles as advocates (Distelberg et al., 2014; Gold et al., 2014; Musheno & Talbert, 2002). Additionally, they need to be trained in ethical standards, ability to find and utilize resources, mediation/conflict resolu- tion skills, knowledge of models and theories, ability to form partner- ships and collaborate, and basic counselor skills such as communication, problem-solving, organization, and self-care (Hamlet et al., 2011; Trust & Brown, 2005). School counselor trainees can also receive training in deal- ing with social, academic, and personal issues stemming from chronic illness as well as how to aid administrators, teachers, and peers in un- derstanding their roles in helping (Kaffenberger, 2006). Further, training programs must provide such opportunities to students through out- reach and community projects, especially in regards to multicultural ex- periences (Dolson-Blake et al., 2010; Hanson & Stone, 2002; Ockerman & Mason, 2012). Teachers are increasingly aware of death and illness and must be aware of the needs that must be addressed, such as providing reason- able choices to students, being aware of specific activities and holidays, assisting with schoolwork, and maintaining contact with the family (Graham, 2004; Haggard, 2005). Teachers and other school personnel must also be aware of the coping mechanisms that some students may employ while working through the issues related to the illness (Gold et al., 2014; Nicholson & Pearson, 2003; Yi et al., 2016). It is important that school personnel understand what has happened and provide sup- port. School counselors, in particular, can facilitate students’ expression of concerns related to the chronic illness. A final aspect to be considered is the impact on the teachers. These can be very trying experiences and, after a long day of handling such intense issues, teachers may also need help in dealing with death and illness through open support from col- leagues and friends (Nutting, 2015; Schlozman, 2003). Dunning (2006) emphasizes the importance of the surviving parent to the adjustment of the child to the death and bereaving process. Par- ents must be aware of this important role and foster healthy relation- ships through granting the child the appropriate distance from the dying Eric Davis 98 parent, preventing parentification with excessive caretaking duties, and accepting the child’s developmentally appropriate efforts to individu- ate (Distelberg et al., 2014; Saldinger, Cain, Poterfield & Lohnes, 2004). School counselors are in a prime position to advocate and aid parents in such endeavors (ASCA, 2012; Bemak & Chung, 2005; Crump et al., 2013; Trust & Brown, 2005). School counselors can aid parents in dealing with a variety of issues. For example, parents may need assistance in finding community support to deal with their own unaddressed grief. Another area that may be helpful to parents is succession planning to discuss im- pending death. School counselors can also be trained to recognize when and how to find an alternative adult if the parent or caregiver is too grief stricken to provide adequate support and care (Charkow, 1998). Cul- tural competencies are skill sets of interest to school counselors globally (Arredondo, Toporek, Brown, Jones, Locke, Sanches et al., 1996; Dolson- Blake et al., 2010; Kohl-Wood & Harper, 2014). Training Opportunities Overall, university training programs must make the training and opportunities available for potential school counselors to gain valuable knowledge and experience in dealing with chronic illness. This can be accomplished through supportive supervisors, clear guidelines, effec- tive models for integrating theory and practice, increased awareness of the role of the school counselor, more time to process and communi- cate experiences (Armam & Scherer, 2002), and redefining the program’s training mission (Bemak & Chung, 2005). School systems can help by providing school counselors, teachers, and other school personnel the opportunity to receive appropriate pro- fessional development. School counselors must be given the freedom and accessibility to students and community to provide counseling ser- vices during and after a chronic illness incident (Allen et al., 2002). It is also up to the school system to provide in-service professional devel- opment training in chronic illness and advocacy skills (Bemak & Chung, 2005). Ninety-four percent of school systems report having a crisis plan in place with 61% of these teams having a school counselor as a member (Allen et al., 2002). Yet the aforementioned suggestions are essential in creating a school environment where all members of the school commu- nity feel connected, respected, and open to sharing and learning about chronic illness (Buss et al., 2015; Servaty-Seib & Tedrick Parikh, 2014). 2016, 18, 89–104 p.International Journal of Psychology: A Biopsychosocial Approach 99 Individuals in training need to be proactive in their education and take risks in order to develop as culturally competent and effective coun- selors and advocates (Allen et al., 2002; Bemak & Chung, 2005; Gehlert et al., 2014; Kohn-Wood & Harper, 2014). Active membership in organi- zations, such as the American School Counseling Association (ASCA), American Counseling Association (ACA), Association for Multicultural Counseling and Development (AMCD), and Counselors for Social Justice (CSJ), and participation in service learning immersion experiences can augment students’ cultural awareness and competence. It is also impor- tant that these activities are done not for a line on one’s curriculum vitae but for growth-inducing experiences that increase understanding in a variety of multicultural settings. An additional component involves training in known effective meth- ods for dealing with chronic illness. Play techniques such as bibliother- apy, art, and puppet play can be strong methods for counseling children affected by chronic illness (Jordan, Perryman, & Anderson, 2013; Mbu- gua, 2004; Nabors et al., 2013; Nicholson & Pearson, 2003; Nutting, 2015; Woong, Mi, Jeongshim, Eun, Ju, Sun-Hyun, & Yong, 2016). When select- ing courses, it is imperative that counselors in training select classes that will provide training and learning in understanding and utilizing such techniques as well as advocating for them if they do not exist. This does not end with training however. Once in the school setting, school counselors must be proactive as counselors and advocates of so- cial justice when creating, implementing, and supporting school-based interventions for all school community members affected by illness- related trauma and crisis (Bemak & Chung, 2005; Howard & Solberg, 2006; Senyonyi et al., 2012). This also includes fostering a strong rela- tionship with all members of the school community such as administra- tors, teachers, staff, parents, and local organizations (Allen et al., 2002; Bemak & Chung, 2005; Otwombe et al., 2015). Of particular interest are the potential relationships that can occur between school systems and colleges and universities. This collaboration can result in valuable re- sources, service learning opportunities, and insight into the needs for both populations (Koch et al., 2014; Musheno & Talber, 2002). Training programs, school systems, and the counselor-trainees must share the responsibility for responding to the needs of children affected by chronic illness. Only 64% of all university training programs reported Eric Davis 100 some type of trauma preparation (Allen et al., 2002). School counseling programs need to provide adequate training experiences in the area of trauma and chronic illness. Arman and Scherer (2002) recommend a combination of course content within an experiential counseling com- ponent to provide relevant and current educational experience. It is this combination of theory and practice that makes for a relevant learning experience. Additionally, curricula can focus on high priority crisis topics, such as suicide, abuse, death, and grief (Allen et al., 2002; Hamlet et al., 2011; Merianos et al., 2015). Further Research Finally, there is a need for research in the area of chronic illness. One such area involves the need to understand why students are lacking ex- periences in service learning and involvement (Dolson-Blake et al., 2010). Is it simply related to training and lack of experiences or are there other factors that are involved? A survey of students may provide insight into this question. There are also issues involved in the service learning experi- ence itself. What is an effective service learning model? How do you build solid, empowering, and mutually empathic relationships before, during, and after a service learning experience? What should be done follow- ing a service learning experience in regards to follow-up and continuing collaboration? These questions can only be answered by actual service learning experiences in the community both at home and abroad. CONCLUSION Chronic illness is an area full of questions and doubt, but also full of hope and potential. Through service learning experiences, such as the one encountered in Southern Africa, students, counselors, and educators can gain incredible insight into this area. This includes becoming aware of differing cultures and how new and different aspects can open a per- son’s mind and conscious. They can also provide insight into the needs of counselor training programs, school counselor interventions, school system development and training procedures, and personal perspec- tives, thus allowing for progress and ultimately change. However, it is up to everyone as counselors, educators, supervisors, and other adults in the lives of children to take risks to allow for exploration and growth because it is the chances that are not taken that lead to life’s deepest regrets. 2016, 18, 89–104 p.International Journal of Psychology: A Biopsychosocial Approach 101 References Allen, M., Bunt, K., Bryan, E., Carter, D., Orsi, R., & Durkan, L. (2002). 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Childhood cancer survivors’ experiences in school reentry in South Korea: Focusing on academic problems and peer victimization. Childhood and Youth Services Review, 67, 263–269. Eric Davis 104 MOKYKLOS PATARĖ JŲ PASIRENGIMAS DARBUI SU MOKINIAIS IR LĖ TINĖMIS LIGOMIS: ĮŽVALGOS IR PRITAIKYMAS REMIANTIS KOOPERUOTŲ STUDIJŲ PATIRTIMI PIE TŲ AFRIKOJE Eric Davis Pietų Floridos universitetas, JAV Santrauka. Mokslinė problema. Remiantis Amerikos mokyklų konsultantų asociacija, mokyklų patarėjai turėtų būti pasirengę darbui su daugybe skirtingų traumų for- mų mokyklos bendruomenėje, tame tarpe su mokiniais ir šeimomis, sergančiais lėtinėmis ligomis. Nepaisant šios rekomendacijos bei padidėjusio lėtiniu ligų dažnio vaikų tarpe, daugelis mokyklos patarėjų nėra pasiruošę spręsti šias problemas dėl parengimo, profesinio tobulėjimo ar skirtingų kultūrinių patirčių trūkumo. Tikslas, metodika. Straipsnio autorius apžvelgia literatūrą apie lėtines ligas ir mokyklos pata- rėjų parengimą. Siekdamas labiau įsigilinti į problemos aktualumą, autorius daly- vavo kooperuotų studijų praktikoje pietų Afrikoje. Rezultatai, diskusija. Duome- nys ir patirtys yra nagrinėjamos kartu aptariant įžvalgas ir pritaikymą, kas gali būti panaudota norint užtikrinti mokyklos patarėjų poreikius, susijusius su darbu su mokiniais ir lėtinėmis ligomis Jungtinėse Amerikos Valstijose. Pagrindiniai žodžiai: ligos sąlygota trauma, konsultavimas mokykloje, ribų išplėtimas. Received: June 7, 2016 Accepted: September 26, 2016