Therapeutic Interventions

1. Describe the facts and feelings associated with parenting a child with physical challenges. (1, 2)

1. Meet with the parents and other family members to gather background information and discuss the ramifications of the child's chronic illness or disability on the family.

2. Invite the parents to fully disclose and explore their feelings and reactions to parenting a child with special health needs; explain that denial,

2. Reframe negative thoughts and fears into a more positive and realistic perspective and attitude. (3, 4)

3. Read materials written for parents of disabled or chronically ill children and seek information from medical personnel, educators, therapists, and other parents. (5, 6)

4. Gather information regarding services from the school, government, and community available for children with physical challenges. (7, 8)

anger, and fear are common reactions for parents with a child that has a chronic illness or disability.

3. Brainstorm with the parents a list of concerns or potential problems they fear may occur (e.g., "Will my child be able to go to school?") and help them develop strategies for addressing their concern (e.g., talk to local school personnel about programs for special health needs children).

4. Ask the parents to complete the "Strategies for Supporting Our Child with Physical Challenges" activity from the Parenting Skills Homework Planner (Knapp).

5. Assign the parents to gather information about their child's health issues from their family physician, the child's pediatrician, and other medical specialists and to share the information and related questions and concerns during their counseling sessions.

6. Encourage the parents to become more informed about the special health needs of their child by reading literature written specifically for parents of children with physical challenges (e.g., Special Kids Need Special Parents by Lavin).

7. Assist the parents in establishing a database of services available for their child with physical challenges by accessing information available from

5. Become actively involved in planning for the treatment of and interventions recommended for the child with physical challenges. (9, 10, 11)

National Information Center for Children and Youth with Disabilities (NICHCY; Web:; e-mail: [email protected]; phone: (800) 695-0285).

8. Assign the parents to contact their local school district, the state board of education, and community health organization to seek information about early intervention and ongoing programs available for children with physical challenges.

9. Inform the parents about the federally mandated services that seek to include the parents in the planning for the child and encourage them to actively participate and advocate for their child.

10. Suggest that the parents keep a notebook which contains an ongoing account of their child's medical history, professional instructions, diagnostic information, prescribed medications, and therapeutic suggestions.

11. Review with the parents the worksheet "When Your Child with Special Health Needs Goes to School" provided by the Seattle Children's Hospital and Regional Medical Center ( or (866) 987-2500) to assist them in requesting necessary special services and accommodations from their child's school.

6. Share feelings, set goals, and create realistic expectations for the child with physical challenges. (12, 13)

7. Enroll the child with physical challenges in programs designed to help him/her cope with the illness or disability. (14, 15)

8. Join a support group for help in addressing the child's special health needs. (16, 17)

12. Ask the parents to clarify their expectations for their child with physical challenges by creating a list of short- and long-term goals which realistically consider the child's age, medical condition, ability level, and interests.

13. Encourage the parents to clarify and disclose their inner feelings through journaling and refer them to a list of topics suggested in the article "Journaling Your Way Through Stress: Finding Answers Within Yourself' by Naseef.

14. Assign the parents to access information for children with special health needs from the Internet (e.g., www.kidshealth .org/kid/, Band-aides and Blackboards for Kids, /fleitas/contkids.html, or Chronic Illness Resources for Teens, /dms/koop/resources /chronicillness/chronic.shtml]).

15. Discuss with the parents the various early intervention services provided through the 1997 Individuals with Disabilities Education Act (IDEA) legislation (e.g., assistive technology devices, nutrition services, psychological services); help them determine which services are appropriate for their child with physical challenges.

16. Assign the parents to join a group supporting parents of special needs children provided

Seek respite help from family members, friends, or community agencies. (18, 19)

Implement strategies of positive discipline to help the child with physical challenges develop self-confidence and responsibility. (20, 21, 22)

by their church, school, medical facility, or community.

17. Encourage the parents to seek friendship, support and guidance from other parents of children with physical challenges by connecting often with compatible parents met at support groups, school, church, and community meetings.

18. Assign the parents to explore available respite care from community agencies or to access a list of respite facilities from ARCH National Respite Network and Resource Center (800) 773-5433 or

19. Help the parents to create a list of respite support possibilities from family members, church groups, and friends and encourage them to use this help to avoid burnout.

20. Instruct the parents to use choices to set limits for the child while at the same time developing a sense of independence and helping the child acquire problem-solving abilities (e.g., "Would you like to take your medication before or after lunch?").

21. Guide the parents to encourage responsible behavior in their child by using natural and logical consequences (e.g., loss of privileges when chores or homework aren't completed, free time delayed until exercises are done).

11. Arrange for the child with physical challenges to participate in social groups and play or leisure time activities with children with similar conditions. (23, 24)

12. Promote the values of integrity and personal best achievement in all of the children by verbalizing and supporting the attainment of age- and ability-appropriate, individualized goals for each child. (25, 26)

22. Encourage the parents to enhance self-esteem and self-reliance by using questions to allow the child to be an essential part of the decision-making and problem-solving process (e.g., "When is the best time to schedule your doctor's appointment?").

23. Stress the importance of maintaining peer relationships for the child with physical challenges and encourage the parents to arrange play groups for younger children, work with the school to develop a circle of friends for a school-aged child, and involve their child in groups of children with similar conditions.

24. Direct the parents to gather information about camps for children with physical challenges provided by the Federation for Children with Special Needs (see /resources.html or (800) 3310688) or from the American Camping Association ( /finding_a_camp.cgi or (765) 342-8456).

25. Assign the parents to use the concept of unique rather than equal to address the distribution of love, attention, and meeting their children's physical needs (e.g., "I love and parent you each uniquely. You need my help with homework and soccer, your sister needs my help with taking medication and physical therapy.").

Help the siblings of the child with physical challenges resolve feelings of resentment through focused discussion and general family activities. (27, 28)

Schedule quality time and relationship enhancing activities with the spouse. (29, 30, 31)

26. Encourage the parents to teach, model, and affirm the positive behaviors they hope to bring out in each of their children (e.g., persistence, responsibility, empathy) using the criteria of age, ability, and personal best rather than comparing one child to another.

27. Alert the parents to watch for reactions of anger, resentment, jealousy, and depression in the child's siblings and encourage them to seek counseling and support for them when necessary.

28. Instruct the parents to schedule time to have fun together as a family engaging in activities that do not involve or focus upon the illness or disability (e.g., a family overnight at a motel with a pool, family movie or video night).

29. Advise the parents of the importance of nurturing and supporting their personal relationship by taking time to share feelings and thoughts and backing each other up in times of crisis.

30. Assign the parents to read The Five Love Languages (Chapman) to gain understanding of how to express love and gratitude to one another in meaningful ways.

31. Advise the parents to participate as a couple in a nonwork and nonfamily-related social or church activity, or other entertainment to reduce stress

15. Schedule personal time to renew energy and regain balance. (32)

16. Involve the grandparents and other extended family members in the care and activities of the child with physical challenges. (33, 34)

17. Involve the child with physical challenges in the plans for coping with the illness or disability. (35, 36)

and become reacquainted with the fun-loving aspects of their personalities.

32. Instruct the parents to carve out personal time for themselves each day to relax and renew their energy for the demands of parenting a child with physical challenges.

33. Encourage the parents to include grandparents and extended family members in the lives of all of their children by sharing problems, setbacks, progress, and achievements.

34. Assign the parents to solicit help from extended family members with doctor visits, occupational therapy appointments, physical therapy sessions, transportation to activities and special classes, and babysitting to forge a loving relationship between the child with physical challenges and the helpful family member and to bring great relief to them as the primary caregivers.

35. Describe to the parents the importance of involving the child with physical challenges in the plans for coping with the illness or disability and setting long-term goals and short-term objectives for progress toward these goals.

36. Assign the parents to work with their special needs child to complete the "Working Together to Create a Plan" activity from the Parenting Skills Homework Planner (Knapp) to structure a

18. Define hopes and dreams, and express optimism for the future of the child with physical challenges and the family. (37)

cooperative effort in solving the daily and long-term problems of living with a serious physical illness or disability.

37. Encourage the parents to remain hopeful and realistically optimistic about the future of the child with physical challenges and the family as a whole and help them to recognize the contributions the child has made to the family.

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