Session 1: Stress Identification and Management

This session introduces important information on understanding just what stress is and how it can affect our bodies. Learning to identify situations that can be stressful is the first step, followed by understanding how different stressors call for different stress management strategies. One particularly important issue in managing the stress that comes from having a chronic illness is sleep. The Children’s Health and Illness Recovery Program (CHIRP) introduces the importance of improving sleep by learning healthy sleep hygiene practices and monitoring this with the help of the Sleep Log. Improvement in sleep hygiene and physical activity are emphasized as important building blocks of CHIRP.

Supplemental Session: The Problem of Chronic Pain

Chapter 11 provides supplemental material for teens whose chronic illness challenges involve major problems with chronic pain. While pain is a necessary protective mechanism of the body, chronic pain involves complex interactions between the nervous system, the brain, our emotions, and various situational factors that can actually make our experience of pain worse. The activities in this session are intended to help teens better understand these interactions and apply pain management strategies. Many of the coping strategies in the Children’s Health and Illness Recovery Program (CHIRP) have been shown to be effective in helping teens manage chronic pain more effectively so that they are able to more actively participate in the multiple areas so important to development.

Session 9: Keys to Maintaining Progress

Session 9 involves a review with you and your parent(s) of the individual skills you have acquired in Children’s Health and Illness Recovery Program (CHIRP) and providing guidance aimed at avoiding a relapse in your improvement. Key components of CHIRP are emphasized as they apply to your “Working Toward a Normal Daily Schedule.” The benefits of improved sleep and activity level, increased social contacts with peers, and increased comfort in assertively communicating with others are reinforced as critical for continued progress. Your parents are encouraged to support and trust your efforts in becoming more independent in managing various aspects of your medical condition, as well as in your decision making in setting a personal schedule and making lifestyle choices. Family members are strongly encouraged to continue to follow family rules for communicating about symptoms and resolving conflicts as discussed in the CHIRP sessions.

Session 8: Family Roles, Communication, and Support

Session 8 focuses on improving family communication, so important to improving your confidence in becoming more independent in managing both the challenges of your medical condition as well as you lifestyle as a teen. You and your family will be engaged in a discussion of parent and teen roles in the family and how the your illness has impacted and changed these roles. To expand on improving family communication skills, “misguided support” and “strong beliefs” are introduced and explored to better understand how these may unintentionally serve to make it harder to increase your feelings of confidence and skills in moving toward the greater independence needed for transitioning to young adulthood.

Session 5: Time Management and Prioritization

In Session 5 you will learn specific strategies for determining what is a desired (want to) versus a required (have to) activity and how to create a more reasonable personal schedule. When dealing with a chronic illness, learning to conserve energy and make good decisions about daily activities is important. Also, being on home-bound/home-hospital or home-schooled academic schedules can result in a less structured daily schedule and decreased peer social contact. Over- and/or underscheduling physical and social activities can become a major problem and source of stress. Setting reasonable and reachable goals and expectations is very important and requires that you learn how to prioritize and adjust your schedule of activities in response to your symptoms and illness.

Session 7: Assertiveness and Relationships

In Session 7 you are introduced to the concept of avoidant coping. We all use avoidance at times in dealing with stressful, unpleasant and uncomfortable situations. However, if we use avoidance as the major way to cope with these challenges, it will have a negative impact on our ability to function physically, emotionally, and in school and social situations. In order to make sure we don’t fall into the trap of over-using avoidance in dealing with the challenges of a chronic medical problem, CHIRP uses activities that teach you strategies that can disrupt this cycle by improving your skills and confidence in dealing with stressful situations you may encounter socially and in your daily life. Key skills you will learn include improving interpersonal communication and assertive behaviors. Increasing your skills and comfort in communicating and asserting your wants and needs with others is a primary goal of this session.

Sessions 10–12: Relapse Prevention

During the remaining Sessions 10–12 of the Children’s Health and Illness Recovery Program (CHIRP) no new skills or strategies are introduced. Rather, these sessions focus on continuing to practice the skills introduced in Sessions 1–9 so that they become positive habits and routines in the your and your family’s coping with their chronic illness while becoming more confident and competent in their movement toward more independence.

Session 6: Increasing Teen Independence

Session 6 is a family-focused session. In these family sessions you and your parent(s) will be seen together for all, or at least a major part, of the session. When a teen has a chronic medical problem it affects everyone in the family. The activities for these sessions are designed to begin the process of helping you and your family better understand the importance of helping put medical challenges in perspective while balancing these needs with the important experiences for teens to have to remain confident and competent in their lives. Workbook exercises and worksheets are used to identify how your lifestyle and activity schedule have been affected by your medical condition. This information is then used to help you and your parent(s) generate ways for increasing your activities and independence so important to this stage of your life.

Session 3: Relaxation Skills

Sometimes even problem-solving skills can’t reduce the stressfulness of a situation. In these circumstances, “Managing the Impact” coping skills are needed to reduce the effects of a stressor on physical and emotional functioning. In Session 3 of the Children’s Health and Illness Recovery Program (CHIRP), the use of diaphragmatic breathing and progressive muscle relaxation skills are introduced as proven methods for increasing relaxation, creating a sense of well-being, and decreasing the impact of stress on chronic illness symptoms. Cognitive behavioral therapy (CBT) skills, what CHIRP refers to as “Thought Challenging and Thought Changing Skills,” are then introduced to help you understand the relationship between thoughts, emotions/feelings, and actions that we take in responding to these.

Session 4: Thought-Challenging and Thought-Changing Skills

Session 4 builds on “Managing the Impact” coping skills by helping you learn to apply “Challenging Your Thoughts” skills to the stressful situations identified earlier and recorded on the “Thought-Changing Skills” Worksheet from the previous session. The goal of this session is to assist you in more accurately identifying those distortions in your assumptions, beliefs and thinking that underly distressful and uncomfortable emotions/feelings, which in turn can amplify unpleasant symptoms such as energy level and pain intensity. Common thinking errors such as hopelessness, catastrophic thinking, and mind reading are introduced and applied to your own identified automatic thoughts. This is followed by introducing strategies for challenging those often unsubstantiated and disabling thoughts that serve as barriers to setting goals, expectations, and motivation, which make it difficult to get your coping and lifestyle back on track.