The Program

How the program works

CHIRP establishes a collaborative relationship between the physician, pediatric specialist, physical/occupational therapist, pediatric health psychologist, school and the patient’s family to create a program targeting key symptoms and functional limitations.  Interventions are designed to facilitate the development of coping and recovery strategies for both the patient and family.

CHIRP has two primary goals.  The first goal is to educate and support the patient, family, and others in the community in the understanding of these painful and fatiguing pediatric conditions.  The second goal is to establish effective interventions that facilitate skill development in the following areas:

  1. Understanding and communicating about illness and symptoms
  2. Identifying and managing illness- and non-illness related stress
  3. Coping and problem-solving
  4. Time management and prioritizing
  5. Improving sleep hygiene
  6. Improving self-expression, communication and assertiveness
  7. Relaxation and self-soothing
  8. Developing helpful family roles for enhancing independence and communication
  9. Advocating for appropriate educational needs and accommodations
  10. Developing effective long-term recovery practices and lifestyle modifications

About the Modules

CHIRP employs a treatment manual and homework activities that are used together with the sessions. The activities are divided into four parts, or modules, that are designed to help the patient and their family learn more effective methods of understanding, coping with, communicating about and managing stress, both related and unrelated to the child’s illness, in moving towards recovery and improvement in quality of life. CHIRP has been designed in a way that allows the clinician to select an intervention that targets the primary concerns of the patient and family as they arise in treatment. The modules focus on one of the following (described in more detail in the following left tabs).

  • Stress Identification and Management
  • Problem-Focused Coping
  • Emotion-Focused Coping
  • Independent Functioning

Stress Identification & Management Module

Stress is universally present in nearly everyone’s life. This can be particularly true for children coping with a chronic fatiguing and/or painful condition. As such, the topic of stress is a logical starting point for treatment. The activities in this module are designed to increase patient and family awareness of illness-specific and non-illness specific stressors, their impact on the patient and their symptoms, and introduce general concepts of problem- and emotion-focused coping.


  • Defining stress
  • Identifying specific patient stressors
  • Recognizing the symptoms of stress
  • Monitoring stress
  • General overview of strategies for coping with stress

Problem-Focused Coping Module

Interventions focused on helping pediatric patients and their parents with improving active problem-solving skills have been frequently employed in assisting patients with chronic painful conditions. The activities in this module are designed to facilitate the patient’s adoption of more effective active problem-focused coping skills in those situations where more action-oriented strategies are likely to change their circumstances and personal outcomes. These include experiences in managing their time more effectively, learning how to prioritize and evaluate the likely impact of their choices, strategies for initiating and sustaining meaningful interpersonal relationships, and assertive skills in self-expression and relationship negotiation. These skills are applied to the task of the patient talking to others about their illness and becoming an advocate for the appropriate accommodations they may need in the process of recovery. Finally, since disturbances in sleep are so common in patients with these conditions, and also play a role in the process of re-regulation and recovery, issues of good sleep hygiene and a program of monitoring of sleep patterns and making lifestyle adjustments are explored and implemented


  • Problem-solving skills
  • Time management and prioritizing
  • Interpersonal and assertiveness skills
  • Sleep problems and sleep hygiene

Enotion-Focused Coping Module

This module more formally introduces the patient and family to the fundamentals of cognitive behavioral therapy (CBT) in order to facilitate increased understanding about the link between thoughts/beliefs, emotional/affective responses and behavioral responses as they pertain to symptoms and recovery.  These skills are applied to patient illness management both with regard to the stressors the patient experiences in coping with their illness, as well as in promoting more effective handling of other life stressors that, if overwhelming, may exacerbate their symptoms.  Specific skills in progressive muscle relaxation, abdominal/diaphragmatic breathing, positive relaxing imagery and “acceptance” are taught and practiced over a series of sessions. These activities are often supplemented with such services as Mindfulness Meditation training, clinical biofeedback, etc., either with the clinician or via referral to another professional. 

The patient and parents are coached in adopting these skills as lifestyle patterns, rather that merely “techniques” to employ when symptomatic.  The considerable body of evidence as to the efficacy of CBT and relaxation/meditative interventions is emphasized throughout treatment, as these may be unfamiliar to patients and require considerable coaching and correction to employ habitually and effectively.  


  • Cognitive “thought changing” strategies
  • Relaxation training/imagery
  • Coping through distraction and self-soothing

Independent Functioning Module

Activities in this module are designed to inform and reassure the patient and parents as to the paramount importance, in the face of often debilitating symptoms, of the need to fashion as “normal” an adolescent experience as possible for the patient.  Initial activities are designed to help the patient and parents assess the adverse impact of the patient’s illness on their academic, social, recreational, vocational and physical functioning.  Each family member is seen as having a “role” to play in the patient’s recovery from their chronic illness, and this is facilitated through homework assignments where these roles and functions are more clearly delineated, with an emphasis on how helpful or unhelpful these efforts at support have been perceived by the patient. 

The concept of “Misguided Support” is introduced wherein, in family members’ efforts to be helpful to the patient, these behaviors are experienced by the patient as undermining their developmental need to become more independent in both illness management and non-illness related arenas.  Parent-patient communication is addressed in the interest of improving these communication patterns so as to support increased self-confidence and sense of self-efficacy on the part of the child.  A behavioral contracting procedure is introduced to the family to be employed in those instances where a more formal commitment and monitoring process are needed to facilitate change.  Finally, guidelines are provided for structuring a post-treatment long-term recovery plan that attempts to minimize regression to previous dynamics that may undermine patient recovery and independent functioning.  


  • Impact of illness on patient and family
  • The role of family members
  • Misguided support
  • Improving parent-teen communication
  • Contracting for behavioral change
  • Long-term coping and recovery management


This section contains a number of activity worksheets from the CHIRP Patient & Family Workbook that may be downloaded or printed out for homework purposes.

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