Dental Care for Children with Special Needs

By Lyn Hughes, BSDH, RDHAP, DMG CRS Dental Hygienist

Imagine you are a child experiencing a dental appointment for the first time. Now imagine that you are a child with special needs, unable to communicate with those around you, and experiencing this for the first time.

Caring for the dental needs of those with complex histories can prove challenging. But at DMG CRS we specialize in caring for kids with complex conditions and we strive to keep those fears at bay as much as possible.

Knowing how to treat patients with complex histories, begins with knowing how to best help the patient feel comfortable and safe in the dental environment. To say this takes practice and patience by the provider is an understatement. Depending on the physical condition and intellectual level of certain individuals, these appointments can usually be modified and tailored to help facilitate as pleasant and successful a visit as possible.

Advances in wheelchairs have afforded patients the ability to stay in the chair rather than transferring to a dental chair. Many patients have sensitivities to the light, to the feel of the gloves, are not comfortable with a provider wearing a mask, do not like the texture of the dental toothpaste and some just don’t care for someone invading their personal space. This is only a short list of many issues facing some of our patients.

With a calm caring voice many fears can be soothed.

Asking the patient or caregiver for help to avoid triggers that insight fear is key. Knowing as much as possible about any conditions that exist prior to the appointment is very helpful when treating any patient but especially those have no way to communicate. For example, a patient with visual impairment may become startled at the sound of some dental equipment if he or she is not given a warning that such noise is about to happen.

Not every appointment is going to be successful. Our patients have good days and bad days just like we do.

I recall a patient who is nonverbal and very fearful of any medical or dental facilities. He came in with his mother and all we were able to do on the first day was sit in the chair. I considered this a successful day. The next appointment, two weeks later, he sat in the chair and I looked in his mouth. This continued until I gained his trust and was able to complete his dental cleaning. It didn’t happen overnight but that wasn’t the goal. Winning his trust and making him feel safe was my goal.

We must always remember that our goal is to provide the best care possible for our patients no matter what. It is rewarding to win over the trust of a patient, and getting a hug when it’s over is the BEST!

DMG CRS provides comprehensive assessments for every new patient

Pediatric ENT doctor phoenix

DMG CRS conducts comprehensive assessments for every new patient

By Nancy Kleinwachter, LPN at DMG CRS Comprehensive Assessment Clinic

DMG CRS is the largest Multi-Specialty Interdisciplinary Clinic (MSIC) in the state of Arizona and designed to meet the unique healthcare requirements of special needs children. Our staff are committed to coordinating multiple appointments for our patients and on the same day when possible. To do this, our team of experts first conducts a comprehensive assessment of each and every child to determine the specialty referrals needed to give them the best quality, complete care.

Comprehensive assessments are such an integral part of the DMG CRS Difference that we have a special clinic, the Comprehensive Assessment Clinic (CAC), with a team of Pediatric Nurse Practitioners highly trained in taking care of special needs children. This first visit is so important for the child, their family and for DMG CRS staff. During this visit the child is examined from head to toe, all medical and historical records are reviewed, and DMG CRS staff have in-depth conversations with the family. This is all done to create a clear understanding of the patient’s needs as well as to address any parental questions or concerns. It is during this assessment when the provider will determine what referrals are needed.

Once the assessment is complete and the referrals have been made, our team of medical professionals will ensure the referral appointments are scheduled. Not only will we ensure the referrals have been made and the appointments have been scheduled, but we also follow up to confirm the appointments have been kept. The CAC staff can even assist with coordinating transportation to appointments, getting in touch with a patient advocate to help with school concerns or connect families with a social worker.

Another great thing about DMG CRS, is that because there are so many specialties under one roof, all medical records are in a single electronic medical record (EMR) and is accessible to all DMG CRS medical providers. And even if referrals are made to a specialty outside of DMG CRS, we will make certain that we have a copy of the visit notes so that we can be aware of what has been done.

At DMG CRS, we pride ourselves on our ability to coordinate care for our patients.
DMG CRS has over 25 pediatric medical specialties onsite.

We also have lab and x-ray in the building in case it is determined that the child needs those services as well. Our Child Life Specialists are great at making those experiences easier on the child. And for those patients where distance is an issue, we offer telemedicine and outreach clinics in San Carlos, Show Low, Globe, Whiteriver and Prescott Valley.

Once the CAC appointment is done, a packet of information is given to take home, which includes the child’s plan of care, a copy of all referrals made, a list of scheduled appointments and direct phone numbers for any follow-up questions or concerns. Our goal is for the family to walk away from the appointment confident in DMG CRS’s ability to provide the best comprehensive healthcare for their child with special needs and that no stone was left unturned.

If you have any questions for the CAC team, please give us a call at 602.914.1520 x6144.

Coping with the Holidays After Involuntary Family Separation

Leer en español


By Sarah Anderson, PhD, DMG CRS Psychologist


This holiday season will find many Arizonan families separated from their loved ones across the border. These involuntary separations cast a shadow over what typically is a joyful time of year.  Families with children in particular, face the challenge of creating a holiday celebration while struggling with a sense of grief and loss. The American Psychological Association Holiday Resource Center states that “We all feel stressed from time to time, but the holidays offer their own special stressors that can make us feel even worse.” How can we cope at this special and difficult time of year? The following strategies may help:

  1. Acceptance of emotions: Accepting and expressing our own emotions and acknowledging the emotions of others around us is important. “You may feel as if you must always be cheerful, but remember that holidays are meant for emotion,” writes Psychologist Dr. Julie Jones, in her blog about grief and the holidays. Being happy one moment and sad the next is a normal part of grieving a loss. Sharing these feelings with each other can help the family bond.
  2. Planning: Decide which holiday traditions you want to continue, and which ones may need to be adapted or changed due to the new circumstances. Don’t be afraid to adopt or invent new traditions. Planning will help ensure that your absent loved ones can be included in some way and that your family bonds can be strengthened. An example of a new tradition might be a letter exchange. Family members write a special letter to each other expressing their best memories, appreciations, love and hopes for each other – to be opened on the holiday.
  3. Avoidance of isolation: It is more important than ever to be part of a community. Participate in a community event or accept an invitation to a friend’s celebration. A sense of community can lessen the effects of stress and promote a sense of well-being.
  4. Reasonable expectations of yourself and others: You may be feeling the pressure to compensate for the absence of your loved one by creating a “perfect holiday” for your children. Instead, consider embracing the holiday for whatever it brings – the beautiful and happy moments along with the sad and difficult ones.
  5. Reaching out: Do one thing to lighten the burden of another human being or reach out to someone else who has also suffered a loss or illness.
  6. Forgiveness: “Holding on to anger is like grasping a hot coal with the intent to throw it at someone—you are the one getting burned.”  This saying is attributed to Buddha and depicts the harm that can result to our physical and mental health when we hold on to anger, rage, and the desire for revenge. Everett Worthington, a noted writer and researcher on the topic of forgiveness states that “you can’thurt the perpetrator by not forgiving, but you can set yourself free by forgiving.” Positive Psychology research suggests that there are health and emotional benefits to forgiveness.


No matter what your situation is this holiday season, resolve to be patient with yourself and take the time you need to heal and be healthy. May your holidays be a time of renewal and peace!

For more information, visit the links below.

American Psychological Association (n.d.) Grief: Coping with the loss of your loved one Retrieved from:

American Psychological Association (n.d.) Holiday Stress Resource Center. Retrieved from:

Jones, J.  (2017). Managing Your Grief This Holiday Season. Retrieved from

Turner, D.  (15 June 20107) The miracle and the irony of forgiving. Retrieved from:

Wehrenberg, M.  (16 Dec 2016).  Holiday Depression and Loss: Family expectations, death, and divorce.  Retrieved from

Worthington, E.  (various dates) Free workbooks on forgiveness.



5 Ways Parents Can Help Their Child Manage Bullying

mom and child manage bullying together

By Megan Aros-O’Malley, PhD, Psychologist, DMG CRS

An estimated one in four children reports being bullied. Moreover, while bullying was once contained to face-to-face interactions, the increase of technology in modern society has brought the advent electronic bullying or “cyberbullying,” which can occur in any place or location via social media and smart phones. Children who experience bullying are at risk for any number of negative outcomes, including poor school adjustment, sleep problems, anxiety, and depression. Parents can play a powerful role in helping their children understand, manage and cope with bullying. Here are five tips for parents:

1. Explain to your child what bullying is. Children who know what bullying is can more easily identify and talk about it if they experience it.

Provide children with examples of the different forms and contexts in which bullying may occur (i.e., physical, name calling, electronic, etc.). Real world examples unfortunately occur too often but can be conversation starters for children. For example, a special needs child was recently recorded in the urinal by a fellow student, and that student posted the video on social media.

This sad example could be used to, not only discuss bullying with your own children, but also encourage children to speak up if they witness bullying and encourage kindness to others. The goal is to create a risk-free, safe environment and ensure your child tells you about any potential bullying as soon as possible.

2. Role-play appropriate responses with your child. As you discuss bullying- potential or actual- help empower your child by talking about and role-playing potential responses. In doing so, you and your child can openly discuss appropriate and inappropriate responses.

Give your child tips for responding, such as assertively telling the bully to “stop” or responding with humor. Help your child identify ways to respond that are not only appropriate but comfortable for your child.

3. Identify a support person at school. When proactively talking about bullying with your child, ask him or her to identify an adult at school he or she trusts and would feel comfortable going to for help.

Make sure that trusted adult at your child’s school knows he is your child’s “go to” person if your child feels threatened, scared, or concerned while at school. Although this adult may not be able to solve the problem immediately, he or she can be an important source of comfort.

4. If your child is bullied, provide empathy, support and a sense of calm. As a parent, we have what we perceive as “bigger, more complex” issues so we may inadvertently minimize problems our children share with us; don’t minimize bullying or any problem your child shares with you.

Instead, empathize and validate your child’s emotions. “If someone said that to me, I’d feel sad and mad, too. I am sorry that happened to you. Let’s talk about it.”

While empathizing, stay calm. Remember, that even if you’re angry at the person who bullied your child, showing your anger can make your child feel more stressed and less likely to share tough situations with you in the future.

Wait until you’re not with your child and then share your emotions with another trusted adult, go to the gym and get a physical release, or find a quiet space alone to experience your emotions of anger, sadness, frustration, etc.

5. Don’t stand by and hope it gets better. Doing nothing is never a good option when you suspect your child is being bullied. If it’s occurring at school or by a classmate, reach out to the school immediately.

Do you know the school’s policy and procedures around bullying? What training with teachers and staff has been done? What, if any, conversations about bullying have occurred with students? I recommend being proactive in understanding how your child’s school is managing bullying, because if it happens to your child, your emotions will be high, and that’s not the time to be trying to understand how the school manages bullying.

DMG CRS: Serving Native American Communities

By Frances Montoya, RMA II, DMG CRS


Frances with a patient

During my recent visit to our Whiteriver Outreach Orthopedic Clinic, I had the opportunity, once again, to help children and families in Northern Arizona with their complex healthcare needs. DMG CRS has several outreach clinics, like this location on the campus of the Whiteriver Indian Hospital, serving the Fort Apache Indian Reservation and the communities of Globe, Prescott, San Carlos and Show Low.  For as long as DMG Children’s Rehabilitative Services (DMG CRS) has been around, we have been serving Whiteriver Indian patients, providing young patients the care they may not receive otherwise in their rural, remote communities due to transportation or mobility challenges.

We work very closely with patients’ primary care providers (PCP), outreach coordinators as well as x-ray and lab departments within the hospital to coordinate care and ensure all the pediatric patients’ needs are addressed.  DMG CRS pediatric orthopedic specialist, Louis Vu, MD, has been caring for patients at the Whiteriver clinic for more than five years.

I have been working with this clinic for 17 years and have gotten to know many of the families very well.  Serving this community is a pleasure, and I appreciate the opportunity to learn more about their culture and values.  They are family-focused people who respect their elders and are also very private.  As a healthcare worker, understanding these values helps me serve the patient better- not just addressing clinical concerns but doing so in a way that makes the patient and family feel comfortable and respected.

In addition to orthopedics, DMG CRS also has pediatric specialists in genetics and cardiology- Margaret Ann Pearson, MD, and Daniel Miga, MD respectively- serving patients in Whiteriver.  We also work in the surrounding communities, including Bylas, Camp Verde, Payson, Peridot, Safford, Springville, St. Johns, and many more.

I really appreciate all that the DMG CRS team from Phoenix does for families in Northern Arizona.  And, I see daily how grateful the families are for what we are doing for them.

Dr. Nick Tanner’s Three Tips for Parents of Children with Health, Developmental, and Behavioral Differences


Doctor Nick Tanner

Dr. Nick Tanner

Never stop advocating.

When parents have a kid with extra needs or differences, things may things get contentious between parents schools, healthcare providers, and government agencies.  Sometimes it can feel a little like it is “us vs. the world.”

As a psychologist, part of my job is encouraging my parents to engage with these complex systems of care, help them navigate the procedural challenges inherent to these systems, and facilitate collaboration with the goal of helping patients and families thrive.

Although it’s important to have realistic expectations, the old saying is true; squeaky wheels tend to get the grease. Families and parents who are persistent tend to be more successful in getting more individualized and intensive treatment.

Though conflict can be uncomfortable, it’s important to be your child’s biggest cheerleader – never stop advocating.


Think about the long-term big picture.

Parents often and understandably get caught up in what their children’s limitations are, right now and in the present. They may lose sight of what’s important to them.

Part of my job at CRS is helping parents and families identify and connect to their values.  Most parents want their children to live vital and meaningful lives, and sometimes an extra need or illness can make it hard to see what’s important in the long run.

Identifying values is one way to help figure out the big picture. Values can act as a compass, providing direction and assisting parents to move from a place of “My child can’t do this,” “What if they fail,” or “My child will never,” to a more productive place. A place where parents can begin to ask “What can my kid do now,” “What do I hope they’ll be able to do later,” and “How can we help them get to that place.”

Think about the big picture, dare to dream, and focus on what is important.


Take care of yourself.

For a good reason, many parents do not consider themselves, or their wellbeing, a critical contributor to their child’s outcomes or a priority.

On top of the already hectic demands of parenting, families of children with extra needs also have additional requirements on financial resources and their time.

Many of the families I work with have to manage busy schedules that include juggling therapy appointments, doctors visits, school, and work.  However, there is reason flight attendants tell parents to put on their air masks before attempting to help others in an emergency – it’s impossible to help other people if you do not take care of yourself.

Research shows that socially isolated parents struggle to build fulfilling relationships with their children and are more likely to develop mental illnesses. It’s not “selfish” to take care of yourself.  Finding some time for yourself is essential.

So go ahead, make that therapy appointment for yourself, get a pedicure, or meet up with some supportive friends. It might be one of the best things you can do for yourself and your child.

Living Beyond Expectations:
Meet Bella and Emma

(desplazarse hacia abajo para la versión en español)

Bella was adopted when she was three months-old and was on a joey pump, and to everyone’s knowledge, that was her only medical challenge.

After visiting DMG CRS geneticist, Dr. Alec, Bella was diagnosed with Jarcho–Levin syndrome, which can be lethal. She started wearing helmets and had three braces for her back.

When Linda Reed, Bella’s adoptive mother, first received her as a foster child, she was told Bella would not live beyond the age of three.

Linda was faced with a difficult decision sharing with us, “Do I protect my heart and hold back a little or do I love her with all my heart?”

Like most mothers, Linda could not hold back and opened her heart and home to Bella, adopting her. Working closely with DMG CRS providers treating Bella, Linda counts every day with her as a gift, as Bella is now six years-old!



Linda also fostered and then adopted a second girl, Emma, who came to Linda at the age of two after being in three previous foster homes. Like Bella, Emma had special medical needs and immediately became a patient at DMG CRS. Emma had a trach, so the ventilation classes offered at DMG CRS enabled Linda to learn how to take care of Emma.

Emma’s medical challenges have been beyond complex. She has had six cranial surgeries, as her head had grown out of her forehead as an infant.

In addition, Emma had never eaten, had a drank, talk or walk nor was she potty-trained when she arrived as a foster child at Linda’s home. She needed feeding therapy in addition to other medical treatments.

Thanks to the multi-specialty care at DMG CRS and a loving, committed adoptive mother, Emma has come further than anyone expected.

“She’s now talking, has an amazing memory and runs rampant through our house,” shared Linda recently.

How DMG CRS Helped Bella and Emma and Their Mom

“We love DMG CRS’ robust network of doctors at the clinic. We’re able to have continuity of care because all the doctors talk to each other. The coordination among the healthcare team is vital so we have confidence that they are all on the same page,” said Linda.

She added, “We have found that everyone who works at DMG CRS is very helpful and informative. If they don’t know the answer to my question, they’ll do the research so I have confidence that they really are working on my child’s behalf.”



Superación de las expectativas de vida: Conozca a Bella y Emma

A Bella la adoptaron con sólo 3 meses de edad, conectada a una bomba portable alimenticia joey pump, y según todos, ése era su único problema médico. Tras visitar al genetista de DMG CRS Dr. Alec, a Bella la diagnosticaron con el síndrome Jarcho–Levin que puede ser fatal. Comenzó a usar un casco y tres aparatos ortopédicos en la espalda.
Cuando Linda Reed, la mamá adoptiva de Bella, la recibió en casa en cuidado temporal Foster, le dijeron que no viviría más de los 3 años. Fue entonces que Linda tuvo que afrontar una difícil decisión que compartió con nosotros: “¿Debo proteger mi corazón y abstenerme un poco, o amarla con todo mi corazón?”

Como toda madre, Linda no pudo abstenerse y le abrió las puertas de su corazón y de su hogar a Bella, adoptándola. Ahora lleva a cabo el tratamiento de Bella en conjunto con los proveedores de DMG CRS, y Linda cuenta cada día de vida de Bella como un regalo, ya que ha alcanzado la edad de ¡seis años!

Linda también fue madre temporal Foster de una segunda niña, para después adoptarla; Emma, quien llego a la vida de Linda a la edad de 2 años y tras haber vivido en 3 hogares temporales Foster. Como Bella, Emma tiene necesidades especiales médicas y rápidamente se convirtió en paciente de DMG CRS. Como Emma tiene una traqueotomía, las clases sobre ventilación que ofrece DMG CRS le han permitido a Linda aprender cómo cuidar de Emma.

Los retos médicos por los que ha pasado Emma han sido mucho más que complejos. Ha tenido 6 cirugías de cráneo, ya que de bebé su cabeza creció desproporcionadamente a su frente.

También, cuando Emma llegó a la casa de Linda como niña bajo cuidados temporales Foster, nunca había comido por la boca, tomado líquidos, hablado y no sabía cómo ir al baño ella sola. Necesitó terapia de la alimentación, además de otros tratamientos médicos.

Gracias a los cuidados de especialidades múltiples de DMG CRS y a su amorosa y dedicada madre adoptiva, Emma ha logrado superarse e ir más allá de lo que cualquiera hubiera imaginado.

“Ahora habla, tiene una memoria increíble y corre por toda la casa” nos contó Linda últimamente.

Cómo DMG CRS ayuda a Bella, Emma y a su madre

“Nos encantan las afiliaciones de doctores tan completas que hay en la clínica DMG CRS. Podemos llevar el cuidado médico sin interrupciones porque los médicos se comunican entre sí. La coordinación del equipo médico es vital y confiamos que todos están en sintonía” dijo Linda.

También añade: “Vemos que todos los que trabajan en la clínica DMG CRS son útiles e informativos. Si no saben la respuesta a mi pregunta la investigan, por eso confío que realmente trabajan en nombre de mis niños”.

Why One Family Travels 100 Miles to DMG CRS

(desplazarse hacia abajo para la versión en español)

Blake was born at 32 weeks. He has diplegic cerebral palsy and is now 12 years-old.

Blake has been a patient at District Medical Group Children’s Rehabilitative Services (DMG CRS) since he was less than three years-old, visiting DMG CRS medical specialists as often as two times weekly.

Blake’s treatment plan is coordinated by medical specialists, including orthopedics, neurology and physical therapy, and the unanimous opinion is that this young patient is doing amazing!

Recently, we sat down with Blake’s mother, Debbi, to get a firsthand look at how DMG CRS has provided unique medical treatment and holistic support to Blake and his family.

Why did you choose DMG CRS for Blake’s care?

“DMG CRS was recommended to us by a nurse where we live in Casa Grande. She explained how DMG CRS provides all the services needed under one roof, and that convenience was very appealing to us.”

What makes DMG CRS stand out from other medical facilities that you may have visited?

“We travel pretty far – more than 100 miles round trip – to visit DMG CRS multiple times a week and have always been met by DMG CRS staff that are happy and welcoming. We’ve never had a bad experience.”


El por qué una familia viaja 100 millas para llegar a DMG CRS

Blake nació a las 32 semanas de gestación. Tiene parálisis cerebral diplégica y ya tiene 12 años. Blake es paciente de District Medical Group Children’s Rehabilitative Services (DMG CRS en inglés) desde antes de cumplir los 3 años, con citas a especialistas dos veces por semana. El plan de tratamiento de Blake es coordinado por especialistas que incluyen médicos de ortopedia, neurología, terapia física; la opinión unánime de los especialistas es ¡nuestro paciente está excelente!

Recientemente tuvimos la oportunidad de sentarnos un rato con Debbi, madre de Blake, para ver por nosotros mismos como DMG CRS le proporciona tratamiento médico único y apoyo integral a Blake y a su familia.

¿Porqué escogieron a la clínica DMG CRS para el cuidado de Blake?

“Una enfermera de Casa Grande en dónde vivimos, nos recomendó la clínica DMG CRS. Ella nos explicó cómo DMG CRS proporciona todos los servicios necesarios bajo un solo techo, eso es tan práctico que se nos hizo muy atractivo”.

¿Qué sobresale de DMG CRS en comparación con otras instalaciones médicas que ha visitado?

“Manejamos desde muy lejos – más de 100 millas de ida y vuelta – para venir a DMG CRS varias veces por semana y el personal de DMG CRS siempre nos han recibido contentos para darnos la bienvenida. Nunca hemos tenido una mala experiencia con ellos”.

Easter Bunny Visits CRS!

Children’s Rehabilitative Services was pleasantly surprised by a friendly visit from the Easter Bunny on Sunday. The happy bunny rabbit stopped in to say hello…

Adam Eaton Visits CRS!

Arizona Diamondback baseball player stops by Children’s Rehabilitative Services in Phoenix. Adam Eaton’s generosity and giving of his time here in the community comes as a wonderful surprise to many at the center…