Tag Archive for: involuntary separation

3 Basic Wellness Tips for Every Family with Special Needs Children

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by Linda Thunn, PT, DPT, DMG CRS Physical Therapist

Life with a special needs child or adult can be a complex, scary, and amazing journey full of ups and downs, triumphs and disappointments that affect the whole family. A good thing to remember is to think about the long-term outcome of a goal rather than just the immediate outcome. You may want your child to walk or talk, but that may not be possible. Therefore consider what can be done to support them in their effort to be the most independent and to find joy in their life.

Caring for a child with or without special needs is a marathon, not a sprint. You won’t always do the right thing, but with good intentions you will be on the right path. Below are three basic tips to improve wellness for the whole family.


1. Breathe

We know we need to eat right and exercise, but when you have a special needs child, you may not have the time to do the “right” things for yourself. Incorporating easy wellness activities into your daily life could make all the difference. The act of deep breathing with intention can decrease your cortisol levels thereby decreasing stress levels. Deep breathing for a few breathes, 3 to 5 times a day, takes practice to become a habit and to be effective.

Try it right now! Sit down in a chair with your feet flat on the floor. Slowly breathe in through your nose, counting to five (using your fingers to count will slow your breath). Hold your breath for two seconds, and exhale through your mouth to the count of five. The goal is to have your midsection expand during the inhale breath and soften during the exhale breath with your shoulders remaining still. Repeat this exercise three times. As you continue this practice you can add repeated positive thoughts while you breathe. And as you improve, you will be able to incorporate this in your walking, standing and exercising.


2. Play

Please take your therapists advice and include their information into typical activities of daily living. Whether you are working on sitting or walking with your child, you are promoting their independence. Ultimately all therapies are to promote progression to a less dependent adulthood. Please do not forget to play. Simple repetitive activities that are common during functional play builds pre-literacy, motor, and thinking skills. Whatever your age or skill level, everyone likes to participate if they are having fun. Arizona has a variety of resources for various skill levels, including adaptive parks and sports. Also family based physical activity increases the health and wellness of your family unit.


3. Community Resources

If you have access to the internet, search for community resources in your area by using terms such as “adaptive recreation” or “adapted technology,” and tailor the search to your child’s age based needs. Participate in the special programs that your child’s school offers, and if your child is going to the Special Olympics games, go with them or volunteer at an event. Another good resource are the support personnel in your child’s life, such as DMG CRS child life specialists, case workers, providers and therapists. For example, I have created the go-to document Arizona Community Sports and Programs for Children and Adults with Special Needs. That would be a great place to start improving wellness for your whole family.


Linda ThunnAbout Linda

Linda Thunn has her doctorate degree in physical therapy and has worked for the CRS program for eight years. Her mission is to provide solution orientated physical therapy through comprehensive care for children through young adulthood with chronic illness and disabilities.


DDD/ALTCS Plan Changes



By Philip Goritsas – CRS Director of Clinical Operations & Troy Nelson, MD – CRS Medical Director

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May 16, 2019


Re: Change with Developmental Disabilities and the Arizona Long Term Care System (ALTCS).

Dear Parent or Legal Guardian,

DMG CRS here in Phoenix appreciates and values you as part of our family. You may have received a letter from the Department of Economic Security at the end of April that informed you about the DDD changes. We want to make this change easier for our patients.

DDD/ALTCS is changing on October 1, 2019. As a member of the CRS program, today you are insured by United Healthcare Community Plan. You will be assigned to a plan for October. All of our patients will now have a choice between two health plans:

  • Mercy Care
  • United Healthcare Community Plan

Remember – You can choose to keep the plan you are assigned to or you can choose another plan. You will have time between June 14th and July 15th, 2019 to change plans, during open enrollment. You will still have access to the same services at the DMG CRS Clinic. Both United Healthcare Community Plan and Mercy Care Plan contract with us to provide services.

Here is what will stay the same:

  • You will still be able to be a patient at DMG CRS
  • You will still have the same range of AHCCCS covered services at DMG CRS as you have now

Here is what will be different:

  • You will have a choice between two health plans, instead of just one
  • We will be adding new specialties and providers to expand services for our patients
  • If you get services outside of our building, like surgery or primary care, please check with your insurance anddoctor’s office

DMG-CRS will continue to be open to treat patients as we have in the past. The plan you choose will not impact your ability to receive care at DMG CRS.

We are here to answer your questions. That is why we have created several ways for you to get more information about this transition:

  • Speak to any DMG CRS staff member at your next appointment
  • Call the DMG Transition Hotline: (602) 914-1555
  • For questions about the new health plans you can contact the DDD Customer Service Unit directly at:
    1-844-770-9500 ext 7 or by visiting des.az.gov/ddd-health-plans on the internet

Troy Nelson, MD
CRS Medical Director


3 Tips for Interacting with Someone on the Spectrum

An insider’s guide on making friends and merging worlds

by Tre’Shawn Rizo, Administrative Assistant at DMG CRS

In the ninth grade I was fortunate enough to meet my best friend Daniel in biology class. At the time I didn’t know he was, as he likes to put it, “different.” It was later in the day that he let me and a few others know about his autism. But that didn’t matter to me. From the moment I first noticed Daniel, I knew he was a guy I wanted to get to know. You see, earlier that day in biology our teacher used the expression “pull yourself up by your own bootstraps.” I didn’t think anything of it, but Daniel quickly raised his hand and said, “Hey Mr. McWilliams, that’s physically impossible to do. So I’m confused by your statement.” Watching my teacher get red in the face and fumble over how to respond was priceless. During lunch that day I decided to find Daniel and sit next to him. And after an awkward introduction and eleven years I’m quite pleased to still call him my best friend.

Over these past eleven years of having an autistic best friend, and in honor of Autism Awareness Month, I want to share my top three tips for interacting with someone who has autism. But first, let’s start with some definitions just so we are all on the same page.

Autism: A neurological disorder characterized by repetitive behavior, difficulties communicating, and problems establishing and maintaining relationships.

Autism Awareness: A movement about spreading awareness and acceptance of people on the autism spectrum.

Neurotypical: A person who doesn’t display atypical thought patterns or behaviors.

Stimming: Self-soothing, repetitive body movements which autistic people do in response to over-stimulation or emotional stress. Common ‘stims’ are rocking back-and-forth motions, hand flapping, and arm and leg rubbing.

Now that that’s out of the way, we as neurotypicals have a way of being weird or awkward when it comes to interacting with someone who falls outside the norm. However, they are people just like we are. The only difference is they think differently. So here are three tips that will help you develop friendships with people on the spectrum.

Tip 1: Be Kind.

It should go without saying, and this applies no matter who you are talking with, but be kind and respectful. A little kindness and respect can go a long way. People with autism are often bullied, teased or talked down to. Do not assume their mental capacity is based off their condition. The two do not always go hand in hand. So do not talk down to or baby them.

Tip 2: Be Patient.

When talking, people with autism may experience an eruption of emotions and misunderstandings. Because of that, when processing social cues, they might miss something and accidentally say something that may be taken as stupid, mean, or offensive. This tends to hinder the formation and maintenance of lasting relationships. But this can be avoided by helping to bridge the gap of misunderstandings. Keep in mind that without the physical emotional cues to guide their responses like neurotypicals do, they are left with just the words. This sometimes can make an awkward experience.

To get a sense of what this is like, try closing your eyes the next time somebody is talking to you. It’ll give you an idea of how much they are missing out on. It is said that over half of all communication is nonverbal. If you’re the neurotypical in the conversation, it’s your job to make sure you are clear in your meaning. If you feel offended by what they may have said, instead of showing your offense through your facial expressions, kindly verbalize that they have offended you. You will get an apology a lot faster than making a face at them that they may not pick up on or understand.

Tip 3: Pay Attention.

Pay attention to their body movements for signs of stimming. This happens when they are experiencing an excess of emotion or sensory stimuli. It isn’t always bad, and it isn’t always good. It just is. Many people with autism have free floating anxiety even when they are happy, and stimming helps keep that under control. If you see that they are moving around more than usual, ask if they need anything. Most of the time they will tell you what they need, and the tiniest gestures go the furthest.

I know that these tips won’t make the stigma surrounding people on the spectrum go away in a day, but it’s a start. Kindness, patience and paying attention are a good start to making new friends and merging these worlds together.

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

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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: https://www.apa.org/helpcenter/grief.aspx

American Psychological Association (n.d.) Holiday Stress Resource Center. Retrieved from: https://www.apa.org/helpcenter/holiday-stress.aspx

Jones, J.  (2017). Managing Your Grief This Holiday Season. Retrieved from https://psychcentral.com/blog/managing-your-grief-this-holiday-season/

Turner, D.  (15 June 20107) The miracle and the irony of forgiving. Retrieved from: https://positivepsychologynews.com/news/doug-turner/20070615298

Wehrenberg, M.  (16 Dec 2016).  Holiday Depression and Loss: Family expectations, death, and divorce.  Retrieved from https://www.psychologytoday.com/us/blog/depression-management-techniques/201612/holiday-depression-and-loss

Worthington, E.  (various dates) Free workbooks on forgiveness.  http://www.evworthington-forgiveness.com/diy-workbooks