Children's experiences (i.e. access to services), can be directly affected through disease self-management. Self-management training is often provided by tertiary care clinics, which includes disease education, and encouragement/support, usually at the time of diagnosis. Most care is given in concentrated sessions during crises times and is in response to a particular problem, which is not the best time to teach self-management skills. Families who are extremely distressed may, in rare cases, receive formal psychological therapy. Although most families receive excellent medical care in the tertiary care centres, the vast majority of patients do not receive comprehensive disease education and self-management therapy. Very few children with IBD receive comprehensive education and self management therapy even when they attend well organized tertiary care clinics.