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Community-Based Programs for Children and Youth: Our Experiences in Design, Implementation, and Evaluation

Pediatric physical and occupational therapists are in the unique position to provide therapeutic and health promotion interventions to children and youth with special health care needs (CYSHCN) including those with chronic conditions (such as overweight and obesity) in a variety of settings. CYSHCN are defined by the federal Maternal and Child Health Bureau as, “Those who have or are at increased risk for a chronic physical, developmental, behavioral, or emotional conditions and who also require health and related services of a type or amount beyond that required by children generally” (McPherson et al., 1998). In the United States (US), CYSHCN experience increased health costs and higher utilization compared to their peers with typical development (Newacheck & Kim, 2005; Trasande & Chatterjee, 2009). Yet, CYSHCN, often have poor overall health, are more sedentary and at higher risk of obesity, functional limitations, and limited social participation compared to their peers with typical development (Bandini, Curtin, Hamad, Tybor, & Must, 2005; Poulson, Ziviani, Cuskelly, & Smith, 2007; Rimmer, Wang, Yamaki, & Davis, 2009). Rimmer (1999) proposed a model of health promotion for people with disabilities in which he advocates for partnerships between rehabilitation professionals and fitness or community center staff to extend therapeutic services and sustain therapy outcomes by promoting prevention, activity, and participation in community settings. It is important for therapists to engage in health promotion strategies to support participation in active, healthy lifestyles for CYSHCN and their families. Three health promotion strategies that therapists use include gathering available