Parenting children or youth with emotional, behavioral, or mental health issues - including many foster and adopted kids - can be very challenging and stressful. Foster and adoptive families sometimes have access to respite: someone else who will caretake their child for a few hours or a few days.

Respite service for children was originally developed as a break for parents. The child stayed with another family and generally participated in all regular family activities including outdoor recreation, movies, and watching TV. While the respite provided a break for parents and foster parents, it seldom reflected the diagnosis of the child and his or her treatment needs.

Over the past few years, respite has evolved into a therapeutic intervention, so that the respite services provided are part of a child's treatment approach. Therapeutic respite can be put into place because the parents need a break, at the request of the child's therapist, or in conjunction with a crisis plan.

Respite interventions will vary from child to child but may include some of the following: limited access to regular, fun activities; no TV or DVDs; writing assignments; school work; practicing being respectful; doing restitution for the transgressions that proceeded the respite; healthy but boring food; thinking time; practice following directions, expending physical energy; and reading time. Therapists may request that the child or adolescent write or draw so as to provide material for the upcoming therapy session. Teachers may have school assignments to be completed.

Therapeutic respite providers are often therapeutic foster parents, with additional training in dealing with particularly challenging kids. Their additional training provides them with the tools to deal with children who steal, lie, run off, are verbally aggressive, physically aggressive, and may be destructive.

Therapeutic respite can be a necessary intervention to keeping a child in a family setting. By utilizing therapeutic respite, parents and therapists have a short-term alternative to a group home or a juvenile detention center. For some kids, several therapeutic respite visits may provide the motivation for them to change their behaviors.

Parents of challenging kids find that sending their child to grandma-type respite escalates the behavior of their child when they return home. The child or teen may resent having to follow the rules at home, whereas going to respite is fun, with few rules, and limited structure. A more structured, therapeutic respite reinforces the goals created by the family services team.

The availability of therapeutic respite services varies from community to community. Agencies utilizing therapeutic respite may include adoption and foster care agencies, the local department of family services, and juvenile justice. Organizations that might access therapeutic respite include parent support groups, family preservation units, and foster parent support groups.

If parents can find therapeutic respite services, the question is how can it be paid for. Funding sources, like availability, vary from community to community and state to state. Agencies that provide therapeutic respite may raise monies through fund-raising or grants, or it may be part of their operating budget. Families may be provided respite as part of their foster, adoption, or mental health service plans. For families that don't get respite services provided, some choose to pay out of their own pocket.

Over time, hopefully state and local agencies will see the benefits of developing therapeutic respite services as part of a continuum of services available for children and teens with emotional, behavioral, or mental health issues. Implementing therapeutic respite can be one of the community-based services that helps a child stay in a family setting, rather than being placed in a residential setting, at more expense and without family support.

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