Children with special health needs have an added risk for mental health problems These problems may be preventable in many cases by focusing on the development of competence in children and their family members in adapting to the chronic condition demands Five strategies for developing competence are discussed (a) encourage normal life experience (b) increase coping skills (c) increase use of social support (d) coordinate the delivery of care and (e) empower families Examples of programs employing these strategies that have been evaluated are presented.