Program Profile

Impact Feature Issue on Children with Disabilities in the Child Welfare System

Entering a Brave New World: Kennedy Krieger's Therapeutic Family Care Program

Now in her second semester as a college freshman at a community college in the Baltimore area, Nicole Jones is still reveling in the new experiences and opportunities. “College is so great…so different,” she says. “Everyone wants to be there, wants to learn and wants to sit down and have real conversations.” She loves planning her own schedule and enjoys the calm, academic atmosphere.

While Nicole’s account may seem like that of any other college freshman’s, it isn’t. In her 19 years, she has faced much adversity, and has relied on her inner strength, and the support of others, to help her succeed. Removed from her birth family, Nicole was placed in Kennedy Krieger’s Therapeutic Family Care program at the age of six. In her younger years, she went through a self-described “rough patch” when she followed the crowd – skipping school and challenging her foster parents. She became a young mother at age 17, but has pushed herself to pursue an education while developing into a wonderful, devoted parent. Looking back, Nicole remembers that each time she went down the wrong path, a Kennedy Krieger social worker was there to encourage and re-direct her frustrations.

Over time, Nicole has flourished with the love and support of her foster family and program staff. A part of the foster care program for much of her life, Nicole’s college enrollment this past fall is a testament to her will to achieve and to the program’s success.

Bringing Stability to Children’s Lives

Funded primarily through the Maryland Social Services and Developmental Disabilities Administrations, Kennedy Krieger’s Therapeutic Family Care program, which started in 1986, serves more than 100 children each year with developmental disabilities, emotional problems and medically fragile conditions. The program, which is a part of both the Social Work department and The Family Center at Kennedy Krieger, helps children with special needs find temporary or permanent new homes when they cannot live with their parents and all other family options have been exhausted.

According to Robert Basler, co-director of Therapeutic Family Care, one of the things that makes this program different from other therapeutic foster care programs is the broad range of conditions served. Children in the program have a history of, or are at risk for, institutional or hospital placements for everything from emotional disorders to learning disabilities, severe behavior disorders, pervasive developmental disorders, intellectual disabilities, cerebral palsy, and spina bifida. Through Therapeutic Family Care, they benefit from placements with trained families in the Baltimore region and surrounding counties.

Individuals who open their homes to foster children with such conditions have direct access to an interdisciplinary team of developmental experts at Kennedy Krieger who provide diagnosis, evaluation, treatment and research of a vast range of cognitive, physical, and emotional conditions. In addition, all foster and adoptive families are supported through a continuum of family-based services provided by dedicated team members at Kennedy Krieger. These include respite care, adoption services, and specialized training for parents or foster parents. Training and technical assistance also are available to community agencies. Three years ago, the program’s name was changed from Therapeutic Foster Care to Therapeutic Family Care to better reflect the spectrum of family services it offers, as well as its emphasis on building and maintaining families.

Kennedy Krieger believes that children with special needs are entitled to live in the least restrictive, safest community environments possible. With the right assistance, these youth can participate fully in family, school and community life. “The best part of the work is helping a child reach his full potential in life,” says Diane Fiala, a dedicated Kennedy Krieger foster parent.

Growing Up and Out of Foster Care

Working in close partnership with state and local child welfare agencies, Therapeutic Family Care matches children with special needs with families who bring stability, love, and attention to their lives, until they can be returned to their families, adopted or transitioned to independent living. In recent years, the program has found itself in the inevitable position of having to transition many of its children, now young adults, out of its foster care program. “The program has been in existence for 19 years, so we are, as a program, at the point where some of the children have now grown up,” Basler says. “And, we’re having to face the issue of transitioning them.” As these children are now facing emancipation, the question of what is the next step for them has become the primary concern. According to Judy Levy, director of Social Work, when most young adults leave home they maintain their family ties while they learn to take care of themselves. Their families are their safety nets. “For young adults in foster care, the system has traditionally seen them as ready for independence,” Levy says. “We know that’s not necessarily true. These children may not have their families as safety nets, even if they have a connection with them.” In response, a new component was added to the Therapeutic Family Care repertoire of services: the Transition Program. The program is designed to help youth, who have spent their childhood in foster care, transition into less restrictive environments, to help them gradually become independent. “We’ve helped them to adjust to their disability and understand their trauma,” says Paul Brylske, co-director of Therapeutic Family Care. “They still have a history of trauma and emotional and behavioral issues. They still have develop- mental disabilities. But, they make it to this point where they’re ready to transition into adulthood, and we’re there to help them be successful.”

Since Therapeutic Family Care serves a wide spectrum of children with varying disabilities and needs, the transition needs vary greatly. Some adolescents require semi-independent living until they reach age 21. These individuals often share an apartment with roommates, and case managers help guide them through daily living activities. Others require more restricted environments, such as assisted living or group homes, because their disabilities prevent them from independently carrying out daily living activities. Still others may remain in the care of their foster parents well into adulthood. Therapeutic Family Care has partnered with several programs outside of Kennedy Krieger to help young people find appropriate living arrangements. “We’re intensively working with a program called New Pathways,” Brylske says. “This allows the young adults to share an apartment and receive wrap-around services, such as independent living groups, job coaching and social work case management.” In addition to clinical case management services, life skills training, and ongoing support, the Transition Program also offers young adults after-care services to ensure that appropriate clinical services are received. Transition coordinators in the Therapeutic Family Care program work closely with the youth after they have transitioned to their new homes, and also when they face other difficult transitions – such as adoption, starting a new job or experiencing the death of a loved one.

In August 2002, Mark Jones, then 18, moved from his foster parents’ home to a New Pathways semi-independent living program. He had been with Kennedy Krieger for more than eight years. In his new situation, Mark continued to receive social services and counseling, as he had at Therapeutic Family Care, to address any emotional and developmental issues he may have faced. At 21, Mark graduated from the program and now lives in an apartment on his own. Living with his foster family taught Mark vital daily living skills, which helped make his independent situation a success. “I learned how to cook from my foster parents,” he admits. At New Pathways, Mark continued to hone the skills he needed to care for himself and his surroundings. He was responsible for doing household activities, such as washing dishes and cleaning the bathroom. Mark’s hopes for his future are clear: “Someday, I plan to own a home,” he says.

Encouraging Education and Work

An important component to the Transition Program is education and employment, areas in which many children in foster care traditionally do very poorly. But among those in Therapeutic Family Care, 100% graduate from high school and 50% maintain jobs while in school – success rates nearly equal to those of children nationwide. Staff and parents encourage students to pursue higher education, as Nicole has done. Nicole credits her foster parents and Kennedy Krieger for helping her continue her studies. “My foster mother helped me with college and financial aid applications and took me to the open houses,” she says. “I also got support from Therapeutic Family Care’s really great social workers. I always wanted to go to college to make something of myself and they were always there for me and pushed me to do better academically.” With only a handful of classes under her belt, Nicole already has clear ambitions. “I always knew growing up that I wanted to help people,” says Nicole, who plans to transfer to Coppin State University next year to earn a degree in social work. “When I was younger, I never really understood the purpose of the social workers who came to see me, but now that’s what I want to be. Given my experiences, I think I will have a great instinct for how to help children in difficult situations.”

Kennedy Krieger’s Transition Program encourages students to be proactive decision-makers. Although Mark was steered in the right direction by his social worker, he took the application process into his own hands. “As far as getting into college, my social worker took me to the college to get an application, but I did everything else by myself – setting up my schedule, taking the placement test, meeting with a counselor, going through the enrollment process,” Mark says. He attended a community college in the Baltimore area, where he took general studies courses. Today, he has a steady job at an area restaurant and continues to dream of his future. In a few years, he wants to be a mechanic. “I like to fix cars,” Mark says. Through his experiences with Therapeutic Family Care, Mark learned at an early age the importance of keeping a positive attitude and persevering, no matter how difficult the circumstances. “Stay in school and use Kennedy as a stronghold,” he advises others who may be going through similar situations. “Worry about what you’re going to be doing in the future and not what happened in the past.”

Building Lasting Relationships

One of the goals of Therapeutic Family Care’s Transition Program is to help children maintain healthy, positive connections to their families and the community. According to Brylske, a main com- ponent of the program is its focus on community and family. “The Transition Program is unique in that it fosters individual connection and linkages to services,” he says. The Transition Program has formed working relationships with community resources, such as DORS (Department of Rehabilitative Services), to link individuals to community services, with the goal of creating relationships and maintaining them. “These children have been in situations that have led them to have difficulty with relationships and connections. They’ve grown up with us, and we’ve built connections with them. We want them to maintain some degree of connectedness with us and their foster families,” Brylske says. “We hope they go back to their foster families for an evening meal every once in a while. Without these connections, foster children are often at risk of ‘falling through the cracks.’”

Nicole feels a strong bond to her foster parents. “It seems like I’ve always been in this family,” she says of their 10-year relationship. “I’ve learned from them not to judge people and to forgive, because everybody makes mistakes. Without their support, I wouldn’t be the person I am today.”

This article by Tania Edghill was originally published inTouch, Winter 2002, a publication from Kennedy Krieger Institute and its Atlanta affiliate, Marcus Institute; it was updated forImpactby Elise Babbitt, Communications Manager, Kennedy Krieger Institute, Baltimore.