Specialized foster family care: a community-based program for children with special needs - Maryland

Children Today, Jan-Feb, 1989 by Michael Luginbull, Allan Spiegler

Specialized Foster Family Care

Five-year-old Jason has cerebral palsy, profound mental retardation, epilepsy and blindness. He is unable to crawl, sit up or perform the most basic actions requiring coordinated muscular effort. Much of his condition is attributed to fetal alcohol syndrome. Two years ago, Jason was placed in foster care after he had contracted a viral infection and his parents were unable to provide basic medical care for him during his illness. Because of the high degree of care he required, however, four foster homes and one group home requested homes and one group home requested his removal after a brief time. Jason was a candidate for a state hospital for children with mental retardation.

Thomas was 14 months old when his young mother, frustrated at his crying, shook him violently, accidentally striking his head on a bed support. Severe neurological damage resulted, including partial blindness, epileptic seizures, and developmental delays in such psychomotor activities as walking, eating and speech. Thomas was an outpatient at several health department and hospital clinics, and he required a lenghty daily regimen of physical and occupational therapy. When Thomas was placed in foster care, the local social services agency could not find a foster home to provide for is many medical and therapeutic needs.

Children like Jason and Thomas are not unique in the experience of the Charles County Department of Social Services, a state public welfare agency in Maryland. In a caseload of approximately 60 court-committed children, eight children under the age of six were found to have severe medical or handicapping conditions, including chronic renal failure, profound mental retardation, and obstructive trachea cyst, neurological disorders, and other conditions needing extensive medical care or surgery. Because of the extensive care involved, these children presented difficult management problems.

To address the needs of young children with developmental disabilities or chronic medical conditions in foster care in the state, the Maryland Department of Human Resources funded a pilot project at the charles County agency to place two children with complex medical needs in foster family care. This project is part of a larger effort by the State of Maryland to create both public and private specialized foster care programs. Most of the other programs in this area target adolescents with emotional or behavioral problems. Currently, specialized foster care for children with disabilities or medical needs is sometimes available as part of the array of services of hospitals or other institutions, but in Maryland it is rarely provided by local departments of social services or other child placement agencies.

Recruiting Foster Homes

Recruitment of foster parents for the project followed the principle that the foster parents would essentially be contractual employees working for the agency. The basic recruitment method used was an ad in the local newspaper describing employment for therapeutic foster parents who would provide in-home care for children with handicaps. Although current agency foster parents were notified of the project, the emphasis in recruitment was to reach the largest possible group of potential providers by advertising in the newspaper. The goal was to locate foster parents who were experienced with problems affecting handicapped children and who would be capable of exercising a great deal of autonomy in caring for children with widely varying individual needs.

Instead of recruiting two foster homes and placing one child in each, one specialized home for the two children was created. This arrangement was preferred because it enabled services, training, funding and program administration to be consolidated. It was also felt that with adequate support, a full-time specialized foster parent could nurture two children with special needs, and that as a sibling unit, the children could provide valuable socialization experiences for each other.

The newspaper ad generated approximately 20 calls, including two from current foster care providers. Some applicants withdrew when they realized the round-the-clock nature of the commitment, and others were screened out because of inadequate facilities or lack of experience in dealing with young children. Routine checking for prior episodes of child abuse resulted in the ruling out of one applicant. Although the two most suitable applicants had each spent several years caring for children with developmental disabilites, only one had ample room for two children.

From the time the program was authorized, recruitment and start-up time took approximately three months. Jason was placed in the home in February 1987, and Thomas followed in April.

Therapeutic Aides

While the foster parents originally cared for the children without assistance or respite care, the need for such support services quickly became evident. In one 3-month period, for example, the foster mother--the primary caretaker--made an average of 22 trips per month involving one or both children. She took the children to the pediatrician's office, to hospital and health department clinics, to visit their families and to school, as well as to other destinations. For medical reasons alone, there were appointments for eyeglasses and braces, eye and neurology clinics at the hospital, and physical and occupational therapy at the local health department.