Entering a Brave New World: Kennedy Krieger's Therapeutic Foster Care program helps young adults successfully transition from foster care to independent living.
By Tania R Edghill

After her last class of the day, Camille Bonus, a freshman at Morgan State University in Baltimore, sits at a table in her school’s cafeteria, eating a sandwich. As she eats, she talks excitedly about her new life. "I live by myself and have my own bathroom. I can stay up late," she says. "I’m in a school play. I have a job." In just four weeks, Camille has settled into her new home, the dormitory - and life.

While Camille’s account may seem like that of any other college freshman’s, it isn’t. In her 18 years, she has faced tremendous adversity, and has relied on her remarkable inner strength, and the support of others, to help her succeed. Since birth, Camille has lived with a condition called spina bifida, which results from the failure of the spine to close properly during the first month of embryonic development. Children with spina bifida often suffer from loss of sensation in the lower extremities, leg and foot deformities and other medical concerns, and require numerous surgeries and other extensive medical care.

Unable to live with her birth family, Camille was placed in Kennedy Krieger’s Therapeutic Foster Care program, where she has flourished with the love and support of her foster family and program staff. She has been a part of its foster care program for much of her life. Camille’s college enrollment this 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 Foster 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 Karen Murphy-Keddell, M.S.W., L.C.S.W.-C., co-director of Therapeutic Foster Care, one of the things that makes this program different from other therapeutic foster care programs is the broad range of conditions served. Children who are enrolled 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, mental retardation, cerebral palsy and spina bifida. Through Therapeutic Foster Care, these children and adolescents 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. This past summer, the program’s name was changed from Therapeutic Foster Care to Therapeutic Foster 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 Foster 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 the past year, 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. "These children have grown up with us," Murphy-Keddell says. "The program has been in existence for 16 years, so we are, as a program, at the point where some of the children have now grown up. 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, M.S.W., 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 has been added to the Therapeutic Foster 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, M.S.W., L.C.S.W.-C., co-director of Therapeutic Foster Care. "They still have a history of trauma and emotional and behavioral issues. They still have developmental 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 Foster 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 21 years of age. 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 Foster 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 on-going support, the Transition Program also offers young adults after-care services to ensure that appropriate clinical services are received. Robert Pettis, a transition coordinator in the Therapeutic Foster Care program, works closely with the youth after they have transitioned to their new homes.

In August 2002, 18-year-old Mark Jones, who has been with Kennedy Krieger since he was 10, moved from his foster parents’ home to his current one at New Pathways. While at the semi-independent living program, Mark continues to receive social services and counseling, as he had at Therapeutic Foster Care, to address any emotional and developmental issues he may be facing.

Living with his foster family has taught Mark vital daily living skills, which he will use when living on his own. "I learned how to cook from my foster parents," he admits. At New Pathways, where he will remain until he is 21, Mark continues to hone the skills he needs to care for himself and his surroundings. He is 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. Staff and parents encourage students to pursue higher education, as Camille has done. Camille credits her foster parents and Kennedy Krieger for helping her get into college. "I learned to do many things from my foster parents - doing laundry and washing dishes," she says. "I also got support from Therapeutic Foster Care. They helped me with personal stuff and pushed me to do better academically."

A math major, Camille has lofty ambitions. "I always wanted to be a doctor," says Camille, who has, in her short lifetime, undergone 13 back and foot surgeries to help her walk. "When I was younger, I feared pediatric neurosurgeons, but now that’s what I want to be. I want to help other people who are like me."

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 admits. He now attends a community college in the Baltimore area, where he takes general studies courses. After college, he wants to be a mechanic. "I like to fix cars," Mark says.

Through his experiences with Therapeutic Foster Care, Mark has 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 Foster Care’s Transition Program is to help children maintain healthy, positive connections to their families and the community. According to Brylske, a main component 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.’"

Camille plans to continue her relationship with her foster family, while she strengthens the one she has with her biological family. On weekends and holidays, she will return to her foster home. "They have been my family for seven years," she says of her foster parents. "This Christmas I will be with my biological family, but I’ve already told my foster parents to save my presents for me," she says with a smile.


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