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A Compassionate Response to a Caregiving Crisis Children with complex medical conditions and in need of foster care find hope in Baltimore-area foster family support programs

Daisy, left, was adopted through Kennedy Krieger's Therapeutic Foster Care program
From left to right: Daisy (6), Noah (8) and Xavier (7) | Photo courtesy of Melissa Hanna

 

A typical week for Melissa Hanna might include doctor’s appointments; occupational, physical or speech therapies and learning as she goes.

She is a foster parent for two medically-complex children younger than age 1 through Kennedy Krieger Institute’s Therapeutic Foster Care program. This program provides a hands-on approach to foster parenting. Therapists come to her home, teach her how to hold a baby to help with tightness in the neck and provide tips on feeding with a G-tube.


“They’re really teaching us so we can use that (information) in day-to-day life with the kids,” she says.

This is Hanna and her husband Sam’s third foster child through the program. Their first—Daisy, now age 7—was placed when she was 3 and adopted when she was 4.

Hanna was inspired to raise a child with Down syndrome after following the story of a couple whose children had the same developmental disability. Her decision to do it through foster care, however, was influenced by her father’s experience growing up in the system.

“He always spoke about how it wasn’t a good situation. He had really negative views on it,” she says.

Her father’s attitude made her want to create a positive experience for children in this environment.

Kennedy Krieger—serving children who are medically fragile or have emotional trauma since 1986—provides one of about 20 to 25 foster care programs with this focus in Maryland, particularly after somewhat of a decline in the past decade, says social work manager Paula Waller.

Through the national Foster Family-Based Treatment Association (FFTA), these programs—many of them in Baltimore—collaborate on policy and communicate common issues and trends.

About 100 children up to age 21 go through Kennedy Krieger’s program each year.

Hanna says one of the greatest benefits it offers is connections.

Whether she needs information on a child, advice on where to go for a particular need or help advocating for accommodations through an individualized education plan (IEP), social workers are much more available than workers from the city or county, who tend to be overbooked, she says.

“All of my kids have been able to really quickly get connected to all the specialists they need,” Hanna adds.

Adoption day for Daisy. She was adopted by her foster family through Kennedy Krieger's Therapeutic Foster Care program
Daisy (left) on adoption day with her new family | Photo courtesy of Melissa Hanna

 

Waller says the program is also nonexclusive. If it’s more convenient for location or type of service to remain with a prior specialist not affiliated with Kennedy Krieger, she can make that accommodation.

Another asset to the program is parent training.

Parents are given the same tools as clinicians, based on the ARC framework Kennedy Krieger created alongside the University of Maryland School of Social Work. Having a prior background in special needs is not required, Waller says.

A portion of the training uses parent support, allowing parents to take the lead in sharing with each other what works best for them.

“I’m really proud of that—of our parents’ effort in that area,” Waller says. “We have the best parents in the world.”

Kennedy Krieger combined the mental health component from its outpatient family center with its medical-based care around 2012 or 2013, Waller says.

Now, its program will also include refugee services.

Lutheran Immigration and Refugee Service (LIRS) added Kennedy Krieger to its national network of foster care providers in April 2021.

The LIRS Director for Children and Family Services, Lorie Davidson, says the program will become active in a few weeks. It will serve up to 16 children at a time.

These kids are children who enter the United States through U.S. Customs and Border Protection in fear for their safety and are permitted to await their immigration cases in the United States under the Trafficking Victims Protection Act as long as they are not from a contiguous country, Davidson explains.

“Most people think these kiddos are trying to sneak into the country and that’s not it,” she says.

Many have family in America, and the foster care program is meant to connect them with a loving home until that family can be reunited. Their stay could be as short as a week or several months.

Davidson says having the therapeutic element of Kennedy Krieger is helpful, particularly with significant trauma from treacherous journeys or with underdiagnosed or undertreated conditions because of limited access to medical care.

“A lot of them are doing this journey alone, and they may be 10, 11, 12 years old or younger,” she adds.

Davidson says you don’t need to have prior experience with unaccompanied minors or refugees to be a successful parent in this program.

“I think a lot of people assume that to be a foster parent for an unaccompanied child that you need to share a language and a culture,” she says. “Through our decades of doing this work, we realized that’s not actually true.”

Many foster families in their network have reported bonding with their children over games or a fun lingual exchange of labeling items in the house.

LIRS also provides training to families on language and culture, as well as on the specific trauma that comes with forced migration.

“They really miss their family, and it’s difficult. Maybe their family is back home and they traveled solo, or they’re not sure what (reunification) is going to look like,” Davidson says.

Families also learn how to be sensitive to the types of foods their children would have normally eaten at home and how to respect and give space for their religion or beliefs.

“I think the cultural exchange is one of the coolest parts of the program because the kiddos are eager to learn about American culture … and our foster families are excited to learn about the child’s culture,” Davidson says.

She cites 9,500 children who are currently in the care of the U.S. Office of Refugee Resettlement. Although this office hasn’t seen a surge like it did in March and April of 2021, the numbers are still high.

The need isn’t going away, she says.

And the same is true for all foster care, Waller notes. Kennedy Krieger now has 50 to 60 families in its program, but more are always needed.

Although Kennedy Krieger can offer the clinical piece, “we can’t do what our families do,” Waller says.

Hanna says as a foster parent, the program was life-changing for her, too. It created a sense of purpose not only in her but also in her two elementary-aged biological sons.

“(They) have said to me at least four times since our last placement—they’ll just be like, ‘thank you for doing foster care,’” because they love to help, she says.

Hanna’s father has also become more open to Hanna doing foster care. His side of the family shows their support by sending the kids gifts.

Hanna says, “All we can do is try to be the good home ourselves.”

About Lindsay VanAsdalan

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