Articles from Reaching Today’s Youth
Reaching Today’s Youth, The Community Circle of Caring Journal, is published by the National Educational Service.
Complete citation for this article: Kendziora, K. (1999). Building resilient families and communities: An interview with Karl Dennis. Reaching Today’s Youth, 3(4), 18-21.
Building Resilient Families and Communities:
An Interview With Karl Dennis Kimberly T. Kendziora
In this exclusive interview one of the pioneers of the wraparound approach to providing youth and family services shares his insights on how this system of unconditional care can help build resilient families and communities.
Karl Dennis, the executive director of Kaleidoscope, Inc., in Chicago, heads the first child welfare agency in the country to provide unconditional care for children. Mr. Dennis was one of the originators of intensive In-Home Family Preservation Services and Therapeutic Foster Care. The Kaleidoscope pediatric AIDS foster-care program, one of the nation’s first, has become a model for programs across the country. Since 1975, Mr. Dennis has also helped to orchestrate state initiatives to return children from out-of-state placements, providing services to thousands of children and their families.
A sought-after lecturer and consultant, Mr. Dennis has shared his knowledge of community-based care with individuals and agencies throughout the United States and also in China, Australia, Canada, Romania, Great Britain, and New Zealand. He served on the Harvard University John F. Kennedy School of Government Executive Session to develop an alternative plan for child protection. Mr. Dennis is a member of the Friends of the Federation of Families and received their Making a Difference Award in 1995. Mr. Dennis was also the recipient of the Marion F. Langer Award from the American Orthopsychiatric Association for his national advocacy on behalf of children and families. Mr. Dennis has received one of only two Lifetime Achievement in Wraparound awards, which was given at a conference sponsored by a consortium of wraparound providers.
Mr. Dennis spoke with me about building resilient families and resilient communities from his Chicago office on March 29, 1999.
Back to Journal Articles Tell me about your philosophy of supporting families first.No child lives alone. Child-centered services are not the direction we need to be heading in. We need to support the entire family. For example, the traditional juvenile justice model removes children from their homes and families, “treats” them, and then returns them to an environment unchanged since they left. Failure to take a child’s context into account leads to high recidivism rates. On the other hand, when the family as well as the targeted children receive services, the whole family can really get it together, and there’s a much better opportunity for success.
Are you opposed to out-of-family services?
On some occasions, children do need to be placed outside the home for some period of time. But when it is suggested that families in trouble need to have a child placed in a residential setting for three or four years, we need to be open to the possibility that intensive, in-home services to that family for that same period of time might achieve the same outcome. Recommendations for short-term residential care (only five or six months) almost always suggest that in-home services might do the job just as well. In either case, in-home services would not only be more cost-effective, but also would keep the family together. It is my belief that when children do need to be placed, they need to be placed in the least restrictive environment possible.
Tell me about your approach to working with families.
We see family strengths. Families can be strong not only for themselves, but also for each other. The Federation of Families exemplifies this. Parents can help other parents, and we need to pay attention to this valuable resource within communities. Some states and communities have made great use of parent advocates in the process of treating troubled children—California, New Mexico, and an Annie E. Casey site in Houston, called The Friend of the Family Program [see box].
Helping others isn’t just good for the ones who are helped; it’s good for the helpers, too. One thing we used to learn about peer counseling is that often, peer counselors learn as much if not more from the people they’re providing services to.
Mr. Dennis told us about . . . The Friend of the Family Program
People in Partnership, Inc.
The Organization of the Casey Initiative
3000 Trulley
Houston, TX 77004
Phone: (713) 659-8630
Fax: (713) 659-2821
Contact: Nelda C. Lewis One way to build resilient communities is to channel the strengths found in families toward other families needing that help. The Friend of the Family Capacity Building Education Program does just that. Families who were a part of planning the Annie E. Casey Mental Health Initiative initiated the concept of families helping families in their community. Their idea was to provide formal training and certification of family members in broad areas of human service work. Training topics include first aid, behavior management, conflict resolution, crisis intervention, respite care, and advocacy. The complete curriculum consists of 60 hours of course work, an internship, and graduation activities. Payment for the course is either $250 or 40 hours of volunteer service. Courses are held on Saturdays, and child care is provided. The value system behind the curriculum reflects the positive values of working together, respecting each other, and promoting and celebrating collective history. Graduates of the program are certified as a “friend of the family,” and their community services can be reimbursed by managed care.
You’re an expert on community-based care. How do you approach working with communities?
In community systems, we focus on building a process of neighbor helping neighbor.
One Ohio county discovered that there was no respite care available for those needing it. A community team made up of representatives from the business, religious, and human service sectors recruited volunteers. One private agency trained the volunteers, and another took on the role of matching volunteers to families.
The religious community has been very helpful in the process of serving families. One church I know of sponsored construction work in the basement of a member’s home in order to allow a relative to move in to help out with the family’s challenges.
How does community mobilization get started?
Dr. Ira Lourie has written beautifully about the many local systems involved with providing care for children. I won’t try to repeat his message here. [See reference below.]
What I’ve seen is that communities come together around some target issue. This issue is sometimes positive and sometimes negative. For instance, a community may come together around applying for a grant. Usually, a few people pull it all together. These people are often not the people at the top of the power structure, but are further down the line. Their passion persuades those in charge to support them.
We miss the boat by thinking that mental health professionals are jacks of all trades. We need community developers to help us meet the needs of our community’s children.
What obstacles face those who are trying to pull resilient communities together?
The systems themselves—such as the mental health service system, the child welfare system, the special education system, and the juvenile justice system—can often be barriers to community mobilization. When you start talking about pulling communities together, then some folks have to give up power. They also have to give up money. Currently, funding is very categorical. To effectively serve our children’s needs, funding for services needs to be more flexible and must be able to be used across service systems.
Another problem in terms of community services is that there are not many universities training folks in family preservation, therapeutic foster care, or independent living services. Many new Ph.D.s often know very little about family preservation, which should be the backbone of all services.
Back to Journal Articles You are one of the pioneers of the wraparound process of engaging multiple service systems within a community to meet the needs of children and families. Tell me about wraparound as you see it. I see several principals as crucial for wraparound. Wraparound is . . . Community-driven. Collaboration across systems is necessary for truly effective service. No one system has all the answers.
Family-focused. We design services to serve the entire family. For example, a child from a poor family may be stealing to help support his family. If he’s caught and incarcerated, that does nothing to change the circumstances that led up to his stealing in the first place. A family-focused approach might work to help the family’s caregiver find a job, which might eliminate the need for the youth to steal. Another thing to note is that when a whole family is served following one child’s crisis, other children in that family can also benefit.
Mr. Dennis told us about . . . The Safety Surveillance Program
Georgia Parent Support Network, Inc.
620 Peachtree St., Suite 300E
Atlanta, GA 30308
Phone: (404) 875-6801
Fax: (404) 875-6755
Contact: Sue Smith, President and CEO The Georgia Parent Support Network was founded in 1989 by 30 parents and professionals who shared a vision of family involvement in issues that affect children with mental health disabilities. The Network has grown to over 2,500 members, who now sit on almost every policymaking board where decisions affecting children and youth with mental disabilities are made. One program the Network runs, the Safety Surveillance program, provides community-based services to juvenile sex offenders. Community volunteers who are invested in the targeted child’s life provide oversight, monitoring, and implementation of treatment protocols. A case manager trains volunteers and coordinates their activities. Services are coordinated through carefully planned collaboration: Agencies across many disciplinary areas work from one individual service plan, and only one case manager works with each family. Every service plan is highly individualized to serve the needs of each unique youth and family. As the family and community gradually take over the care of each child, professional services are faded out. During the four years that the Safety Surveillance program has been in place, none of the youths have reoffended. [For more information, see article in Reaching Today’s Youth, Volume 3, Issue 3.]
Creative. Here’s an example. One state asked me to help put a plan together for a particularly hard-to-serve youth. There was an autistic child who was institutionalized at the cost of about $100,000 per year. This child spent weekends with his father, who interacted wonderfully with him. I asked why the father couldn’t take care of the child all the time, and the response was that the father had to work. “How much does the father earn?” The answer was $40,000. My suggestion was to pay the father $40,000 per year to stay home and take care of his son. Even with state money spent on various outpatient treatments and services, the state would still save a substantial amount of money.
Unconditional. There must be no artificial time frames on how long we’re going to serve a family. We care for our own children for life, and we need to regard children in the community the same way.
Strengths-based. It is natural to approach people based on positives. If, when I first met my wife, she had said, “You’ve got big ears, funny eyes, and you walk a little strange,” we never would have gotten together. That’s no way to build a relationship with another human being. To get people to respond well to you, focus on the positives, on the strengths. The deficit-focused approach that has dominated mental health may not be the most successful way to see someone.
Individualized. I have never met two people whose minds work just the same. Think about your own family, especially if you have more than one child. Can you reasonably care for these different children in exactly the same way? Can you always discipline them in exactly the same way?
Culturally competent. We have to look at people as different. We have to find out what each person’s approaches and values are. Most people think of ethnic differences here, but regional differences, or gender differences, are just as legitimate. Imagine an orthodox Jewish family who approached a service agency for help with family problems. Imagine that this agency insisted on the family coming in on a Saturday, their Sabbath. How would the family feel toward that agency?
Cost-effective. If it is not cost-effective, then there’s a problem. We’re not using bricks and mortar in our work. Human services don’t have large materials-related costs. Never pay for what you can get for free. This is not a motto of “cheapness,” but rather one that reflects an emphasis on sustainability of care. I tell my staff, “It is your responsibility to work your way out of a job.”
Outcome-driven. Accountability is crucial. We need to ask ourselves: Is what we’re doing making any sense? Is it working? You must always revisit your goals to make sure that what you’re trying to change is having an effect. If you’re working with a family with a child who has been truant from school for more than 30 days, and you decide you need to work on helping the father get a job, does that help the child stay in school?
Wraparound is an exciting approach to service. For wraparound to continue to grow, we need to expand the circle of advocates for the process.
Back to Journal Articles What trends are you noticing in service systems?Things have changed in the world of services. On the up side, in the ’70s, folks thought that the staff at Kaleidoscope was crazy for “doing whatever it takes.” Now, according to Barbara Burns and Sybil Goldman (1999), over 100,000 children and youth have been served using a wraparound process. On the down side, there have been some policy changes that have affected services for the worse. When government changes, services change, and it can be a struggle to keep up. More than ever, I’m irritated by some of the changes I’ve seen.
One current case involves a woman who has been both a client and a trainer at Kaleidoscope. She is on public aid, and although she is on a heart transplant waiting list, she has been ordered to find a job. One of her sons has recently interviewed for a full college scholarship in architecture. Another son has seizure disorder and has been receiving SSI benefits. She is now fighting to have those benefits continued.
Another trend has been toward shorter-term service. At Kaleidoscope, the family served the longest was in care for about five years. The caregiver had some mental health problems and seven children. Kaleidoscope provided care to each of the children. Had Kaleidoscope not been there, the children would have been placed and almost certainly separated. The move toward shorter-term services represents a lack of a holistic approach.
Still another trend is that systems with paraprofessional providers are moving back toward an emphasis on more services provided by professionals. This process is influenced by Medicaid and other reimbursement policies. However, sometimes the best people do not have the paper qualifications to work with children. For example, a juvenile court judge I know who is an exceptional person could not be hired to work as a supervisor at Kaleidoscope because the judge did not have at least a master’s degree in social work.
With respect to permanency planning, I’ve been getting many calls from people around the country who are really concerned that their parental rights will be terminated. This is based on some federal legislation. There is a suggestion that in some states, as many as 13,000 parents will have their rights terminated. There are certainly humane issues involved, but also, I can’t see how the human services system can absorb this influx of cases. Other legislation has now passed such that cultural issues can no longer be considered in adoption cases. I would prefer to place children within their own cultural and ethnic backgrounds and, when this is not possible, train the adopting families in that cultural background. However, adoption services in most states are “front-end”; that is, once the adoption is finalized, it is difficult for families to then receive services.
Mr. Dennis told us about . . .Wraparound Milwaukee
Child, Adolescent Treatment Center
Milwaukee County Mental Health Complex
9501 Watertown Plank Road
Milwaukee, WI 53226
Phone: (414) 257-7639
Fax: (414) 257-7575
Contact: Bruce Kamradt, Project Director The underlying philosophy of wraparound involves empowerment of families and communities, not entitlement. When community agencies can come together to effectively help those in need in a way that builds upon natural supports, they build a true system of resilience. Wraparound Milwaukee is an intervention program that works with children identified as having Serious Emotional Disturbance (SED) or are at immediate risk of psychiatric hospitalization or residential placement. The program uses a managed care approach, building service delivery upon a case management system. A mobile crisis response team deals with family needs and helps avoid unnecessary psychiatric hospital admissions. The services begin with a strengths-based inventory and needs assessment. The program creates a child/family team, and then works out a highly individualized service plan. Over 60 agencies, organizations, and supports representing a comprehensive array of services function as the Provider Network for Wraparound Milwaukee and collaborate to provide a seamless system of care. Funding from Medicaid, child welfare, and juvenile justice sources is combined into a flexible fund that supports individualized plans. Wraparound Milwaukee has reduced the use of restrictive placements and has reduced costs. More important, children show significant improvements in their functioning.
Any final comments?
About our approach to our work: we’re no different from the people we’re serving. The only difference between them and us is luck. When possible, we like to include our own families in recreational pursuits with the folks to whom we’re providing care. It is important for client families to see providers as involved—with no big desk in between them. At Kaleidoscope, we see ourselves as friends helping friends.
Kimberly T. Kendziora is a research analyst at the American Institutes for Research, where she works for the Center for Effective Collaboration and Practice. She focuses her work on issues of prevention of mental health problems in children. She can be reached at the American Institutes for Research, Pelavin Research Center, 1000 Thomas Jefferson Street, N.W., Suite 400, Washington, DC 20007, telephone (202) 944-5391, fax (202) 944-5454, e-mail kkendziora@dc.air.org.
Back to Journal Articles REFERENCESBurns, B. J., & Goldman, S. K. (Eds.) (1999). Promising practices in wraparound for children with serious emotional disturbance and their families. Systems of care: Promising practices in children’s mental health, 1998 series, Volume IV. Washington, DC: Center for Effective Collaboration and Practice, American Institutes for Research. Lourie, I. S., & Katz-Leavy, J. (1991). New directions for mental health services for families and children. Families in Society, 72, 277–285.
© 2001 The CECP is part of the American Institutes for Research (AIR), and is funded under a cooperative agreement with the Office of Special Education Programs (OSEP), U.S. Department of Education (ED), with supplemental funding from the Center for Mental Health Services (CMHS), U.S. Department of Health and Human Services (HHS).
http://http://cecp.air.org/resources/journals/RTY/interviewkarldennis.asp