Tim is 9 years old and lives in a small city in Montana with his parents and younger brother and sister. He has cerebral palsy, severe mental retardation, cannot walk, and needs assistance in most all daily activities and routines. His family was considering out- of-home placement, but as an alternative decided to keep him at home with support from SFC.
A "hab aide" comes to the home 15 hours per week (3 hours a day, 5 days a week). She is at the house when Tim comes home from school. During her time there, she assists Tim in self- help and communication skills. For example, when he has an after-school snack, he participates in feeding himself. They are also working on a "yes/no" response (i.e., "want more juice?"). She stays through the family dinner to assist Tim with eating.
Once a week, a "home teacher" comes to Tim's house both to discuss any concerns with his parents and to observe and give technical assistance to the hab aide if necessary. Tim's family can use up to 48 hours of respite per month (it can be used by the hour, or by the day); they choose to have the "hab aide" provide this respite. The family enjoys going for evening bike rides; Tim can now join them, since, through STEP, they have acquired a cart that attaches to the back of a bicycle.
Mark, who is 7 years old, is diagnosed as having spastic athetoid cerebral palsy and mental retardation. In addition, just recently he was found to have a degenerative condition of undetermined origin. Since December he has lost most of the control of his upper extremities, and needs assistance to walk. Mark lives with his mother, who just recently had another child. They live in a small trailer park in the foothills on the outskirts of a small city in Montana. His father drinks heavily, and is often not at home.
The hab aide, who comes 3 hours a day (5 days a week), assists Mark in bathing and in potty training. They are working on his communication through a recently acquired "communiclock," on which one presses a switch to move the clock hand to the desired symbol or word. Mark and his hab aide also spend time reading stories, going swimming, or other recreational activities.
In addition, the "home teacher" comes once a week to visit. She has assisted them in obtaining adaptive equipment such as the communiclock, a travel chair, and a bath chair, and in arranging evaluations and other services before he was in a school program (PT, OT). With the presence of the combined family supports of the hab aide and respite (in addition to Mark's time at school each day), Mark's mother has been able to maintain a full-time job and go to school to become an LPN, something she has wanted to do for a long time.
Tim and Mark provide just two examples of many children and their families who are being supported through the SFC program throughout Montana. There are a number of strengths of the program. First, it begins by asking families what they need to keep their child at home. Second, "home teachers" and "habilitation aides" are doing much more than just teaching or habilitation; they are assisting to coordinate services for the family, and to support families in whatever ways are needed. A few parents commented on the tremendous "moral support" they have received from STEP. Although hab aides are STEP employees, the families can hire (and fire) them.
Third, families can choose a friend or neighbor to provide respite--someone
they are comfortable with in the care of their child. In addition, however,
STEP also has an active list of people who are willing to provide respite.
These people are trained in CPR, and would be oriented to the needs of
the individual child prior to actual respite care. Fourth, the STEP program
utilizes a combination of many sources of funding (Medicaid, state DD funds,
respite funds, state education funds, and so forth) to provide supports
to families. Funds can be pooled (i.e., the state DD funds for the allocated
number of "slots"), providing significant financial flexibility at the
regional level. Overall, the program's success can be attributed to the
fact that it takes a "family-centered," approach, asks families what they
need, and provides individualized, flexible supports to meet these needs
as well as is possible.