Permanency planning. MORC has embraced the concept of permanency planning for all children with developmental disabilities, including those requiring ongoing medical care. Families of these children are offered support services to maintain the child in their home. If these services are not enough and the child must live outside the family, a foster home is offered. Families are not given other options, such as group living facilities, nursing homes, or institutional care. Instead, they are helped to accept the idea of foster care as a temporary placement, with the goal of returning the child to the natural family.
When this is not possible, the agency tries to find an adoptive home for the child. The natural families of some children are no longer involved in their lives. For these children, Macomb- Oakland looks for adoptive families who will take over all of the parenting of the child. In other cases, families want to stay involved. Then Macomb-Oakland explores "open adoption," where the child's natural family can visit frequently and maintain the affectional ties they have with the child. Sometimes a child cannot be freed for adoption. Then the agency pursues options such as "shared care" and "permanent foster care." Shared care is an arrangement in which the natural and foster parents agree to share responsibility for the child; permanent foster care is a nonlegal agreement by foster families to serve as primary parents for children until adulthood.
Specialized foster care. Like many service systems, Macomb-Oakland has turned to foster families to provide homes for people with developmental disabilities. Nearly one-fourth of the people served by MORC live in foster homes; over half of these are children. What distinguishes MORC from most service systems is that it has placed people with severe disabilities in foster homes. Indeed, MORC is finding foster homes for children with most severe multiple disabilities and medical involvement, and does not place children in other forms of care.
MORC's foster homes are referred to as Community Training Homes and this creates an expectation about what foster families are supposed to do. Community Training Homes serve from one to three people. In addition, MORC contracts with families to operate "alternative family residences" for four people. These families are provided with a separate budget to hire staff to come into the home. All of the homes are licensed by the Department of Social Services.
Ensuring good foster homes. MORC employs specific techniques to ensure the recruitment of good foster homes. First of all, it makes foster home recruitment an agency priority. It employs three full-time community training home specialists who recruit, screen, and train foster parents. Second, Macomb-Oakland pays families relatively well. Community training homes receive between $25 and $35 per person per day ($9,125 to $12,775 per year) and higher in some instances. The amount depends on the needs of the person in the home. MORC looks for sensitive and caring families, but it doesn't mind if they become foster families for the extra money.
Third, Macomb-Oakland uses a range of aggressive recruitment techniques: ads, public service announcements, newspaper articles, radio and television appearances, community presentations, newsletters, flyers, posters, and referrals from other people. Finally, MORC provides a lot of support to Community Training Homes, including respite, professional consultation (nurses, occupational therapists), home aides, and financial assistance for special equipment and supplies and making necessary modifications in the home. MORC case managers also maintain close contact with foster homes, making at least monthly visits. They also make unannounced visits to all homes.
Respite care. Macomb-Oakland is also looking to community training
homes to provide respite for natural and foster families. Families are
paid the community training per diem for each day of respite. MORC is working
on one arrangement for respite care whereby families would receive four
weeks of pay for providing three weeks of respite. This arrangement carries
a "no-reject" clause. In other words, families would have to agree to accept
anyone sent to them for respite.