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Intensive Care

Years ago KARL DENNIS developed a revolutionary approach to social work. Finally everyone else is catching on.

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By Tori Marlan

When Karl Dennis speaks to groups of social workers, child psychologists, or mental health professionals, he often tells the story of Yvette. She came to his child-welfare agency in 1985, when she was 17, having spent the previous six years moving between foster homes, group homes, residential-care facilities, and mental hospitals. She'd tried to kill herself 13 times.

Dennis met with Yvette in his office at Kaleidoscope, an agency that serves Illinois children with severe emotional and behavioral problems. He found her surprisingly unguarded. She had an open face and smiled easily; only the scars on her wrists betrayed her miserable past. He asked her what she liked to do. She said she liked to draw cartoons. He asked to see some of them. She reached into the plastic garbage bag the Department of Children and Family Services had given her to use as luggage and pulled out a crumpled drawing. After studying it for a moment, Dennis made her an offer: he would pay her to draw a picture for his office. She mumbled that she'd do it for $10 or $15. Dennis offered her $200. "At first she looked at me kind of weird," Dennis tells his audiences. "But then she got excited."

At this point in the story Dennis's audiences usually are looking at him kind of weird too. Eyebrows rise or wrinkle, mouths form uncertain smiles. Nobody knows whether to believe him. But Dennis did pay Yvette $200, and her cartoon--a colorful Magic Marker drawing of people in an office--now hangs, matted and framed, in his West Town agency.

Dennis tells this story not to advocate throwing money at clients but to encourage his audiences to see their charges as more than the sum of their problems. In Yvette's case the cartoon was just the beginning. Kaleidoscope set her up in her own apartment and assigned a social worker and a team of youth workers to help her make the transition. They visited daily. Noticing she was a compulsive cleaner, they helped her enroll in a janitorial training program and later find a job as a housekeeper at a motel. "By looking at her strengths and building services around her strengths," Dennis says, "we showed her that she had worthwhile skills and that she was worthwhile herself."

With barely any formal education in his field, Dennis has developed a few radical ideas about human services in the 24 years he's run Kaleidoscope--ideas that are starting to catch on. He pioneered an approach called wraparound, which some experts say is now changing the way agencies around the country deliver social services. Many of Dennis's colleagues glowingly look to him as a leader, though he's little known outside his profession. "He is the most important person in human services in America," says John VanDenBerg, a child psychologist who has directed child-welfare programs for Alaska and Kansas.

Dennis parts ways with the traditional "pathology-oriented" methods of treatment, even advocating a few practices that are antithetical to the training many professionals have received. He believes that people who provide social services should never give up on clients and should do whatever it takes to help them, even if it seems outrageous--like paying someone $200 for a drawing.

He hops around the country and travels overseas exporting his philosophy of care. Essentially he tells his audiences that when clients don't respond to their programs, the problem is the programs, not the client. He also asks his audiences to give up some of the control they have over other peoples' lives. "It is not our job to make all the decisions," he says. "Families make good decisions about their kids when they have options."

His colleagues seem eager to listen. Nearly every day speaking invitations arrive in the mail and messages from all over the country clog his voice mail. "Karl always says he's just talking common sense," says Linda Roebuck, deputy director of psychiatric services for the Missouri Department of Mental Health. "And he is, but it's the kind of common sense you have to be wise to see."

Dennis begins each workday he's in Chicago cruising the long hallways of the sprawling Kaleidoscope office, on Milwaukee Avenue just north of Division. It's a practice he calls "dipstick administration": he dips in and out of each department--foster care, pediatric AIDS, adolescent parenting, youth development services, and in-home services. A robust 63, he's tall and trim, with silvering hair, a tidy beard, and hazel eyes. He's an impeccable dresser, and has been ever since a juvenile-court judge pulled him aside one day in the mid-70s and told him that his getup--jeans, cowboy boots, and fringed shoulder bag--was a sign of disrespect. Along with suits, he also wears a silver and turquoise watch and pine oil, the scent of which trails in his wake, tributes to the Cherokee and Blackfoot parts of his heritage.

Dennis likes to think of his agency as a big family, a family of 108 staff and the 500 people they serve. As its patriarch, he shouts for people from down the hall, hugs them, kisses them, and is always good for a compliment, a ribbing, a witty retort, a bit of sympathy, or a few bucks. (Framed in his office is a money order for $4.75 from a client making good on a debt.) On a recent morning he told a young woman in platforms, "I hope you don't have to run nowhere in those shoes." To another he said, "How's the baby? You looked like you was dragging when you came in. She keeping you up?"

Under his administration Kaleidoscope has evolved from a small disorganized experiment the Tribune once referred to as a "fiasco" into a large well-respected agency the Chesapeake Institute, a federal think tank, recently lauded as a national model. What separates Kaleidoscope from other agencies, according to Donna Petras, professor at the University of Illinois' Jane Addams College of Social Work, is "out of the box thinking"--both its creative, flexible programming and the way Dennis and the staff relate to their clients. "They have done things," she says, "that other agencies wouldn't think about."

When, for example, a teenage client prone to temper tantrums had to be restrained a couple of times a day, Dennis came up with an innovative solution. We'll break out in song, he told his staff. From then on, whenever the client, Marlene, had an outburst, Dennis and the staff performed a musical comedy using furniture as props and singing in mock operatic tones, "Marlene needs to be restr-ai-ai-ai-ai-ained." Marlene could never do much damage when she had a serious case of the giggles.

At the turn of the century early social work practitioners relied on creativity, intuition, and common sense to guide them as they strove to help people and create social reform. As the field evolved and became established as an academic discipline, tension developed between this humanistic way of working and one that was rooted in science. According to a 1990 article by Howard Goldstein in Families in Society: The Journal of Contemporary Human Services, early texts called upon practitioners to approach social problems from "the point of view of medical analysis" and to collect evidence about families and clients "as a basis for making rational decisions about service." Academics developed theories and models for treatment based on such evidence. According to William Borden, professor of social work at the University of Chicago's School of Social Service Administration, faithful adherence to some of these models, with their preconceived stages and phases and tasks, can lead practitioners away from one of the fundamental tenets of social work--"start where the client is"--in favor of standardized interventions.

Dennis didn't major in social work in college. He was in an education program. In his 20s and 30s he held a series of jobs--salesman, extra in a TV soap opera, delivery-route planner for a barbecue-sauce company--before going into social services. He started out by volunteering at Operation Impact, a federally funded program designed to prevent students from dropping out, and later was hired as an administrator. He read about the therapeutic models of treatment on his own but rejected them, instead coming up with his own method, one that was simultaneously new and old. Borden says he isn't well acquainted with Kaleidoscope's specific programs, but Dennis's approach to social services sounds as though "it takes us back to our roots."

Dennis traces his approach to his own roots. He grew up in the 40s and 50s in a moderately poor but tight-knit south-side neighborhood near 58th and Perry. He lived with his mother, brother, grandmother, great aunt, and her husband. His father, a Harlem Globetrotter, spent most of Dennis's childhood away on tour. In those days shooting baskets didn't make men wealthy, but Dennis remembers his family sharing what they could with the hoboes who lined up for sandwiches at their back door.

With the exception of occasional childish pranks that included digging holes for people to fall in, Dennis says he was well behaved and the watchful eyes of adults usually kept him out of trouble. "You belonged to the whole neighborhood. All the adults in the community knew all of the kids in the community. You couldn't get away with anything."

Like his father and uncle, who was also a Globetrotter, Dennis was a talented basketball player. His high school team--the Du- Sable Panthers of '53-'54, one of a handful of high school teams honored at the Basketball Hall of Fame in Ohio--attracted the attention of recruiters, and Dennis received a scholarship to Northern Illinois University.

It didn't escape his notice that circumstances, rather than lack of desire or intelligence, prevented many of his peers from going to college. Some dropped out of high school, others wound up in prison, one was shot by police and paralyzed during a holdup. Without his family, athleticism, and a bit of luck, Dennis figures, his life would have unfolded very differently. He now enjoys a comfortable upper-middle-class existence with his wife, Kathy, and his ten-year-old grandson, whose mother is in Africa researching her dissertation. They live in a huge three-story lakeside condominium in Rogers Park with its own patch of beach and a rooftop deck. "I believe that the difference between me and the people we provide service to is a matter of circumstance," he says. That belief has shaped the way he delivers social services.

Dennis went into social services in the 70s, when providers across the country were questioning the wisdom of institutional care and beginning to recognize the need for alternatives. Illinois children with severe problems typically were rejected by private agencies on the grounds that they'd be too difficult to serve, so DCFS sent them out of state. In 1973 the director of DCFS heard reports that some Texas institutions were offering substandard care and abusing clients and ordered the children sent back to Illinois. One hundred and seventeen of the state's most difficult children--many had severe psychiatric problems--were headed back to Illinois, and nobody knew what to do with them.

A young psychologist in Bloomington named Mel Breed and three colleagues decided to start an agency to serve the influx. An expectant father awash in paternal instincts, Breed believed that if agencies were to be entrusted with other people's children, they ought to treat the children as their own--with unconditional acceptance and care. He and his colleagues decided that the agency would accept every client DCFS referred, as long as there was room, and never, under any circumstances, kick a kid out of its programs. It was a trailblazing idea. Agencies typically defined the populations they served, as they do today. They could choose to work with fire setters and bed wetters but not sex offenders, for example. And their services were usually limited. They might provide tutoring, individual therapy, and family therapy, but if a child needed something that fell outside the scope of what they offered they sent the child back to DCFS. Some people called this good clinical practice--providers recognizing their limits. Breed and his colleagues called it cruel, believing each uprooting exacerbated a child's problems.

They decided to place the returning wards in their own homes or the homes of other professionals. Today about 350 private child-welfare agencies contract with DCFS, handling 77 percent of foster care cases. But in the early 70s foster care was provided mostly by the department or by large religious organizations such as Catholic Charities and Lutheran Social Services; smaller private agencies operated orphanages. Breed and his colleagues took their proposal to the director of DCFS, Jerome Miller, a reformer in juvenile corrections who'd implemented community-based alternative programs in Massachusetts. Scrambling for placements for the returning wards, Miller gave Breed and his colleagues the go-ahead. They called their agency Kaleidoscope to reflect their ambition to change patterns in child care.

The agency was up and running in July, and by the following spring it had opened several group homes where four or five wards lived together with staff who worked round the clock in shifts. But few communities were eager to be the testing ground for an alternative program. Most of the returning wards were minorities from Chicago, and their presence in predominantly white Bloomington and Champaign caused an uproar. "There was a lot of public scrutiny," says Breed, who now works with disabled adults in Wisconsin. Every time a kid got into trouble it made headlines. Kaleidoscope opened two group homes closer to Chicago, in the more racially integrated communities of Oak Park and Maywood, but the reception was largely the same. After receiving complaints about vandalism, the village attorney of Maywood sought an injunction to close the home there, claiming its occupants had engaged in a "reign of terror." Kaleidoscope's plan to open more group homes in the area didn't go over well.

In 1975 Breed was looking for a regional director, and a colleague at DCFS recommended Dennis, who'd begun to work part-time as a consultant at a department shelter. "My first impression was that he was a very caring person," Breed says. "I had the sense that he really understood kids and families, and we had shared values." Dennis was impressed by the agency's unconditional-care philosophy and firmly believed in community-based services. He didn't think about children's problems strictly in terms of bad parenting or bad genes. He believed societal factors--sexism, racism, poverty, violence in the communities--also played a part in what went wrong for families. Breed offered him the job.

At the time Breed was the only founder still at Kaleidoscope, and the agency was floundering. It was under investigation by DCFS, the state audit commission, and a General Assembly committee on charges that it had mistreated children, provided lax supervision, and overcharged for its services. It was at this time that the Tribune editorial called it a fiasco. Despite the bad press, Dennis eagerly accepted the job, believing the controversy stemmed from fear. "We were working with kids a lot of people felt couldn't be worked with in the state of Illinois, much less in the community."

On his first day he and Breed attended a village council meeting in Maywood on the proposed group homes. An irate crowd hardly let Dennis get a word in, but when he did he announced that he was scrapping the plan. The move wasn't a concession to the opposition; he simply believed that children should remain in their own communities, or as close to them as possible.

The controversy surrounding Kaleidoscope died down shortly after Dennis took over the Chicago-area operation. DCFS placed a number of restrictions on the agency, most of them administrative. The department addressed the serious charges by requiring the agency to refrain from corporal punishment and to keep off its payroll staff members it had already fired for providing inadequate supervision.

As Dennis settled into his job, DCFS heard more stories of abuse in out-of-state institutions and began repatriating a second wave of Illinois wards. Again it turned them over to Kaleidoscope, the only agency willing to serve them. Its group homes were filled to capacity, so DCFS sent some of the children back to their families as a temporary measure and contracted with the agency to serve them in their homes.

But the children hadn't been able to function in the homes before. So Dennis, realizing it was a mistake to isolate children's problems from their environments, decided to tinker with the homes and see what happened. He extended Kaleidoscope's services to the entire family, for less than the state had been spending per child on out-of-state institutional care. If a father was unemployed, Kaleidoscope helped him find a job. If a mother was an alcoholic, Kaleidoscope referred her to treatment. The agency met both clinical and concrete needs. Its staff helped families manage their money; bought them food, phones, and clothes; and generally did what they had to do to create stability for the child and keep the family intact.

Dennis was relatively inexperienced, yet he assumed he knew what the families needed. "I would go out in the community, and I was overjoyed, and I was grinning and smiling," he recently told an audience of mental health workers. "I'd sit down and put this wonderful plan together. I'd say, 'These are the things I'm going to do for you, and these are the things that you're going to have to do.' And I would leave. I'd come back in two weeks, and I would have done all of the things I was supposed to do--and they would have done none of the things they were supposed to do. But I was young and enthusiastic, and I would say, 'That's OK. I understand you're busy.' And then I'd come back. Same thing. They were smiling and laughing to my face, but they probably had their finger like this behind their back"--he raised his middle finger--"because I was trying to make decisions about their life. And no one likes that." So Dennis started asking families, what do you need?

The at-home setup was supposed to be temporary until more appropriate living arrangements could be made, but it became the backbone of Kaleidoscope's approach. "What we discovered was pretty amazing," Dennis says. "We discovered that if the service we provided to those families was intensive enough and long-term enough--if there was a 24-hour crisis-intervention component to those services, and if we asked the family what they needed and provided that for them, no matter what it was--then we could keep 83 percent of those kids at home with their families."

Dennis believed that even a mediocre family was considerably better than substitute care, but that substitute care, at its best, could provide children with stability, intimate relationships, and respect for themselves and others. When assessing each case, he adopted the role of the parent, asking himself what he would do if his family were facing the same troubles. He genuinely liked most of his clients, especially the difficult ones, who tended to "worm their way" into his heart.

At times when he thought there was no better alternative he even housed clients in his own home. "Don't no average person do that," says a former client who briefly lived with him in the 70s and now works for the city. "That's a no-no with DCFS. But he took that chance. He made an impact in my life. I got a chance to see what a normal life was like. I love Karl. He took time out for me, he talked to me, but if I got out of line he let me know. He treated me like his daughter."

Dennis says, "In human services we like to talk about raising people's self-esteem. We can't raise people's self-esteem by setting them aside somewhere." He allowed his children, a daughter and two stepsons, to spend time at the office socializing with the clients. One day three female clients came into his office and gently broke the news that one of his stepsons was dating another client. When Dennis voiced his approval, they were stunned. "They said, 'You mean you don't care if he dates someone like us?' It nearly ripped my heart out."

Dennis had seen that from the moment they entered the social-welfare system, children were made to feel there was something wrong with them. They came to the attention of DCFS only when there was a problem--their parents neglected them or they had emotional or behavioral problems. Those problems were identified; a psychiatric illness might be diagnosed. The focus, Dennis realized, was always on what was wrong. It was a backward approach, he thought; concentrating on people's problems and the negative aspects of their personalities wasn't usually how people formed caring, trusting relationships. He began telling his staff to look for the things their clients did well and to incorporate them into their treatment.

Dennis knew that many of the older returning wards had been away from their families for a long time and that DCFS would drop them when they turned 21 (it's now 19 without a court order). He figured that a slow transition with supportive services into their communities would increase their chances for success there as adults. So he did something unheard of, something risky, with some of the wards who were between 17 and 20: he put them--kids who'd committed sex offenses, who were suicidal, who were extremely aggressive, even kids who had killed people--into their own apartments. Kaleidoscope paid their rent and utilities and gave them a small allowance. Youth workers stopped by to check on them daily; social workers checked in three times a week; and a staff member was always on call to deal with middle-of-the-night emergencies. In some cases the agency hired "friendly gorillas," social workers with only a bachelor's degree, to provide round-the-clock supervision. The workers tapped into local resources and found kids therapy and enrolled them in GED courses or school or vocational training. And they kept asking, what do you need? Like a good parent, Dennis would always deliver--as long as he found the requests reasonable and thought they made sense. "Children who had run away from all over," he says, "stopped running."

Back then UIC's Donna Petras was a DCFS caseworker who referred children to Kaleidoscope. "They were the very best," she says. "They had a way of building relationships with kids who were so troubled and so alienated. They really were miracle workers." For a while Dennis would actually wave a "magic" wand when asking clients what they needed.

There are of course risks in placing seriously disturbed children in a community, and over the years some of Kaleidoscope's clients have engaged in antisocial behavior. "I always assume that most people are going to make it," Dennis says. "I've seen kids do such miraculous things, I never bet against them anymore." But, he admits, Kaleidoscope can only do so much. "There have been disappointments. There are kids who have everything working for them, and you think that it's really going to work--and then it doesn't work." One such client was working a full-time job, earning more than his social worker, and taking college courses in the evenings. He lost his job, went out drinking one night, and killed a woman he brought home.

Another client kidnapped an infant she was baby-sitting. "The FBI was going to throw me in jail," Dennis recalls. "They wanted all the information about her history, and I just didn't want to give it to them. I was afraid that if they had all that they might shoot her or something. She had a history of violence--but not that kind of violence. She was always good with kids." Constantly looking for strengths, Dennis says that after a few days the young woman returned the baby--safe, well fed, and freshly diapered.

"It really pains me when something goes wrong for a kid out there or something goes wrong for someone who comes in contact with them," he says. "But I don't think it happens in terms of per capita more than it does for the rest of the community. We live in a society where we have judges we send to jail. We have aldermen we send to jail. People in well-placed professions are convicted of murder. I don't know how human services can keep the community safer than it is." Besides, he says, warehousing disturbed children in institutions is probably riskier in the long run. "Let's say we stick them in a group home or institution or locked facility until they're 18, 19, or 21, and then we let them out, right back into the community, and there are no services for them.That to me seems to be a lot more dangerous."

Dennis has an unshakable faith that people are inherently good and that no one is beyond help. But he's realistic in his expectations. What might look like a failure to the rest of the world sometimes looks good to Dennis. If, for example, a client who steals ten cars one year steals only two the next, Dennis considers it progress and is encouraged to think that perhaps the following year, with continued services, the kid won't steal any. In his view, it isn't surprising that children who grow up in the system sometimes act abominably. What he finds surprising is that they have the strength to survive it.

One morning in the late 70s Dennis was getting ready for work when an employee called and said, "Karl, wear jeans today." "Why is that?" "We've got a lot of work to do. Someone burned down the office." The someone, it turned out, was a teenage client who'd been kicked out of 16 placements before DCFS sent him to Kaleidoscope. Dennis concluded that what the boy had done was no more hostile or criminal than what adults had done to him for years by failing to provide him with a stable home. What do we expect from a kid, he asked himself, if we bounce him from placement to placement and sever every connection he makes?

Dennis sometimes tried to repair those connections. On the day he met Yvette, the cartoonist, he asked if she'd liked any of the adults at her previous placements. She mentioned one of her former psychologists. Dennis jotted down the man's name, then arranged to have him see her twice a week. When the psychologist complained that Yvette spent entire sessions banging her head against the wall and said he didn't think he could continue to see her, Kaleidoscope workers asked him what they asked of families: What do you need? The psychologist said he needed someone in the room to help with behavior management. So, with Yvette's permission, a Kaleidoscope worker sat in on the sessions. Eventually she reached the point where she could sit calmly by herself, and the Kaleidoscope worker was no longer needed.

Despite a few disappointments, Dennis says, most of his clients thrived, whether they were back with their parents or in their own apartments. By comparison, the group homes began to look institutional.Typically five or six children with the same problems lived under the same roof--an arrangement, Dennis noted, that didn't reflect the world at large or prepare individuals to live in it. "There's a strange thing that we like to do in human services," he now tells groups when he lectures, "and that's that we think there's something very magical about putting people together who have the same issues. So we put all the fire setters together--and wonder what they're trying to teach each other. And we put all the sex offenders together--and wonder what they're trying to teach each other. And I don't think that normalizes anybody's lifestyle."

He also noticed that his staff wound up doing more control and less treatment in the group homes. "You're always really terrified that if one person gets violent or doesn't follow the rules and you don't step on that right away, then everyone will follow along."

One day while visiting a group home Dennis saw five ecstatic children rushing to greet the head of the household, who'd just returned from a monthlong absence. One child grabbed the man's left arm, another hugged his right arm, a third clung to his right leg, and a fourth enveloped his left leg. "The fifth kid didn't have any place to grab," Dennis says. He concluded right then and there that five children to a home were too many. By the end of his first year at Kaleidoscope, Dennis had closed all the group homes in favor of the smaller, more intimate environment of foster care.

Dennis's foster care was different from that of DCFS. He required those who signed up to be parents to quit outside jobs and become full-time caretakers. DCFS foster parents received only small compensation to cover the added expense of taking in wards, but Dennis paid his foster parents decent salaries, using funds that had previously gone toward operating the group homes. (Kaleidoscope's senior foster parents now receive about $30,000 a year.) He also offered foster parents the same in-home support services he offered the biological families he was trying to keep intact. And he gave them whatever they needed--at times he even put staff in foster homes overnight to deal with disruptive children so the foster parents could sleep.

Unlike DCFS foster parents, who could terminate their duties on 14 days' notice, Dennis expected Kaleidoscope foster parents to embrace the agency's unconditional-care philosophy. Giving up on a child meant quitting your job--Kaleidoscope wouldn't try to find you a better match.

By 1976 Dennis was offering three cutting-edge services that became Kaleidoscope mainstays: independent living, in-home services, and therapeutic foster care. He later added pediatric AIDS foster care and foster care for adolescent parents.

In the 80s, with Kaleidoscope and a handful of other innovative agencies across the country demonstrating that seriously troubled children could be served outside of institutions, legislation and lawsuits began shifting child-welfare policy, requiring states to place children in the least restrictive environments possible. A major 1981 lawsuit, Willie M. v. North Carolina, forced that state to find community-based alternatives for the children in its care, adding momentum to the nationwide push toward deinstitutionalization. Lenore Behar, chief of Children's Mental Health Services in North Carolina, coined the term "wraparound" to describe the state's goal of integrating children into the community and wrapping services around them. Dennis, of course, had been doing this for years, and Kaleidoscope became known as the first wraparound agency in the country.

In 1983 the National Institutes of Mental Health started its Child and Adolescent Service System Program (CASSP), which gave grants to states to find better ways to serve emotionally and behaviorally disturbed kids. CASSP embraced the wraparound idea, but its founder, psychiatrist Ira Lourie, also believed that agencies in each system that served children--mental health, child welfare, special education, and juvenile justice--should pool their resources and expertise to expand treatment options for children whose needs crossed disciplinary boundaries. Dennis attended early CASSP meetings and, according to Lourie, "became known to the movement." Dennis agreed that interdisciplinary collaboration was important, especially since children didn't always find themselves in the system best suited to serve their needs. "One of the realities is that white middle-class kids wind up in mental health systems," he says, "and minority kids end up in juvenile justice, special education, and child-welfare systems."

Around that time, Dennis says, "I had come to the conclusion that the only way you really get systems changed is if it's top down and bottom up at the same time. I sat with that theory, and in 1985 I had a chance to put it into practice."

That year, John VanDenBerg, a CASSP project manager charged with coordinating an effort to bring Alaskan youths home from out-of-state institutions, invited Dennis to help him implement wraparound services throughout Alaska. The governor had given VanDenBerg the freedom to direct the funds as he saw fit but had imposed a $67,000 cap per child, the amount the state had been spending on institutional care.

A team of professionals from each system that served children came together to manage the effort, which they called the Alaska Youth Initiative (AYI). To the basic wraparound values that had been established--family-focused treatment, community-based services, and now interdisciplinary collaboration--Dennis added the concepts of treatment based on a client's strengths, unconditional care, and "individualization," which required providers to tailor treatment plans to each client's individual needs rather than offer predesigned services. "Individualization had to be far more extensive than human services had ever thought," says VanDenBerg, now a wraparound consultant in Pittsburgh. "What most people called individualization was that a child with complex emotional needs would get three or four services at a time. I'm a child psychologist, I had run state programs in Kansas before--this was really radical. I don't want to use the term blinding light, but epiphany would be an appropriate term. When Karl said, 'You don't kick kids out, and you change your service,' this was really an epiphany."

AYI developed child-and-family teams to work with service providers in their communities, and soon the initiative was offering children treatment its administrators previously would have deemed ludicrous. In some cases, when families in remote areas said they needed transportation to get into town for therapy or medication, AYI rented snowmobiles for them. When a Yupik Indian village protested the return of a violent kid, VanDenBerg learned that the villagers' social life centered on movie nights at the local school and that the selection of videos was outdated. He began sending the boy a new video every month to share with the community. The kid nobody wanted around suddenly took on an important and respected role.

In another case, an aggressive 17-year-old boy attributed his bad behavior to the fact that his mother had abandoned him. He believed that finding her would make his problems vanish. Find her, Dennis said. AYI hired a private investigator, who located her thousands of miles away. When she agreed to meet the boy, AYI flew him and his psychologist out to see her. She failed to show up at the designated time and place, however, and the boy returned to Alaska, his fantasy shattered. It might seem risky to expose such a boy to a new trauma, but VanDenBerg points out that the boy was under psychological supervision, both before and after the planned meeting, and that he was already at "high risk of not being able to move on with his life." Besides, VanDenBerg says, "It worked." Forced to let go of the idea that finding his mother would change everything for the better, the boy began to take responsibility for that himself.

"If you don't know what wraparound is it looks pretty weird--like you're giving kids a lot of stuff," says Lourie. "And you are." But, wraparound advocates argue, if you really want to help people, it sometimes involves spending money on such things as snowmobiles, videos, and plane tickets.

In the long run wraparound has proved cost effective. "A good wraparound plan is never more than 25 percent things that cost money," says VanDenBerg. "The other 75 percent is family, faith, and friends woven into the plan." Over three years AYI reduced the amount the state was spending per child from $67,000 to $20,000. After VanDenBerg presented this outcome at a national CASSP conference in 1987, singing Dennis's praises, he came home to a stack of messages "an inch high." VanDenBerg says, "My life has never been the same." Neither has Dennis's. They were soon helping implement wraparound plans all over the country.

The Alaska experience reinforced Dennis's idea that to change the system you had to come at it from both the top and the bottom, from both the policy-making level and the direct-service level. The experience--as well as a financial crisis back at Kaleidoscope--also underscored the need for funding to be flexible rather than locked into specific programs.

By 1990 the rate DCFS was paying per diem per child couldn't cover all of Kaleidoscope's expanded services, and Dennis was tired of asking his employees to survive on a pittance (one was selling hot dogs on the beach to supplement her income). He created a development-director position and hired Kathy, who would become his wife, to raise funds through grants and to find charitable donations. Kathy had been a frustrated social worker before she went into fund-raising. "I ended up sending a lot of kids to residential treatment centers and psychiatric hospitals," she says. "I would see the kids come back after they had been there for a couple of years, and nobody had worked with their families in between--and nothing had changed in the families. The kids looked better at first, but we'd put them back in a chaotic family. And we didn't work with the family once the kids came back, for the most part. So within a short period of time all the problems were back. So when I interviewed here, and Karl started talking about keeping kids in their own home and working with them in their own communities, it was like a lightbulb--it made lots of sense."

Today DCFS no longer refers children who are in their own homes to outside agencies, and Kaleidoscope has adapted its stabilizing services to wards in foster homes who are either fresh out of institutions or on the verge of losing their placements. The shift in referrals coincided with a legislative push to speed up adoptions. A 1997 state law intended to prevent children from lingering in foster care required them to be moved toward permanent placements within nine months of entering the system, so DCFS stopped investing its money in long-term family preservation. As a result, if parents can't patch up their lives within the designated time limit--which critics argue is unrealistic for people with substance-abuse problems--they stand a good chance of losing their parental rights. Kathy complains, "To give kids the right to come back and live with their biological parents is something that we just can't put arbitrary time limits on."

Despite all the emphasis on "permanency planning," many clients still arrive at Kaleidoscope with dozens of placements behind them--the record, Dennis rarely fails to tell audiences, is 69. As a result of all the moving around, their education has been disrupted; if they're lucky they read at an eighth-grade level by the time they're 21. They don't trust adults, and they have trouble forming lasting relationships. Dennis recently told a group of mental health workers about a friend who only partly jokes about wanting to add a new diagnosis to the Diagnostic and Statistical Manual of Mental Disorders. "He refers to these kids as 'multiple placement disorder' kids," Dennis said, "which really describes who they are."

To some degree, Dennis and his staff expect threatening, aggressive behavior from their clients. They believe the system breeds it--then tries to control it with psychotropic drugs. While Dennis acknowledges that sometimes these drugs are helpful, he believes that clients are often overmedicated. Kaleidoscope usually tries, with psychiatric supervision, to wean its clients off medication and doesn't rush to put them back on it at the first signs of bad behavior.

Usually bad behavior gets wards attention, and it's one of the only ways they can exert control over their lives. If they threaten a staff member or fellow client or otherwise act in an aggressive manner, other agencies often kick them out. Instead of learning to work through problems, they learn to avoid them.

At Kaleidoscope the staff involves clients in designing treatment plans that reflect their interests and meet their needs. If the children have conflicts, bad behavior will only make their problems worse. If the behavior is criminal--if, say, a client punches a hole in the wall or assaults a worker--Kaleidoscope usually presses charges. A worker will appear in court to testify to the facts and another will show up to advocate a community-based sentence so that the client can remain with the agency. "I can imagine it's a little confusing," says Olivia Delgiudice, the agency's associate director. "But overall the message gets conveyed: there are consequences, but we're not going to abandon you."

Dennis says the agency has remained true to its unconditional-care philosophy and has never thrown anyone out of its programs. "And that has not been easy," he says. "It's been difficult." It's no longer difficult for Dennis, who doesn't work directly with the kids anymore, but it's difficult for his unusually committed--some might say masochistic--staff, the people who have day-to-day contact with the clients. They endure verbal abuse, death threats, battery, all-night strategizing sessions, taking turns sleeping with a beeper, and making 4 AM trips to emergency rooms.

The unconditional-care philosophy requires them to be flexible, creative, and relentless. If a client isn't responding to a treatment, they must try something else. And if that doesn't work, they have to come up with another idea. Their job, Dennis says, is to "find the right formula" to help their clients, because there's no getting rid of them. The workers at Kaleidoscope tend to thrive under this philosophy. "You're given the opportunity to break some of the rules, cross some of those boundaries, go the extra mile," says Bonnie Guerra, a supervisor who has worked at the agency for 14 years. "You'll find a lot of people in social work go by the book. The basic rules are good, but some people are slaves to the damn book. I think a lot of rebels stay here."

Because the work is so intensive and the clients so difficult, workers in each department form teams of four or five and share small caseloads. The independent-living-services teams have no more than 22 clients; the in-home-services teams no more than 14 families. The small caseloads and teamwork help prevent burnout. If a worker can't deal with a particularly difficult kid one day, there are several other workers to rely on. Delgiudice says, "I always joke we'll wear the kid down before the kid wears us down."

Employees who make it past their first year at Kaleidoscope tend to stick around, despite the stress, long hours, and low pay. Unconditional care also means that relationships with clients don't end arbitrarily when the clients become adults and DCFS stops paying Kaleidoscope for their care. If necessary, workers refer them to agencies that serve adults, but they'll still help former clients find jobs and often spend time with them. Guerra drove a former client to work every day for five months--nine years after she left the program. She also manages money for three others, and spent a recent Sunday shopping for a crib for a former client who'd just had a baby. "A lot of folks at Kaleidoscope do similar things," she says. Dennis regularly sends books and money to two former clients in prison. He and Kathy recently cooked dinner for a former client and her mother. And he walked another down the aisle at her wedding, then lent her $700 for a down payment on a house. She paid it back.

Wraparound now exists in most states and reaches an estimated 100,000 families. Its principles were part of the 1994 U.S. Department of Education's National Agenda for Achieving Better Results for Children and Youth with Serious Emotional Disturbance. Congress has asked the Department of Defense to set up a wraparound program for military dependents. Although approximately 2,600 Illinois wards still live in institutions, DCFS has organized 62 Local Area Networks to create wraparound plans and provide flexible funding for services that fall outside the scope of agencies' contracts.

UIC's Petras says social work curricula now generally embrace some of the principles of wraparound, though that label isn't always used. She exposes her students to the approach and invites Dennis to speak to her classes. "Do they see it when they get out of school?" she says. "It depends on where they work." There's often a lag between the acceptance of an idea and its widespread implementation. "We've seen some changes over the years," Dennis says, "but not the sweeping reform we all hoped for and thought would happen."

While there have been many successful wraparound initiatives, there have been setbacks as well. CASSP eventually lost its NIMH support because, according to Lourie, its effectiveness couldn't be quantified. And after Alaska elected a new state government, AYI was disbanded for what Dennis calls political reasons.

He says the biggest obstacle to implementing and sustaining wraparound initiatives is "traditional thinking." Wraparound requires bureaucrats and social service professionals to give up power over their clients' lives and to shift decision making to family members and children. It also requires them to stop focusing solely on clients' problems and to overcome what he calls a "natural resistance" to collaborating with professionals in other systems of care. "Unfortunately," he likes to say, "it is my opinion that interagency collaboration is an unnatural act between unconsenting adults."

Lourie, who calls Dennis a "national treasure" and is now working with him on a book of wraparound stories, recalls a classic wraparound moment he had while visiting the director of Missouri's mental health department. Lourie arrived just moments after the director learned that a ward had run away from an institution and stolen a train. The director was going on and on about how horrible the kid was and asked Lourie for advice. "This is a marvelous kid!" Lourie said. Could you steal a train? Could you drive a train? Lourie figured the kid had to have some outstanding mechanical skills; the question was, how could they inspire him to put those skills to good use? But in a culture that's getting tougher and tougher on juvenile offenders, such thinking isn't always welcome.

Still, Dennis is working hard to spread the gospel. He has lectured in every state except Utah (he's scheduled to go there later this month) as well as in Canada, China, and New Zealand. He sits on the boards of more institutes and universities and organizations than he can keep track of. In one recent month alone he attended a board meeting in New York; trained visiting groups from Washington, D.C., and Romania; delivered a keynote address at an educators' conference in Champaign; trained in two Idaho cities; and participated in the first-ever White House Conference on Mental Health--the second time the Clinton administration brought him to the nation's capital to brainstorm about issues affecting children.

"He'll get invited two years in a row to be the keynote speaker for the same organization," says Kathy, "and you'll say why? And they say, because we had so many requests for him to come back. It's like he has these groupies. I've heard people say they've heard Karl talk eight, nine times. People will stop me at a conference and say, 'You know I heard Karl talk four years ago, and I just really need to tell you how that changed my life.'"

His growing prominence has been good for the agency's coffers. He commands $1,500 an appearance, and a few years ago he made enough money on the road to cover his salary. In May the CTA, hearing about Kaleidoscope's work, handed Dennis a $10,000 charitable donation prize it had won from USA Weekend's "Make a Difference Day" contest.

Dennis's ideas are still better known than he is. He was recently in Washington, D.C., at a conference on mental illness in the criminal justice system sponsored by the Department of Justice. A speaker at the opening session on the second day kicked off his talk with a series of quotes, including one he attributed to Dr. Joycelyn Elders; he said she'd once remarked that interagency collaboration was an unnatural act between unconsenting adults. Four or five people in the audience caught Dennis's eye and smiled knowingly.

In June, Dennis celebrated his 24th anniversary at Kaleidoscope. He hadn't taken a vacation in two years and had been working for 19 days straight, most of that time traveling. He had deep circles under his eyes. His voice was hoarse.

He was in the conference room one morning opening a dauntingly tall stack of mail when someone appeared at the door and announced that Yvette had returned. Dennis hadn't seen her in nine years. "Where is she?" he said, leaping out of his chair.

He found her holding court in Delgiudice's office. One by one, workers who'd known her when she was a teenager filed in to see her: Dennis, Guerra, Cassandra Jackson, Bob Devaney. Yvette grew giddier with each familiar face. They each asked the same questions: How are you? Where are you staying? Do you want something to eat?

She told them she'd been homeless for about a month. The building she'd lived in on South Shore Drive had been sold, and the new landlord had forced out everyone who was on a fixed income. Yvette, who had a seizure disorder, was on SSI.

As the day wore on, she flipped in and out of coherency, and it became clear to everyone--Yvette included--that she needed to be hospitalized. She chose a hospital she liked, and Delgiudice, after taking her out to eat and buying her some toiletries, drove her there. After a week and a half medication stabilized her, and Kaleidoscope found her temporary low-income housing on the south side.

A few days after she moved in Dennis took her out to lunch. In the car she told him she planned to get married but later mentioned that the wedding would have to wait because her fiance was in jail. When Dennis asked about him, she said, "I'm honest with you. I would never lie to you. Everyone else I would tell to mind their own business." She said her fiance wanted to have six kids. "I don't feel like popping no kids, not right now. But what can I say? That's what he wants."

"You can say no," Dennis told her. "Love does not mean doing everything that somebody wants you to do." Later he added, "I think anyone who wants to have six kids ought to go work in a nursery or volunteer in a nursery school and see what it's like."

Yvette beamed in his presence, admiring his bear-claw necklace, his watch, and his multicolored leather shoes, which were hand painted with musical symbols and piano keys. She told him that she still kept in touch with her psychologist. Then they reminisced about former clients they both knew and laughed about how she'd made a killing on her cartoon. After Dennis had bought it, he'd asked her for permission to reproduce it on invitations for the agency's open house, shortly after it moved to its current location. Yvette had said that would be fine--as long as he paid another $200. Dennis handed it over.

Before dropping her off, he asked her to come swim sometime at the beach in front of his house. She said she loved water but didn't have a bathing suit. "We'll have to get you one," he told her.

As he drove home, Dennis pointed out that while Yvette was having a rough time at the moment, she was surviving. "This was someone everyone expected to be on a back ward somewhere."

Art accompanying story in printed newspaper (not available in this archive): photo/Lloyd DeGrane.

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