Program for infants confronts cash crunch

Toddlers: Demand for a statewide program offering free therapeutic services has grown, but funding has not.

August 05, 2004|By Aparna Balakrishnan | Aparna Balakrishnan,SUN STAFF

"Good girl!" 20-month-old Mya Ellis exclaimed, cherry Popsicle in hand, echoing her physical therapist, Fran Leibowitz. The therapist had praised Mya after the child walked up and down the stairs of Ellis' Reisterstown home.

Leibowitz, a therapist for 27 years, works for the Baltimore County Infants and Toddlers Program, which provides free services such as physical and speech therapy for children ages 3 and younger who have developmental disabilities. Many are children who were very premature babies.

Born at 28 weeks, Mya has difficulties with walking, balance and motor skills that were delayed by premature birth. The toddler was the first of four children the therapist would see that day.

In recent years, the Infants and Toddlers Program has been sending therapists and nurses to homes and day care centers rather than requiring enrolled children and their parents to come to one of the county's five regional centers to receive services. But proponents of the program say it has had trouble keeping up with the demand for services.

The number of children enrolled in the program has increased sharply but not the money to run it, said Kelli Nelson, a parent of children who were in the program. Now Nelson is a volunteer on a state council that coordinates the efforts of the Baltimore County school system and the local offices of health and social services to run the program.

"Parents need to know the help is out there," Nelson said. "It can be life-changing."

Nelson said her twin daughters benefited greatly from Infants and Toddlers. Now healthy 5-year-olds, the twins underwent physical therapy and other treatment for the full duration of the program because they were born 11 weeks premature.

Statewide, more than 11,000 children are enrolled in the Infants and Toddlers Program, an increase of about 110 percent over the past 10 years. In the Baltimore region, 1,600 are in Baltimore County, 786 in the city, 340 in Howard County, 600 in Anne Arundel County, 150 in Carroll County and 265 in Harford County.

Funded by federal, state and local governments and by Medicaid reimbursements, resources and staffing have remained tight, according to program officials.

Edward Feinstein, director of the program in Anne Arundel County, said that enrollment has increased by about 13.5 percent in the past year but that the county's annual operating budget of $3 million has for the most part remained unchanged.

"We have kids coming in literally every day. It puts tremendous strain on the program to provide full services," Feinstein said.

In Baltimore County, participation has jumped about 20 percent over the past four years, but the budget -- about $6.7 million this fiscal year -- has stayed relatively constant over the same period, said Paula Boykin, director of the county's Infants and Toddlers Program.

Federal grants have been drying up, and as a result, Boykin said, "the only hope the program has had is to appeal to the local government." Last year, Baltimore County provided about 60 percent of the program's funding, she said.

The results of that investment can be seen in 20-month-old Mya Ellis, who has come a long way since she started in the program, her father said.

"It's great," said Derrick Ellis. "Everyone's been very supportive."

After Mya's appointment, Leibowitz stepped into a red Honda Civic filled with maps, papers and toys to hustle off to the next home visit.

She spends a large part of each morning on the road, between appointments. One of the consequences of a staff stretched thin, the therapist said, is that she and other staff members are constantly on the move, making one house call after another.

The Baltimore County program has 69 employees, who are employed by the schools or the health and social services departments. Four of them are physical therapists, including Leibowitz. The program has hired contractors to handle some of its caseload and make up for gaps in permanent staffing, Nelson said.

Leibowitz, who has been with the program since it started in 1991, said that her workload is heavier because of a lack of trained staff.

"The trouble is finding people who are qualified to provide the services," said Stephanie Savar, director of Carroll County Infants and Toddlers, which is also experiencing funding difficulties.

Word of the program's success has increased the demand for services and added to the cash crunch. "Our outreach efforts have really contributed to the program's growth," said Savar.

While the task of finding adequate resources continues, Leibowitz soldiers on, helping her tiny clients overcome their problems. Some children require mild improvements in motor skills, such as 13-month-old Jordan Brown, who displayed an unusual inability to sit. Others need more serious attention, like 28-month-old Alexa Kelz of Reisterstown.

Alexa, a lively toddler, has CHARGE syndrome, a disorder that causes multiple problems, including hearing loss and heart defects. Leibowitz began seeing the child at 8 1/2 months, and uses sign and body language to make Alexa more comfortable with walking, running and jumping.

"She's a success story. She's come so far," said Leibowitz, as she instructed the toddler to throw a tennis ball.

Alexa's grandmother, Carmy Lloyd, agreed that the child had done very well since starting in the program.

"She's doing really good now," said Lloyd with a big smile.

Toward the end of another long day, Leibowitz said her job has had a significant impact on her own life.

"I have a lot of respect for these families and what they go through with their children and the love they have for them," she said. "I love watching the children grow and improve."

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