The Arc Montgomery County Karasik Family, Infant & Child Care Center, affectionately known as KFICCC, is a family-centered child care program. In every classroom, typically-developing children, children with developmental disabilities, and children with special health care needs play and learn together. The program has been a smash hit in the community, due in no small part to the thoughtful planning and implementation led by CEO Chrissy Shawver.

By modeling and teaching inclusion from the start, The Arc Montgomery County is ensuring that the next generation knows the value of inclusion and spreads love and acceptance in whatever path they take. In case you missed their presentation at this year’s National Convention, learn more about how they’ve built such a successful program below!

How did the program start?

The current KFICCC program was originally two separate programs. Karasik Child Care Center was for children ages 2-10 years old with and without disabilities. It was named after Monroe and Joan Karasik, very strong advocates for people with disabilities. Family, Infant & Child Care Center was for children ages 6 weeks to 5 years old who were medically-fragile, or who had complex medical conditions.   

In 2011, these programs merged, becoming KFICCC (Karasik Family, Infant & Child Care Center). KFICCC is the only fully-inclusive child care center in Maryland, where children with and without disabilities and special health care needs play, grow, learn and explore together in all classrooms. Approximately one-third of the children enrolled have identified disabilities; the remaining two-thirds are typically-developing.

What is your training and onboarding process like for new staff?

All KFICCC teachers have college degrees and all other KFICCC staff must hold a 90-hour child care certificate geared toward the ages of the children with whom they work. The Arc provides a comprehensive on-boarding and training process, which includes CPR, first aid, Maryland State Department of Education trainings, and other trainings specific to working with people who have disabilities. 

The most important quality for KFICCC staff is a really strong background in early childhood education. The child is a child first; any disability is simply part of the child. If you understand child development, you can work with all children by simply getting to know them and being willing to make accommodations to meet their individual learning styles and needs.

What about new children? How do you ensure the transition into the program is smooth and that everyone is set up to succeed?

KFICCC offers a seamless delivery of services, including therapies, special education, pre-kindergarten, and on-site nursing support. It’s all about coordination of care and giving parents an integrated support team.

New children come with their parents to meet with the staff and tour the building. During this visit, the child spends time in the identified classroom. Once a commitment is made, the child attends for his/her first week, spending progressively longer periods in the classroom. 

If the child has an IEP or IFSP, the staff will meet with the child’s team to learn how to best meet the child’s needs in the classroom. If the family is not yet linked to services, staff may recommend them to Child Find or Montgomery County Infants & Toddlers Program.

What should chapters who are trying to implement a similar program in their community know?

Operating KFICCC is expensive, primarily because child-staff ratios must be higher than what is required by licensing. Community partnerships are essential for success.  Staff must believe in inclusion and understand the benefits of having children with and without disabilities in the same classroom. When done right, it should be hard to tell who has a disability and who doesn’t—the program should feel very natural.

What has been the most challenging part of building the program, and how did you overcome it?

Adequate funding was and continues to be a challenge, especially when trying to keep the cost of child care affordable for families with lots of other financial pressures. It’s key to have someone who can write grants and connect with other funding sources because the program cannot run on tuition alone.

Another big challenge was breaking down barriers. Parents had many misconceptions about their typically-developing children “catching” disabilities or being held back because the attention was directed to children with special needs. The only way to overcome that was to demonstrate that it was untrue. Today, KFICCC’s greatest advocates are children without disabilities, because they just see their friends—not the disability.

Today, with advances in medical care, deinstitutionalization, and people working and living more productive lives, individuals with I/DD are living much longer. Mark Keeley, President and CEO of the St. Louis Arc, recognized the growing needs of this aging population and committed to better serve and support them. Under the leadership of Mary Anne Tolliver, Director of Aging Services, Dautel Circle has become the premier retirement community for seniors with I/DD.

Education of staff is paramount to guide them and the people they are supporting through the grief process. The goal is to understand what grief can look like, as it does not look the same from person to person, know how to respond to each individual’s loss, or just “be with them” to listen and provide support. The journey to the end of life can be extended or abrupt. Explaining what to expect through the grieving process and what is occurring can be especially helpful to someone with I/DD. Grief counseling also gives individuals with I/DD the mechanism to express their loss and sadness.

Since many of the aging individuals we support have declining health and decreases in cognitive and physical abilities, we are changing our supports around them. We have instituted a Holistic Aging Review committee to both meet funder due process responsibilities and provide a holistic review with an interdisciplinary team approach. The committee is designed to provide guidance and recommendations on medical/health concerns, medication review, behavior supports, restrictions, adaptive devices, and staff training for skill development and education. In addition to the review committee, we also provide grief counseling, support groups and hospice, and palliative care.

How do prepare someone with I/DD for the news of a loved one being sick or facing a terminal illness? How do you support someone with I/DD facing end of life themselves – and how do you support their family?

Mary Anne: The best practice we have found is being honest with the person affected about what is happening to them or to their loved one. We do this through words or pictures to help them understand. When discussing or explaining, it may not always be about a specific ailment or situation, but more about the understanding that their family member, friend, or housemate will no longer be here. We provide grief counseling to residents, staff, and families through our therapist, our Employee Assistance Program, and hospice and palliative care. Understanding their spiritual, religious, and cultural beliefs helps us to guide them through their grief. It is important to not push our own beliefs onto them but be a guide through this journey with their beliefs and understanding of death. We try and make sure the families are involved in decisions, spend quality time with their loved one, and have the opportunity to say goodbye. We also encourage families to include their loved one’s friends and housemates in the process so they can express their feelings and understand their grief.

Do you partner with health care professionals? If so, has the exposure helped build awareness and competency working with the disability community?

Mark: We have a long-term partnership with a primary care physician who consults with our RNs and who also provides care for many of our residents. We have also partnered with Visiting Nurses Association for hospice care for our residents. VNA understands the regulations we need to follow and works with us to provide the best possible care for our residents within their own homes.

What advice do you have for chapters who want to provide aging services/supports, but don’t have a program started yet?

Mary Anne: Aging, loss, and death are a natural process of life. People with I/DD grieve the loss of a loved one just as the rest of us do. Providing support, respect, and inclusion in the process of loss and grief and not sheltering someone with I/DD from this life experience is vital. Initiating a Holistic Aging Review committee, identifying or employing a reputable, credentialed grief counselor, and educating staff through professional training on aging and dementia is paramount to being able to accommodate these individuals through the natural progression of life and loss.