Health Horizons : PSYCHOLOGY : Family Preservation : A growing movement is targeting families on the verge of having their children removed from their homes. Adherents aim to stem the growing tide of foster-care placements.

Clete Menke remembers one of his first days on the job in Orange County.

He drove to the home of what county social workers said would be a family on the edge.

This was what he hoped for, what his B.A. in psychology, his M.A. in counseling, and his own personal values had prepared him for: helping troubled parents keep their family together.

About to ring the doorbell, he was surprised to see a man storm out the door and past him, with a child under each arm. Their mother ran out after him, shouting at the man who was apparently the children’s father, her ex-husband. As Menke watched, the mother managed to wrest the children away, put them into an old car, and drive off, yelling threats of suicide.

Menke decided to wait at the house. When she did not return, he gave his home phone number to her current husband and went home. At 11 p.m., his beeper went off. Menke drove back to the house, asked her to sign a pact not to kill herself and eventually persuaded her to seek counseling.

As one of a rare, new breed of in-home counselors, Menke sees more than most therapists or social workers--sometimes more than he bargained for--but believes it is the only way to really help them.

“It’s a difficult thing to do, going into people’s homes,” he says. “You uncover a lot more than you were told was there. . . . What people tell you goes on and what really happens are rarely the same. People can put on masks, but after a certain point, they can’t hide too many things.”

In his job, it is essential to see families at their rock-bottom worst. “In order to teach them how to deal with the major issues,” he says, “I have to see one (an issue.)”

In-home counselors like Menke make up a small, growing movement called “family preservation,” which targets families on the verge of having their children removed and aims to stem the growing tide of foster-care placements.

A significant number of children who are now placed in foster homes would be better off, even in marginal families, if only their parents knew more about parenting and homemaking, says Menke, a counselor with Boys Town, one of two organizations that provide in-home counselors to the County of Orange. Los Angeles County uses the Children’s Bureau, the Exchange Club, Bienvenidos Children’s Center and the Black Family Investment Project among others.

As the numbers of children being removed from their parents surge upward, and the money to support them declines, many others are starting to agree. At least 10 states other than California are aggressively pursuing family preservation programs with mandates and hefty budgets.

Currently there are about 500,000 children in foster care in the United States. In California, where 80,000 children are in out-of-home care, it costs almost $1 billion to provide substitute care for them.

No one questions that children should be placed when they have been abandoned, or are at risk of serious physical harm. But most are placed for reasons of neglect, a byproduct of poverty, according to the Edna McConnell Clark Foundation in New York, which grants $4 million each year to family preservation programs.

Once in foster care, three of every 100 children are abused, according to the foundation. New studies by the National Assn. of Social Workers show that, in California, nearly half of the children who wind up in runaway shelters had been in foster care during the previous year. One advocate of family preservation is author Maya Angelou, who was sent away from her parents after a divorce, and was once advised to give up her own son on the grounds that the life she then led as an itinerant cabaret singer might harm him. Every child torn from his parents asks, “If I wasn’t good enough for my own family, which they say is no good, how can I be accepted here?” she has written. “Tragically, the question is unanswerable and perseveres under the skin, in the viscera through the days, hours and years into adulthood. . . .

“When a child is protected, but its family is shattered, we are forced to question if indeed our process has succeeded. Or are we, in fact, living the cliche that ‘the operation was a success, but the patient died?’ ”

Counselors in family preservation programs are on call 24 hours a day to families referred by county social workers. They they work with only one to three families at a time, 15 to 40 hours a week, for an intensive six- to 12-week period.

Variously called “family consultants” or “teaching demonstrating homemakers,” they use behavior intervention, not psychotherapy. “We don’t spend a lot of time on ‘How does it feel?’ ” said Mike Riley, site director for the Boys Town branch in Anaheim. “We know how it feels.”

Instead, they roll up their sleeves and do the dishes, or clean the house. Sometimes they shop, or drive a parent to a job interview. They sit on the floor and play board games with children. They go to the park and swing and play with children--all parenting or homemaking skills that some of the parents never learned. The goal is to model good behavior so the parents can copy it later by themselves.

As they clean or play, they also observe (Are the children safe? What do the parents need to know?) and they teach--about anger control, setting limits, following through and making decisions.

In addition to education and training in behavioral sciences, good counselors have a sense of humor, are empathetic, yet tough enough to “turn up the heat” on self-pitying parents, Riley says. Particularly, they must be non-judgmental. “Needless to say, most people out of college come out of a middle-class background but work with people who are not middle class. It’s important to leave your values and judgments at the door. . . .

“The type of person we are looking for has the ability to go into a situation that’s chaotic and look at the family and not blame them and say, ‘Man, what a mess. Let’s get to it.’ ”

Cletus Menke, 26, was raised in Catholic schools in the Midwest. At one point in his youth, he considered becoming a priest. Now more of a fallen away Catholic, he still believes there is some spirituality associated with the word helping.

A mild-mannered bachelor who works in cutoffs and rimless glasses, Menke says people often wonder how he can help families when he has never had children himself.

“I’m not teaching them how to be a family,” Menke says. “I’m teaching how to manage their children, how to resolve conflicts in their homes. And how to provide a safe environment.”

He is driving in rush-hour freeway traffic and misses his turnoff for one of his families, so he decides to visit the other one first. She is a divorced mother of three children, so depressed she can barely function.

Most of his clients are single mothers, some still married, whose boyfriends drift in and out. Some have been reported for abuse or neglect. Some are alcoholic. Many come from generations of abusive alcoholic families and have come to disdain the social workers they feel have judged or threatened them.

Tonight, the young mother has cleaned her house, put on makeup, and seems glad enough to see Clete. She has quit smoking, and he brings her some chewing gum.

The children jump on him and tell him their news.

It is the end of the month, and she has nothing but potatoes and macaroni and cheese to feed the children. While she makes dinner, Clete holds the baby till the child falls asleep, then plays a board game with the girls on the living room floor, by the lavender light of the TV.

The mother says she has learned from Clete how to discipline her children without spanking or nagging them. On her refrigerator is a list of House Rules: “Eat only in the kitchen. No jumping on the furniture. Flush the toilet and wash your hands after you use the toilet. Bed time is 8 on school nights. . . .”

Before leaving, Clete praises her for using “contingency management” (“If you clean your room, you can have a party”) and makes plans to drive her to an office where she can apply for a a grant to go to college.

On the road again, he explains his checklist: Are the children safe? Is the parents’ discipline effective enough without hurting the children? Is there enough food in the refrigerator and is the house clean enough?

Sometimes parents complain about new, higher standards for parenting. They were beaten with a belt, and it worked for them, so they do it too. “I don’t care,” replies Menke, who said he was also beaten as a child, as were most children in his neighborhood. “This is the law. I can help you find a better way. If parents are shown another way, he says, “they’ll do it.” To fit in and gain their support, Menke says, he may adopt the family’s mannerisms, or language--even if they speak in obscenities.

Now, he drives up through a middle-class neighborhood and stops at a large, two-story home. The parents, at rope’s end with four children, two who had been hospitalized for emotional problems, had called social services themselves, asking for help. The boy is out of control, the teen-age girl is a chronic runaway. Part of the problem, they said, is a former husband with a serious drug addiction.

Menke knocks on the door. The husband yells, “C’mon in, Clete!” The wife, just home from work, offers him tacos made by the sitter. The boy, 8, runs up excitedly and tells Menke about his progress on his behavior chart, and details of his recent cold and fever.

As the boy runs in and out of the room, complaining about his sisters, Menke helps the parents draw up a contract for the girl, and a new behavior chart for the boy. The girl comes downstairs, curls up in an overstuffed chair, and cries as she hears she is grounded for a month and cannot go out with her friends until she earns the privilege back through good behavior.

“You know why I run away!” she cries. “It’s the only way I can have fun! I sit here and I get so bored. . . .”

The boy races through the living room, chased by his younger sister, who complains that he hit her. “I didn’t do anything,” he yells. “Go to your room,” says the mother. “You jerks,” says her son.

“Go. Now. Shut the door. Be quiet!”

The parents look shellshocked. As Clete begins to leave, they keep the conversation going, asking more questions about the charts. Clearly, they want him to stay.

Sometimes, Menke says, parents ask if he would please move in with them. They are only half joking, he says.

He claims he does not “fix” anything. He only helps parents do better. The behavior charts, for example, are more for the parents than the children. They help them become more consistent and follow through on what they say.

“When it works, I say, ‘Look what you did!’ ”

In a few weeks, it will be his last visit for the family. Then, as he does with all his families, he will bring in pizza for a party. “They should be proud of what they’ve accomplished,” he says. “They’ve worked hard.”