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Kennedy Krieger Institute therapeutic foster care program

Kennedy Krieger Institute’s therapeutic foster care program works with children in Baltimore who have experienced complex trauma and are at risk for institutional placements and trains and supports foster parents. The program uses the attachment, self-regulation, and competency framework.

This is one of 31 profiles that appears in Support Matters: Lessons from the Field on Services for Adoptive, Foster, and Kinship Care Families.

Publication date: 2015

Population served

Children and youth who need foster care placement, most of whom have experienced complex trauma and have a history of, or are at risk for, institutional placements. Many have experienced multiple placement moves and many have developmental and other disabilities, medical conditions, and emotional or behavioral challenges.

The program serves about 100 children and youth at one time. The average age of youth served is about 14 years old.

Theory of change

When families receive necessary training and support, they can care for children and youth who have experienced complex trauma and help these children heal and learn to attach and trust again.


Kennedy Krieger Institute is a nonprofit organization in Baltimore, MD, dedicated to improving the lives of children and adolescents with pediatric developmental disabilities and disorders of the brain, spinal cord, and musculoskeletal system, through patient care, special education, research, and professional training.

Role of public child welfare agency

The Maryland Department of Human Resources is the primary funder of the program.

Key service components

Kennedy Krieger’s Therapeutic Foster Care program operates using a Trauma Integrative Model, which integrates elements of treatment foster care with the Attachment, Self-Regulation, and Competency framework.

Services include:

  • Assessments — Children and youth entering the program receive comprehensive psychosocial and medical assessments. Family and community functioning are evaluated using the Child and Adolescent Needs and Strengths tool. The results of these assessments are used to guide case planning and services provided.
  • Case management — A clinical social worker serves as case manager and facilitates the development of relationships between the child and her treatment parents, between the treatment parents and the birth parents, and between the child and the birth parents. The social worker also facilitates and supports permanency planning.
  • Therapeutic services — The child and family have access to evidence-based treatments such as Trauma-Focused Cognitive-Behavioral Therapy, Structured Psychotherapy for Adolescents Responding to Chronic Stress, and Parent-Child Interaction Therapy. The case manager also connects the child and family with needed psychiatric services, medical care, or community-based supports.
  • Training and support for parents — Treatment foster parents receive extensive training, including on the Attachment, Self-Regulation, and Competency framework, positive behavior management, best practices in permanency, and other key issues facing children who have experienced complex trauma. They are trained and supported to:
    • Develop a safe, secure environment for the child or youth
    • Use trauma-sensitive approaches to respond to behaviors
    • Help the child access effective medical, educational, legal, or other services
    • Serve as key members of the treatment team
    • Develop supportive relationships with birth family and other relatives, and help the child maintain and build relationships with birth family members
    • Support permanency
    • Support the relationship between the child and her birth family members
  • Transition support for older youth — The program uses the Transition to Independence Process model, which is an evidence-supported model to help youth exiting care to prepare for their futures.
  • Adoption support — If children leave the program to adoption, the adoptive family can attend adoption support groups and receive ongoing support.

Outreach efforts

Treatment parents are recruited through an ongoing integrated recruitment campaign that includes current treatment parents, staff, social media, and outcome data.

Staffing and training

  • 15 clinical social workers, all of whom have master’s degrees in social work or who are licensed clinical social workers
  • 1 program director and 2 managers/supervisors who are licensed certified social workers and have many years of clinical and child welfare experience
  • 1 parent recruitment staff member
  • 1 part-time foster parent recruiter
  • Administrative professional staff

The agency has access to a neuropsychologist, three psychiatrists,a developmental pediatrician, and a research director who provide support and assistance to the therapeutic foster care program.

Staff receive training in the Trauma Integrative Model and attachment, self-regulation, and competency framework.

In addition, staff receive hands-on training, weekly supervision meetings, and weekly clinical training sessions. Staff have access to training on evidence-based models and receive reimbursement for continuing education and tuition.

Evaluation and outcomes

The therapeutic foster care program contracts with the Children’s Outcome Management Center at the University of Maryland School of Medicine, Department of Psychiatry for the use of the KIDnet outcome database system, which is used by the state of Maryland for its therapeutic foster care providers. KIDnet is used to develop treatment plans, evaluate outcomes, and conduct other research, and gathers information on:

  • The child’s or youth’s case
  • The treatment process
  • Case outcome information
  • Results of the Child and Adolescent Strengths and Needs Assessment

The program also uses case-based review and review of crisis calls to assess program outcomes and learn from previous cases.

In 2013:

  • 58 percent of children and youth served left the program to less restrictive placements
  • 9 children and youth left to permanency (6 to adoption and 3 to reunification)

Budget and funding

Approximate annual budget: $5 million

The Maryland Department of Human Resources provides 90 percent of the program funding using federal Title IV-E funds, Medicaid, and general state revenue.

Remaining program funds are provided through contracts with Maryland’s Developmental Disabilities Administration.

Partnerships required or recommended

As noted above, Kennedy Krieger partners with the University of Maryland for data tracking and evaluation.

Partnerships with the Maryland Coalition for Families, the University of Maryland School of Social Work, and the Trauma Center enable the agency to extend its resources and increase staff knowledge on current treatments to then better help our clients.

Challenges and future directions

  • Building a diverse funding base
  • The challenging needs of children and youth in care
  • Recruiting families who have the capacity to parent children who have experienced complex trauma

The program has begun to include children in kinship care, but this model is still in the early stages of development.

Learn more


  • Paul Brylske, interview, June 20, 2013.
  • Kennedy Krieger Institute website, accessed April 23, 2014.
  • Laura Boyd, Paul Brylske, and Erin Wall, “Beyond Safety and Permanency: Promoting Social and Emotional Well-Being for Youth in Treatment Foster Care” (2013), Foster Family-based Treatment Association.


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