Cognitive Behavioral Therapy Plus (Baltimore County FY18 and beyond) Annual

Story Behind the Curve

Out-of-Home (OOH) placement describes the situation of children who are in the care and custody of the State for a variety of reasons, and is often used when less restrictive interventions have failed. Children and youth may enter OOH placements for a variety of reasons including the following:

  • Children who experience abuse or neglect may enter the child welfare system (e.g., kinship care, foster care). “Eighty percent of youth involved with the child welfare system require mental health intervention and services due to developmental, behavioral or emotional issues” (National Conference of State Legislatures).
  • Delinquent youth may enter the juvenile justice system. “Sixty-seven to seventy percent of youth in the juvenile justice system have a diagnosable mental health disorder” (National Center for Mental Health and Juvenile Justice).
  • Children and youth with behavioral health disorders may enter care for residential treatment, either through a Voluntary Placement Agreement (VPA) or though the public behavioral health system. “Children and youth in residential treatment centers, 69 percent of whom come from the juvenile justice and child welfare systems, have extremely high rates of mental and behavioral health disorders compared to the general population (National Center for Children in Poverty).

According to the FY2019 Out-of-Home Placement Report and Resource Guide, the County OOH placement rate for 2019 is 5.5. In actual numbers, the 2019 rate of 5.5 represents 661 County children and youth placed out-of-home.

The overarching Goal of the CBT+ program is to reduce the out-of-home placements of children and youth by preventing entry or further penetration of the juvenile or adult justice system (e.g., detention), child welfare system (e.g., foster care or residential placement), and/or behavioral health system (e.g., psychiatric hospitalization or residential treatment). The Objective of the CBT+ program is to reduce the severity of or remedy the symptoms of the diagnosed behavioral health disorders of children and youth that may contribute to out-of-home placement.

  • Baltimore County Public Schools
  • Baltimore County Department of Social Services
  • University of Maryland, School of Social Work
  • Associated Catholic Charities
Action Plan

The intervention provided by the CBT+ program is clinical counseling services. The objective of these services, using the CBT+ practice model, is to reduce the severity of or remedy the identified behavioral health condition(s) of children and youth. These services are delivered in a manner that: (a) supports the participation of children, youth, and their families/caregivers in counseling and related services (e.g., parent support groups); (b) provides timely and effective intervention; (c) reduces the need for more intensive and intrusive intervention; and (d) improves functioning.


CBT+ clinical counseling services are typically delivered at 4 community-based clinics located throughout Baltimore County and in over 30 Baltimore County Public Schools.  At this point in time, CBT+ clinical counseling services are being delivered virtually using the telehealth model.

Program Summary

The Cognitive Behavioral Therapy Plus (CBT+) program provides clinical counseling services using the CBT+ practice model. The four evidence based treatments within the CBT+ practice model include CBT for depression, CBT for anxiety, CBT for problem behavior, and Trauma Focused-CBT. Services are delivered by licensed behavioral health clinicians via school-based and community-based clinic sites and via telehealth as necessary. Telehealth is the delivery of health services via remote technologies such as a telephone or computer.


In addition to the CBT+ clinical counseling services described above, children, youth, and their families have access to additional support services.


  • Support groups for families who have a member with mental/behavioral health challenges are held monthly in five locations around the County. Support group facilitators are legacy parents and have significant personal experience with the County’s behavioral health system of care.
  • A skill building program for children and youth to practice the strategies/skills taught during CBT+ counseling services are held throughout the year in the four community-based clinics located around the County. Over 200 children and youth participated in the skill-building program during FY19.
  • Two board-certified child psychiatrists are available to provide psychiatric assessment and intervention for children and youth as needed. Approximately 300 children and youth are assessed and treated annually by the child psychiatrists in addition to receiving CBT+ counseling services.
Target Population

The target population for CBT+ is children, youth, and young adults between the ages of 5 and 21 who have two or more Adverse Childhood Experiences (ACEs)* and are assessed to have an Axis I mental health diagnosis, otherwise known as a behavioral health disorder.  Adverse Childhood Experiences (ACEs) is the term given to describe traumatic experiences that occur to children and youth under the age of 18.  These traumatic experiences include emotional abuse, physical abuse, sexual abuse, emotional neglect, physical neglect, mother treated violently, household substance abuse, household mental illness, parental separation or divorce, and incarcerated household member.

Governor's Strategic Goal

Adverse Childhood Experiences.

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