One-on-one support for foster youth: What is it and does it work?

In September 2025, 16-year-old Kanaiyah Ward tragically died, allegedly due to an overdose, in a Baltimore hotel.

A child in foster care, Kanaiyah had been placed in the hotel by the local department of social services (department), who had assigned her a one-on-one aide.

Children in foster care who have high service needs may be assigned a 1:1 temporarily by the department.

“The goal of providing one-on-one service(s) is to provide a more intensive level of care for the safety and security of the youth and others affected by the youth’s behavior.”

“These are exceptional interventions provided beyond the scope of the [foster care program] deemed necessary to resolve the immediate situation and to maintain the placement for the youth.”

1:1 services are temporary supplemental services that “are not intended to replace the professional treatment services needed by the youth and are generally for the purpose of providing awake supervision by staff comparable to Provider childcare staff.”

Importantly, “[y]outh who require long-term one-on-one support should not be placed with [foster care providers] whose service profiles do not address the intensity of need demonstrated by the youth.”

For children with intense medical or mental health needs, 1:1 support should supplement, not replace, a setting that can meet their needs.

Children in foster care who are diagnosed with serious medical conditions or a serious emotional, behavioral, or psychological condition are eligible for treatment foster care placements. COMAR 07.02.11.33.

“The goal of treatment foster care is to provide intensive services to a child with a serious emotional, behavioral, medical, or psychological condition.” COMAR 07.02.21.02.

According to the State’s Request for Proposals for 1:1 services, all 1:1 staff must, among other requirements, pass a criminal background check; meet certain education and experience requirements; be available 24 hours a day, 7 days a week; and receive certification in Therapeutic Crisis Intervention, Crisis Prevention Intervention, and Safe Crisis Management, prior to providing any services.

The minimum education and experience requirements are an associate’s degree in a human services field and one year of experience working with children, adolescents, or transition-age youth or a high school diploma or GED and a minimum of two years’ experience working with children, adolescents, or transition-age youth.

Within 60 days of hiring, 1:1 staff must possess and maintain a Residential Child and Youth Care Practitioner license.

RCYCP Certification requires participation in a State Board-approved training program designed to provide a “fundamental working knowledge of the varied aspects of performing the direct responsibilities related to activities of daily living, self-help, and socialization to children and youth in residential child care programs”, and the passing of an online Standards Examination with a minimum score of 75%. See COMAR 10.57.01.01(B)(8)(a) and (b).

Topic areas covered in the RCYCP training include: (1) the Residential Child and Youth Care Practitioner, (2) Child and Adolescent Development, (3) Communication Skills, (4) Life Skills Development, (5) Trauma, (6) Legal and Ethical Issues in Residential Care, and 7) Standards of Health and Safety.

Regulations require weekly clinical supervision of 1:1 staff by a Licensed Clinical Social Worker and that staff “receive a minimum of two (2) in-service training programs annually on such topics as: child safety, trauma-informed care, crisis de-escalation, youth engagement and executive skills coaching.”

The requirements for and regulations governing 1:1 staff appear to provide for the appropriate degree of professionalism required.

However, there is a significant absence in the regulations addressing the number and length of contact hours 1:1s are to have with the foster children they serve.

The structure and purpose of those contact hours is also not subject to regulation.

The 1:1 serving Kanaiyah was reportedly on a 53-hour shift.

Regulations that provide guidance and standardization concerning a 1:1’s contacts with the child being served would encourage and support stability in that child’s placement and promote the best interests of children in the foster care system.

Joan Little is a Chief Attorney at Maryland Legal Aid.