Responsive engagement in mental health services for foster youth transitioning to adulthood

ABSTRACT

As youth near the transition to adulthood and aging out of the foster care system, exposure to stress increases, especially for youth who have less-than-adequate support systems. Although mental health problems among foster youth often continue into adulthood, service use decreases dramatically within a year of turning age 18. Understanding how foster youth experience mental health services as they transition from care provides social workers and other mental health professionals important insight that can lead to specific, targetable strategies. This study sought to explore what situations were helpful in supporting mental health as foster youth transitioned to adulthood. Focus groups and interviews with former foster youth and professionals informed the development of a quantitative instrument, which was used to identify the most supportive and frequently encountered situations former foster youth experienced. Findings indicate the most helpful situations were those in which professionals and mentors were flexible and responsive to their individual needs and trusted their ability to make decisions. Supportive adults who honored their choices and collaborated in decision-making were also helpful. Engaging, empowering, and partnering with transition-age youth may increase the likelihood of positive mental health outcomes for this population, offering implications for family-centered, strengths-based practice.     

Youth with disabilities in the United States Child Welfare System

Existing literature suggests that youth with disabilities are known to be at increased risk of maltreatment in the form of abuse and/or neglect. Little is known, however, about the experiences of youth with disabilities who are living in foster care or who are supervised by child protection authorities. This study establishes a baseline estimate of the prevalence of youth with disabilities living in foster care, documents reasons for child protection system involvement, identifies placement types while youth are in care and explores case outcomes. This cross-sectional, exploratory study draws on data from the 2012 Adoption and Foster Care Reporting System (AFCARS) for foster youth in 50 states, the District of Columbia and Puerto Rico. A sample of youth with disabilities (N = 36.492) and a comparison group without disabilities (N = 601.539) were identified. Findings about demographics, reasons for child removal, foster care placements, permanency planning goals and case outcomes are presented. Findings have implications for the prevention the removal of youth from caregivers, the need for family supports to prevent foster care involvement, the promotion of community inclusion of foster youth while in foster care and the need for inter-system collaboration at the transitional age stage.     

Foster care,geographic neighborhood change,and the risk of delinquency

Background and purposePrevious studies report that foster care placement is associated with an increased risk of delinquency. Yet it remains unclear which aspects of the placement experience increase the risk of delinquency. The current study addresses this knowledge gap. This study investigates the relationship between geographic neighborhood change and the risk of delinquency for adolescents in foster care settings. Based on findings from the neighborhood effects literatures, we hypothesize that moving to a neighborhood characterized by concentrated disadvantage and residential instability is associated with increased risk of delinquency.MethodsThe design for the current study is longitudinal. The sample is comprised of 145 foster youth from two birth cohorts, one born in 1983 and one in 1984, in Chicago, Illinois. The sample was 92% African American and 52% male. Overall, 11% had an official juvenile arrest. We used data from multiple sources, including the 1990 census data and administrative data from the Illinois Department of Children and Family Services and the Cook County Juvenile Court. To measure neighborhood change, we calculated a difference between children's home and placement neighborhoods on ten census variables: percentages of households in a given neighborhood that were below the poverty line, neighborhood households on public assistance, female-headed households, unemployed population, and persons < 18 years old, African American, Latino, foreign-born, residents living in the same house as five years earlier, and owner-occupied homes, all of which are commonly used in neighborhood studies. We identified two factors within the neighborhood variables—concentrated disadvantage and residential instability,—and used the two-factor scores in the following analysis. We conducted a Cox regression to model time to first arrest.ResultsThe results indicate that moving to a neighborhood with high residential instability significantly increases an individual's risk of juvenile delinquency. In addition, two subgroups—male foster youth; and all foster youth with an experience of neglect—are significantly more likely to be associated with a formal delinquency petition.Conclusions and implicationsThe current study is unique and builds the knowledge base with regard to the placement of children and adolescents in substitute care settings. The findings indicate that the neighborhoods in which children are placed do matter in terms of their outcomes, and thus they should be considered in the placement decision process. This finding is consistent with the “person-in-environment” concept advanced by social work professionals.     

Sibling relationships of youth in foster care: A predictor of resilience

Few empirical investigations have been conducted examining sibling relationships among youth in foster care, and even fewer have explored relationship warmth as a protective factor. With a sample of 246 youth from a non-profit organization's summer camp program, Camp To Belong, this study examined the association between a warm sibling relationship and resilience for youth in foster care. A warm sibling relationship significantly predicted individual resilience for both middle childhood and adolescence developmental periods. Younger youth with poorer sibling relationship warmth had lower resilience. The implications of these findings are important given that resilience is a factor associated with improved outcomes in the face of adversity. The promotion of sibling relationships, a readily available resource, can be drawn upon by those in clinical practice to improve outcomes for youth in foster care.     

Extracurricular activity participation and educational outcomes among older youth transitioning from foster care

This study examined factors associated with extracurricular participation and whether participation in extracurricular activities is associated with completing high school and attending college among a sample of older youth transitioning from foster care (n = 312). Results indicated that better self-reported grades and greater educational aspirations were associated with extracurricular participation. Participation in extracurricular activities was associated with graduating from high school, but not starting college by age 19. Consistent with provisions of the Preventing Sex trafficking and Strengthening Families Act of 2014, results suggest that efforts that make extracurricular participation a normative aspect of the developmental experience of foster youth are important for their educational well-being.     

Housing experiences of former foster youth: How do they fare in comparison to other youth?

Research indicates that foster youth tend to fare poorly in a number of domains in the transition to adulthood, and the shift to independent living may be particularly challenging. However, it is unclear whether negative housing outcomes are attributable to foster care history or if they are due to other risk factors. This study uses data from the National Longitudinal Survey of Youth 1997 to compare housing outcomes for foster youth to a matched sample of youth who share similar risk factors and to an unmatched sample. Results indicate that foster youth struggle more in the transition to independent living in comparison to both groups, showing higher rates of homelessness, less housing stability, poorer neighborhood quality, and more reliance on public housing assistance. The paper explores how factors related to foster care and confounding risk factors that tend to have higher prevalence among foster youth may contribute to these outcomes.     

Can Machine Learning Create an Advocate for Foster Youth?

ABSTRACT

Statistics are bleak for youth aging out of the United States foster care system. They are often left with few resources, are likely to experience homelessness, and are at increased risk of incarceration and exploitation. The Think of Us platform is a service for foster youth and their advocates to create personalized goals and access curated content specific to aging out of the foster care system. In this article, we propose the use of a machine learning algorithm within the Think of Us platform to better serve youth transitioning to life outside of foster care. The algorithm collects and collates publicly available figures and data to inform caseworkers and other mentors chosen by the youth on how to best assist foster youth. It can then provide valuable resources for the youth and their advocates targeted directly toward their specific needs. Finally, we examine machine learning as a support system and aid for caseworkers to buttress and protect vulnerable young adults during their transition to adulthood.     

The outcome of institutional youth care compared to non-institutional youth care for children of primary school age and early adolescence: A multi-level meta-analysis

ObjectiveThe outcome of institutional youth care for children is heavily debated. This multilevel meta-analysis aims to address the outcome of institutional youth care compared to non-institutional youth care for children of primary school age and early adolescence in economically developed countries. A gain of knowledge in this area may help the decision for referral of children to institutional youth care or other types of care (e.g., foster care or community-based care), and improve outcomes for children in youth care.MethodsOf 19 controlled studies (15.526 participants), 63 effect sizes of behaviour problems (externalizing, internalizing, and total), skills (social and cognitive) and delinquency were computed based on comparisons between institutional Evidence-Based Treatment (EBT), institutional Care As Usual (CAU), non-institutional EBT, and non-institutional CAU.ResultsInstitutional CAU showed a small-to-medium negative significant effect compared to non-institutional CAU (d = − 0.342). Furthermore, children in institutional care showed slightly more delinquent behaviour compared to children in non-institutional care (d = − 0.329). Significant moderating effects were also found for study design, year of publication and sex of the child.ConclusionsChildren receiving non-institutional CAU (mostly foster care) had slightly better outcomes than children in institutional CAU (regular group care). No differences were found between institutional and non-institutional care when institutional treatment was evidence-based. More research is needed on the conditions that make established treatment methods work in institutional care for (young) children.     

Children’s Psychosocial Rehabilitation: Clinical Outcomes for Youth with Serious Emotional Disturbance Living in Foster Care

Children living in foster care are an especially vulnerable population who often come to the attention of Medicaid mental health providers. These children experience a high incidence of emotional and behavioral disorders and may have specialized treatment needs related to their living arrangement status. This study assessed whether Children’s Psychosocial Rehabilitation could effectively treat youth with severe emotional and behavioral disorders who live in foster care. Analysis of data from an open trial of 218 clinically-impaired youth, aged 3–18 years, revealed no reliable differences in treatment outcome between foster versus non-foster children, with a trend toward more favorable outcomes for foster youth. Findings justify further study of the effectiveness of this Medicaid-funded service for the treatment of youth in care.     

Health outcomes for adults in family foster care as children: An analysis by ethnicity

Studies have linked the experience of child abuse or adversity to health problems in adulthood, and researchers have long documented health problems affecting children in foster care. Yet, the adult health outcomes of maltreated children placed in foster care have not been sufficiently isolated. Although information on transitioning youth and young adults is now beginning to emerge, the impact of ethnicity on adult health outcomes has been largely ignored. Given the overrepresentation of ethnic minority children in foster care and the national disparities in the health of ethnic minorities, this study examined the relationship between ethnicity and physical health outcomes for African American, Hispanic, and White adults who experienced family foster care as children. Logistic regression models indicated that ethnicity was not a significant predictor of physical health (p > .05). However, gender and age were associated significantly with their physical health outcomes.     

Ethnic Identity Development Among Adolescents in Foster Care

Because past research indicates that stronger ethnic identity is related to better outcomes in areas such as academic achievement and mental health, it is important to provide youth in foster care with opportunities to develop their ethnic identity. Using data from in-person interviews with 188 youth aged 14–17 in foster care (88.7% response rate), this paper explores two areas related to ethnic identity: (1) youth perceptions about their own ethnic identity, and (2) attitudes about ethnic identity development specific to the experience of being in foster care. Results suggest that black youth and Hispanic/Latino youth have a stronger sense of ethnic identity than white youth. Most youth are interested in learning more about their ethnic background. Understanding how youth in foster care identify ethnically and understanding their beliefs related to ethnic identity may lead to the enhancement of services provided to youth across child welfare, education, and mental health systems.

Creating Foster Care Youth Biographies: A Role for the Internet

ABSTRACT

Large numbers of youth continue to enter foster care despite federal and state efforts to minimize placement. Some youth will experience lengthy tenure in care with multiple placements and be at risk for adverse events. They are also at risk for losing an accurate biography of their childhoods. We suggest a two-tiered approach to help youth develop a personal history. Agencies can establish a digital depository of basic information including pictures that document the life course of the youth. Agencies can help youth procure e-mail accounts. These e-mail accounts are under the control of the youth and can function as an electronic diary. Thus, youth would have a portable life biography and sense of self over time.     

Interdisciplinary Collaboration for LGBTQ Students in Foster Care: Strategies for School Counselors

abstract

Unsafe and ill-prepared school environments exist for many lesbian, gay, bisexual, transgender, and queer (LGBTQ) students in foster care. School counselors are uniquely positioned to develop safe and inclusive schools for this vulnerable student population; however, strategies for interdisciplinary collaboration and advocacy with schools, families, and systems incorporated with LGBTQ youth in foster care are limited. This article explores how school counselors can advocate across disciplines for LGBTQ youth in foster care, including K-12 education systems, family/caregivers, and social service organizations providers.     

Nutritional status of foster children in the U.S.: Implications for cognitive and behavioral development

ObjectiveChildren in foster care are at greater risk for poor health, physical, cognitive, behavioral, and developmental outcomes than are children in the general population. Considerable research links early nutrition to later cognitive and behavioral outcomes. The aim of this narrative review is to examine the prevalence of poor nutrition and its relation to subsequent health and development in foster children.MethodRelevant studies for inclusion were identified from numerous sources (e.g., PubMed, Google Scholar, and reference sections). Inclusion criteria were studies published between 1990 and 2016 of (i) the nutritional status of children in foster care or (ii) the nutritional status of children exposed to early adversity (e.g., low-income and internationally adopted children) or (iii) the developmental effects of poor nutrition and micronutrient deficiencies.ResultsTwo key findings that have adverse implications for cognitive development emerged: (i) the prevalence of anemia and iron-deficiency anemia is higher among foster children than among the general population of children in the U.S., and (ii) the developmental demands of catch-up growth post-placement may lead to micronutrient deficiencies even after children have begun sufficient dietary intake of these nutrients. Moreover, there is a paucity of recent studies on the nutritional status of children in foster care, despite the multiple factors that may place them at risk for malnutrition.ConclusionAttention to nutritional status among care providers and medical professionals may remove one of the possible negative influences on foster children's development and in turn significantly alter their trajectories and place them on a more positive path early in life. Recommendations for further research, policy, and practice are discussed.     

Hispanic and African American Youth

SUMMARY

This exploratory, qualitative study of 28 (10 Hispanic and 18 African American) former foster care youth attempts to capture the essence of their quest for self-sufficiency. While research on former foster care youth continues to highlight the problems confronting them after they emancipate from care, the depth of their struggles is often lost in the aggregation of statistics. The numbers themselves often fail to capture the hardships, isolation, hope, and despair many of them may face as they attempt to adjust to life after foster care. Furthermore, existing research often regards emancipated youth as a homogeneous population. Interviews with these respondents of color were coded to determine the themes and stories they held. The themes emergent from these interviews were: the importance of people in the independent living programs; vagueness in recalling the content of the independent living programs; family conflict; housing instability; regrets, fears, and lessons learned; and future goals. Implications for culturally sensitive practice and research are drawn from these data.     

The voices of youth formerly in foster care: Perspectives on educational attainment gaps

As a population, youth who experience foster care graduate from high school at rates well below their non-foster care peers (National Working Group for Foster Care & Education, 2014). A Consensual Qualitative Research (CQR) study was conducted to better understand the perspective of former foster youth on the graduation gap and their experience in school. Analysis of focus group data revealed one overarching domain, emotional consequences, as well as seven additional domains that related to youths' experiences surrounding their educational attainment: resilience, basic needs, internalized messages about education, educational stability, consequences of school mobility, fastest or easiest positive exit from K-12, and recommendations from youth. This research highlights the challenges faced by 16 former foster youth, their perspectives regarding the need to raise expectations, and their suggestions for closing the educational attainment gap.     

Foster youth and drug use: Exploring risk and protective factors

Substance use and misuse experiences of foster youth remain an under-researched area. Given that early use of drugs is said to be a common factor among 90% of those who develop substance misuse problems in their lifetime, this is an important area of academic study (Dennis, White, & Ives, 2009). By drawing upon primary empirical data from a mixed-methods study, this paper addresses an important gap in the literature and seeks to provide an improved understanding of foster youth, drug use and vulnerability. A total of 261 foster youth, who had exited care, contributed to a quantitative survey, and a further 35 provided qualitative narratives of their lived experience. Key risk factors including experience of homelessness, school exclusion and living setting are identified as strong influences that predict high levels of drug use among foster youth. Targeted social support and interventions in the form of pre-leaving care in the context of a strong practitioner/youth relationship are suggested to help ameliorate poor outcomes to obviate the problem of substance misuse among foster youth.     

The Use of Online Social Support by Foster Families

ABSTRACT

The extent to which foster families utilize social support on the Internet is examined in a sample of 34 foster families in a digital divide intervention program and a comparison sample of 30 foster families who were not part of the program. In spite of increased Internet access, the frequency of using online social support is low. A minority of parents and children increased their use of the Internet to give and receive help, communicate with other foster families and e-mail with their foster care worker. More than half of foster youth have used the Internet to stay in touch with friends and relatives and have “made a new friend” over the Internet. Implications for child welfare practice and for further research are discussed.