Barriers and facilitators of the transition to adulthood for foster youth with autism spectrum disorder: Perspectives of service providers in Illinois

The lack of established and well-evaluated models of coordination between child welfare agencies and other public institutions presents lingering challenges to preparing foster youth to make the transition to adulthood. This may be particularly true for foster youth with developmental disabilities who must exit child welfare systems and enter into adult service systems, if eligible. The qualitative study we present explores the barriers and facilitators of the transition to adult service systems from the perspectives of service providers. Due to the rising prevalence of autism spectrum disorder (ASD) in the general population, focus groups were specifically conducted to better understand the transition of foster youth with ASD. Barriers included perceptions of two separate systems and abrupt transitions; a lack of training, identification, and tracking of autism; and confusion about services and funding. Facilitators included persistence and professional relationship building, and consistent communication and information sharing. Implications for improving the transition to adult service systems are discussed.     

The role of housing in the transition process of youth and young adults: a twenty-year perspective

Lighthouse Youth Services in Cincinnati, Ohio, began placing foster youth, ages sixteen to eighteen, in individual apartments and other living arrangements in 1981 as a way of preparing them for life after foster care. The program has assisted over thirteen hundred youth and their children using scattered-site apartments, shared homes, roommate situations, host homes, and subsidized housing. The agency works with referring agencies to develop a transition plan one youth at a time and allows youth to move along a continuum of housing options depending on their level of functioning and behavior. Aftercare services assist youth for years after they leave custody. This chapter includes some case studies and summarizes the author's observations from running the program for the past twenty years.     

Receipt of independent living services among older youth in foster care: An analysis of national data from the U.S.

Fifteen years has passed since the Chafee Foster Care Independence Program was created under the Social Security Act, which marked an increased role of the U.S. federal government in supporting foster care youth to independence. It was not until the National Youth in Transition Database (NYTD) was launched in 2010 that all 50 states reported standard data on receipt of the 13 types of Chafee independent living services. This paper, which draws on the first two years of NYTD data, analyzes Chafee service receipt across the U.S. among youth in foster care (ages 16–21). About half of the 131,204 youth included in this analysis received at least one type of Chafee service, and considerable variation existed in the proportion of youth that received each of the 13 specific types of services. Females were more likely than males to receive all but one type of service, and African Americans were less likely to receive most of the services. An interaction effect indicated that Black youth were significantly less likely to receive services in large urban areas than other racial/ethnic groups. Young people with disabilities or medical/psychological conditions were generally more likely to receive services than youth without disabilities. Youth in large urban regions receive fewer services than youth residing in other areas, and substantial variation exists between states in proportions of service recipients. Recommendations are made for targeting services, future data collection, and research, including suggestions on ways to improve measurement of Chafee services.     

Receipt of help acquiring life skills and predictors of help receipt among current and former foster youth

US law has long recognized the need to help prepare foster youth for the transition to adulthood and states receive funds specifically intended to provide their foster youth with independent living services. Nevertheless, little attention has been paid to whether foster youth in fact receive the services states are supposed to provide using federal funds. This study uses data from the Midwest Evaluation of the Adult Functioning of Former Foster Youth to describe the kinds of help foster youth receive in making the transition to adulthood and the factors associated with help receipt. Study findings call for a redoubling of efforts to provide foster youth with the assistance called for in federal law, provide support for the extension of foster care through age 21 in the interest of ensuring that such assistance is provided, highlight the need to involve foster parents more actively in providing youth with life skills training, and call into question whether current efforts to assist foster youth in acquiring independent living skills are well targeted.     

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.     

In their own words: Overcoming barriers during the transition to adulthood for youth with disabilities who experienced foster care

The transition to adulthood can be especially challenging for youth who experience the foster care system. These challenges are magnified for youth with disabilities, who account for at least 40–47% of all children in foster care (Powers et al., 2012). In order to move from a deficit-based to a strength-based approach, this qualitative study focused on understanding the lived experience of transitioning to adulthood for alumni of foster care with disabilities. Semi-structured interviews were conducted with seven young adults who had exited care over a six-month time period. Participants described their journeys from foster care to independence and articulated a vision for a successful adulthood. Key themes that emerged included a desire for stability and personal fulfillment in adult life. Participants also identified common barriers encountered including unmet mental health needs and lack of disability awareness or the implications of mental health diagnosis. Personal strengths that helped overcome those barriers included resilience, advocacy, and self-determination.     

Using the bridges transition framework for youth in foster care: Measurement development and preliminary outcomes

Youth in foster care often undergo multiple transitions before reaching adulthood, and these transitions often create significant stress and can exacerbate emotional and behavioral problems. A measurement instrument (the Youth Experience of Transitions, or YET) was designed to assess foster care youths' understanding of transitions, and this instrument was tested on a group of youth undergoing an intervention program designed to assist them in coping with the stress of these transitions while in foster care. The intervention was based on the Transitions Framework by William Bridges and was implemented in multiple community agencies with funding from the Andrus Family Fund. Using factor analysis, we found that the YET contained two factors representing (1) openness and (2) determination. For youth in the participating foster care programs, growth in openness from baseline to 6 months was linked to a significant decrease in internalizing symptoms; no significant links were found for externalizing symptoms. Implications for foster care intervention programs are discussed.     

A cost–benefit analysis of transitional services for emancipating foster youth

Over 24,000 youth “aged out” of the nation's foster care system in FY 2005. While independent living programs and other services are available to foster youth, and almost all states allow dependency courts to retain jurisdiction of foster youth beyond age 18, outcomes for former foster youth are disturbing. This paper describes a program to address these challenges by providing extended foster care benefits and support to former foster youth from their 18th to 23rd birthdays. A detailed cost–benefit methodology documents expected costs and key benefits of the program. According to this cost–benefit analysis, a program providing funding and guardian support for former foster youth is projected to result in net benefits to the State of California over the 40-year careers of participating former foster youth. The program, if successful for all youth, would increase lifetime earnings and taxes paid due to increased education and would lower use of TANF and prison, resulting in a benefit–cost ratio of 1.5 to 1, using discounted present value dollars. Even at 75% success, the ratio is 1.2 to 1, showing a net benefit to society. This methodology can also be used to assess the costs and benefits of similar programs.     

Pediatricians and foster children

The poor state of health and health care of foster children is well documented. The cure lies in the hands of the agencies that administer the foster care system and pay for medical services, and in those of the physicians who provide that care. This study suggests that much of the problem may be solvable. Adequate numbers of pediatricians in Connecticut seem to be committed to caring for foster children, but major impediments remain, including inadequate reimbursement for both primary and specialty health services. The institution of a medical passport can make needed information available and help to establish and promote standards of care. Pediatricians appear willing to take a leadership role in assisting other agencies in developing programs to improve the care of these children; despite the problems in providing medical care to foster children, most pediatricians view it as part of their responsibility to the community and to all children.     

Linking structure, process, and outcome to improve group home services for foster youth in California

The California Youth Connection obtained funding from two foundations to evaluate the performance of group homes serving foster youth in Alameda County, California, in order to inform state policy-making. The evaluation team initially included 14 foster youth that personally experienced group home living. Three inter-related aspects of service were studied: structure, process, and client outcomes, specifically residents' increase in developmental assets leading to the ability to transition successfully to independent living by the age of 18 years. Data were collected at 32 group homes from 127 residents and 72 staff members using three questionnaires. Both structural and process aspects of services influenced residents' satisfaction with services. However, only the process of care predicted changes in residents' developmental assets. State-level regulatory agencies learned from these results that auditing only structural aspects of services was not sufficient to promote effective services. Further, one structure item and two process items were identified as less consistently occurring in the group homes: timely distribution of clothing allowances, healthy communication between staff and youth, and staff support of regular exercise for the residents. Focusing on these aspects of service first should promote more change in outcomes and satisfaction for foster youth residing in group homes.     

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.     

Perceived self-stigma in the utilization of mental health services in foster care and post foster care among foster care alumni

Foster youth experience higher rates of mental health disorders and receive higher rates of mental health services in comparison to the general population. Yet, upon foster care exit, mental health service use drastically declines. Little is known as to the reasons for mental health service decline after foster care exit. However, research studies in the mental health literature have consistently shown that self-stigma and public stigma are significant in mental health service receipt. Studies have also shown that self-stigma affects an adolescent's self-identity, self-efficacy, and interpersonal relationships, which impact self-sufficiency once youth leave foster care. This study explores self-stigma in the utilization of mental health services while in foster care, and whether the stigma developed while in foster care impacts mental health service use upon foster care exit. The role of public stigma in the utilization of mental health services post foster care is also examined. Thirteen former foster youth with a mental health treatment history while in foster care were interviewed. Results show that foster youth experienced self-stigma, which increased the negative impact of mental health service receipt while in foster care. After foster care exit, youth who identified experiencing self-stigma while in foster care tended to discontinue mental health services after foster care exit. In contrast, foster youth who did not identify self-stigma in the receipt of mental health services while in foster care continued accessing services upon foster care exit. Public stigma was not identified as influencing mental health service use post foster care, but was coupled with negative labels, stereotypes, and negative perceptions. Implications for preventive and intervention measures are also discussed/proposed.     

Re-entry among former foster youth in early adulthood: Findings from illinois

On January 1, 2010, the Foster Youth Successful Transition to Adulthood Act went into effect in the state of Illinois to legally permit former foster youth who are at least 18 years old and not yet 21 years old to voluntarily re-engage with child welfare agencies and juvenile court to receive Supporting Emancipated Youth Services. Not much is known about the number or characteristics of foster youth who have taken advantage of this new opportunity to receive support following a hardship. This study used administrative data from the Illinois Department of Children and Family Services (IDCFS) to describe foster youth who have legally re-entered out-of-home care after exiting through emancipation. Findings revealed that a low number of former foster youth re-entered out-of-home care. This article discusses possible explanations for why so few youth have re-entered out-of -home care when research suggests they may be at increased risk for making the transition to adulthood.     

The system-of-care for homeless youth: perceptions of service providers

Service providers' perceptions of the system of care for homeless youth are described. Face-to-face structured interviews were conducted with staff at homeless youth agencies in Los Angeles County (L.A. County) regarding organizational and staff characteristics, issues affecting youth, types of available services, gaps in services, and barriers to service delivery.Overall, agencies were large, well established, and provided multiple services. Most agencies (62%) were concentrated in Hollywood, a cruise area of L.A. County. Clear distinctions emerged between large and small agencies; large agencies had more resources, more professional staff, were established longer, and were policy advocates. Typical of other US metropolitan areas, services for homeless youth in L.A. County are located in cruise areas, and are not as readily available in other geographic areas. Such geographic barriers to providing a comprehensive and coordinated system of care can affect youth's pathways out of homelessness.     

Increasing college access for youth aging out of foster care: Evaluation of a summer camp program for foster youth transitioning from high school to college

Young people who transition from the foster care system face many challenges including lack of support and other educational barriers. They are less likely to graduate from high school than their counterparts and go on to college yet despite challenges, many succeed and take advantage of higher education programs.In Michigan, a state with one of the highest percentage of youth in foster care, Michigan State University developed a small scale, targeted intervention to help transitioning foster youth achieve their goals of pursuing higher education. Led by the School of Social Work in collaboration with other colleges and disciplines, it was demonstrated that a campus based learning program for transitioning foster youth can help contribute toward a perceived increase in knowledge and information about college life, funding and admissions procedures. The educational process involved peer support, role modeling, mentoring and active learning sessions led by the faculty and students who were often foster care alumni themselves. Leaders and speakers came from a range of disciplines, institutions and organizations. This approach and curriculum contributed to perceptions of the camp as enhancing life skills, self-concept, empowerment and sense of purpose. Consequently, this program contributed to the resilience of those who attended and potentially helped build steps from care to higher education.     

Perspectives on Independent Living Services Among Resilient Youth

This article describes the results of a qualitative research study of youth who are primarily aging out of foster care and utilizing Independent Living Services. Interviews and focus groups from youth revealed the following four themes: (1) emotional support needed (family support, case manager support), (2) tangible independent living services requested (financial resources, life skills, daycare), (3) communication of program services, and (4) the role of resiliency. A discussion of the themes and recommendations for child welfare agencies that work with this population are forwarded.     

Are services to prevent foster care effective?

The prevention of foster care became an important issue for child welfare services during the 1970s. Two main types of prevention models have emerged: crisis intervention programs intended to prevent imminent placement and intensive service programs designed to avert those crisis situations that precipitate placement. A critical analysis of several project evaluations leads to the conclusion that neither model has been markedly successful. Low nominal project placement rates seem attributable to inability to predict placements and to client selection biases. From a strictly financial perspective, preventive services have been considerably more expensive than regular services, including temporary family foster care. Data from a new demonstration project in New Jersey illustrate various problems in providing and evaluating preventive services to families referred to protective service agencies. Implications of the findings for prevention programs and policies are discussed, and a new direction focused on truly early intervention with children and families is proposed.     

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.     

Sexual and reproductive health policies for foster youth in California: A qualitative study of child welfare professionals' experiences and perceptions of policies

Child welfare professionals and foster parents increasingly suggest the importance of establishing clear and consistent policies and procedures to address the sexual and reproductive health of youth in foster care. The present study examines the content and context of such policies across 18 California counties through a search of publically available county policy documents, and surveys and expert interviews with child welfare professionals (N = 22). A policy framework for agenda setting and policymaking was used to guide the data collection and analysis process. Child welfare professionals were aware of multiple sources of information, support and services for foster youths' sexual and reproductive health, though few practiced in counties with formal policies that outline the resources and support that youth should receive. Participants demonstrated widespread recognition that issues of youth sexual and reproductive health were significant; posing challenges to youth, foster parents and child welfare staff. Identified policy solutions included: 1) training for social workers and foster parents; 2) collaborative partnerships with public health nurses and community providers; 3) data tracking and monitoring of outcomes to assess youth needs and evaluate the impact of programs and policies; and 4) involvement by advocacy organizations in defining problems and advocating for improved services and support for youth in care. Social workers largely perceived that support from child welfare administrators and policy leaders is necessary to prioritize this issue and initiate policy formation. Additional research is needed to further examine the impact of policy mandates on social workers, foster parents and youth in foster care.