Foster youth emancipating from care: caseworkers' reports on needs and services

This article presents findings from a survey mailed to caseworkers, who answered questions about special needs, independent living skills, educational attainment, and services for 416 randomly selected foster youth in Illinois. A third of the adolescents had a mental health disorder, developmental disability, or other special need that their caseworkers believed would interfere with their ability to live independently. Additionally, urban youth were underserved relative to other youth. Youth with more behavior problems and educational and job skill deficits were less likely than other youth to continue to receive child welfare services past age 18, suggesting that services must be provided throughout adolescence to meet the needs of the most vulnerable clients.     

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.     

Baseline Characteristics of Dependent Youth Who Have Been Commercially Sexually Exploited: Findings From a Specialized Treatment Program

ABSTRACT

Commercial sexual exploitation of children has emerged as a critical issue within child welfare, but little is currently known about this population or effective treatment approaches to address their unique needs. Children in foster care and runaways are reported to be vulnerable to exploitation because they frequently have unmet needs for family relationships, and they have had inadequate supervision and histories of trauma of which traffickers take advantage. The current article presents data on the demographic characteristics, trauma history, mental and behavioral health needs, physical health needs, and strengths collected on a sample of 87 commercially sexually exploited youth. These youth were served in a specialized treatment program in Miami-Dade County, Florida, for exploited youth involved with the child welfare system. Findings revealed that the youth in this study have high rates of previous sexual abuse (86% of the youth) and other traumatic experiences prior to their exploitation. Youth also exhibited considerable mental and behavioral health needs. Given that few programs emphasize the unique needs of children who have been sexually exploited, recommendations are offered for providing a continuum of specialized housing and treatment services to meet the needs of sexually exploited youth, based on the authors’ experiences working with this population.     

Former system youth with mental health needs: Routes to adult mental health care, insight, emotions, and mistrust

Objective

Public health concern surrounding the mental health needs of former system youth is escalating. We know very little about mental health service utilization on the other side of the developmental transition to adulthood. The purpose of this study was to explore the mental health service use experiences among former system youth with childhood histories which included mental disorder, use of publicly-funded mental health services, and use of additional public systems of care.

Methods

In-depth face-to-face interviews were conducted with 60 participants currently struggling with mental health difficulties regarding their service use experiences over the transition. Participants were recruited from one Midwestern state. Multi-phase analysis was conducted utilizing immersion/crystallization, constant comparison and concept matrices.

Results

Few participants received continuous mental health care across the transition, with the majority experiencing interruptions or discontinuation of care. Important facilitators of service use emerged, such as physicians, former caseworkers and family. Health clinics and parenting programs emerged as potential entrée points for reconnecting disengaged young adults to mental health services. Insight, mistrust, and emotions emerged as novel factors associated with service utilization among young adults.

Conclusions

Mental health service utilization remains a complicated phenomenon over the developmental transition to adulthood. Future research is needed that closely examines the associations between insight, emotion, mistrust and service use among young adults.     

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.     

Facilitating Mental Health Service Use for Caregivers: Referral Strategies among Child Welfare Caseworkers

Unmet needs for mental health care are common among caregivers involved in the child welfare system. Although child welfare caseworkers are well positioned to identify service needs and refer caregivers to treatment, little is known about the types of referral strategies used in practice, or their effectiveness for promoting mental health service use. The current study examined child welfare caseworkers' use of different referral strategies and the extent to which these strategies are associated with caregivers' receipt of mental health services within a national sample of child welfare cases. Analyses of the second cohort of families from the National Survey of Child and Adolescent Well-Being suggest that child welfare workers more often use informational strategies for referring caregivers, including suggesting treatment or providing information about treatment options. However, social referral strategies such as providing caregivers with direct assistance in completing applications and making and attending appointments were associated with a greater likelihood of caregivers receiving mental health services. Findings support evidence from other service contexts that service use is facilitated by caseworkers' direct support for arranging services. Implications for research and for child welfare managers and administrators are discussed.     

Characteristics of children in residential treatment in New York State

This study addresses three questions about the population of children and families served in the highest level of care in the child welfare system in New York State residential treatment centers (RTCs): (1) How prevalent are emotional and behavioral problems in the youth entering RTCs? (2) Has the proportion of youth with such problems increased compared to 10 years ago? (3) Are there identifiable subgroups of youth entering RTCs? One-fourth of RTC admissions in fiscal year 2001 were randomly selected from a representative sample of 16 RTCs. The study completed a standardized data collection instrument based on a review of agency records, and included information that was known at the time each child was admitted. The results show significant increases compared to t10 years earlier in the proportion of youth with mental health problems and juvenile justice backgrounds. The findings suggest that youth who traditionally have been served by other systems of care are now being served in the child welfare system. The increased treatment needs of these youth and the heterogeneity of the RTC population have important implications for policies, programs, and practice.     

Emerging adulthood among former system youth: The ideal versus the real

Recent research has indicated that emerging adulthood, the late teen years and early twenties, is a distinct developmental period, which occurs gradually and is often filled with exploration, stress, uncertainty and a lack of a distinct role in life. Few studies, however, have examined how emerging adulthood tenets are experienced by young people involved with social service systems. With this in mind, fifty-nine young adults, ages 18 to 25, participated in in-depth interviews regarding their perspectives on transitioning to adulthood and adulthood. Participants were struggling with emotional difficulties, and shared a childhood history, which included a mood disorder diagnosis and utilization of public mental health and social services (e.g., child welfare, juvenile justice, and/or public welfare). The study sought to understand whether or not young adults with mental health and social service histories experience similar (or different) dimensions of mainstream emerging adulthood developmental theory during the late teens and early twenties. Theoretical thematic analysis indicated support not only for the theory of emerging adulthood, but also aspects unique to this sub-population. Implications for practice, policy and research are discussed.     

Child welfare caseworkers' perspectives on the challenges of addressing mental health problems in early childhood

Although nearly half of child maltreatment victims are under the age of five and at high risk for developing serious emotional or behavioral problems, few young children involved in the child welfare system receive treatment. As the first point of service contact, child welfare caseworkers can play a key role in quickly identifying children with mental health problems and linking them to services. This study examines caseworkers' perspectives on the challenges of addressing mental health problems in early childhood. Based on five focus groups conducted with 50 caseworkers from an urban, public child welfare agency, results suggest that although workers acknowledge the importance of early intervention, difficulty identifying mental health needs in early childhood and workplace barriers impede linkage to services. Given the lasting impacts of early experiences on children's development, it is imperative that these challenges be addressed. Implications for systematic mental health screening and caseworker training are discussed.     

The role of interagency collaboration in facilitating receipt of behavioral health services for youth involved with child welfare and juvenile justice

Unmet need for behavioral health care is a serious problem for crossover youth, or those simultaneously involved with the child welfare and juvenile justice systems. Although a large percentage of crossover youth are serious emotionally disturbed, relatively few receive necessary behavioral health services. Few studies have examined the role of interagency collaboration in facilitating behavioral health service access for crossover youth. This study examined associations for three dimensions of collaboration between local child welfare and juvenile justice agencies - jurisdiction, shared information systems, and overall connectivity - and youths' odds of receiving behavioral health services. Data were drawn from the National Survey of Child and Adolescent Well-Being, a national survey of families engaged with the child welfare system. Having a single agency accountable for youth care increased youth odds of receiving outpatient and inpatient behavioral health services. Inter-agency sharing of administrative data increased youth odds of inpatient behavioral health service receipt. Clarifying agency accountability and linking databases across sectors may improve service access for youth involved with both the child welfare and juvenile justice systems.     

Assessing Public Support for State Government Social Welfare Expenditures

Abstract

This study compared two different approaches to assessing the level of public support for social welfare spending at the state government level. The first approach focuses on the degree to which the public supports state government's involvement in public welfare spending. The second approach identifies the importance the public places on social welfare spending when compared to other possible functions of state government. Using Alabama data, the paper examined changes in general and comparative public support for state budget expenditures from 1980 to 2000 in Alabama. In addition, we examined the effectiveness of sociodemographic and attitudinal characteristics of respondents as predictors of both general and comparative support for three social welfare functions of state government. Support for “benefits for poor people” grew both generally and comparatively in the 20-year period; support for programs for older people remained steady; and support for mental health services declined. Sociodemographic predictors of general and comparative sup port were generally consistent with a self-interest model     

Lesbian, gay, and bisexual homeless youth: an eight-city public health perspective

This article reports on results of a one-day public health survey conducted in six states by homeless youth providers to measure and compare risk factors between lesbian, gay, and bisexual (LGB) homeless youth and non-LGB homeless youth. This article intends to inform the child welfare field on existing gaps in services and areas where more training and technical support is necessary in providing services to homeless LGB youth. The findings point to substantial differences within the homeless youth sample and demonstrate that in addition to the public health risks young people face merely by being homeless, the risks are exacerbated for those who self-identify as lesbian, gay, or bisexual. The article informs child welfare providers and policymakers about the substantial vulnerability of LGB youth beyond that of non-LGB homeless youth and the need to fund programming, training, technical assistance and further research to specifically respond to the complex needs of this population.     

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.     

Managing moods and parenting: Perspectives of former system youth who struggle with emotional challenges

Young adults who were served in public systems of care as children are much more likely than their peers to be parenting in adolescence and young adulthood. They are also more likely than their counterparts to have a history of mental health problems. This study examined the perspectives of young adult parents with mood problems who had been involved in public systems of care before age 18. Qualitative interviews with twenty-eight participants were analyzed to examine the experience of managing moods and parenting. Young parents described how their symptoms impact their parenting and how parenting impacts their coping. They also described the strengths and challenges of using mental health services while parenting. Findings highlight the need to provide interventions that include supports for both parenting and symptom management and for providers to include both tangible and emotional support in their interventions.     

Context matters: The state of racial disparities in mental health services among youth reported to child welfare in 1999 and 2009

Upwards of 50% of youth reported to the child welfare system (CWS) do not receive mental health services, despite need. While children of color are less likely to receive services than Caucasians, the mechanisms through which disparities are sustained remain largely unknown. Data come from two nationally representative cohorts of youth who were referred to the CWS in 1999 and 2009. Results showed that while need for mental health services decreased, significant differences in the number of children who received services was not detected between cohorts. African American youth were less likely to receive services compared to their Caucasian counterparts, even after controlling for age, gender, type of maltreatment, and placement instability. However, after taking into account urbanicity, poverty, and the organizational-social context, the disparity between African American and Caucasian youth dissipated. Service disparities between Latino and Caucasian youth were not detected. The odds of service receipt were lower among youth nested within stressful organizational climates and urban (versus rural) counties, and the organizational-social context did not moderate the relationship between race and service receipt. Findings underscore the need to develop and implement strategies to increase access to services in urban counties and to promote an organizational climate conducive to reducing racial disparities.     

Lost in transition: Illicit substance use and services receipt among at-risk youth in the child welfare system

This study examined the use of mental health and substance abuse services among adolescents in the child welfare system (CWS) who reported use of illicit substances. 1004 adolescents age 11–15 years at baseline were followed for 5–7 years, over five waves of data collection. Shortly after the investigation for maltreatment (baseline), 69.1% of youths using illicit substances received mental health and/or substance abuse outpatient specialty services. By the last follow-up, during the transition to adulthood, only 21.5% of young adults using illicit substances received outpatient specialty services. Youth who used illicit substances were more likely to receive outpatient and inpatient specialty services than non-users at the time of contact with the CWS (mostly baseline), but this difference faded over the follow-up period. By 5–7 years follow-up, there was no significant difference in specialty services receipt for illicit substances users versus non-users. Predictors of outpatient service use at most waves were having Medicaid, mental health needs, and having recently seen a school counselor or primary care physician. Among illicit substance users transitioning to adulthood, African American youths were less likely to receive outpatient specialty services than White youths. These findings reveal a need for more attention to illicit substances use among youth in the CWS, better cross agency integration, and special attention to the needs of transition-age youth to better connect them with services as they age out of the CWS.     

Reaching the hard to reach: innovative housing for homeless youth through strategic partnerships

This article features three housing programs designed to target the needs of youth aging out of child welfare. One program combines housing and treatment to move substance-dependent youth off the streets; one combines the resources of Urban Peak, the only licensed homeless and runaway youth shelter in Colorado, with the Denver Department of Human Services to prevent youth in child welfare from discharging to the streets; and one addresses the intense mental health needs of this population. It costs Colorado 53,655 dollars to place a young person in youth corrections for one year and 53,527 dollars for residential treatment. It costs Urban Peak 5378 dollars to move a young person off of the streets. This article describes how data have driven program development and discusses how policy implications and relationships with the public and private sector can leverage additional resources.     

Barriers and facilitators for access to mental health services by traumatized youth

Polytrauma is a highly prevalent public health problem in the U.S. with even higher rates in urban areas. Children with polytrauma often end up in multiple child-serving systems (e.g., mental health, child welfare, education, juvenile justice) with needs that are both complex and severe. Providers within these child-serving systems have potential to serve as gatekeepers to trauma services by linking youth with trauma-informed treatments and supports that promote recovery. The purpose of our study was to assess the perspective of providers who participated in a nine-month, trauma-informed care (TIC) training intervention on 1) their capacity to make referrals to trauma-specific services following the training, and 2) factors external to the training intervention that supported or hindered their ability to link traumatized youth with services. A subset of sixteen participants from the TIC training completed individual interviews. These participants were predominantly female, African American, and based in the social services sector. The constant comparative method was used to derive three thematic domains related to participant perceptions regarding youth referrals: 1) Organizational and provider capacity to provide trauma treatment or to make referrals to trauma-specific services, 2) Barriers to youth accessing trauma services, and 3) Suggestions for improving coordination of care and referrals. Our study highlights the influence of contextual factors on whether a TIC training can improve the capacity of agencies and individual providers to support traumatized youth in accessing appropriate services. The development of a structure that formally connects youth-serving agencies and providers with specialists trained in addressing traumatized youth is recommended.