The policy context of leaving care services: A case study of Northern Ireland

The transition of foster youth from state care to independent living has received increased research, practice, and policy attention in the United States and in many other countries. Most contributions to this literature have focused on documenting poor outcomes across various dimensions of need in the young people's lives whereas little attention has been given to the policy context in which the responses to those needs are being developed. In this article, we argue that there is a pressing need for better understanding of how the policy context can both promote and impede the development of appropriate services. To illustrate our argument, we use Northern Ireland as a policy case study both because of recent initiatives underway there in regard to youth transitions from state care and because of the heightened political sensibilities associated with it as a society. We draw attention to the socio-political historical context, a number of intersecting social policies, and the place of social work as a key occupation involved in delivering service improvements. We conclude by suggesting that this case study not only highlights the need to address similar aspects of the policy on youth transition from state care in the United States but also demonstrates the benefits of reflecting on policy development and implementation elsewhere in the world.     

Moving On From Supportive Housing (MOSH): Development and evaluation of a transitional skill-building curriculum for providers helping residents exit homeless services

This article describes the development and evaluation of MOSH (Moving On From Supportive Housing), a transitional skill-building curriculum for providers helping residents exit homeless services to mainstream housing without embedded supports. In this evaluation, we assess the feasibility, acceptability, fit, and potential efficacy of the MOSH curriculum to improve proximal provider-level outcomes, including self-efficacy to provide MOSH-related independent living skills and supports. Homeless-services providers (N = 49) from a range of programs and settings participated in the training. Findings from focus groups and pre- and posttest surveys indicate high levels of overall satisfaction with the training. The majority of trainees perceived the training to be useful to their work and potentially useful for service recipients, felt the training would fit well within their existing day-to-day work, and said they were very likely to use MOSH skills in such work. Statistically significant improvements in self-efficacy regarding all skills but one were also found. MOSH holds promise as an intervention that can enhance provider practice and promotion of independent living skills in homeless services. Although these initial findings on MOSH are encouraging, further research will be needed to evaluate provider knowledge gains and effective use of these skills in practice.     

Independent living services,adjudication status,and the social exclusion of foster youth aging out of care in the United States

Recent policy changes have increased the availability of independent living services (ILS) to foster youth aging out of care in the United States. Yet, it is possible that youth who are also involved in the juvenile justice system may have trouble accessing these services. This study uses a social exclusion framework to examine associations between independent living service receipt, adjudication status, and early adult outcomes for youth aging out of the U.S. foster care system. Outcomes and ILS receipt data for 7412 older youth from the National Youth in Transition Database (NYTD) were used for this study. Chi-square tests and logistic regression models were used to explore the relationships among adjudication status, ILS, social exclusion, and social connectedness at age 19. Findings indicated that postsecondary education support and education financial services at baseline were related to a higher likelihood of being socially connected and lower likelihood of being socially excluded at age 19. Being an adjudicated delinquent and receiving special education and career services were related to a lower likelihood of being socially connected. This suggests that ILS are well-suited for youth already doing well, but may not do enough for those who struggle the most during this period.     

The potential contribution of mentor programs to relational permanency for youth aging out of foster care

This article summarizes published research regarding the effectiveness of mentor programs in general, and for youth in foster care specifically, as a basis for evidence-based practice in child welfare. It examines the pros and cons of mentor programs and characteristics of programs that are more or less effective for achieving specific social goals. The author explores the opportunity cost of investments in transitional mentor programs versus efforts to find permanent parents for youth aging out of care, and concludes with practice and policy implications of these findings.     

Chinese disability independent living policy

Despite strong statements on disability rights in Chinese legislation since 1990, independent living policy as experienced by disabled people falls short of the social inclusion goals expected from such a policy commitment. Analysis of empirical research about disabled people's experiences shows that responsibility for independent living rests primarily with disabled people and their families. Only when they have no family does the government provide support, in the form of institutional care. Very little personal assistance or community-based housing is available. Minimum income support and the introduction of social services are slowly addressing the social exclusion of disabled people in China.     

Independent living programs for young people leaving the care system: The state of the evidence

A substantial body of evidence suggests that young people leaving public care systems are at increased risk for low educational attainment, unemployment, homelessness, physical and mental health difficulties, dependency on public assistance, and involvement with the criminal justice system. Independent living programs (ILPs), which incorporate life skills and personal development, are one strategy frequently used to improve outcomes for young people leaving care. However, the effectiveness of ILPs remains unknown. This paper systematically reviews the current evidence for ILPs, summarizing all controlled comparisons designed to evaluate their effectiveness. Reviewers were unable to find any randomized controlled trial evaluating ILPs, but the results of eight non-randomized controlled studies suggest that some ILPs may have protective effects for youth leaving the public care system. These trends were observed for outcomes related to educational attainment, employment, housing, health, and other life skills; nevertheless, the weak methodological quality of the evidence tempers the validity and generalizability of these conclusions. Further research utilizing random assignment of participants is imperative in order to draw reliable conclusions for policy and practice.     

Who Pays for Seniors Housing and Care Communities? Evidence from the Residents Financial Survey

To examine the financial characteristics of residents in assisted living and independent living communities and to see how they currently pay for their care arrangements, we surveyed 2,617 residents in assisted living and independent living communities. We asked them how they pay for their current costs and verified their answers by examining self-reported information on their cost and income. Residents stated that they are largely paying for their community costs independently. Approximately one third of respondents reported using their assets and income to cover their current costs. The data supported the notion that individuals living in assisted living and independent living communities are largely mid- to high-income elderly. However, the cross-sectional analysis showed that length of time in the community was positively associated with paying for their expenses independently out of income, after controlling for many confounders including age, education, and lifetime earnings to try to rule out differential longevity and differential selection over time. Further longitudinal analysis is needed to understand the cause and the implications of the positive correlation between ability to pay one's bills out of income and the length of time in the community before conclusions about spend-down can be made.     

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.     

Living Room Assessment

Abstract

Community living room programs, initially developed as part of the settlement house movement, strive to maintain a safe and welcoming atmosphere for clients with basic needs who can then be linked to concrete services. These rare programs do not generally include formal intake and termination criteria and are thus difficult to assess by quantitative means. In this project, the authors used the Community Oriented Programs Environment Scale (COPES) to perform a social climate assessment of a living room program at an urban homeless shelter. The agency board and staff were concerned that expanding numbers of clientele might deter potential and current members from participation and thus defeat the program's major purpose. This paper reports the social climate perceptions of staff and members and recommends agency program adjustments. This type of evaluation has implications for macro practice in determining whether nontraditional programs can be shown to meet certain human needs that complement those addressed by the broader social service system.     

The association between perception of relationship with caregivers and behaviours of youth in foster care: a child and caregiver perspective

The transition into foster care can be difficult for children. Research has consistently shown an increased risk for children in foster care to exhibit higher levels of problem behaviours in comparison to youth in the general population. The purpose of this study was to analyse the associations between the youths' perception of their relationship with their caregiver on their perception of their own internalizing and externalizing behaviours as well as the youths' perception of the relationships with caregivers and how caregivers report of youths' internalizing and externalizing behaviours. This study utilized the secondary data from the general release version of the National Survey of Child and Adolescent Well-Being [National Survey of Child and Adolescent Well-Being (2009) Introduction to the wave 1 general and restricted use releases, Nation Data Archive on Child Abuse and Neglect, Ithaca, NY]. Significant relationships between youths' perception of relationship with their caregiver were found with both youth perception of internalizing behaviours and caregiver perception of internalizing and externalizing behaviours. Results are explained with implications for practice, training, research and policy.     

The Impact of Public Housing Policy on Family Social Work Theory and Practice

Social workers are the professionals most engaged with families living in low-income and subsidized housing and most familiar with the problems associated with inadequate housing. Yet the discussion of public housing policy has been left largely to economists and housing activists and the clear implications for family social work practice have not been made clear. To connect these critical policy and practice issues, this article provides a theoretical foundation and a review of the research supporting the use of housing vouchers to combat race and class segregation, joblessness, family breakdown, inferior public services, child abuse, mental illness and crime victimization.     

Future Planning and Financial Education Needs for Asset Building Among Persons with Multiple Sclerosis in Rural Areas

Abstract

This paper presents findings from a study of individuals with multiple sclerosis examining their planning and preparation activities for their future independent living and long-term care needs. Data collected from a representative sample of National Multiple Sclerosis Society members in the greater metropolitan St. Louis and eastern Illinois area indicate significant differences in income, assets, education, health and functional limitation status between individuals living in rural versus urban areas. Additionally, findings show respondents with greater levels of education and assets, and those living in urban areas, are more likely to have saved for retirement, made legal preparations, or engaged in planning activities for future needs. Recommendations for asset building programs include incorporating education and training on planning for independent living and long-term care into financial planning curriculum, particularly for people with multiple sclerosis living in rural areas.     

Federal nutrition programs and childhood obesity: inside the black box

In response to the dramatic rise in childhood obesity, particularly among low income individuals, federal nutrition assistance programs have come under scrutiny. However, the vast majority of this research focuses on the direct relationship between these programs and child health, while little is known about the mechanisms by which such relationships arise. Using the 2007 American Time Use Survey and the Eating and Health Module, we explore differences in time use—albeit in a non-causal framework—across families that participate in the Supplemental Nutrition Assistance Program, the School Breakfast Program, and the National School Lunch Program to better understand behavioral differences across participants and non-participants. These differences have important implications for future research and policy.     

Increasing College Access and Retention Rates of Youth in Foster Care: An Analysis of the Impact of 22 State Tuition Waiver Programs

Youth in foster care face educational disparities in terms of college access, retention, and graduation. To address this, 22 states have implemented tuition waiver programs targeting current and former foster youth. A comparative analysis was conducted of all 22 programs implemented since 2014. Similarities include student eligibility based on youth’s age upon foster care entry, university admission and time in care requirements. Differences include type of expenses covered, time limits on use, program oversight, and funding availability. No differences were found based on political party control, gubernatorial power, and state population composition. Recommendations for policy and practice reform are offered.     

Housing for Older People in Iceland: Apartments and Nursing Homes

The first residential and nursing homes in Iceland were built in the early 1920s, and the first apartments for older people in the early 1970s. Most of the existing housing for older persons was built in the last 30 years. Legislative provisions on housing and particularly on assisted living have not changed significantly since laws relating to the affairs of the elderly were first passed in 1983. While approximately 90% of older people in Iceland own their own home and the primary stated goal of the government is to support independent living, official policy relies on placement in nursing homes. Services and care at home, provided by social and home healthcare services, has not been developed to the same extent as in the other Nordic countries. Clearer guidelines on integrated service housing are needed to reach the government's primary stated goal. Placing more emphasis on delivering services, care, and rehabilitation to people living in the community could shorten individuals’ length of stay in hospitals, delay admission to nursing homes, and better meet the expectations of older people for independent living.     

Which transition concept is useful for describing the process of young people leaving state care? A reflection on research and language

The transition of adolescents from state care to independent living is receiving increased research attention in many countries. Despite this interest, the concept of ‘transition’, though central, still remains relatively undeveloped. One main issue in comparative work is how we use language to define concepts as well as use them to analyse our findings and shape practice. ‘Transition’ over the last decade has become a key concept in the research and practice field of social work with adolescents, therefore we need to reflect on its use, its possibilities and its limitations. This paper examines selected research literature on the transition from state care to adulthood. The paper suggests that more theorisation needs to be done within the field.     

Exploring the politics and policy surrounding senior center gambling activities

Gambling is a controversial activity that is supported by some but opposed by others for a variety of reasons that are largely ethical, moral, and religious. These issues have been in place a long time and will continue. But gambling has become even more controversial because of the ever-expanding dependence of local and state governments on gambling and gambling-related tax revenue as a source of support for their programs, including senior centers. This dissertation research addresses the politics and policy surrounding the relationship between gambling and senior centers. The results indicate that senior center gambling is on the local agenda of nearly all of the case study communities. A variety of issues relating to senior center gambling was found, including evidence of the negative impact of dependence on gambling-generated revenues for centers and their clientele. These findings have implications for future research and for practice and policy relating to senior center gambling activities. In particular, these findings suggest the need for further investigation of the independent roles of historical, political, and cultural factors in the development of gambling regulations and their respective impacts on the agenda-setting process.     

Juvenile justice,mental health,and the transition to adulthood: A review of service system involvement and unmet needs in the U.S.

Although adolescents are the primary focus of juvenile justice, a significant number of young people involved with this system are considered transition age youth (i.e., 16–25 years of age). The aims of this review are to summarize the specific needs of transition age youth with mental health conditions involved with the juvenile justice system, identify the multiple service systems relevant to this group, and offer recommendations for policies and practice. A comprehensive search strategy was used to identify and synthesize the literature. Findings highlight the paucity of research specific to transition age youth. Thus, we also summarized relevant research on justice-involved adolescents, with a focus evaluating its potential relevance in the context of the unique milestones of the transition age, including finishing one's education, setting and working towards vocational goals, and transitioning from one's family of origin to more independent living situations. Existing programs and initiatives relevant to transition age youth with mental health conditions are highlighted, and nine specific recommendations for policy and practice are offered.     

Mom and Pop Versus the Big Boys: Adult Family Homes as Providers of Medicaid-Funded Residential Care

This paper compares assisted living apartments (ALs), adult residential care facilities (ARCs), and small adult family homes (AFHs) for Medicaid residents in Washington State, with particular emphasis on the settings, staffing, services, and policies of AFHs. We targeted for enrollment all residents entering an AFH, ARC, or AL setting on Medicaid/state funding in a three-county area of Washington State. We obtained information on 199 settings, interviewing administrative and direct care providers. AFHs are smaller than ARCs and ALs and less likely to be part of a chain, with no significant difference in staffing ratios of registered nurses and licensed practical nurses. Sixty-four percent of AFH residents were receiving public funds compared to 32% of AL residents. AFHs report admitting residents with more activities of daily living needs, health conditions, and behavior problems. They are less likely to have autonomy-related policies, and they provide more services and fewer activities. While attention should continue to be paid to staff supports, policy and practice should support the continued role of AFHs, which are of special interest because of their potential to provide more homelike, less costly care but with possible trade-offs compared to larger facilities.