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.     

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.     

“At times I kinda felt I was in an institution”: Supportive housing for transition age youth and young adults

Housing stability is essential for young adult development. Older youth and young adults transitioning from public systems of care, such as foster care, the public mental health system and residential settings, commonly experience high levels of transience and housing instability. In recent years, supportive housing policies and programs have emerged to address this situation, yet we know little about whether (or not) new programs are meeting the needs of youth in transition, and, if so, how they are addressing the unique developmental, social, and emotional needs of this population. This study is one of the first to speak directly with young adults living in a supportive housing program designed specifically for youth transitioning out of children's systems of care. Study participants spoke about both their overall transition experience and their views on the housing program where they reside. The study conducted four focus groups (N = 26) with transitioning youth and young adults, ages 18 to 25 (Mean age = 22), in order to explore the following three broad research questions: 1) what is it like to make the transition to adulthood from public children's systems of care?; 2) how does the supportive housing model they reside in shape their transition experiences?; and, 3) how do they experience the services and staff who are part of the program? Data analysis included grounded theory coding techniques and constant comparison with four coders. Results suggest that participants feel like they continue to be treated as children, and they receive mixed messages regarding their need to be increasingly autonomous, yet follow the rules. Finally, they reported specific aspects of what they found to be helpful in both staff relationships and overall program components. These themes constitute the results of the study. Findings underscore the importance of both listening directly to service users, and developing young adult supportive housing programming expressly designed to meet the unique needs of marginalized young adults transitioning to increased independence and self-sufficiency.     

Transitional Youth Services: Practice Implications from a Systematic Review

Independent living programs have emerged as the primary intervention to address the needs of foster youth transitioning out of care. Prior reviews of independent living programs have focused on implications for research and policy, but not on direct practice. In order to create effective independent living programs, direct service workers must be provided with concrete practice guidelines for providing effective independent living services. This article summarizes 19 studies on independent living and provides evidence-based implications for each in an effort to begin to fill the gap between research, policy and practice.     

Conceptualizing a Mobile App for Foster Youth Transitioning to Adulthood: A Mixed-Method Approach

Despite the promise of mobile smartphone applications (apps) in addressing challenges faced by foster youth transitioning to adulthood, the literature is devoid of conceptual frameworks for the development of these apps. This article documents the process of using Concept Mapping to delineate a conceptual framework germane to developing an app to assist youth transitioning from foster care to adulthood, and explore differences in development priority areas among participants. Participant data was collected via qualitative brainstorming sessions, and analyzed using multidimensional scaling and hierarchical cluster analysis. This article explicates findings from this study, discusses implications, and identifies apposite areas for future research.     

The invisibility of adolescent sexual development in foster care: Seriously addressing sexually transmitted infections and access to services

Adolescents residing in foster care are at higher risk for acquiring sexually transmitted infections (STIs) and human immune deficiency virus (HIV) compared to their non-foster care peers. A literature review was conducted to determine whether youth residing in foster care face different barriers to sexual health care compared to their peers in the general population and, if so, what those barriers are. The review revealed barriers common to adolescents in general as well as additional barriers specific to the ecosystem of adolescents in foster care. Systemic issues that decreased access to sexual health services included child welfare policies that were either missing or implemented without fidelity; complicated financial factors; barriers to service utilization; lack of collaboration between child welfare and medical professionals; and limited information provided to foster youth on their sexual health and development. Consent and confidentiality issues that foster youth face in seeking sensitive health services also need to be resolved. More research is needed on how to facilitate development of coherent policies and effective practices that promote sexual health care access for adolescents in foster care.     

Voices of former foster youth: Supportive relationships in the transition to adulthood

As the adolescent development literature has recognized the importance of social supports in the transition to adulthood, child welfare research, policies, and programs have turned their attention to the relational needs of youth emancipating from the foster care system. This study builds on the extant literature on social support among transitioning foster care youth; it goes beyond the sole identification of relational networks, to explore how youth actually utilize their network members, and the overall quality of their support system. This study collects data from twenty qualitative interviews with foster youth, ages 18–21. We analyze the data using consensual qualitative research methods in order to develop core themes around shared youth experiences. We found that while foster youth did identify a wide network of both formal and informal supports during their transition to adulthood, there were “holes” in the form of support, especially appraisal and instrumental support, provided by informal network members. Additionally, an unrealistic perception of supportive and permanent relationships may be contributing to poor outcomes in emerging adulthood. Implications for policy and practice are discussed.     

The first three years after foster care: A longitudinal look at the adaptation of 16 youth to emerging adulthood

Sixteen former foster youth were followed for 3 years to examine their adaptation to emerging adulthood. Youth were classified on their adaptation according to 2 concepts, Connectedness and Risks. Connectedness refers to engagement with the adult world through work, schooling, marriage, and parenthood. Risks refer to problems with substance abuse, financial difficulties, and mental health problems that would hinder engagement with the adult world. All of the youth maintained at least one adult connection, but only 6 youth did not have a risk at the final interview. Three years after discharge 50% of the respondents had a drug and/or alcohol problem, and had neither savings nor health insurance. Despite many problems the post foster care period was marked by much resilience as most struggled to remain independent, and continue their schooling. Factors which facilitated successful adaptations were: a period of transitional residence after foster care, good support systems including family and former social workers, and a commitment to further education.     

Experiences of youth who transition to adulthood out of care: Developing a theoretical framework

Adverse adulthood outcomes are well documented among youth who age out of foster care. However, not all youth who age out of care experience deleterious adult outcomes, despite struggling with similar challenges during the transition from adolescence to adulthood. Childhood maltreatment, which places youth at greater risk for later maladaptive functioning and psychopathology, may partially explain poor adjustment outcomes in adulthood. Similarly, a history of unstable placements and residing in institutional congregate care settings may also contribute to hardship during this time. However, none of these factors help to explain how some young people aging out of care manage to achieve stability while transitioning into adulthood. This article reviews the literature through the lens of the identity capital framework, and discusses the applicability of this framework to the experiences of youth aging out of foster care.     

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.     

The transition from state care to adulthood: international examples of best practices

Around the world, the transition from adulthood is a difficult time for many youth. It is even more difficult for those who are transitioning to adulthood without the benefit of a support network full of family and friends. Youth leaving state care face a transition to independence and adulthood without many of the skills and supports most others take for granted. Preparedness is key to a successful transition, and youth leaving state care tend to be lacking it. In order for youth to truly be prepared for the transition process, they must have support in key areas of their lives: relationships, education, housing, life skills, identity, youth engagement, emotional healing, and adequate financial support. Without these supports, the dismal outcomes for youth transitioning to adulthood will remain unchanged. The United States, England, and Australia have successful programs targeting youth as they transition out of state care. These initiatives bring together and address the variety of needs of this unique population and aim to improve outcomes. While many of these programs and policies are in their infancy, they show promising results, and each contributes valuable experience to successfully working with youth through this tough transition.     

The Family and Social Networks of Recently Discharged Foster Youth

Many youth leave foster care with disrupted relationships with family and others in their social networks. Previous research has documented the severe adversity that former foster youth face in the transition to young adulthood. Some of these difficulties are at least partially related to a lack of social support that results from frayed relationships. The purpose of this research was to examine the role that social support plays in the transition to adulthood. It was hypothesized that foster youth with higher levels of social support would make more successful adaptations to early adulthood than youth without that support. Ninety-seven former foster youth were followed for 2 years. Youth reported low levels of “feeling close to parents,” but higher levels of “closeness” were expressed for other relatives. Findings were mixed. Organizational involvement and having many “close” friends were associated with better outcomes. On the other hand, family contact and family support was inversely associated with resiliency. The implications of these findings are discussed.     

Professional and youth perspectives on higher education-focused interventions for youth transitioning from foster care

Youth transitioning from foster care to adulthood access and succeed in college at much lower rates than the general population. A variety of services exist to support youth with their postsecondary goals, but few if any have evidence for their effectiveness. As part of a National Institute on Drug Abuse-funded intervention development project to design Fostering Higher Education, a structured, testable postsecondary access and retention intervention for youth transitioning from foster care to adulthood, focus groups were conducted with community stakeholders to collect recommendations for how to most effectively structure the intervention. Analyses of focus group findings resulted in four theme groups: (1) general recommendations for intervention development; (2) recommendations for an educational advocacy intervention component; (3) recommendations for a mentoring intervention component; and (4) recommendations for a substance abuse prevention intervention component. These themes offered a variety of important insights for developing interventions in a way that is usable for youth and feasible for communities to implement.     

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.     

Why youth leave care: Understandings of adulthood and transition successes and challenges among youth aging out of child welfare

Child welfare policies and practices are changing to allow more youth to remain in care beyond age 18. Yet, the majority of youth do not stay. Given recent evidence suggesting that remaining in care may be beneficial, there is a need to understand why youth leave. Using data gathered from in-depth interviews with young people aging out of care, this paper explores this question, relating it to youths' understandings of adulthood and the successes and challenges they face during their transitions. We find that youth leave care because of misunderstanding and misinformation about the requirements for remaining in care, as well as because of a desire for autonomy and independence. Specifically, many youth equated adulthood with independence, and thus felt that they needed to leave care to achieve adulthood. Unfortunately, these efforts to be independent often hinder youths' development of supportive relationships, which they reported to be one of the greatest challenges in their transitions. Based on these findings, we conclude by challenging the conflation of adulthood and independence, as well as of childhood and dependence, calling for connected autonomy as a goal for child welfare involved young people of all ages.     

Mental health and substance use disorders among foster youth transitioning to adulthood: Past research and future directions

At a time when there is increasing attention being given to systematically integrating the well-being of children with the goals of safety and permanence in child welfare, little is known about the psychosocial functioning of foster youth transitioning to adulthood from substitute care. This article systematically reviews 16 peer-reviewed articles and/or research reports to identify lifetime and past year prevalence rates of mental health disorders and service utilization. At ages 17 or 18, foster youth are 2 to 4 times more likely to suffer from lifetime and/or past year mental health disorders compared to transition aged youth in the general population. Findings show that mental health service use declines at ages when the prevalence rate of mental health disorders is peaking. The findings of this review suggest the need to focus future efforts in three main areas: 1) setting a common research agenda for the study of mental health and service use; 2) routine screening and empirically supported treatments; and 3) integration and planning between child and adult mental health service systems.     

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.     

Journey towards independent living: resilience processes of women leaving residential care in South Africa

Among the many youth transitioning to young adulthood, a group that has been found to be particularly vulnerable is young people transitioning out of care, particularly residential care. Research on this population of youth has burgeoned over the past few decades, but in South Africa it remains limited. This article focuses on the resilience processes that facilitate better transitions of young women out of care and towards independent living. It replicates the research design of a previous study with young men, with the aim of determining to what extent the resilience process of young women are similar to those of men. A sample of nine women was purposively selected, interviewed in-depth and data analysed using grounded theory methods. The findings indicate that the same resilience process found among male care-leavers are evident also in the narratives of female care-leavers, confirming the findings of the previous study. However, these processes had a slightly stronger relational focus among women than was seen among men. The authors conclude that similar resilience-building programmes can be implemented to prepare both males and females for leaving 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.     

Exploring the Experiences of Lesbian,Gay, Bisexual,and Questioning Adolescents in Foster Care

This article is based on the findings from a subset of gender identity and sexual orientation questions from The Casey Field Office Mental Health Study (CFOMH). It aims to contribute the experiences of youth in the care of Casey Family Programs to the increasing body of research on lesbian, gay, bisexual, transgender, or questioning (LGBTQ) youth in foster care, as well as inform future studies in this area. The CFOMH study interviewed 188 adolescents ages 14 to 17 who were receiving foster care services from Casey Family Programs in 2006. The experiences in care of youth who identified as LGBQ (n = 10) are presented in narrative form, along with data from all youth in care (N = 188) regarding their perceptions of the foster care environment for LGBTQ youth. These findings are intended to underscore the need to conduct a larger, more in-depth study of the experiences of LGBTQ youth in foster care and the environment that foster care provides for them.