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.     

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 mental health of young people aging out of care and entering adulthood: Exploring the evidence from England and France

This paper explores the research evidence from England and France on the mental health of young people aging out of care and into adulthood. It represents the first comparative review based on the evidence from these two countries. Set in the legal, policy and service framework for both countries, it reviews evidence on the mental health of young people in the general population, young people living in care, young people aging out of care, and young adults. It shows: the high levels of psychological adversity of young people entering care; the high rates of mental health problems of young people in care compared with the general population of young people; the increased risk of mental and physical problems at the time of aging out of care, and the general improvement in longer-term outcomes for young adults, although some continue to have serious mental health problems. In conclusion, it suggests that interventions across the life course of young people are needed.     

“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.     

Life after Growing Up in Care: Informing Policy and Practice through Research

Abstract

Existing research on the impact of growing up in care focuses upon either the care experience itself or the period of transition from care to independence. Our knowledge of outcomes largely ceases when former residents of the care system reach their early twenties. There are strong social justice reasons for extending research into the older adult lives of such young people. We know a great deal about the multiple disadvantages that such individuals face as children. But research is largely silent about their subsequent adult lives. While we must be cautious in drawing causal links to the childhood care experience as the time period since life in care extends, we know that early experiences can affect care-leavers across their life course—just as childhood experience affects all adults in a variety of ways. In this review, we highlight evidence drawn from research in Australia, the United Kingdom, Canada, Ireland, and the United States, with particular attention paid to the first two of those countries. We use a wide range of sources and identify areas for further consideration, including access to personal records, mental health, education, and parenting. By doing so, we seek to open up this area for further research with the hope that such research will lead to an increasing recognition of care-leavers' needs and thus to improvements in social policy and service provision.     

Paths to Intimate Relationship Quality From Parent–Adolescent Relations and Mental Health

Using a developmental systems perspective and public‐use longitudinal data from participants currently in a romantic relationship at Wave 4 of the National Longitudinal Study of Adolescent Health (n = 2,970), the current study explored direct and indirect paths from parent–adolescent relationship quality to young adult intimate relationship quality. Structural equation modeling tested whether mental health (depressive symptoms and self‐esteem) in the transition to adulthood mediated the association between parent–adolescent relations and young adult intimate relations. The results indicated that higher quality parent–adolescent relations predicted higher self‐esteem and lower depressive symptoms during the transition to adulthood as well as higher young adult intimate relationship quality, controlling for adolescent mental health and parent–young adult relationship quality. Higher self‐esteem during the transition to adulthood was associated with greater intimate relationship quality, whereas greater depressive symptomatology predicted reduced intimate relationship quality. One significant indirect path emerged: parent–adolescent relationship quality → self‐esteem → intimate relationship quality.     

Child Care as a Relational Context for Early Development: Research in Neurobiology and Emerging Roles for Social Work

The quality of child care in the United States is an important social problem, particularly for economically vulnerable families. This is highlighted by multidisciplinary research on the importance of early caregiving as a determinant of child health and wellbeing. This article examines center-based child care as an important relational and developmental context for infants and young children. Through an integration of psychosocial studies and emerging research in the cognitive neurosciences, this paper describes how developmental research on early emotional development can be utilized to inform our understanding of child care as a critical social and interpersonal context for infants and young children. In particular, this paper examines research on early interpersonal experience as a determinant of the capacity for affect regulation. Focusing on the application of theory to practice, this paper discusses the relevance of this research to informed direct practice, advocacy and program development.     

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.     

Socioeconomic success and mental health profiles of young adults who drop out of college

Based on the developmental theories of life course and emerging adulthood, the current study examines a central question about the diversity of trajectories among young adults who drop out of college. The National Longitudinal Study of Adolescent to Adult Health (Add Health) provides prospective data on a nationally representative sample of US young adults. Our subsamples include young adults who dropped out of college (N?=?1,530) and those who obtained a bachelor’s degree (N?=?1,977). We examined five dimensions of well-being: socio-economic success indicators, happiness/satisfaction, mastery, stress, and depression. Using latent class analysis, five classes of young adults who dropped out emerged that reflected variability in the patterns of well-being. Differences in socio-economic and mental health dimensions are elaborated in the study. The findings from this study provide valuable basis for challenging stereotypes about the college student dropout population.     

Exploring Trajectories of Pornography Use Through Adolescence and Emerging Adulthood

While the scholarly literature on pornography use is growing, much of this literature has examined pornography use as a static feature that does not change. Despite this trend, pornography use, like most sexual behaviors, is likely best viewed as a dynamic feature that may shift across the developmental life span. Using a sample of 908 adults from the United States, retrospective data on pornography use through adolescence and emerging adulthood were gathered to explore trajectories of pornography use across these developmental periods. Latent mixture models suggested the presence of common patterns of use across both developmental periods. Adolescence patterns appeared to largely be distinguished by those who either engaged or did not engage with pornography, while emerging adulthood data revealed the presence of a group of experimenters who engaged in pornography through adolescence but then decreased use through their 20s. Men were found to be more likely to have consistent profiles of pornography use, while single adults were likely to have delayed entry into pornography use. Associations with adult mental health and pornography use were found, suggesting that early exposure to pornography was related to elevated current pornography use patterns and, to a lesser extent, dysfunctional pornography use. Trajectories also had a weak association with life satisfaction, with individuals reporting trajectories involving consistent pornography use reporting lower life satisfaction after controls.     

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.     

Social support and interdependency in transition to adulthood from child welfare services

This qualitative study explores the need for social support in transition to adulthood for youths in the child welfare service, focusing on what support they need and from whom they can get such support. We have conducted individual and focus group interviews with in all 43 adolescents that are, or have been, in contact with the child welfare service in adolescence/young adulthood. The interviews are transcribed and analyzed by doing initial longitudinal analysis, and thematic analysis inspired by the main structure in Systematic Text Condensation (STC).Through the analyses we have highlighted four different categories of social support that the youths need; practical support, emotional support, affirmational guidance support and participation support. Our findings indicates that such support is necessary, but not always available for youths transitioning out from the Child Welfare System, as many of them lack an informal network of adults that can support them in their transition to adulthood. Several of them consequently need continued support from employees in the Child Welfare Service, which for many of these youths seems to represent a crucial source of social support. One of the challenges seems to be that the youths urge of independency together with the expectations of independency from the Child Welfare Services, makes youths end the contact with the Child Welfare Service too early. The simultaneously need for social support and urge for independency makes it relevant to discuss this in light of the concept of interdependency; which emphasizes the importance of connections and social relations as not only normal but also necessary. This underlines the need for more flexibility and a gradual independency; in contrast to the “sudden adulthood” that many youths transitioning out of child welfare seem to experience.     

Casual Sexual Relationships and Mental Health in Adolescence and Emerging Adulthood

Casual sexual relationships are relatively common in emerging adulthood. Yet the mental health implications of engaging in these relationships are unclear; past research has found negative associations, positive associations, or no association with mental health. In addition, little research has accounted for mental health status prior to entering casual sexual relationships. Using data from the National Longitudinal Study of Adolescent Health (N = 12,401), we measured mental health prior to engaging in casual sexual relationships and subsequent mental health after engaging in these relationships. We found that suicidal ideation and depressive symptoms in adolescence were associated with entrance into casual sexual relationships in emerging adulthood. Furthermore, casual sexual relationships were associated with an increased likelihood of reporting suicidal ideation in emerging adulthood.     

"It Was Basically College to Us": Poverty, Prison, and Emerging Adulthood

With the tremendous rise in the United States' incarceration rates over the last four decades, historically high numbers of young African Americans are spending their "emerging adulthood" (as theorized by Arnett) in close contact with the penitentiary. In contrast to the exploration of future possibilities facilitated by academic, military, and professional institutions geared toward people in this life stage, imprisonment typically restricts one's social, occupational, and civic opportunities during and after confinement. In this article, I draw on in-depth interviews with young men who had recently exited state prison and their intimate partners to probe the meanings of incarceration for emerging adults in the neoliberal era. This investigation invokes Merton and Barber's concept of sociological ambivalence, Blankenship's discussion of sociological thriving, and Bourdieu's notion of amor fati to analyze the paradoxically positive accounts offered by young people when describing their early experiences with the prison. I argue that these narratives must be interpreted in the broader context of diminished social welfare and intensified socioeconomic disadvantage that force poor people to turn to a punitive institution as a "resource" for the social goods distributed through valorized channels to their more privileged peers. This analysis invites further research by highlighting the necessity of developing a thorough understanding of the dominant role of the prison as a shaping institution at a critical juncture in the lives of those born into poverty.     

Indicators of Adolescent Depression and Relationship Progression in Emerging Adulthood

Adolescent depression may be associated with future relationship problems that have long‐term consequences given the developmental importance and health benefits of forming committed unions in emerging adulthood. The authors examined associations between emotional and behavioral indicators of adolescent depression (depressive symptoms, alcohol problems, and suicidal ideation) and romantic relationship and union formation and dissolution in emerging adulthood (n = 14,146) using the National Longitudinal Study of Adolescent Health. Adolescent alcohol problems were associated with more romantic relationships in emerging adulthood. Emerging adults with depressive symptoms or alcohol problems in adolescence were significantly more likely to enter into a cohabiting union, and those with adolescent alcohol problems were less likely to marry. Cohabiting emerging adults with a history of adolescent depressive symptoms were less likely to marry, whereas suicidal ideation was associated with a decreased likelihood of cohabitation dissolution. Implications for future research are discussed.     

Non-Profit Organizations in Mental Health: Their Roles as seen in Research

Non-profit organizations (NPO) for mental health are becoming significant actors. Here, their roles in welfare society as understood in research are identified and analyzed. Results from recent research publications on the mental health field are synthesized and categorized in order to find out their origin, theoretical orientation, and view on mental health NPO’s in relation to the public welfare systems. Relevant publications are primarily from the US, empirically oriented, and addressing surveys on both individual and organizational level. NPOs were most often seen as consensus-oriented service organizations, while very few (4%) were seen as conflict-oriented advocates (i.e., anti-professional). It is concluded that these NPOs are most often studied as complements or alternatives to existing public welfare services rather than on their own terms, and that research on the topic lacks more complex theoretical attempts.     

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.     

Young Adults’ Life Outcomes and Well-Being: Perceived Financial Socialization from Parents,the Romantic Partner,and Young Adults’ Own Financial Behaviors

We examined how perceived financial socialization—from parents, the romantic partner, and young adults’ own behavior—was associated with young adults’ life outcomes and well-being (i.e., physical and mental health, finances, romantic relationship). Using data (N?=?504) from young adults specific to their finances, results from hierarchical regression analyses showed that young adults’ own financial behaviors were the most patterned, followed by financial socialization from the romantic partner, and then from financial socialization from parents (only objective financial knowledge). We discuss how young adults’ financial behavior, financial socialization from the romantic partner and, to a lesser extent, parental socialization are associated with young adults’ life domains, underscoring the developmental salience of increased financial capability and relationship formation and decreased dependence on parents during the transition to adulthood.     

‘Life stage dissolution’ in Anglo‐American advertising and popular culture: Kidults,Lil’ Britneys and Middle Youths

The ‘long road to adulthood’ that supposedly now characterizes the period from the teens to the late twenties (for individuals in developed countries) has been the subject of much recent media and academic commentary. This paper adopts a sociological perspective to review and critique this commentary, and in particular the argument made by certain developmental psychologists that the period between adolescence and fully‐fledged adulthood is now distinct enough to constitute a new stage in the life cycle known as ‘emerging adulthood’. In contrast, it is argued that, rather than anything as significant as a new life stage, what is actually happening is the erosion of established ones. To illustrate this point, the article introduces the new theoretical concept of ‘life stage dissolution’ (and its attendant bi‐directional processes of ‘adultification’ and ‘infantilization’) – a blurring (or more accurately merging) process that makes it increasingly difficult for young people to differentiate and disassociate themselves from the generation immediately ahead of them, and indeed vice versa. The paper argues that, whilst this process takes a number of cultural/psychosocial forms, it is at its most prominent in contemporary Anglo‐American advertising and marketing practices that actively seek to erode traditionally demarcated adult and childhood roles, differences, and oppositions as a new and distinct message within contemporary consumerism.     

Childhood adversity,sense of belonging and psychosocial outcomes in emerging adulthood: A test of mediated pathways

Childhood adversity is a complex issue with the potential for lasting effects over the developmental trajectory. Research has confirmed that people who experience significant adversity, hardship and trauma in early stages of development are at an increased risk of a range of negative outcomes at later stages of the life-course, including increased psychological distress and dysfunction, decreased likelihood of educational engagement and an increased risk of early parenthood. However, distal events exert their influence on later outcomes through various proximal mechanisms. One such postulated mechanism is a sense of belonging. This study investigated the role of sense of belonging as a mediator between experiences of adversity in childhood and psychosocial outcomes in emerging adulthood, amongst a sample of 254 young people receiving a range of social services throughout Australia. Results of three mediation analyses confirm that the path from childhood adversity to psychological distress and educational engagement is only weakly mediated by sense of belonging. No other statistically significant relationships were found. These results indicate that additional mediators are likely needed to more fully explain the effects of childhood adversity on psychosocial functioning in emerging adulthood. The paper concludes with a discussion of the relevance of belonging for practice in the field of child and youth welfare.