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.     

Health Issues of Homeless Youth

The purpose of this paper is to provide an overview of what is currently known about the health issues of homeless youth, focusing on risk-taking behaviors, health status, and access to care. The paper addresses the health issues of homeless youth in the U.S. within an international context. Existing data suggest that homeless adolescents exhibit high rates of risk-taking behaviors, face additional barriers to access of health care, and suffer from a high burden of poor health. However, most research on the health of homeless youth has been cross-sectional and has relied on convenience sampling. Future research should focus on conducting more methodologically rigorous studies on the specific health needs of homeless youth. Research should include eliciting information directly from the youth about their preferred health care interventions.     

Caregivers' Endorsement of Barriers to Mental Health Services for Children and Youth in Child Welfare

The purpose of this study was to examine the three most common types of caregivers in the child welfare system (birth parents, relative caregivers, and foster parents), an active child welfare case, caregivers' endorsement of barriers to mental health services and mental health service use by caregivers for the children under their care. The sample consisted of 430 dyads (caregivers and their children). Results indicate that an active child welfare case, provider characteristics, and accessibility of services predicted mental health service use for children. Implications for the child welfare and mental health systems are discussed.     

Considering the best interests of infants in foster care placed separately from their siblings

This article offers a perspective on the child welfare practice of placing infants and their siblings in foster care using the theoretical frameworks of attachment and infant mental health. The authors highlight issues for child welfare workers to consider when determining if moving an infant or young child from one home to another for the purpose of placing him with his siblings would cause trauma or disruption; and also issues to consider when determining the infant or young child's best interest when separated from siblings. First, the authors summarize the literature regarding attachment relationships and attachment disruptions. Then, they review outcome studies of children residing in foster care who are placed with their siblings and of those who are placed separately. Finally, the authors conclude with specific recommendations for child welfare workers to aid in making such difficult decisions about placing infants in foster care.     

Transitioning youth: Policies and outcomes

The primary policies and outcome studies regarding youth transitioning from foster care and young adults who have aged out of foster care over the past quarter of a century are reviewed. Although several policies have increased services and funding for this population, overall, their outcomes have not significantly improved. In terms of educational achievement, employment, and well-being, many continue to fare poorly in young adulthood. Further policies and practice improvements may need to be implemented. The population of youth transitioning has far outpaced the funding available, state and program eligibility requirements may be eliminating the most vulnerable from services, in many states there is an inadequate provision of basic needs such as housing and healthcare, the expectations of self-sufficiency for this population now exceed societal norms, and the restrictions and placement instability associated with many older adolescents in care may be in contrast to their developmental needs. In order to more fully address the needs of youth transitioning from foster care, child welfare policies and practices may need to focus more attention on the relational and social development of youth while in foster care. Furthermore, during young adulthood, policies and practices may need to provide greater safety nets and resources to this population.     

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.     

Decision-making skills of emerging adults aging out of foster care

This study examines the decision-making skills of emerging adults that have aged out of foster care and transitioned to independent life. Emerging adults face a wide variety of life-direction determining decisions and those aging out of foster care experience even more significant transitional issues. Youth aging out of foster care may lack the requisite decision-making competencies for coping with these challenges. This study compares the decision-making skills of foster care alumni to a group of similar individuals who were not involved in the child welfare system. Using a validated quantitative survey instrument, 29 foster care alumni and 29 demographically similar non-fostered participants described their general decision-making skills and elaborated on their personal experiences of reaching the age of majority. Statistical analyses of group differences indicate foster alumni score lower on overall decision-making skills and the decision-making process. In anecdotal comments, foster alumni tended to focus on their experience of leaving the foster system, while the non-fostered population elaborated on what it was like to become a legal adult. This study suggests that youth aging out of the foster care system may need support with the aspects of decision-making relating to the generation of alternatives and inferential reasoning about decision consequences as one way to augment and improve the transitional services designed to prepare foster youth for independent life.     

Evidence-based practice for youth in supervised out-of-home care: a framework for development, definition, and evaluation

Adolescents comprise more than half of the children in child welfare supervised out-of-home care. This article considers the evidence-base for an array of services to adolescents in out-of-home care and evaluates the existing research base for each program. This review advances a framework for considering the critical need to develop, define, and evaluate the essential elements of out-of-home care services for older foster youth. Policy, program, and evaluation recommendations are forwarded.     

Homelessness and aging out of foster care: A national comparison of child welfare-involved adolescents

The present study represents the first large-scale, prospective comparison to test whether aging out of foster care contributes to homelessness risk in emerging adulthood. A nationally representative sample of adolescents investigated by the child welfare system in 2008 to 2009 from the second cohort of the National Survey of Child and Adolescent Well-being Study (NSCAW II) reported experiences of housing problems at 18- and 36-month follow-ups. Latent class analyses identified subtypes of housing problems, including literal homelessness, housing instability, and stable housing. Regressions predicted subgroup membership based on aging out experiences, receipt of foster care services, and youth and county characteristics. Youth who reunified after out-of-home placement in adolescence exhibited the lowest probability of literal homelessness, while youth who aged out experienced similar rates of literal homelessness as youth investigated by child welfare but never placed out of home. No differences existed between groups on prevalence of unstable housing. Exposure to independent living services and extended foster care did not relate with homelessness prevention. Findings emphasize the developmental importance of families in promoting housing stability in the transition to adulthood, while questioning child welfare current focus on preparing foster youth to live.     

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.     

How different are their experiences and outcomes? Comparing aged out and other child welfare involved youth

This paper adds to the growing body of research examining the experiences of youth aging out of the child welfare system. Through a comparison of youth aging out with two other groups of child welfare-involved youth—those whose families received child welfare services but were never placed out of home and those who were in out-of-home placement but did not age out—it presents a profile of their care careers and other system involvement (e.g., mental health, justice system). Analyses indicate that young people aging out of care have experienced significant amounts of time in out-of-home placement, a great deal of placement instability, and high levels of other system involvement. In general, their involvement is more extensive than that of the two comparison groups. However, the justice system involvement of youth who experienced out-of-home placement but did not age out is just as high as that of youth who have aged out. This finding highlights the importance of devoting resources not only to youth aging out of care but also to similarly-aged young people with prior child welfare involvement.     

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.     

Barriers and facilitators to delivering effective mental health practice strategies for youth and families served by the child welfare system

While the gap between need for and access to mental health services is well documented among children of color in foster care, little is known about why they are sustained. To illuminate barriers of service delivery, thirty-six caseworkers participated in one of five focus group meetings in a large urban Mid-Atlantic City. Ground Theory Methods revealed that there are barriers and facilitators at the macro, meso, and micro practice orientations. At the macro-level, development of effective practice strategies and proximity to effective services are likely to influence dissemination of effective practices. Secondly, at the meso-level, job support is needed to facilitate awareness, but for case managers to feel supported, they need effective training and opportunities to facilitate interagency collaboration. Finally, at the micro-level, cultural competence largely impacts implementation of effective practices. However, increased awareness around the social ills of stigma and the salience of “insider work” are needed to increase cultural competence. A “downstream” effect in which there are numerous barriers identified at the macro level has a direct negative impact on organizational capacity and readiness to deliver and engage youth and families in mental health services served by the child welfare system. Findings underscore the need for child welfare agencies to build supports at the macro, meso, and micro practice levels to ameliorate mental health service disparities.     

Connective complexity: African American adolescents and the relational context of kinship foster care

Attempts to address racial disproportionality in child welfare must include a focus on the benefits and challenges facing children in kinship care. African American children not only are overrepresented in the child welfare system, but also are placed disproportionately in kinship foster care. Using a sample of 18 African American adolescents ages 11 to 14, this article explores how the relational context of care experienced by adolescents in kinship foster care differs from that of adolescents in nonkinship foster family placements. Findings are presented regarding the stability of relationships as well as complex role dilemmas experienced by kinship youth as they relate to caregivers and birthparents in the child welfare context. Implications are given for practice with kinship families.     

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.     

Functional outcomes among sexual minority youth emancipating from the child welfare system

The heterogeneity of youth emancipating from the foster care system makes it difficult to establish the extent to which their functional outcomes are equivalent across different subgroups. In the present study, we use secondary data from the Multi Site Evaluation of Foster Youth Programs (MSEYP) to explore the challenges faced by sexual minority youths in comparison to their heterosexual peers. We focus on measurements of key independent living outcomes at age 19 to obtain a broad picture of how sexual minority youth fare during the period of transition to adulthood. Bivariate results indicate that the deficits for sexual minority youth are noteworthy across all categories of functional outcomes (i.e. education, employment, homelessness and financial stability). Furthermore, results from binary logistic regression models indicate that sexual orientation was associated with each category of functional outcomes, even when controlling for demographics and child welfare history factors. Findings suggest that sexual minority youth leaving foster care are particularly vulnerable to negative outcomes and may require more intensive supports during the period of transition to adulthood. Implications for practice and future research are discussed.     

Interventions for youth aging out of care: A scoping review

Youth aging out the child welfare system are being transitioned out of the child welfare system with few interventions in place to support their move to independence. In developed countries, compared to their peers, youth aging out of care face poorer outcomes when it comes to education, employment, and housing. A better understanding of the effectiveness of the existing interventions that support youth in care is warranted. This paper presents a critical scoping review of the available evidence on interventions available to youth who are aging out of the child welfare system and identifies gaps for future research. Arksey and O'Malley's framework for scoping reviews shaped the process of this review. A total of thirteen databases were searched resulting in the retrieval of 1978 articles. Of the 1978 retrieved, only 68 met the review's criteria. Studies included were in English, described an intervention that was implemented and evaluated in developed countries, and published within the last 20 years. Interventions were categorized as: housing, employment, education, mentorship, independent living, and health. The majority of studies fell under the independent living category which provide cohesive resources to improve education, housing, and employment. Studies evaluating these programs generally reported positive outcomes on youth's ability to complete their education and attain part- or full-time employment. Methods of evaluations were found to be methodologically weak with respect to determining the effectiveness of interventions in ensuring youth's successful transitions to independence. Future research should look at longitudinal outcomes of youth and cost-benefit analysis of supporting youth transitioning out of the child welfare system. Recommendations also include policy changes extending the age of eligibility for youth transitioning out of the child welfare system.     

Culturally Competent Practice with African American Juvenile Sex Offenders

African American juveniles adjudicated for sexual offenses may struggle with the mistrust of both the judicial and treatment systems. Unlike general mental health services, juvenile sex offender treatment is often mandated by the court or child welfare services, thus these youths and their families must engage in the treatment process. Without clinicians and services that can acknowledge and respond to a minority youth’s experience in a sensitive, culturally competent manner, there could be significant resistance to treatment. Traditional treatment approaches fail to prioritize issues involving cultural competence. This article addresses the unique challenges of African American juvenile sex offenders and makes recommendations for creating culturally competent practice for these youth and their families.     

Assessing Child Well-Being in Non-Relative Foster Care with a New Outcome Measurement Tool

ABSTRACT

The Child Health and Illness Profile–Adolescent Edition (CHIP-AE), a recently developed standardized instrument, was administered to 49 adolescents living in non-relative family foster care under the auspices of the child welfare system in Illinois. Youth reported high levels of satisfaction with their health, academic progress, resiliency and risk resistance, but low levels of work performance. These youth also reported higher levels of psychosocial problems, major and minor adverse effects from injuries, migraines, and chronic medical conditions such as epilepsy, diabetes and sickle-cell anemia. This study demonstrated the potential usefulness of the CHIP-AE as a tool for involving youth living in non-relative foster care in assessing their own health and well-being. Suggestions for future use of the CHIP-AE are discussed.