Predicting Homelessness among Emerging Adults Aging Out of Foster Care

This study examines risk and protective factors associated with experiencing homelessness in the year after “aging out” of foster care. Using a state‐level integrated administrative database, we identified 1,202 emerging adults in Washington State who exited foster care between July 2010 and June 2012. Initial bivariate analyses were conducted to assess the association between candidate predictive factors and an indicator of homelessness in a 12‐month follow‐up period. After deploying a stepwise regression process, the final logistic regression model included 15 predictive factors. Youth who were parents, who had recently experienced housing instability, or who were African American had approximately twice the odds of experiencing homelessness in the year after exiting foster care. In addition, youth who had experienced disrupted adoptions, had multiple foster care placements (especially in congregate care settings), or had been involved with the juvenile justice system were more likely to become homeless. In contrast, youth were less likely to experience homelessness if they had ever been placed with a relative while in foster care or had a high cumulative grade point average relative to their peers.     

Foster Care Youth Share Stories of Trauma Before,During, and After Placement: Youth Voices for Building Trauma-Informed Systems of Care

Many research studies address child trauma experiences that take place before foster care placement. However, few studies focus on the types and patterns of trauma experiences that reportedly take place during and after foster care placement; that is, after entry into adult living. This study examined the testimony of 43 foster care youth who spoke to a listening panel comprised of state legislators, child welfare professionals, and university educators. Qualitative analyses of transcribed text data revealed 3 main themes. First, the youth reported experiencing trauma before, during, and after placement. Second, the youth described trauma events and situations that were chronic (i.e., intense, composite, or cumulative). Third, youth offered suggestions for reducing traumatic experiences for foster care youth. They recommended earlier family interventions, access to people who listen and care, improved parenting skills for foster parents, continuity of relationships, and opportunities for leadership for foster youth. Foster youth voices offer important suggestions for building, strengthening, and evaluating trauma-informed systems of care.     

Occupational Therapy's Emerging Role With Transitioning Adolescents in Foster Care

The American Occupational Therapy Association's Centennial Vision advocates for an emphasis on intervention and prevention services for children, young people, the aging, and those with severe and persistent mental illness. This article discusses mental health issues among adolescents in foster care, a population that would greatly benefit from occupational therapy services emphasizing skill development in the areas of independent living, vocation, and health. Additionally, current intervention modalities used by other disciplines with adolescents in foster care are explored. Finally, a pilot study demonstrating the opportunities for occupational therapists to influence the long-term outcomes of adolescents in foster care is described.     

Youth Subgroups who Receive John F. Chafee Foster Care Independence Program Services

To date over two billion dollars have been invested in the John F. Chafee Foster Care Independence Program (CFCIP) to help youth who are transitioning out of foster care to achieve self-sufficiency through an array of independent living services. Although states are required to report CFCIP service provision to the National Youth in Transition Database (NYTD), the degree of heterogeneity of the aging out population from the service receipt perspective and state implementation is unknown. The CFCIP calls for a deeper understanding of the underlying patterns of services receipt to prepare for youth’s successful transition to adulthood. Based on the population of 68,057 first-time youth who received CFCIP services in FY2011-FY2013 from the NYTD, we used multi-level latent class analysis (MLCA) to identify underlying combinations of service receipt that may be influenced by youth-level and state-level characteristics. We identified the most preferred model based on interpretability, fit statistics, and split-half replication. The optimal model was a three-class, MLCA solution characterized by a high-service receipt profile, an independent living assessment and academic support receipt profile, and a limited service receipt profile. Among male and female youth, age, education level, and whether states serve youth aged 18 or above were significant characteristics associated with LCA profile membership. States could benefit from understanding existing service receipt patterns and gaps to optimize decisions on service delivery in order to meet youth needs and to identify specific services that may prepare youth aging out of foster care towards positive outcomes.     

The foster parenting center: A multidisciplinary resource for special needs preschoolers

A combined foster parent training and preschool education program for developmentally delayed and emotionally disturbed children is described. This program was organized and run by a multidisciplinary group of independent professionals, who served as a liaison with a foster care agency. The goals of preventing placement breakdown by giving early attention to problems, and of improving foster parents' abilities to manage difficult children were met at modest cost to the agency. The model can be replicated in other communities to improve the quality of foster care provided to young children.     

A systematic review of cognitive functioning among young people who have experienced homelessness,foster care,or poverty

Young people who have experienced homelessness, foster care, or poverty are among the most disadvantaged in society. This review examines whether young people who have these experiences differ from their non-disadvantaged peers with respect to their cognitive skills and abilities, and whether cognitive profiles differ between these three groups. Three electronic databases were systematically searched for articles published between 1 January 1995 and 1 February 2015 on cognitive functioning among young people aged 15 to 24 years who have experienced homelessness, foster care, or poverty. Articles were screened using pre-determined inclusion criteria, then the data were extracted, and its quality assessed. A total of 31 studies were included. Compared to non-disadvantaged youth or published norms, cognitive performance was generally found to be impaired in young people who had experienced homelessness, foster care, or poverty. A common area of difficulty across all groups is working memory. General cognitive functioning, attention, and executive function deficits are shared by the homeless and poverty groups. Creativity emerges as a potential strength for homeless young people. The cognitive functioning of young people with experiences of impermanent housing and poverty has been relatively neglected and more research is needed to further establish cognitive profiles and replicate the findings reviewed here. As some aspects of cognitive functioning may show improvement with training, these could represent a target for intervention.     

Outpatient Psychotropic Medication Use in the US: A Comparison Based on Foster Care Status

Using data from the Client/Patient Sample Survey, a nationally representative study of outpatient mental health service utilization, the prevalence and correlates of psychotropic medication receipt for youth who live with families and in foster care are compared. The medication rate is similar for both groups, with slightly more than one-third of youth treated with medication. Additionally, when medication is prescribed, it is the sole intervention provided for close to one half of each group, and the distribution of other services received (such as clinical case management and collateral services) is similar, regardless of living situation. However, the predictors of medication use differ for the two groups. Among foster care youth, only presenting problems of depressed mood, being withdrawn, and suicidality significantly increase the odds of medication; among youth with families, sociodemographic characteristics (male gender), and a range of clinical factors (disruptive behavior disorder, presenting problems of hyperactivity and sleep disturbance, prior mental health service receipt, and inpatient or residential care referral sources) increase the likelihood of medication. The conclusion that distinct sets of factors predict medication for the two groups was reinforced by results of multivariate analyses; foster care status moderates the association between medication receipt and only one of the correlates examined (gender). Implications, limitations, and areas for future research are presented.     

Ethical Considerations for the Treatment of Youth in Foster Care

Mental health clinicians treating youth in foster care face several ethical challenges, such as competence for treating youth in foster care, understanding who can provide informed consent, and confidentiality. However, few articles have addressed these ethical concerns or provided recommendations for clinicians on how to navigate these issues. This article presents a brief summary of the foster care system, an overview of the major ethical challenges clinicians may encounter when treating youth in foster care, areas of the American Psychological Association’s Ethics Code, Code of Ethics of the National Association of Social Workers, and American Counseling Association Code of Ethics most germane to the treatment of youth in foster care, and general recommendations for clinicians treating this population.     

Multidimensional treatment foster care (MTFC): results from an independent replication

This study examines 24‐months post‐baseline outcomes for thirty‐five Swedish antisocial youths who received either treatment in multidimensional treatment foster care (MTFC) or treatment as usual (TAU). MTFC is a community‐based treatment programme that has been successful in treating chronic juvenile offenders in the USA. This study is the first randomized control study outside the USA. The youth treated in the MTFC programme consistently showed some statistically significant positive treatment effects compared to the youth exposed to TAU. The results suggest that MTFC might be an effective method in treating youth with severe behaviour problems in a Swedish context. The authors conclude that the programme ought to be of great interest for Swedish social services as an alternative to traditional care.     

Assessment of Needs in Residential Care: Perspectives of Youth and Professionals

The evaluation and identification of needs profiles for youth in residential care, through qualitative and quantitative methodologies involving different stakeholders, are still relatively uncommon, even though they are essential in developing specific and effective services. This article will present two studies, one with youth and another with professionals. To assess needs from the standpoint of youth, four focus groups were held with youth in residential care (n = 21). To identify needs profiles of youth from the standpoint of professionals, 47 professionals evaluated a sample of youth in residential care (n = 110) using the RCYNA questionnaire. The results of the study with youth point to needs in three main areas: living situation, social and family relationships, and education. The results of the study with professionals reveal three needs profiles with distinct risk levels: low risk, without emerging needs; intermediate risk, with needs in terms of the economic and living situation; and high risk, with needs in terms of relationships, behavioural, psychological and emotional skills, and education and employment.     

Ethnic Differences in Children’s Entry into Public Mental Health Care via Emergency Mental Health Services

For children and youth making a mental health crisis visit, we investigated ethnic disparities in whether the children and youth were currently in treatment or whether this crisis visit was an entry or reentry point into mental health treatment. We gathered Medicaid claims for mental health services provided to 20,110 public-sector clients ages 17 and younger and divided them into foster care and non-foster care subsamples. We then employed logistic regression to analyze our data with sociodemographic and clinical controls. Among children and youth who were not placed in foster care, African Americans, Latinos, and Asian Americans were significantly less likely than Caucasians to have received mental health care during the three months preceding a crisis visit. Disparities among children and youth in foster care were not statistically significant. Ethnic minority children and youth were more likely than Caucasians to use emergency care as an entry or reentry point into the mental health treatment, thereby exhibiting a crisis-oriented pattern of care.     

Prior Trauma Exposure for Youth in Treatment Foster Care

Very little research has focused on rates of trauma exposure for youth in treatment foster care (TFC). Available research has utilized record review for assessing exposure, which presents limitations for the range of trauma types examined, as records are predominantly focused on abuse and neglect. The current study examines exposure rates and association with emotional and behavioral outcomes for 229 youth in 46 TFC agencies. The youth in this study had exceptionally high rates of trauma exposure by foster parent report, similar to youth in traditional foster care, with nearly half of the sample exposed to four or more types of traumatic events. A composite child abuse and neglect exposure variable was associated with child and adolescent emotional and behavioral outcomes. Implications for services provided as part of TFC are discussed.     

Service Needs of Foster Families with Children who have Disabilities

We examined the service needs of foster families with children who have disabilities. Foster parents in a large Canadian city were asked “What services or supports would be helpful to you?” The responses to this question were edited for clarity and to eliminate redundancies, and sorted into piles of like statements by a group of 15 foster care professionals. Two types of statistical analysis were applied to the sorting of the statements to describe the relationship between statements and their groupings. The major concepts were identified according to the contents of the cluster and a map was constructed to provide a graphic representation of the conceptualization process. The major services and supports identified in this study were: support in the community, financial support, accommodating school system, good relationships with social workers, responsive professionals, information, comprehensive medical care, services for aboriginal children and families, transitional services, and respite.     

Different Pathways to Juvenile Delinquency: Characteristics of Early and Late Starters in a Sample of Previously Incarcerated Youth

We examined the differences between early and late start juvenile delinquents in a sample of 531 previously incarcerated youth in Oregon's juvenile justice system. Data were analyzed with logistic regression to predict early start delinquency based on four explanatory variables: foster care experience, family criminality, special education disability, and socioeconomic status. Youth with foster care experience were four times more likely to be early start delinquents than youth with no foster care experience. Youth with a family member convicted of a felony were two times more likely to be early start delinquents than youth with no family felony. Implications for future research are discussed, as well as implications for practice and policy. We suggest that future studies examine differences between male and female delinquents, the effects of foster care on children, and interfamilial processes that facilitate criminal behavior. Efforts to support children and families at risk of abuse and neglect should be reexamined in light of the results of our study, which adds to the emerging knowledge base regarding the relationships between violence experienced in early childhood, and future criminal behavior.     

Foster Care Placement,Poor Parenting,and Negative Outcomes Among Homeless Young Adults

Although homeless youth with and without foster care histories both face adverse life circumstances, little is known about how these two groups compare in terms of their early histories and whether they face similar outcomes. As such, we compared those with and without a history of foster care placement to determine if the associations between a history of poor parenting and negative outcomes including depression, delinquency, physical and sexual victimization, and substance use, are similar for these two groups. The sample consisted of 172 homeless young adults from the Midwestern United States. Multivariate results revealed that among those previously in foster care, a history of physical abuse and neglect were positively associated with more depressive symptoms whereas sexual abuse and neglect were related to delinquency and physical victimization. Additionally, lower caretaker monitoring was linked to greater delinquent participation. Among those without a history of foster care, physical abuse was related to more depressive symptoms whereas sexual abuse was positively correlated with delinquency, sexual victimization, and substance use. Furthermore, lower monitoring was related to more substance use. Our findings are discussed in terms of a social stress framework and we review the implications of foster care placement for homeless young adults.     

Supporting Mentoring Relationships of Youth in Foster Care: Do Program Practices Predict Match Length?

Implementation of research‐ and safety‐based program practices enhance the longevity of mentoring relationships, in general; however, little is known about how mentoring programs might support the relationships of mentees in foster care. Benchmark program practices and Standards in the Elements of Effective Practice for Mentoring, 3rd Edition (MENTOR, 2009) were assessed in the current study as predictors of match longevity. Secondary data analyses were conducted on a national agency information management database from 216 Big Brothers Big Sisters agencies serving 641 youth in foster care and 70,067 youth not in care from across the United States (Mean = 11.59 years old at the beginning of their matches) in one‐to‐one, community‐based (55.06%) and school‐ or site‐based (44.94%) matches. Mentees in foster care had shorter matches and matches that were more likely to close prematurely than mentees who were not in foster care. Agency leaders from 32 programs completed a web‐based survey describing their policies and practices. The sum total numbers of Benchmark program practices and Standards were associated with match length for 208 mentees in foster care; however, neither predicted premature match closure. Results are discussed in terms of how mentoring programs and their staff can support the mentoring relationships of high‐risk youth in foster care.     

Use of Out-of-Home Care Among a Statewide Population of Children and Youth Enrolled in Medicaid

System-wide research on the use of out-of-home care among children and youth is needed to inform the development of policies and services. We used Medicaid claims from North Carolina to examine patterns of out-of-home care, identify demographic and diagnostic differences between those who received care in residential treatment, psychiatric hospitals, or general hospitals, and determine whether demographic or diagnostic characteristics were associated with having more than one out-of-home stay during the year. Among those who received out-of-home care during a 1 year period, 36% received care in residential treatment only, 32.4% in general hospitals only, and 17.6% in psychiatric hospitals only, while 14.0% used more than one sector of out-of-home care. Boys, teenagers, and youth in foster care or diagnosed with emotional disturbance or hyperkinetic syndrome had higher odds of receiving care in residential treatment only whereas girls, youth age 19–21, and those with depressive and stress and adjustment disorders had higher odds of receiving care from hospitals only. Teenagers and youth in foster care had higher odds of having more than one stay. Among those with more than one stay, there were 300 patterns of care and nearly half received care from more than one service sector. The implications for services and policy are discussed. Further research is needed to understand patterns of out-of-home care and the factors that influence placement decisions.     

A Secondary Analysis of Perceptions of Quality of Life of Older Adults Residing in a Nursing Home and Assisted Living Setting Using an Integrated Conceptual Model of Measurement

Quality of life is difficult to measure but is fast becoming the standard for long-term care. A secondary analysis was conducted of quality-of-life perceptions of older adults residing in a nursing home and then an assisted living facility from the perspectives of older adults and their family members/friends. This study shows that using a comprehensive integrated model that incorporates six major life domains of physical well-being, social well-being, psychological well-being, cognitive well-being, spiritual well-being, and environmental well-being into the assessment process appears to be a promising approach to determining quality-of-life perceptions of older adults. Findings also suggest that healthcare and human services professionals should place more reliance on indicators of social and environmental well-being, including opportunities for choice, when striving to maximize quality of life of older adults. As the demographic composition of the United States changes, policies and services will need to be modified to accommodate the changing needs of older adults in a way that optimizes perspectives of quality of life.