Services and outcomes for transition-age foster care

0 downloads 0 Views 202KB Size Report
Jun 8, 2011 - Full Terms & Conditions of access and use can be found at ... Vulnerable Children and Youth Studies ... To cite this article: Mary E. Collins & Rolanda L. Ward (2011) Services ... the United States regarding the transition-related services they ... outreach program to assist youth with the transition from care.
Vulnerable Children and Youth Studies An International Interdisciplinary Journal for Research, Policy and Care

ISSN: 1745-0128 (Print) 1745-0136 (Online) Journal homepage: http://www.tandfonline.com/loi/rvch20

Services and outcomes for transition-age foster care youth: Youths' perspectives Mary E. Collins & Rolanda L. Ward To cite this article: Mary E. Collins & Rolanda L. Ward (2011) Services and outcomes for transition-age foster care youth: Youths' perspectives, Vulnerable Children and Youth Studies, 6:2, 157-165, DOI: 10.1080/17450128.2011.564226 To link to this article: http://dx.doi.org/10.1080/17450128.2011.564226

Published online: 08 Jun 2011.

Submit your article to this journal

Article views: 261

View related articles

Citing articles: 4 View citing articles

Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=rvch20 Download by: [Boston University]

Date: 21 October 2015, At: 03:25

Vulnerable Children and Youth Studies Vol. 6, No. 2, June 2011, 157–165

Services and outcomes for transition-age foster care youth: Youths’ perspectives Mary E. Collinsa * and Rolanda L. Wardb a

Department of Social Welfare Policy, Boston University School of Social Work, Boston, MA, USA; Department of Sociology, Anthropology, Social Work and Criminal Justice, State University of New York – Fredonia, Fredonia, NY, USA

Downloaded by [Boston University] at 03:25 21 October 2015

b

This article reports findings from a study of 96 former foster youth in one state in the United States regarding the transition-related services they received (both prior to and after age 18 years) and the outcomes achieved since age 18. At the time of the survey, approximately 60% of the sample was in the voluntary care of the state agency. Quantitative data describe the services received and outcomes achieved. Qualitative comments provide further feedback about young people’s perceptions of services. Many statutory and private child-serving agencies continue efforts to develop services to meet the needs of this population. Study findings have implications for further development of these services to assist youth at the time of transition. Keywords: adolescent foster care; adolescent transition; independent living services

Introduction Research focusing on adolescents’ transition from foster care to independence is relatively small in comparison to other areas of child welfare. The bulk of the research literature has focused on documenting poor outcomes for this population. Much of this research has been conducted in the United States and the United Kingdom (e.g. Courtney & Dworsky, 2006; Dixon, 2008). Challenging circumstances facing this population have also been identified in other countries (Benbenishty & Schiff, 2009; Höjer & Sjöblom, 2010; Mendes, 2009; Snow, 2009), although these reports have been limited to industrialized nations. As these poor outcomes have now been firmly established research has aimed to explain variation in outcome, including differences in national policy (e.g. Stein, Pinkerton, & Kelleher, 2000) or within different jurisdictions of a country (e.g. Courtney, Dworsky, & Pollack, 2007). Other studies have described the decisions of youth to stay in care when eligible (e.g. McCoy, McMillen, & Spitznagel, 2008) and qualitative experiences during the transition process (e.g. Samuels & Pryce, 2008). There is accumulating evidence that specialized services can be of help to young people during the transition process (Cook, 1994; Reilly, 2003), but questions remain regarding the necessary type, quality and characteristics of services. Youth perspectives on services are a critical area of research. The current study contributes to the literature by examining self-reported services received and outcomes attained for a sample of youth from one US state (Massachusetts). The State of Massachusetts has been active in working to provide

*Corresponding author. Email: [email protected] ISSN 1745-0128 print/ISSN 1745-0136 online © 2011 Taylor & Francis DOI: 10.1080/17450128.2011.564226 http://www.informaworld.com

158

M.E. Collins and R.L. Ward

support to this population. The Department of Social Services (DSS) offers an adolescent outreach program to assist youth with the transition from care. Youth who receive services from this program are assigned a worker to assist with accomplishing transition-related tasks. Other support is available to youth; for example, including a specialized life skills training curriculum, educational assistance and access to health insurance. Further, state policy allows young people to continue in care up to age 22 if they comply with a plan that includes education and/or employment.

Downloaded by [Boston University] at 03:25 21 October 2015

Method The study was a retrospective survey of youth who had turned 18 while in care. The study was reviewed by the authors’ university Institutional Review Board as well as the Research Committee of DSS. According to agency data, 660 youth turned 18 while in foster care in 2005, and these youth were the target sample. Because of confidentiality restrictions, efforts to contact youth involved a letter sent by the state agency to the last known address of the youth. The letter described the study and requested that the youth telephone the project hotline number if interested in participating. Four different mailings were conducted in attempts to reach potential interview subjects. Additionally, recruitment materials advertising the study were sent to approximately 700 social service agencies to be posted in public places. Also, throughout the duration of the field period, we contacted by telephone, letter, e-mail or in-person numerous agency personnel likely to be in contact with this population, requesting that they publicize the study and refer any eligible youth. The survey instrument consisted primarily of closed-ended items, with some openended questions to allow the young person the opportunity to provide feedback in his/her own words and style. Content included: services received, perceived helpfulness of services, feedback about experiences while in care, risk behaviors, current outcomes, goals and demographics. Youth who called to participate were screened to insure they were: (1) aged over 18 and (2) turned 18 while in foster care. Those who turned 18 in 2005 were the initial target, but we chose to include those who asked to participate who had turned 18 in either 2004 or 2006 (n = 25). The interview was then assigned to a trained interviewer to conduct the in-person interview [youth out-of-state (n = 4) were interviewed by telephone]. A half-day training session was provided to interviewers. Interviews took approximately one hour. Written informed consent was obtained. Incentives included a payment of US$25 and inclusion in a raffle for an iPod. A list of human services resources was provided to all respondents. A total of 105 young people telephoned the project hotline and 96 interviews were completed. Survey data were analysed using SPSS. Qualitative data collected in response to openended questions were handwritten by interviewers. These data were later entered into a word-processing program for analysis. The data were grouped thematically to identify common versus unique experiences. Common experiences are summarized in the presentation of the findings. Some of the more unique and detailed illustrative quotes are presented to provide added depth to the quantitative results. Self-reported demographic data are presented in Table 1. Findings Services received Fifty-two per cent reported that they had an outreach worker while in care, but approximately one-third of the respondents reported being unaware of the adolescent outreach

Vulnerable Children and Youth Studies

159

Table 1. Demographics (n = 96).

Downloaded by [Boston University] at 03:25 21 October 2015

Demographics Gender Male Female Transgender Race/ethnicity Black/African American Latino/Hispanic White Other Language English Spanish Other Sexual orientation Heterosexual Gay or lesbian Bisexual Not sure Current marital status Single Married Separated/divorced Living with partner Has child living with them

n

Percentage

34 60 2

35 63 2

25 23 42 6

26 24 44 6

96 27 14

100 28 15

81 5 8 2

84 5 8 2

80 2 2 12 14

83 2 2 13 15

program. Responses from adolescents who had been involved in the adolescent outreach program commonly identified help in applying to college and assistance with financial needs. There were also comments about the workers’ ability to be caring, honest and consistent; for example: [The outreach worker] is always on time. She seems like she really cares about any minute problem I have. She would email me every day when I was getting into college. She would send me examples highlighted of how to fill things out. One time I wasn’t treated well by [DSS] – she went right to the office and the problem was straightened out in a few days.

Although many respondents were quite positive, others identified areas that needed improvement. Examples of these types of comments included the following: They should give us a little more space and respect our boundaries too. I have my priorities too. I don’t need to be babied. If I had a worker that is from [my city] instead of [nearby city]. She doesn’t know much about resources [in my city].

In addition to the outreach program, respondents were asked to identify the services that they received both prior to and after age 18. Table 2 provides these data on the frequency of various services received. For each service category, fewer youth received services post-18 compared to pre-18. Accessing health care was the most frequently received service at both time-periods. Prior

160

M.E. Collins and R.L. Ward Table 2. Services received (n = 96).

Downloaded by [Boston University] at 03:25 21 October 2015

Completing HS or GED Reconnecting with family Employment services/job training/job search Life skills training Accessing health care Housing assistance Other service

Before 18% receiving service

After 18% receiving service

n

%

n

%

44 51 36

46 53 38

39 20 32

41 21 33

63 80 46 54

66 83 48 56

27 59 42 37

28 62 44 38

Notes: HS, high school; GED, general educational development.

to age 18, 66% of youth received life skills training. Approximately half the sample received help completing high school or general educational development (GED), help reconnecting with family, housing assistance or “other service”. After age 18 the pattern of services received was different. Fewer services were received, and the only category in which more than half of respondents received assistance was “accessing health care”. For each category, youth were asked to describe the help received. Summary comments of the range of responses are provided below, with some verbatim examples. High school/GED Responses were generally positive for this service, albeit brief. Respondents spoke about assistance with enrollment and completion of educational programs, via tutoring, special programs and encouragement; for example, “DSS helped me find a school. An alternative diploma school. My DSS worker gave me incentives to stay in school – she would take me out”. Reconnecting with family Responses identified a range of efforts to reconnect the youth with family while in care and included positive, negative and neutral experiences. The outcome of this service was sometimes not what the young person hoped for but, in general, DSS efforts were not blamed for the poor outcome. The range of responses suggests that efforts at reconnection are fraught with challenges. . . . Their motto was: if the family wants to be involved, then they can. Main purpose was to keep me out of trouble. A lot of time they deny your request for a visit. Sometimes the family don’t want to have a [background] check because they like to keep things private. The DSS worker worked with my mother to schedule visits, but going back home was never the plan. Mom never came. . . . They made us do family therapy because reunification was the goal before 18. Family therapy was the most we did. Even though it wasn’t in my best interest, DSS and worker’s supervisor made me go through the process. I wanted to go into IL [Independent Living]. They made a deal with me, if I did eight sessions and after I graduated from high school, then I could find a place.

Vulnerable Children and Youth Studies

161

The efforts at reconnection are different after age 18, as this would no longer be the role of DSS. For example, one respondent stated: “They gave me more freedom to call my family and gave me choice of members that I’d like to see and visit and get to know. I was able to call anyone after I turned 18, without DSS approval. They made decisions before but now it’s up to me about where I go although I still have to follow program rules”.

Downloaded by [Boston University] at 03:25 21 October 2015

Employment services The responses in this section suggested primarily concrete activities, such as help with résumés, applications, transportation to interviews, shopping for work clothes and connecting to employment programs and specific jobs. A particularly successful story is the following: My adolescent outreach worker told me I should volunteer at [program]. DSS paid me a stipend at the end of the summer. [The program] liked me so much that after the summer they hired me and I work there today. Before she suggested that I volunteer she helped me search for a job on the Internet. We filled out a few applications but then the volunteer opportunity came up and I took it.

A less successful story is the following: . . . Not allowed to work much because they have to limit your freedom so you don’t get in trouble. Then no work history, it’s difficult to get a job now at 18. This has been frustrating to me. I’ve always wanted to work but was unable to.

Life skills training Many respondents listed the type of life skills they learned, including banking, laundry, grooming, cooking, shopping and cleaning. Most comments on this topic were brief and simply listed the skills. A few respondents, such as the following, provided more depth: I was 17 and they gave me a worker . . . At first I brushed her off when she said she would work with me, I said “no”. She kept trying though . . . To this day I am more independent because of the [life skills training]. It gave me motivation. It helped me with everything. I accomplished a lot.

Health care The responses regarding health care were straightforward, suggesting that the DSS worker, foster parent or program staff member helped the young person to enroll in the state medical insurance program. Occasionally, the respondent also commented on receiving assistance finding a doctor or dentist, gaining access to medication and transportation to appointments. A more unique experience was described by one respondent: “ . . . At age 16, I was hospitalized and about to be intubated and my social worker came to be with me which was really nice. Foster parents also helped and took time off to stay with me”. Housing assistance The intent of asking about housing assistance was to determine assistance youth received in securing housing after age 18. However, respondents talked primarily about receiving

162

M.E. Collins and R.L. Ward

Downloaded by [Boston University] at 03:25 21 October 2015

assistance with placement into foster homes, group settings or independent living programs. One respondent, for example, stated: “All the programs put a roof over my head. DSS did a lot for me in terms of finding a program that meets my needs”.

Services needed but not received Youth were asked whether any of the listed services that they had not received would have been helpful to them. Sixty-one respondents (64%) stated that some of these services would have been helpful to them before age 18; 58 respondents (60%) stated that some of these services would have been helpful to them after age 18. Table 3 provides the frequencies of affirmative responses for each service. The data suggest that housing assistance was the greatest perceived service need. Also important were educational assistance, especially before age 18, employment assistance at both time-periods and life skills training, especially after 18.

Outcomes Data on several core outcome domains are provided in Table 4.

Housing Most frequently, respondents were living on their own (32%), but many were living with relatives. The percentage reporting ever having been homeless since age 18 appears substantial (37%) [the survey question asked: “Have you been homeless at any time since turning 18?”]. Respondents were asked to describe the circumstances leading to their homelessness. Review of these data suggested several were “kicked out” or asked to leave by a program, DSS or foster home (n = 10). Others were “kicked out” by a landlord or the family or friends they had been living with (n = 7); for example: “I was living in [city]. A friend invited me to [different city] to move in. I saw it as an opportunity to get out from DSS rules. I signed out from DSS. I lived with my friend for two weeks. Her boyfriend didn’t like me. He said he wanted me out and I moved to a shelter”. Another category of respondents included those who chose to be on their own (n = 4); for example: “I wasn’t liking my situation, wanted to be my own person and get out on Table 3. Services not received that would have been helpful. Before 18 (n = 61)

Completing HS or GED Reconnecting with family Employment services/job training/job search Life skills training Accessing health care Housing assistance Other service All the above

After 18 (n = 58)

n

%

n

%

14 3 12 7 1 18 5 1

23 5 20 12 2 30 8 2

9 2 11 10 3 20 1 2

16 3 19 17 5 35 2 3

Notes: HS, high school; GED, general educational development.

Vulnerable Children and Youth Studies Table 4.

163

Outcomes (n = 96).

Downloaded by [Boston University] at 03:25 21 October 2015

Percentage Outcome

n

%

Ever homeless since age 18 Enrolled in High school GED program Job training program College Employment Currently employed Working >20 hours per week (n = 43) Wage >US$8.00 per hour (n = 41) With health benefits (n = 42) Total monthly income Able to save money Amount of savings (n = 37) Perceived excellent or good physical health Perceived excellent or good emotional health Currently have health insurance Able to see health-care provider in past year (n = 94) Able to see counselor/therapist in past year (n = 69) Seen dentist in last 6 months

35

37

51 17 28 41

53 18 29 43

44 46 24 55 18 43 5 12 Mean = US$621 (SD = US$500) 41 43 Mean = $900 (SD = US$1248) 29 70 47 49 87 90 89 95 60 87 60 63

Notes: HS, high school; GED, general educational development; SD, standard deviation.

my own . . . I’m still in DSS care, but was considered on the run for that time”. Other respondents’ explanations provided insight into the challenges of finding a home for former foster youth. For example, one respondent stated: “I’ve never actually lived on the street but I’ve never had anyplace to call home. I’ve bounced from house to house”. Education and training Data on educational outcomes identified that prior to turning 18 youth in the sample attained the following educational achievements: completed GED program (9%), completed high school (21%), completed college course(s) (6%) and completed “other” education (3%). Many continue on an educational path post-18. Only 9% of the sample reported no educational or job training activities after age 18. Employment Fewer than half of the respondents were employed. Of those employed, slightly more than half were working more than 20 hours per week (55%) and fewer than half were earning more than $8.00 per hour. Only 12% received health benefits through employment. Despite these job characteristics, employment was the chief source of income for most of the sample. Health Although 70% perceived themselves to be in excellent or good physical health, fewer than half (49%) rated their emotional health at this level. Most were able to see health care providers or counselors when needed.

Downloaded by [Boston University] at 03:25 21 October 2015

164

M.E. Collins and R.L. Ward

Discussion Only about half the sample received specific transition assistance from the adolescent outreach program and many had never heard of this program. More access to this transition support is needed, particularly as it is viewed quite positively. The limited criticism of the program was the lack of a sufficient number of workers to meet the needs of all youth who are eligible for outreach services. With regard to the specific services youths received, feedback regarding housing and reconnecting with family was most provocative. We found it illuminating that when respondents were asked to describe the housing assistance that they had received they often spoke of foster care or program placements. From their long experiences in care it appears that some youth equate “housing” with “placement”. These types of responses indicate that more work is needed to assist youth in understanding and conceptualizing their after-care housing situation. Responses regarding reconnecting with family were thoughtful, and provide insight into a difficult reality. Although these were short qualitative responses rather than in-depth interviews, their brevity highlighted their poignancy (e.g. “mom never came”). Efforts to reunify youth with their family frequently do not work, despite numerous studies that have found that former foster youth often reconnect and sometimes reside with family members after emancipation (Collins, Paris, & Ward, 2008). Greater understanding regarding the family relationships after care is needed to identify potential factors that may assist with reunification at earlier stages. In the area of youth transitioning from foster care, there has been increasing attention to the need to include the youth’s voice in their own service plan. Consequently, we paid specific attention to youths’ responses to questions about services they did not receive that would have been helpful. The data suggested that housing assistance is the greatest perceived service need. Also important was employment assistance. Virtually all studies of former foster youth have identified the threats of homelessness and unemployment. Thus, we do not believe these needs are unique to young people in Massachusetts, and recommend these needs receive priority if we want to be true to the concept of “youth voice”. The data regarding outcomes were generally consistent with other research on this population. Again, a few outcomes were particularly striking. Health outcomes were mostly positive, in part because this population is entitled to health care coverage. The notable exception to good health was that fewer than half (49%) reported excellent or good emotional health. This may reflect an indication of clinical depression or more general states of isolation, loneliness or sadness. Conclusion and limitations The study reported here is limited by the design, which lacked both pretest data and a comparison group. Moreover, the sample was not selected randomly. These design factors limit generalizability. Additionally, like most studies, there were limitations in the amount and type of data that could be gathered. In particular, the study did not collect data on the socio-economic background of these youth. Economic vulnerability, and its associated risks, may be a key part of explaining poor outcomes. Despite these limitations, the study contributes to the knowledge base regarding the range of services that might be provided to young people as they leave care. Many jurisdictions in the United States (states and counties) and in many other countries in the world are designing programs and services to meet the needs of this population. The qualitative

Vulnerable Children and Youth Studies

165

data hint at rich stories of these young people’s lives and experiences with social service systems. Further in-depth research regarding experience with the systems highlight the complicated realities which need to be acknowledged to inform realistic policies. Acknowledgement This project was funded by the Home for Little Wanderers.

Downloaded by [Boston University] at 03:25 21 October 2015

References Benbenishty, R., & Schiff, M. (2009). Perceptions of readiness to leave care among adolescents in foster care in Israel. Children and Youth Services Review, 31, 662–669. Collins, M.E., Paris, R., & Ward, R. (2008). The permanence of family ties: Implications for youth transitioning from foster care. American Journal of Orthopsychiatry, 78, 54–62. Cook, R. (1994). Are we helping foster care youth prepare for their future? Children and Youth Services Review, 16, 213–229. Courtney, M.E., & Dworsky, A. (2006). Early outcomes for young adults transitioning from out-ofhome care in the USA. Child and Family Social Work, 11, 209–219. Courtney, M.E., Dworsky, A., & Pollack, H. (2007). When should the state cease parenting? Evidence from the Midwest Study. Chicago, IL: Chapin Hall Center for Children. Dixon, J. (2008). Young people leaving care: Health, well-being and outcomes. Child and Family Social Work, 13, 207–217. Höjer, I., & Sjöblom, Y. (2010). Young people leaving care in Sweden. Child and Family Social Work, 15, 118–127. McCoy, H., McMillen, J.C., & Spitznagel, E. (2008). Older youth leaving the foster care system: Who, what, when, where, and why? Children and Youth Services Review, 30, 735–745. Mendes, P. (2009). Young people transitioning from out-of-home care: A critical analysis. Australian Social Work, 62, 388–402. Reilly, T. (2003). Transition from care: Status and outcomes of youth who age out of foster care. Child Welfare, 82, 727–746. Samuels, G.M., & Pryce, J.M. (2008). “What doesn’t kill you makes you stronger”: Survivalist selfreliance as resilience and risk among young adults aging out of foster care. Children and Youth Services Review, 30, 1198–1210. Snow, K. (2009). The case for enhanced educational supports for children in public care: An integrative literature review of the educational pathway of children in care. Vulnerable Children and Youth Studies, 4, 300–311. Stein, M., Pinkerton, J., & Kelleher, P. (2000). Young people leaving care in England, Northern Ireland, and Ireland. European Journal of Social Work, 3, 235–246.