Former Foster System Youth: Perspectives on Transitional Supports and Programs

Abstract

Youth aging out of the foster care system have well-documented challenges when transitioning to adulthood. Multiple transition services provide support in the transition process; however, limited research is available regarding youth’s perceptions of programming. In this pilot study, sixteen youth between ages 18 and 20 participated in semi-structured interviews, support mapping, and resiliency measurements to gather the experiences of the transition from foster care. Comparisons between those who chose initial transition supports and those who did not receive or delayed receiving transition supports were initially explored. Common themes emerged in participants’ needs and perceived resiliency regardless of transition support services. All youth reported relationship, trust, and concern for well-being as highly important characteristics in transition team members. A need for earlier transition programming, decision-making opportunities, and life skills courses were important themes in transition programming needs. Implications for policy, research, and practice are presented based upon findings.

Introduction

Foster youth transition out of system care between the ages of 18 and 21. Every year, approximately 24,000 adolescents make this transition within the USA.¹ By the age of 26, 40% of these discharged adolescents have experienced homelessness and many have experienced difficulties in maintaining consistent transportation which affected their work, education and relationships.^{2, 3} Forty six percent of these youth have received their diploma or GED and 3% have obtained their bachelor’s degree.³

To improve outcomes, multiple transition programs exist and fall within one of three categories: (1) permanency supports; (2) sustainable social capital supports; (3) postsecondary access and success supports.² Permanency supports include housing, health care, transportation, employment, and financial support.² Sustainable social capital supports include programs that focus on mentorship, self-advocacy skills, life skills, and well-being.² Postsecondary access and success supports include programs that are centered around vocational training, interviewing skills, college assistance, and tutoring.²

Despite the volume of programs, there is very limited evidence on the effectiveness of the programs, or participant’s perceptions of these programs. Large scale studies such as the Midwest study by Courtney et al. report outcomes of the individuals who have transitioned out of care but do not link these outcomes to program participation.⁴ Smaller studies have reported outcomes of programming, such as a 2004 study regarding transitional living services in Northern California.⁵ However, small sample sizes and study design do not provide conclusive evidence. Measurement of hourly wages and housing situations 6 months post-discharge are not necessarily a measure of program effectiveness but could be correlated with additional factors post-discharge since there is no comparison group. A 2014 issue brief by the US Department of Housing and Urban Development discussed the importance of evaluating housing programs for this population, the barriers to evaluating them, and how the field can move forward to build the evidence base in this area as it is currently lacking.⁶

Access to transition services for foster youth throughout their transition into young adulthood has its own challenges post-discharge. Barriers reported to accessing these services include displacement pre- and post-discharge, learned helplessness, and a lack of trust.^7–10 Placement permanency within foster care has a significant effect on the positive and negative outcomes foster youth experience. Adolescents who enter foster care between the ages of 11 and 14 are less likely to receive permanent placements and may experience as many as 13 placements before discharge.¹¹ Experiencing higher placement rates negatively impacts youths’ future outcomes and their independent living skills. These youth are less likely to gain a substantial work history, or to receive their GED, diploma or independent living services.¹¹ These youth are also more likely to have unmet behavioral health needs, abuse substances and become incarcerated.¹¹ Foster youth are given few opportunities to practice their decision making skills within foster care, and this lack of opportunity creates learned helplessness in young adults.^{7, 8} Lack of trust may also occur when youth have feelings of distrust towards the foster care system and child protective services and therefore want to avoid further contact or turn to this system for further aid.^{9, 10}

According to the literature, placement permanency, financial aid, having a mentor, feeling empowered, and being goal oriented encourage access and use of transition services.^{7, 9} While high placement rates were cited as barriers earlier, low placement rates or a permanent placement contribute to the likelihood of foster youth utilizing transitioning services.⁷ The additional burden of physically relocating upon discharge may be alleviated if youth voluntarily stay in foster care for an additional 6 months post-discharge.⁹ Receiving financial aid also contributed to youth accessing further services like transition services.⁹ Feeling empowered and having goals for the future were cited as positive contributions to youth accessing transition services.^{7, 9}

Previous research has found that foster youth felt successful transitions occurred when one or more of the following were present: awareness of available services and opportunities, positive experiences within foster care, reliable transportation and communication, job security for the first year post-discharge, full-time student status, transition support utilization, and at least one consistent and committed person.^{12, 13} Events that negatively impacted youths’ transition included the following: unemployment, lack of health insurance and education, poor relationships, financial and legal issues, and feelings of disempowerment.^12–18

Previous research also examined perceived resilience in this population and the relationship of resilience to perceived success—e.g., maintaining housing, employment, educational status—following aging out.^19–22 Resiliency is defined as the ability to “successfully overcome significant adversity, despite exposure to multiple high risk situations.”^23(p30) Identified factors that increase resiliency include having a sense of identity, future expectations and goals, a support system, and independent living skills.^19–22 Factors that decrease resiliency include having behavioral and external problems, and either living with a family member or contacting a family member post-discharge.²¹ However, no past research has used a validated resiliency measurement tool to measure resiliency or describe youth who have recently transitioned out of care.

Purpose

Many factors have been identified regarding facilitators and barriers to successful transition and the importance of resiliency during transition processes. Yet to date, minimal research exists documenting the youths’ overall perceptions of transition programs, reasons for choosing to participate, and what the youth feel is needed to improve transition programming. Currently available research regarding youth’s perceptions of transition programs overall is limited. Typically reported are perceptions about one aspect of transition, such as health care or education. No studies to date have reported what youth see as overall strengths and needs.

This community-engaged pilot project was completed in partnership with regional foster care youth providers in order to inform the development of transition programming. The study objectives were the following: (1) To identify what foster youth see as their strengths during the transition into adulthood; (2) To identify what foster youth see as their needs during their transition into adulthood; (3) To explore what drives post-discharged foster youth to utilize transition supports programs; (4) To understand what foster youth are provided upon discharge now and what would they change about these provisions; and (5) To understand how social networks and resiliency relate to decisions regarding transition services.

Methods

Design

In order to achieve the study objectives, the research team used a convergent parallel mixed-methods design, in which qualitative and quantitative data are collected and analyzed simultaneously.²⁴ In order to get a full understanding of the transition needs of foster youth, an area largely unexplored in research, a qualitative approach was necessary to allow for open discussion and understanding.²⁵ The quantitative data on social networks and resiliency, then complemented the qualitative data, by providing specific exploration of how these concepts influenced decisions regarding transition services.

Setting

The setting for study recruitment included four, youth-serving organizations in Maricopa County, Arizona. Organizations included both state-funded programs and not-for-profit transitional service providers in the region. Youth were provided the opportunity to choose a convenient community location for their participation in the study. At least one member of the research team met the participant in-person at a time and place of the participant’s choosing. Common locations selected by participants for data collection activities included the following: homes, coffee shops, and workplaces. The study team included four occupational therapy students and two occupational therapy faculty members from a local state university. Funding for the project was received from an intramural, university faculty-eligible research grant and all study procedures were approved by the university’s institutional review board.

Participants

Youth were recruited through convenience sampling. Outreach to foster youth occurred through both state-funded programs and not-for-profit transitional support services. A recruitment video and flier were created for all organizations. Recruitment fliers were distributed via case managers/case workers, youth themselves, and via concrete supports such as transition suitcases for youth who were currently in transition. Transition suitcases may be provided to youth in congregate care on his/her 18th birthday and contain items like toiletries, linens, bus passes, and gift cards.

Study participants included youth who utilized transition services (N =11), and youth who did not initially choose services but delayed access to transition services or did not utilize any services (N = 5). Demographic data was collected including participants’ gender, age, ethnicity, highest level of completed education, employment status, food scarcity, and transitional housing history (number of places lived, relying on others for housing, homelessness, current living situation). Overall, the sample included 8 women and 8 men with a mean age of 18.69 (SD=0.79). Additional demographic data of the sample by transition status can be found in Table 1.

Table 1.

Demographic data

	Group A (N = 11)	Group B (N =5)
Sample size	11	5
Gender (N, % female)	5 (45)	3 (60)
Age (mean years ± SD)	18.3 ± 0.48	19.2 ± 0.84
Ethnicity (N, % of group)
Caucasian	8 (73)	1 (20)
Hispanic	7 (64)	2 (40)
Other	4	3
Employed (N, % of group)	5 (46)	2 (40)
Places Lived (N, % of group)
1–2	11 (100)	0 (0)
> 3	0 (0)	5 (100)
Disparities experienced (N, % of group)
Housing reliance	2 (18)	4 (80)
Homelessness	1 (9)	3 (60)
Food scarcity	0 (0)	3 (60)

Group A—youth who utilized transition services; group B—youth did not initially choose services but delayed access to transition services

Instruments

All participants engaged in one-on-one in-person sessions which ranged from 40 min to 2.5 h. During this session, they completed an in-depth interview and completed the Child and Youth Resilience Measure (CYRM) and the Support Network Assessment for Practice (SNAP). The in-depth interview addressed study objectives 1–4 and the CYRM and SNAP addressed study objective 5.

Interview

The interview protocol included both closed-ended and open-ended questions. Interviews were recorded, de-identified, and stored in a password protected drive. The purpose of the interview was to explore perspectives of foster youth to answer research questions 1–4. Closed-ended questions included demographic information and questions regarding number of placements, and education and employment history. The open-ended questions explored the following topics: specific transition programs and resources utilized (or not utilized), youths’ perceptions of the provided transition resources, and transition resources they believed were missing.

Child and Youth Resilience Measure

The CYRM was utilized to determine if resiliency or perceived resiliency was an important factor in choosing supports, since this research has yet to be measured quantitatively. The CYRM is a measure of the resources available to individuals that may bolster their resilience.²⁶ Respondents answer questions regarding individual, relational, communal, and cultural resources that may impact their resilience. The 12-item CYRM was chosen for its brevity with a 3-point Likert scale for responses (1 = No, 2 = Sometimes, 3 = Yes). The twelve questions were as follows: (1) I have people I want to be like; (2) Getting an education is important to me; (3) I feel that my parent(s)/caregiver(s) know a lot about me (for example, who my friends are, what I like to do); (4) I try to finish activities that I start; (5) When things do not go my way, I can fix it without hurting myself or other people (for example hitting others or saying nasty things); (6) I know where to go to get help; (7) I feel that I belong at my school; (8) I think my family cares about me when times are hard (for example if I am sick or have done something wrong); (9) I think my friends care about me when times are hard (for example if I am sick or have done something wrong); (10) I am treated fairly; (11) I have chances to learn things that will be useful when I am older (like cooking, working, and helping others); (12) I like the way my community celebrates things (like holidays, festivals).

Support Network Assessment for Practice

The Support Network Assessment for Practice (SNAP) was utilized as a tool to provide evidence of relationships/supports and to examine if specific patterns exist within the two groups.²⁷ The SNAP includes four quadrants titled: People I Consider Family, Friends, School/Work, and Community. Within those quadrants, participants listed individuals in their lives who have supported them in the past year and then described the types of support those individuals provided as emotional support, informational support, or concrete support. Then lines are drawn between people indicating the strength of their relationship (i.e., strong, neutral, or weak).

Data Collection

Youth who received study information reached out to the principal investigator via email, phone call, or text message. At that time, further questions about participation were answered and appointments were established for those wishing to participate. One or two members of the research team met with individual participants at a location of their convenience. The individual meetings took between 45 and 120 min. After obtaining informed consent, the youth completed the SNAP, followed by the interview, and finally completed the 12-item CYRM. Youth were given gift cards for participation. One $25 Visa gift card was provided for transportation costs and one $25 gift card (youth chose between Amazon or Target) was provided for their time.

Data Analysis

Interview

The interviews were recorded and transcribed verbatim and coded by two researchers for themes. Interviews were coded and analyzed using the framework method, a form of thematic analysis, which allows for an inductive and deductive process to determine common themes.²⁸ The framework method is comprised of seven stages: (1) transcription of interviews; (2) becoming familiar with interview data by reviewing transcripts; (3) coding the transcripts; (4) developing an working analytic framework consisting of codes and themes; (5) applying the analytic framework to existing interview data; (6) charting the coded data into the analytic framework matrix, and (7) interpreting the data by reviewing the framework matrix. Each researcher initially coded transcripts alone and then two researchers met to review transcripts for themes to reach consensus. Additionally, data from the demographic closed-ended questions was analyzed. Descriptive statistics were completed to examine frequencies, variability, and central tendency of demographic variables of youth electing transition services and youth delaying transition services of two groups. Chi-square statistics examined demographic differences between the two groups.

Child and Youth Resilience Measure

CYRM response distributions were summed and examined to determine appropriate tests for overall and between-group analysis and correlations examined relationships between sub-scales and overall resiliency score, and whether the services were used or delayed. The 28-item CYRM has been validated using confirmatory factor analysis to have three individual sub-scales: individual capacities/resources, relationships with primary caregivers, and contextual factors that facilitate a sense of belonging. Previous validation of sub-scales using the 12-item CYRM has not been completed. Thus, 12-item CYRM sub-scales were scored based on the 28-item factor analysis results. For contextual factors that facilitate a sense of belonging, questions 2 and 7 comprised the educational (questions 2 and 7) sub-score, and questions 1, 10, and 12 comprised the cultural sub-score. For individual capacities and resources, questions 6 and 11 comprised the social sub-score and questions 4 and 5 comprised the personal sub-score. Resilience in the relationship sub-scale was scored using questions 3, 8, and 9. All analyses were conducted using SPSS for Windows, version 25, with significance threshold for all statistical procedures set at p < 0.05. Kendall’s tau correlation statistic, appropriate for non-parametric data in small samples, was utilized to determine correlations between CYRM 12-item sub-scales.²⁹

Support Network Assessment for Practice

Using SNAP, the network size was indicated for each participant by the total number of names listed within all four categories (people I consider family, friends, school/work, community).²⁷ The network range was defined by the number of categories that contain at least one person (0–4).²⁷ Mean support type was categorized for each group and the overall sample. The total number of supports (emotional, concrete, and information) were recorded along with the mean number of supports supplied by each person listed in the SNAP.

Results

Participant Characteristics

Descriptive statistics (Table 1) show the majority of group B (individuals with a gap in transition service or no transition services) was female (N = 3, 60%) while group A (individuals without a gap in receiving transition services) was mostly male (N = 6, 55%). Average age between the groups were similar with group B (19.2 + − 0.84) being slightly older than group A (18.3 + − 0.48). Reported ethnicities varied with several participants reporting mixed heritage. The majority of group A participants reported (n = 8, 73%) Caucasian heritage and group B mostly identified as other heritage (n = 3, 60%).

Significant differences were found for the number of places lived, housing reliance, homelessness, and food scarcity between groups. Group A (those who proceeded directly into transition services) 100% had only lived 1–2 places, whereas those without or delayed services (Group B) 100% had lived in greater than 3 places. Only 18% of group A relied on others for housing, whereas 80% of group B had. Only 9% of group A had reported experiencing homelessness, in stark contrast to 60% of group B. No participants in group A had reported food scarcity, however 60% of group B had experienced lack of food or access to food.

Preliminary data analysis of both qualitative and quantitative data demonstrated little to no measurable difference between group A and group B on study objectives. The interview data did not reveal differences between groups and the quantitative analysis of CYRM scores between groups were non-significant (p > 0.05). Due to this, data was reanalyzed with the same methods as listed above only not as a comparison but using the entire, pooled sample in order to describe the answers to the research objectives. The only differences between groups A and B were related to their demographics and this finding was reported in the descriptive statistics regarding the study sample. However, all analyzed data is being reported collectively due to lack of differences on outcomes related to the study objectives. The following will present the qualitative and quantitative results regarding the five research questions.

Research Objective 1: To Identify What Foster Youth See as their Strengths During the Transition into Adulthood

A number of strengths were discovered that include individual qualities and skills that aided foster youth during their transition. Motivation, persistence, and determination were frequently mentioned while acknowledging the need for patience. Motivation was exemplified in one participant’s response, “I wanted to make sure that I was utilizing them [services] also to their full extent so that I knew, okay, if I need this for school and I don’t have it at the moment, what can I go to? Who can I turn to? What programs can I use to my advantage that can actually help me get to where I need to go? (Participant1B).” Despite their motivation, persistence, and determination, youth acknowledged change often did not occur immediately and relied upon patience.

Independence, responsibility, and discipline were highly valued strengths along with having hope and focusing on goals and aspirations. Independence was acknowledged often, “I took on my own behalf to actually go and apply for the jobs. I’m self-sufficient, independent in that sense (Participant13B),” coupled with self-reliance. Self-reliance was commonly framed as the following, “That’s one thing I’ve learned, I just can’t wait around for people. You just got to make it happen. If they can’t do it right, do it yourself (Participant8B),” and echoed by many participants. Responsibility was seen as taking care of themselves and others and discipline was acknowledged as a contributing factor of successful outcomes by participants. Additional required strengths included the ability to be financially competent. Youth noted the importance of personal advocacy skills as a strength in obtaining services and items of need. “Yes, you got to do the footwork, you got to do the talking. They would lead you, they will give you, but you got to do the talking. You got to do the mouth (Participant4B).” Many youth felt that growing up in the system drove them to be focused on giving back to other kids in the system. Many report wanting to work or become a mentor within the system in order to give back.

Positive relationships, with even one person, had a dramatic impact on many participants. Above all else, youth relied upon hope and future-orientation to navigate foster care and therefore became an asset through transition. Hope was so clearly defined by one participant when asked what advice s/he give peers during transition, “Just to hold on. No matter what difficulties there are, there’s even better coming up (Participant5A).”

Research Objective 2: To Identify What Foster Youth See as their Needs During their Transition into Adulthood

Identified needs include four categories: personal needs, environmental needs, concrete supports, and support services. All participants when asked questions regarding needs stated that the needs they had throughout transition and now, began while in care.

Personal Needs

Personal needs included autonomy, normalcy, safety, opportunities for decision making, boundaries, and permission. The need for autonomy was coded in multiple interviews as youth were forced out of group homes or living situations upon their 18th birthday. “I was celebrating my 18^th birthday at my group home… they contacted me midway through the birthday party, told me that they had to pick me up that day and take me (Participant 9A).”

The need for normalcy was highlighted as foster youth performed their daily routines often in different environments as they frequently moved from one living situation to the next. Normalcy was also needed in social contexts to model relationships and behaviors.

It’s hard for me to like be normal with people and a lot of times, I feel like being in foster care or being in jail for a whole bunch, like a long time, or being in boot camp, it made me weird. Like they make you act weird when they say ‘This is how you’re going to act in the world. This is how the world is,’ and it’s not. I mean they make you act some way and then like when I felt and I’m 18, like I don’t know what to do (Participant8A).

Environmental Needs

Environmental needs included safety, increased decision-making opportunities, and allowance to make mistakes, well-defined boundaries, and even some luck. Theft was commonly reported, which left participants feeling a need for safety. Decision making was reflected as the need to practice conflicts and issues youth may experience post-discharge. Two types of needs for permission were commonly reported, the permission to ask for help and permission to make mistakes. Reflecting on the year post-transition, a participant stated she finally learned,

It’s all right to ask for help basically. That it’s okay to reach out to someone if you need support. It’s okay to reach out to someone in behavioral health services if you’re breaking down over something or life gets so stressful that it’s okay to reach out to agencies and other case workers if you’re not getting the assistance that you need or something is not quite right (Participant1B).

The need for clearly defined boundaries and expectations with each of the many new environments youth encountered was reported. “Definitely what’s the rules inside, what can I get away with, what I can’t get away with (Participant9A).” This information may keep youth from experiencing homelessness, as one youth described, “When I broke one of the rules they’re like, ‘Okay. Well, take your bags, time to go’ (Participant13B).”

Concrete Supports

Concrete supports needed included household goods, technology, and personal items. Clothing, kitchenware, and bedding were commonly reported. Continually moving from one housing situation to the next, youth also needed luggage as their personal belongings remained in trash bags as they moved. Youth also mentioned the need for technology including cell phones and Wi-Fi. “I was going to different fast food restaurants using their Wi-Fi to apply for jobs (Participant 13B).” Most importantly, identification such as state IDs, driver licenses, birth certificates, and social security cards were needed as youth were unable to access most services prior to obtaining identification.

Support Services

Needed services identified included education, employment, food, finances, health with mental health, housing, transportation, and skill building. The need for information regarding available transition services was stated repeatedly. For education, scholarships and grants were needed along with subsidies to purchase technology and pay for performance tests to further their education. Needs within employment services included clothing for interviews, resume building and job interviewing skills, and transportation to and from. One participant remarked on the importance of his case worker who gathered clothing items for his job interview and provided transportation, “He took me to the interview and he bought me some – they’re really baggy but he bought me some slacks and a dress shirt really quick (Participant4A).”

The need for food services was echoed when youth recalled periods without food. The need for financial services included skills to budget and save, and utilize financial institutions. The need for an increase in allotted money was also expressed, “I would say just having like finance – you should be financially strong in the places that I needed to be… I could have paid certain debts. I could have maybe had a stable apartment. I could put some money in a savings account for later stuff that could happen (Participant13B).” Youth encountered difficulty in accessing and participating in financial institutions as many needed willing co-signers. Health services included health insurance for themselves and their children along with knowledge regarding benefits and eligibility, and the need for mental health services. One participant explained how mental health services were only provided as a reward. “I love my therapist, but when I was at a group home, they said I wasn’t going because I was doing bad things (Participant4B).” Housing services were needed including housing applications, searches and eligibility and houseware and furniture to fill their homes with. One participant reflected the importance of housing in their personal growth. “I needed a place to rest my head, and so that way I can develop myself (Participant9A).”

Transportation affected all of these services as youth needed to travel from one destination to the next to obtain and maintain services. Youth needed bus passes and to be aware of other transportation options when buses were limited or destinations needed to be reached in a timely manner. Lastly, life skills were needed and included in aforementioned services such as budgeting plus job and house searching. Youth also needed to develop social skills, personal awareness, and cooking and caretaking skills. Permanency was a repeated theme in interviews including the need for permanent, stable relationships. Within relationships, trust and honesty from adults and peers were also needed. Key phrases that emerged include listen to me, believe in me, and show me you care. The need for guidance and mentorship from adults and peers was heavily coded as well. Relationship permanence created trust of others, and was described as, “It has to be someone who’s like always kind of been there and helping me without knowing, kind of like someone who’s been there without like me having to ask him to be there (Participant11A).” Yet the impermanence of case workers and within foster care organizations was experienced by most participants.

There was always a different person, because that person was put on a different case or that person quit, or I don’t know – but yes, it was always a different person and they’d always ask me the same exact questions that the last maybe asked me or the last guy. So, it was like I feel like we never made any progress there (Participant11A).

Finally, guidance from adults and peers alike was needed—especially guidance from those who are tied to foster care in some manner. “But you still don’t know what you’re doing until you actually talk to people that have gone through it or that has seen others go through it and that could be of benefit to you (Participant1B).” Increasing the amount of adult guidance is later mentioned as an additional change to current transition services. Peer guidance and modeling fostered youths’ connections with others,

Peer support also increased the likelihood for some youths to pursue of transitional services, as one youth explained,

When I was meeting with other peer service provider - kids, they’re 19–20 years old, 21 years old I’m like, ‘What?’ They have all these new cars and their own place and they’re all in college. I’m like, ‘What is going on?’ At that time, I was like, ‘Okay, it’s time to submit to the program.’ I met so many kids who go to college and all these places. I’m like, ‘What?’ (Participant10A).

Research Objective 3: To Explore What Drives Post-Discharged Foster Youth to Utilize Transition Supports Programs

Services that youth were informed of and that seemed relevant and beneficial to youth increased youths’ likelihood to pursue transition services. Positive relationships with adults from foster care organizations including state run and not-for-profit organizations also impacted youths’ drive. Relationships defined by advocacy, guidance, and modeling increased communication with progress monitoring and encouraging words and beliefs increased youths’ drive to access services. Individual strengths previously mentioned were also a benefitting factor including initiation and future-orientation. Lack of options also appeared within the data as youth expressed lack of family or other resources to rely on—resulting in reliance of transition services.

Information regarding services available was the initial stepping stone for many youth. Positive relationships were also pertinent to youths’ decision, as one interviewee stated, “I’m in all these different programs because of my ILS [Independent Living Services] worker (Participant10A).” Relationships provided guidance and modeling as stated previously,

She really broke it down and she really listed all the programs that I need to do, and she actually was there with me. She’s like, “Okay, be there at a certain time. We’ll meet up at this certain time. We’ve got to do this at this certain time… like I was saying, if a kid can have a worker be there with them because they don’t know everything, they can’t do it all by themselves (Participant13B).

Utilization rates of transitional services also increased when mentors monitored youths’ progress, were available and willing to communicate and encouraged foster youth. One interviewee acknowledged the need for progress monitoring, “It helps to have someone who’s constantly checking in just to make sure I’m staying on top of things and asking what’s going on with me and stuff (Participant10B).” Youth also utilized services due to the lack of living options, as one participant stated, “I just made the choice because it was better than being homeless (Participant9A).”

Research Objective 4: To Understand What Foster Youth Were Provided upon Discharge and What Would they Change About these Provisions

Mentioned services provided upon transition include educational, health, financial, housing, and youth development. Educational services included the Education and Training Voucher (ETV), and health services included mental health, “If I needed it, I can talk to either my social worker to set up some groups for that (Participant4A).” Housing services were mentioned, yet no additional programs or services were discussed. However, many foster youth had difficulty recalling the names of programs and people they received services from and pinning which organization provided what form of assistance. Changes in transitional services included increased accessibility—both when searching for and applying for programs—as well as services that were more individualized. Improving communication while increasing guidance from those encountered in transitional services were also desired. The need to initiate services sooner was also highlighted.

Easily finding information regarding services and receiving services was emphasized as a needed change. One youth spoke of increased accessibility to allow youth to research transition services independently. “So I could look into it and see what is available to me when I did turn 18, because I feel like I found out about a lot of stuff late (Participant10B).” Change was also desired in the manner in which information was presented, “At least like way more in-depth from what it was, in a friendlier content space, so that way I have more of an idea of what I was getting into (Participant9A).” Some participants stated a need for a list of questions to ask regarding transition services and life skills. Another youth spoke of increased accessibility of receiving services as they attempted to re-enter foster care. “You don’t have to work so hard to get back into the system. Because through your whole life, you were in there so you don’t have to wait your whole life to get back in there (Participant8A).” Limitations in eligibility for services resulted in some youth experiencing homelessness. Creating a life skills course and also programs that were individualized for youths needs was also a welcomed change.

I’ll make a program where I would want to know what they would want to do in life before they actually get out there… Let’s say they want to do this in life, so we’ll push them and then we’ll get them in a school, let’s say, cooking, we can get them to a cooking school. After they’re done with that, because that’s their main interest, after they’re done with school we can start helping them with like – basically it will be like a life program, in a sense. After cooking school, we just get them with, ‘Do you want to get a car?’ And then - it’s just basically like all the things that they’ll need combined in one program (Participant13B).

Change was also desired in shifting encounters with foster care staff into supportive relationships with increased communication and guidance.

For communication, one youth suggested, “Maybe like twice a week just checking on your client, making sure they’re doing good, and if they need anything (Participant3A).” And for adult guidance, one participant envisioned change as, “If you could have case managers for each program, they can sit with the kid once a week and tell them – like, make a case plan. That would really benefit them a whole lot of better ways (Participant13B).”

Finally, change was desired for initiating transition services sooner along with adult and peer mentorship. Youth hoped transition services could begin as early 14 or 16. “I think more training, like starting younger, like the independent living training would be better. if I knew that before I was 18, I would have definitely taken that possibility (Participant6A).” For guidance, adult mentorship was envisioned as, “When you’re 16, you should be given one so that way, you have those two years to know and to learn about things so when 18 hits, you know what it’s going to be like (Participant4A).” And changes in peer guidance would include, “I feel like we should’ve met with more kids at a younger age. Kids who already transitioned out and they have lives set up already (Participant10A).”

Research Objective 5: How Do Social Networks and Resiliency Relate to Decisions Regarding Transition Services?

Child and Youth Resilience Measure

Overall, resiliency scores ranged from 12 to 36 (out of a possible 12–36 with a mean of 30.1 (SD = 5.78). Independent samples Mann-Whitney test of between-group differences found no statistically significant mean differences between group A and group B on the resiliency scale or any of the theorized sub-scales. Kendall’s tau test for relationship between non-parametric variables resulted in non significant correlations between use of services and sub-scales and overall resiliency score. Using all participants, relationships between services used/delayed and Individual Personal, Relationship, and the Resiliency Score Total were approaching significance. A p value approaching significance was also observed between use of services and the Context Cultural sub-scale in male participants.

While no significant correlations were found between the use/delay of services and CYRM 12-item scales of resiliency using the previously published 28-item scoring algorithms, there are notable results after stratifying by gender. The relationship between services used/delayed and contextual factors in cultural settings is largely driven by the male respondents indicating that choosing to delay services tended to result in a lower score on this sub-scale. Also noteworthy is the opposing trend between male and female respondents on the individual sub-scale of social skills. Larger scores indicated more resiliency, thus delaying services was related to a decrease in resiliency in females but an increase in resiliency in males. For example, male respondents delaying services tended to have higher scores on the questions of “I know where to go to get help” and “I have chances to learn things that will be useful when I am older” than their counterparts electing for services immediately. Whereas, female respondents delaying services tended to have lower scores on the same questions.

Table 2 shows the principal components analysis results conducted on the 12-item CYRM to test the existence of the same scales represented by the 28-item measure. These results verify 3 identifiable constructs. Questions 3, 7, 9, and 12 all contributed to a “Community Support” construct ( = 6.31) with loadings ranging from 0.81–0.99). An “Individual Support” construct was identified ( = 1.91) with loadings ranging from 0.45–0.99 from questions 1, 2, 4, 6, and 11. Lastly, a “Social Support” construct was identified ( = 1.19) from questions 5, 8, and 10 with loadings ranging from 0.56–0.90) (Table 3). Kendall’s tau test for relationship between non-parametric variables and new scales, again, stratified by gender (Tables 2 and 4), show a significant relationship (τ = − 0.716) between the use of services and Social Support in females, indicating positive responses on social support questions are significantly correlated with not using services in females.

Table 2.

Relationships between services use and resiliency/sub-scales of resiliency

	Use of services
	Total	Females	Males
n	16	8	8
Context education	− 0.178	− 0.323	0.000
Context cultural	− 0.331	−.063	− 0.662*
Individual-social	− 0.264	− 0.501	0.218
Individual-peer	− 0.425*	− 0.501	− 0.441
Relationship	− 0.429*	− 0.338	− 0.516
Resiliency score total	− 0.375*	− 0.253	− 0.369

Kendall’s tau correlation statistic

No significant differences (p > 0.05)

^*Notes approaching significance

Table 3.

Principal components analysis of the 12-item CYRM

	Components and component loadings
Questions	1	2	3
I have people I want to be like	0.56	0.59	−0.25
Getting an education is important to me	0.14	0.45	0.42
I feel that my parent(s)/caregiver(s) know a lot about me (for example, who my friends are, what I like to do)	0.81	− 0.08	0.11
I try to finish activities that I start	0.02	0.95	− 0.12
When things do not go my way, I can fix it without hurting myself or other people (for example hitting others or saying nasty things)	− 0.19	0.39	0.56
I know where to go to get help	− 0.18	0.99	0.05
I feel that I belong at my school	0.99	− 0.06	− 0.05
I think my family cares about me when times are hard (for example if I am sick or have done something wrong)	− 0.09	0.03	0.87
I think my friends care about me when times are hard (for example if I am sick or have done something wrong)	0.88	− 0.02	0.01
I am treated fairly	0.29	− 0.22	0.90
I have chances to learn things that will be useful when I am older (like cooking, working, and helping others)	0.11	0.75	0.25
I like the way my community celebrates things (like holidays, festivals)	0.85	0.05	0.03

Values closer to 1.00 indicate contribution toward that component. Italicized values indicate loading on that respective component

Table 4.

Relationships between service use and resiliency/sub-scales of resiliency after PCA

	Use of services
	Total	Females	Males
n	16	8	8
Community support	− 0.38	− 0.304	− 0.412
Individual support	− 0.139	− 0.211	− 0.666
Social support	− 0.440*	− 0.716+	− 0.272
Resiliency score total	− 0.375	− 0.253	− 0.369

Kendall’s tau correlation statistic No significant differences (p > 0.05)

^*Notes approaching significance

⁺Notes significance (p < 0.05)

Support Network Assessment for Practice

Support Network Assessment for Practice was used to develop a greater understanding of the impact of social support on positive outcomes in transition foster youth. Refer to Table 5 for SNAP data. Differences amongst groups were minimal and results remained consistent amongst the two groups in most categories. Analyzing SNAP, the greatest difference observed was in the network percentage, which is how many people within participants’ support network map were considered family, friends, school/work, or community. Group A considered more than 50% of their support network family versus group B considered less than 35% of their network as such. Since there was not a striking difference between the network size, group B filled this 15% gap by naming more people as friends.

Table 5.

Support Network Assessment for Practice (SNAP) data

	Group A (N = 11)	Group B (N =5)
Network size	10	9
Total support	17	14
Support provided per person % of network	1.7	1.5
People I consider family	50.4%	34.1%
Friends	17.7%	31.8%
Community	15.0%	18.2%
School/work	16.8%	15.9%

Group A—youth who utilized transition services; group B—youth did not initially choose services but delayed access to transition services

Discussion

Upon interview, participants were easily able to identify strengths, needs, and motivations to utilize transition services and the changes they would like to see regarding these services. Participants felt that personal strengths required to transition out of care included being persistent, self-reliant, motivated, and possessing self-advocacy skills. Personal needs commonly reported for more opportunities in decision making, making mistakes, (social) skill building, and peer supports. Common themes that drove participants to utilize services involved relationships. Relationships with advocacy, guidance, and modeling skills were important to participants as well as regular communication. Important themes regarding changes participants would make in services include starting the transition process sooner, the availability of peer mentors, and more frequent and regular communication with staff assisting with transition.

Limitations

Multiple limitations exist within this pilot study. The inability to recruit participants who had chosen to not receive any transition services strongly limited the generalizability of our findings due to small sample size. The research team’s initial plan was to have youth described as group B as those with no supports or programs. This was amended to youth with no supports or programs and/or youth with delayed supports. Youth who have not received any supports have valuable perspectives which should be given voice but provide another challenge to research. This population has a higher number of physical moves, less consistent housing, and less consistent employment. This leads to decreased ability to consistently communicate via cell phone, mailing addresses, and emails and thereby overall reduces accessibility of this population. Further attempts to recruit these youth who were disengaged from services were made by asking study participants. Multiple participants replied that they no longer interacted with disengaged youth as they were engaged in illegal behavior or were incarcerated or homeless. Again, study design in future work is important to consider to capture the experience of youth with no transition services and supports.

The initial hope of the research project was to be able to utilize group A and group B as comparisons and therefore report differences amongst these groups in terms of their strengths, needs, decision making, resiliency, and supports. However, upon initial analysis, no differences were found. The fact that no differences were found in strengths, needs, resiliency scores, or supports between the group receiving services immediately and those who either had no services or a delay in services should be further investigated. A larger sample size overall and increased number of individuals who did not receive any services are warranted in future research to determine why this lack of difference exists.

The use of the 12-item CYRM presented limitations to impact of the data as well. The 12-item version, while valid, was chosen in the interest of brevity and lacks the identification of the 28-item constructs. This limited our analysis of sub-scales due to lack of previously identified validation. As well, the number of participants in the study allowed for saturation in qualitative data, but was less robust for quantitative analysis. Although no statistically significant results emerged from using the 28-item sub-scales on the results of the 12-item CYRM, the principle component analysis (PCA) was capable of determining different sub-scales, resulting in quantitatively defined results after stratifying the data by gender. Future studies that examine sub-scales of perceived resilience may provide more information about the relationship between gender and acceptance of transition services. Detailed analysis may provide more information about resiliency and relationship to transition programming and youth’s decision making for choosing these supports. This may better explain the results found in this study in which no statistically significant results were found between groups who had transition services and those who received delayed services.

Implications for Behavioral Health

Research

Three areas are identified as future implications for adolescent behavioral health-research, policy, and practice from this study. Gaps in research were identified in this population which, if strengthened, would provide an improved foundation for adolescent behavioral health programming. Many of the participants in this study were unable to identify what types of services and placements they had utilized. Many had only a first name of a transition member but no awareness of what program or role this individual had in the team, capturing youths’ individual pathway through foster care: noting each placement including adoption, kinship care, foster families, congregate care, and treatment facilities; length of stay at each placement; age youth entered foster care; and re-entry is valuable detail. These factors weave an intricate web that result in youths’ offered programs, supports, and potential outcomes. This was a finding which our community stakeholders agreed is common. This should be considered in study design of future research as case management or other system representatives may need to provide this information.

There is evidence linking congregate care placements to negative outcomes within foster youth, including decreased development and executive functioning skills like decision making.³⁰ The requirements of congregate care create restrictive environments as they often hinder youth from opportunities their peers experience which negatively impact their independent living skills. For example, it limits opportunities for foster youth to socialize with peers and other adults.³¹ Developing these relationships is a key component in facilitating a successful transition into adulthood, as youth will call upon their support network for resources and assistance post-discharge.³¹ Other opportunities limited by congregate care include participating in age-appropriate activities like socializing with peers outside of school hours, participating in extracurricular activities, preparing for meals, and participating in home management activities like repairing home appliances or using hardware tools and cleaning products. If the site allows for these activities to occur, adolescents are usually supervised. This rigidity is not conducive to facilitating independence and growth in daily living skills.¹¹ Due to linkages with poor outcomes and high expense to operate group care, much discussion in the literature relates to how to solve issues surrounding congregate care. Research specifically regarding congregate care programming is needed for youth with a pathway that includes congregate care.

Youth who have experienced congregate care, for any length of time, also have higher rates of diagnoses and placements. Due to the dynamic relationship between person and environment, several correlations have been identified amongst the out-of-home placement setting, displacement rates, and mental or behavioral health issues. Shook et al. reported foster youth who were “experiencing or exhibiting behavioral, mental health and/or substance abuse problems were more likely to experience placement instability and to spend time in congregate care settings.”^31(p.17) Another factor that has been correlated with mental and behavioral issues in foster youth is entry age.³² Font discovered that the older the children are upon entry into foster care, the more likely they will exhibit mental and behavioral health problems as they age.³² Shook et al. claims these limitations within congregate care may even exacerbate pre-existing issues in behavioral or mental health and/or substance use or even lead to other problems.³¹ Due to the complexity of this relationship, Havlicek claims that the child welfare system may look past the effects of placement instability and congregate care for individuals with complex needs.³³ If youth’s individual pathways were tracked, more individualized service provision could occur.

Practice

When asked what needs youth had during transition, many specific themes emerged which can be implemented in current programming. Specific skills or items youth in both groups asked for include the following: social skills development, increased participation in meaningful activities, peer support programs with youth who have already aged out, more decision-making opportunities and life skills training, and lists of questions for each type of support offered. Individualized assessments or a needs assessment conducted within the transition team can support development in these specific areas.

Within current programs, youth from both groups also expressed the need for person-centered services. Several youth identified instances when they were given information or applied for programs that were not relevant or they were not qualified for. Given that both youth and transition workers are pressed for time, youth expressed frustration when time and effort was poured into irrelevant tasks. Again, current programming can support this by initiating transition plans by conducting needs assessments or interviews prior to provide informational supports.

Participants heavily emphasized relationships with aftercare providers including housing staff, mentors, transition service workers, and case managers. Youth repeatedly stated that they needed to trust these adults and know with confidence that these adults were accountable and would treat them with respect. Many interviewees recalled accounts of being treated like a child or with disrespect, which they believed then justified their child-like behavior. Most youth mentioned their keen sense to detect whether staff truly cared about their situation or were merely working for a paycheck. Building rapport, trust, and a culture of respect within a transition team is a necessary step before proceeding with transition plans.

The lack of knowledge youth have about the services they were receiving, how to access those services, including who to contact about those services and what other services were available, was startling. Finally, youth (specifically those who waited to participate in transition programs) stated the need to decrease wait time between presentation of information and initiation of service. Current programming can support these findings by starting to discuss transition younger. Current programming can also increase focus and urgency for goal setting and future transition planning. It is necessary to empower youth and increase decision making and future outcomes post system care.

Policy

The authors propose two policy changes as additional implications for adolescent behavioral health. The first relates to the age at which transition services begin for youth. Although all states provide transition services for youth under federal policy, the age at which transition planning begins is arguably too short to prepare. Youth in foster care are considered a high-risk population, meaning they are at a greater likelihood to experience poor life outcomes.³⁴ Youth with developmental, intellectual, and physical disabilities are also considered a high-risk population. For youth with disabilities, federal policy—Individuals with Disabilities Education Act (IDEA)—outlines requirements for transition services in school settings. According to IDEA, transition plans are initiated at age 14 and continue to age 22 to prepare youth for adulthood by providing independent living skills and pairing youth with community resources. According to the 2004 policy, “Transition planning must: be individualized, be based upon the student’s strengths, preferences and interests, and include specific opportunities to develop functional skills for work and community life.”^35(n.p.) IDEA has monitoring procedures to ensure the development of this transition plan and holds states accountable for providing evidence of completion. This monitoring process determines compliance or lack thereof. Lack of compliance results in loss of funding.

In contrast to IDEA, the federal policy Preventing Sex Trafficking and Strengthening Families Act of 2014 states a required provision of transition services information to children over the age 14 in foster care. This must include a document which contains each child’s rights including education, health, visitation and court participation, and exploitation avoidance.³⁵ However, implementation of this policy is problematic due to vague language and lack of monitoring procedures. As well, consultation and provision of information regarding rights is vastly different than provision of information regarding specific programs and eligibility and documentation of developing an individualized plan with services and goals. Child Welfare Information Gateway is a clearinghouse of information provided by the Children’s Bureau, Administration for Children and Families, and U.S. Department of Health and Human Services. Documents provided by these agencies state, “While the law refers to a 90-day period (for a personalized transition plan), most youth will benefit from more time to prepare.”^36(p.4) The agencies responsible for the administration of foster youth transition services acknowledge this policy error and mitigate this by providing toolkits of information to foster care families.

Transition services for foster youth should mirror that of IDEA’s transition planning requirements from ages 14–22. Increased length of time to practice executive functioning and independent living skills would likely increase foster youths’ ability to receive employment and housing, and complete their education. Additionally, it would offer individualized instruction and supports based upon the strengths, wishes, and needs of the youth. Execution of this would need to include monitoring for compliance.

The second proposed policy implication is related to consideration for additional professionals on transition teams for youth aging out of foster care. According to Fostering Connections to Success and Increasing Adoptions Act of 2008, transition teams are required to include child welfare agencies, caseworkers or other child representatives which are most appropriate to assist in the development of a plan.³⁶ Occupational therapists (OT) would make a substantial impact on foster youth as one of the “other child representatives which are most appropriate to assist.”^37(n.p.) Occupational therapists are well established in transition teams and services especially in youth from early development to adulthood. As emphasized by the American Occupational Therapy Association (AOTA), “Occupational therapy can make a distinct and powerful contribution to improving transition outcomes to further education, employment, and independent living.”^38(n.p.)

As part of the transition team, occupational therapists could use meaningful, function-based activities (or occupations) to help foster care youth aging out of the system to accomplish their personal goals and also better help them obtain the concrete supports and support services they noted as important in this study. Also, instrumental activities of daily living (IADLS) are within occupational therapists’ scope of practice, which includes such tasks as managing finances, transportation, cleaning, meal preparation, and shopping.³⁹ Youth in this study reported needed assistance with learning how to manage their IADLs and therefore occupational therapists would be of great support during the transition process. An occupational therapist could evaluate and implement individual supports for foster care youth to maximize occupational performance within noted life skill areas that youth in this study reported needing supports to successfully navigate.