Transitions of Youth in Foster Care
Transitions of Youth in Foster Care
- Joe M. SchriverJoe M. SchriverSchool of Social Work, University of Arkansas
This entry focuses on the transition to independent living process required of youth and young adults who are “aging out” of the foster care system. It addresses the multiple risks and challenges faced by young people who are aging out of care and those of young adults who have “aged out.” This entry addresses existing policies and programs intended to assist youth who are transitioning from care. Current research findings about the experience of these youth over time both prior to and after exiting foster care are presented. Finally, the unique risks and challenges faced by as well as existing resources for LGBTQ youth who are in the process of or who have aged out are presented as an exemplar of unique needs and experiences of youth from vulnerable populations. Attention is also given to the strengths and resiliency of many former foster care youth who successfully make the transition from foster care to independent living.
- Children and Adolescents
- Health Care and Illness
- Social Work Profession
TransitionSource: Oxford English Dictionary, http://www.oed.com. Accessed October 22, 2013.1.
A passing or passage from one condition, action, or (rarely) place, to another; change2.
Passage in thought, speech, or writing from one subject to another.3.
The passage from an earlier to a later stage of development or formation.
As Everett suggests, in her excellent article on foster care and its history in the U. S. (in this edition of the ESWO), substitute care systems for children in Native American tribes existed prior to colonization and were grounded in extended family systems and tribal cultures ensuring, “a child always had substitute care and was never considered dependent or neglected” (2013, p. 2). Subsequent to colonization, the English Poor-Law tradition became the foundation for substitute care for children in the Colonies and consisted “of indentureship and the binding out of dependent children to a master artisan until the age of 21” (2013 p. 2).
In this article the emphasis is on “transitions” in foster care. It focuses on research, policies, resources, programs, and key issues of significance to social workers whose practice includes responsibility for youth in care who are “aging out” or moving toward independence as their individual developmental trajectories take them from adolescence to young adulthood with its attendant rights and responsibilities. In addition, attention is given to key issues faced generally by youth in transition. The risks and challenges faced by LGBTQ youth who are aging out are addressed as an exemplar of unique issues faced by members of vulnerable populations in addition to those faced by the general foster care population. Finally, suggestions for further reading and additional information resources are provided.
Youth Development: Adolescence and Young Adulthood
In its final report on The National Conversation on Youth Development in the 21st Century, the National 4-H Council defined youth development as:
the natural process of growing up and developing one’s capabilities. Positive youth development occurs from an intentional process that promotes positive outcomes for youth by providing support, relationships, and opportunities. Youth development takes place in families, peer groups, schools, in neighborhoods and communities, and prepares youth to meet the challenges of adolescence and adulthood through coordinated, progressive research-based experiences that help them to become socially, morally, emotionally, physically, and intellectually competent. (National 4-H Council, 2002, p. 4)
For many youth who are in foster care, successfully completing this critical developmental process is fraught with challenges. These challenges occur on several fronts: their experiences prior to placement in foster care; the quality of their experiences while in foster care; and particularly, if they remain in foster care through adolescence and the beginning of young adulthood, during the transition from foster care to independence or “emancipation” and their subsequent search for safety, stability, connectedness, and well-being as young adults in the larger society. Emancipation for these youth results from being removed from their family due to allegations of abuse or behavior problems. Their exit from care occurs because of their age, not because permanency was created through “reunification, adoption, or guardianship” (Casey Family Programs, 2008, p. 1)
There are approximately 73,000 youth in foster care in this country who are between the ages of 16 and 20 years of age and make up those who are approaching and should be engaged in the “aging out” process through formal permanency planning programs provided by their state foster care programs (Jaudes, 2012, p. 1170). Each year between 20,000 and 30,000 youth “age out” of foster care in the US (Courtney & Dworsky, 2005, p. 1; Dworsky, Dillman, Dion, Coffee-Borden, & Resenau, 2012, p. 3; Emerson & Bassett, 2010, p. 8; Frey, Greenblatt, & Brown, 2005, p. 1). Frey et al. argue that a crisis exists for those youth aging out who do not have a permanent family. Lack of this essential support is correlated with many other risks and problems including early pregnancy and parenthood, involvement in the criminal justice system, dropping out of high school, homelessness, and the inability to find employment with sufficient pay to meet day-to-day and long-term needs. In addition, the situation has resulted in a “a public emergency for our national child welfare system” (2005, p. 1).
Meeting the complex needs of youth transitioning to independent living is guided by four fundamental principles.
Youth Development [discussed earlier]: includes developing the necessary life skills for successful independence, training youth to respond to crises that place youth at risk after emancipation, involving the youth in planning and decision-making processes about their case throughout, and a sense of empowerment.
Collaboration: transition teams need community involvement from stakeholders, who can provide links to jobs and mentoring, and team member expertise in family team meetings that include “multiple family members, friends/acquaintances, and professional helpers, both intra- and inter-agency partners” (National Child Welfare Resource Center for Youth Development,n.d.)
Cultural Competence: Because of disproportionality, the greater proportions of children of color and other vulnerable populations in foster care such as LGBTQ youth, special attention is given to the strengths and needs of these youth in relation to culture.
Permanent connections: Given the likelihood these youth have had poor role models for developing healthy relationships these youth need skills in and opportunities for developing healthy relationships with others. Skills include building, maintaining, and appropriately ending romantic and friendship connections. (National Child Welfare Resource Center for Youth Development, n.d.)
Youth aging out of foster care need to understand and develop a particular skill set to allow them to successfully live independently. The necessary skill set includes readiness to:
Pursue or complete their education or vocational training
Obtain and maintain employment (e.g., learn how to prepare a resume, conduct a successful interview, develop on-the-job skills, communicate effectively with supervisors)
Locate and maintain affordable housing (e.g., learn where to look for an apartment and how to complete a lease)
Manage their money and keep a budget
Cook meals, keep house, and perform other “daily living” routines
Access health care and community services. (1999, p. i)
Significant attention must also be given their need to continue:
developing their social and interpersonal skills and
building confidence in themselves and their self-esteem.
(U.S. Department of Health and Human Services Administration on Children Youth and Families, 1999, p. i)
Characteristics of the Population
Youth aging out of foster care share a number of characteristics. Unfortunately, many of these characteristics reflect the risks and challenges they face and that greatly influence their ability to successfully achieve important developmental and social outcomes including a sense of connectedness, physical and mental health, education, employment, a supportive family environment, and the basic goals set for all children and youth in foster care: safety, permanency and well-being (Casey Family Programs, 2008).
Research: The Midwest Study
One significant and current research effort to document the experiences of youth about to age out and those who have aged out is that conducted through the Midwest Evaluation of the Adult Functioning of Former Foster Youth or as it is more commonly known, The Midwest Study. This study is based on interviews with a large sample of foster care and aging out youth themselves. It is a longitudinal study, first developed in 2001, with a sample of 732 youth from Iowa, Illinois, and Wisconsin. Data were collected at five points or Waves. Its goal is to study outcomes for youth in foster care about to age out (17 to 18) through the transition process to well into their young adulthood (age 26). Wave 1 was conducted using interviews with 732 (Response Rate = 96%) of the original 736 youth who were still in foster care (ages 17 or 18) as they began the process of moving from foster care to independent living (http://www.chapinhall.org/sites/default/files/CS_97.pdf). Wave 1 data were collected from May 2002 through March 2003 (Courtney & Dworsky, 2005; Courtney, Terao, & Bost, 2004). Wave 2 data were collected between March and December 2004 with 603 (Response Rate = 82%) members of the original sample at age 19 (http://www.chapinhall.org/sites/default/files/ChapinHallDocument_2.pdf). Wave 3 data were collected with 591 (Response Rate = 81%) of the original sample members between March 2006 and January 2007 when almost all of members of the group were 21 (http://www.chapinhall.org/sites/default/files/ChapinHallDocument_2.pdf). Wave 4 data were collected between July 2008 and April 2009 through interviews with 602 (Response Rate = 82%) of the original sample members who were ages 23 and 24 (http://www.chapinhall.org/sites/default/files/Midwest_Study_Age_23_24.pdf) (Courtney & Dworsky, 2005; Courtney, Lee, & Raap, 2009). Wave 5 data were collected between October 2010 and May 2011 through interviews with 596 (since 12 participants were deceased by Wave 5, the Response Rate = 83%) respondents in the from original sample members who were 25 to 26 years old (http://www.chapinhall.org/sites/default/files/Midwest_Study_Age_23_24.pdf) (Courtney, Dworsky, et al., 2011).
In a number of areas, outcome data collected by the Midwest Study researchers were compared to outcome data from another large longitudinal study, the National Longitudinal Study of Adolescent Health (referred to as the Add Health Study). The Midwest Study used for comparison an 890-member sub-sample of the Add Health Study core sample with demographic characteristics of youth matching those in the Midwest Study with the exception of experiencing foster care (Courtney & Dworsky, 2005, p. 4).
Then and Now: Changes Over Time
By the end of Wave 5 the Midwest Study researchers, were able to look back at findings of Waves 1 through 4 as well as those of Wave 5 and report changes in the study sample members’ experiences over time in a constellation of areas that together provide a profile of this group of young people as they progressed from their first interview at 17 to 18, when most of the youth were still in foster care, until they were well into young adulthood at age 25 to 26, almost 10 years since their original interviews.
Compared to youth who had never been in foster care, the Midwest Study participants were clearly not doing nearly as well in educational attainment at age 26. While almost all (four-fifths) of the Midwest Study young adults had a high school diploma or GED, only 8% had a post-secondary degree (2- or 4-year school) at age 26. This is much lower than for the general population. In 2009 among people 25 and over in the United States eight percent held an associate’s degree, but 28% of this age group held a bachelor’s degree. In terms of gender, 35% of women and 27% of men in the general population between the ages of 25 and 34 held a bachelor’s degree or higher in 2009 (Courtney & Dworsky, 2005, p. 4).
The economic situation of the Midwest Study participants was also quite dismal as well. There were fewer than 50% of participants employed. Half of these 26-year olds who reported being employed were not making enough to sustain themselves. Half of the group made $9,000 or less annually and more than 25% were completely unemployed. A majority of the women, two-thirds, and two-fifths of the men received food stamps in the past year (Ryan & Siebens, 2012, p. 1). The employment status of participants in the study peaked for men at age 21 with 49% employed compared to only 39% at age 26. Women’s employment status remained fairly stable with 54% employed at age 21 and 52% at age 26 (Courtney, Dworsky, et al., 2011, p. 20).
Not surprisingly, many of the Midwest Study participants struggled with mental and physical health problems. Almost sixty percent of the participants did have health insurance. Some two-thirds of those with health insurance received their insurance from a government program such as Medicaid or S-Chip (Courtney, Dworsky, et al., 2011, p. 113). In comparison, according to U.S. Census Bureau in 2012, 73% of 26 to 34 year olds in the U.S. had health insurance (Courtney, Dworsky, et al., 2011, p. 49).
In terms of mental health symptoms and treatment, almost 25% of the Midwest Study participants reported symptoms of depression with almost 6% reporting thoughts of suicide and 2% reporting they had attempting suicide (DeNava-Walt, Proctor, & Smith, 2013, p. 23). Twenty percent of the age 25 and 26 participants received mental or behavioral health treatment with 12% specifying psychological or emotional counseling (Courtney, Dworsky, et al., 2011, p. 53).
Criminal justice system involvement was a significant risk for many male study participants at age 26. Twelve percent of all males in the study were in jail or prison at age 26 (Courtney, Dworsky, et al., 2011, p. 9). Through all waves of the study men were approximately twice as likely as women to reported an arrest, a conviction, or incarceration. Over half of the young women and four-fifths of the males reported being arrested at some point in their lives. One-third of women and two-thirds of men had spent at least a night in jail since they were 17-18 years old (Courtney, Dworsky, et al., 2011, p. 5).
The portrait of the study participants would be incomplete if it included only the deficits of these young people. Clearly, they exhibited both strengths and resiliency. Some of the participants were in college and eventually completed a degree. Most of these young adults maintained connections with their families of origin or their foster families and many reported high levels of overall social support (Courtney & Dworsky, 2005, p. 14). Even at age 26 many of these young adults were generally satisfied with their lives and were optimistic about their future (Courtney, Lee, & Perez, 2011).
Given the often dire picture of these youth and young adults that emerges from the research, it is important for social workers to be familiar with currently policies intended to address their needs and ensure better outcomes in the future. The following section presents some promising policies that can have a direct and positive impact on these young people.
Independent Living Program.
The foundation of a federal policy framework for supporting youth aging out of foster was laid in 1985 when Title IV-E of the Social Security Act was amended to include the Independent Living Program. This was the first time state were allow to use federal funding for services to support the needs of foster care youth transitioning from foster care to living independently (Courtney, Dworsky, et al., 2011, pp. 1-2; Gardner, 2008, p. 4).
John H. Chafee Foster Care Independence Program (FCIA)
In 1999 the Independent Living Program became the Chafee Foster Care Independence Program, which continues to be the core of federal efforts to address the needs of youth aging out of foster care. Its purpose is to assist current (and former) foster care youth in making the transition to independence and self-sufficiency. The program is funded through grants to states and tribes after federal approval of a state plan to provide a range of services to youth aging out. The funding level for grants to states is $140 million annually, though states must provide a 20% match in order to receive grant funding. Specific assistance efforts are made to support education, employment, housing, mental health, and the maintenance of relationships between foster care youth and adults who provide support and mentoring. The Chafee Program also allows states to extend health care coverage through Medicaid for aging out youth up to 21 years of age. The program provides a degree of flexibility in the choice of what specific services they will offer. Current and former foster care youth aged 18 to 21 years old are eligible (Courtney, Dworsky, et al., 2011, pp. 1-2; Gardner, 2008, p. 4).
The Chafee Education and Training Vouchers Program
This program focused specifically on the educational and training needs of youth aging out. It provides $60 million to states to pay education and training costs for youth in approved post-secondary education programs. These funds are in addition to the annual $140 million available to states through the Chafee Act. Through the program an individual youth can receive a voucher of up $5,000 per year for higher education (Gardner, 2008, p. 4).
Fostering Connections to Success P.L. 110-351
This act again amended Title IV-E to extend service eligibility for aging out youth from 18 to 21 years old. States eligible for the extension are required to help transitioning youth develop a transition plan that is during the 90 days before they leave care. Notably, foster youth must be allowed to lead in the development of the plan. According to Courtney, Lee, and Rapp, beginning in 2011 states became eligible for federal reimbursement for foster care maintenance costs under Title IV-E for aging out youth up to age 21 who meet several conditions:
either completing high school or participating in an equivalent program; enrolled in postsecondary or vocational school; participating in a program or activity designed to promote or remove barriers to employment; employed for at least 80 hours per month; or incapable of doing any of these activities due to a medical condition (2009, pp. 1-2).
Courtney, et al. point out that this significant change in federal policy to improve support for youth aging out was influenced by findings from the Midwest Study discussed earlier (2011, pp. 1-2).
The Patient Protection and Affordable Care Act (Affordable Care Act)
The Affordable Care Act, when fully implemented, will for the first time provide national health insurance coverage in the US. The provisions of the Act include several that are intended improve health care services for youth aging out of foster care. The Affordable Care Act required state child welfare agencies to include new health related components in the “Foster Youth Transitions Plans” for youth aging out of foster care described earlier. The plans must include information about health insurance options available to the youth after they age out of care. In addition, the transition planning process must now emphasize the importance for youth aging out to designate a person who will have the youth’s health care power of attorney. Youth aging out during 2014 or later must be provided all Medicaid services until the age of 26, rather than the current maximum age of 21. They are eligible if they were in foster care at the age of 18 or higher.
Foster care youth who have transitioned or are transitioning out of care are at higher risk than the general population for mental health problems. Importantly, the Affordable Care Act requires health insurers with plans recognized by the Act to provide “access to mental health and substance abuse treatment services, including behavioral health treatment” to all participants in the plan, including foster youth who have aged out (Center for the Study of Social Policy, n. d.; Klain, Kendall, & Pilnik, 2010, pp. 42-44).
Practice Environment: Processes, Programs and Services
Meeting the needs of youth transitioning from foster care to independent living requires a variety of services, programs, and professional skills. The practice environment requires professionals to have knowledge and skills in multiple areas. These areas include permanency planning, physical and mental health, education, employment, legal issues, financial issues, housing, and connectedness.
Permanency Planning for Youth in Transition
When it is not possible for youth to achieve permanency through a legal connection to a family (birth, foster, kinship, legal guardianship) social workers and others working to secure permanency pursue two other types of permanency. One is physical permanency, a “home or a place to be.” The second is relational permanency, “having a relationship or connection with a caring adult” (Child Welfare Information Gateway, 2013, p. 1).
Unlike permanency planning for younger children involved with the foster care system, permanency planning for youth in transition or aging out requires a much greater degree of involvement by the youth themselves in planning and decision-making about their future. Typically their emotional, cognitive, and biological development is sufficiently advanced to give them the ability to participate more directly in and even lead the process of planning for their transition to independent living. In addition, the planning process itself presents opportunities for youth preparing for adulthood to begin to build and practice the skills necessary for the independent decision-making required of these young adults post-foster care. Frey et al., argue this involvement by youth is essential to successful preparation for adulthood. However, successful permanency planning and decision-making can only come about with the involvement of “caring adults” as well. The relationship between the youth and the caring adult must be a true partnership with active involvement by both parties (2005, p. 3; Louisell, 2009). Additionally, successfully achieving desired outcomes is a collaborative process and includes a team made up of key stakeholders in the preparation process. Youth should be directly involved in deciding who will be included on the team. Members of the planning team may include “parents, family members, caregivers, significant adults, professionals [social workers] and community members” (Frey, et al., 2005, p. 8; Washington State Department of Social and Health Services, 2006).
As indicated earlier, preparation for adulthood is multi-faceted and requires planning and outcomes in several areas including education, housing, healthcare, and employment (Eyster & Oldmixon, 2007). According to Frey, et al. these outcomes seek to meet multiple needs including:
Employment: Young people generate a sufficient income to support themselves by obtaining and retaining steady employment leading to a viable career path.
Education: Young people acquire sufficient education, training and opportunities that provide them with choices to pursue post-secondary education and/or the means to obtain and retain steady employment.
Housing: Young people have access to safe, stable, appropriate, affordable housing in the community that is near public transportation, work or school.
Life Skills: Young people demonstrate mastery of basic study skills, work skills, money management, social development, self-care and practical daily living skills.
Personal and Community Engagement: Young people have in place supportive relationships, are able to access services in the community to achieve their personal goals and are supported in their efforts to contribute to the civic life of their communities.
Personal and Cultural Identity: Young people demonstrate a healthy sense of ethnic or cultural identity, personal identity (including sexual orientation and gender identity) and spiritual identity.
Physical and Mental Health: Young people have sufficient and affordable health insurance for both physical and mental health.
Legal Information and Documents: Young people have the skills, information and assistance to access essential legal documents pertaining to their personal, family, medical and educational histories. (2005, p. 5)
Housing and Homelessness
Findings of research studies focused on housing and homelessness present a wide range of estimates of the numbers of youth aging out who are homeless. Study findings suggest the range varies from 11% to 36% (Dworsky, et al., 2012, p. 4). However, overall these young adults experience a high degree of housing mobility. In addition, these young adults also experience other forms of housing instability including couch surfing (very short term and frequent movement from place to place or “couch to couch”), temporary living arrangements with others, or doubling up with others because they are unable to afford individual housing. In addition, many young adults who have aged out experience times of “housing precariousness” during which they may live with others but in circumstances that are temporary or they may experience periods of living independently, but may not be able to maintain their independent living arrangements (Dworsky, et al., 2012, pp. 1-5).
Numerous barriers increase the risk of homelessness or housing instability for these young adults. These include inadequate income and assets, lack of any family safety net, lack of close relationship with supportive adults, early and often single parenthood, having a juvenile or criminal record, and the availability or affordability of housing due to market conditions. In addition, the child welfare system itself can create barriers due to a lack of effective services to prepare for independent living, lack of sufficient support during the transition to independent living, and lack of effective coordination between the child welfare agency and other systems needed to help secure stable housing arrangements (Dworsky, et al., 2012, pp. 8-14).
On the other hand, a stable housing situation has considerable positive ripple effects on other areas of wellbeing beyond having shelter. Research suggests that good housing creates a foundation for positive outcomes in other areas including education, employment, and physical and mental health (Dworsky, et al., 2012, p. 8).
A number of programs, including a number of those discussed earlier, are designed to support the housing needs of transitioning youth. Others include components that may assist in meeting housing needs. The Chafee Foster Care Independence Program provides in its service array skills training to help youth find and maintain housing. Up to 30% of Program funds can be spent by states on “housing subsidies, transitional housing, independent living stipends, or other housing-related costs” (Dworsky, et al., 2012, p. 15). The Education and Training Voucher Program can provide funds for housing while its recipients are in school. The Fostering Connections to Success and Increasing Adoptions Act of 2008 expanded the degree of discretion for states about how they define “child-caring institutions” that provide “supervised independent living” services. For example, “host homes, college dormitories, shared housing, and semi-supervised and supervised apartments all qualify” (Dworsky, et al., 2012, pp. 15-16; “Fostering Connections to Success and Increasing Adoptions Act of 2008,” 2008). A central element of Transitional Living Programs required services is the provision of “safe, stable living accommodations” to youth aging out of care (National Clearinghouse on Families & Youth, 2013). The Department of Housing and Urban Development Family Unification Program provides housing vouchers to former foster care youth between 18 and 21 years old who exited care at 16 years of age or older. Vouchers are limited to 18 months (U.S. Department of Housing and Urban Devleopment, 2013).
State and local governments can provide a variety of housing types and several youth housing programs. Housing types include:
Community-based Group Homes are congregate care housing sites where youth share bedrooms and common spaces with live-in staff providing most of the cooking and cleaning. They have been described as “a non-secure residential program emphasizing family-style living in a homelike atmosphere” (Pope, 2011, p. 4). Disadvantages of group homes include group control issues, negative peer pressure, and high staff turnover.
Shared Houses include a live-in staff member and youth who share a common kitchen and living area. This housing type requires more advanced independent skills including the ability to cook their own meals and determine their own schedules unlike the more regimented community-based group homes. Disadvantages again include high staff turnover as well as potential group dynamics problems among housemates. This model prepares youth to transition directly into living more independently (without live-in staff) (Pope, 2011, pp. 5-6).
Supervised Apartments or cluster apartments provide youth with the opportunity to practice independent living skills while also being supported by staff if needed. Supervised apartments are usually provided for older youth 17 to 24 years old. This house model is defined as “an apartment building, rented or owned by an agency, in which numerous youth live with a live-in supervisor who occupies one of the units” (Kroner, 1999 in Pope, 2011, p. 6). Like shared housing, the cluster apartment model is intended to allow the residents to move directly into independent housing (Dworsky, et al., 2012, p. 23; Pope, 2011, p. 6).
Scattered Site Apartments are privately owned apartments with rent paid either by an agency (i.e. child welfare) or by the young adult alone or shared among housemates. Support services such as financial assistance, training, and some oversight of the youth continue to be available. Staff of the supporting agency do home visits, usually weekly, but more often if needed. Staff advocates for the young adults in this living environment. Other services may include case management and help navigating systems in the larger environment. This living arrangement requires youth to develop coping and interpersonal skills necessary to interact with neighbors, deal with loneliness, determine appropriate visitors, and deal with landlords. Disadvantages of scattered site apartment living arrangements include the potential for property damage and problematic relationships with other tenants. On the other hand, this model allows youth the most autonomy of any of the other housing types (Pope, 2011, p. 6).
The statistics for youth aging out or who have aged out of foster care and who pursue higher education are grim as indicated by the findings of the Midwest Study. Some estimates suggest only 7 to 13% of foster care youth begin higher education. Completion rates are equally dismal. A Casey Family Programs study found that only about 2% of foster care youth earn a bachelors degree compared to 24% of the general adult population On the other hand, research suggests up to 70% of foster care youth would like to attend college (Emerson & Bassett, 2010, p. 8).
These youth often have had few early life role models who have completed a degree. Since youth aging out of foster care face so many challenges in a number of areas (sufficient income, employment, housing, mental and physical health), it should then not be surprising that for many of these young adults enrolling in and, particularly, graduating from higher education can have a lower priority than meeting their basic needs. In addition, the other challenges they must confront during the transition from foster care can pose significant barriers to their ability to attend or complete post-secondary education. Higher education support for these young adults in order for them to enroll in graduate include year-round housing (i.e. a place to live during semester breaks, holidays, or summers), financial aid, and academic institutional support including advising and assistance with choosing a career (Emerson & Bassett, 2010, p. 8).
In recent years more and more higher education and social policies and programs have begun to respond to the special higher education needs of youth in transition from foster care. In 2008 the Higher Education Opportunity Act of 1965 was amended to reflect the unique higher education needs of foster and former foster care youth. These include sections that specifically target youth in foster care or former foster care youth for services in the areas of both pre-college and after enrollment. Sections of the act addressing these youth and young adults include federal TRIO programs (Section 403), Early Awareness for Financial Aid Eligibility (Section 490), and the Fund for the Improvement of Post-Secondary Education (Section 707) (Emerson & Bassett, 2010, p. 13; “Higher Education Opportunity Act,” 2008).
Another source of support for these young adults is the Chafee Education and Training Vouchers Program. As indicated earlier, through this program an individual youth can receive a voucher of up $5,000 per year for higher education (Emerson & Bassett, 2010, p. 65). This voucher can be used flexibly to pay for tuition, books, food, housing, etc. The 2008 Fostering Connections to Success and Increasing Adoptions Act also supports the higher education needs of these youth. It can provide federal matching funds for states that choose to extend foster care services and provide support to youth up to 21 years of age who were in foster care and are in school.
The National Association of Social Workers (NASW) has taken a position on the need to address the educational needs of foster youth who are or have aged out by social workers. NASW suggests a number of things social workers can do to improve higher education opportunities and success for these young adults. Suggestions include assessment by social workers along with the young adult to determine strengths and competencies of the youth that can assist in preparing for the transition to college. School social workers can help ensure youth are on track to high school graduation and can work with the young person to explore a range of higher education possibilities including two- and four-year colleges or vocational schools. Importantly, social workers can help these youth who are likely not to have had college educated family members or others support to help them learn to navigate the complex systems that make up higher education. Social workers can help prepare these youth for the post-secondary bureaucracies by making sure they have necessary and basic documents including birth certificates, social security cards, etc. Social workers can also help these young adults meet their housing needs, which may differ from students with intact and supportive families. As indicated earlier, for these young adults on-campus housing may not meet the needs of these college students during semester breaks, holidays, and summers when most college age students can choose to stay with their families or other members of their family support system or have resources to afford alternative housing during these periods (Meruvia, 2011, pp. 1-6).
Physical and Mental Health
Youth who are transitioning from or have aged out of foster care, as is the case with the other barriers and challenges discussed earlier in this entry, face significant challenges both in terms having more health and mental health problems and in terms of gaining access to quality health and mental health services to address their needs. For youth who have aged out, the issue of lack of access to health and mental health services is particularly pronounced. These problems are well documented in the literature. Multiple studies have found very similar high rates of health and mental health problems among youth in foster care as well as problems of access to services for youth who have aged out. These studies also report significant disproportionality between health and mental problems and service access for these youth and young adults than their non-foster care peers (American Public Human Services Association, 2007; Center for the Study of Social Policy, n. d. ; Child Welfare Information Gateway, 2013; Courtney & Dworsky, 2005; Courtney, Dworsky, et al., 2011; Courtney, et al., 2009; Courtney, et al., 2004; DeNava-Walt, et al., 2013; Harris & Udry, 2013; Jaudes, 2012; National Association of Public Child Welfare Administrators, 2010).
According to the American Public Human Services Association, between 30 and 60% of foster care children and youth have chronic health problems (diabetes, seizures, asthma, etc.). If mental health and developmental difficulties are added, over 80% of these foster children and youth have serious health care problems.
In terms of mental health, over 60% of youth in foster care will experience mental health problems at some point in their lives. Often as a result of the neglect and maltreatment they experienced prior to entering foster care 30 to 40% of adolescents must cope with mental health problems including posttraumatic stress disorder, (2010, p. 1). According to the Midwest Evaluation of the Adult Functioning of Former Foster Youth Study at age 21, only 50% reported having health insurance. This is twice as many as young adults the same age who had never been in foster care (Jaudes, 2012, p. 1170).
While this data is disheartening, if not alarming, service provision to reduce these numbers is increasingly becoming available. The John F. Chafee Foster Care Independence Program of 1999 requires comprehensive transition plans 90 days prior to a foster care youth exiting foster care. These plans must include information about options for health care available to the youth (Klain, et al., 2010, p. 42). Beginning January 2014, the Affordable Care Act will provide full Medicaid benefits until age 26 for all foster youth who were in foster care prior to or on the 18th birthday (Center for the Study of Social Policy, n. d., pp. 1-2). The Affordable Care Act also requires approved health care plans to include access to mental health treatment, behavioral health, and substance abuse treatment (Jaudes, 2012, p. 44).
Clearly, foster care youth and those aging out face a multitude of barriers and challenges in their efforts to transition from foster care to successful independent living. However, in recent years the needs of this population have increasingly been recognized. This recognition, fortunately, has led to the creation of policies and programs at both federal and state levels to begin to provide essential services to these young adults. It is important to recognize, though, that some of these young people face even more challenges to their successful transitions to independent living due to their membership in diverse groups that have historically and continue to face discrimination and oppression in U. S. society at large. These groups include, but are not limited to youth and young adults of color, youth with disabilities, youth who are LGBTQ. The following section illustrates, as an exemplar, the unique and additional barriers faced by foster care youth who are LGBTQ.
LGBTQ Foster Youth
Foster youth transitioning to adulthood who are lesbian, gay, bisexual, transgender, or questioning/queer face significant challenges in addition to those faced by all foster care youth making this transition. LGBTQ youth and young adults involved with the child welfare system (foster care) are disproportionately represented among homeless youth populations and in the juvenile justice system for a variety of complex reasons associated with sexual orientation or gender identity. Important factors associated with this over-representation are a lack of LGBTQ affirming and supportive social services and rejection from their families and peers (Mountz, 2011). These and other challenges require special attention to the needs of these youth and young adults in order to reduce or ameliorate risk factors unique to LGBTQ youth in foster care. In addition, effective transition plans for LGBTQ youth aging out of care that are sensitive to the special post-foster care needs and risks of these young adults.
Mallon described three types of situations that can result in LGBTQ youth entering the foster care system, youth who:
are forced from their homes because of family of origin issues related to the discovery or disclosure of their sexual orientation or gender identity and who consequently enter the (foster care system);
leave, or are rejected or removed from, the homes of their family of origin for reasons that appear unrelated to their sexual orientation or gender identity (e.g., sexual abuse, educational neglect, etc.) and that may or may not reveal themselves to be a by-product of sexual orientation or gender identity; and
come of age and become aware of their sexual orientation or gender identity while in the foster care system. (1998 in Mountz, 2011)
Problems faced by LGBTQ youth in the foster care system include discrimination and harassment, multiple placements, violence related to their sexual orientation or gender identity, and being removed or running away from placements because of intolerance of their sexual orientation or gender identity (Mallon 1998 in Mountz, 2011). According to Byrne, et al., fifty-two percent of homeless GLBTQ youth had been involved with the child welfare system at some point (2005 in Mountz, 2011). An estimated forty percent of homeless youth are LGBTQ (Lambda Legal Defense and Education Fund, 2001 in Yarbrough, 2012, p. 2). One study found that LGBTQ youth average 6.35 different foster care placements (Mallon, Aledort & Ferrera, 2002 in Yarbrough, 2012, p. 4). Another reported 100% of LGBTQ youth living in group homes in New York City reported “verbal harassment by peers, facility staff, and other providers based on sexual orientation or gender identity.” Seventy percent report physical violence. Seventy-eight percent said they had been removed or had run away for placements because of hostility as a result of being LGBTQ (Urban Justice Center, 2001 in Yarbrough, 2012, p. 4). Fifty-six percent had lived on the streets, concluding this was safer than being in prior group or foster homes (Mallon, Aledort & Ferrer, 2002 in Yarbrough, 2012, p. 4) .
This complex array of challenges and barriers facing LGBTQ youth involved in the foster care system requires intervention at multiple levels ranging from changing the system itself to training for individual staff members and foster parents to finding or creating alternative living arrangements for this population.
Federal and state policy is gradually recognizing the omission of LGBTQ youth in much foster care policy. In 2010, Secretary of the Department of Health and Human Services, Kathleen Sebelius, took action to promote permanency for LGBTQ foster youth and through her office the Administration for Children [,Youth] and Families (ACYF) provided grant funding of $3.3 million to the Los Angeles Gay and Lesbian Community Services Center to develop “a county-wide system of care to address barriers to permanency and well-being for lesbian, gay, bisexual, transgender, and questioning children and youth that are in or at-risk of placement in foster care, placement in the juvenile justice system, or homelessness” (ACYF, 2010 in Yarbrough, 2012, p. 9).
In April 2011 the Commissioner of the Administration on Children, Youth, and Families urged child welfare agencies to “continue to explore the ways in which they may improve daily life and outcomes for young people who are involved in the foster care system and who are LGBTQ.” In addition, the Commissioner encouraged child welfare agencies to offer information and training to staff working with LGBTQ youth and for families of origin for LGBTQ youth who included reunification in their permanency plans. The Commissioner also reinforced the importance of targeted efforts to recruit foster parents who were gay affirming. With all of these recommendations he included suggestions for how federal funding could be used for these efforts (ACYF, 2011 in Yarbrough, 2012, p. 9).
Interventions and best practices to meet the unique need of LGBTQ foster youth and young adults include actively recruiting foster parents from the LGBTQ community; requiring all foster care agency staff receive and have on-going training in cultural competency for working with LGBTQ youth is one system-wide interventions. Helping these youth access LGBTQ support services in their communities is another. Finally, ensuring LGBTQ youth are actively engaged in selecting an appropriate foster care placement and involving them as leaders of their own permanency planning as they transition out of foster care (Yarbrough, 2012, p. 5).
At the state level California state policy provides and example of inclusion of services and protections to LGBTQ youth is foster care. In 2003, California’s Foster Care Non-Discrimination Act—AB 458 passed and was implemented in 2004. The act prohibits discrimination against LBGTQ youth in foster care based on sexual orientation or gender identity. The act supports group home administrators, foster parents, and staff licensing foster care programs by providing mandated training on non-discrimination (National Center for Lesbian Rights in Yarbrough, 2012, p. 10).
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