How Young Adults with Serious Mental Health Diagnoses Navigate Poverty Post-emancipation: The Complex Roles of Community Mental Health Services & Informal Social Support

Serious mental health diagnoses are prevalent among youth who "age out" of foster care by reaching the maximum age for child welfare service eligibility. Post-emancipation, little is known about how youth engage in community mental health services, or leverage informal social networks, to navigate independence. Twenty emancipating youth completed three interviews over 16 months. All emancipated into poverty; most lived alone and initially connected to adult community mental health teams. Four service use and informal support profiles emerged from analysis: (1) Navigators (n = 2) actively used mental health services and provided limited informal support; Treaders (n = 9) passively used mental health services and heavily exchanged informal support; Survivors (n = 5) used mental health services when in crisis and heavily provided informal support; and Strugglers (n = 4) avoided mental health services and took resources from informal connections. Findings have implications for both child and adult mental health and social service providers.

"Just being there, like a shoulder to lean on": Resilience and Mental Health among Older Youth in and Aged out of Foster Care during COVID-19

Disasters share a common potential for significant ecological and psychosocial disruption at the individual, community, and societal levels, and are especially harmful to members of social groups in vulnerable situations, including youth in foster care and those recently emancipated from care. These young people are susceptible to mental health challenges and understanding their resiliency is key to mitigating pandemic-related harms. This qualitative study aims to (1) understand how the COVID-19 pandemic affected the mental health of older youth between the ages of 18 and 23 (M = 20.5 years, S.D. = 1.7 years), currently in or aged out of foster care (M = 5.9 years in care, S.D. = 4.4 years), and experiencing mental health challenges, and (2) gain insight into the resiliency that supports young people in dealing with these challenges. Twenty-six young people (77% female-identifying, 38% White, 27% Hispanic) in the USA participated in in-depth interviews. Salient themes include: 1) supportive relationships, 2) adaptive coping skills and mindsets, and 3) environmental, institutional, and social supports. Results amplify the voices of these young people concerning the impact of COVID-19 on their mental health and foreground the dynamic strategies they are using to alleviate their distress.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40653-022-00498-7.

Experiences of young parents with foster care backgrounds during the COVID-19 pandemic

BACKGROUND

The COVID-19 pandemic has brought unique challenges to parents of young children, due to the closure of schools and childcare centers, and increased caregiver burden. These challenges may be especially pronounced for youth with foster care backgrounds, as they lack critical support and resources to rely on during emergency situations.

OBJECTIVE

The purpose of the present study was to examine the experiences of these vulnerable young parents since the beginning of the pandemic.

PARTICIPANTS AND SETTING

Our study included 17 young parents ages 18-26, who had recently aged out of foster care or were currently in extended care. Participants were predominantly female, and Black, Indigenous, or people of color (BIPOC).

METHODS

Youth participated in virtual focus groups or individual interviews and described their experiences and challenges during the COVID-19 pandemic. A structured thematic analysis approach was employed to examine key themes in youths` accounts.

RESULTS

Analysis resulted in five major themes: (a) employment disruptions and economic hardships, (b) educational challenges for parents and children, (c) parental and child mental health concerns, (d) insufficient resources and barriers to service receipt, and (e) "silver linings".

CONCLUSIONS

Young parents with foster care backgrounds faced numerous challenges due to COVID-19 and struggled to access critical resources and supports. Implications for policy, practice, and research are discussed.

Nothing About Us Without Us: Using Participatory Action Research (PAR) and arts-based methods as empowerment and social justice tools in doing research with youth 'aging out' of care

Child welfare practices and policies are often disconnected from youth in care's perspectives and lived realities. Youth 'aging out' of care should be empowered to define their own needs, goals and success based on the unique context they are transitioning from. In research, this can be supported by engaging them as co-researchers through emancipatory approaches. Participatory Action Research (PAR) requires collaboration with those who are affected by the issue being studied in all aspects of the research, with the aim to build advocacy capacity and affect transformative social change. Photovoice employs photography and group dialogue - the fusion of images and words - as an empowerment tool, through which individuals can work together to represent their own lived experiences rather than have their stories told and interpreted by others. This is a particularly powerful approach in engaging youth with care experience, as they are often systemically disenfranchised, isolated and in need of connections to the community. This article presents the Relationships Matter for Youth 'Aging Out' of Care project, a Participatory Action Research (PAR) photovoice research project with young people with lived experience, as a case study. The project aimed to take a closer look at the relationships that matter to youth from care and how they can be nurtured over time. Narratives about the experience of participating in the project are also featured, from the perspectives of three of the youth co-researchers. Some of the benefits, challenges and lessons learned are also explored, framed within the Relationships Matter project methodology and process. Recommendations for future social work research are also presented.

Defining and achieving permanency among older youth in foster care

Permanency is a key child welfare system goal for the children they serve. This study addresses three key research questions: (1) How do older youth in foster care define their personal permanency goals? (2) How much progress have these youth made in achieving their personal permanency goals and other aspects of relational permanency, and how does this vary by gender, race, and age? and (3) What transition-related outcomes are associated with relational permanency achievement? Surveys were conducted with 97 youth between the ages of 14 and 20 currently in care. Over three-fourths of participants had an informal/relational permanency goal; however, only 6.7% had achieved their goal. Of eight additional conceptualizations of relational permanency assessed, the one associated with achievement of the highest number of key transition outcomes was Sense of Family Belonging. The transition outcomes with the most associations with permanency achievement were physical health and mental health. Relational permanency is a highly personal part of the transition process for youth in care, warranting personalized supports to ensure individual youths' goals are being addressed in transition planning. Permanency achievement may also provide a foundation for supporting youth in achieving other key transition outcomes.

Timely Health Service Utilization of Older Foster Youth by Insurance Type

PURPOSE

To evaluate the impact of a policy change for older foster care youth from a fee-for-service (FFS) Medicaid program to health maintenance organization (HMO) providers on the timeliness of first well-child visits (health care physicals).

METHODS

A three-year retrospective study using linked administrative data collected by the Michigan Departments of Human Services and Community Health of 1,657 youth, ages 10-20 years, who were in foster care during the 2009-2012 study period was used to examine the odds of receiving a timely well-child visit within the recommended 30-day time frame controlling for race, age, days from foster care entry to Medicaid enrollment, and number of foster care placements.

RESULTS

Youth entering foster care during the HMO period were more likely to receive a timely well-child visit than those in the FFS period (odds ratio, 2.46; 95% confidence interval, 1.84-3.29; p < .0001) and days to the first visit decreased from a median of 62 days for those who entered foster care during the FFS period to 29 days for the HMO period. Among the other factors examined, more than 14 days to Medicaid enrollment, being non-Hispanic black and having five or more placements were negatively associated with receipt of a timely first well-child visit.

CONCLUSIONS

Those youth who entered foster care during the HMO period had significantly greater odds of receiving a timely first well-child visit; however, disparities in access to preventive health care remain a concern for minority foster care youth, those who experience delayed Medicaid enrollment and those who experienced multiple placements.

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

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