Implementation Considerations for Family-Based Telehealth Interventions for Youth in Foster Care: Focus Group Study With Child Welfare System Professionals

BACKGROUND

Between 2016 and 2020, over 600,000 youth were served annually by the foster care system. Despite approximately half of foster youth struggling with emotional or behavioral challenges, few receive much-needed services to address their mental health concerns. Family-based interventions are efficacious in addressing both youth and caregiver mental health needs; however, foster youth participation in these family-based interventions is limited by many barriers, including out-of-home placement far from their family of origin. Telehealth is a promising tool for mitigating barriers to access to treatment interventions for foster youth and their families.

OBJECTIVE

This study aims to understand child welfare system professionals' perspectives on enabling factors and barriers to providing family-based interventions via telehealth to youth in out-of-county foster care placement.

METHODS

This qualitative study derived themes from 3 semistructured focus groups with child welfare system professionals. Participants were asked to discuss how family-based interventions are delivered to foster youth and their caregivers in their jurisdictions, as well as to share their thoughts about how to use telehealth to improve access to family-based interventions for families with youth in out-of-home placement. Data were analyzed using constant comparative analysis and inductive thematic analysis, with the Behavioral Model for Vulnerable Populations as the theoretical framework.

RESULTS

Participants were 19 child welfare system professionals (eg, social workers, residential treatment staff, and supervisors) who participated in 1 of the 3 focus groups (6-7/group). Most participants were women (n=13, 68%), White individuals (n=10, 53%), and social workers (n=8, 42%). On average, participants worked in the child welfare system for 16.6 (SD 8.3) years. Participants identified multilevel factors impacting family-based intervention delivery including environmental factors (eg, Medicare billing and presumptive transfer), predisposing characteristics (eg, psychological resources), enabling factors (eg, transportation and team-based youth-centered care), and need factors (eg, motivation to engage). Participants expressed optimism that telehealth could increase access to needed mental health care, diverse providers, and longevity of care while also expressing some concerns regarding telehealth access and literacy.

CONCLUSIONS

Child welfare system professionals highlight the need to develop policies and telehealth interventions that are youth versus placement centered, include resources that limit barriers and bolster motivation for engagement, and follow a team-based care model. Findings from this study inform how telehealth can be used to increase access to and engagement with family-based interventions for youth in out-of-home placements and their caregivers of origin.

A Meta-Regression of Racial Disparities in Wellbeing Outcomes During and After Foster Care

Children in foster care face heightened risk of adverse psychosocial and economic outcomes compared with children in the general population. Yet, the effects of foster care as an intervention are heterogeneous. Heterogeneity outcomes by race and ethnicity are of particular interest, given that Black and Indigenous youth experience foster care at higher rates than other racial/ethnic groups and experience group differences in setting, duration, and exits to permanency. This meta-regression explores racial disparities in education, employment, mental health, and behavioral outcomes during and following foster care. A systematic search of PsycINFO, ERIC, and Academic Search Complete using a series of search terms for studies published between January 2000 and June 2021 found 70 articles and 392 effect sizes that provided outcomes of US-based foster care by race/ethnicity. Findings reveal that Black foster care impacted persons (FCIPs) have 20% lower odds (95% CI: .68-.93) of achieving employment or substantial financial earnings and have 18% lower odds (95% CI: .68-1.00) of mental health concerns compared to White FCIPs. Hispanic FCIPs have 10% lower odds (95% CI: .84-.97) of achieving stable housing compared to non-Hispanic FCIPs. Moderator analyses revealed certain study features (i.e. publication type, timing of the study, location of the study, and placement status of the participants) have a significant impact on the gap between Black and non-Black and Hispanic and non-Hispanic FCIPs. The findings provide important implications for racial disparities in foster care outcomes, as well as highlight important gaps and missing information from published studies.

A Framework for Addressing Foster Care Trauma in the Public Education System: Perceptions and Implications

BACKGROUND

It is estimated that approximately 90% of children in foster care have experienced a traumatic event, with nearly half reporting exposure to 4 or more types of traumatic events. Educators must remain alert to indicators suggesting a history of trauma and understand the difficulties foster youth may face regulating their emotions and behavior while in school.

METHODS

A framework for foster youth trauma in the public education system identifies the interplay between macro-level forces, such as federal and state policy, and school and teacher micro-level forces.

RESULTS

The framework highlights the inadequacy of educators in identifying the manifestations of trauma, specifically in foster youth, and how the current implemented policy leads to misinterpretation of the outward behavioral displays of trauma as other behavioral issues.

IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY

Federal and state policies, school districts, teacher and principal practices, teacher and school administrator preparation programs must incorporate knowledge about trauma pervasiveness and the consequences of trauma on foster youth attitude and behavior in the classroom.

CONCLUSION

The framework guides change efforts toward improving school climate and culture through preparing school professionals to meet the diverse needs of foster youth and tackling those policies and behaviors that exclude foster youth from schooling.

Sexual Health and Communication Between Foster Youth and Their Caregivers

PURPOSE

Foster youth are at increased risk for negative sexual health outcomes and rarely receive the information or social/familial support needed to reduce risks. Foster and kinship caregivers report lacking the information and skills needed to effectively talk to youth in their care about sexual health. In a sample of caregivers from 2 large urban jurisdictions, our goals were to: 1) describe caregiver sexual health variables including communication and monitoring characteristics; and 2) assess associations between self-reported emotion regulation and caregiver-youth conflict and these variables.

METHODS

We administered surveys to foster and kinship caregivers in New York, New York and Los Angeles, California. Surveys assessed caregiver emotion regulation, caregiver-youth conflict, sexual/reproductive health knowledge, communication expectations and behaviors, and caregiver monitoring/youth disclosure. We generated descriptive statistics for all variables (aim 1) then performed multivariate regression analyses for aim 2.

RESULTS

Our sample included 127 foster and kinship caregivers who were primarily female (92%) and African American (55%). Most reported having >4 years of caregiving experience with foster youth (66%). On average, caregivers answered sexual health knowledge questions correctly 68% of the time. Caregiver-youth conflict was the only variable significantly associated with assessed sexual health variables; it was inversely associated with percent correct on the knowledge scale, outcomes expectations, number of topics discussed, and monitoring/disclosure.

CONCLUSION

Our study suggests that caregiver-youth conflict behaviors are related to sexual health knowledge, communication, and monitoring variables. Further prospective and longitudinal investigation is warranted to better characterize the complex relationship between these variables.

Coping and Resilience: PTSD Screening and Brief Intervention for Underrepresented Students at a Public University

The undetected and untreated PTSD symptoms (difficulty paying attention, nightmares and difficulty sleeping, irritability or aggression, flashbacks, diminished interest in activities, self-destructive behavior, and feeling isolated) of college students may interfere with their relationships, well-being, learning, and academic success. To examine the feasibility, acceptability, and impact of providing a short-term trauma-specific evidence-based group intervention, Coping & Resilience (C&R), an adaptation of Cognitive Behavioral Intervention for Trauma in Schools (CBITS) was implemented at a large urban public university. Fifty college students (54 percent male, 90 percent students of color), with a mean PTSD symptom score of 34 at pretest (considered in the moderate range of symptom severity) participated in C&R groups. As expected, student PTSD symptoms improved after group participation. A Quade test showed a significant decrease in the scores from pretest to follow-up for PTSD and two subscales (intrusion and avoidance). Large public universities serving underrepresented students are uniquely positioned to become trauma- and resilience-informed systems and to provide trauma support services to promote student well-being.

Exploring youth voices in a pre-college program: Implications for policy, practice & research

BACKGROUND

Youth transitioning from foster care to college face multiple obstacles. Pre-college programs can promote college access for underrepresented students. The research on pre-college programs that prepare foster youth for college is limited. There is a paucity of research that illuminates youth voices in pre-college programs.

OBJECTIVE

This article reviews key program components of a pre-college summer program designed specifically for youth transitioning from foster care, the National Social Work Enrichment Program (NSEP). Findings from a qualitative research study of NSEP are presented. Implications for policy, practice, and research for pre-college programs are discussed.

PARTICIPANTS AND SETTING

Fourteen youth, who successfully completed NSEP and had enrolled in college following the program, participated in the study.

METHODS

Participants completed semi-structured interviews via a video conferencing tool. Interviews were transcribed verbatim and analyzed using NVivo 12.

RESULTS

Thematic analysis captured youth voices, highlighted in the themes: college aspirations, college preparation, and community building. Results suggest NSEP youth aspired to enroll in college. Results also suggests that the NSEP experience helped to prepare youth for college and facilitated the development of community among participants.

CONCLUSIONS

Investment in pre-college programs could provide the right support and resources that youth need to transition from foster care to college. Pre-college programs provide an opportunity for youth to develop college readiness skills, build relationship skills, and grow personally. Further research on the efficacy of pre-college programs is needed.

Resilience factors in youth transitioning out of foster care: A systematic review

OBJECTIVE

Youth who emancipate from the foster care system often experience poor outcomes during their transition into independent living (e.g., criminal justice involvement and homelessness). Yet, some youth are resilient and achieve positive outcomes. The purpose of this study is to review the resilience factors identified in the literature for youth transitioning out of care.

METHOD

A systematic review of the literature was conducted using PsycINFO, PubMed, and EMBASE databases. A total of 12 studies met our inclusion criteria.

RESULTS

A total of 38 different resilience factors were identified across the studies reviewed. From these resilience factors, 18 were statistically significant, including four assets and 14 resources.

CONCLUSION

Understanding the assets and resources that promote resilience can aid clinicians in assessing and capitalizing on youths' strengths and can help researchers develop effective interventions and target gaps in the literature. Further, it can assist policymakers in generating legislation to improve outcomes for foster youth transitioning out of care. To assist in this process, we systematically reviewed studies to provide a summary of resilience factors currently identified in the literature. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

After Child Maltreatment: The Importance of Voice for Youth in Foster Care

Once social services steps in to protect children from violence and neglect in their homes, many youth become wards of the specialized juvenile or family court that assists in child protection (e.g., the dependency court). Some of these children will be ordered into foster care. Within this "dependency system," such children often feel a lack of voice. This study tests the prediction that foster youth who perceive having more opportunity for voice, even indirectly via a representative, more favorably rate the dependency system. Adolescents (n = 110), aged 17 years, involved in foster care and age-matched nonfoster youth rated "how good or bad the foster care/dependency court is for foster youth." The foster youth were also asked about their interactions with the court and with their attorney representatives. Foster and nonfoster youth did not significantly differ in dependency system ratings when considered at the overall group level. However, foster and nonfoster youth ratings significantly differed when foster youth's views of relevant prior legal experiences (e.g., frequency of child-attorney contact, quality of attorney representation) were taken into account: Youth with the highest perceived quality of experiences indicated more positive views than any other group. The importance of perceived quality of experience adds insight into mechanisms for improving adolescents' feelings of voice in the legal system.

Individual and interpersonal factors associated with psychosocial functioning among adolescents in foster care: A scoping review

Risk reduction and strength enhancement are both necessary strategies to improve outcomes for youth in foster care who have experienced adversity. Decades of research have articulated the negative long-term outcomes of youth in foster care, but less is known about youth-level modifiable protective factors that can be nurtured through intervention to improve well-being. This scoping review was conducted to synthesize the state of the science on proximal, modifiable individual and interpersonal factors that are associated with psychosocial well-being among adolescent youth in foster care. Following rigorous and recommended methods, we systematically searched, selected and synthesized 20 years of peer-reviewed literature focused on 13-19 year olds in foster care. 41 peer-reviewed, quantitative studies met specified inclusion criteria and were included in this review. We charted the data and synthesized our findings in consultation with an advisory group of researchers, practitioners, and youth with lived experience. Overall, the review highlighted key categories of individual factors (individual strengths, psychosocial needs, and developmental skills) and interpersonal factors (relationships with peers/siblings, caregiving adults, and caring adults in the community) that can have protective value and are associated with psychosocial functioning for adolescent youth in foster care. Moreover, when youth have their needs met, increase their skills and develop strengths, it often leads to better outcomes as well as more and/or higher quality relationships with important people in their lives. Similarly, when youth develop and maintain quality relationships, those connections often lead to opportunities to advance their skills, strengths and positive outcomes. The results of this review contribute new insights for research, practice, and policy intended to enhance psychosocial well-being for young people in foster care. Findings also highlight specific individual and interpersonal factors that interventionists might consider as potential targeted mechanisms of change when developing programming for this population. Implications are discussed.

Life is a highway: Driver's license acquisition and social determinants for youth in foster care and their non-foster care peers

BACKGROUND

Data regarding the connection between driver licensure and social determinants for youth could provide insight into the impact of driver license acquisition. These relationships are important for youth overall and particularly for foster youth given that adolescents in foster care obtain driver's licenses less often than their non-foster care peers. This integrative review explores the association between driver licensure and social determinants.

METHODS

Whittemore and Knafl guidelines were used to conduct the integrative review. The articles were identified in collaboration with an expert in library science and public health. Results were organized by the Healthy People 2030 (HP 2030) Social Determinants of Health (SDOH) model.

RESULTS

Six studies were included. Social and community context included social support structures helping youth get driver's licenses. Economics, including income and education, influenced license acquisition. Driver license acquisition was associated with improved well-being, security, and mental health.

CONCLUSION

While fewer of those living in urban, walkable neighborhoods with access to public transportation were licensed, results from other studies suggest that car access is associated with psychological well-being. Further, licensure is disproportionately lower for populations historically marginalized from equal housing, education, and employment opportunities. Licensure plays a role in well-being.

Exploring the Relationship between Foster Care Experiences and Social Network Engagement Among a Sample of Homeless Former Foster Youth

INTRODUCTION

Recent research has begun to demonstrate high rates of poor behavioral health outcomes among homeless former foster, but with relatively little attention in the scientific literature. Because social networks have been shown to impact behavioral health outcomes, we need to better understand the network characteristics of homeless young adults with a history of foster care.

METHODS

Data were collected from 184 homeless former foster youth at a drop-in center in Hollywood, California. A series of logistic regressions were conducted for network engagement behaviors that may be impacted by foster care experiences.

RESULTS

Youth were largely African American, Latino, and Mixed race, approximately 22 years old, and majority male. Significant results from the logistic regressions indicated that youth experiencing homelessness for the first time before exiting foster care were more likely to have alters engaging in condomless sex, and youth with higher numbers of foster care placements were more likely to have alters engaging in methamphetamine use.

CONCLUSION

These results suggest that certain foster care experiences impact the types of alters with which youths engage. Time spent in placement was significantly associated with alter behaviors, evident from homeless experiences and multiple foster care placements, negatively impacting the types of alters with which youths are connected, and thusly the risk factors for the youth themselves. Frequent network disruptions may be associated with engagement with risky alters. Included are intervention-based implications for providers as well as structural-based implications for child welfare systems.

Exploring college student identity among young people with foster care histories and mental health challenges

Young adults with foster care histories experience unique barriers to success in postsecondary academic settings, including higher rates of mental health challenges. This study reports the perspectives of college students with foster care histories and self-identified mental health concerns (N=18) about how these factors relate to their post-secondary academic experiences. Study participants describe managing their mental health amid other academic and life stressors, share their perspectives on campus-based support and help-seeking experiences, and highlight the need for acknowledgement of their foster care identities in conjunction with their developing college student identities. Participants make a case for programming to help with managing challenges related to overwhelming emotions in response to compounding stressors, balancing self-reliance with help-seeking when needed, and developing interpersonal relationships that reduce feelings of otherness in the campus context. Recommendations for improving student experiences include mental health services provided by people familiar with the lived experience of foster care, access to foster student-specific programs providing social, emotional, and academic support, and campus-wide efforts improve the conditions for academic success in the face of difficult personal histories and elevated mental health challenges.

Adapting Pediatric Medical Homes for Youth in Foster Care: Extensions of the American Academy of Pediatrics Guidelines

This article provides recommendations for adapting the pediatric medical home (PMH) model for health care needs of youth in foster care. Recommendations are based on key informant interviews regarding experiences at an established PMH for youth in foster care. Major clinic recommendations include expanding the PMH framework to include proficiency in Medicaid billing, promoting true interdisciplinary care teams, improving care accessibility via phone consultation, providing a stable place for medical records to be housed, delivering services throughout stages of the child welfare case, incorporating all family members, and implementing trauma-informed practice. Preliminary evidence suggests that the PMH model of care may be ideal for addressing the complex and often underserved needs of youth in foster care and their families. The present recommendations provide a logistical framework for establishing a clinic that thoughtfully considers the unique needs of this population. Future research is needed to examine best practices for implementation.

Spirituality and its Relation to Mental Health Outcomes: An Examination of Youth in Foster Care

The effects of spirituality and youth relationships with others on internalizing, externalizing, and adaptive outcomes were examined in a sample of 159 youth between the ages of 8 and 21 in foster or residential care. Indirect effects of direct coping and perceived social support on the relations between these factors and youth outcomes were examined. Preliminary analyses indicated a significant relation between youth spirituality and adaptive outcomes, with a significant indirect effect of perceived social support on these relations. However, these relations were nonsignificant when accounting for youth relationships with others. Final results indicated that youth relationships with others significantly affected youth adaptive functioning through both coping and perceived social support. Youth relationships also significantly affected youth internalizing symptoms, albeit only through youths' perceived levels of social support. These findings suggest that, while spiritual beliefs are potentially an important factor in affecting outcomes for foster youth, the strongest effects likely occur through youths' relationships with others, social support, and coping in relation to adaptive outcomes for these youth.

Assessing Support Network Stability With Transition-Age Foster Youth: Measuring Change Over Time

OBJECTIVE

This study uses the Support Network Assessment for Practice (SNAP) approach to measure the support provided to young people transitioning from foster care.

METHODS

The SNAP was administered on two occasions, approximately 7 months apart, to a cohort of transition-age foster youth (n = 27). Analyses investigated measurement reliability and sensitivity to change for network-level characteristics as well as baseline factors associated with relationship stability.

RESULTS

Most network-level indicators had strong test-retest correlations, and differences in mean scores over time also were detected, suggesting measurement sensitivity to change. Respondents were able to explain most observed changes in their networks, further suggesting reliable measurement. Stable relationships were those reported as stronger and providing more multifaceted support and those with family members and/or parent figures.

DISCUSSION

The SNAP approach could be used to facilitate planning around support needs for youth transitioning out of foster care and to evaluate efforts to enhance support networks.

Validation of a Measure of Foster Home Integration for Foster Youth

OBJECTIVES

This article introduces a youth-reported measure (Essential Youth Experiences [EYE]) developed to assess the experiences of foster youth in their home environment and their critical relationships across a number of service systems. Empirically, the article reports on the psychometric properties of a 9-item scale within the EYE that measures the construct of positive home integration (PHI).

METHODS

The EYE was administered to 328 preadolescent and adolescent youth (164 sibling dyads) enrolled in a larger randomized clinical trial.

RESULTS

Correlational analysis suggests that the PHI Scale shows good psychometric properties and strong current and predictive validity.

CONCLUSION

The PHI is a reliable and valid scale that measures youth perspectives of inclusion in the foster home and relationships with their foster care provider. This scale quickly gathers youth perspectives and differentiates between youth who have more versus less significant needs. Implications for research and social work practice are discussed.

Visits to Primary Care and Emergency Department Reliance for Foster Youth: Impact of Medicaid Managed Care

OBJECTIVE

To examine the rate of access to primary and preventive care and emergency department (ED) reliance for foster youth as well as the impact of a transition from fee-for-service (FFS) Medicaid to managed care (MC) on this access.

METHODS

Secondary administrative data were obtained from Medicaid programs in one state that transitioned foster youth from an FFS to an MC (Texas) and another state, comparable in population size and racial/ethnic diversity, which continuously enrolled foster youth in an FFS system (Florida). Eligible participants were foster youth (aged 0-18 years) enrolled in these states between 2006 and 2010 (n = 126,714). A Puhani approach to difference-in-difference was used to identify the effect of transition after adjusting for race/ethnicity, gender, and health status. Data were used to calculate access to primary and preventive care as well as ED reliance. ED reliance was operationalized as the number of ED visits relative to the number of total ambulatory visits; high ED reliance was defined as ≥33%.

RESULTS

The transition to MC was associated with a 6% to 13% increase in access to primary care. Preventive care visits were 10% to 13% higher among foster youth in MC compared to those in FFS. ED reliance declined for the intervention group but to a lesser extent than did the control group, yielding a positive mean percentage change.

CONCLUSIONS

Foster youth access to care may benefit from a Medicaid MC delivery system, particularly as the plans used are designed with the unique needs of this vulnerable population.

Systems theory as a framework for examining a college campus-based support program for the former foster youth

Increased attention to former foster youth pursuing post-secondary education has resulted in the creation of college campus based support programs to address their need. However, limited empirical evidence and theoretical knowledge exist about these programs. This study seeks to describe the application of systems theory as a framework for examining a college campus based support program for former foster youth. In-depth semi-structured interviews were conducted with 32 program stakeholders including students, mentors, collaborative members, and independent living program staff. Using qualitative data analysis software, holistic coding techniques were employed to analyze interview transcripts. Then applying principles of extended case method using systems theory, data were analyzed. Findings suggest systems theory serves as a framework for understanding the functioning of a college campus based support program. The theory's concepts help delineate program components and roles of stakeholders; outline boundaries between and interactions among stakeholders; and identify program strengths and weakness. Systems theory plays an important role in identifying intervention components and providing a structure through which to identify and understand program elements as a part of the planning process. This study highlights the utility of systems theory as a framework for program planning and evaluation.

Network Indicators of the Social Ecology of Adolescents in Relative and Non-Relative Foster Households

Though the presence, composition, and quality of social relationships-particularly as found in family networks-has an important influence on adolescent well-being, little is known about the social ecology of youth in foster care. This study examined the social networks of foster youth participating in a large RCT of an intervention for siblings in foster care. Youth reported on the people they lived with and the relatives they were in contact with, which provided indicators of network size, composition, and relationship quality. Cluster analysis was used to identify five family network profiles for youth living in foster homes. Two identified subgroups reflected robust family networks where youth were living with relative caregiver(s) and related youth, and also reported multiple family ties outside the household, including with biological parents. The remaining three profiles reflected youth reports of fewer family connections within or beyond the foster household, with distinctions by whether they lived with siblings and/or reported having positive relationships with their mothers and/or fathers. The identified network profiles were validated using youth- and caregiver-reported measures of mental health functioning, with increased caregiver report of post-traumatic stress symptoms indicated for the three subgroups that were not characterized by a robust family network.

Where Are the Beds? Housing Locations for Transition Age Youth Exiting Public Systems

Transition age youth (TAY) from the child welfare and juvenile justice systems experience high rates of homelessness, but little is known about the neighborhoods to which they return after they exit these systems. This exploratory study investigates whether housing options are located in areas where TAY exit public systems and if the characteristics of areas surrounding these facilities support their transition to adulthood. Results show that housing is not related to areas where TAY exit public systems. Further, supportive housing and shelter density is related to low-income areas. Implications for practice and policy on housing locations for TAY are discussed.

Health outcomes in young adults from foster care and economically diverse backgrounds

BACKGROUND AND OBJECTIVES

Foster youth have high rates of health problems in childhood. Little work has been done to determine whether they are similarly vulnerable to increased health problems once they transition to adulthood. We sought to prospectively evaluate the risk of cardiovascular risk factors and other chronic conditions among young adults formerly in foster care (FC) and young adults from economically insecure (EI) and economically secure (ES) backgrounds in the general population.

METHODS

We used data from the Midwest Evaluation of the Adult Functioning of Former Foster Youth (FC group; N = 596) and an age-matched sample from the National Longitudinal Study of Adolescent Health (EI and ES groups; N = 456 and 1461, respectively). After controlling for covariates, we performed multivariate regressions to evaluate health outcomes and care access by group at 2 time points (baseline at late adolescence, follow-up at 25-26 years).

RESULTS

Data revealed a consistent pattern of graduated increase in odds of most health outcomes, progressing from ES to EI to FC groups. Health care access indicators were more variable; the FC group was most likely to report having Medicaid or no insurance but was least likely to report not getting needed care in the past year.

CONCLUSIONS

Former foster youth appear to have a higher risk of multiple chronic health conditions, beyond that which is associated with economic insecurity. Findings may be relevant to policymakers and practitioners considering the implementation of extended insurance and foster care programs and interventions to reduce health disparities in young adulthood.

Maltreatment histories of foster youth exiting out-of-home care through emancipation: a latent class analysis

Little is known about maltreatment among foster youth transitioning to adulthood. Multiple entries into out-of-home care and unsuccessful attempts at reunification may nevertheless reflect extended exposure to chronic maltreatment and multiple types of victimization. This study used administrative data from the Illinois Department of Children and Family Services to identify all unduplicated allegations of maltreatment in a cohort of 801 foster youth transitioning to adulthood in the state of Illinois. A latent variable modeling approach generated profiles of maltreatment based on substantiated and unsubstantiated reports of maltreatment taken from state administrative data. Four indicators of maltreatment were included in the latent class analysis: multiple types of maltreatment, predominant type of maltreatment, chronicity, and number of different perpetrators. The analysis identified four subpopulations of foster youth in relation to maltreatment. Study findings highlight the heterogeneity of maltreatment in the lives of foster youth transitioning to adulthood and draw attention to a need to raise awareness among service providers to screen for chronic maltreatment and multiple types of victimization.

Trajectories of depressive symptoms in foster youth transitioning into adulthood: the roles of emotion dysregulation and PTSD

Foster youth often experience considerable adversity both in and out of foster care, including histories of abuse and/or neglect, and further stressors within the foster system. These adverse experiences often occur at key developmental periods that can compromise emotional functioning and lead to posttraumatic symptomatology, including posttraumatic stress disorder (PTSD) and emotion dysregulation. In the face of difficult histories and ongoing mental health challenges, youth transitioning into adulthood may be particularly vulnerable to increases in depressive symptoms. We explored the trajectory of depressive symptoms in foster youth from age 17 to 19 using a piecewise linear growth model, examining the effects of PTSD and emotion dysregulation on youth's depressive symptoms over time. Results revealed depressive symptoms decreased from age 17 to 18 but increased from 18 to 19. PTSD and emotion dysregulation predicted greater baseline depressive symptoms and decreases in symptoms from age 17 to 18, whereas only PTSD predicted increases in depressive symptoms from 18 to 19. Females reported higher levels of depressive symptoms compared to males. Additionally, emotion dysregulation was a stronger predictor of depressive symptoms for females than males. Implications for service delivery for foster youth transitioning into adulthood are discussed.

In search of connection: The foster youth and caregiver relationship

Placement instability is an ongoing challenge for the 125,000 foster youth aged 14 - 18 that are living in foster care, with youth living in approximately 3 placements before aging out of the system. Despite the importance caring adult relationships can play in promoting positive youth development and resiliency, there has been limited inquiry into the characteristics of the foster youth and caregiver relationship. The goal of this paper is to provide a descriptive account of the foster youth and caregiver relationship, and explore what qualities and experiences foster youth desire from their caregivers. Qualitative data were gathered from 9 focus groups. Data were analyzed using thematic content analysis approaches. Foster youth, caregivers, and child welfare staff described relationships lacking in formative bonds and connection, where youth didn't "fit in", and chaotic homes marked by reactivity and judgment. Characteristics of supportive foster homes include a sense of belonging, structure, guidance, and consistency. This research underscores the important role positive relationships can play in foster youth's feelings of well-being and points to the need for foster parent training to include tangible strategies to develop stronger bonds.

Risk for arrest: the role of social bonds in protecting foster youth making the transition to adulthood

This study examines a sample of foster youth at the onset of the transition to adulthood and explores how social bonds are related to the risk of arrest during adulthood. Drawing from official arrest records, event history models are used to examine the time to arrest. Because individuals may be at risk for different types of crime, competing risk regression models are used to distinguish among arrests for drug-related, nonviolent, or violent crimes. Between the ages of 17-18 and 24, 46% of former foster youth experience an arrest. Arrests were evenly distributed across drug, nonviolent, and violent crimes columns. Although findings fail to support the significance of social bonds to interpersonal domains, bonds to employment and education are associated with a lower risk for arrest. Child welfare policy and practice implications for building connections and protections around foster youth are discussed.

Dimensions of health in young people in foster care

To describe the dimensions of health and illness from the perspective of adolescents in foster care.

METHODS

Descriptive analyses of dimensions of health were conducted on N = 105 adolescents in foster care. Differences among demographic (age, gender, race/ethnicity) and foster care placement (age at first placement, reason(s) for foster care placement, length of time in care, number, and types of placement) variables and the dimensions and subdimensions of health (Child Health and Illness Profile- Adolescent Edition) were determined using T-tests and ANOVA.

RESULTS

Most were placed in long-term foster care (x = 6.46 years; SD = 4.86) during adolescence (38%), with multiple placements (x = 3.99; SD = 3.8). All domains of health were self-reported to be average to low average, with poorer findings in specific risk and resilience subdomains. There were no significant differences by age or race/ethnicity. Girls had lower satisfaction with health and self esteem and more physical and emotional discomfort. Pre-placement adverse experiences were associated with increased risks.

CONCLUSIONS

Adolescent self-report of the domains of health for those in foster care was better than expected, based on literature review and qualitative data for the larger study. Potential explanations for this inflation of status and functioning include the need for self-protection in foster care, the familiarity of testing regimes by children in foster care with some social desirability effect, and their paradoxical responses to pre-placement problems. Data including qualitative and significant other-reported data may be necessary to gain an accurate portrayal of the health status of adolescents in foster care.