Instruments for research on transition

Children and Youth Services Review 33 (2011) 2431–2441

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Children and Youth Services Review journal homepage: www.elsevier.com/locate/childyouth

Instruments for research on transition Applied methods and approaches for exploring the transition of young care leavers to adulthood Annemiek T. Harder a,⁎, Stefan Köngeter b, Maren Zeller c, Erik J. Knorth a, Jana Knot-Dickscheit a a b c

University of Groningen, The Netherlands University of Toronto, Canada University of Hildesheim, Germany

a r t i c l e

i n f o

Available online 26 August 2011 Keywords: Transition Young care leavers Research review Approaches Instruments

a b s t r a c t Young people who have been in care show relatively poor outcomes in comparison to young people who have not been in care, and run a high risk of social exclusion. Therefore, the transition to adulthood of young people leaving care is an important topic for research. However, there is still little knowledge about the different research approaches and research instruments that are being used in studying this topic. The aim of the present study is to review the approaches and instruments that are used in empirical studies that focus on young care leavers' transitions to adulthood. The results show that the studies apply a diversity of topics and instruments, but that there is also considerable overlap. To make better comparisons on the transition from out-of-home care to adulthood between different countries, a common research framework and one or more research instruments should be developed that can assess this transition and the situation of young care leavers in diverse social contexts. © 2011 Elsevier Ltd. All rights reserved.

1. Introduction In the past decade, there has been much interest in and research activity around the issue of care leaving and the transition to adulthood. Projects in various countries have been carried out (cf. Stein, 2008). These studies consistently show that young people leaving out-of-home care are at high risk of material disadvantage and social marginalization. Furthermore, a majority of the care leavers move to independence at 16–18 years of age, whereas most of their peers remain at home well into their 20s (Stein, 2006b). According to Biehal and Wade (1996), youth leaving care have a journey to adulthood that is ‘both accelerated and compressed’ (p. 443). In comparison to young people who have not been in care, those who have show relatively poor outcomes, especially in terms of education, health and well-being (Munro & Stein, 2008). However, some of these young people do succeed despite the difficulties they encounter in their transition to adulthood and independence. Therefore, Stein (2005) reviewed 66 empirical research studies carried out between 1986 and 2005 that explored the resilience-promoting factors for young people who have left care.

⁎ Corresponding author at: University of Groningen, Faculty of Behavioral and Social Sciences, Department of Special Needs Education and Youth Care, c/o A.T. Harder, PhD, Groote Rozenstraat 38, NL-9712 TJ Groningen, The Netherlands. E-mail address: [email protected] (A.T. Harder). 0190-7409/$ – see front matter © 2011 Elsevier Ltd. All rights reserved. doi:10.1016/j.childyouth.2011.08.017

Resilience was used as a conceptual framework and defined as ‘the quality that enables some young people to find fulfillment in their lives despite their disadvantaged backgrounds’ (Stein, 2005, p. 1). The review shows that stable placements providing good quality care are important for promoting resilience of young people in care, but that this stability is often lacking in care practice. Other factors that are associated with resilience are helping young people in promoting self-efficacy, having a positive experience at school, and preparing young people for leaving care (Stein, 2005). To address the cross-national gap of knowledge and comparative work on the transitions of young people leaving care to adulthood, quite recently there appeared another overview on young people leaving care containing information from 16 countries (Stein & Munro, 2008). This review shows that there is a high risk of social exclusion for young people leaving care, despite differences in the care population, types of care placements and legal and policy frameworks within the countries (Stein, 2008). In particular males, minority ethnic or immigrant young people and early care leavers seem to have a higher risk of social exclusion according to several European studies. Furthermore, the development of programs concerned with preparing young people for leaving care is patchy across the 16 countries. In studying the transition from care to adulthood, Sweden and the US make use of relatively large samples and quantitative methods while Australia, Canada and many European countries often use smaller scale and qualitative methods (Stein, 2008). As a result, for the first time an overview is available that shows the situation of care

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leavers in various countries and contains important indications for comparative studies that will be needed in the future. However, since in recent years the transition of young people from care to adulthood has become more complex (Biggart, Furlong, & Cartmel, 2008; Walther, 2006), it is critical that one reflect on the various topics that have been studied and the research approaches that have been used. The transition process itself has changed with the result that different dimensions of the transition (e.g., work, housing, family formation) are no longer as closely linked as was previously the case (Liefbroer, 2009); sometimes this involves moving back and forth between dependence and independence—the so-called “yo-yo transition” (cf. Walther & Stauber, 2002). This makes that young people are unable to follow predetermined paths and have to choose and cope with various challenges instead. Despite previous attempts to address the cross-national gap in knowledge about the transitions of young people from out-of-home care to adulthood, there is still little knowledge about the different research approaches and research instruments that are being used in studies focusing on this issue. It is important to know which methods are currently applied in these studies in order to help refine methods and improve comparison of findings from different countries. As was already mentioned above, studies focusing on the transition to adulthood contain both qualitative research methods that are generally focused on developing theories and quantitative research methods which are often focused on testing whether a specific theory is sustainable. Since the studies differ in focus and therefore apply different methods, the types of instruments that are used in these studies will also differ. The central aim of this article is to review the approaches and instruments used in empirical studies that focus on care leavers' transition to adulthood. The following research questions are the focus of attention: – What are the topics and approaches applied in the studies on transitioning from care into adulthood? – Which research designs and instruments are used in these studies? In reviewing the research evidence, we will focus on empirical studies on this topic from different countries. After describing the method of our study, we will first pay attention to the topics that are applied in these studies. After that, we will focus on the instruments that have been used in the studies. We will conclude our review study by discussing our findings, including recommendations for future research. 2. Method The starting point of our research analysis is the International Research Network on Transitions to Adulthood from Care (INTRAC). INTRAC is a network of researchers concerned with the process of transition made by young people moving to adulthood from public care (INTRAC, 2010). The network currently consists of 25 members from 16 nationstates. 2.1. Procedure For the present study, all the INTRAC members have been contacted and asked to provide information on their current or recently completed research projects on ‘the transition to adulthood of care leavers’. In some cases, also other colleagues who are involved in this research area were asked by INTRAC members to provide information about their research. Since it was ascertained that numerous studies were being carried out by doctoral candidates, the members of a recently established network of these young social scientists connected with INTRAC were asked separately to participate in this survey.

2.2. Inclusion criteria Our inquiry resulted in a total of 34 studies. For inclusion in this research overview, two formal criteria were taken into account. First, attention was paid to whether the topic ‘transition of young care leavers into adulthood’ was at the focus of the particular study. So, the studies had to be focused on making the transition of young people from care into the community. Studies that were in fact not focused solely on the topic of the transition into adulthood but also on the transition of young people from a residential or foster care setting into the community were included as well. Furthermore, we included studies that were focused on the life situation of young people after they had left care (i.e., care leavers). The second criterion for inclusion was that the study had to be empirical in nature. One of the studies did not meet these requirements, because it consisted of a literature review, and was therefore excluded from the present study. The application of these inclusion criteria resulted in a group of 33 studies that were eligible for inclusion in the present review. 2.3. Instruments In contacting the INTRAC members, a semi-structured questionnaire was used which was developed for the present study. This questionnaire consisted of open-ended questions regarding the characteristics of relevant research projects (e.g., the country in which the study was conducted, the title and keywords of the study), a table with information on the contents of the study, and two open questions regarding 1) publications or reports on the instruments that were used in the study, and 2) relevant core studies that were of particular significance for the study or for the respective country. The most important information had to be entered into a table. The first columns in the table concerned information about 1) the key question(s) of the study, 2) the participants and the care setting in which the young adults had lived, and 3) the design of the study, including the research inquiry period. The second part of the table was concerned with information about the instruments used for data collection and analysis. This information was divided by three sub columns comprising information about the name of the instrument, the construct measured, and the psychometric properties, including an assessment of whether these research instruments and methods had already been tested or had been employed in other cross-national studies. 2.4. Study characteristics The 33 studies were carried out in fifteen different countries within five continents. The characteristics of the studies are shown in Table 1. The 22 studies carried out in Europe (67%), were conducted in nine different countries. Five of these studies were conducted in the United Kingdom, four studies in France and three in the Netherlands. In Germany, Romania, Spain and Sweden two studies were carried out. One of the European studies was focused on Switzerland and another one focused on Ukraine. The seven Middle Eastern studies were Table 1 Countries in which the ‘transition studies’ were carried out (2000–2010). Country/continent

Number of studies

Percentage

Europe Asia North America Africa Australia Total

22 7 2 1 1 33

66.7 21.2 6.1 3.0 3.0 100

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largely represented by Israel and with one study by Jordan. The two North American studies were carried out in Canada and the United States. The studies date without exception from the last ten years. The oldest studies began its data collection in 1998 (Del Valle, Bravo, Alvarez, & Fernandez, 2008), followed by studies that started their data collection in 2002 (Anghel, 2010; Courtney, Dworsky, Lee, & Raap, 2010). One of the studies was in preparation and not yet in the data collection phase at the moment of the data collection for the present review (Frimpong-Manso, 2012). Several studies are still in the progress of data collection (e.g., Munro, Maskell-Graham, Ward, & National Care Advisory Service, 2010; Munro, Ward, Lushey, & National Care Advisory Service, 2009), or in the phase of data processing (e.g., Harder, 2011). Furthermore, eleven studies (33%) consist of research within the scope of a PhD project (Anghel, 2010; Benbenishty, Zeira, Dinisman, & Sulimani-Aidan, in press; Dima & Skehill, 2008; Frimpong-Manso, 2012; Geurts, 2010; Harder, 2011; Hyde-Dryden, 2012; Ibrahim, 2010; Novozhylova, in press; Van Oijen, 2010; Zeller, 2012). The types of out-of-home care that are the central focus mainly consist of residential care (15 studies), followed by a combination of various types of care (e.g., residential care, foster care, kinship care; eight studies), both residential and foster care (five studies), foster care (four studies) and kinship care (one study). Most of the studies (24 studies, 73%) are focused on adolescents from 16 years upwards. 3. Results Our survey in the INTRAC research network shows that in some countries (e.g., the United States, the United Kingdom, France and Sweden) a considerable amount of reliable data on this topic already exists, whereas in others the research basis is outdated (e.g., Germany), or in many other countries such data still do not exist (e.g., Jordan, Spain, Romania, Ukraine). 3.1. The life situation of young people after care Independent of the state of research in the respective countries, all studies are mainly interested in how the life situation of care leavers develops as they become adults. In examining this life situation, they focus on the determinants of adult life (for example work, partnership and children) and on the criteria that can be applied in judging whether the care leavers cope well with their lives as adults. Though there are many studies on the life situation of young people after they leave care, the topics covered in these studies vary enormously. Nonetheless, three areas that are covered in most of the studies will be discussed in greater detail here. The first area involves the social networks of care leavers and the type of social support they receive (23 studies; 70%). Their relationships to peers (Dixon, Wade, Byford, Weatherly, & Lee, 2006) and other significant others, such as parents (e.g., Geurts, 2010), foster carers (e.g., Munro et al., 2009; Skuse & Ward, 2003) and educators (e.g., Schiff & Benbenishty, 2006), play a central role here. But formalized forms of social support are in part also examined (for example, follow-up monitoring by social workers or the utilization of social services). Second, the education and employment of the young people being studied are examined. A total of 22 studies (67%) include questions about the current enrolment status in education and training or the current employment status (e.g., Flynn & Tessier, 2010; Hyde-Dryden, 2012; Zeira, 2009). The young people are also asked about the highest level of education they have attained, about the nature of the efforts they have made to find training or a job, and whether they have a job on the side or are active in voluntary work. Two studies (Flynn & Tessier, 2010; Zeller, 2012) specifically examine the connections between education and the transition to adulthood.

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A third topic is the housing situation of care leavers, which is documented in 19 studies (58%) (e.g., Frechon, 2009). In examining this, in addition to questions concerning their housing situation and fellow occupants, the care leavers are also asked about their housekeeping arrangements. A relatively minor role is played by questions concerning the behavior of the young adults. Seven studies (21%) examine aspects of non-normative behavior (for example delinquency, drug dependence, alcohol abuse or prostitution) or behavioral problems (for example aggressive behavior or difficulties in concentrating). Similarly, studies frequently focus on the coping strategies or the self-efficacy of care leavers (six studies; 18%), while only in three studies (9%) is information gathered on their normative behavior (leisure activities, for example). In order to capture the care leavers' life situation, numerous studies employ one or more comprehensive models that focus on various spheres of life. All in all, four research access points which also differ in terms of their theoretical connotations may be identified. The main key words for designating them are: health (ten studies; 30%), wellbeing/quality of life (seven studies; 21%), life skills (five studies; 15%) and social integration (three studies; 9%). 3.2. Research perspectives on care leaving Only a few research projects contain solely a description and assessment of the life situation of young people after they have left care. On the other hand, in most studies it is considered important to determine which factors have influenced or are influencing the young people's life situation at the time of the study. The 33 studies dealt with here involve three main research perspectives. The first perspective includes a focus on the outcomes of out-of-home care; the second studies the process of transition from care; and the third is concerned with the outcomes of specified services during and after the transition from care. 3.2.1. Outcomes of out-of-home care The first group of research projects examines the connection between the type of care being received (e.g., residential care, foster care) and the life situation of adults who left care. In these studies an attempt is made to identify features of the care process that might predict the outcomes of out-of-home care. A total of ten studies (30%) from seven different countries (i.e., the Netherlands, France, the United Kingdom, Israel, Spain, Switzerland and Germany) are assigned to this category. In order to establish this connection, data on the out-of-home care support being provided needed to be gathered. A cross comparison of the issues examined reveals a broad spectrum of topics. First, the objective features of the care being received by the young people are brought together, such as the reasons for applying a particular type of care, the length of care and the incidental events that may have arisen during care (cf. Del Valle, Lázaro-Visa, López, & Bravo, in press; Del Valle et al., 2008). Those studies that do not concentrate exclusively on the significance of the support but ask the general question about which young people fare better or worse on leaving care (Dixon et al., 2006) take into consideration a broader array of topics. Factors that affect a successful transition include: the personal characteristics of the young people (e.g., mental disorders), non-normative behavior (e.g., drug use and delinquency) or the familial context of the young people, such as information (for example in the Dutch studies) on the family of origin, the predominant upbringing behavior and the family atmosphere (Geurts, 2010; Harder, 2011; Van Oijen, 2010). Second, the young people's subjective experiences in dealing with care institutions are examined (e.g., Zeira, 2009). Biographical studies, such as the one by Zeller (2012), also take into greater account these experiences of young people with several institutions, while

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Table 2 Research designs and instruments of transition studies. N age

Type of care

Name instrument (source)

Construct measured

Instrument(s) tested?

Instrument(s) used in cross-national studies?

1. Anghel (2010) Romania

Prospective case-study design, 2 measurements (before and after discharge)

28 17–21 yrs

Institutional long-term (≥5 yrs) care

1) Experiences in leaving care; early outcomes in life areas (e.g., accommodation, etc.) 2) Skills, resources and goals

No

No, self-developed

2. Benbenishty (2009) Israel

Prospective evaluation study, 3 measurements (during and after intervention) and 3 groups

No

No

Retrospective study

Youth from: a) Welfare and educational placements b) Delinquency hostels c) A ‘farm-like’ facility Foster care

1,2,3,4) Evaluation of three experimental intervention programs for youth leaving care

3 Benbenishty and Schiff (2009) Israel

105 3 groups: a) 77 b) 14 c) 14 157 16–18 yrs

1,2) Readiness for leaving care 2a) Social support 2b) Quality of relationship with foster family 2c) Use of psychoactive drugs 2 d) Perpetration of violence

No

No

4. Benbenishty and Zeira (2008) Israel

Retrospective study

No

No

Prospective panel study, 2 measurements (during and after care)

Youth from: a) Foster care b) Residential (welfare) c) Youth villages d) Group homes for delinquents Residential care

Readiness for leaving care

5. Benbenishty et al. (in press) Israel

1878 16–18 yrs a) 178 b) 291 c) 1257 d) 152 270 19 yrs (M)

1) Semi-structured interviews (youth and practitioners) 2) Goal Attainment Map (GAM) 3) Field notes 4) Documentary material 1) In depth interviews (professionals) 2) Unstructured observations 3) Structured (mostly phone) interviews (youth) 4) Structured questionnaires (staff) 1) Files (staff, N = 157) 2) Interviews (youth, N = 66) containing a) Medical Outcomes Scale (MOS) b) Children's Reports of Parent Behavior Inventory (CRBPI) c) instrument by Rahav et al. d) five items from Israel's National Study of School Violence Structured questionnaires (staff)

Yes

Prospective multi-wave panel study, 4 measurements (during and after care)

732 17–18 at T1

Foster care

1) Self-esteem, social relationships, social support, life orientation, relationship with father/mother, school performance, readiness to leave care, future expectations et cetera. 2) Mental health, problem behavior, economic and accommodation security et cetera. 1) Functioning of young people in a variety of domains and physical health 2) Mental health and substance abuse

Yes

6. Courtney et al. (2010) United States

1) Self fulfillment questionnaire in small groups, e.g. Rosenberg Self-Esteem Scale, the Medical Outcome Scale (MOS) social support survey, Life Orientation Test (LOT-R), Relationship with Father/Mother Questionnaire (RFMQ) 2) Telephone interviews, e.g. MHI-5 (youth) 1) Interviews including self-developed items and items from studies of nationally-representative samples of youth (e.g., the MOS social support survey, National Study of Adolescent Health (Add Health); National Longitudinal Survey of Youth (NLSY)) (youth) 2) Composite International Diagnostic Inventory (CIDI) (youth) 1) Interview (youth) 2) Files 1) Child Behavior CheckList (CBCL-C) and Youth Self Report (YSR) 2) Strengths and Difficulties Questionnaire (SDQ) 3) Scale of life satisfaction Cummins 4) Scale of life satisfaction Diener 5) Self esteem Scale Rosenberg 6) Support social network for adolescents Del Valle (youth)

1) No

1) No

2) Yes

2) Yes

No

No, self-developed

Yes

Yes

7. Del Valle et al. (2008) Retrospective study Spain 8. Del Valle et al. (in press) Retrospective study Spain

260 Residential care 20.9 yrs (M) 140 Kinship care

1,2) Indicators of integration (e.g. employment, housing, health) 1,2) Behavior problems 3,4) Life satisfaction 5) Self esteem 6) Social support

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Design

Retrospective mixed methods study: qualitative with complemented by quantitative dimension

34 20–26 yrs

10. Dixon et al. (2006) United Kingdom

Prospective study, 2 measurements (during independent living)

106 16–20 yrs

11. Dumaret (in press) France

Prospective historical study, 2 measurements

130 23–50 yrs

12. Dumaret and Crost (in press) France

Retrospective study (follow-up)

13. Flynn and Tessier (2010) Canada 14. Frechon (2009) France 15. Frechon (2009) France

Prospective, cross-sectional (over 1 year only)

227 1) 182 18 yrs 2) 45 16–17 yrs 405 18–20 yrs

16. Frimpong-Manso (2012) Ghana 17. Geurts (2010) the Netherlands

18. Gabriel and Stöhler (2005) Switzerland 19. Harder (2011) the Netherlands

Retrospective study Prospective, 6 month follow-up study, ≥2 measurements (during and after care) Retrospective Qualitative/Quantitative

809 21 yrs (M) 108 at T1 17–20 yrs

34 15–24 yrs

Residential care

1) Generalized Self-efficacy Scale (GSES) 2) Social Support Questionnaire (SSQ)—short form, adapted 3) Inventory of Parent and Peer Attachment (IPPA) 4) Adolescent Coping Scale (ACS) (youth) Various (59% foster care; 1) General Health Questionnaire (GHQ-12) 2) Cantril's Ladder 34% residential care; 3) In-house intermediate 7% other placements) outcome measures (youth and care workers) SOS children's 1) Duke Health Profile villages ≥ 3 yrs 2) Own score on 103 subjects (with subscales and cotation) 3) Semi-structured interviews (youth and foster carers, N = 73) 4) Interviews: narration analysis of all the records (psychologists) 1) Duke Health Profile Various (e.g. foster families, kinship care, 2) Postal survey Questionnaires (youth) residential care, etc.)

Independent living, foster care, group care, kinship care Various Various

Questions cover the range of areas described: out of care experiences in terms of housing state, educational and work state, socio-economical state, social relations, physical and health state, in-care and leaving care experiences.

Yes, but not for Yes the Romanian translation

1) Mental well-being 2) Quality of life 3) Housing, education, employment careers, life skills, social networks

1,2) Yes 3) No

1,2) Yes 3) No, self-developed

1) Quality of life and health 2) General social integration in adulthood 3) Experiences after care 4) Biographies and genograms on siblings' groups

1) Yes 2, 3, 4) No

1) Yes 2,3, 4) No

1) Quality of life and health 2) Situation after leaving care

1) Yes 2) No

1) Yes 2) No

Educational and Single-item and standardized multi-item employment success scales of Assessment and Action Record from Looking after Children (AAR-C2-2006) Event-history calendars Care histories/trajectories of children Structured interviews Difficulties during (youth, N = 99 at T2) transition period

Yes

Yes

Yes

No

No

No

Residential care

The Child and Youth Resilience Measure (CRRM-28) (youth)

Resilience

Yes

Yes

Prospective, comparison study 173 8–18 yrs (2 groups), 3 measurements from admission to departure

Residential care (family- focused and care as usual)

1) Family climate 2) Parental stress regarding care & upbringing 3) Social network of youth 4) Family oriented characteristics of care 5, 6) Behavior problems youth 7) Experiences effectiveness and satisfaction 8) Goal realization

1) Yes 2, 3) Yes 4) No 5) Yes 6) Yes 7) Yes 8) No

1) No 2, 3) Yes 4) No, self-developed 5) No 6) Yes 7) No 8) No, self-developed

Retrospective study, quantitative and qualitative

65 18–27 yrs

Residential care

1) Family Climate Scale (in Dutch; GKS; parents) 2) Parenting Stress Index (PSI; parents) 3) Social Network Map (SNM; youth) 4) G-Interview on family- and context orientation of care process (parents) 5) QUICKSTEP (care workers) 6) CBCL (parents) and YSR (youth) 7) BESTE 8) Treatment goal list (care workers) 1) Database (N = 65) 2) Interviews (youth, N = 39)

1,2) Social and job related integration

No

No

Prospective study including one sample, 4 measurements from admission to one year after departure

226 12–21 yrs

Residential care in secured environment

1) Aftercare interview (youth) 2) EMBU-C (youth) 3) Involvement in care interview (parents) 4) Parenting Stress Index (PSI; parents)

1) Support following secure residential care 2) Parental upbringing behavior 3) Involvement of parents in care 4) Parenting stress re care & upbringing 5) Quality of Life (QOL)

1) No

1) No, self-developed 2) Yes 3) No, self-developed 4, 5) Yes

2) Yes 3) No 4, 5) Yes 6) Yes

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9. Dima and Skehill (2008) Romania

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Design

N age

Type of care

Construct measured

Instrument(s) tested?

Instrument(s) used in cross-national studies?

5) Lanchasire Quality of Life Profile interview (youth and parents) 6) Scientific Research and Documentation Centre (SRDC) interview (youth) 7) CBCL (parents, care workers), TRF (teachers) and YSR (youth) 1) Qualitative semi-structured interviews 2) Structured telephone interviews (youth and professionals) 1) Internet questionnaires (N = 6000) 2) Interview guides for semi structured interviews (N = 66) (students)

6) Delinquency and risk and protective factors 7) Behavior problems youth

7) Yes

6) No 7) Yes

1,2) Housing, work, education, economic support, emotional support

No

No

1) Availability and practical provision of student support 2) Experiences of support provision in practice. 1) Experiences and life histories 2) General background profile

No

No

No

No

Housing and biographical histories

No

1) Experiences and views of young people 2) Self-esteem, educational attainment, housing status, levels of self-esteem, perspective of professionals involved in planning and implementing intervention a) Remaining in employment, education or training; b) Nurturing attachments to significant ‘parental’ figures; c) Preparation for independence d) Costs of the program

No

No, self-developed instrument(s) based on Clapham No, self-developed instruments

20. Höjer and Sjöblom (2010) Sweden

Prospective, qualitative follow-up study, 2 measurements

16

21. Hyde-Dryden (2012) United Kingdom

Retrospective, cross sectional, quantitative and qualitative

±6000

Residential, foster and kinship care

22. Ibrahim (2010) Jordan

Retrospective exploratory qualitative study

42 17–28 yrs

23.Johnson et al. (2010) Australia

Retrospective cross-sectional study, 2 measurements

77 18–25 yrs

Residential care (incl. secure care), boarding school Various

1) In depth semi-structured interviews 2) General Demographic and Case History Questionnaire (youth) In-depth and semi-structured interviews (youth)

24. Munro et al. (2009)

Prospective study, 2 measurements after leaving care

184

Foster care and residential care

1) Survey

Retrospective

In progress ≥18 yrs

United Kingdom

25. Munro et al. (2010) United Kingdom

Foster care and residential care

Name instrument (source)

18–22 yrs

≥16 yrs

2) Interview topic guide (youth)

Foster care

Semi-structured interviews (youth)

No

No, self-developed

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Table 2 (continued)

26. Novozhylova (in press) Ukraine 27. Schiff and Benbenishty (2006) Israel

Retrospective

21 21–23 yrs

Residential care, boarding school

Self-developed topic guide (youth and educators)

(leaving) care and transition experiences

Yes, tested during a pilot

No, self-developed

Retrospective study

185 ≥ 18 yrs

Residential care

1) 2) 3) 4)

1) Pre-admission backgrounds of youth, behavioral difficulties 2) Quality of relationship with the group home parents and peers 3) Current functioning and care transition experiences 4) Social support Support and difficulties of the transition process

1,2,3) No 4) Yes

1,2,3) No

No

No, self-developed

1) Emotional, behavioral and social problems, prosocial behavior 2) Well-being 3) Perception of their care process 1) Family climate 2) Parenting tasks

1) Yes

1) Yes

2, 3) No

2, 3) No

1, 2) Yes

1,2) No

3) Yes

3) Yes

Files (N = 185) Staff report Phone interviews (N = 109, youth) Medical Outcome Study (MOS)

Retrospective

80

Foster care and residential care

Structured telephone interviews (youth and directors)

Prospective study, 2 measurements after leaving care

49

Foster care and residential care

30. Van Oijen (2010) the Netherlands

Prospective study, 2 measurements, 3–6 months after foster care placement and 18 months later

1) Interview schedule Strengths and Difficulties Questionnaire (SDQ) 2) Adolescent well-being scale (youth) 3) Semi-structured interviews 1) Family Climate Scale (in Dutch: GKS; parents) 2) Questionnaire Parenting Tasks (in Dutch: VOVO; care workers) 3) CBCL (foster parents) and YSR (youth) 4) Attitude Scale Social Limits Phone interviews (youth)

31. Zeira (2009) Israel 32. Zeller (2012) Germany 33. Zeller et al. (2009) Germany

≤ 9 yrs ≥ 10 yrs 92 14.4 yrs (M)

Foster care

Retrospective study

500

Youth villages

Retrospective qualitative study

20

Residential care (group settings or assisted living) Residential care

Retrospective evaluation study

18–26 yrs 12 16–26 yrs

Narrative interviews (youth)

1) Expert interviews 2) Workshops (professionals) 3) Narrative biographical interviews (youth)

3) Behavior problems youth 4) Handling of social limits Status of care leavers after care and their care experiences Biographical learning processes

4) Yes

4) No

No

No

No

1,2,3) Portrait of the program

No

No, but biographical research is used in different countries No, but the qualitative elements of evaluation studies are well-known

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28. Sjöblom and Höjer (in press) Sweden 29. Skuse and Ward (2003) United Kingdom

4) Yes

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at the same time focusing primarily on the complex interplay of care experiences, the family and other factors that may determine the life course. 3.2.2. Transition process A total of 12 studies (36%) from eight different countries (i.e., Australia, France, Ghana, Israel, Jordan, Romania, Sweden and Ukraine) place their focus on the process of transition from care to becoming part of a community. One approach to this topic considers the issue of how well out-ofhome care settings prepare young people in their care for this phase. Four research projects fall back on the theoretical concept of life skills (Anghel, 2010; Benbenishty & Schiff, 2009; Benbenishty & Zeira, 2008; Dixon et al., 2006). The list of life skills includes aspects such as decision making, problem-solving, effective communication, interpersonal relationship skills, self-awareness, and so on. A second research emphasis is on the experiences of young people who find themselves in the phase of transition from care into adulthood. These studies, which are frequently designed to be exploratory, are aimed at reconstructing the complex process of transition from the young people's perspective (Anghel, 2010; Dima & Skehill, 2008; Frechon, 2009; Ibrahim, 2010; Novozhylova, in press). These explorative research studies provide insights into the many issues and challenges that confront care leavers. A third thematic emphasis is on the issue of support after care and during the transition to adulthood. In this respect, the studies in our sample consider a broad range of different forms of support, including economic, emotional and social support. In this connection, there is a focus on both the support provided by out-of-home care settings (Frimpong-Manso, 2012; Ibrahim, 2010) and the informal support provided by members of the family of origin, peers or other significant others (cf. Höjer & Sjöblom, 2010; Novozhylova, in press; Sjöblom & Höjer, in press). 3.2.3. Evaluation of interventions In contrast to the first two types of studies, program evaluations bring into focus the outcomes of interventions in respect of the transition to adulthood. Numerous studies have come about in this connection, especially in those countries where the topic of the transition to adulthood has been on the social–political agenda for quite some time (e.g., the United Kingdom) and the importance of support also following the care leaving phase has been underlined. A total of seven studies from our sample, which were conducted in Canada, Israel, Germany, the United Kingdom and the United States, can be assigned to this category. The primary research emphasis in these studies is on the issue of whether the support offered after out-of-home care may leads to an improvement in the life situation of care leavers. In this respect, special attention is paid to whether the educational success of young care leavers can be influenced. As is shown both in previous studies (Biehal, Clayden, Stein, & Wade, 1992; Stein & Carey, 1986) and in studies from our sample (Courtney et al., 2010, etc.), when these care leavers are compared with people of the same age, they have on average a lower level of educational attainment and, consequently, also fewer opportunities for obtaining an apprenticeship or a university place. Thus, the Extended Care and Maintenance Program in Ontario (Canada), for example, is evaluated to determine if it successfully supports the educational endeavors of young people (Flynn & Tessier, 2010). In the United Kingdom, care leavers in the ‘By Degrees’-action research project are supported in their efforts to begin and complete university studies (Hyde-Dryden, 2012). A second thematic focus of these evaluation studies is the examination of particular after-care programs and their implementation (Munro et al., 2009; Munro et al., 2010). The Right2BCared4 program in the United Kingdom, for example, is aimed at empowering young people to participate meaningfully at each stage of the transition

process, to enhance communication and relationships between social workers (and/or Independent Reviewing Officers) and young people, and to implement feedback mechanisms to ensure that care and pathway plans reflect the needs and wishes of young people (Munro et al., 2009). Another study examines and categorizes the challenges and pitfalls of social workers' strategies in supporting care leavers in their transition to adulthood (Zeller, Köngeter, & Schröer, 2009). 3.3. Research designs and instruments An overview of the applied research designs and instruments used in the 33 studies included is shown in Table 2. The designs of nineteen studies (58%) can often be characterized as retrospective, in that there is a focus on the experiences of young people regarding their period in and/or after care. Six of the fourteen prospective studies include measurements that are carried out in the period after the young people have already left care, and therefore, have a retrospective character with regard to the care context (Dixon et al., 2006; Dumaret, in press; Flynn & Tessier, 2010; Höjer & Sjöblom, 2010; Munro et al., 2009; Skuse & Ward, 2003). Although the sample sizes in the studies vary widely, the main focus of the studies is on smaller (sub) samples. Nine studies (27%) include larger samples of more than 200 young people, and thirteen studies (39%) include smaller samples with 100 young people or less. Studies with very large samples (N≥ 500) are conducted in the United Kingdom, France, Israel and the United States. Small sample sizes (N≤ 30) are used in studies that are carried out in Germany, Romania, Sweden and Ukraine. All the studies include one sample of young people, except for an Israeli study by Benbenishty (2009), a French study by Dumaret and Crost (in press) and a Dutch study by Geurts (2010) in which two or more samples are used. In the study of Benbenishty (2009) outcomes of three experimental programs for care leavers are compared. Dumaret and Crost (in press) compare the care trajectories of a group of younger (early) care leavers aged 16–17 with a group of care leavers aged from 18 years old. Geurts (2010) compares the outcomes of a group of youth in family-focused residential care with a group in residential care as usual. In several other studies, relatively small subgroups of young people are interviewed, while there is information for a larger group based on files or questionnaires (e.g., Benbenishty & Schiff, 2009; Gabriel & Stöhler, 2005; Hyde-Dryden, 2012). Looking at the designs of the studies in relation to the types of care that the young people received, it appears that the proportion of prospective studies, in which the young people are followed up during a period of time while in and/or after out-of-home care, is relatively small among studies focusing on residential care (33%). Three out of five (60%) studies with a prospective design focus on young people who stayed in foster and/or residential care. In the application of instruments, almost all the studies (29 out of 33 studies; 88%) use the young people as the (primary) source of information. Professionals who are working in the child and youth care context are also often involved as a source of information (Anghel, 2010; Benbenishty, 2009; Dixon et al., 2006; Höjer & Sjöblom, 2010; Schiff & Benbenishty, 2006; Van Oijen, 2010; Zeller et al., 2009). In some studies, care workers are used as the primary source of information (Benbenishty & Schiff, 2009; Benbenishty & Zeira, 2008). Furthermore, few studies also include the young people's parents as a source of information (Geurts, 2010; Harder, 2011; Van Oijen, 2010). However, there are some studies that do focus on the young people's contact with parents (Dima & Skehill, 2008; Munro et al., 2010). Table 2 shows that few standardized or well-known instruments have been used in the studies. There is often no information about the psychometric properties, among others because of the use of self-developed instruments in various studies (Anghel, 2010; Del

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Valle et al., 2008; Geurts, 2010; Harder, 2011; Johnson et al., 2010; Munro et al., 2009; Munro et al., 2010; Novozhylova, in press). These self-developed instruments often consist of interviews with the young people or professionals. The instruments are focused on the experiences of young people and/or parents during the care process, outcomes in key life domains after departure (e.g., accommodation, employment, health), and experiences of young people after care. Instruments that were reported to have been tested or used in cross-national research are for example well known and standardized instruments such as the Child Behavior Checklist (CBCL, Achenbach, 1991a), Youth Self Report (YSR, Achenbach, 1991b), Strengths and Difficulties Questionnaire (SDQ, Goodman, 1997), which are focused on assessing young people's behavioral problems. An instrument specifically designed for cross-national comparison of mental and behavioral health problems is the Composite International Diagnostic Inventory (CIDI, World Health Organization, 1994). The CBCL and YSR are used by four studies in our review (Del Valle et al., in press; Geurts, 2010; Harder, 2011; Van Oijen, 2010). Among these studies are three Dutch studies which are mainly focused on the outcomes of out-of-home care and therefore, look at change in behavior problems during and after care. The SDQ is reported in two different studies (Del Valle et al., in press; Skuse & Ward, 2003) and the CIDI is used in the US study (Courtney et al., 2010). The Rosenberg Self-Esteem Scale, which was tested in a study by Reilly (2003), is used in two different studies (Benbenishty et al., in press; Del Valle et al., in press). The Lancashire Quality of Life Scale (Gaite et al., 2000; Huxley, Evans, Burns, Fahy, & Green, 2001; Oliver, 1996) is also used in two different studies (Dixon et al., 2006; Harder, 2011). In two French studies, the Duke Health Profile (Parkerson, Broadhead, & Tse, 1990) is used to measure the young people's quality of life and health (Dumaret, in press; Dumaret & Crost, in press). Furthermore, two Israeli studies and the US study report to use the Medical Outcome Scale (MOS, Sherbourne & Stewart, 1991) in assessing the young people's relationship with staff and friends (Benbenishty et al., in press; Benbenishty & Schiff, 2009; Courtney et al., 2010). For the three Dutch studies in the review there was also overlap in instruments used. The Parenting Stress Index (PSI, Abidin, 1990) was used by Geurts (2010) and Harder (2011) and the Dutch Family Climate Scale (GKS, Jansma & De Coole, 1996) was applied in the studies of Geurts (2010) and Van Oijen (2010). 4. Conclusion The central aim of this article was to review the topics, approaches and instruments that are used in empirical studies that focus on young people making the transition from care to adulthood. An important starting point for this review was the INTRAC network of researchers which focuses on the process of transition by young people moving to adulthood from public care. An inquiry among researchers of this network resulted in 33 studies on the transition from care into adulthood that are included in the present review. The life situation of young people after care is often viewed in terms of their social networks and social support, followed by their education and employment and their living arrangements. Relatively few studies are concerned with the behavior of the young adults, while research indicates that young people who have been in care show relatively poor behavioral outcomes compared with their peers (Munro & Stein, 2008). Therefore, young people's normative and abnormal behavior is a topic that seems to deserve more attention by studies looking at the situation of young people after care. In addition, our overview indicates that overall a broad spectrum of topics is considered in examining the life situation of young care leavers. Nonetheless, there is clearly no consensus on which aspects need to be analyzed in all circumstances in order to assess reliably how successful the transition to adulthood may turn out to be.

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Most of the studies try to determine which factors have influenced or are influencing the young people's life situation after they have left care. Three main research perspectives can be distinguished, including 1) the outcomes of out-of-home care; 2) the process of transition to adulthood; and 3) the outcomes of specific services or interventions during the transition from care. In recent years an increased interest in the transition process itself can be seen. As a result, the research focus shifts from the impact of care to the transition to adulthood considered as a process. This probably also has to do with the fact that in modern ‘risk societies’ (cf. Beck, 1992; Giddens, 1991) attaining the status of an adult has become more confusing and has expanded. The transition has to a certain extent become an independent phase (cf. Arnett, 2000) that cannot be attributed to previous experiences alone. The significance of this transition process itself also becomes clear in our sample of research projects. At the same time, research traditions play just as great a role as the differing national and welfare state contexts, which suggest alternative research questions. In some countries, such as the U.K. and the U.S., there are programs aimed at supporting care leavers in the transitional phase to adulthood (cf. Stein & Munro, 2008). Correspondingly, the first evaluation studies on these support processes can already be found here. Still there is largely a lack of research on the significance of other welfare state support programs (e.g., employment services) for care leavers. Research into forms of out-of-home care has nonetheless shown that in many cases it is not enough simply to examine the support that was afforded most recently. Decisions that were taken much earlier frequently determine the success or failure of the support. In recent years there has often been criticism of the frequency of placement instability and the associated change of residence that affects young people (Dixon & Stein, 2005; Hamberger, 2008), both of which have a negative impact on both the course of the support and the period following it. Surprisingly, only a few studies analyze the entire course of the support trajectory. The three different research access points shed light on different phases of the transition process and different factors that have an influence on the successful transition to adulthood. Despite this wealth of research access points, one desideratum would be to combine the findings of these research projects into an integrated theoretical model. A majority of the studies comprise a research design that can be characterized as retrospective, because most of the studies focus on the experiences of young people regarding their period in or after care. Studies focusing on residential care are particularly likely to employ a retrospective design, which is consistent with other studies focusing on residential care (Knorth, Harder, Zandberg, & Kendrick, 2008). Since many studies on transition from care into adulthood include only one sample of young people and relatively small sample sizes, it is difficult to draw causal inferences between the care that is being offered and the outcomes that are achieved. Furthermore, many of the studies focus on the period after care, without a clear focus on the preceding process of out-of-home care that was received by the young people. To get a clearer view on why some of these young people do succeed in their transition to adulthood and some do not (Stein, 2005), it is important to focus on the entire care process in these studies. In looking at the care that is received, studies might especially focus on the stability of placements, the quality of care practice and education, the preparation for leaving care and the receipt of support following the departure from out-ofhome care (cf. Harder et al., 2011; Stein, 2005). Many studies are focused on the young people's experiences or life situation, and therefore, almost all studies use the young people as a source of information. However, relatively few instruments that are used in the studies focus on the parents of the young people, despite the fact that research shows that parents or members of the family of

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origin are important and often still belong to the social network of young people in out-of-home care (Courtney & Dworsky, 2006). In addition, few studies include parents or other members of the young people's social networks as respondents. Few standardized instruments are used in the studies on the transition of young people into adulthood. The instruments that are used often focus on different aspects of the young people's lives, and several studies focus specifically on the young people's quality of life by using the Lancashire Quality of Life Scale (Dixon et al., 2006; Harder, 2011) and the Duke Health Profile (Dumaret, in press; Dumaret & Crost, in press). This corresponds to the finding that research on the life situation of young people after care has broadened its view (Dumaret & Coppel-Batsch, 1997; Stein, 2006a), without, however, achieving a consensus on which aspects of the transition to adulthood definitely need to be considered. The use of standardized instruments has the advantage that good comparisons between research findings from different studies can be made. Another advantage of these instruments is for example that they (can) have an established level of reliability or validity, which results in measures that consistently measure what they are supposed to. A disadvantage of standardized instruments is that they might not be suitable for measuring aspects that are of special interest, such as the experiences of individual participants with regard to specific situations or circumstances. The research approaches and instruments that are used in the INTRAC studies are frequently developed by the researchers according to their own research interests and the care context they are focusing on. As far as we know, there are no studies which have studied the transition of care leavers in the form of a cross-national comparison. Therefore, one of the recommendations based on our findings is the need to develop a common framework in order to be able to study the transition to adulthood in an international perspective. This framework should take into account specific global, welfare state and regional features (cf. Pinkerton, 2008). For the purpose of examining the transition to adulthood of care leavers, the research instruments that have already been developed by several researchers of the INTRAC group are a starting point. Instruments that focus on young people's quality of life can play an important role in assessing the life situation of young people after care, because these instruments often assess several life domains (Knorth, 2005; Wallander, Schmitt, & Koot, 2001). All the instruments should, however, be screened for their transferability and adjusted accordingly. The aim is to develop one or more instruments that focus on the assessment of leaving care (i.e., preparation for departure and the moment of departure) and the period after care (e.g., living situation, social support) which can be applied in diverse social contexts. This then makes it possible for one to make better comparisons between studies carried out in different countries. The present review study has several limitations. First, the study contains a selection of studies that are focused on leaving care. We only included empirical studies and information provided by researchers of the International Research Network on Transitions to Adulthood from Care (INTRAC). Therefore, our study is not exhaustive of research on the transition to adulthood for care leavers. Furthermore, most of the studies in our review are focused on Europe, which might cause the outcomes to have limited applicability to non-European countries. Moreover, some of the included studies are not solely focused on the transition into adulthood, but have the intention to provide a broad longitudinal perspective on the transition to adulthood. The characterization of studies in our review may misrepresent some of the projects being reviewed by more narrowly characterizing their purposes than is the intent of the principal researchers. Despite these limitations, our study is the first that explicitly focuses on the approaches and instruments that are used in studies on the transition of young people from care into adulthood. The results show that the studies apply a diversity of topics and

instruments, but that there is also considerable overlap. There is no standardized instrument that can assess the transition from care to adulthood and the situation of young people after care in diverse care systems and their national and welfare state context. To make good comparisons between countries, one of our main recommendations is to develop one or more instruments that can assess the leaving care process of young people and their period after out-of-home care.

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