Interventions for youth aging out of care: A scoping review

Children and Youth Services Review 82 (2017) 280–300

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

Interventions for youth aging out of care: A scoping review a,⁎

b

Roberta L. Woodgate , Oluwatobiloba Morakinyo , Katrina M. Martin

MARK

b

a Canadian Institutes of Health Research Applied Chair in Reproductive, Child and Youth Health Services and Policy Research, Rady Faculty of Health Sciences, College of Nursing, Helen Glass Centre for Nursing, 89 Curry Place, University of Manitoba, Winnipeg, MB R3T 2N2, Canada b Rady Faculty of Health Sciences, College of Nursing, Helen Glass Centre for Nursing, 89 Curry Place, University of Manitoba, Winnipeg, MB R3T 2N2, Canada

A R T I C L E I N F O

A B S T R A C T

Keywords: Youth Scoping review Child welfare system Aging out of care Transition Intervention

Youth aging out the child welfare system are being transitioned out of the child welfare system with few interventions in place to support their move to independence. In developed countries, compared to their peers, youth aging out of care face poorer outcomes when it comes to education, employment, and housing. A better understanding of the effectiveness of the existing interventions that support youth in care is warranted. This paper presents a critical scoping review of the available evidence on interventions available to youth who are aging out of the child welfare system and identifies gaps for future research. Arksey and O'Malley's framework for scoping reviews shaped the process of this review. A total of thirteen databases were searched resulting in the retrieval of 1978 articles. Of the 1978 retrieved, only 68 met the review's criteria. Studies included were in English, described an intervention that was implemented and evaluated in developed countries, and published within the last 20 years. Interventions were categorized as: housing, employment, education, mentorship, independent living, and health. The majority of studies fell under the independent living category which provide cohesive resources to improve education, housing, and employment. Studies evaluating these programs generally reported positive outcomes on youth's ability to complete their education and attain part- or full-time employment. Methods of evaluations were found to be methodologically weak with respect to determining the effectiveness of interventions in ensuring youth's successful transitions to independence. Future research should look at longitudinal outcomes of youth and cost-benefit analysis of supporting youth transitioning out of the child welfare system. Recommendations also include policy changes extending the age of eligibility for youth transitioning out of the child welfare system.

1. Introduction

average, youth in the US, Canada, Australia, and the UK transition out of the child welfare system at the age of 18 (Courtney, Terao, & Bost, 2004; Liabo, McKenna, Ingold, & Roberts, 2016; Mendes, Baidawi & Snow 2014a; Provincial Advocate for Children & Youth, 2012). In the US, they have enacted the Fostering Connections to Success and Increasing Adoptions Act of 2008, which allows states to extend care up to age 21 (National Conference of State Legislatures, 2017). Most recently, 25 states in the US have extended foster care (National Conference of State Legislatures, 2017). Some provinces in Canada are also extending support services for youth aging out of care until age 21 (Milne, Kozlowski, & Sinha, 2014; Wegner-Lohin, Kyte, & Trocmé, 2014). In Australia, legislation and policies have allowed support to be provided on an “as needed basis” from 19 to up to 25 years of age (Department of Families, Housing, Community Services and Indigenous Affairs, 2010). Lastly, in the UK, the government requires local authorities to support youth leaving the child welfare system up to the age of 25 provided that they are engaged in educational or vocational

The period of adolescence is a time when youth begin to assert their independence and explore their identities as they prepare to transition to adulthood. Marginalized youth, which include but are not limited to Indigenous, refugee, sexual minority (Edge, Newbold, & McKeary, 2014; Wexler, DiFluvio, & Burke, 2009), and youth in care of the child welfare system, face additional adversities during adolescence (Kääriälä & Hiilamo, 2017). Studies on marginalized youth show that they experience poverty, trauma, and discrimination, which can lead to negative health outcomes and risky behaviors (Edge et al., 2014; Wexler et al., 2009). According to Jones, Sinha, and Trocmé (2015), there were 62,428 youth in care in Canada in 2013. In the United Kingdom (UK), approximately 10,000 youth transition out of the child welfare system each year (National Audit Office, 2015). In 2015, an estimate of 27,703 youth in the United States (US) transitioned out of the child welfare system (U.S. Department of Health and Human Services, 2015). On ⁎

Corresponding author. E-mail addresses: [email protected] (R.L. Woodgate), [email protected] (O. Morakinyo), [email protected] (K.M. Martin).

http://dx.doi.org/10.1016/j.childyouth.2017.09.031 Received 18 July 2017; Received in revised form 19 September 2017; Accepted 20 September 2017 Available online 23 September 2017 0190-7409/ © 2017 Elsevier Ltd. All rights reserved.

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opportunities (National Audit Office, 2015). Even with the extension of support, youth transitioning out of care experience difficulties in finding and maintaining employment, securing stable housing (Dworsky, Dillman, Dion, CoffeeBorden, & Rosenau, 2012; Gypen, Vanderfaeillie, De Maeyer, Belenger, & Van Holen, 2017; Montgomery, Donkoh, & Underhill, 2006; Provincial Advocate for Children & Youth, 2012; Reilly, 2003), and completing their education (Bender, Yang, Ferguson, & Thompson, 2015; Courtney et al., 2004; Forsman & Vinnerljung, 2012; Gypen et al., 2017; Kääriälä & Hiilamo, 2017; Montgomery et al., 2006; Reilly, 2003). Studies have shown that many youth are unable to meet their basic needs and end up in poverty once they age out of care (Dworsky, 2005; Gypen et al., 2017; Reilly, 2003). Difficulties in the areas of housing and employment, resulting from their low-income status lead to health issues among youth aging out of care, including mental health issues. Moreover, youth in care may also experience barriers when it comes to accessing health care (Collins, 2016; Reilly, 2003). These youth are at higher risk for developing mental health issues related to psychological or substance abuse (Bender et al., 2015; Kääriälä & Hiilamo, 2017). Hence, they are more likely than their peers to receive counseling for these concerns (Courtney et al., 2004). The literature further states that youth formerly in care frequently find themselves involved with the criminal justice system (Dworsky et al., 2012; Gypen et al., 2017; Montgomery et al., 2006; Provincial Advocate for Children & Youth, 2012). Interventions (e.g., services, programs, and policies) have been created in an attempt to support former youth in care and give them a level playing field. The interventions prepare youth for transition into adulthood through services, which vary depending on the political context, funding, and location (Dworsky et al., 2012; Edge et al., 2014; Montgomery et al., 2006). Despite the plethora of services, programs, and policies that aim to remedy the problems that former youth in care face, research on these interventions is limited (Bender et al., 2015; Donkoh, Underhill, & Montgomery, 2006; Forsman & Vinnerljung, 2012; Manno, Jacobs, Alson, & Skemer, 2014; Scott, Moore, Hawkins, Malm & Beltz, 2012). A scoping review was chosen in order to examine the extent, range, and nature of research activity, and identify knowledge gaps, especially in an area where there is a limited number of randomized controlled trials (Levac, Colquhoun, & O'Brien, 2010). The objectives of this scoping review were to examine and map the available evidence on the interventions available to youth aging out of the child welfare system and to identify avenues for future research. While there are many terms used in the literature to refer to children leaving the care of the government (e.g., care leavers, youth aging out of foster care), in this scoping review, the terms youth “aging” or “transitioning” out of “care” or the “child welfare system” are applied. The specific questions guiding this scoping review were: (1) What types of interventions (services, programs, policies) are used to support youth aging out of the child welfare system? (2) What are the characteristics of these interventions? (3) How are the interventions evaluated? The scoping review concludes with an overview of the findings, limitations of the interventions and the studies, and directions for future research.

• •

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reference lists, and hand-searching of key journals, existing networks, organizations, and conferences. Stage three: Study selection. Inclusion and exclusion criteria are developed and adjusted accordingly as researchers become more familiar with the literature. Stage four: Charting the data. This stage involves “charting” important information identified in the data generated by the literature search. Specifically, creating categories to organize the information gathered from the literature sources. “Charting” of data may include making note of the study population, type of intervention, outcome measures utilized, study design, and results. Stage five: Collating, summarizing, and reporting the results. An overview of the included literature is reviewed and presented.

Scoping reviews act as stepping-stones for future researchers because of its ability to identify gaps in the literature, and highlight key areas of research (Arksey & O'Malley, 2005). 2.2. Search strategy Searches were conducted in May 2016, and 13 databases were searched resulting in a total of 1978 articles found. These databases include: Academic Search Complete, Child Development and Adolescent Studies, CINAHL, Cochrane Library, Dissertations and Theses, Educational Resources Information Center (ERIC), Family and Society Studies Worldwide, Google Scholar, Medline (Ovid), PsycINFO, Social Sciences Citation Index (Web of Science), Social Services Abstracts, and Social Work Abstracts. Four central concepts with related search terms were used in combination, and guided the search for the review: Youth (e.g., young people, young person, adolescent, teen, young adult), Aging Out (e.g., age out, aged out, aging out, transition, care leavers, leaving care), Child Welfare System (e.g., child welfare, children services, child and family services, social services, foster, child protection), and Interventions to Support (e.g., intervention, initiative, support, program, service, policy, policies). 2.3. Inclusion and exclusion criteria The titles of the 1978 articles retrieved from the literature search were scanned for relevance by two reviewers. The articles were then selected for further screening provided the articles included two or more of the four central concepts that guided the search. One hundred and seventy-six articles were initially considered for inclusion as they met the inclusion criteria designed for the review: literature published in English within the last 20 years, developed countries, ages 16–30 years, and population: youth transitioning out of care (excluding pregnant youth, youth in the criminal justice system, and emancipated youth). Articles included had to describe an intervention, and an evaluation of the intervention. To further establish relevance, articles were excluded if the interventions/policy changes were hypothetical or were considered as recommendations rather than implemented interventions. Articles describing policies regarding the emancipation process were also excluded. Dissertations/thesis and articles that lacked an evaluation component of the described intervention were also excluded. Finally, populations with physical disabilities were excluded due to a significant influence of hospital or medical-based interventions.

2. Methods 2.1. Framework The methodological framework developed by Arksey and O'Malley (2005) for scoping reviews served as a guide for this review. The following outlines the steps for a scoping review as stated by Arksey and O'Malley (2005):

2.4. Data extraction Two reviewers performed a comprehensive screen of each of the 176 articles independently using an extraction form that outlined the aim of the study, the location, the population group and size, the intervention presented, method of evaluation, effectiveness and outcomes of the said interventions and the limitations of the study. Through this process, articles were thoroughly screened for relevance and final

• Stage one: Identifying the research question. • Stage two: Identifying relevant studies. Scoping reviews are designed to be comprehensive. Therefore, published and grey literature sources are identified, which includes electronic databases,

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adulthood by strengthening the resident's independent living skills, selfcontrol, sense of responsibility, and ability to take initiative (Sinkkonen & Kyttälä, 2015). A general overview of the studies included in the housing category showed that youth who received housing interventions had better outcomes compared to youth who did not. Youth using housing services experienced less homelessness compared to those who did not (Simon, 2008). Other areas of success for these youth included: a greater incidence of employment stability and economic security, as well as fewer incidences of school attrition and substance abuse (Brown & Wilderson, 2010; Jones, 2011b). Youth were reported to have had a positive experience and felt that most of their needs were fulfilled as a direct result of supportive housing (Sinkkonen & Kyttälä, 2015). Recommendations include the need for available alternative environments for these youth, due to a high probability of returning to high-risk environments once they age out of care. (Jones, 2011b). Another recommendation is the need for child welfare systems to be more proactive when engaging youth with their families in order to provide additional support required for a successful transition to independence (Jones, 2011b). 3.2. Employment Employment as an intervention referred to employment-focused programs and employment-oriented training to help youth transitioning out of care find employment to solidify their financial stability. One particular article focused on time banking exchange system, which is a transaction based system used to create economic opportunities and assistance for youth in the criminal justice and child welfare systems (Marks, 2012). Studies showed that youth who engaged in these interventions had positive outcomes in terms of successful employment. Lenz-Rashid (2006) reported that 60% of participants found employment within three months of employment training. Furthermore, an evaluation of the effectiveness of time banking services revealed a potential for successful outcomes for youth (Marks, 2012). Edelstein and Lowenstein (2014b) stated that few employment-related interventions show longterm positive effects for youth. However, some studies found a positive correlation between employment services received through general independent living programs and employment outcomes for youth in care (Edelstein & Lowenstein, 2014b). Recommendations include the need to educate youth on soft skills, such as interpersonal, emotional regulation, conflict resolution, and self-advocacy skills, which are required for youth to thrive in work environments (Edelstein & Lowenstein, 2014a, 2014b). Policy makers, child welfare administrators, and service providers are also encouraged to evaluate the present needs and issues encountered by youth aging out of care, and to enact policies that appropriately respond to the identified issues (Lenz-Rashid, 2006).

Fig. 1. Scoping review. *Inclusion criteria: English literature, article within the last 20 years, developed countries, youth ages (16–30), population: youth transitioning out of care.

inclusion, as articles lacking explicitly stated interventions were excluded. Articles describing interventions to specific target populations such as pregnant youth and youth in the juvenile system were also excluded. Finally, articles lacking an evaluative component of the presented intervention were also excluded. A third reviewer resolved any discrepancies, screened for relevance, and determined final inclusion. Following the comprehensive screen of the 176 articles, 68 articles were considered for final inclusion in the review. Please refer to Fig. 1 for a visual depiction of the steps followed leading to the final 68 articles included in the review. 3. Results Multiple services, programs, and policies referred to as interventions in this review, were noted across the literature. Interventions fell under the following categories: housing, employment, education, mentorship, independent living, and health. Please refer to Table 1 for a more detailed description of the included studies. Although the majority of the programs were regulated and funded by the government or public agencies, the implementation of policies and design of interventions were variable. The following sections describe the interventions and how they were evaluated, as well as recommendations for youth transitioning out of the child welfare system.

3.3. Education The vast majority of educational interventions in this review were found in the US, most of which were campus support programs that offered social, personal, and informational support to promote resilience and to prepare youth for transition from high school to college (Kirk & Day, 2011; Watt, Norton, & Jones, 2013). Other interventions included within this category aimed at addressing barriers that youth often face in the process of acquiring an education (Batsche et al., 2014; Dworsky & Pérez, 2010; Hernandez & Naccarato, 2010). Outcomes for educational interventions were generally positive. For example, students who participated in the Education and Training Voucher program were able to achieve their educational goals as the program helped them cope with or overcome challenges they faced (Dworsky & Pérez, 2010). The Foster Care Alumni Creating Educational Success (FACES) program showed that, in the year in which the

3.1. Housing In this review, housing as an intervention included residential services and assistance (e.g., group homes and subsidized housing) available to youth aging out of care. Transitional housing programs provided former youth in care with safe and stable housing while paying minimal or no rent (Brown & Wilderson, 2010; Jones, 2011b). Supportive housing is another intervention, which attempts to support transition to 282

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Table 1 Description and summary of included studies. Author(s), year

Location Sample

Intervention Category

Intervention

Method of evaluation

Outcomes

Avery, 2011

US

Youth in foster care (n = unknown)

Housing

Mentorship programs that provides support to children aging out of care

Literature review of 55 mentorship programs

Barnow et al., 2015

US

Youth leaving care (16–21 years old), (n = 1058)

Independent living

Quarterly collection of qualitative data on youth characteristics, activities and outcomes

Batsche et al., 2014

US

Former foster youth (18–25 years old), (n = 27)

Education

Services aimed at improving outcomes for children and alumni of foster care including: Job preparation, transportation, child care, education support services and life skills KH2Go is a national media campaign designed to help middle school and high school youth obtain information on how to go to college

Mentoring programs offered the greatest potential benefits to youth at-risk; however, its effects were modest in magnitude overall Nearly half of the participants obtained at least one positive outcome, with employment being the most common outcome

Broad, 1999

UK

Care leavers attending leaving care projects (n = 3309)

Independent living

Brown & Wilderson, 2010

US

Foster care alumni who received services (n = unknown)

Education

Bruster & Coccoma, 2013

US

Youth mentees and mentors (n = unknown)

Independent living

Camacho & Hemmeter, 2013

US

Youth entitled to/ receiving supplemental security income payments (14–25 years old), (n = unknown)

Independent living

Choca et al., 2004

US

Youth leaving care (n = unknown)

Independent living

Positive outcomes: the youth who participated in the study became goal oriented and determined to create a better family life than they had experienced. They had a strong belief in their own abilities and were able to seek out and accept help The provision of an increased 46 care leaving projects Two part questionnaire number and range of housing consisting of 29 detailed established since The for youth leaving care; the questions covering youths Children Act was provision of extended and employment benefits, housing introduced improved services by leaving and financial situation care teams to youth leaving care; 2% increase in employment rate of youth leaving care; decline in financial support Transitional living programs, Transitional housing Data collection and analysis especially those that operate on programs upon entry into the programs a prevention model as part of a and monthly updates of youth planned transition, may protect status performed by staff and youth against negative exit data outcomes in the transition to adulthood Mentoring for Pre and post survey. Instrument The results of the survey Educational Success developed focused on foster care administrated by the MESP Project (MESP). This supports the fact that youths' current and future pilot project paired mentoring programs ultimately educational plans and on selfsocial work students as assist youths with making efficacy; using the Self-efficacy mentors with ILP youths Questionnaire for Children positive decisions regarding to improve the foster postsecondary education and (SEQ-C). youth's educational vocational training. The youths outcomes. The MESP who participated in the MESP have high academic selfpilot project overview efficacy and stated that was designed to meet for although they already had 5 weeks on Fridays plans post-graduation; the involving five mentors project reinforced their paired with five mentees. thoughts that college or a vocational program was the key to self-sufficiency. Employment status and earnings Results from the study show the Youth transition intervention was successful, as of participants were measured demonstration provides a significant percentage of 5 years after enrollment a combination of youth who participated in the services designed to transition service had jobs and improve educational earnings after five years. outcomes for participants Increase in number of youth Article reviews several Housing projects and able to access emancipation collaborations from several collaborations with services; collaboration also appropriate services that states aimed at improving outcomes; however, comparison increased number of housing promote employment services available to youth studies are largely used and education leaving care. Decrease in the opportunities number of homeless youth and increase in educational achievement and employment rates in youth leaving care (continued on next page)

283

Qualitative (Interviews with open ended questions asking about experiences)

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Table 1 (continued) Author(s), year

Location Sample

Intervention Category

Intervention

Method of evaluation

Outcomes

Citizens' Committee for Children of New York, 2000

US

Young people receiving independent living services (n = 15)

Independent living

Members of a task force interviewed independent living coordinators, task force members also reviewed the records of youth who had left foster care and conducted a focus group

Two agencies reported that 60%, and 67% of the youth enrolled with them completed their GEDs; two agencies reported 60% and 66% of youth had jobs upon discharge. Two agencies reported 33% to all youth discharged to permanent housing.

Collins & Ward, 2011

US

Former foster youth (n = 96)

Independent living

Quantitative data evaluating the services received and outcomes achieved. Qualitative comments providing further feedback about young people's perceptions of services

Health outcomes were mostly positive, in part because this population is entitled to health care coverage. Only 9% of the sample reported no educational or job training activities after age 18. Fewer than half of the respondents were employed. Most frequently, respondents were living on their own (32%), but many were living with relatives.

Collins et al., 2010

US

Former foster youth 19 years and older (n = 96)

Independent living

Independent living programs: based on the Independent Living programs developed by the New York State Department of Social Services in 1987, local social service districts are required to provide 16 h of life skills classes annually and vocational training to prepare youth for self-sufficiency. Services aimed at aiding the transition process: assistance from an outreach worker, receiving assistance with enrolment and completion of educational programs, assistance with efforts to reconnect with family, employment services, life skills training and healthcare Social support from: professionals, birth family and mentors.

Courtney et al., 2008

US

Youth in out-of-home care placements (n = 482)

Independent living

Dixon & Stein, 2002

UK

Young people who had left care or moved to independent living (n = 107)

Independent living

Donkoh et al., 2006

UK

Systematic review (n = unknown)

Independent living

Qualitative (interviews with and Supportive relationships may testimonies of participants) have a positive effect on outcomes for youth leaving care (positive effect on completing high school, housing, employment; although these observations were not considered statistically significant) The evaluation findings give Education and employment The life skill training NO reason to believe that LST program (LST) provides were measured using high had a significant positive school diploma or general a total of 30 h of life skills training. The five- equivalency diploma and impact on any of the concrete week curriculum consists employment status. Economic indicators of successful of ten three-hour classes well-being was measured by transition to adulthood. The held twice a week in 19 reported earnings and current evaluation provides strong net worth, economic hardship, community colleges evidence that foster youth are throughout Los Angeles and receipt of financial already getting some of this County. The program is assistance. Youths were also kind of help from their foster asked how prepared they felt in care providers, though there is based on seven state18 areas of adult living and in adopted competency room for improvement. obtaining a job. Finally, the skill areas: education, employment, daily living evaluation considered youths' housing. skills, survival skills, choices and consequences, interpersonal/social skills, and computer/ Internet skills. Services provided while Survey of the 107 youth and an Among the main findings of the in depth follow up study of 61 of policy survey are that most in care such as: leaving authorities offered a planned care planning. Aftercare these young people to explore through care program but less services include personal starting points and outcomes than half of youth had received over a six month time-span. support; one. accommodation; finance; education, employment and careers; and health care. Reported favorable outcomes Non-randomized or nonIndependent living comparative designs were found for ILP participants. On the programs: widespread whole, adverse effects were across 18 studies, outcomes of and varied group of rarely observed. interest included educational programs intended to attainment, employment, improve outcomes for foster care (looked-after) health, housing, and other relevant life skills outcomes. youth leaving the care system. (continued on next page)

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Table 1 (continued) Author(s), year

Location Sample

Intervention Category

Intervention

Method of evaluation

Dumaret et al., 2011

France

Former foster care youth Independent living at least 23 years old (n = 123)

Leaving care services: housing services (transitional apartments), young adult welfare services (contracts), Job training services and informal supports Campus support programs: provide an array of financial, academic, social/ emotional, and logistical supports to help former foster youth stay in school and graduate. 10 programs were looked at. Campus support programs created to help former foster youth graduate from college

A large majority of them underwent transitions and successfully began living independently by the age of 24–25. A quarter of the diplomas were obtained thanks to prolonged support after the age of the majority Three-quarters of respondents Telephone interviews with received financial aid from program directors and a Webbased survey that asked students their campus support programs; about their experiences with and approximately two-thirds of the respondents received housing perceptions of the program. assistance from their campus support programs; 88% reported that they are likely or very likely to recommend the program to other foster youth. Qualitative (Testimonies from Youth received support in participants) education, financial aid, housing and mentoring. 88% Reported they were likely to recommend the program to other foster youth suggesting a high level of satisfaction with the program. Review of existing research and Although youth employment programs have existed for convening conducted with researchers, program managers decades, the field has not found much evidence of their and federal staff effectiveness. Only the National Guard Youth Challenge evaluation shows long-term positive effects specifically on youth employment. There are a handful of rigorous evaluations of local or regional youth programs, some of which have found modest positive impacts. Only some studies have found a correlation between receipt of employment services through a general independent living program and improved employment outcomes. Review of existing research The evidence of the effectiveness of both financial literacy and asset-building programs for youth, including youth in foster care, is limited. Existing studies often examine changes in attitudes or knowledge—often selfreported—rather than changes in behavior, such as saving. There is some evidence that financial education can improve financial knowledge. While studies have found a relationship between financial education and behavior. The findings of this review Systematic review of studies suggest that those receiving examining transitional support these services may be slightly services less likely to be young parents than youth not receiving such services, and this finding is validated by reasonable- and good-quality evidence. There is evidence of mixed effectiveness and varying quality from the studies included in this review. (continued on next page)

Dworsky & Pérez, 2009

US

Youth from 10 campus support programs (n = unknown)

Mentorship

Dworsky & Pérez, 2010

US

Former foster youth using campus support programs (n = 98)

Independent living

Edelstein & Lowenstein, 2014a

US

Youth in Foster care (n = unknown)

Mentorship

Existing employment focused programs for youth in foster care

Edelstein & Lowenstein, 2014b

US

Youth in foster care (n = unknown)

Independent living

Independent living programs with an assetbuilding or financial literacy focus

Everson-Hock et al., 2011

UK

Transitioning youth (n = unknown)

Independent living

Multiple transitional support services (TSS)

285

Evaluation is done by examining the level of education achieved and the level of independence attained after exiting the program

Outcomes

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Table 1 (continued) Author(s), year

Location Sample

Intervention Category

Intervention

Method of evaluation

Outcomes

Flynn & Tessier, 2011

CAN

Youth in Extended care and maintenance (18–20 years old), (n = 406)

Independent living

Participants reported data on three outcomes of interest: educational attainment, educational aspirations and notNEET/NEET (not in education, employment or training) status

Educational outcomes of youth who were enrolled in the ECM program were shown to be positive and a great majority of the participants were engaged in education, training and employment with only 13% found to be in the NEET category.

Freundlich & Avery, 2006

US

Independent Respondents from 6 living stakeholder groups (n = 77), family court judges (n = 7), representatives of child welfare agencies (n = 14), and young adults (18–25 years old), (n = 21)

Extended care and maintenance (ECM) is a legislatively established transitional living program that provides financial, instrumental and emotional support to former youth in care in the province who have had their individualized plans for education, training or work accepted by their local Children's Aid Societies Independent living preparation services/ programs

General Accounting Office, Washington D. C., 1999

US

Transitioning youth (n = unknown)

Georgiades, 2005a

US

Youth who were eligible Independent living for Independent living services during their stay in foster care (18–26 years old), (n = 67)

Independent living

Independent living program: designed to help foster care youths make the transition to living independentlyassisting youths in attaining their educational goals, such as completing high school or passing the General Educational Development (GED) test and attending postsecondary schools; as well as assisting youths in finding and maintaining employment.

Independent living services

286

Mixed success outcomes Qualitative (Testimonies from interviews with participants and depending on individual experiences of the youth; outcomes of youth) however, most young adults stated that they were not ready to be on their own. Overall, both young adults and professionals who participated in the study reported a very poor preparation of youth for life after foster care; although, some young adults who received educational and job training opportunities expressed satisfaction with their independent living preparation. A review of relevant literature in Result from this study show addition to the1998 annual ILP that only one national study completed since ILP was reports submitted by the states to the Department of Health and established in 1985, found that services provided by ILPs have Human Services. Federal and the potential to improve state officials and independent outcomes for youths. A survey living experts were also of 61 youths currently interviewed. participating in an ILP or those receiving after-care services showed over 80% indicated that their quality of life improved after they received independent living services. A study of 26 youths in Nevada about 3 months after leaving foster care showed that most of the respondents believed the ILP helped prepare them to some extent for making the transition to living on their own. These and other housingrelated findings indicate a definite, though gradual, movement toward independent living that is more pronounced for ILP participants than for nonparticipants. Participants reported on how Findings show that youth are generally satisfied with IL effective the program was able services. Results suggest that to prepare them for education, most youths fail to attend IL employment, money programs because they are management, housing, uninformed about them, are transportation, social skills, parenting as well as prevention mostly dissatisfied with financial pressures in adulthood of sexual risk, substance abuse and criminal involvement (continued on next page)

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Table 1 (continued) Author(s), year

Location Sample

Intervention Category

Intervention

Georgiades, 2005b

US

Young adults (18–26 years old), (n = 49), young adults (comparison group n = 18).

Housing

Giffords et al., 2007

US

Homeless adolescents between (16–21 years old), (n = unknown)

Housing

Goddard & Barrett, 2008

UK

Youth who were covered Mentorship by the provision of the children (leaving care) act (16–24 years old), (n = 70)

Green & Ellis, 2007

US

Residents (n = 127) and staff members (n = 72) from 32 group homes

Independent living

Greeson et al., 2010

US

Youth respondents (including former foster youth) (n = 15,197)

Independent living

Program participation associated with better educational, employment, income, housing, early parenting-prevention, transportation, anger control, criminal prevention, and selfevaluation outcomes. IL participation is not associated with better social support, perceived parenting competence, substance abuseprevention, sexual riskprevention outcomes, increased knowledge in money management skills, job seeking and job maintenance skills, interpersonal skills, or lower depression. Formal quality and The walkabout programs Continuous quality and performance improvement performance improvement are independent living planning have demonstrated strategic plan to monitor the programs that are that the services provided transitional, community- effectiveness of the programs impact on the lives of those who produces positive outcomes for based homes for youth use it homeless adolescents aged 16–21. The program offers continued housing and support to young adults with the intent of helping them live and work independently in the community. A significant number of young Qualitative (questionnaires, The Children (Leaving people have negative Interviews and Focus groups care) act introduced a experiences after aging out of asking these youth about their number of key developments for youth experiences after leaving foster care with increasing demands to the government to care with respect to health, aging out of care; local education, employment, income adequately respond to the authority financial growing health needs of care and housing) responsibility for care leavers. leavers from ages 16–18 as well as a needs assessment and pathway plan by the age of 16 to map out a route to independence for young people up to and beyond the age of 21 Outcomes were closely related Group homes Three inter-related aspects of service were studied: structure, to preparing residents for process, and client outcomes, emancipation at 18 years of specifically residents' increase in age, just over 50% of youth said developmental assets leading to activities directed at this goal the ability to transition were happening, while only successfully to independent two-thirds of the staff members living by the age of 18 years. said they were. Results from this study show Natural mentorship is a Qualitative (Respondents were that having a natural mentor way of cultivating caring asked retrospectively if their who served as a role model was natural mentor made an relationships between youth and adults; natural important positive difference in associated with having a bank account, increased income mentoring relationships their lives any time since they expectations and success were 14 years old form gradually and are overall therefore likely to be less pressured (continued on next page) Independent living (IL) programs prepare foster wards for effective adult living and independence after foster care. They provide instruction in the basics of daily living. The “Subsidized Independent Living” (SIL) program allows teens 16 years old or older to live in an approved setting and receive a monthly stipend for living expenses

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Method of evaluation

Multi-level evaluation. Data collected via DMILA Assessment for Life Skills and an additional questionnaire. Multiple bivariate analyses.

Outcomes

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Table 1 (continued) Author(s), year

Location Sample

Intervention Category

Intervention

Method of evaluation

Outcomes

Greeson, Garcia, Kim, & Courtney, 2015

US

Youth in out-of-home care (n = 482), who were 17 years-old at the start of the Multi-Site Evaluation of Foster Youth Programs (MEFYP)

Independent living

Qualitative (Questionnaire seeking effectiveness from participants)

Findings from this study show that it is plausible that while these programs provide informational support for youth, they do not offer tangible, emotional or affirmational types of support. Findings also show that classroom-based instructional models which are typically the focus of independent living services are no more effective than services as usual

Greeson, Garcia, Kim, Thompson, & Courtney, 2015

US

Youth in intensive foster care (n = 194)

Independent living

Statistical tests performed using Stata version 12 StataCorp LP.

Outreach did not increase foster youth's social support, compared to usual service. No racial/ethnic disparities in program effect were detected.

Hernandez & Naccarato, 2010

US

College program coordinators from different universities, colleges, non- profit or government agencies (n = 12)

Education

Life skills training program of LA utilizes a traditional, didactic-style classroom based approach that incorporates supportive case management in an effort to promote the achievement of positive well-being outcomes, such as educational attainment, employment and interpersonal and social skills Massachusetts's Adolescent Outreach program. A voluntary service that assists adolescent foster youth with preparing to live independently and achieve permanence after exiting state care. Services available to foster care alumni within each program; these services include mentoring, networking or internship opportunities

Qualitative (interviews with participants)

Jones, 2010

US

Foster youth (n = 106)

Independent living

Youth were queried on seven measures of post-placement functioning and self-sufficiency: education and training, employment, finances, housing, social support, life events and cost to the community

Jones, 2011a

US

Former foster youth (n = 16)

Independent living

The residential education program is an approach that places emphasis on education and social development. Some may provide some mental health services for low-level problems but the primary focus is to provide an educational program in a congregate care setting. Residential education designed to meet some of the problems youth encounter with emphasis placed on education and social development

The services were reported to address academic supports, Provide assistance in finding housing, scholarships, emergency financial assistance, counseling or referrals to access health and mental health providers and staff who serve as advocates for the youth. The youth in this study were seen to be resilient as most of them sought to continue their education at two-year colleges or entered vocational training programs.

Jones, 2011b

US

Former foster youth (n = 106)

Housing

Youth were queried on eight domains of post-discharge functioning and self-sufficiency (education, employment, finances, social support, major family life events, mental health, substance use, cost to the community and victimization Youth were interviewed and Transitional living responses were compared on programs: provide eight measures of placement former youth with safe and stable housing while functioning and self-sufficiency (education, employment, paying minimal or no finances, housing stability, rent social support, major life event, health and cost to the community)

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Youth had a successful adaptation. They were also able to find and maintain employment and avoided criminal justice involvement.

Youth enrolled in other living arrangements (OLA) had greater incidence of employment instability and economic insecurity compared to youth in transitional housing (TH). Youth in OLA were four times more likely to have a substance abuse problem. Youth in TH also achieved initial housing stability, were able to find jobs at a faster rate and maintained employment in greater portions than the OLA youth (continued on next page)

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Table 1 (continued) Author(s), year

Location Sample

Intervention Category

Intervention

Method of evaluation

Outcomes

Jones, 2014

US

Foster youth (n = 95)

Independent living

Youth were queried about if they thought they were prepared for life after care. They were also queried about what they thought could have been done by the child welfare system to help them better adapt to adulthood

Most of the youth reported being somewhat prepared for independent living with 60% of the youth satisfied with the Independent living services. Youth reported poor educational outcomes, lack of sufficient income.

Jones & Lansdverk, 2006

US

Foster youth (n = 206)

Education

The study uses a needs assessment approach to gather data that can give insight into the needs of former foster youth which will better inform practices and policies regarding emancipating and emancipated foster youth The academy is based on the concept of residential education with an emphasis placed on education and social development.

Results show that the Academy provides a quality educational experience that ensure that the youth have basic tools for selfsufficiency, as youth in the academy have higher high school completion rate relative to other foster care studies

Katz & Courtney, 2015

US

Youth under the jurisdiction of the state child welfare agency (17–18 years old), (n = 732)

Independent living

Qualitative: A series of questions about youth's progress in school and their attitudes toward education are included into the protocol. Data was also collected on post-secondary education, vocational training, employment and some other measures six months after graduation and post-academy residence. Qualitative. Interviews with youth focusing on their experience, covering the following domains social support, relationships with family, delinquency, contact with criminal justice system, victimization, substance abuse, sexual behavior and receipt of independent living services.

Kirk & Day, 2011

US

Young people who participated in the camp and were currently or had been in foster care and were still involved with the child welfare system in Michigan (15–19 years old), (n = 38)

Education

Kroner & Mares, 2009

US

Youth enrolled between 2001 and 2006 (n = 455)

Independent living

Kroner & Mares, 2011

US

Youth in care (n = 455)

Independent living

34.5% of youth indicated that they had an independent living service need that went unmet at age 17, 27.9% at age 21 and 35.5% at age 23, with the largest percentage indicating they lacked preparation in the area of finance. Over 25% of the youth in the study reported that all of their needs were not being met pertaining to independent living. Participants perceived that they A mixed method short term The Michigan had acquired a range of new longitudinal evaluation design Educational Opportunities for Youth comprising process and outcome learning about the practicalities components was used to assess of higher education that in Care program is a resulted from the camp. processes and perceived residential camp program on MSU campus outcomes related to the content Participants also perceived of the curriculum, self-efficacy, great increase in areas of taking for youth transitioning responsibility for their own skills, attitudes and program out of the system. It action, forward planning. quality offers social, personal Participants also reported and informational perceptions of enhanced senses support within a of self, felt more competent and learning campus were more optimistic about environment to promote their future resilience, and prepare youth for transition from high school to college. At discharge 60% had Lighthouse Independent Independent samples t-tests, Chi-square tests, and analysis of completed high school/GED Living Program. Serves dependent foster youth, variance (ANOVA) tests were program, 31% employed, and used to examine possible and delinquent youth. 33% independently housed differences in service use and Provides transitional housing, and supervised outcomes between client subindependent living skills groups of interest. training. Also serves as a placement setting of last resort for harder to place youth. Descriptive statistics were used Findings indicate that a housing The lighthouse based IL program can be to describe clients living independent living program began in 1981 arrangement and levels of care. successful in moving emancipating youth from more ANOVA was used to compare in order to help youth restrictive to less-restrictive leaving the child welfare client characteristics between clients who were discharged to and, in most cases less and juvenile justice various levels of care and those expensive living arrangements systems, who were who entered the program from a chosen by clients at the time of unable to return home, to make the transition to supervised/system level of care leaving the program setting self-sufficiency. (continued on next page) Independent living programs.

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Table 1 (continued) Author(s), year

Location Sample

Intervention Category

Lawler et al., 2014

US

Foster care alumni of the Independent living Academy (residential education program) (n = 478)

Lemon et al., 2005

US

Foster youth (n = 216)

Independent living

Lenz-Rashid, 2006

US

Youth living in a homeless shelter/ transitional living (n = 251)

Employment

Lindsey & Ahmed, 1999

US

Current ILP participants and staff (n = 13). Compared group of former foster youth that participated in ILP (n = 44) and foster youth that had not been involved in an ILP (n = 32)

Independent living

Manno et al., 2014

US

Youths (17–22 years old), (n = 1322)

Independent living

McMillen et al., 1997

US

Former foster youth (n = 25)

Independent living

Intervention

Method of evaluation

Outcomes

For youth who were attended the Academy to their 18th birthday or older, 92% of them graduated from the Acdemy with a high school diploma or GED. 51% of the Academy youth had obtained either part time or full time employment. More than half of the youth had access to healthcare after leaving the program. The majority of the youth had safe housing arrangements after leaving the program and at least one significant relationship with an adult. Self-administered questionnaire The study indicates ILP may Independent living play an important role in the that covered educational and services use an transition out of foster care and instructional model that employment history, financial teaches older adolescent and social support, health status, into young adulthood. Youth who were ILP participants had foster youth certain skills history of homelessness, better outcomes overall and substance abuse, criminal considered to be activity, skills training, personal were more prepared for associated with selfindependent living adjustment and current life sufficiency, including money management, job satisfaction readiness and retention, housekeeping and nutrition Approximately 60% of Employment outcomes are Employment training measured for participants a few participants found employment program assists youth within 3 months following the months following the with developing the completion of training. skills and resources that completion of the training can help them exit street life ILP participants more likely to Survey designed for this Independent living be independently living or evaluation. Questions focused programs included on 4 outcomes: housing & living paying all of their house training programs arrangements, designed to teach basic expenses while living with employment, education, education & training, others, and reported higher employment & earnings; money and household level of educational attainment financial self-sufficiency. management skills; and aspirations, compared to Respondents asked to answer in non-participants. No statistical support groups; retrospect 1–3 years prior to this differences regarding supervised living; study, and at the time of survey. employment or financial selfstipends for education; Questions also included about and counseling. sufficiency. perceptions of help they received in each of the 4 areas. Analyzed via descriptive statistics. Evaluation done by comparison Transitional living specialists Youth Villages of outcomes: 788 assigned to a provided support to youth in Transitional Living program group, which received many areas of focus, including program. Participants Transitional Living services, and securing stable housing, get support for 534 into a control group, which education maintenance Or education, housing, attainment, employment and did not receive those services. mental or physical job-seeking skills development, health, employment, and mental health, and life skills life skills. development The youth found that skills Qualitative data from focus Independent living classes and stipends for groups of former foster youth services described as independent living were skills classes, managing a who had used the independent helpful, that instruction in living service budget, cooking, managing a budget was building a social support particularly valuable, and that network the services lessened the stigmatization and isolation of being in care. (continued on next page) The Academy is a program established to address the needs of emerging adults in foster care. It delivers an array of services to its students through its parent organization and in partnership with the county department of health and human services, county office of education and workforce partnership.

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Data from admin records and on current living situations were collected. Academy admin staffs were also interviewed and evaluation procedures were reviewed through teleconferences with academy leadership. Also, the dependent variables were indicators for federal outcome standards of safety, significant relationships with adults and wellbeing.

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Table 1 (continued) Author(s), year

Location Sample

Intervention Category

Intervention

Minnesota Department of Human Services Family and Children's Services Division, 1999

US

Youth who transitioned out of care (n = 911)

Independent living

Montgomery et al., 2006

UK

Youth Leaving care (n = unknown)

Independent living

Naccarato & Park, 2009

US

Youth in the Northern California County (15–23 years old), (n = 365)

Independent living

Nesmith & Christophersen, 2014

US

Adolescents foster care agencies (n = 88)

Mentorship

Youth rated the quality of service they received; survey also includes basic indicators of independent living status. Youth were also rated by their group leaders concerning their readiness for independent living pre and post attendance of ILS sessions, the ratings made using the PULSE (Preparation Useful for Living Skills Enhancement) scale. Systematic review: 8 non-RCTs. Independent Living The effectiveness of ILPs Programs focus on compared to usual care, no personal development intervention, or another and independent living intervention. Outcomes of (provides supervised interest: participants' living spaces so youth can practice their skills). educational attainment, employment, housing, health, Personal development and life skills. skills include communication, decision-making, anger management. Independent living skills may include job skills, budgeting, household tasks, seeking housing, obtaining legal assistance, and utilizing community resources. Logistic regression model Independent living/Life offered a tool for investigating Skills training: classes the relationship between the were designed to equip the participants with the independent and dependent variables. Used human capital as skills needed to be selfa viable outcome measure for sufficient. this population. Data from in-person interviews CORE is a foster care program model designed with the foster youth, including self-report scales; Relationship to address the socioemotional needs of Competency Assessment and the older youth in foster care Quality Youth Relationship Assessment. who are nearing transition to adulthood

Petr, 2008

US

Youth aging 16 and Independent above whose case plans living centered on independent living (n = 27)

Powers et al., 2012

US

Youth receiving special education services, with at least 90 days in foster care and attending a large school district in the study target area (16.5–17.5 years old), (n = 69)

Mentorship

Support for Emancipation and Living Functionally (SELF)SELF-program activities address these youths' unique need to develop the practical and interpersonal skills required to attain critical educational and vocational goals.

Method of evaluation

Outcomes

One year follow-up showed a 32% increase in the proportion of youth living on their own, an increase from 12% to 25% in the proportion of youth in college or vocational-technical programs, and an increase from 10% to 24% in the proportion of youth with full-time jobs.

Some ILPs may have protective effects for youth leaving the public care system. Educational attainment: 3/5 studies report that a higher portion of ILP participants than nonparticipants had completed high school. Employment 3/5 studies reported that ILP participants more likely to be employed than nonparticipants. Housing: every study examining housing reported more favorable outcomes for ILP (such as independently living, fewer moves, experienced less homelessness) There were statistical relationships found in the logistic regression models between youths' education goals and ILP attendance in this sample.

The CORE model yielded promising results at helping older youth in foster care to develop relationship-building skills, and most importantly, to nurture a relationship with an adult who will support them through their transition Youth in this study, especially Data collected from interviews Independent Living with participants asking them to those still in custody, were services and programs generally satisfied with the that are the result of the evaluate their experience with independent living services independent living services Chafee Act they were receiving or expected to receive. Most of the youths reported that they were doing well in their educational progress, 75% of them had paid jobs and were well aware of the benefits they qualified for The intervention (TAKE Data collected from participants Youth in the intervention group had higher rates of high school post intervention and at one CHARGE) included completion, employment and coaching for youth in the year follow up good living status. The application of selfintervention group also determination skills to reported having significantly achieve youth-identified higher quality of life. goals, and youth participation in mentoring workshops with near peer foster care alumni. (continued on next page)

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Table 1 (continued) Author(s), year

Location Sample

Intervention Category

Rácz & Korintus, 2013

Hungary Young people (n = 35), Independent nominated adults in their living lives (n = 35), and decision makers (n = 4)

Rashid, 2004

US

Former foster care youth Independent using transitional living living services in Northern California (n = 23)

Ringle et al., 2007

US

Youth who departed from a residential program five years after discharge (n = 40)

Independent living

Rogers, 2015

US

Respondents who are support staff from different regions in England (n = 28)

Independent living

Rosenwald et al., 2013

US

Youth from a community Independent agency that coordinates living ILS for transitioning youth (n = 6)

Intervention

Method of evaluation

Outcomes

Aftercare provision is a combination of services that include accommodation, financial support, personal advice, help to find the most suitable form of education, support for studying, assistance to achieve integration into society and conflict management Transitional living programs (Avenues to independence) which include daily living skills, employment training, education, and supervised practice living

Qualitative, interviews with participants

Findings from the study show that a majority of youth who used the services followed pathways that either ended in securing a job after vocational school or enrolled in higher education courses.

The findings from this study indicate that comprehensive transitional living programs can provide former foster care youth, who were previously homeless or without stable living, with an opportunity to find and maintain employment, save a substantial amount of money for move-out costs, learn daily living skills, experience a “mock” real-world living situation, and achieve an hourly wage necessary to sustain independent living Survey by telephone, mail or via Results from the study show The treatment family that youth who completed this the internet to measure social home program (TFH) is planning process (i.e., functioning and quality-of-life based on the Teachinggraduated from high school domain Family Model that while in the program) tended to comprises of six report more positive outcomes, fundamental elements: (1) suggesting that investment in teaching life skills, (2) the skills for independence using motivational yields a more successful systems, (3) building transition into adulthood in trusting relationships with these areas peers and adults, (4) living in the most familystyle oriented setting possible, (5) encouraging the development of moral and spiritual values, and (6) making self-control and self-government a goal for every youth Based on interviews with Further Results show a lack of clarity Financial, housing, and between agencies as to their education colleges and social emotional support provided to care leavers services to explore what type of respective responsibilities for support young people are during their transition care leavers. The study also provided with while still in school showed limitations to the into independence, and while they were in post- to help them make decisions support provided by colleges. about post-compulsory education compulsory education Based on data collected through In general, this study portrays a Independent Living “mixed bag” with respect to Services (ILS) are a set of a 14-question interview guide where participants relayed their how responsive ILS is to federally and statemeeting their needs. With views on their success during funded service delivery respect to tangible services, the transition views on ILS, and programs for youth young adults mentioned that transitioning from foster potential connections between some tangible services were the two. care (and other provided that they found challenges such as helpful, including life skills homelessness) whose training and financial support goal is to promote such as the monthly check. “increased educational attainment, higher employment rates and stability, greater interpersonal and relationship skills, reduced non-marital pregnancy and births, and reduced delinquency and crime rates” (continued on next page)

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Data comparing status of participants at intake, discharge and 6 months post discharge

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Table 1 (continued) Author(s), year

Location Sample

Intervention Category

Scannapieco et al., 2015

US

Former foster care youth Independent (n = unknown) living

Simon, 2008

UK

Care leavers (n = 80) and a group of young people for comparison (n = 59) who met certain criteria of disadvantage

Sinkkonen & Kyttälä, 2015

Finland

Spencer et al., 2010

US

Housing Young people who had been residents in supportive care in Helsinki for 3–36 months (17–26 years old) (n = 39) Youth in foster care Mentorship (n = unknown)

Uzoebo et al., 2008

US

Youth in care (n = unknown)

Independent living

Valentine et al., 2015

US

Foster care youth (n = 1300)

Independent living

Housing

Intervention

Method of evaluation

Outcomes

Transition Resource Action Center (TRAC): provider of Preparation for Adult Living (PAL) services to youth who are still in substitute care, and youth who have already emancipated from the foster care system.

Records collected from TRAC and Children's Protective Services databases. SelfSufficiency Matrix used to measure outcomes in education, employability, employment, financial literacy, and shelter. Statistical tests were used to examine differences in outcomes between youth who received TRAC services before and after leaving care. Based on data collected from interviews with participant describing their experience of accessing housing and factors that helped them access and use housing services

TRAC is having a positive influence on the youth receiving services. Youth showed significant improvement in education, employability, financial literacy, and shelter

Housing legislation and services available to youth leaving care

Supportive housing is an after-care programme that should support the transition from foster care to independent adulthood Multiple mentoring programs available to serve foster care youth

Qualitative: questionnaire asking respondents to rate their experiences of supportive housing services

The interview findings suggested that relative to other young people in difficulty, care leavers had access to and were in receipt of more consistent housing support (largely because of leaving care teams who supported care leavers), both at the point of leaving care/home and for some time following first transitions to independent living. Findings from the study show that most respondents felt that the supportive housing service had fulfilled many of their need

Findings from the study show that mentoring, if done well, may hold the potential to meet some of the critical needs of youth transitioning from foster care to independent living and early adulthood Quantitative data collected with Findings suggest that youth VISIONS is an consider ILS programs to be an the Ansell Casey Life Skills independent living Assessment (ACLSA) instrument, important element in meeting program with a goal to while qualitative data comprised their human development prepare youth aged needs/potential. 13–21 years who are in a a Life Skills Evaluation Questionnaire (LSQ) and focus foster care residential group discussions (FGDs). treatment program for Pre−/post-test ACLSA was adulthood by teaching administered to participants and them the basic skills assessed mastery of skills in: needed to become money management, daily living productive adults postskills, ability to access foster care community social support resources, work and study habits and communication. The program, which was Using survey and administrative After one year, the program increased earnings, reduced renamed “YVLifeSet” in data, the evaluation team is homelessness and material measuring outcomes for both April 2015, is intended hardship, and improved groups over time to assess to help these young outcomes related to health and people make a successful whether Transitional Living services led to better outcomes. safety. transition to adulthood by providing intensive, individualized, and clinically focused case management, support, and counseling. (continued on next page)

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Analysis of research and literature examining the role and effectiveness of youth mentoring programs

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Table 1 (continued) Author(s), year

Location Sample

Intervention Category

Intervention

Van Ryzin et al., 2011

US

Foster youth (n = 569)

Independent living

Watt et al., 2009

US

Foster care youth (18–21 years old), (n = 25)

Independent living

Watt et al., 2013

US

Foster care alumni (n = unknown)

Education

Wells & Zunz, 2009

US

Service providers of the Chafee Educational and Training Voucher Program (Chafee ETV) (n = 276)

Independent living

Findings show that youth who became more comfortable and more open and reflective regarding change and transition were better equipped to handle the change they experienced, resulting in lower levels of internalizing symptoms such as anxiety and depression. Although this link does not provide evidence for the efficacy of the interventions described in this article, it does suggest that the theory behind the Transitions Framework was operating as intended. Assessment findings indicate The Thresholds Mothers' Program effectiveness was determined by tracking monthly that program participation is Project (TMP) is associated with positive status changes, such as primarily funded changes in participants' familial education, employment, and through Department of relationships, family hospitalizations, as well as by Children and Family responsibility and care, proper comparing scores on four biServices (DCFS) and parenting behavior and serves approximately 30 annually administered feelings, and parental distress women who are wards of standardized assessments of and competency, but no change parenting competency and the state, ethno-racial in mental health symptoms. stress, child maltreatment risk, minorities, have Positive behavior changes and mental health symptoms. economic and/or associated with program educational participation were observed in disadvantages, and have education, employment, and not succeeded in less low numbers of suspected and intensive program substantiated child maltreatment reports. Negative behavior changes associated with the program were frequency of AWOL incidents and subsequent pregnancies In the year in which FACES was Evaluation was based on data FACES (Foster Care implemented, the Freshmen collected from interviews with Alumni Creating foster care alumni retention participants and information Educational Success) is rate exceeded the rate for the the initiative developed collected from field research. general student freshman at Texas State University Quantitative data was also gathered as part of a formative population (84.2% versus in 2011. The program 76.4%). Other findings include evaluation; retention and offers direct services to graduation rates were compared a clear need to shift from views foster care alumni at of self that emphasize deficit, Texas state to encourage for foster alumni who were stigma, and shame, to one of involved with FACES versus recruitment, retention strength, survival, and stamina those who were not. and success after graduation Chafee Educational and Mail surveys distributed to Providers shared that they felt Training Voucher that youth who lacked role purposeful sample of service Program (Chafee ETV). models struggled in the providers in Maine, New The Chafee ETV program Hampshire, and Vermont, and transition to post- secondary provides up to $5000/ education. Providers noted qualitative in-depth interviews individual a year toward with key Chafee ETV instances where there was the higher education stakeholders in all 3 states. SPSS limited or non-existent health expenses of this insurance coverage for youth 14.0 was used for quantitative population including aging out of foster care, or a analysis. Qualitative data funds to defray costs for analysis involved at least three lack of clarity regarding health tuition/fees, room and insurance options for youth members of the research team board, transportation, over age 18. The most common coding responses to identify and child care expenses. themes. issue that was mentioned by the service providers was related to youth who were disadvantaged in their educational pursuits if they had psychological damage or scars from childhood traumas. Youth-serving agencies and organizations in this project agreed to integrate the concepts from the Transitions Framework into their programming and services in order help young people improve their skills in managing the difficult changes they face in the foster care system

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Method of evaluation

Youth completed surveys at both baseline (when they started receiving services from a participating agency) and 6 months later. The survey assessed youth for how prepared they felt for transition taking into account the services they received from the participating organizations

Outcomes

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Alonso, & Bell, 2007; Jones, 2010; Jones, 2011a; Jones, 2014; Jones & Lansdverk, 2006; Kroner, 2007; Kroner & Mares, 2011; Lawler et al., 2014; Manno et al., 2014; Munson & Lox, 2012; Rashid, 2004; Rogers, 2015). Employment is also a focus of independent living with programs providing career planning opportunities (Uzoebo, Kioko, & Jones, 2008), job readiness and retention strategies (Barnow et al., 2015; Dumaret et al., 2011; Lawler et al., 2014; Lemon, Hines, & Merdinger, 2005), and employment training (Manno et al., 2014; Rashid, 2004). Programs also provide financial training, specified as “money management” (i.e., learning how to balance a budget) (Kroner, 2007; Lemon et al., 2005; McMillen et al., 1997; Uzoebo et al., 2008) and educational assistance (Barnow et al., 2015; Broad, 1999; Choca et al., 2004; Collins & Ward, 2011; Manno et al., 2014; Rácz & Korintus, 2013; Rashid, 2004; Wells & Zunz, 2009). Lastly, three articles described an intervention that included a social capacity building component, which provided transitioning youth emotional support and guidance (Kroner, 2007) or facilitated in building social support networks (McMillen et al., 1997; Rácz & Korintus, 2013; Uzoebo et al., 2008). The residential education program has been studied more in comparison to other interventions included in this scoping review (Jones, 2010; Jones, 2011a; Jones, 2014; Lawler et al., 2014). This program simultaneously addresses the educational, employment, housing, and mental health needs of youth, while providing mentorship opportunities (Jones, 2010; Jones, 2011a; Jones, 2014; Lawler et al., 2014). Additionally, it allows transitioning youth to live on campus, thus increasing their access to services and promoting academic achievement (Jones, 2010; Jones, 2011a; Jones, 2014). In one article examining independent living services, 80% of youth (of 61 youth surveyed) reported an improvement in the quality of their lives (General Accounting Office, 1999). Meanwhile, Jones (2014) stated that most youth felt prepared for independent living and 60% were satisfied with the services they had received. Petr (2008) reported that youth were satisfied with the intervention, especially in the areas of finance and education. Studies also reported positive outcomes when it came to employment (Barnow et al., 2015; Broad, 1999; EversonHock et al., 2011; Jones, 2011a; Lawler et al., 2014; Scannapieco, Smith, & Blakeney-Strong, 2015) and education (Collins & Ward, 2011; Everson-Hock et al., 2011; Flynn & Tessier, 2011; Jones & Lansdverk, 2006; Scannapieco et al., 2015). Studies evaluating independent living programs, reported that youth were more likely to complete high school (Georgiades, 2005a) and be enrolled in post-secondary education (Montgomery et al., 2006). In addition, youth were more likely to acquire part- or full-time employment (Montgomery et al., 2006) and had higher hourly wages in comparison to their cohorts (Rashid, 2004). However, a couple of studies reported that independent living programs did not meet or improve outcomes (Collins & Ward, 2011; Mendes et al., 2014a; Scannapieco et al., 2015; Valentine, Skemer, & Courtney, 2015) and some articles had mixed reviews on its effectiveness (Abrams, Shannnon & Sangalang, 2008; Freundlich & Avery, 2006).

program was implemented, the retention rate for students formerly in care was higher than their peers who were not in care (Watt et al., 2013). An evaluation of the Youth Transition Demonstration project revealed that participating youth had jobs and earnings up to five years after enrollment (Camacho & Hemmeter, 2013). Continued and expanded support policies that promote post-secondary transition services for youth aging out of care is warranted (Batsche et al., 2014). Another recommendation is the need for support services to be provided in conjunction with employment services to produce successful employment outcomes for youth upon completion of their degree (Camacho & Hemmeter, 2013). Hernandez and Naccarato (2010) recommended the need for emotional support for youth in college, as well as the need to promote tuition waiver programs and support services that address the emotional, financial, and housing needs of youth attending college. Watt et al. (2013) further state that campus programs must identify, celebrate, and make use of the unique strengths of youth aging out of care in hopes of retaining and recruiting these youth. 3.4. Mentorship Mentorship programs include those that provide socio-emotional support to youth aging out of care via relationships created between youth and their mentor (Avery, 2011; Nesmith & Christophersen, 2014). Findings for this category revealed that longer relationships between the youth and mentors produced more positive effects and had the potential to better meet the needs of youth transitioning to independent living (Avery, 2011; Nesmith & Christophersen, 2014; Spencer, Collins, Ward, & Smashnaya, 2010). Greeson, Usher, and Grinstein-Weiss (2010) identified that having a mentor who served as a role model was associated with overall success for these youth. Specifically, positive educational outcomes (e.g., high academic self-efficacy, higher rates of high school completion) were reported among youth enrolled in educational mentoring programs (Bruster & Coccoma, 2013; Powers et al., 2012). Mentorship programs also gave youth the opportunity to exercise their relationship-building skills, which left youth feeling empowered (Powers et al., 2012) and better equipped in regulating their emotions (Nesmith & Christophersen, 2014). Components of mentor programs that resulted in positive outcomes for youth include: ongoing training for mentors, structured activities for mentors and youth, and monitoring of overall program implementation (Avery, 2011). Recommendations for practice that stemmed from these articles include the need for interventions that aim to enhance existing relationships rather than creating new ones (Collins, Spencer, & Ward, 2010). Nesmith and Christophersen (2014) also recommend that programs that nurture relationships be included in independent living skills training. 3.5. Independent living Independent living services or programs, also referred to as transitional living programs, are designed to help youth transition successfully to adulthood through “training” them to live independently, thus promoting self-sufficiency (Kroner & Mares, 2011). It also includes life skills training (Barnow et al., 2015; Collins & Ward, 2011; Courtney et al., 2008; Georgiades, 2005a; Jones, 2014; Kroner, 2007; Kroner & Mares, 2011; Lawler, Sayfan, Goodman, Narr, & Cordon, 2014; Manno et al., 2014; McMillen, Rideout, Fisher, Tucker, & Goldstein, 1997; Rashid, 2004) and the provision of housing for youth transitioning out of care (Broad, 1999; Choca et al., 2004; Collins & Ward, 2011; Dumaret, Donati, & Crost, 2011; Giffords,

3.6. Health In this review, few articles (n = 11) addressed health-related interventions. These articles described mental health supports such as counseling services (Manno et al., 2014; Scott, Munson, & White, 2009), outpatient therapy groups (Holmes, Wright, Ott, & Atkins, 1996; Munson & Lox, 2012), day rehabilitation clinics (Jones & Lansdverk, 2006), and campus-based mental health treatment centers (Jones, 2010). Of the 11 articles, only three focused solely on health-related

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services among youth aging out of care (Dworsky & Pérez, 2009). Overall, youth desire more support and services once transitioned out of care. This includes an increase in programs that focus on building social capital to support the social and emotional development of youth transitioning out of care (Uzoebo et al., 2008). Having adequate financial support was found to be especially challenging for youth transitioning out of care (Dworsky & Pérez, 2009). Youth identified having sufficient income as vital in their ability to save money, and felt that financial education paired with follow-up financial support would lead to positive outcomes (Edelstein & Lowenstein, 2014a). Wells and Zunz (2009) noted that five thousand US dollars per year provided to students to cover all their expenses was deficient, given the fact that youth in care most likely had no prior savings and lacked familial support. This finding was supported by Dworsky and Pérez (2009), who found that youth wanted more and longer provisions of financial aid. This was also echoed by Gypen et al. (2017), who stated that child welfare systems should provide longer social and financial assistance to improve educational attainment. However, even when resources are set aside for programs to support youth during their transition, disparities exist in regards to how resources are used and distributed within each country's child welfare agencies (Collins, 2004; Dumaret et al., 2011; Lindsey & Ahmed, 1999). The description of independent living programs in the literature was unclear and vague, only describing components including housing, employment, and educational opportunities. No further details are given regarding specifics of the previously mentioned components, as well as timing of services. Some youth also felt that independent living programs were inadequate in preparing them to live independently (General Accounting Office, 1999; Sinkkonen & Kyttälä, 2015; Vorhies, Glover, Davis, Hardin, Krzyzanowski, Harris, Fagan, & Wilkniss, 2009), and sought more support in parenting and housing (Georgiades, 2005a). Youth receiving housing support reported needing additional education in financial matters, employment, and healthcare (Sinkkonen & Kyttälä, 2015). Lastly, youth supported by campus programs felt that additional academic support, and supports to enhance their decision-making abilities was warranted (Watt et al., 2013). Issues also arise during the collaboration of multiple agencies. Broad (1999) discussed government laws and policies as a barrier experienced by those working in the child welfare system. One study noted difficulties establishing connections with employers to improve youth's employment outcomes (General Accounting Office, 1999). Another study noted that the intervention failed to achieve cohesiveness between the caseworker, court, and community service plan (Waldinger & Furman, 1994). Confusion exists when it comes to determining an agency's role in aiding youth through this transition period (Mendes et al., 2014a; Mendes et al., 2014b; Rogers, 2015). Overall, this reviews reinforces the need for greater interagency collaboration, with service providers working with others in the same sector and beyond to provide holistic interventions to support and ease the transition process for youth aging out of care (Mendes et al., 2014b; Rogers, 2015; Wells & Zunz, 2009).

interventions specific to improving youth's access to health care services (Collins & Ward, 2011; Manno et al., 2014; Uzoebo et al., 2008). The remaining health interventions were mentioned in the independent living and mixed articles. Cognitive behavioral therapy was found to lower rates of substance abuse and reduce criminal activity among youth who had previously been involved in the criminal justice system (Manno et al., 2014). Jones (2011a) stated that mental health services led to improvements in youth's ability to find and maintain employment. Alternatively, one study found no changes in mental health symptoms among youth (Watt, Norton, & Jones, 2009). Jones and Lansdverk (2006) reported that after-care services do not have sufficient resources to deal with mental health issues. Since health services were combined with independent living programs, the majority of reported outcomes were unrelated to the health and well-being of youth. Recommended is the need for mental health professionals tailor interventions to meet the demands of these youth (Munson & Lox, 2012; Scott et al., 2009). 4. Discussion 4.1. Overview of findings To our knowledge, this is the first scoping review to examine and map the available evidence on the interventions available to youth who are aging out of the child welfare system, which is a necessary and important step in identifying gaps for future research. The majority of the studies evaluated independent living interventions (n = 48). These interventions aimed to improve the ability of youth transitioning out of care to live independently, as well as assist them in attaining housing, gaining employment status, and achieving successful educational outcomes. Additionally, the studies in these categories reported positive outcomes in aspects of education, employment, and housing. Independent living interventions in particular, were generally funded through the government as opposed to private agencies or nonprofit organizations. Consistent with findings from a survey of former youth in care now attending US colleges (Lemon et al., 2005), government-funded programs generally varied with respect to how services were implemented and provided insufficient information about each program. Few studies evaluated the impact of mentorship in the transition period for youth in care. Mentorship outcomes resulted in more successful transitions to adulthood as evidenced by higher rates of education completion, employment, and a higher quality of life among youth in these programs (Nesmith & Christophersen, 2014; Powers et al., 2012). There was scant information concerning health interventions for youth aging out of care, as most studies tended to report on education, employment, and housing outcomes. The three studies specifically focusing on the health of these youth (Holmes et al., 1996; Klodnick, Davis, Fagan, & Elias, 2014; Scott et al., 2009) explored mental health interventions available to them but did not address other aspects of health (e.g. physical or sexual health).

4.3. Limitations of the studies 4.2. Limitations of interventions This review revealed a number of limitations with the research to date including the majority of studies reported sampling issues as a weakness in their studies. Small sample sizes used in the study were commonly cited as a limitation (Abrams et al., 2008; Batsche et al., 2014; Bruster & Coccoma, 2013; Gallagher & Green, 2012; Georgiades, 2005a; Georgiades, 2005b; Hernandez & Naccarato, 2010; Jones, 2010; Jones, 2011a; Jones, 2011b; Lindsey & Ahmed, 1999; Montgomery

The literature noted that programs had challenges in identifying eligible students for their programs (Dworsky & Pérez, 2009) with limited access to student level data (Dworsky & Pérez, 2010). Dixon and Stein (2002) found that most regions offered programs to youth aging out of care, yet not even half of transitioning youth enroll in these programs. This may be due to the lack of awareness of the existence of

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interventions available to youth who are aging out of the child welfare system. The review reinforces the need for further research considering the noted limitations of existing work. Overall, methods of evaluations of the interventions were found to be methodologically weak with respect to determining the effectiveness of interventions in ensuring youth's successful transitions to independence. Results of the review will be of use for research and end-user communities concerned with implementing and evaluating interventions available to youth who are aging out of the child welfare system.

et al., 2006; Nesmith & Christophersen, 2014; Nsonwu, Dennison, & Long, 2015; Powers, 2012; Rashid, 2004; Rosenwald, McGhee, & Noftall, 2013; Scott et al., 2009; Vorhies et al., 2009; Watt et al., 2013). Further limitations included sampling bias (Georgiades, 2005a; Georgiades, 2005b; Hernandez & Naccarato, 2010; Kirk & Day, 2011; Kroner & Mares, 2011; Lemon et al., 2005; Manno et al., 2014; McMillen et al., 1997; Nsonwu et al., 2015; Ringle, Ingram, Newman, Thompson, & Waite, 2007; Sangalang, 2006) and non-randomization of sample (Collins & Ward, 2011; Jones, 2010; Lenz-Rashid, 2006; Petr, 2008; Rashid, 2004; Rosenwald et al., 2013; Scott et al., 2009). Studies also lacked a control group to which comparisons can be made to determine the effectiveness of interventions (Barnow et al., 2015; Batsche et al., 2014; Brown & Wilderson, 2010; Collins & Ward, 2011; Jones & Lansdverk, 2006; Powers, 2012; Senteio, Marshall, Ritzen, & Grant, 2009; Van Ryzin, Mills, Kelban, Vars, & Chamberlain, 2011; Vorhies et al., 2009). Other limitations noted in the research include the majority of the work to date, being conducted in the US (n = 57). There is a lack of information pertaining to youth aging out of care in other countries. Overall, it was unclear in most studies as to the eligibility criteria needed for youth to be enrolled in programs or services, the age range of eligibility, as well as the length of time interventions are offered. As well, determining whether interventions have actually improved outcomes for youth proves almost impossible as youth are difficult to track once they have been transitioned from care (Barnow et al., 2015; Giffords et al., 2007; Lindsey & Ahmed, 1999; Rogers, 2015). Finally, considering independent living programs are composed of a group of resources, it is difficult to determine which specific resource led to positive outcomes (Jones, 2011a).

Declaration of interests The authors declare no conflicts of interest. Acknowledgements Dr. Roberta L. Woodgate is supported by The Canadian Institutes of Health Research Applied Chair in Reproductive, Child and Youth Health Services and Policy Research (Grant#: CIHR APR −126339). Katrina M. Martin is supported by a University of Manitoba Graduate Scholarship and a Graduate Nursing Student Association Scholarship at the University of Manitoba. The funding sources had no role in the conduct of this review, analysis of data or decision for publication. References Abrams, L. S., Shannon, S. K. S., & Sangalang, C. (2008). Transition services for incarcerated youth: A mixed methods evaluation study. Children & Youth Services Review, 30, 522–535. http://dx.doi.org/10.1016/j.childyouth.2007.11.003. Arksey, H., & O'Malley, L. (2005). Scoping studies: Towards a methodological framework. International Journal of Social Research Methodology, 8(1), 19–32. http://dx.doi.org/ 10.1080/1364557032000119616. Avery, R. J. (2011). The potential contribution of mentor programs to relational permanency for youth aging out of foster care. Child Welfare, 90, 9–26. Retrieved from http://web.b.ebscohost.com.uml.idm.oclc.org/ehost/pdfviewer/pdfviewer?vid=1& sid=be721a05-1d4b-459d-9382-094a11658a8d%40sessionmgr101. Barnow, B. S., Buck, A., O'Brien, K., Pecora, P., Ellis, M. L., & Steiner, E. (2015). Effective services for improving education and employment outcomes for children and alumni of foster care service: Correlates and educational and employment outcomes. Child & Family Social Work, 20, 159–170. http://dx.doi.org/10.1111/cfs.12063. Batsche, C., Hart, S., Ort, R., Armstrong, M., Strozier, A., & Hummer, V. (2014). Postsecondary transitions of youth emancipated from foster care. Child & Family Social Work, 19, 174–184. http://dx.doi.org/10.1111/j.1365-2206.2012.00891.x. Bender, K., Yang, J., Ferguson, K., & Thompson, S. (2015). Experiences and needs of homeless youth with a history of foster care. Children and Youth Services Review, 55, 222–231. http://dx.doi.org/10.1016/j.childyouth.2015.06.007. Broad, B. (1999). Young people leaving care: Moving towards “joined up” solutions? Children & Society, 13, 81–93. Brown, S., & Wilderson, D. (2010). Homelessness prevention for former foster youth: Utilization of transitional housing programs. Children and Youth Services Review, 32, 1464–1472. http://dx.doi.org/10.1016/j.childyouth.2010.07.002. Bruster, B. E., & Coccoma, P. (2013). Mentoring for educational success: Advancing foster care youth incorporating the core competencies. Journal of Human Behavior in the Social Environment, 23, 388–399. http://dx.doi.org/10.1080/10911359.2013. 764218. Camacho, C. B., & Hemmeter, J. (2013). Linking youth transition support services: Results from two demonstration projects. Social Security Bulletin, 73, 59–71. Retrieved from https://www.ssa.gov/policy/docs/ssb/v73n1/v73n1p59.html (Accessed June 6, 2016) . Choca, M. J., Minoff, J., Angene, L., Byrnes, M., Kenneally, L., Norris, D., & Rivers, M. M. (2004). Can't do it alone: Housing collaborations to improve foster youth outcomes. Child Welfare, 83, 469–492. Retrieved from http://web.a.ebscohost.com.uml.idm. oclc.org/ehost/pdfviewer/pdfviewer?vid=1&sid=c7478bb2-1747-495c-abaaf696d1bb3627%40sessionmgr4009 (Accessed June 6, 2016) . Citizens' Committee for Children of New York. Can they make it on their own? Aging out of foster care–A report on New York City's independent living program. (2000). Retrieved from http://files.eric.ed.gov/fulltext/ED440163.pdf (Accessed June 6, 2016). Collins, J. L. (2016). Integrative review: Delivery of healthcare services to adolescents and young adults during and after foster care. Journal of Pediatric Nursing, 31, 653–666. http://dx.doi.org/10.1016/j.pedn.2016.07.005.

4.4. Future research Since the majority of the research was completed in the US, an evaluation of interventions in other countries is necessary. Further information is needed in terms of the effectiveness of interventions including determining the factors necessary for successful transition to independence (Holmes et al., 1996; Manno et al., 2014; Mendes, 2009; Schelbe, 2011; Scott et al., 2009; Watt et al., 2009). Also warranted are longitudinal studies to establish long-term outcomes (Choca et al., 2004; Flynn & Tessier, 2011; Sangalang, 2006; Scannapieco et al., 2015) and more rigorous testing of interventions (Courtney et al., 2008; Everson-Hock et al., 2011; Jones & Lansdverk, 2006; Watt et al., 2009). Moreover, studies are needed that explore the health needs of youth transitioning out of care and their well-being. Lastly, cost-effectiveness studies are needed, considering this review found no studies that evaluated the cost-effectiveness of supporting youth's journey to independence versus withdrawing support at premature ages. 4.5. Limitations of our review While extensive, this review may not have captured the entirety of all available data on this topic as the inclusion criteria was limited to English-based materials available in developed countries within the last two decades. Another limitation is the lack of comparison of services and programs between studies within the same intervention category due to the uniqueness of each intervention. 5. Conclusion This scoping review provides a map of the available evidence on

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