Outcomes of children who grew up in foster care: Systematic-review

Children and Youth Services Review 76 (2017) 74–83

Contents lists available at ScienceDirect

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

Outcomes of children who grew up in foster care: Systematic-review☆ Laura Gypen a,⁎, Johan Vanderfaeillie a, Skrallan De Maeyer a, Laurence Belenger a, Frank Van Holen b a b

Vrije Universiteit Brussel, Department of Clinical and Lifespan Psychology, Pleinlaan 2, 1050 Brussels, Belgium Pleegzorg Vlaams Brabant en Brussel, Belgium

a r t i c l e

i n f o

Article history: Received 30 September 2016 Received in revised form 26 February 2017 Accepted 28 February 2017 Available online 04 March 2017 Keywords: Foster care Outcomes Transition to adulthood Effects Family foster care Residential care

a b s t r a c t Foster care is one of the most far-reaching interventions targeted at children who are abused or neglected by their parents, or who are engaged in anti-social behavior (Lindquist & Santavirta, 2014). The large number of children in foster care and the high cost of child welfare, makes the outcomes of former foster youth a trending topic in research. However, research that combines results on different extents (education, employment, wages, housing, mental health, substance abuse and criminality) is sparse. Using the PRISMA method, the outcomes of 32 original quantitative studies were compared. The studies were categorized into two groups reflecting on the child welfare orientation of the country: child protection vs. family service (Gilbert, Parton, & Skivenes, 2011). The results are clear as well as troubling. In both systems, children who leave care continue to struggle on all areas (education, employment, income, housing, health, substance abuse and criminal involvement) compared to their peers from the general population. A stable foster care placement, establishing a foothold in education and having a steady figure (mentor) who supports youth after they age out of care seem to be important factors to improve the outcomes. © 2017 Published by Elsevier Ltd.

1. Introduction Each year, about 400000 children in the USA are served in the foster care system in (U.S. department of Health and Human Services, 2013). These children are participants in a child welfare system that costs the U.S more than $29.4 billion annually (Devooght & Cooper, 2012). In 2013, 10% of the children that aged out of foster care started living independently (U.S. department of Health and Human Services, 2013). Despite the large number of children in foster care and the high cost of child welfare, research that combines results on different extents (education, employment, mental health, substance abuse, criminality and housing) is sparse.

1.1. Children in foster care When the safety of a child cannot be assured, they are most often removed from their family and placed into the foster care system (Kessler et al., 2008; Pecora, White, Jackson, & Wiggins, 2009). Foster care settings include (non-)relative foster family homes, group homes,

☆ On behalf of all authors, the corresponding author states that there is no conflict of interest. ⁎ Corresponding author at: Vrije Universiteit Brussel, Faculty of Psychology and Educational Sciences, Pleinlaan 2, Department of Clinical and Lifespan Psychology, 1050 Brussel, Belgium. E-mail address: [email protected] (L. Gypen).

http://dx.doi.org/10.1016/j.childyouth.2017.02.035 0190-7409/© 2017 Published by Elsevier Ltd.

emergency shelters, residential facilities and pre-adoptive homes (Pecora et al., 2009). Most foster children reside in relative- (24%) or nonrelative (53%) foster homes. Only 25% stay in trivial homes, preadoptive homes or institutions (U.S. Department of Health and Human Services, 2013). There are many reasons why children are placed in the foster care system. Inevitably, all these factors determine a vulnerability and shape the journey to adulthood for young people leaving care (Wade & Dixon, 2006). Foster children often experienced different types of maltreatment (Pecora, 2012; Pecora, Kessler et al., 2006; Salazar, 2013; Stewart, Kum, Barth, & Duncan, 2014) and a subsequent lack of stability in their childhood (Salazar, 2013). Furthermore, a considerable percentage of children (18%) enter the system because of their own behavioral problems (Kessler et al., 2008; Pecora et al., 2009). Many of the foster children come from low-income families with few resources and/ or social support (Lindquist & Santavirta, 2014; Zlotnick, Tam, & Soman, 2012). Additionally their parents often have high rates of physical, psychological and social problems (von Borczyskowski, Vinnerljung, & Hjern, 2013; Zlotnick et al., 2012). Furthermore, approximately 55% of the children in foster care are children from ethnic minorities (Villegas & Pecora, 2012). It is important to remind ourselves that this large group of minority children might have different needs and risk factors. In 2013, nearly one third (29%) of the children in foster care were two years or younger when they entered the foster care system (U.S. Department of Health and Human Services, 2013), and even though the policy makers have the intention to shorten the length of placements trough permanency planning programs, 54% of the children

L. Gypen et al. / Children and Youth Services Review 76 (2017) 74–83

stayed in care longer than twelve months in 2012 (Child Welfare Information Gateway, 2013).

75

needs. The aim of this article is to give the reader a short yet comprehensive presentation of what the most recent researchers found on the perspectives of children who grew up in foster care.

1.2. Aging out of care 2. Method Research shows that the last decades have been hard on young people making the transition to independent living. The decline in the labor market, the rapid growth of education and the shortage of affordable housing has extended young people's reliance on family support and since youth aging out of foster care lack family support, their transition to adulthood becomes even more challenging (Dworsky, 2005; Jones, 2010; Lindquist & Santavirta, 2014; Wade & Dixon, 2006; Zlotnick et al., 2012). One third of the foster care agencies indicate that they continue to provide help even after the children leave the foster care system. However, research indicates that support from social workers drastically declines after leaving care (Wade & Dixon, 2006). Furthermore, not only do they have less support, foster children are obliged to become independent at a younger age than their peers from the general population (Dworsky, 2005; Jones, 2010; Wade & Dixon, 2006). To provide in the needs of youth aging out of care, many programs are organised to support emancipating youth (Pecora, Williams et al., 2006; Reilly, 2003). Despite these programs, youth aging out of care indicate that they were not properly prepared for independent living (Naccarato, Brophy, & Courtney, 2010; Wade & Dixon, 2006). Nearly half of the foster care alumni report that they were not ready to live alone at the moment they left care (Pecora, Williams et al., 2006). The research of Scannapieco, Connell-Carrick, and Painter (2007) indicates that former foster youth have a positive experience with the independent living classes but report a lack of opportunities to test the skills they learned in real life. They also note that they have concrete needs such as money, safe housing and bus passes, in which the programs do not foresee (Naccarato et al., 2010; Scannapieco et al., 2007). 1.3. Theoretical foundation For this review, the theoretical model of Bronfenbrenner (1977) was used as a framework. This model explains and links developmental outcomes to the multiple and diverse environmental contexts to which a person is exposed across the life course. These environmental contexts can range from personal interactions to cultural inputs (Bronfenbrenner, 1977). The model is relevant to this research because it explains how outcomes of former foster care children can be influenced by their environmental experiences. For example, their personal characteristics (biological and genetic makeup, personality and cognitive ability) can interact with their direct environment (the foster family or the residential group home where they stay, the other children that live there, the school they go to). The society they live in and the cultural aspects also influence this interaction. To increase understandings of the outcomes of foster care alumni, it is important to look at the results with the model of Bronfenbrenner in mind. There is no simple linear influence in this matter, the different systems all influence each other and determine the outcomes. 1.4. Purpose of this study There is a significant amount of research available on the outcomes of former foster children, however, combining and comparing different studies remains a challenge and studies that provide a clear overview are scarce. Current research indicates that youth aging out of care are extremely vulnerable and seem to experience many negative outcomes. It remains important to invest in research to reduce the gap between former foster youth and the general population (Jones, 2010). The current study provides important information regarding the outcomes of foster care alumni on different areas. This understanding can help inform those who work with (former) foster youth, preparing them for emancipation and developing programs that more closely meet their

This review was conducted confirm with the PRISMA methodology (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) (Moher, Liberati, Tetzlaff, & Altman, 2009). During the period of October 2014 until October 2015 three electronic databases (PsychINFO, Springer, Science Direct) were searched using the following terms: (1) “Foster care” or “Foster alumni” or “Foster Children” and (2) “Long-term perspectives” or “Long-term results”. The same search terms were used to identify relevant literature though Google Scholar. All found articles and literature were manually screened for further relevant studies, matching the following including and excluding criteria. All searches were restricted to publications in English or Dutch language and availability of full text. To create an overview of the information found in the past ten years, all articles were restricted for publication years 2004–2015, there were no restrictions concerning gender or other demographical criteria for participants. Because the study focusses on youth who already aged out of care, only articles where participants were 17 years or older were included, there was no maximum age for participants. Only publications in which family foster care or residential care were evaluated were considered for inclusion in the study. Only studies using original quantitative research methodologies were included, qualitative research was excluded because of a lack of comparability. To compare the outcomes of the different studies, studies were categorized into the child welfare system orientation from their country. Gilbert, Parton, and Skivenes (2011) distinguished two main orientations: child protection oriented and family service oriented child welfare systems. Child protection oriented systems are mostly found in Liberal countries such as the United States, Canada and England. These governments use an individual, moralistic way of protecting children and legal procedures (such as out of home placement) are used to ensure the safety of the child. Family service oriented systems use a more social, psychological frame, which thinks of parents as important partners in care. Countries such as Denmark, Sweden, Finland (SocialDemocratic) and, Belgium, the Netherlands and Germany (Conservative) most often use this framework in child welfare. Table 1 describes the used studies to analyze the outcomes of foster care alumni. Because of space limitations, readers are referred to the major study publications for additional data. 3. Results 3.1. Educational accomplishments 3.1.1. High School education Overall young adults with foster care experience, as well in child protection systems as in family service systems, encounter considerable difficulties achieving a high school degree. All found studies report lower success or graduation rates for former foster children. The rates found in research are very diverse (40–97%) (Dworsky & Courtney, 2009; Harris et al., 2010; Hines, Merdinger, & Wyatt, 2005; Hook & Courtney, 2011; Martens, 2011; Pecora, Kessler et al., 2006; Pecora, Williams et al., 2006; Villegas et al., 2011), this can possibly be explained by the different ages used in the samples of the studies (Fig. 1). 3.1.1.1. Child protective systems. The Midwest Study found that only 64% of the young alumni completed high school by the age of nineteen, compared to 91% in the general population (Dworsky & Courtney, 2009; Hook & Courtney, 2011). However, when foster children were asked the same question at the age of 29, 85% graduated high school or obtained a General Education (GED) (Pecora, Williams et al., 2006). This nearly matches the general population rate (87%) (Pecora, Williams et al.,

76

L. Gypen et al. / Children and Youth Services Review 76 (2017) 74–83

Table 1 Summary of Studies used in this review (n = 32). Study

Country

Type of carea

Child welfare systemb

Sample Mean age (range)

Time in care (SD)c

Characteristic assessed

X

X

X

Educ. Empl. Earn. Hous. Health Subst. Crim. ab. Beh.

Cashmore & Paxman, 2006

Australia

FFC + RC

CPS

41

(16–18)

Courtney, Dworsky, & Perez, 2007 Courtney et al., 2011 Day, Dworsky, Fogarty, & Damashek, 2011 Dworsky & Courtney, 2009 Dworsky, 2005 Goerge et al., 2002 Harris, Jackson, O'Brien, & Pecora, 2009 Harris, Jackson, O'Brien, & Pecora, 2010 Hook & Courtney, 2011 Jackson & Cameron, 2012

US

FFC + RC

CPS

590

(21−22)

10.7 Y (5.4) –

US US

RC FFC + RC

CPS CPS

596 444

26.1 –

– –

X X

X

X

US US US US

FFC + RC FFC + RC FFC + RC FFC

CPS CPS CPS CPS

321 8511 2588 708

(19–22) 15 – 30.8

– 20.2 M – –

X X X X

X X X

X X

US

FFC + RC

CPS

708

30

–

US UK, Denmark, Sweden, Spain, Hungary US Sweden

FFC + RC FFC + RC

CPS FOS

602 170

(17–24) (18–24)

– –

X X

RC FFC

CPS FOS

106 573

18.3 (19–31)

X

(16–24) 21.9 SD = 2.2 (18–23)

– 20.6 M (30.84) – 7Y

Jones, 2010 Lindquist & Santavirta, 2014 Macomber et al., 2008 Maliszewski & Brown, 2014 Martens, 2011

US US

FFC + RC RC

CPS CPS

3301 100

Belgium

FFC

FOS

99

Naccarato et al., 2010 Okpych & Courtney, 2014 Pecora, 2012

US US US

RC FFC + RC FFC

CPS CPS CPS

591 564 1895

Pecora, Kessler et al., 2006 Pecora, Williams et al., 2006 Salazar, 2013

US US

FFC FFC

CPS CPS

659 1087

US

FFC + RC

CPS

250

US US Belgium US US

FFC + RC FFC + RC RC FFC FFC

CPS CPS FOS CPS CPS

926 3301 93 810 810

25.6 SD = 2.4 (18–23) (17–30) (18–23) (20–49) (20–49)

(17–21) 26 28.05 SD = 4.1 24.2 30.5 (20–51)

110 M (80.59) – – 7.1 Y (3.4) 6.1 Y 10.5 Y (5.1) 8.6 Y (5.0) – – – –

Singer, 2006 Stewart et al., 2014 Vernieuwe, 2013 Villegas & Pecora, 2012 Villegas, Rosenthal, O'Brien, & Pecora, 2011 von Borczyskowski et al., 2013 Vinnerljung & Hjern, 2011

Sweden

FFC + RC

FOS

2408

(15–35)

12 Y

Sweden

FOS

3961

–

15,7 Y

Wade & Dixon, 2006

UK

FFC + RC + AD FFC + RC

CPS

106

White, Brien et al., 2008 Zlotnick et al., 2012

US US

FFC + RC FFC + RC

CPS CPS

479 2606

Range = 16– – 20 24.2 – – –

a b c

X X X

X

X

X

X X X

X X

X

X

X

X X X

X X X

X

X

X

X

X X X X X

X

X

X X X

X X X

X

X X X X

X

X

X

X

X

X X X X X X X

X X X X

X X

X X

X

X X

X X X

X

X

FFC = family foster care; RC = residential youth care; AD = adoptees. CPS = child protective system; FOS = Family orientated system. Y = years; M = months.

2006; Villegas, Rosenthal, O'Brien, & Pecora, 2014). This is a tendency found in multiple studies (Maliszewski & Brown, 2014; Pecora, Williams et al., 2006). Children form ethnic minorities have even worse odds (Harris et al., 2009; Villegas et al., 2014; Wade & Dixon,

2006). White foster alumni significantly completed high school more compared to African Americans (Harris et al., 2010). Although the numbers are sobering, U.K. government statistics point to a slow but steady improvement in the educational outcomes. In

Fig. 1. High School Degree, foster children compared to children from the general population.

L. Gypen et al. / Children and Youth Services Review 76 (2017) 74–83

2002–2003, 54% of the care leavers left without any formal qualifications while in 1999–2000 this percentage was still 66%. However, the contrast with the general population remains striking. In 2002–2003 only 3% of the sixteen year old failed to obtain any qualification (Wade & Dixon, 2006). 3.1.1.2. Family service systems. Foster children who aged out of family service systems seem to have the same disadvantages as those who aged out of child protection systems. The study of Vernieuwe (2013) indicates that only 45% of the former foster care alumni achieved a high school degree compared to 73% of the general population, this is a significant difference. The study of Martens (2011) found that 73% of the former foster children obtain a high school degree between the ages of 17 and 23, compared to 83% of the general population, this difference is also significant. Jackson and Cameron (2012) found that former foster children seem to have a higher chance to obtain a high school qualification if you give them more time. At the age of 18, only 33% of the sample obtained a high school degree, by the age of 24, this percentage has risen to 73%. 3.1.2. College education In addition to high school challenges, youth formerly placed in foster care often struggle with post-secondary school completion, as well in family service systems as in child protection systems (Fig. 2).

77

3.1.2.2. Family service systems. Foster children who aged out of family service systems seem to have the same disadvantages as those who aged out of child protection systems. The study of Martens (2011) found that 7.2% of the former foster children obtain a bachelor degree and only 1% obtains a master degree before the age of 23. In the study of Vinnerljung and Hjern (2011) the numbers of former foster youth who obtained a two or four-year college degree are between 8 and 13% in the foster care population, compared to 34–44% in the general population. The study of Vernieuwe (2013) indicates that only 7.5% of the former foster care alumni achieved a master degree, however, in this study 22.5% achieved a bachelor degree. Those rates are notably higher than previous rates. A possible explanation might be that the study of Vernieuweis a Belgian study where the registration fee of college is relatively low compared to other countries. Furthermore, Jackson and Cameron (2012) indicate that former foster children seem to have a higher chance to obtain a high school qualification if you give them more time. At the age of 18, only 33% of the sample obtained a high school degree, by the age of 24, this percentage has risen to 73%. As in the child protection systems, especially the four-year education (or master education) seems to be a stumbling block. Significantly more former foster children obtain a two year or bachelor degree. Furthermore, as in the child protection system, for all degrees, women's educational outcomes exceeded those of men participating in the study (Jackson & Cameron, 2012). 3.2. Employment

3.1.2.1. Child protective systems. In addition to high school challenges, youth formerly placed in foster care often struggle with post-secondary school completion. Although data are sparse, the college education rates for former foster children are low (Fig. 2). The rates for obtaining a twoyear college degree are in all studies significantly lower for the former foster care population than for the general population (Courtney et al., 2011; Naccarato et al., 2010; Pecora, Williams et al., 2006; Salazar, 2013; Villegas et al., 2014). The four-year college completion rates are even lower, (Pecora, Williams et al., 2006; Villegas et al., 2014). For all degrees, women's educational outcomes exceeded those of men participating in the study (Naccarato et al., 2010; Pecora, Williams et al., 2006; Villegas et al., 2014). As said in the beginning of this paragraph, especially the school completion rate is low. The Northwest Study indicated that 42,7% of the former foster children started an additional education after high school (Pecora, Kessler et al., 2006; Pecora, Williams et al., 2006; Villegas et al., 2014). However, only 9.6% of the former foster children were enrolled in school by the age of 25. Children who aged out of care were almost twice as likely to drop out of college during their first year of college as their peers from the general population (Day et al., 2011). Especially the four-year education seems to be a stumbling block (Courtney et al., 2011). Jones (2010) reported that none of the students, who attended a four-year study, lasted longer than two years. However, rather than giving up their studies, most of these students continued their education at two-year colleges or other training programs. Former foster children from ethnic minorities have worse odds (Villegas et al., 2014).

Foster youth are more likely to obtain a lower educational degree, often leading to lower employment rates (Dworsky & Courtney, 2009; Goerge et al., 2002; Hook & Courtney, 2011; Stewart et al., 2014), and not only is literature clear on the low employment rates of former foster children, it also paints a consistent picture of the unstable employment patterns and low incomes foster care alumni experience (Dworsky, 2005; Hook & Courtney, 2011; Stewart et al., 2014). The numbers of unemployment vary from 15% to 80% (Dworsky & Courtney, 2009; Goerge et al., 2002; Hook & Courtney, 2011; Martens, 2011; Macomber et al., 2008; Maliszewski & Brown, 2014; Stewart et al., 2014; Wade & Dixon, 2006). This high variation can be explained by the big age differences of the former foster children, questioned in the different studies (16–35 years). Furthermore, when we compare former foster children with national samples, the former foster children seem to stop their education at an earlier age than the youth from the general population. Therefore, the employment rates from the general population are biased. 3.2.1. Child protection systems Although it seems that foster children have difficulties finding a job after they leave care, giving them some time seems to be promising (Courtney et al., 2011; Hook & Courtney, 2011; Stewart et al., 2014)(Fig. 3). Dworsky (2005) found that 80% of the former foster children were employed at sometime within two years after exiting care. Singer (2006) confirms these results and found that 86% of the children

Fig. 2. College Degree, foster children compared to children from the general population.

78

L. Gypen et al. / Children and Youth Services Review 76 (2017) 74–83

Fig. 3. Employment rates among former foster children compared to children of the general population.

who left the foster care system reported earnings within three years after leaving care. When foster children were compared to youth coming from low-income families, the results remained disappointing (Maliszewski & Brown, 2014; Naccarato et al., 2010). Maliszewski and Brown (2014) found that the rate of employment of former foster care youth is 6 to 12% lower than low-income youth and 27 to 31% lower compared to the national comparison group. By the age of 30, the rate of employment of former foster care youth is still 15% lower than the low-income comparison group (Stewart et al., 2014). If we take a closer look at the role of ethnicity, different studies found racial and ethnic differences in employment outcomes (Courtney et al., 2011; Dworsky, 2005; Goerge et al., 2002; Hook & Courtney, 2011). Hook and Courtney (2011) found that African American men tend to look harder for work than other youth (39% versus 16%). African American women also seem to have more trouble finding a job, 43% is unemployed versus 20% of the White women. At the age of 24, African American youth are about half as likely to be employed as White youth. In the results of the Midwest Study we find that by the age of 24, only 36% of the African American men and 42% of the African American women were working, compared to nearly 60% of the non-African American Youth (Courtney et al., 2011). Dworsky (2005) indicates that African American and Latino former foster youth have lower employment rates than White foster youth. Findings related to gender regarding employment are less consistent. Multiple studies indicate that females are more likely to be employed than males (Courtney et al., 2011; Dworsky, 2005; Goerge et al., 2002). Dworsky (2005) found that in at least one of the first eight quarters after discharge, 85% of the females were employed, compared to 78% of the males. Stewart et al. (2014) found no significant differences between males and females concerning employment rate. Although that females are more likely to be employed, males seemed to be working more hours per week (Courtney et al., 2011) and had higher wages (Courtney et al., 2011; Goerge et al., 2002). All the previous findings are results from American researches. Studies in other continents suggest similar results although in different policy and labor market context. Youth aging out of care in the United Kingdom, Australia and Canada also experience poorer employment outcomes than their peers from the general population (Cashmore & Paxman, 2006; Wade & Dixon, 2006). 3.2.2. Family service systems Foster children who aged out of family service systems seem to have the same disadvantages as those who aged out of child protection

systems. In the study of Martens (2011) the unemployment rate of former foster children is significantly higher than the rate from the general population. However, 75% of the former foster children indicate that they are satisfied with their daily activities. In the study of Vernieuwe (2013), former foster children are more employed than their peers from the general population (who are mostly still studying at this age). 3.3. Annual earnings Former foster youth are less likely to be employed and earn substantially less than the general population as well in child protection systems as in family service systems (Dworsky & Courtney, 2009; Dworsky, 2005; Hook & Courtney, 2011; Macomber et al., 2008; Martens, 2011; Naccarato et al., 2010; Salazar, 2013) (Fig. 4). 3.3.1. Child protection systems In most studies, former foster children earn roughly half that of their peers in a general population. For the purpose of this study, all reported earnings were converted to yearly earnings. The annual earnings of former foster children varied between $5170 and $15,600 whereas the annual earnings of their peers varied between $14,148 and $18,300 (Dworsky, 2005; Naccarato et al., 2010; Okpych & Courtney, 2014; Stewart et al., 2014). The amount of $5170 is below the poverty level of the United States. According to the study of Hook and Courtney (2011), 56% of the foster alumni would be classified as poor at the age of 24. Even among those who are employed, 22% would still be classified as poor. These results are confirmed by the study of Zlotnick et al. (2012), former foster children significantly have higher odds to have an income below the poverty level. Although the starting wages are definitely lower than those in the general population, several studies indicate that the wages, hours and job tenure of former foster youth do increase over time (Dworsky, 2005; Hook & Courtney, 2011; Stewart et al., 2014). The annual earnings increased for all groups over time, but the earnings of former foster care youth remained below that of the low-income group and the national sample group, even by the age of 30 (Stewart et al., 2014). When comparing ethnicity, African Americans and Latinos often have poorer incomes, compared to White foster care alumni (Dworsky, 2005; Naccarato et al., 2010; Stewart et al., 2014). Even with all other variables held constant, they annually earn $7547.83 less (Naccarato et al., 2010). The study of Harris et al. (2009) specifically compared White youth with African American youth. In this study, more Whites (80%) had household incomes at or above the

Fig. 4. Annual earnings, foster children compared to general population.

L. Gypen et al. / Children and Youth Services Review 76 (2017) 74–83

poverty line than African Americans (67%). The findings about gender are less consistent. Courtney et al. (2011) found that men have higher earnings than women. These findings are consistent with the findings of Stewart et al. (2014), where females worked more than males, yet significantly earned less. The females in the sample of Dworsky (2005) on the other hand, earned significantly more than the males in the first two years after their discharge from foster care. This difference, however, disappeared when the not-working youth was excluded from the sample. Furthermore, several studies indicate that former foster children need more help from the government (Dworsky, 2005; Naccarato et al., 2010). In other words, they were discharged from state care, only to become dependent on the state again. Studies indicate that 17–33% of the former foster children depends on public assistance. Receipt of cash assistance was higher among females (27%) than among males (25%). This might be due to the fact that foster women are often young mothers (Dworsky, 2005; Naccarato et al., 2010). 3.3.2. Family service systems Regarding income, former foster children who aged out of family service systems seem to have the same disadvantages as those who aged out of child protection systems. Martens (2011) notes that most Belgian former foster children don't have any sort of income by the age of 23. Having a partner seems to be a high risk-factor. 32% of the former foster children living with a partner don't have any sort of income, compared to only 3% of the general population. Furthermore, former foster children more often experience troubles paying their monthly bills (Vernieuwe, 2013). The study of Vinnerljung and Hjern (2011) confirms the results of many studies in child protection systems. By the age of 25, 10,5% of the former foster boys and 7,2% of the former foster girls are dependent on social welfare (compared to approximately 1,2% and 0,8% of their peers in the general population).

79

reported they had been helped to look after their homes more efficiently (Wade & Dixon, 2006). Wade and Dixon (2006) note that young people are expected to have some mobility in their early housing careers. They may move to study or to find a job, to be closer to their families or to set up with a new partner. However, former foster children tend to move a lot in the first years after they age out of care. In the sample of Dworsky and Courtney (2009), a quarter of the never homeless people had moved at least three times within the last 14 months. In the study of Wade and Dixon (2006) over one-third of the foster care alumni indicates that they had to make two or more moves in the past year, almost one in five (18%) indicates having to move four or more times and over one-third (35%) indicates experiencing homelessness at some stage after leaving care. This percentage was significantly higher for young people with mental health, emotional or behavioral difficulties and for young people who had experienced a number of problems in their lives. Furthermore, this high rate of moving around also has big consequences on educational outcomes. 3.4.2. Family service systems Housing arrangements and circumstances differed between countries. In Spain and Hungary, a high proportion of young people were living in extended residential care. In Denmark and Sweden, they were mostly living independently, either alone or with partners (Jackson & Cameron, 2012). The satisfaction however, is mostly promising. In the study of Martens (2011), 85% of the sample indicates that they are satisfied with their current home. Nevertheless, they are significantly less satisfied than their peers form the general population. Vernieuwe (2013) indicates that former foster children from residential settings experience more housing difficulties than former family foster children. 3.5. Mental health outcomes

3.4. Housing Numerous studies, as well in child protection systems as in family service systems, have shown that former foster children are often homeless for a brief time after they emancipate from the foster care system (Dworsky & Courtney, 2009; Stewart et al., 2014; Wade & Dixon, 2006; Zlotnick et al., 2012). The numbers vary between 11 and 35% (Dworsky, 2005; Martens, 2011; Wade & Dixon, 2006). However, although many foster care alumni face homelessness at least once after they are discharged from care, most of the former foster care youth live in good housing circumstances (Martens, 2011; Wade & Dixon, 2006). 3.4.1. Child protection systems The study of Dworsky (2005) found that at the age of nineteen, nearly one-third (28%) lives in their own place, 17% lives in the home of a relative, 16% lives in the home of a parent, 12% lives in the home of another person, 9% lives with a foster parent and 0.3% is homeless at the time of the interview. Fourteen percent of this sample indicates being homeless at some point after exiting care and 54% of those who had been homeless, had been homeless more than once. Twenty-one percent of the youth who experienced homelessness had been homeless for more than a month. In the study of Wade and Dixon (2006) over one-third (35%) of the sample indicates experiencing homelessness at some stage after leaving care. At the time of the interview, nearly one-third of the sample (31%) were living in independent housing, almost twofifths (38%) were living in a supported accommodation, 14% were living with a family member, 6% continued to live with a foster parent and a further 12% were living in ‘other’ settings. Although many former foster children face homelessness and only have limited possibilities, over half (56%) of the foster care alumni were considered to have good housing outcomes and almost one-third (31%) had a fair housing outcome. Furthermore, almost all (93%) of the young people received support in this area since leaving care, 86% received help finding a home and 64%

Findings indicate that foster care alumni, as well from child protection systems as from family service systems, have more mental health problems than children from the general population (Geetrui, 2013; Martens, 2011; Vinnerljung & Hjern, 2011; Zlotnick et al., 2012). Furthermore, foster children are more likely to have their mental health problems interfering with their daily functioning (Vinnerljung & Hjern, 2011; Zlotnick et al., 2012). 3.5.1. Child protection systems Many studies indicate that former foster children suffer from physical and mental health challenges due to a highly permanent past of neglect and/or abuse (Pecora et al., 2009; Stewart et al., 2014; Villegas & Pecora, 2012; White, Brien et al., 2008). After their exit from foster care 12 to 25% of the foster care alumni report emotional problems deriving from early histories of abuse and neglect (Harris et al., 2009). The prevalence of psychiatric disorders varies between 33 and 45% (Courtney et al., 2007; Villegas & Pecora, 2012). The rates of a lifetime diagnosis are even higher, 62–63% of the foster care alumni qualify for at least one psychiatric disorder (Villegas & Pecora, 2012). The highest rates were found in disruptive disorders, depression, social phobia and ADHD (Courtney et al., 2007; Okpych & Courtney, 2014; Villegas & Pecora, 2012). Depression and PTSD are more prevalent for women, while substance abuse is more prevalent for men (Courtney et al., 2007). Pecora (2012) also indicates that former foster children more often report symptoms of conduct disorder. However, not all results are negative. Naccarato et al. (2010) indicate that the majority of former foster youth were identified as not having a mental health diagnosis (91%). Only 4.4% of the males and 13.7% of the females reported a mental health diagnosis in this study. The findings regarding mental health outcomes and gender are very consistent. Women show poorer mental outcomes than men (Villegas & Pecora, 2012). When comparing mental health outcomes by ethnicity, no significant results were found (Harris et al., 2010; Villegas & Pecora, 2012).

80

L. Gypen et al. / Children and Youth Services Review 76 (2017) 74–83

3.5.2. Family service systems Former foster care children from family service systems, have more mental health issues than children from the general population (Geetrui, 2013; Martens, 2011; Vinnerljung & Hjern, 2011). Furthermore, foster children are more likely to have their mental health problems interfering with their daily functioning (Martens, 2011; Vinnerljung & Hjern, 2011). Vinnerljung and Hjern (2011), indicate that former foster children have a higher chance for developing a depression. Martens (2011) confirms these results, former foster children are more often diagnosed with depression (28%) than their peers from the general population (4%), this difference is significant. However, 85% of the former foster children in this study indicate being in good mental and physical health. The results from Vernieuwe (2013) are even clearer, 36% of the former foster children indicate they were diagnosed with depression during the last 12 months, compared to only 4% from the general population. Concerning gender or ethnicity no results were found. 3.6. Substance abuse Substance abuse is unfortunately highly prevalent among youth in foster care and foster care alumni, the numbers are significantly higher than in the general population, as well for smoking, the use of cannabis as the use of hard drugs (Maliszewski & Brown, 2014; Martens, 2011; Singer, 2006; von Borczyskowski et al., 2013; White, Brien et al., 2008). 3.6.1. Child protection systems Concerning alcohol abuse, the numbers vary between 40 and 49% in the foster care alumni population compared to 30 to 33% in the general population (White, Brien et al., 2008). The alcohol dependence rates are lower, they vary from 2.7 to 12.9% in the alumni population compared to 1.8 to 7.1% in the general population (Courtney et al., 2007; Okpych & Courtney, 2014; White, Brien et al., 2008). The numbers of using drugs vary from 12.2 to 26.4% for foster care alumni and from 4.5 to 6.4% for the general population (Okpych & Courtney, 2014; White, Brien et al., 2008). The rates of substance dependency vary between 2.3 and 21% for former foster children compared to 1.4 to 4.5% in the general population (Courtney et al., 2007; White, Brien et al., 2008). Studies indicate that the numbers of substance and alcohol abuse increase by age. The Midwest study found that the lifetime rates at the age of 17 of dependence were 2.7% for alcohol and 2.3% for substance dependence. Two years later the lifetime rates of dependence were 4.3% for alcohol and 3.2% for substance dependence (Courtney et al., 2007). Concerning gender, males are up to 3 times more likely to abuse substances (Maliszewski & Brown, 2014). Concerning ethnicity only one study made conclusions, Hispanic youth reported less substance abuse than White youth, and the researchers indicated that this is because of different parenting strategies (Maliszewski & Brown, 2014). 3.6.2. Family service systems Former foster care children from family service systems, do not drink more than youth from the general population. However, the smoke significantly more (39% compare to 20% of youth in the general population) and tend to use more cannabis (16% compared to 6.5%) (Martens, 2011). In the study von Borczyskowski et al. (2013) more than 26% of the former foster boys had at least one indication of substance abuse. Almost double of the rate compared to adopted boys and almost four times the rate of the general population. Concerning gender, males are up to 3 times more likely to abuse substances than females (von Borczyskowski et al., 2013). 3.7. Criminality Research indicates that former foster youth is more often involved in criminality than their peers from the general population, as well in

family service systems as in child protection systems (Courtney et al., 2010; Lindquist & Santavirta, 2014; Singer, 2006). Males are in all studies more likely to be convicted than females (Hook & Courtney, 2011; Lindquist & Santavirta, 2014). 3.7.1. Child protection systems By the age of 24, 20–60% of the foster alumni had at least one criminal conviction (Hook & Courtney, 2011; Courtney et al., 2010). Seven percent of the Midwest study participants were incarcerated at the time of interview (Hook & Courtney, 2011). In the study of Singer (2006), 37.2% of the sample was arrested for a felony within three years of leaving foster care. Concerning gender, the results are clear, males are more likely to have a criminal conviction than females (Hook & Courtney, 2011). In the Midwest study, 60% of the male foster alumni had at least one criminal conviction by the age of 24. In the female group this percentage was 30% (Hook & Courtney, 2011). Maliszewski and Brown (2014) noted that children who spent more time with (extended) relatives show less criminal behavior than children in nonrelative foster care. 3.7.2. Family service systems Lindquist and Santavirta (2014) found that the reason of placement is associated with the later crime rates. Boys who were placed in foster care due to their own anti-social behavior are 22% more likely to commit crime during adulthood than their peers from the general population with the same background. Boys who were placed due to parental behavior had 20% less chance to show criminal behavior than their peers with the same background who haven't been placed in the foster care system. Concerning gender, also in family service systems, the results are clear, males are more likely to have a criminal conviction than females (Lindquist & Santavirta, 2014). 4. Discussion Our findings regarding the outcomes of former foster youth are sobering. Overall, former foster youth, as well from family service systems as from child protection systems, have several disadvantages compared to their peers from the general population. They have poorer educational outcomes (Courtney, Piliavin, & Grogan, 2001; Harris et al., 2010; Jones, 2010; Naccarato et al., 2010; Pecora, Williams et al., 2006; Villegas et al., 2014), lower chances in the labor market (Harris et al., 2009; Hook & Courtney, 2011; Naccarato et al., 2010; Okpych & Courtney, 2014), lower annual earnings (Naccarato et al., 2010; Okpych & Courtney, 2014; Pecora, 2012) and they more often face homelessness (Dworsky & Courtney, 2009; Nicoletti, 2007; Stewart et al., 2014; Wade & Dixon, 2006; Zlotnick et al., 2012) and more mental health problems (Kessler et al., 2008; Okpych & Courtney, 2014; Stewart et al., 2014; Villegas & Pecora, 2012; White, O'Brien et al., 2008). Furthermore they seem to have higher odds to abuse alcohol and/or substances (Maliszewski & Brown, 2014; von Borczyskowski et al., 2013; White, Brien et al., 2008) and to be in contact with justice departments (Lindquist & Santavirta, 2014). In several studies, former foster children were compared with children from low-income families. The results remained disappointing, as well former foster children as children from low-income families seem to experience more difficulties compared to their peers from the general population. However, the results of the former foster children always remained below the results of the children coming from low-income families (Maliszewski & Brown, 2014; Naccarato et al., 2010; Stewart et al., 2014; Urban Institute, 2008). The same results derive from a study comparing children in foster care with adoptees. The results of adoptees and children in foster care are poorer than the results of peers, however, children who stayed in foster care seem to have more disadvantages compared to adopted children (Vinnerljung & Hjern, 2011). However, former foster children seem to indicate that they are fairly satisfied with their education, housing experience and mental health (Martens, 2011). We found no

L. Gypen et al. / Children and Youth Services Review 76 (2017) 74–83

significant differences between children coming from family service systems than for children coming from child protection systems. The reasons for foster children's lower outcomes are mostly consistent. An often returning explanation is the lack of stability foster children experience during their period in care (Salazar, 2013; Villegas et al., 2014; Wade & Dixon, 2006). Frequent changes in family or group placement, frequent school changes and often moving are named as a negative predictor of success. And although mobility may be expected in young people, foster care alumni show higher mobility than the general population (Wade & Dixon, 2006). Furthermore, we must keep in mind that not only the history of foster care placement plays an important role in the negative outcomes, these children often have a large history of neglect and abuse and tend to have emotional problems, even before they were placed in the foster care system. In addition, they often grew up in low-socioeconomic circumstances (Zlotnick et al., 2012). All these problems are known to predispose them to poorer outcomes (Lindquist & Santavirta, 2014). However, although many studies suggest that the reason of their lower outcomes may be their history of abuse and neglect (Hook & Courtney, 2011; Pecora, Kessler et al., 2006; Villegas et al., 2014; White, Brien et al., 2008) we must be careful attributing poor educational outcomes, lower income and low employment rates to childhood experiences of foster care alumni. Mental health issues, behavioral challenges, genetic factors and other individual factors also contribute to the difficulties they experience (Pecora, 2012). Furthermore, once these young adults leave the foster care system, they depend fully on themselves (Harris et al., 2009; Naccarato et al., 2010; Pecora, Kessler et al., 2006). Since they have many responsibilities and only limited social support they often obtain lower outcomes than peers (Courtney et al., 2011; Naccarato et al., 2010; Pecora, Williams et al., 2006; Wade & Dixon, 2006). Their higher amount of stress during the period they age out of care, may be a possible explanation for the poorer mental health outcomes for foster care alumni experience (Pecora et al., 2009; Dworsky & Courtney, 2009). They face a period of financial instability and have fewer sources to rely on as well emotionally, as financially. Furthermore, they often have limited education, which leads them to a lower chance at work and lower earnings. They often don't have the needed coping skills to handle this stressful period, which might lead them to mental health problems or substance abuse. Addictions among foster care alumni are lifetime problems, persisting into young adulthood. These dependencies may be a way to cope with maltreatment and other mental health disorders these youngsters experience. There is a consistent finding about gender, former foster men use significantly more drugs and alcohol than former foster females (Maliszewski & Brown, 2014). White, O'Brien et al. (2008) found that a greater foster family nurturing and other supports reduced maladaptive behavior rates. Optimizing foster care experiences, starting with decreasing family bounding and helping foster families to support their foster children may have a significant effect on the substance use behaviors of foster care alumni. Combined, the higher rates of substance abuse and mental health disorders may contribute to poor educational and employment outcomes of foster alumni (White, Brien et al., 2008). Due to their history of abuse and neglect, their lack of stability during their stay in care and their high responsibilities once they live independently, foster children often have lower educational outcomes. These lower outcomes predispose them for poorer general results. The level of education has large consequences and plays an important role in employment rates and yearly earnings (Okpych & Courtney, 2014; Pecora, 2012). When former foster youth had a college degree, their yearly earnings were almost 50% higher than those who only had a high school degree. Furthermore, researchers indicate that a higher level of education is significantly correlated with better health, higher job satisfaction, lower rates of reliance on public welfare programs, increased earning power, increased empowerment, lower smoking and incarceration rates, higher personal and professional mobility, higher self-reports of health quality, increased volunteerism and voting, increased

81

participation in leisure activities and more stability in life (Salazar, 2013). This vicious circle is a very determining reason why foster children don't succeed to accomplish the same results as children from the general population. These findings highlight the extreme vulnerability of this population, especially during periods of economic downturn (Okpych & Courtney, 2014). The earnings of foster youth are not enough to raise them out of poverty. This calls for renewed efforts to improve employment outcomes and equal wages. To boost the wages of former foster youth, the government should invest in special training and studying programs for these young adult, because higher wages are mostly associated with more years of schooling (Naccarato et al., 2010). 4.1. Implications for the out-of-home-care organization One of the main findings of this study is the low educational outcome of foster care alumni. Nearly all researchers found that former foster youth had lower educational attainments than peers from the general population. However, well-educated youth are needed for economic stability and development of a nation but also for the social stability of the families living in this society (Villegas et al., 2014). A promising strategy to help foster children obtaining a job and earning an average annual wage, would be helping them navigate through the education system with a focus on attending college (Naccarato et al., 2010). Efforts are needed to improve the educational attainment. Foster children need a steady school carrier, since changing schools, teachers and peers has a negative effect on the school career. Furthermore, foster students should receive extra support, financially and socially. They need help to get their school registrations in order, to arrange scholarships, to schedule tasks and to study efficiently. In regular families, this is the help parents provide for their child. Foster children however, can't rely on anyone for this matter. It should be considered that each care leaver is provided with a volunteer (buddy) supporting the former foster child, and help him or her navigate through the educational system and other difficulties they face when aging out of care. Another conclusion is the lack of stability in housing and/or social environment. Placement changes should be avoided. Each move equals losing friends and a safe, known environment. Former foster youth tend to move a lot in the first years after they age out of care, which has negative influences on educational and employment outcomes. Since many alumni experience homelessness, it is important to provide housing assistance to foster youth after leaving care (Dworsky & Courtney, 2009). Furthermore, former foster youth need more assistance into adulthood. The findings suggest that foster alumni continue to struggle on multiple areas even up to age 30. Research shows that non-foster youth continue receiving social and financial support from their family up to their late twenties. Foster care agencies should provide longer social and financial assistance. Foster children need a steady social support figure who helps them in taking right decisions and supports the child when needed. Furthermore, social services need to prepare foster children even more for leaving care. Although many programs already exist, none of them proves to be effective. This calls for more attention to developing better independent programs and employment services for foster youth. As the model of Bronfenbrenner states, all factors influence each other mutually. Not having a degree, not being employed, living in bad circumstances or even being homeless, having an alcohol or drug addiction, having mental health problems, being in contact with justice, all these factors strengthen each other. To help foster children to a brighter future, support strategies should be adapted. The foster care agencies have to collaborate with schools in order to improve the educational attainment, with governments to create jobs or facilitate job opportunities, with mental health services to provide therapy if needed, and many other agencies. Foster care organizations have to overcome any gap between the challenges foster children are confronted with, at least someone has to. In short, experiencing permanency during care and establishing a foothold in education or employment are ingredients

82

L. Gypen et al. / Children and Youth Services Review 76 (2017) 74–83

for a successful transition to adulthood. These factors should be combined with a mentor who supports the child taking decisions and with other challenges. 4.2. Limitations This study has some limitations. The organization of youth welfare is different in every country and all countries have different policies, for example, studying in the US is more expensive than in Belgium, the Netherlands or Sweden. Furthermore, the criminal justice department works different in each country. This might have influenced the results, however, all results remained low, unrelated to the policies of the country. Secondly, foster care is a container concept that not only includes family foster care and non-relative foster care but also institutions and group homes. Therefore, is difficult to compare outcomes. Most studies use different including criteria, measurements and follow-up periods. The used studies compared outcomes of alumni with outcomes of their peers from the general population who faced similar historic and economic conditions. Nevertheless, foster care children are often associated with a large number of baseline risks, which makes a comparison with peers from the general population invalid. For researchers it is hard to find a representative comparison group. Only few studies were able to find a group who was, at baseline, equally likely to be removed from their family, but were not actually removed. Another limitation is that given the complexities of life, the cause of some events is not always clear. A variety of experiences between youth and later adulthood happen, these experiences might disguise the effects of earlier events. Last but not least, small sample sizes have been the norm in this kind of research, this may raise questions about the validity and generalizability of the results of foster care evaluation studies. Some findings are important to keep in mind for further research. 4.3. Future research We found many negative outcomes, a future research topic might be the care that was provided. Is this care offered evidence based, or resulting from continuing the care we already provide for years? Foster care outcomes varied by the age the child enters the foster care system, the duration of the foster care, the number of placements, the quality of each placement and the characteristics of the child (Zlotnick et al., 2012). Only few studies have examined the link between the demographics of the placement and the outcomes on long term. Furthermore, foster parents and siblings play an important role in the outcome of foster care, especially on the outcome of substance abuse (Maliszewski & Brown, 2014). It might be interesting to examine the role of siblings on other outcomes. This might not only give a more accurate explanation of outcomes, but also be an important future implication for the foster care system. If treatment providers had the ability to optimize youth's experience of positive sibling role models, this could lead to better foster care outcomes. Further research should also consider using self-esteem, resilience scales and family-support to predict or explain outcomes. References von Borczyskowski, A., Vinnerljung, B., & Hjern, A. (2013). Alcohol and drug abuse among young adults who grew up in substitute care — Findings from a Swedish national cohort study. Children and Youth Services Review, 35(12), 1954–1961. http://dx.doi.org/ 10.1016/j.childyouth.2013.09.024. Bronfenbrenner, U. (1977). Toward an experimental ecology of human development. American Psychologist, 4, 513–531. Cashmore, J., & Paxman, M. (2006). Predicting after-care outcomes: The importance of “felt” security. Child & Family Social Work, 11, 232–241. Child Welfare Information Gateway (2013). Foster care statistics, 2012. Courtney, M. E., Dworsky, A. L., & Perez, A. (2007). Midwest evaluation of the adult functioning of former foster youth: Outcomes at age 21. Social Work. Courtney, M. E., Dworsky, A., Brown, A., Cary, C., Love, K., & Vorhies, V. (2011). Midwest evaluation of the adult functioning of former foster youth: Outcomes at age 21. Chicago,

IL: Chapin Hall Center for Children at the University of Chicago Retrieved from http:// pdxscholar.library.pdx.edu/socwork_fac/60/ Day, A., Dworsky, A., Fogarty, K., & Damashek, A. (2011). An examination of post-secondary retention and graduation among foster care youth enrolled in a four-year university. Children and Youth Services Review, 33, 2335–2341. http://dx.doi.org/10.1016/j. childyouth.2011.08.004. Devooght, K., & Cooper, H. (2012). Child Welfare in the United States. State Policy Advocacy and Reform Center. http://dx.doi.org/10.1016/S0140-6736(00)93677-8. Dworsky, A. (2005). The economic self-sufficiency of Wisconsin's former foster youth. Children and Youth Services Review, 27, 1085–1118. http://dx.doi.org/10.1016/j. childyouth.2004.12.032. Dworsky, A., & Courtney, M. E. (2009). Homelessness and the transition from foster care to adulthood. Child Welfare, 88(4), 23–57. Gilbert, N., Parton, N., & Skivenes, M. (2011). Child protection systems: International trends and emerging orientations. New York, NY: Oxford University Press. Goerge, R. M., Bilaver, L., Lee, B. J., Needell, B., Brookhart, A., & Jackman, W. (2002). Employment outcomes for youth aging out of foster care. Harris, M. S., Jackson, L. J., O'Brien, K., & Pecora, P. J. (2009). Disproportionality in education and employment outcomes of adult foster care alumni. Children and Youth Services Review, 31(11), 1150–1159. http://dx.doi.org/10.1016/j.childyouth.2009.08.002. Harris, M. S., Jackson, L. J., O'Brien, K., & Pecora, P. (2010). Ethnic group comparisons in mental health outcomes of adult alumni of foster care. Children and Youth Services Review, 32(2), 171–177. http://dx.doi.org/10.1016/j.childyouth.2009.08.010. Hines, A. M., Merdinger, J., & Wyatt, P. (2005). Former foster youth attending college: Resilience and the transition to young adulthood. The American Journal of Orthopsychiatry, 75(3), 381–394. http://dx.doi.org/10.1037/0002-9432.75.3.381. Hook, J. L., & Courtney, M. E. (2011). Employment outcomes of former foster youth as young adults: The importance of human, personal, and social capital. Children and Youth Services Review, 33(10), 1855–1865. http://dx.doi.org/10.1016/j.childyouth. 2011.05.004. Jackson, S., & Cameron, C. (2012). Leaving care: Looking ahead and aiming higher. Children and Youth Services Review, 34(6), 1107–1114. http://dx.doi.org/10.1016/j. childyouth.2012.01.041. Jones, L. P. (2010). The educational experiences of former Foster youth after discharge. Child Welfare, 89(6), 7–23. Kessler, R. C., Pecora, P. J., Williams, J., Hiripi, E., O'Brien, K., English, D., ... Sampson, N. A. (2008). Effects of enhanced foster care on the long-term physical and mental health of foster care alumni. Archives of General Psychiatry, 65, 625–633. http://dx.doi.org/10. 1001/archpsyc.65.6.625. Lindquist, M. J., & Santavirta, T. (2014). Does placing children in foster care increase their adult criminality? Labour Economics, 31, 72–83. http://dx.doi.org/10.1016/j.labeco. 2014.10.001. Macomber, J. E., Duncan, D., Kuehn, D., Mc Daniel, M., Vericker, T., et al. (2008). Coming of age: Employment outcomes for foster youth who age out of foster care trough their middle twenties. Washington, DC: The Urban Institute. Maliszewski, G., & Brown, C. (2014). Familism, substance abuse, and sexual risk among foster care alumni. Children and Youth Services Review, 36, 206–212. http://dx.doi. org/10.1016/j.childyouth.2013.11.021. Martens, K. (2011). Vergelijking van volwassen pleegzorgalumni met leeftijdsgenoten uit een algemene populatie inzake gezondheid, opleiding, werk, huisvesting en sociale contacten. (Unpublished thesis). Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & The PRISMA Group (2009). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Medicine, 6(7), e1000097. http://dx.doi.org/10.1371/journal.pmed.1000097. Naccarato, T., Brophy, M., & Courtney, M. E. (2010). Employment outcomes of foster youth: The results from the Midwest Evaluation of the Adult Functioning of Foster Youth. Children and Youth Services Review, 32(4), 551–559. http://dx.doi.org/10. 1016/j.childyouth.2009.11.009. Nicoletti, A. (2007). Aging out of foster care. Journal of Pediatric and Adolescent Gynecology, 20(3), 205–206. http://dx.doi.org/10.1016/j.jpag.2007.03.090. Okpych, N. J., & Courtney, M. E. (2014). Does education pay for youth formerly in foster care? Comparison of employment outcomes with a national sample. Children and Youth Services Review, 43, 18–28. http://dx.doi.org/10.1016/j.childyouth.2014.04.013. Pecora, P. J. (2012). Maximizing educational achievement of youth in foster care and alumni: Factors associated with success. Children and Youth Services Review, 34(6), 1121–1129. http://dx.doi.org/10.1016/j.childyouth.2012.01.044. Pecora, P. J., Kessler, R. C., O'Brien, K., White, C. R., Williams, J., Hiripi, E., ... Herrick, M. A. (2006). Educational and employment outcomes of adults formerly placed in foster care: Results from the Northwest Foster Care Alumni Study. Children and Youth Services Review, 28, 1459–1481. http://dx.doi.org/10.1016/j.childyouth. 2006.04.003. Pecora, P. J., Williams, J., Kessler, R. C., Hiripi, E., O'Brien, K., Emerson, J., ... Torres, D. (2006). Assessing the educational achievements of adults who were formerly placed in family foster care. Child & Family Social Work, 11(3), 220–231. http://dx.doi.org/10.1111/ j.1365-2206.2006.00429.x. Pecora, P. J., White, C. R., Jackson, L. J., & Wiggins, T. (2009). Mental health of current and former recipients of foster care: A review of recent studies in the USA. Child & Family Social Work, 14(2), 132–146. http://dx.doi.org/10.1111/j.1365-2206.2009.00618.x. Reilly, T. (2003). Transition from care: Status and outcomes of youth who age out of foster care. Child Welfare League of America, 727–747 (LXXXII(6)). Salazar, A. M. (2013). the value of a college degree for foster care alumni: Comparisons with ceneral population samples. Social Work, 58(2), 139–151. http://dx.doi.org/10. 1093/sw/svvt014. Scannapieco, M., Connell-Carrick, K., & Painter, K. (2007). In their own words: Challenges facing youth aging out of foster care. Child and Adolescent Social Work Journal, 24(5), 423–435. http://dx.doi.org/10.1007/s10560-007-0093-x.

L. Gypen et al. / Children and Youth Services Review 76 (2017) 74–83 Singer, A. (2006). Assessing outcomes of youth transitioning from foster care. State of Utah: Department of Human Services. Stewart, C. J., Kum, H. C., Barth, R. P., & Duncan, D. F. (2014). Former foster youth: Employment outcomes up to age 30. Children and Youth Services Review, 36, 220–229. http:// dx.doi.org/10.1016/j.childyouth.2013.11.024. U.S. department of Health and Human Services, Administration for Children and Families, Administration on Children, Youth, and Families, C. B. (2013). The AFCARS report. Urban Institute (2008). Coming of age: Employment outcomes for youth who age out of foster care through their middle twenties. Retrieved from http://www.urban.org/ uploadedPDF/1001174_employment_outcomes.pdf Vernieuwe, G. (2013). Toekomstperspectieven van jongeren die begeleidingstehuizen ontgroeien. (Unpublished thesis). Villegas, S., & Pecora, P. J. (2012). Mental health outcomes for adults in family foster care as children: An analysis by ethnicity. Children and Youth Services Review, 34(8), 1448–1458. http://dx.doi.org/10.1016/j.childyouth.2012.03.023. Villegas, S., Rosenthal, J. a., O'Brien, K., & Pecora, P. (2011). Health outcomes for adults in family foster care as children: An analysis by ethnicity. Children and Youth Services Review, 33(1), 110–117. http://dx.doi.org/10.1016/j.childyouth.2010.08.020. Villegas, S., Rosenthal, J., O'Brien, K., & Pecora, P. J. (2014). Educational outcomes for adults formerly in foster care: The role of ethnicity. Children and Youth Services Review, 36, 42–52. http://dx.doi.org/10.1016/j.childyouth.2013.11.005.

83

Vinnerljung, B., & Hjern, A. (2011). Cognitive, educational and self-support outcomes of long-term foster care versus adoption. A Swedish national cohort study. Children and Youth Services Review, 33(10), 1902–1910. http://dx.doi.org/10.1016/j. childyouth.2011.05.016. Wade, J., & Dixon, J. (2006). Making a home, finding a job: Investigating early housing and employment outcomes for young people leaving care correspondence. Child & Family Social Work, 11, 199–208. White, C., Brien, K., White, J., Pecora, P. J., & Phillips, C. (2008a). Alcohol and drug use among alumni of foster care: Decreasing dependency through improvement of foster care experiences. Journal of Behavioral Health Services and Research, 35(4), 419–434. White, C. R., O'Brien, K., Pecora, P. J., English, D., Williams, J. R., & Phillips, C. M. (2008b). Depression among alumni of foster care: Decreasing rates through improvement of experiences in care. Journal of Emotional and Behavioral Disorders. http://dx.doi.org/ 10.1177/1063426608320356. Zlotnick, C., Tam, T. W., & Soman, L. A. (2012). Life course outcomes on mental and physical health: The impact of foster care on adulthood. American Journal of Public Health, 102(3), 534–540. http://dx.doi.org/10.2105/AJPH.2011.300285.