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Transition to adulthood for youth with disabilities who experienced foster care: An ecological approach
Child Abuse & Neglect 99 (2020) 104310
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Child Abuse & Neglect journal homepage: www.elsevier.com/locate/chiabuneg
Research article
Transition to adulthood for youth with disabilities who experienced foster care: An ecological approach
T
Robin Marie Harwicka,*, Deanne Unruhb, Lauren Lindstromc a b c
University of Washington, Alcohol and Drug Abuse Institute, 1107 NE 45th St Ste. 120, Seattle, WA, 98105, United States University of Oregon, 212 Clinical Services Bldg. 5260, Eugene, OR, 97403, United States University of California Davis, One Shields Ave., Davis, CA, 95616, United States
A R T IC LE I N F O
ABS TRA CT
Keywords: Foster care Transition Disability Child welfare Adolescent development Mental health
Background: Almost 21,000 youth, in the U.S., leave foster care due to "emancipation" each year. Although not well documented for this age group, nearly half of children/youth in foster care receive a disability diagnosis. There is a growing body of literature about the transition to adulthood for youth with disabilities. However, minimal research exists on the transition experiences of youth in foster care who also have a disability. This study intends to help fill this gap in the literature. Objective: The purpose of the study was to uncover challenges during the transition to adulthood for youth with disabilities who experienced foster care and elucidate the supports most beneficial in addressing these challenges. Participants and setting: All participants reside in the United States pacific northwest. Seven foster care alumni aged 19–23 and five professionals serving the target population participated in the study. Methods: We conducted semi-structured interviews with YDFC and a focus group with professionals to understand the process of the transition to adulthood for YDFC. Our findings generated an ecological model useful for transition planning prior to the youth leaving foster care. Within our model we focus on alterable factors to bring intervention points to light. Results: Barriers uncovered included lack of consistent high school graduation requirements, high quality Independent Living Programs, positive relationships and highly skilled professionals; frequent placement changes; and inappropriate disability or mental health diagnosis. Conclusions: Recommendations include systems improvements; improved intra- and interagency collaboration; and helping youth build and maintain positive relationships.
1. Introduction In the United States, there are approximately 65,000 youth (16–25 years old) in foster care (Department of Health and Human Services, 2016) – whether they have a documented disability is not adequately tracked. However, approximately 40–47% of total children/youth in foster care have documented disabilities (Powers et al., 2012). For youth with disabilities, the transition into adult roles, for example post-secondary education or employment, is frequently challenging (Trainor, Lindstrom, Simon-Burroughs, Martin, & Sorrells, 2008). When disability and foster care intersect the challenges faced during the transition to adulthood are multiplied. Youth who experience disability and foster care (YDFC) experience lower educational achievement and are at greater risk of poor ⁎
Corresponding author. E-mail address: [email protected] (R.M. Harwick).
https://doi.org/10.1016/j.chiabu.2019.104310 Received 27 November 2018; Received in revised form 19 November 2019; Accepted 1 December 2019 Available online 12 December 2019 0145-2134/ © 2019 Published by Elsevier Ltd.
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adult outcomes than youth in foster care who do not have disabilities or receive special education services (Quest, Fullerton, Geenen, Powers, & The Research Consortium to Increase the Success of Youth in Foster Care, 2012). YDFC must navigate both the child welfare and special education systems. However, the agencies involved often fail to communicate adequately, leading to inappropriate educational placements, delayed school enrollment, and Individual Education Programs (IEPs) that are lost or not implemented (Harwick, Lindstrom & Unruh, 2017; Geenen & Powers, 2006; Pecora, 2012). Barriers to services and instability of placements are exacerbated for YDFC compared to youth in care without disabilities (Geenen & Powers, 2007). A recent study reported an increased number of placements had a negative relationship with education, employability, employment, financial literacy, and adequate housing for YDFC (Scannapieco, Smith, & Blakeney-Strong, 2016). Also of concern, professionals and foster parents report that Independent Living Programs (ILPs) designed to assist youth in foster care in preparing for adulthood are often inaccessible or inappropriate for youth with disabilities – lacking the ability to make appropriate accommodations (Geenen & Powers, 2007). Furthermore, Collins’ (2004) analysis of the Foster Care Independence Act (P.L. 106–109) suggests that the legislation does not address the reality that youth with disabilities or mental health issues might require permanent access to supports. Consistent relationships with caring adults are critical to improving outcomes for YDFC (Harwick, Tyre, Beisse, & Thomas, 2015; Geenen & Powers, 2007). However, foster parents might not be knowledgeable about disability and may have difficulty managing a youth’s behavior and social needs, contributing to placement changes (Harwick et al., 2015; Geenen & Powers, 2007). These placement changes often cause school changes, resulting in abruptly terminated relationships with teachers. Additionally, YDFC often have limited contact with their biological parents. Requirements for visitation vary by state – while generally recommended, visits are often intermittent (Leathers & Testa, 2006; McWey, Acock, & Porter, 2010; McWey & Mullis, 2004). Therefore, maintaining consistent, caring relationships is challenging for YDFC. Almost 21,000 youth leave foster care due to “emancipation” each year (U.S. Department of Health and Human Services, 2016). Although there is a growing body of literature about the transition to adulthood for youth with disabilities, there is a minimal research on the transition experiences of youth in foster care who also have a disability (Geenen & Powers, 2007). Our study intended to help fill this gap in research. Our purpose was to uncover challenges during the transition to adulthood for YDFC and elucidate the supports most beneficial in addressing these challenges. We interviewed YDFC to understand from their perspective their transition process. To obtain a different perspective, we also held a focus group with professionals working with YDFC. 2. Methods We used a qualitative approach informed by grounded theory (Strauss & Corbin, 1998). An a priori literature review was conducted to understand the existing literature about the transition to adulthood and to guide protocol development. Study procedures were approved by an institutional review board. There was no external funding for this project. 2.1. Participants Purposeful sampling was used to identify alumni of foster care and professional potential participants. Professionals working with YDFC referred those they perceived made a “successful transition.” Success was left open to the interpretation by the professional, however, if asked for clarification we gave examples such as YDFC who completed one year of post-secondary education or one consecutive year of employment. These are frequently considered positive post-school outcomes. Additional criteria included YDFC who (a) received special education or identified as having a disability, (b) graduated from high school or received a GED, (c) were in foster care for more than 6 months during high school, and (d) were between the ages of 18 and 24. Seven foster care alumni aged 19–23 were interviewed; five self-identified as female and two as male; two participants selfidentified as African American, three as Native American and Caucasian, and two as Caucasian. Length of time in foster care was between 4 and 19 years. Interview participants’ self- reported demographics, disability, and employment/educational status at the time of the interviews are detailed in Table 1. Additionally, five professionals (aged 27–63) participated in a focus group. Focus group participants worked for community-based organizations or in higher education and had served youth in foster care from 2.5 to more than 14 years. Three identified as Table 1 Self-Reported Demographic Characteristics of Participants. Participant
Gender
Ethnicity
Age
Years in foster care
Disability
Diploma/GED
Mona Tammi Manny Sandra Matt DD Rex
F F F F M F M
African American African American Native/Caucasian Native/Caucasian Caucasian Native/Caucasian Caucasian
21 22 19 19 19 22 23
16 N/D 4 4 4 19 11
SLD/ED Epilepsy/ADHD PTSD SLD SLD, Depression MH ADHD/ BP
Diploma Diploma GED N/A Diploma Diploma Diploma
Notes. Attention Deficit and Hyperactivity Disorder (ADHD), Emotional Disturbance (ED), Mental Health (MH), Specific Learning Disability (SLD), Post-Traumatic Stress Disorder (PTSD), Bipolar Disorder (BP), Not disclosed (N/D). 2
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professionals, one as a paraprofessional, and one as an expert in working with this population. Three self-identified as male and two as female. 2.2. Study procedures Prior to the interviews with each of the seven YDFC and the focus group with the five professionals we obtained informed consent, and participants filled out the demographic survey. Participants were informed they did not have to answer any questions that made them uncomfortable. Interviews and the focus group discussion were audio recorded and transcribed verbatim. The interviewer, the lead author, took field notes during and immediately following each interview and focus group. The format used follows the generally recommended practice for qualitative methodology of separating description from reflective material (Patton, 1990). To protect the privacy pseudonyms are used throughout this article. 2.2.1. Interview protocol Participants were interviewed in person twice, within a six month period, by the lead author. Follow up interviews were between two weeks and two months of the first interview, depending on the YDFC participants availability. The initial interviews were transcribed and follow up and/or clarifying questions were created before the second interview. Additionally, each interview was limited 60–90 min to prevent fatigue of the YDFC. Questions focused on (a) high school experiences, (b) placement changes, (c) disability, (d) barriers encountered during the transition to employment or post-secondary education, and (e) helpful services and supports. In alignment with a responsive interviewing approach outlined by Rubin and Rubin (2005) the young adults individuality was recognized and respected. The interviewee and the lead author were conversational partners; the YDFC answers steered the direction of the follow up questions allowing the YDFC to suggest topics and meaning that was important to them. The interview questions for each respondent changed or were worded differently based on the direction of the conversation, their level of comfort, and/or the YDFC personal experience (Rubin & Rubin, 2005). Possible interview prompts are included as Appendix A. 2.2.2. Focus group protocol The focus group lasted 90 min. Questions focused on (a) services provided, (b) IEP goals, (c) ILPs, (d) conversations about becoming an adult, (e) needed services or supports, and (f) availability of services (see Appendix B for prompts). 2.3. Data analysis All audio recordings were transcribed verbatim. Interview transcripts were uploaded to NVIVO 10 for analysis. Transcripts from the interviews were read several times by the first author to identify common themes. The initial framework for analysis was created collaboratively be the authors, then focused coding was conducted by the first author to understand which emergent themes provided the strongest framework for categorizing the data (Charmaz, 2006). After each stage of analysis, the co-authors discussed the preliminary results until consensus was reached. We used the same method to analyze the focus group transcripts. These data offered a different perspective – not a source of triangulation (Patton, 2015) – because our primary goal was to provide a platform for YDFC to share their perspectives of what they encountered during their transition to adulthood. As themes emerged from our data, we recognized an ecological model inspired by the work of Bronfenbrenner (1979) could be created for organizing findings. We concentrated our analysis on the exosystem, mesosystem, and microsystem to find malleable factors easily targeted for intervention. At the center of our ecological model is the individual YDFC, who is surrounded by multiple ecological systems (Fig. 1). During focus coding, the content involving the people and institutions closest to YDFC (e.g., teachers, social workers) was coded within the microsystem. Next, we coded data involving the larger systems and laws that can affect individuals (e.g., Children’s Administration, ILPs) to the exosystem. These are consistent with Bronfenbrenner’s definition of the microsystem. Next we coded content that represented complex interactions occurring within the microsystem and between the microsystem and exosystem to the mesosystem. This interpretation of the mesosystem expands the definition by Brofenbrenner (1994), which limits it to the linkages between microsystems. Within each circle of our ecological model (Fig. 1), the people, settings, and systems unique to individuals in foster care are represented in bold print. The remaining elements potentially affect all youth with disabilities. Lastly, we elicited feedback from participants either in person or via email, whichever the participant preferred. The lead author asked all participants how accurately the narrative and model (Fig. 1) reflected their experiences. This member checking increases trustworthiness of our analysis (Patton, 2015). 3. Findings In this section of the article we will summarize the key findings/observations that emerged from our analyses of interviews with YDFC and a focus group with professionals who serve them. Emergent themes within and across participant data were mapped onto our model (Fig. 1) to categorize our data within the ecological layers were they occur. Therefore, findings are organized by layers of the ecological model. 3
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Fig. 1. An ecological model of the transition to adulthood for youth with disabilities who experience foster care.
3.1. Microsystem Bronfenbrenner (1994) describes the microsystem as “a pattern of activities, social roles, and interpersonal relations experienced by the developing person in a given face-to-face setting with particular physical, social, and symbolic features that invite, permit, or inhibit engagement in sustained, progressively more complex interaction with, and activity in, the immediate environment.” We coded the data that aligns with this definition to the microsystem. Themes from the interview data included unstable or negative housing experiences and lack of consistent, positive relationships. Stable, positive relationships were beneficial and were also coded within the microsystem. Focus group data coded with the microsystem included a lack of highly skilled social workers, special education teachers, and foster parents; similar to themes exposed in the interview data. We present these separately in our findings because lack of training was stressed within the professional focus group and relationship quality was reported in the interviews with YDFC. 3.1.1. Unstable or negative housing experiences Unstable housing occurred both in foster care and after the transition to adulthood. Of the placement types, participants reflected most negatively on their experience in group homes. Several participants said they “hated” group homes, because of their lack of privacy and free choices. One shared that the group homes were “the worst thing ever…in life” and she felt like “I'm this criminal that's in … this prison. And like cupboards are locked with food. And it's just, it was like this whole big thing and I hated it. I absolutely hated it.” Some participants said they were often afraid. They didn’t know where they would live next or whether they would have enough food. They were “just trying to survive.” One participant said that hope began with her connection to her foster mom. 3.1.2. Lack of consistent, positive relationships Contact with birth parents or siblings was infrequent or non-existent. One participant’s brother rejected her when she tried to reestablish their relationship. Another’s mother suggested she place her son into foster care, which further damaged their relationship. Existing relationships with adults in their lives were not always positive; and professionals serving the youth changed frequently. Due to frequent moves a social worker lost track of one of the participants – she called and said, “I don’t even know where you are.” Another participant’s foster family intercepted calls from the social worker. He never had a chance to share his perspective. He said he wondered if his “journey would have been different” if he communicated directly with his social worker. Conflicts with teachers were common. Several participants discussed differences in teaching styles at various schools. One participant reported a teacher said, “you will either learn the way I teach or you are not going to learn.” She then dropped out and later entered a GED program. Due to many moves and school changes, another participant lacked connection to her teachers and was credit deficient – when encouraged (mostly by her foster parent) to drop out and get her GED, she did. Developing strong peer relationships was also difficult due to frequent moves and school changes, and exclusion from activities typical of people their age. Several participants shared problems encountered when desiring a normal childhood experience (e.g., sleepovers) because adults present needed background checks. Participants expressed hesitancy to make friends because by the time 4
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they got to know somebody, they moved again. Contrastingly, some participants reported the effects of a positive relationship with a social worker or teacher. They expressed gratitude for social workers who went the extra mile, such as driving them to another state to see a birth parent, attending IEP meetings, or explaining the benefits of extended foster care. Participants frequently credited teachers for helping them stay in school by providing one on one support, advocating for schedule changes, and showing interest in them. [My teacher] can understand me a lot better because she knows how I feel, like when I get angry, she watched my facial expressions before I blow up or before I act up or whatever. She can see it before I do it, and she can take me aside and calm me down. A science teacher also made a noteworthy impression. Everybody else was like, ‘Oh, she's the foster kid!’ and I felt like she… didn't look at me like this foster kid. I felt like everybody felt bad for me. It's not like I wanted everyone to feel bad for me so… she was like the one person that was like, ‘Oh you're actually a human being’… I think she's the first teacher that actually like, really got me into considering college… For several participants, a stable placement and a consistent adult during high school prevented many of the challenges faced by others. A few reported that their foster mothers were actively involved in their education and adult lives. One credits her final placement with turning her life around. Her relationship with her foster mother went through periods of trial and periods of healing, but ultimately she was adopted and became a permanent part of the family. Focus group participants echoed the need for consistent positive relationships. “That stability of having a placement that feels like home and looks like home, and it has been like that for the majority of their life is, I think, the biggest indicator of reaching the level of success.” They reported youth who experience one or two placements often fared best. For youth who moved frequently, having one constant person whom they trusted was essential. Several focus group participants described how youth appreciate transparency and clear expectations. [Y]ou don’t have to be everything for me, but gosh, it really helps when I know what I can expect from you. It is cool if I can't live with you or leave my stuff at your place, or if you can't sign a lease agreement for me. But if I can come over on Friday nights and that is our thing and that will be consistent and maybe a long term thing, then that is so valuable to me. But please don't do the thing where you promise me the world and then a month later you are out of my life. Additionally, professionals said youth peer support groups are indispensable. Youth may feel less embarrassed or stigmatized around others with similar life histories. 3.1.3. Lack of highly skilled professionals Participants in the focus group remarked that youth only have access to resources their social worker or caregiver knows about. However, they are not always aware of all possible resources available. High turnover rates for social workers and special education teachers are concerning because people working with this population need specialized skills. Focus group participants said that many service providers do not understand developmentally appropriate adolescent behavior. It is a “systemic issue, and… teens are often just ‘being teens’ but when they experiment, they lose their placement or they go to jail or they lose resources.” 3.2. Mesosystem Bronfenbrenner (1994) describes the mesosystem “as a system of microsystems” or “the linkages and processes taking place between two or more settings containing the developing person.” In our model, we include interactions occurring within the microsystem and between the microsystem and exosystem because systems or laws within the exosystem directly affected what occurred within the microsystem. Two mesosystemic barriers were consistently identified across the interview and focus group data: frequent placement changes and inappropriate disability or mental health diagnoses. The third theme, barriers to employment, was unique to the interviews with young adults. The main beneficial theme to emerge was coordinated services within and across agencies, particularly when programs, systems, or laws in the exosystem worked together to provide appropriate mental health and disability services. 3.2.1. Frequent placement changes Interactions among laws, systems, and caregivers influenced the stability of YDFCs’ placements. As previously reported (Author, 2015), YDFC interview participants in this study experienced multiple placements and living situations, including living with a relative, foster homes, group homes, psychiatric hospitals, and specialized homes for teen parents. Several participants reported their foster parents to the authorities because of adverse treatment. One participant said his foster parents “would leave [him] outside… they did it in the winter, too. They would be gone for three or four hours with nothing to eat.” Professionals also reported placement changes as a significant barrier. One focus group participant said if a youth had more than three placement changes, he knew he was “going to have to dig in and really do some work.” Others said each placement change felt like starting the case over. They stressed the value of coordinated services and of understanding a youth’s goals. Professionals advocated for a whole team/cross systems approach to achieving goals and a thoughtful hand-off from youth to young adult programs. 5
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3.2.2. Inappropriate disability or mental health diagnoses Special education and mental health services received were not always appropriate. Frequent school changes resulted in invalid diagnoses or inappropriate IEPs. One participant reported that after a school change, her new school was unaware she had an IEP. Another participant was misidentified as “borderline retarded” and placed in a self-contained classroom, which she described as “traumatic” and “chaotic.” In another school, she received a proper diagnosis of specific learning disability in the seventh grade (and removal from the self-contained classroom) and dyslexia in ninth grade. Appropriate accommodations (e.g., audio books) needed for school success were finally identified. Inappropriate mental health diagnoses were also prevalent. One participant self-reported incorrect diagnosis of “bipolar” in the eighth grade. She reported the prescribed medication turned her into “a complete zombie.” Later, another psychiatrist said she was never “officially diagnosed” with bipolar disorder and questioned the prescription – then diagnosed depression, anxiety, and PTSD. Correct diagnoses and access to mental health services were transformative. A focus group participant said during “an issue identification process with youth,” overmedication and inappropriate institutionalization came up frequently. He shared the story of a youth who testified before Congress. At age seventeen she was – locked in a psychiatric facility and was on heavy doses of psychotropic medications that she did not want to take. She was picked up on her 18th birthday by a man who has now adopted her, and against doctor's order had to reduce and then discontinue taking medication…[S]he is 21, 22 now, living independently, has her AA, and is on no medication and feels really strong that the state made a huge mistake to lock her up, to give her multiple diagnoses that she feels weren't helpful for her to heal and move forward in her life. Her thing, her line is always, ‘Foster kids don't need pills. They need loving adults who are going to show up for them and actually adopt them because that is what worked for me.’
3.2.3. Barriers to employment ILPs helped set goals; however, staff did not always teach how to achieve the goals or explore options. One participant reported that no one ever discussed college or extended foster care with him. After being unsuccessful in finding a job, due to his disabilities, he was connected with the Division of Vocational Rehabilitation (DVR) and began receiving Social Security benefits. Another reported not being informed about workplace rights or receiving guidance about when or how to disclose her disability during a job interview. Her ILP program goal sheet stated that she will “get a job” but did not identify the steps needed to achieve the goal. 3.3. Exosystem Brofenbrenner (1994) describes the exosystem as the “linkages and processes taking place between two or more settings, at least one of which does not contain the developing person, but in which events occur that indirectly influence processes within the immediate setting in which the developing person lives.” Three themes of exosystemic barriers for YDFC emerged from our interviews. Themes were inconsistent high school graduation requirements; access to Independent Living Program (ILP) services; activities and services to support successful post-secondary transitions; and lack of safety nets after aging out. Ongoing supports and services were judged beneficial. Focus Group participants identified an inadequate service delivery model as the main exosystemic barrier. 3.3.1. Inconsistent high school graduation requirements Inconsistency in school policies and requirements for graduation between schools, districts, and states created hardship, especially for participants who experienced frequent school and placement changes. One participant summarized what others articulated: I had a really big problem because, once you get in high school, your credits follow you, and I was moving all over the place, and certain schools require certain things, and other schools required things that they didn't.
3.3.2. Inconsistent access to ILP services and activities and services to support successful post-secondary transitions YDFC participants felt inadequately prepared for adult living. One participant didn’t have access to an ILP until five months before beginning college. Many shared feeling unprepared for household responsibilities (e.g., bill paying or budgeting). I knew people paid bills, but I didn't know how to do it…It was something that everybody told me, it was something I had to do, but nobody really talked about how to do it.
3.3.3. Lack of safety net Several participants reported a lack of services after “aging out” of foster care. Four of the seven participants experienced homelessness. Reasons included conflict with a foster parent, failed attempts at living with friends, and aging out with no place to go. Participants who accessed adult services and Social Security disability benefits fared better. Two participants agreed to extended foster care, during college, after their social workers explained they could receive benefits while living independently (in approved housing). ILPs that provided housing and household necessities, bill paying classes, referrals to other agencies, and assistance with college and job applications were useful. Programs for homeless youth provided services such as GED completion, community college and financial aid application assistance, and temporary housing. 6
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3.3.4. Inadequate service delivery model The focus group with professionals revealed many caregivers are isolated, unsupported, need ongoing training, and respite to improve placement stability. Participants also commented on providers’ lack of cultural competence. One focus group participant provided an example of how the system is also not designed to address cultural needs of immigrants and/or refugees, which may result in multiple placements because the caregiver and youth’s beliefs systems are not in alignment. In addition, issues like citizenship complicate the transition to adulthood and may not have been addressed before the youth ages out of care. Another focus group participant agreed and added that cultural competence training is needed so caregivers know how to relate to a youth of another ethnicity and what to do if the youth “doesn’t know how to relate to them.” 4. Discussion Due to the paucity of literature describing experiences of YDFC (Geenen & Powers, 2007), we designed this study to gain understanding of the process of their transition to adulthood. Although we initially hoped our study would illuminate a wealth of services and supports that were helpful for this population, the numerous barriers shared by participants frequently overshadowed services and supports that were helpful and their transitions were turbulent. Perhaps the most striking finding was that although the professionals serving these young adults perceived them as doing very well, all had experienced extremely challenging transitions. 4.1. Exosystem The complexity of the transition to adulthood for YDFC warrants a correspondingly sophisticated response from professionals and systems that are charged with assisting them. The model we generated facilitates understanding of the complex interactions among the systems, services, and people that influence the lives of YDFC. Our approach also illuminated the contexts and social relationships that intersect during the transition to adulthood for YDFC. Our findings and model expand the literature on YDFC and can facilitate improvements in service delivery to this vulnerable population. Many systems and laws directly impact YDFC, including social service agencies program policies, national and state educational laws, and the political climate. The lack of consistent national high school graduation requirements created barriers for youth who experienced high mobility. The absence of national laws and systems to mediate the effects of mobility hinders the transition to adulthood for YDFC. According to Casey Family Programs (Joftus, Cross, & Joftus, 2007), one of the biggest barriers to school success for youth in foster care is mobility – several recommendations for improvement include expansion of the McKinney-Vento Homeless Assistance Act (42 USC 11431 et seq.) to cover all youth in out-of-home care and expansion of associated funding. Youth in care could then remain in their school of origin (whenever possible) and receive transportation to school. Currently, only youth awaiting foster care placement or within 30-days of their shelter care order qualify for transportation services. Additionally, adequate and fully funded ILP services are not universally available (or accessible to youth with disabilities). Participants who experienced a program matching their needs reported benefits, however many others left their ILPs feeling unprepared for adult life. The variability in quality and services provided by ILPs and their accessibility and appropriateness for those with disabilities is also reflected in the literature (Geenen & Powers, 2007). YDFC have few options as to where they can receive services and what services are offered. Courtney et al. (2005) reported 11–27 % of alumni of foster care received independent services while still in care. Without these services, youth in foster care may not gain essential skills, since they often lack family or other community support networks that could teach them (Samuels and Pryce 2007). Overall an inadequate service delivery model contributes to instability for YDFC. Due to a lack of professional development and training, many caregivers working within the system are unprepared to support youth with diverse needs (e.g., different cultural backgrounds, disability, or mental health diagnosis) and often cannot determine if ILP, special education, or mental health services are appropriate and/or adequate. Moreover, children of diverse backgrounds are overrepresented in the child welfare system and their adult outcomes are disparate when compared with those of Caucasian children (Clark, Buchanan, & Legters, 2008). Therefore, caregivers must be culturally competent to best serve the youth in their care (Collins, 2004). Systems that serve youth in foster care must be designed to address the needs of youth from diverse cultural backgrounds and those with disabilities or mental health diagnoses. YDFC lose their manufactured safety net when as they “age out” of the system. Without a safety net, homelessness occurs frequently – the case in over half of the youth in our study. Casey Family Programs (2008) reported that 22 % of alumni of foster care between the ages of 18 and 24 experience homelessness for at least one day after leaving care. Unfortunately, the level of support available to youth aging out of care depends on where they reside; not all U.S. states guarantee the same level of support. Therefore a safety net that continues after they leave care must be created – through formal or informal services (e.g., supportive extended family, continued adult relationships with foster parents, extended foster care, or supported housing programs for individuals with disabilities). 4.2. Mesosystem Barriers encountered due to poor communication and/or lack of coordinated services could be remedied through improved intraand inter- agency collaboration. Frequent placement changes were one of the most prevalent and damaging barriers encountered by our participants. Their loss of family and place frequently occurred because of decisions made by social workers and caregivers (microsystem), the rules and regulations of the system (exosystem), or the interaction between service providers and the system. The 7
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YDFC had little or no control during these interactions and were often left with negligible support to process the loss. While the Adoption and Safe Families Act (1997), passed twenty years ago, requires social workers to plan concurrently for youths’ reunification with their families and adoption, only one of the young adults in our study experienced a successful adoption (and that was not until she was an adult). Also noteworthy, none of our participants experienced reunification with their biological families before aging out of care. Poor communication within and between systems also resulted in inappropriate diagnoses for special education, lost knowledge about eligibility for special education, and lost IEPs. This breakdown contributed to a host of problems. One participant received special education services in a self-contained classroom despite her capacity to participate in the general student population. Additionally, several participants received inappropriate mental health diagnoses and professionals reported overmedication of youth in foster care. Corroborating this concern, Raghavan et al. (2005), examining data from the National Survey of Child and Adolescent Well-Being, concluded that children in the child welfare system receive psychotropic medications at two to three times the rate of their peers outside the system. Employment barriers encountered by participants also highlight the interaction between multiple layers within the model – employers (microsystem) and civil rights laws (exosystem). Two important school outcomes for youth with disabilities are understanding their disabilities so they can express how it affects their adult lives and understanding their associated rights (Pyle & Wexler, 2011). In our study, two participants experienced barriers to employment due to their medical or mental health needs. However, they were never taught their rights or how to disclose their disabilities to employers. In addition, they received no training on advocating for accommodations needed to succeed in the workplace. Only one participant was connected to DVR. Knowledge about disability rights and how to access workplace accommodations are vital – individuals must self-disclose before requesting accommodations. Teaching about disability, the use of accommodations, and the Americans with Disabilities Act should be included in transition plans – along with an exploration of methods and timing for disclosure (Doren, Lindstrom, Zane, & Johnson, 2007; Madaus, Gerber, & Price, 2008). Students connected to a rehabilitation counselor in high school are more likely to use their services as an adult – gaining important access to career counseling, vocational assessments, work placement, and referrals for medical and therapeutic services and assistive technology (Agran, Cain, & Cavin, 2002). Our participants could have benefited from such services; several unemployed participants strongly voiced wanting a job. Ultimately, coordinated services produce positive results. Participants benefited from appropriate mental health or disability services. Therefore, as our focus group participants suggested, it is prudent to improve training for service providers and caregivers. Service providers cannot refer their clients to services if they do not know how to do so or understand what is available. Our findings also demonstrate how high turnover rates among social workers, resulting in a continuous pool of relatively new professionals, adds to the complexity of coordinating services for highly mobile youth. This issue is problematic at both the microsystem and exosystem level, since the high rate of turnover needs to be addressed systemically (exosystem) but its impact if felt at the microsystem level. 4.3. Microsystem Our findings suggest that the proximal institutions and people closest to YDFC often have the biggest effect on their transition to adulthood. Research suggests that supportive relationships protect against poor outcomes for youth in foster care (Samuels & Pryce, 2008). Unfortunately, many of our participants reported poor relationships with their foster families and had little to no contact with their biological families. The participants that reported positive relationships (e.g., social workers, teachers, foster parents) expressed gratitude and acknowledged needing the extra support to succeed. Murray (2003) suggests that positive teacher–student relationships have a lasting effect on youth with disabilities. Our results support this. Several participants shared that even one positive relationship with a teacher changed the way they felt about education and their future possibilities. They also credited teachers for helping them stay in school. Therefore, teachers may be especially important for the success of YDFC. 5. Implications for practice Greater awareness is needed about the social contexts, relationships, systems, and service providers that affect YDFC. Without careful attention YDFC can slip through the cracks resulting in unmet needs during adolescence and poor adult outcomes. Our model provides a visual representation that can be a useful guide when designing interventions for YDFC. It can serve as a reminder to open dialogue with potential collaborators to align goals, save time, and ensure service providers are not working at cross purposes. In Table 2, we provide recommendations for practice and resources for professionals. 5.1. Limitations of the study This study has several limitations that should be noted. The interviews occurred in a short time frame; a longitudinal study would provide more information about changes in adult outcomes across time. All participants lived in the same geographic region and experienced the same state system, which might not be transferrable to other states. Additionally, few males and no transgender YDFC were referred to the study – it is unknown how a gender may impact the themes. 6. Implications for future research This study fills an important gap in the existing literature by proposing an ecological approach to transition planning for YDFC. 8
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Table 2 Needs identified, recommendations, and resources to improve services provided to YDFC during their transition to adulthood. Identified Need
Recommendation
Resources
Systems Improvements
Build collaborative networks to better recruit, support, and retain foster parents trained in the needs of youth with disabilities and mental health needs Advocate for continued funding for extended Foster Care Provide ongoing cultural competency training to caregivers Provide training for caregivers and social workers about disabilities and IDEA Advocate for national standardized high-school graduation requirements Transition planning meetings should include all professionals providing services To facilitate goals alignment between systems/ providers, teach YDFC self-advocacy and selfdetermination skills. Empower them to lead their transition planning meetings Special educators can share evidence-based practices for transition and the youth’s identified disability and with foster parents and social workers Help youth remain in schools, in which they report positive relationships with teacher; or help them maintain those relationships if they must relocate. Ensure YDFC maintain contact and relationships with biological family, whenever possible
Child Welfare Information Gateway https://www.childwelfare.gov
Interagency Collaborations
Positive Relationships
CASA: Court Appointed Special Advocates for Children http://www.casaforchildren.org/site/c.mtJSJ7MPIsE/b.6367927/ k.1D9A/Cultural_Competence__Diversity__Inclusion.htm IDEA: Individuals with Disabilities Education Act https://sites.ed.gov/idea/
Taxonomy for Transition Planning 2.0 https://transitionta.org/sites/default/files/Tax_Trans_Prog_0.pdf National Technical Assistance Center on Transition: NTACT https://transitionta.org/
Law Center for Foster Care & Education http://www.fostercareandeducation.org/AreasofFocus/ EducationStability.aspx
Family Engagement: A Web-Based Practice Toolkit http://www.nccwe.org/toolkits/family-engagement/introduction.htm
Our findings confirm multiple barriers previously reported in the literature and highlight the need for improved interagency collaboration and more research in this area. Additional research should investigate the role of gender on transition outcomes for YDFC. Finally, we recommend research to expand our model to include additional layers of that we did not address in this study (i.e, macrosystem and chronosystem). This would help place the transition of YDFC within the environmental and cultural contexts that influences them, their education, and services available. Acknowledgments This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Appendix A. Supplementary data Supplementary material related to this article can be found, in the online version, at doi:https://doi.org/10.1016/j.chiabu.2019. 104310. References Adoption and Safe Families Act (1997). P.L. 105–189. Agran, M., Cain, H. M., & Cavin, M. D. (2002). Enhancing the involvement of rehabilitation counselors in the transition process. Career Development and Transition for Exceptional Individuals, 25(2), 141–155. https://doi.org/10.1177/088572880202500204. Bronfenbrenner, U. (1979). The ecology of human development (1st ed.). Cambridge, Mass: Harvard University Press. Bronfenbrenner, U. (1994). (2nd ed.). Ecological models of human devleopmentVol. 3Pxford: Elsevier. International Encyclopedia of Education. http://www.psy.cmu. edu/∼siegler/35bronfebrenner94.pdf. Casey Family Programs (2008). Supporting success: Improving higher education outcomes for students from foster care – A framework for program enhancement. Seattle: WA. Retrieved fromhttp://www.casey.org/resources/publications/SupportingSuccess.htm. Charmaz, K. (2006). Constructing grounded theory: A practical guide through qualitative analysis. London: Sage Publications. Clark, P., Buchanan, J., & Legters, L. (2008). Taking action on racial disproportionality in the child welfare system. Child Welfare, 87(2), 319–334. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/18972945. Collins, M. E. (2004). Enhancing services to youths leaving foster care: Analysis of recent legislation and its potential impact. Children and Youth Services Review, 26(11), 1051–1065. https://doi.org/10.1016/j.childyouth.2004.08.005. Courtney, M. E., Dworsky, A., Ruth, G., Keller, T., Havlicek, J., & Bost, N. (2005). Midwest evaluation of the adult functioning of former foster youth: Outcomes at age 19. Chicago: Chapin Hall Center for Children at the University of Chicago. Doren, B., Lindstrom, L., Zane, C., & Johnson, P. (2007). The role of program and alterable personal factors in postschool employment outcomes. Career Development for Exceptional Individuals, 30(3), 171–183. https://doi.org/10.1177/08857288070300030601. Geenen, S. J., & Powers, L. E. (2006). Transition planning for foster youth. The Journal for Vocational Special Needs Education, 28(2), 4–15. Geenen, S., & Powers, L. E. (2007). Tomorrow is another problem. Children and Youth Services Review, 29(8), 1085–1101. https://doi.org/10.1016/j.childyouth.2007. 04.008.
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Harwick, R., Tyre, A., Beisse, K., & Thomas, C. (2015). Intervention targets for youth with disabilities in foster care. School Psychology Forum, 5–20. Harwick, R., Lindstrom, L., & Unruh, D. (2017). In their own words: Overcoming barriers during the transition to adulthood for youth with disabilities who experienced foster care. Children and Youth Services Review, 73, 338–346. Joftus, S., Cross, & Joftus, L. L. C. (2007). Educating children in foster care: The McKinney-Vento and No child left behind acts. Retrieved fromCasey Family Programshttp:// svcf.org/wp-content/uploads/Casey_ExecSummary_NCLB.pdf. Leathers, S. J., & Testa, M. F. (2006). Foster youth emancipating from care: Caseworkers’ reports on needs and services. Child Welfare, 85(3), 463–498. Trainor, A. A., Lindstrom, L., Simon-Burroughs, M., Martin, J. E., & Sorrells, A. M. (2008). From marginalized to maximized opportunities for diverse youths with disabilities: A position paper of the division on career development and transition. Career Development and Transition for Exceptional Individuals, 31(1), 56–64. https://doi.org/10.1177/0885728807313777. Madaus, J. W., Gerber, P. J., & Price, L. A. (2008). Adults with learning disabilities in the workforce: Lessons for secondary transition programs. Learning Disabilities Research and Practice, 23(3), 148–153. https://doi.org/10.1111/j.1540-5826.2008.00272.x. McWey, L., Acock, A., & Porter, B. (2010). The impact of continued contact with biological parents upon the mental health of children in foster care. Children and Youth Services Review, 32(10), 1338–1345. https://doi.org/10.1016/j.childyouth.2010.05.003. McWey, L., & Mullis, A. (2004). Improving the lives of children in foster care: The impact of supervised visitation. Family Relations, 53, 293–300. Murray, C. (2003). Risk factors, protective factors, vulnerability, and resilience: A framework for understanding and supporting the adult transitions of youth with high-incidence disabilities. Remedial and Special Education, 24(1), 16–26. https://doi.org/10.1177/074193250302400102. NVivo qualitative data analysis Software (2012). QSR international Pty Ltd. version 10. Patton, M. (1990). Qualitative evaluation and research methods (2nd ed.). Newbury Park, CA: Sage Publications. Patton, M. Q. (2015). Qualitative research and evaluation methods (4th ed.). Thousand Oaks, CA: Sage Publications. 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. https://doi.org/10.1016/j.childyouth.2012.01.044. Powers, L. E., Geenen, S., Powers, J., Satya, S., Turner, A., Dalton, L., ... The Research Consortium to Increase the Success of Youth in Foster Care (2012). My life: Effects of a longitudinal, randomized study of self-determination enhancement on the transition outcomes of youth in foster care and special education. Children and Youth Services Review, 34(11), 2179–2187. https://doi.org/10.1016/j.childyouth.2012.07.018. Pyle, N., & Wexler, J. (2011). Preventing students with disabilities from dropping out. Intervention in School and Clinic, 47(5), 283–289. https://doi.org/10.1177/ 1053451211430118. Quest, A. D., Fullerton, A., Geenen, S., Powers, L., & The Research Consortium to Increase the Success of Youth in Foster Care (2012). Voices of youth in foster care and special education regarding their educational experiences and transition to adulthood. Children and Youth Services Review, 34(9), 1604–1615. https://doi.org/10. 1016/j.childyouth.2012.04.018. Raghavan, R., Zima, B. T., Andersen, R. M., Leibowitz, A. A., Schuster, M. A., & Landsverk, J. (2005). Psychotropic medication use in a national sample of children in the child welfare system. Journal of Child and Adolescent Psychopharmacology, 15(1), 97–106. https://doi.org/10.1089/cap.2005.15.97. Rubin, H. J., & Rubin, I. S. (2005). Qualitative interviewing: The art of hearing data (2nd ed.). Thousand Oaks, CA: Sage Publications. Samuels, G. M., & Pryce, J. M. (2008). What doesn’t kill you makes you stronger: Survivalist self-reliance as resilience and risk among young adults aging out of foster care. Children and Youth Services Review, 30(10), 1198–1210. Scannapieco, M., Smith, M., & Blakeney-Strong, A. (2016). Transition from foster care to independent living: Ecological predictors associated with outcomes. Child and Adolescent Social Work Journal, 33(4), 293–302. https://doi.org/10.1007/s10560-015-0426-0. Strauss, A., & Corbin, J. (1998). Basics of qualitative research: Techniques and procedures for developing grounded theory. Thousand Oaks, California: Sage. U.S. Department of Health and Human Services, Administration for Children and Families, Children’s Bureau (2016). AFCARS report: Preliminary estimates for FY 2015 as of June 2016Retrieved fromhttps://www.acf.hhs.gov/sites/default/files/cb/afcarsreport23.pdf.
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Research article
Transition to adulthood for youth with disabilities who experienced foster care: An ecological approach
T
Robin Marie Harwicka,*, Deanne Unruhb, Lauren Lindstromc a b c
University of Washington, Alcohol and Drug Abuse Institute, 1107 NE 45th St Ste. 120, Seattle, WA, 98105, United States University of Oregon, 212 Clinical Services Bldg. 5260, Eugene, OR, 97403, United States University of California Davis, One Shields Ave., Davis, CA, 95616, United States
A R T IC LE I N F O
ABS TRA CT
Keywords: Foster care Transition Disability Child welfare Adolescent development Mental health
Background: Almost 21,000 youth, in the U.S., leave foster care due to "emancipation" each year. Although not well documented for this age group, nearly half of children/youth in foster care receive a disability diagnosis. There is a growing body of literature about the transition to adulthood for youth with disabilities. However, minimal research exists on the transition experiences of youth in foster care who also have a disability. This study intends to help fill this gap in the literature. Objective: The purpose of the study was to uncover challenges during the transition to adulthood for youth with disabilities who experienced foster care and elucidate the supports most beneficial in addressing these challenges. Participants and setting: All participants reside in the United States pacific northwest. Seven foster care alumni aged 19–23 and five professionals serving the target population participated in the study. Methods: We conducted semi-structured interviews with YDFC and a focus group with professionals to understand the process of the transition to adulthood for YDFC. Our findings generated an ecological model useful for transition planning prior to the youth leaving foster care. Within our model we focus on alterable factors to bring intervention points to light. Results: Barriers uncovered included lack of consistent high school graduation requirements, high quality Independent Living Programs, positive relationships and highly skilled professionals; frequent placement changes; and inappropriate disability or mental health diagnosis. Conclusions: Recommendations include systems improvements; improved intra- and interagency collaboration; and helping youth build and maintain positive relationships.
1. Introduction In the United States, there are approximately 65,000 youth (16–25 years old) in foster care (Department of Health and Human Services, 2016) – whether they have a documented disability is not adequately tracked. However, approximately 40–47% of total children/youth in foster care have documented disabilities (Powers et al., 2012). For youth with disabilities, the transition into adult roles, for example post-secondary education or employment, is frequently challenging (Trainor, Lindstrom, Simon-Burroughs, Martin, & Sorrells, 2008). When disability and foster care intersect the challenges faced during the transition to adulthood are multiplied. Youth who experience disability and foster care (YDFC) experience lower educational achievement and are at greater risk of poor ⁎
Corresponding author. E-mail address: [email protected] (R.M. Harwick).
https://doi.org/10.1016/j.chiabu.2019.104310 Received 27 November 2018; Received in revised form 19 November 2019; Accepted 1 December 2019 Available online 12 December 2019 0145-2134/ © 2019 Published by Elsevier Ltd.
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adult outcomes than youth in foster care who do not have disabilities or receive special education services (Quest, Fullerton, Geenen, Powers, & The Research Consortium to Increase the Success of Youth in Foster Care, 2012). YDFC must navigate both the child welfare and special education systems. However, the agencies involved often fail to communicate adequately, leading to inappropriate educational placements, delayed school enrollment, and Individual Education Programs (IEPs) that are lost or not implemented (Harwick, Lindstrom & Unruh, 2017; Geenen & Powers, 2006; Pecora, 2012). Barriers to services and instability of placements are exacerbated for YDFC compared to youth in care without disabilities (Geenen & Powers, 2007). A recent study reported an increased number of placements had a negative relationship with education, employability, employment, financial literacy, and adequate housing for YDFC (Scannapieco, Smith, & Blakeney-Strong, 2016). Also of concern, professionals and foster parents report that Independent Living Programs (ILPs) designed to assist youth in foster care in preparing for adulthood are often inaccessible or inappropriate for youth with disabilities – lacking the ability to make appropriate accommodations (Geenen & Powers, 2007). Furthermore, Collins’ (2004) analysis of the Foster Care Independence Act (P.L. 106–109) suggests that the legislation does not address the reality that youth with disabilities or mental health issues might require permanent access to supports. Consistent relationships with caring adults are critical to improving outcomes for YDFC (Harwick, Tyre, Beisse, & Thomas, 2015; Geenen & Powers, 2007). However, foster parents might not be knowledgeable about disability and may have difficulty managing a youth’s behavior and social needs, contributing to placement changes (Harwick et al., 2015; Geenen & Powers, 2007). These placement changes often cause school changes, resulting in abruptly terminated relationships with teachers. Additionally, YDFC often have limited contact with their biological parents. Requirements for visitation vary by state – while generally recommended, visits are often intermittent (Leathers & Testa, 2006; McWey, Acock, & Porter, 2010; McWey & Mullis, 2004). Therefore, maintaining consistent, caring relationships is challenging for YDFC. Almost 21,000 youth leave foster care due to “emancipation” each year (U.S. Department of Health and Human Services, 2016). Although there is a growing body of literature about the transition to adulthood for youth with disabilities, there is a minimal research on the transition experiences of youth in foster care who also have a disability (Geenen & Powers, 2007). Our study intended to help fill this gap in research. Our purpose was to uncover challenges during the transition to adulthood for YDFC and elucidate the supports most beneficial in addressing these challenges. We interviewed YDFC to understand from their perspective their transition process. To obtain a different perspective, we also held a focus group with professionals working with YDFC. 2. Methods We used a qualitative approach informed by grounded theory (Strauss & Corbin, 1998). An a priori literature review was conducted to understand the existing literature about the transition to adulthood and to guide protocol development. Study procedures were approved by an institutional review board. There was no external funding for this project. 2.1. Participants Purposeful sampling was used to identify alumni of foster care and professional potential participants. Professionals working with YDFC referred those they perceived made a “successful transition.” Success was left open to the interpretation by the professional, however, if asked for clarification we gave examples such as YDFC who completed one year of post-secondary education or one consecutive year of employment. These are frequently considered positive post-school outcomes. Additional criteria included YDFC who (a) received special education or identified as having a disability, (b) graduated from high school or received a GED, (c) were in foster care for more than 6 months during high school, and (d) were between the ages of 18 and 24. Seven foster care alumni aged 19–23 were interviewed; five self-identified as female and two as male; two participants selfidentified as African American, three as Native American and Caucasian, and two as Caucasian. Length of time in foster care was between 4 and 19 years. Interview participants’ self- reported demographics, disability, and employment/educational status at the time of the interviews are detailed in Table 1. Additionally, five professionals (aged 27–63) participated in a focus group. Focus group participants worked for community-based organizations or in higher education and had served youth in foster care from 2.5 to more than 14 years. Three identified as Table 1 Self-Reported Demographic Characteristics of Participants. Participant
Gender
Ethnicity
Age
Years in foster care
Disability
Diploma/GED
Mona Tammi Manny Sandra Matt DD Rex
F F F F M F M
African American African American Native/Caucasian Native/Caucasian Caucasian Native/Caucasian Caucasian
21 22 19 19 19 22 23
16 N/D 4 4 4 19 11
SLD/ED Epilepsy/ADHD PTSD SLD SLD, Depression MH ADHD/ BP
Diploma Diploma GED N/A Diploma Diploma Diploma
Notes. Attention Deficit and Hyperactivity Disorder (ADHD), Emotional Disturbance (ED), Mental Health (MH), Specific Learning Disability (SLD), Post-Traumatic Stress Disorder (PTSD), Bipolar Disorder (BP), Not disclosed (N/D). 2
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professionals, one as a paraprofessional, and one as an expert in working with this population. Three self-identified as male and two as female. 2.2. Study procedures Prior to the interviews with each of the seven YDFC and the focus group with the five professionals we obtained informed consent, and participants filled out the demographic survey. Participants were informed they did not have to answer any questions that made them uncomfortable. Interviews and the focus group discussion were audio recorded and transcribed verbatim. The interviewer, the lead author, took field notes during and immediately following each interview and focus group. The format used follows the generally recommended practice for qualitative methodology of separating description from reflective material (Patton, 1990). To protect the privacy pseudonyms are used throughout this article. 2.2.1. Interview protocol Participants were interviewed in person twice, within a six month period, by the lead author. Follow up interviews were between two weeks and two months of the first interview, depending on the YDFC participants availability. The initial interviews were transcribed and follow up and/or clarifying questions were created before the second interview. Additionally, each interview was limited 60–90 min to prevent fatigue of the YDFC. Questions focused on (a) high school experiences, (b) placement changes, (c) disability, (d) barriers encountered during the transition to employment or post-secondary education, and (e) helpful services and supports. In alignment with a responsive interviewing approach outlined by Rubin and Rubin (2005) the young adults individuality was recognized and respected. The interviewee and the lead author were conversational partners; the YDFC answers steered the direction of the follow up questions allowing the YDFC to suggest topics and meaning that was important to them. The interview questions for each respondent changed or were worded differently based on the direction of the conversation, their level of comfort, and/or the YDFC personal experience (Rubin & Rubin, 2005). Possible interview prompts are included as Appendix A. 2.2.2. Focus group protocol The focus group lasted 90 min. Questions focused on (a) services provided, (b) IEP goals, (c) ILPs, (d) conversations about becoming an adult, (e) needed services or supports, and (f) availability of services (see Appendix B for prompts). 2.3. Data analysis All audio recordings were transcribed verbatim. Interview transcripts were uploaded to NVIVO 10 for analysis. Transcripts from the interviews were read several times by the first author to identify common themes. The initial framework for analysis was created collaboratively be the authors, then focused coding was conducted by the first author to understand which emergent themes provided the strongest framework for categorizing the data (Charmaz, 2006). After each stage of analysis, the co-authors discussed the preliminary results until consensus was reached. We used the same method to analyze the focus group transcripts. These data offered a different perspective – not a source of triangulation (Patton, 2015) – because our primary goal was to provide a platform for YDFC to share their perspectives of what they encountered during their transition to adulthood. As themes emerged from our data, we recognized an ecological model inspired by the work of Bronfenbrenner (1979) could be created for organizing findings. We concentrated our analysis on the exosystem, mesosystem, and microsystem to find malleable factors easily targeted for intervention. At the center of our ecological model is the individual YDFC, who is surrounded by multiple ecological systems (Fig. 1). During focus coding, the content involving the people and institutions closest to YDFC (e.g., teachers, social workers) was coded within the microsystem. Next, we coded data involving the larger systems and laws that can affect individuals (e.g., Children’s Administration, ILPs) to the exosystem. These are consistent with Bronfenbrenner’s definition of the microsystem. Next we coded content that represented complex interactions occurring within the microsystem and between the microsystem and exosystem to the mesosystem. This interpretation of the mesosystem expands the definition by Brofenbrenner (1994), which limits it to the linkages between microsystems. Within each circle of our ecological model (Fig. 1), the people, settings, and systems unique to individuals in foster care are represented in bold print. The remaining elements potentially affect all youth with disabilities. Lastly, we elicited feedback from participants either in person or via email, whichever the participant preferred. The lead author asked all participants how accurately the narrative and model (Fig. 1) reflected their experiences. This member checking increases trustworthiness of our analysis (Patton, 2015). 3. Findings In this section of the article we will summarize the key findings/observations that emerged from our analyses of interviews with YDFC and a focus group with professionals who serve them. Emergent themes within and across participant data were mapped onto our model (Fig. 1) to categorize our data within the ecological layers were they occur. Therefore, findings are organized by layers of the ecological model. 3
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Fig. 1. An ecological model of the transition to adulthood for youth with disabilities who experience foster care.
3.1. Microsystem Bronfenbrenner (1994) describes the microsystem as “a pattern of activities, social roles, and interpersonal relations experienced by the developing person in a given face-to-face setting with particular physical, social, and symbolic features that invite, permit, or inhibit engagement in sustained, progressively more complex interaction with, and activity in, the immediate environment.” We coded the data that aligns with this definition to the microsystem. Themes from the interview data included unstable or negative housing experiences and lack of consistent, positive relationships. Stable, positive relationships were beneficial and were also coded within the microsystem. Focus group data coded with the microsystem included a lack of highly skilled social workers, special education teachers, and foster parents; similar to themes exposed in the interview data. We present these separately in our findings because lack of training was stressed within the professional focus group and relationship quality was reported in the interviews with YDFC. 3.1.1. Unstable or negative housing experiences Unstable housing occurred both in foster care and after the transition to adulthood. Of the placement types, participants reflected most negatively on their experience in group homes. Several participants said they “hated” group homes, because of their lack of privacy and free choices. One shared that the group homes were “the worst thing ever…in life” and she felt like “I'm this criminal that's in … this prison. And like cupboards are locked with food. And it's just, it was like this whole big thing and I hated it. I absolutely hated it.” Some participants said they were often afraid. They didn’t know where they would live next or whether they would have enough food. They were “just trying to survive.” One participant said that hope began with her connection to her foster mom. 3.1.2. Lack of consistent, positive relationships Contact with birth parents or siblings was infrequent or non-existent. One participant’s brother rejected her when she tried to reestablish their relationship. Another’s mother suggested she place her son into foster care, which further damaged their relationship. Existing relationships with adults in their lives were not always positive; and professionals serving the youth changed frequently. Due to frequent moves a social worker lost track of one of the participants – she called and said, “I don’t even know where you are.” Another participant’s foster family intercepted calls from the social worker. He never had a chance to share his perspective. He said he wondered if his “journey would have been different” if he communicated directly with his social worker. Conflicts with teachers were common. Several participants discussed differences in teaching styles at various schools. One participant reported a teacher said, “you will either learn the way I teach or you are not going to learn.” She then dropped out and later entered a GED program. Due to many moves and school changes, another participant lacked connection to her teachers and was credit deficient – when encouraged (mostly by her foster parent) to drop out and get her GED, she did. Developing strong peer relationships was also difficult due to frequent moves and school changes, and exclusion from activities typical of people their age. Several participants shared problems encountered when desiring a normal childhood experience (e.g., sleepovers) because adults present needed background checks. Participants expressed hesitancy to make friends because by the time 4
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they got to know somebody, they moved again. Contrastingly, some participants reported the effects of a positive relationship with a social worker or teacher. They expressed gratitude for social workers who went the extra mile, such as driving them to another state to see a birth parent, attending IEP meetings, or explaining the benefits of extended foster care. Participants frequently credited teachers for helping them stay in school by providing one on one support, advocating for schedule changes, and showing interest in them. [My teacher] can understand me a lot better because she knows how I feel, like when I get angry, she watched my facial expressions before I blow up or before I act up or whatever. She can see it before I do it, and she can take me aside and calm me down. A science teacher also made a noteworthy impression. Everybody else was like, ‘Oh, she's the foster kid!’ and I felt like she… didn't look at me like this foster kid. I felt like everybody felt bad for me. It's not like I wanted everyone to feel bad for me so… she was like the one person that was like, ‘Oh you're actually a human being’… I think she's the first teacher that actually like, really got me into considering college… For several participants, a stable placement and a consistent adult during high school prevented many of the challenges faced by others. A few reported that their foster mothers were actively involved in their education and adult lives. One credits her final placement with turning her life around. Her relationship with her foster mother went through periods of trial and periods of healing, but ultimately she was adopted and became a permanent part of the family. Focus group participants echoed the need for consistent positive relationships. “That stability of having a placement that feels like home and looks like home, and it has been like that for the majority of their life is, I think, the biggest indicator of reaching the level of success.” They reported youth who experience one or two placements often fared best. For youth who moved frequently, having one constant person whom they trusted was essential. Several focus group participants described how youth appreciate transparency and clear expectations. [Y]ou don’t have to be everything for me, but gosh, it really helps when I know what I can expect from you. It is cool if I can't live with you or leave my stuff at your place, or if you can't sign a lease agreement for me. But if I can come over on Friday nights and that is our thing and that will be consistent and maybe a long term thing, then that is so valuable to me. But please don't do the thing where you promise me the world and then a month later you are out of my life. Additionally, professionals said youth peer support groups are indispensable. Youth may feel less embarrassed or stigmatized around others with similar life histories. 3.1.3. Lack of highly skilled professionals Participants in the focus group remarked that youth only have access to resources their social worker or caregiver knows about. However, they are not always aware of all possible resources available. High turnover rates for social workers and special education teachers are concerning because people working with this population need specialized skills. Focus group participants said that many service providers do not understand developmentally appropriate adolescent behavior. It is a “systemic issue, and… teens are often just ‘being teens’ but when they experiment, they lose their placement or they go to jail or they lose resources.” 3.2. Mesosystem Bronfenbrenner (1994) describes the mesosystem “as a system of microsystems” or “the linkages and processes taking place between two or more settings containing the developing person.” In our model, we include interactions occurring within the microsystem and between the microsystem and exosystem because systems or laws within the exosystem directly affected what occurred within the microsystem. Two mesosystemic barriers were consistently identified across the interview and focus group data: frequent placement changes and inappropriate disability or mental health diagnoses. The third theme, barriers to employment, was unique to the interviews with young adults. The main beneficial theme to emerge was coordinated services within and across agencies, particularly when programs, systems, or laws in the exosystem worked together to provide appropriate mental health and disability services. 3.2.1. Frequent placement changes Interactions among laws, systems, and caregivers influenced the stability of YDFCs’ placements. As previously reported (Author, 2015), YDFC interview participants in this study experienced multiple placements and living situations, including living with a relative, foster homes, group homes, psychiatric hospitals, and specialized homes for teen parents. Several participants reported their foster parents to the authorities because of adverse treatment. One participant said his foster parents “would leave [him] outside… they did it in the winter, too. They would be gone for three or four hours with nothing to eat.” Professionals also reported placement changes as a significant barrier. One focus group participant said if a youth had more than three placement changes, he knew he was “going to have to dig in and really do some work.” Others said each placement change felt like starting the case over. They stressed the value of coordinated services and of understanding a youth’s goals. Professionals advocated for a whole team/cross systems approach to achieving goals and a thoughtful hand-off from youth to young adult programs. 5
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3.2.2. Inappropriate disability or mental health diagnoses Special education and mental health services received were not always appropriate. Frequent school changes resulted in invalid diagnoses or inappropriate IEPs. One participant reported that after a school change, her new school was unaware she had an IEP. Another participant was misidentified as “borderline retarded” and placed in a self-contained classroom, which she described as “traumatic” and “chaotic.” In another school, she received a proper diagnosis of specific learning disability in the seventh grade (and removal from the self-contained classroom) and dyslexia in ninth grade. Appropriate accommodations (e.g., audio books) needed for school success were finally identified. Inappropriate mental health diagnoses were also prevalent. One participant self-reported incorrect diagnosis of “bipolar” in the eighth grade. She reported the prescribed medication turned her into “a complete zombie.” Later, another psychiatrist said she was never “officially diagnosed” with bipolar disorder and questioned the prescription – then diagnosed depression, anxiety, and PTSD. Correct diagnoses and access to mental health services were transformative. A focus group participant said during “an issue identification process with youth,” overmedication and inappropriate institutionalization came up frequently. He shared the story of a youth who testified before Congress. At age seventeen she was – locked in a psychiatric facility and was on heavy doses of psychotropic medications that she did not want to take. She was picked up on her 18th birthday by a man who has now adopted her, and against doctor's order had to reduce and then discontinue taking medication…[S]he is 21, 22 now, living independently, has her AA, and is on no medication and feels really strong that the state made a huge mistake to lock her up, to give her multiple diagnoses that she feels weren't helpful for her to heal and move forward in her life. Her thing, her line is always, ‘Foster kids don't need pills. They need loving adults who are going to show up for them and actually adopt them because that is what worked for me.’
3.2.3. Barriers to employment ILPs helped set goals; however, staff did not always teach how to achieve the goals or explore options. One participant reported that no one ever discussed college or extended foster care with him. After being unsuccessful in finding a job, due to his disabilities, he was connected with the Division of Vocational Rehabilitation (DVR) and began receiving Social Security benefits. Another reported not being informed about workplace rights or receiving guidance about when or how to disclose her disability during a job interview. Her ILP program goal sheet stated that she will “get a job” but did not identify the steps needed to achieve the goal. 3.3. Exosystem Brofenbrenner (1994) describes the exosystem as the “linkages and processes taking place between two or more settings, at least one of which does not contain the developing person, but in which events occur that indirectly influence processes within the immediate setting in which the developing person lives.” Three themes of exosystemic barriers for YDFC emerged from our interviews. Themes were inconsistent high school graduation requirements; access to Independent Living Program (ILP) services; activities and services to support successful post-secondary transitions; and lack of safety nets after aging out. Ongoing supports and services were judged beneficial. Focus Group participants identified an inadequate service delivery model as the main exosystemic barrier. 3.3.1. Inconsistent high school graduation requirements Inconsistency in school policies and requirements for graduation between schools, districts, and states created hardship, especially for participants who experienced frequent school and placement changes. One participant summarized what others articulated: I had a really big problem because, once you get in high school, your credits follow you, and I was moving all over the place, and certain schools require certain things, and other schools required things that they didn't.
3.3.2. Inconsistent access to ILP services and activities and services to support successful post-secondary transitions YDFC participants felt inadequately prepared for adult living. One participant didn’t have access to an ILP until five months before beginning college. Many shared feeling unprepared for household responsibilities (e.g., bill paying or budgeting). I knew people paid bills, but I didn't know how to do it…It was something that everybody told me, it was something I had to do, but nobody really talked about how to do it.
3.3.3. Lack of safety net Several participants reported a lack of services after “aging out” of foster care. Four of the seven participants experienced homelessness. Reasons included conflict with a foster parent, failed attempts at living with friends, and aging out with no place to go. Participants who accessed adult services and Social Security disability benefits fared better. Two participants agreed to extended foster care, during college, after their social workers explained they could receive benefits while living independently (in approved housing). ILPs that provided housing and household necessities, bill paying classes, referrals to other agencies, and assistance with college and job applications were useful. Programs for homeless youth provided services such as GED completion, community college and financial aid application assistance, and temporary housing. 6
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3.3.4. Inadequate service delivery model The focus group with professionals revealed many caregivers are isolated, unsupported, need ongoing training, and respite to improve placement stability. Participants also commented on providers’ lack of cultural competence. One focus group participant provided an example of how the system is also not designed to address cultural needs of immigrants and/or refugees, which may result in multiple placements because the caregiver and youth’s beliefs systems are not in alignment. In addition, issues like citizenship complicate the transition to adulthood and may not have been addressed before the youth ages out of care. Another focus group participant agreed and added that cultural competence training is needed so caregivers know how to relate to a youth of another ethnicity and what to do if the youth “doesn’t know how to relate to them.” 4. Discussion Due to the paucity of literature describing experiences of YDFC (Geenen & Powers, 2007), we designed this study to gain understanding of the process of their transition to adulthood. Although we initially hoped our study would illuminate a wealth of services and supports that were helpful for this population, the numerous barriers shared by participants frequently overshadowed services and supports that were helpful and their transitions were turbulent. Perhaps the most striking finding was that although the professionals serving these young adults perceived them as doing very well, all had experienced extremely challenging transitions. 4.1. Exosystem The complexity of the transition to adulthood for YDFC warrants a correspondingly sophisticated response from professionals and systems that are charged with assisting them. The model we generated facilitates understanding of the complex interactions among the systems, services, and people that influence the lives of YDFC. Our approach also illuminated the contexts and social relationships that intersect during the transition to adulthood for YDFC. Our findings and model expand the literature on YDFC and can facilitate improvements in service delivery to this vulnerable population. Many systems and laws directly impact YDFC, including social service agencies program policies, national and state educational laws, and the political climate. The lack of consistent national high school graduation requirements created barriers for youth who experienced high mobility. The absence of national laws and systems to mediate the effects of mobility hinders the transition to adulthood for YDFC. According to Casey Family Programs (Joftus, Cross, & Joftus, 2007), one of the biggest barriers to school success for youth in foster care is mobility – several recommendations for improvement include expansion of the McKinney-Vento Homeless Assistance Act (42 USC 11431 et seq.) to cover all youth in out-of-home care and expansion of associated funding. Youth in care could then remain in their school of origin (whenever possible) and receive transportation to school. Currently, only youth awaiting foster care placement or within 30-days of their shelter care order qualify for transportation services. Additionally, adequate and fully funded ILP services are not universally available (or accessible to youth with disabilities). Participants who experienced a program matching their needs reported benefits, however many others left their ILPs feeling unprepared for adult life. The variability in quality and services provided by ILPs and their accessibility and appropriateness for those with disabilities is also reflected in the literature (Geenen & Powers, 2007). YDFC have few options as to where they can receive services and what services are offered. Courtney et al. (2005) reported 11–27 % of alumni of foster care received independent services while still in care. Without these services, youth in foster care may not gain essential skills, since they often lack family or other community support networks that could teach them (Samuels and Pryce 2007). Overall an inadequate service delivery model contributes to instability for YDFC. Due to a lack of professional development and training, many caregivers working within the system are unprepared to support youth with diverse needs (e.g., different cultural backgrounds, disability, or mental health diagnosis) and often cannot determine if ILP, special education, or mental health services are appropriate and/or adequate. Moreover, children of diverse backgrounds are overrepresented in the child welfare system and their adult outcomes are disparate when compared with those of Caucasian children (Clark, Buchanan, & Legters, 2008). Therefore, caregivers must be culturally competent to best serve the youth in their care (Collins, 2004). Systems that serve youth in foster care must be designed to address the needs of youth from diverse cultural backgrounds and those with disabilities or mental health diagnoses. YDFC lose their manufactured safety net when as they “age out” of the system. Without a safety net, homelessness occurs frequently – the case in over half of the youth in our study. Casey Family Programs (2008) reported that 22 % of alumni of foster care between the ages of 18 and 24 experience homelessness for at least one day after leaving care. Unfortunately, the level of support available to youth aging out of care depends on where they reside; not all U.S. states guarantee the same level of support. Therefore a safety net that continues after they leave care must be created – through formal or informal services (e.g., supportive extended family, continued adult relationships with foster parents, extended foster care, or supported housing programs for individuals with disabilities). 4.2. Mesosystem Barriers encountered due to poor communication and/or lack of coordinated services could be remedied through improved intraand inter- agency collaboration. Frequent placement changes were one of the most prevalent and damaging barriers encountered by our participants. Their loss of family and place frequently occurred because of decisions made by social workers and caregivers (microsystem), the rules and regulations of the system (exosystem), or the interaction between service providers and the system. The 7
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YDFC had little or no control during these interactions and were often left with negligible support to process the loss. While the Adoption and Safe Families Act (1997), passed twenty years ago, requires social workers to plan concurrently for youths’ reunification with their families and adoption, only one of the young adults in our study experienced a successful adoption (and that was not until she was an adult). Also noteworthy, none of our participants experienced reunification with their biological families before aging out of care. Poor communication within and between systems also resulted in inappropriate diagnoses for special education, lost knowledge about eligibility for special education, and lost IEPs. This breakdown contributed to a host of problems. One participant received special education services in a self-contained classroom despite her capacity to participate in the general student population. Additionally, several participants received inappropriate mental health diagnoses and professionals reported overmedication of youth in foster care. Corroborating this concern, Raghavan et al. (2005), examining data from the National Survey of Child and Adolescent Well-Being, concluded that children in the child welfare system receive psychotropic medications at two to three times the rate of their peers outside the system. Employment barriers encountered by participants also highlight the interaction between multiple layers within the model – employers (microsystem) and civil rights laws (exosystem). Two important school outcomes for youth with disabilities are understanding their disabilities so they can express how it affects their adult lives and understanding their associated rights (Pyle & Wexler, 2011). In our study, two participants experienced barriers to employment due to their medical or mental health needs. However, they were never taught their rights or how to disclose their disabilities to employers. In addition, they received no training on advocating for accommodations needed to succeed in the workplace. Only one participant was connected to DVR. Knowledge about disability rights and how to access workplace accommodations are vital – individuals must self-disclose before requesting accommodations. Teaching about disability, the use of accommodations, and the Americans with Disabilities Act should be included in transition plans – along with an exploration of methods and timing for disclosure (Doren, Lindstrom, Zane, & Johnson, 2007; Madaus, Gerber, & Price, 2008). Students connected to a rehabilitation counselor in high school are more likely to use their services as an adult – gaining important access to career counseling, vocational assessments, work placement, and referrals for medical and therapeutic services and assistive technology (Agran, Cain, & Cavin, 2002). Our participants could have benefited from such services; several unemployed participants strongly voiced wanting a job. Ultimately, coordinated services produce positive results. Participants benefited from appropriate mental health or disability services. Therefore, as our focus group participants suggested, it is prudent to improve training for service providers and caregivers. Service providers cannot refer their clients to services if they do not know how to do so or understand what is available. Our findings also demonstrate how high turnover rates among social workers, resulting in a continuous pool of relatively new professionals, adds to the complexity of coordinating services for highly mobile youth. This issue is problematic at both the microsystem and exosystem level, since the high rate of turnover needs to be addressed systemically (exosystem) but its impact if felt at the microsystem level. 4.3. Microsystem Our findings suggest that the proximal institutions and people closest to YDFC often have the biggest effect on their transition to adulthood. Research suggests that supportive relationships protect against poor outcomes for youth in foster care (Samuels & Pryce, 2008). Unfortunately, many of our participants reported poor relationships with their foster families and had little to no contact with their biological families. The participants that reported positive relationships (e.g., social workers, teachers, foster parents) expressed gratitude and acknowledged needing the extra support to succeed. Murray (2003) suggests that positive teacher–student relationships have a lasting effect on youth with disabilities. Our results support this. Several participants shared that even one positive relationship with a teacher changed the way they felt about education and their future possibilities. They also credited teachers for helping them stay in school. Therefore, teachers may be especially important for the success of YDFC. 5. Implications for practice Greater awareness is needed about the social contexts, relationships, systems, and service providers that affect YDFC. Without careful attention YDFC can slip through the cracks resulting in unmet needs during adolescence and poor adult outcomes. Our model provides a visual representation that can be a useful guide when designing interventions for YDFC. It can serve as a reminder to open dialogue with potential collaborators to align goals, save time, and ensure service providers are not working at cross purposes. In Table 2, we provide recommendations for practice and resources for professionals. 5.1. Limitations of the study This study has several limitations that should be noted. The interviews occurred in a short time frame; a longitudinal study would provide more information about changes in adult outcomes across time. All participants lived in the same geographic region and experienced the same state system, which might not be transferrable to other states. Additionally, few males and no transgender YDFC were referred to the study – it is unknown how a gender may impact the themes. 6. Implications for future research This study fills an important gap in the existing literature by proposing an ecological approach to transition planning for YDFC. 8
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Table 2 Needs identified, recommendations, and resources to improve services provided to YDFC during their transition to adulthood. Identified Need
Recommendation
Resources
Systems Improvements
Build collaborative networks to better recruit, support, and retain foster parents trained in the needs of youth with disabilities and mental health needs Advocate for continued funding for extended Foster Care Provide ongoing cultural competency training to caregivers Provide training for caregivers and social workers about disabilities and IDEA Advocate for national standardized high-school graduation requirements Transition planning meetings should include all professionals providing services To facilitate goals alignment between systems/ providers, teach YDFC self-advocacy and selfdetermination skills. Empower them to lead their transition planning meetings Special educators can share evidence-based practices for transition and the youth’s identified disability and with foster parents and social workers Help youth remain in schools, in which they report positive relationships with teacher; or help them maintain those relationships if they must relocate. Ensure YDFC maintain contact and relationships with biological family, whenever possible
Child Welfare Information Gateway https://www.childwelfare.gov
Interagency Collaborations
Positive Relationships
CASA: Court Appointed Special Advocates for Children http://www.casaforchildren.org/site/c.mtJSJ7MPIsE/b.6367927/ k.1D9A/Cultural_Competence__Diversity__Inclusion.htm IDEA: Individuals with Disabilities Education Act https://sites.ed.gov/idea/
Taxonomy for Transition Planning 2.0 https://transitionta.org/sites/default/files/Tax_Trans_Prog_0.pdf National Technical Assistance Center on Transition: NTACT https://transitionta.org/
Law Center for Foster Care & Education http://www.fostercareandeducation.org/AreasofFocus/ EducationStability.aspx
Family Engagement: A Web-Based Practice Toolkit http://www.nccwe.org/toolkits/family-engagement/introduction.htm
Our findings confirm multiple barriers previously reported in the literature and highlight the need for improved interagency collaboration and more research in this area. Additional research should investigate the role of gender on transition outcomes for YDFC. Finally, we recommend research to expand our model to include additional layers of that we did not address in this study (i.e, macrosystem and chronosystem). This would help place the transition of YDFC within the environmental and cultural contexts that influences them, their education, and services available. Acknowledgments This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Appendix A. Supplementary data Supplementary material related to this article can be found, in the online version, at doi:https://doi.org/10.1016/j.chiabu.2019. 104310. References Adoption and Safe Families Act (1997). P.L. 105–189. Agran, M., Cain, H. M., & Cavin, M. D. (2002). Enhancing the involvement of rehabilitation counselors in the transition process. Career Development and Transition for Exceptional Individuals, 25(2), 141–155. https://doi.org/10.1177/088572880202500204. Bronfenbrenner, U. (1979). The ecology of human development (1st ed.). Cambridge, Mass: Harvard University Press. Bronfenbrenner, U. (1994). (2nd ed.). Ecological models of human devleopmentVol. 3Pxford: Elsevier. International Encyclopedia of Education. http://www.psy.cmu. edu/∼siegler/35bronfebrenner94.pdf. Casey Family Programs (2008). Supporting success: Improving higher education outcomes for students from foster care – A framework for program enhancement. Seattle: WA. Retrieved fromhttp://www.casey.org/resources/publications/SupportingSuccess.htm. Charmaz, K. (2006). Constructing grounded theory: A practical guide through qualitative analysis. London: Sage Publications. Clark, P., Buchanan, J., & Legters, L. (2008). Taking action on racial disproportionality in the child welfare system. Child Welfare, 87(2), 319–334. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/18972945. Collins, M. E. (2004). Enhancing services to youths leaving foster care: Analysis of recent legislation and its potential impact. Children and Youth Services Review, 26(11), 1051–1065. https://doi.org/10.1016/j.childyouth.2004.08.005. Courtney, M. E., Dworsky, A., Ruth, G., Keller, T., Havlicek, J., & Bost, N. (2005). Midwest evaluation of the adult functioning of former foster youth: Outcomes at age 19. Chicago: Chapin Hall Center for Children at the University of Chicago. Doren, B., Lindstrom, L., Zane, C., & Johnson, P. (2007). The role of program and alterable personal factors in postschool employment outcomes. Career Development for Exceptional Individuals, 30(3), 171–183. https://doi.org/10.1177/08857288070300030601. Geenen, S. J., & Powers, L. E. (2006). Transition planning for foster youth. The Journal for Vocational Special Needs Education, 28(2), 4–15. Geenen, S., & Powers, L. E. (2007). Tomorrow is another problem. Children and Youth Services Review, 29(8), 1085–1101. https://doi.org/10.1016/j.childyouth.2007. 04.008.
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