Former Foster

System YouthPerspectives on

Transitional Supports &

Programs

Amy Armstrong-Heimsoth, Molly Hahn-Floyd, Heather WilliamsonGary Webb, Shevaun Sullivan

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Acknowledgements

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Acknowledgements

This project was funded by a Northern Arizona University, College of Health & Human Services Dean Seed Grant

Special thanks to Jonathan Kurka, Paulina Calli, Tessa Burt & Casey Blaesing

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Goal

Create a sustainable, evidence-based transition program for OCJ Kids to implement with foster youth transitioning into adulthood

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State of the evidence

Accessing services

Discourage

● Learned

helplessness1,3

● Lack of placement

permanency1,3

● Physical move4-5

● Lack of trust4-5

Encourage

● Empowerment1-2

● Goal-oriented4

● Financial aid4

● Placement

permanency1-2

● Stay in care <6 mos.

post-charge4

● One important

person1-2

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State of the evidenceResiliency

Increase resilience● Sense of identity6-9

● Future expectations6-9

● Support system6-9

● Independent living skills6-9

Decrease resilience● Living w/family member or

contact w/family member post-discharge8

● Behavioral problems8

● External problems8

“Successfully overcome significant adversity, despite their exposure to multiple high risk situations”10(p.30)

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● Greater risk for mental health & substance abuse disorders than their peers11

○ Multiple placements increase risk for substance abuse● Transitioning more difficult with behavioral health & substance use disorder11

● Reported decreased confidence in accessing behavioral health services12

○ Limited knowledge regarding diagnoses & services12

● After transition, drop out rate from behavioral health services is 60%14

State of the evidenceBehavioral health & substance abuse

Lack of well disseminated evidence-based programs (EBP)

Lack of agreement regarding best supports to provide at transition

Limited understanding of utilization rates of transition services

Implementation science

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Objectives

1) What do foster youth see as their strengths during the transition into adulthood?

2) What do foster youth see as their needs during the transition into adulthood?

3) What drives post-discharged foster youth to utilize transition supports programs?

4) What are foster youth provided upon discharge now and what would they change about these provisions?

Methods

Qualitative interviews - Inductive/deductive

analysis using Person-Environment-Occupation-Performance (PEOP) model

Support Network Map- Who do they get

support from?- What type of

supports do these individuals/organizations provide?

Child & Youth Resiliency Measure (CYRM)

- 12 item resiliency scale

- Independent samples t test 10

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DemographicsGroup A- continuous, utilized transition services immediatelyGroup B- delayed, lost or had no transition services

Convenience sampling from OCJ Kids and transitional programs: Young Adult Program (YAP), Youth Advisory Board (YAB), and Transition to Independent Living Program (TILP)

Group A Group B

N 11 5

Gender (n, % female) 5 (45) 3 (60)

Age (mean years ± SD) 18.3 ± 0.48 19.2 ± 0.84

Ethnicity (n, % of group)

Caucasian 8 (73) 1 (20)

Hispanic 7 (64) 2 (40)

Other 4 3

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DemographicsChi-square test for group differences indicated the following differed between groups (p<0.05)

Group A Group B

Employed 5 (46) 2 (40)

Places Lived

1-2 11 (100) 0 (0)

>3 0 (0) 5 (100)

Housing Reliance 2 (18) 4 (80)

Homelessness 1 (9) 3 (60)

Food Scarcity 0 (0) 3 (60)

““All right, now you’re 18, go be normal.”

- Interviewee 8A

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Support network maps

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Support network maps

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Child Youth Resiliency Measure (CYRM)

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Difference in resiliency scores were not statistically significant between group A and B

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Person Environment Occupation Performance (PEOP) model

PersonAutonomy

Advocacy Confusion Awareness Independence Motivation

FamilyShow me you care Future-oriented

Independence Self-reliant

OccupationEnvironmentHousingFinancesStructure

Lack of discipline

Person + EnvironmentRelationshipTrust mentorLearned complianceLearned helplessnessNormalcySupport

Person + OccupationReputationIdentityRoleRoutine

Performance/OutcomeResiliency

Occupation + EnvironmentInformationAccessibilityClient-centered

PersonAutonomy

“When I was little, I didn’t really knowwhat I was going to do. Like when I was little,I really thought I was just going to go to jail,and when I was 13, 14, I was like, ‘Well,if I’m going to go there,I might as well just go right now.’”

- Interviewee 8A20

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- Person- Show me you care

- “She knows my schedule and stuff. She’s like, “Come over to my office.

- Let’s just talk and catch up,- and I’m like, ‘Yay.’”

- Interviewee 10A

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Person + EnvironmentRelationship

“A lot of the things that I learned from her are a lot of things that I use today. Like that’s how I go about my life.”

- Interviewee 4A

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Person + EnvironmentRelationship“It’s okay to reach out to someone if you need support. It’s okay to reach out to someone in behavioral health services if you’re breaking down over something or life gets so stressful…It’s okay to reach out to DCS and other case workers if you’re not getting the assistance that you need or something is not quite right.”

- Interviewee 1B

Person + EnvironmentLack of support

“That’s one thing I’ve learned,I just can’t wait around for people.

You just got to make it happen.If they can’t do it right, do it yourself.”

- Interviewee 8B

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Person + EnvironmentLack of support

“So if I’m not going to help you out,why would you help me out?

So, it was just mainly me.”-Interview 8B

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Lack of occupationNormalcy

“I haven’t experienced like a lot of normal stuff.Just like just going to school or just living with the family in that house or just – like a lot of things – like sometimes I’d be feeling really nervous because sometimes I feel like I don’t really know how to act around people like just being normal...”

- Interviewee 8A26

Lack of occupation

“‘No, I’m going to teach you how to make this and then next time you’re going to make this.’Like actual teaching.We just live here and just get lazy…”

- Interviewee 2A27

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Implications for adolescent behavioral health● Research● Policy● Practice

Future research

● Placement type- congregate care○ ↓developmental & decision making skills○ ↑diagnoses, placements

● Temporal aspects- across life span15

● Hard to reach youth

Policy● Aligning ‘aging out’ with transition timelines already existing for high

risk populations (IDEA -Individuals with Disabilities Education Act) ● Occupational therapist’s involvement in transition as ‘other child

representatives which are most appropriate’ according to already established federal law for transition teams

● “Occupational therapy can make a distinct and powerful contribution to improving transition outcomes to further education, employment, and independent living”16n.p.)

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Develop list of questions for each type of support offered

Build social skills

Provide occupational opportunities

Practice

Increase peer supports

Increase decision making opportunities

Cowboy camp-opportunity to begin the conversation

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● Person centered● Relationships

○ Trust○ Accountability○ Respect

● Information● Promptness

Practice:Changes to current provisions

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“You just show them that they matterin this world and show them the love.It’s all they need.”

- Interviewee 4B

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Questions?

References1)Gomez RJ, Ryan TN, Norton CL, et al. Perceptions of learned helplessness among emerging adults aging out of foster care. Children and Adolescent Social Work Journal. 2015;32:507-516.

2) Pecora PJ. Maximizing educational achievement of youth in foster care and alumni: Factors associated with success. Children and Youth Services Review. 2012;34:1121-1129.

3) Edelstein S, Lowenstein C. Transitioning out of foster care: Employment. Washington, DC: US Department of Health and Human

Services Administration for Children and Families, 2014.

4) Courtney ME, Dworsky A, Ruth G, et al. Midwest evaluation of the adult functioning of former foster youth: Outcomes at age 19. Chicago,

IL: University of Chicago Chapin Hall Center, 2005.

5) Braciszewski JM, Tzilos Wernette GT, Moore RS, et al. Developing a tailored substance use intervention for youth exiting foster

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6) Samuels GM, Pryce JM. “What doesn’t kill you makes you stronger”: Survivalist self-reliance as resilience and risk among young

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8) Jones L. Measuring resiliency and its predictors in recently discharged foster youth. Child and Adolescent Social Work Journal. 2012;29:515-533.

9) Jones L. The first three years after foster care: A longitudinal look at the adaptation of 16 youth to emerging adulthood. Children and Youth Services Review. 2011;33:1919-1929.

10) Strolin-Goltzman J, Woodhouse V, Suter J. A mixed method study on educational well-being and resilience among foster care.

Children and Youth Services Review. 2016;70:30-36.

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References11) Administration for Children and Families. Number of children in foster care continues to increase. US Department of Health and Human

Services. Available online at https://www.acf.hhs.gov/media/press/2017/number-of-children-in-foster-care-continues-to-increase. Accessed

on March 9, 2018.

12) Sakai C, Mackie TI, Shetgiri R, et al. Mental health beliefs and barriers to accessing mental health services in youth aging out of foster

care. Academic Pediatrics. 2014;14(6): 565-573.

13 ) Rutman D, Hubberstey C. Is there anybody there? Informal supports accesses and doubt by youth from foster care. Children and Youth Services Review. 2016;63:21-27.

14) Havlicek J, Garcia A, Smith DC. Mental health and substance abuse use disorders among foster care youth transitioning to adulthood: Past research and future directions. Child and Youth Services Review. 2013;35:194-203.15) Havlicek J. Lives in motion: A review of former foster youth in the context of their experiences in the child welfare system. Children and Youth Services Review. 2011;33:1090-1100.

16) American Occupational Therapy Association. Transition Resources. Retrieved from https://www.aota.org/Practice/Children-

Youth/Transitions/Resources.aspx. Accessed on December 1, 2018.

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