Policy and Supports to Facilitate the Transition to Adulthood

Policy and Supports to Facilitate the Transition to Adulthood Table of Contents EXECUTIVE SUMMARY ..........................................................................................................................................i INTRODUCTION .......................................................................................................................................................1 RESEARCH COMPONENTS: PURPOSE AND METHODS ...............................................................................3 FINDINGS: DSS ADMINISTRATIVE DATA ........................................................................................................8 FINDINGS: RETROSPECTIVE SURVEY OF YOUTH .....................................................................................11 FINDINGS: QUALITATIVE STUDY OF YOUTH RETURNING TO CARE..................................................37 FINDINGS: STAKEHOLDER INTERVIEWS .....................................................................................................56 CONCLUSIONS AND RECOMMENDATIONS ...................................................................................................68 ii Table Index TABLE 1: DEMOGRAPHIC DATA ................................................................................................................................8 TABLE 2: REASONS FOR HOME REMOVAL (% YES) ...................................................................................................9 TABLE 3: END REASONS FOR HOME REMOVAL .........................................................................................................9 TABLE 4: PLACEMENT SETTINGS ACROSS 10 PLACEMENTS......................................................................................10 TABLE 5: LENGTH OF STAY (IN DAYS) ACROSS 10 PLACEMENTS..............................................................................10 TABLE 6: GEOGRAPHIC REGION ..............................................................................................................................11 TABLE 7: DEMOGRAPHICS.......................................................................................................................................12 TABLE 8: SERVICES RECEIVED ................................................................................................................................13 TABLE 9: PERCEIVED HELPFULNESS OF SERVICES RECEIVED ...................................................................................16 TABLE 10: SERVICES NOT RECEIVED THAT WOULD HAVE BEEN HELPFUL ................................................................16 TABLE 11: EXPERIENCE WITH DSS .........................................................................................................................17 TABLE 12: YOUTHS’ PERCEPTIONS OF YOUTH DEVELOPMENT APPROACHES USED ..................................................18 TABLE 13: SATISFACTION .......................................................................................................................................19 TABLE 14: RESPONDENTS CONTACTS WITH BIRTH FAMILY MEMBERS .....................................................................19 TABLE 15: TYPES OF CONTACTS WITH BIRTH MEMBERS ..........................................................................................19 TABLE 16: MENTOR TYPE .......................................................................................................................................20 TABLE 17: TYPES OF SUPPORT PROVIDED ................................................................................................................22 TABLE 18: HOUSING OUTCOMES .............................................................................................................................23 TABLE 19: EDUCATIONAL OUTCOMES POST AGE 18 ...............................................................................................24 TABLE 20: EMPLOYMENT AND FINANCIAL OUTCOMES ...........................................................................................25 TABLE 21: HEALTH OUTCOMES ...............................................................................................................................26 TABLE 22: RISKS.....................................................................................................................................................27 TABLE 23: COMPARISON OF SERVICES RECEIVED ....................................................................................................29 TABLE 24: COMPARISON OF EXPERIENCES IN DSS ..................................................................................................29 TABLE 25: RELATIONSHIP BETWEEN CARE STATUS AND OUTCOMES .......................................................................31 TABLE 26: RELATIONSHIP BETWEEN DEMOGRAPHICS AND OUTCOMES ...................................................................34 TABLE 27: RELATIONSHIP BETWEEN SERVICES RECEIVED AND OUTCOMES .............................................................36 TABLE 28: DEMOGRAPHICS .....................................................................................................................................37 TABLE 29: DSS EXPERIENCE ...................................................................................................................................37 TABLE 30: SUMMARY OF OUTCOMES ......................................................................................................................54 iii Executive Summary Young adulthood is a challenging developmental time period even under the best of circumstances. For youth leaving foster care to transition to a life of independent adulthood this period has particular challenges. Although many of these young people have both the internal resilience and external support to successfully manage this challenge, for others serious obstacles can temporarily or permanently derail prospects for a healthy adulthood. Numerous studies have identified that former foster youth who leave care at age 18 are vulnerable to a wide variety of negative outcomes. None of these studies, however, focused specifically on Massachusetts. The current study was designed to spotlight the situation in Massachusetts with the intent to produce data for use in developing enhanced strategies to assist transition-age foster youth with establishing a successful young adulthood. This study was conducted in response to a Request for Proposals (RFP) issued by the Massachusetts Task Force on Youth Aging Out of Department of Social Services (DSS) Care. The RFP indicated the desire for a study to gather information related to: • the quantity and quality of transitional services youth received or utilized while in care; • outcomes achieved within 1-2 years of leaving custody; • relationship between services received and youth outcomes; • policy and program responses needed to improve outcomes for these youths. To address these information needs we designed a study with four components: • an examination of DSS administrative data; • a retrospective survey of youth who turned 18 while in care; • a qualitative study of youth who have re-entered care after 18; • interviews with key policy and program stakeholders. These multiple methods were utilized to provide a comprehensive perspective on the issue of youth transitioning from care. Key Findings Numerous findings are provided in the final report. The findings reflect analysis of DSS administrative data for 812 youth who turned 18 in 2005, surveys with 96 former foster youth, qualitative interviews with 16 youth who re-entered care after age 18, and qualitative interviews with 30 policy and program stakeholders. Selected findings are highlighted below. i Analysis of State Agency Data • 812 youth turned 18 while in the care of DSS in 2005. • The most frequent reasons why these young people were initially removed from their homes were: child behavior problems (34%), neglect (27%), and caretaker inability (25%). • Being on the run from placement was not uncommon; approximately 5% of youth placed out of home were on the run. Retrospective Survey of Youth • Prior to age 18: 46% received assistance with high school or GED; 53% with reconnecting with family; 38% with employment; 66% with life skills; 83% with accessing health care; and 48% with housing assistance. • Post age 18: 41% received assistance with high school or GED; 21% with reconnecting with family; 33% with employment; 28% with life skills; 62% with accessing health care; and 44% with housing assistance. • In all categories, both prior to and after age 18, at least 75% of those receiving these services reported them to be helpful. • Housing assistance was the most common service that young people thought would be helpful. • Over half of the sample reported having a DSS outreach worker at some point in care (pre or post 18); feedback about this service was generally positive. • Both quantitative and qualitative feedback about experiences with DSS care were overall more positive than negative and identified several experiences with caring workers. Often, however, young people did express the belief that the agency or workers could have done more for them. • Qualitative comments about earlier foster care experiences suggested many young people perceived these experiences negatively. • The majority of respondents (90%) had contact with their birth families. Siblings and mothers were the most frequent family members with whom the young people were in contact. • The majority of respondents (69%) reported that they had a mentoring relationship with an adult other than a parent or guardian. • Data on outcomes included the following: o o 37% reported an experience of perceived homelessness since age 18 Since age 18: 62% had completed high school, 28% had completed a GED, 38% had completed a job training program, and 42% had enrolled in college ii o o o o o o o o o o 46% were currently employed; of these, 55% were employed more than 20 hours per week average monthly income was $621; less than half (43%) reported being able to save money 70% reported excellent or good physical health; 49% reported excellent or good emotional health 95% were able to see a health care provider, when needed, in the past year; 87% were able to see a counselor or therapist, when needed, in the past year 43% have been pregnant or gotten someone pregnant 30% reported being threatened or injured with a weapon in the previous 12 months 33% reported ever having been hurt physically and/or sexually on a date 11% reported sexual contact against their will within the past 12 months 67% had not used illegal drugs and 69% had not drunk heavily in the past 30 days 59% reported within the past 12 months having felt “sad or hopeless almost every day for two weeks or more in a row.” • Outcomes were generally better for those young people who were still in care versus those not in care although it is uncertain whether being in care protects against negative outcomes or whether those doing better on these outcomes are more likely to remain in care. • Those still in care reported more empowering treatment while in foster care and more satisfaction with services from DSS than those who were no longer in care. Qualitative Study of Youth Who Return to Care • Reasons for choosing to initially leave care included: desire for independence, failure of their last placement/living situation, being tired of programs and placements after a long history of care, and running from placement. • Youth experienced greater freedom in decision-making when they returned to care post-18 and this helped make their experience with DSS better than it had been prior to age 18. • Youth expressed appreciation and positive feedback for the work of the DSS adolescent outreach worker at this stage in their life. • The main reason young people chose to return to DSS care was because of the concrete assistance DSS could provide, primarily with housing and educational assistance. Some had experienced a crisis after living on their own that led them to ask for help. Stakeholder Interviews • Stakeholders had a variety of perspectives on the problem of youth transition and potential solutions. Some of the key system problems identified included: the core focus of the child welfare system is child protection which is not congruent with this population; state agencies do not work collaboratively to serve this population; there is a lack of existing opportunities and iii options for this population (especially housing); implementation of large scale initiatives is lacking even when there is vision; and there is no accountability for poor outcomes. • Potential solutions included: create a sense of permanency for these youth; develop better data, research, and evaluation systems; develop more comprehensive youth-development-oriented programming; enhance coordination among state systems; create legislative change that supports services to this population; and encourage more youth to sign back in for care post-18. • Two political challenges to serving this population included the belief that children and adolescents do not get a fair share of political attention and that resources to assist them are constantly inadequate. There was some political optimism expressed, however, due to the new governor and committed members of the legislature. Conclusions and Recommendations Concrete assistance, especially with employment and housing, is warranted. In other domains, such as health care and education, positive outcomes are more apparent. The challenges of employment and housing appear more difficult, hence they require concentrated attention. Additionally, these are the two service areas that youth most frequently suggested would be helpful to them (Table 10). Good employment opportunities not only provide skills and entrée into the world of work, but can also provide the natural mentoring opportunities that provide sustained interpersonal connections as well as enhanced linkage to the world of work and the possibility of career trajectories. We found very little evidence of concentrated planning and linkage to sustained employment. It was noted by some respondents that although federal, state, and local employment and training programs are technically open to foster youth, in reality it can be hard to get these young people into these slots. While education is important, and may lead to good jobs in the long term, more immediate employment options are also needed. Many youth spoke about completing high school or obtaining a GED while others spoke about enrolling in college. These are obviously fine accomplishments. It is important to consider, however, the appropriateness and timing of continued educational pursuits. Young people described instances in which education was pushed on them in order to receive services. This practice should be reexamined. Youth who are not ready to attend secondary or proprietary schools should be allowed to explore alternative transition pathways, namely employment. Although education is an important and easily measured outcome, it should not be a standard pathway by which all youth are measured. Housing assistance is definitely needed and we believe this may be the most difficult challenge for this population because of the high cost. When asking respondents about the housing assistance they received, most responses focused on foster homes and group care or independent living arrangements. This is not the kind of housing assistance the questions sought to elicit but the answers are indicative of the rather short-term approaches that seem to be in play. The high percentage of young people who reported episodes of homelessness since age 18 also indicated problems in this area. Housing experts participating in the stakeholder interviews spoke well on this issue, but other stakeholders rarely addressed housing needs at all. Further efforts in this area need to make use of housing experts, who identified the need for additional rent subsidies as part of the solution. iv Given the feedback provided by the surveyed youth about their experiences in the foster care system (Appendix B), we suggest greater attention to the selection and oversight of foster parents, as well as mechanisms by which youths’ voices about their foster care experience while in placement can be heard. Respondents’ statements of their negative earlier experiences in foster care surprised us because this was not the focus of the survey. It clearly must be important if so many youth speak to it when not even prompted by a specific question. We had expected the feedback that youth would provide would be more focused on their transition experience; instead, a sizable number focused on their earlier, negative experiences in foster care. Aside from the need to address this issue for all the current young people in foster care, it may also suggest that for transition-age youth this continued focus on their painful earlier experience and the associated trauma, may inhibit their ability to be fully successful in their transition. We recognize that the lack of sufficient quality foster homes is a substantial problem. DSS needs assistance to address this problem; citizens of the Commonwealth need to share this responsibility by stepping forward to serving as foster parents and to support foster parents and foster children in their communities. DSS is responsible for recruiting, training, and licensing foster homes, but this work can only be done if there is a sufficient supply of quality foster homes available. Much of the data gathered from young people illustrate their “likeability” and similarity to other young people in their age group. Other data spoke to the negative public perceptions regarding adolescents in care. Greater efforts to change these negative inaccurate perceptions of young people are needed and may serve foster home recruitment efforts. As for mechanisms by which youth voices can be heard regarding their current foster care experience, there are multiple options for this and we assume that DSS already has some mechanisms in place. Review of these options should be conducted, including the establishment of a children’s ombudsperson to receive and address these complaints. Additionally, periodic surveys of all youth in foster care, independently conducted, might be used as a protective mechanism. The data suggest, for the most part, young people who had access to the DSS adolescent outreach program found this experience to be helpful and felt a good rapport with their outreach worker. Data also suggest that many young people do not have access to this service. Expansion of the DSS adolescent outreach program to serve a greater number of youth is recommended. Unlike many other child welfare services, providing outreach services, like other post-18 services, can be relatively low cost. Much of the work involves guidance, check-in, and concrete assistance by a supportive, knowledgeable worker. This type of service does not carry the same expense as residential or therapeutic services, for example. Currently all funding for the adolescent outreach program is provided by the federal government. State funding is needed to expand the program. Much of what we heard from young people in this study seems reminiscent of the challenges of the vast majority of young adults. To the extent possible, programming should emphasize a normative model of intervention. Interventions need to treat them like young adults. They appear to respond well to guidance rather than rules. Several spoke of their greater satisfaction with post-18 care than pre-18 care because of this difference. Furthermore, the voluntary nature of post-18 services makes a big difference to the young people. Enhanced efforts to allow young people as much real choice and voice as possible prior to 18 may lead to greater satisfaction with DSS services. The extensive lack of collaboration among the state agencies who serve this population was identified as a problem by many. This is a long-standing problem for children’s services in nearly every state in the country and there appears to be virtually no progress on this problem. It is clearly related to v state agency resources. When state agencies have difficulty meeting the needs of their core populations they will always remain reluctant to expand their services to other populations served by other agencies. Appropriate incentives need to be created at the executive level that will induce better cooperation. Another problem, identified in this study, and common across child welfare is the implementation of initiatives both within and outside DSS. Leaders often get extensive credit for the unveiling of new efforts, but comparatively little attention is addressed to the difficult and unheralded work of translating ideas, vision, and frameworks into the reality of day-to-day practice. There was evidence in the data that practices related to permanency initiatives, adolescent outreach services, and connections with family can vary across DSS offices and the contracted agencies. Greater standardization is needed across the agency. Furthermore, state agencies should utilize the expertise of front-line workers in identifying and removing barriers to implementation of new practices. Allowing former foster youth to sign back into care seems to be an idea that is supported by the youth and the policy/program stakeholders. There have been problems in the implementation of this policy, however. First, the study identified concerns that the criteria for signing back into care are too stringent, and consequently that DSS serves the easier and more compliant youth. This is a particular concern because some youth with great needs may not be able to access services post-18. Youth expressed some concern and also partial confusion about the criteria. Some also identified, however, that having these criteria forced them to take some positive action. The data are inconclusive as to whether this is a problem, how big it is, and the reasons for it. We would suggest that it is in part a resource issue; there are not enough resources to serve all eligible youth and, therefore, the agency must engage in rationing. It may also be an implementation issue; the return-to-care policy is relatively new and procedures may need refinement. It may also be true that DSS does “cherry-pick” the cases. Greater attention to this issue is needed, as overall it does appear that youth who returned valued the opportunity to do so. There is no doubt that relationships and social networks are of vital importance to these young people. Many young people seem to have relationships with adults and their brief descriptions in these interviews suggest some healthy and strong bonds. The science of creating sustained relationships in natural environments is not strong, however. While the desire to help youth have permanent relationships is reasonable and should be pursued, it should be pursued cautiously. Connection with birth family is common among these young people. This finding is consistent with other studies and continues to raise questions about how we might better facilitate connection and reconnection between foster youth and members of their families of origin. These are often highly complicated situations and reconnection with family is not a panacea for helping young people find connection. Yet, sometimes our efforts can be overprotective, especially with adolescents and young adults who have or can learn the ability to assess relationships and make choices about what works for them. In this study we did not hear many youth express the desire for greater connection with their birth families. Some already have a connection, either facilitated by DSS or developed on their own. Others spoke about earlier efforts at reconnection that did not work. Only small percentages thought additional efforts would be helpful to them. Young people with special circumstances did not receive as much attention in this study as they deserve. Groups with special needs might include youth with serious developmental disabilities or mental illness, youth with substance abuse issues, and immigrant youth. This study aimed to examine the broad population of youth transitioning from care. Youth with needs such as those listed are likely to need some vi specific and concentrated attention. We did have a fairly large sample of parenting young adults and can draw some conclusions for this sub-population. Youth who become parents at an early age most likely will experience some challenges, regardless of whether they experienced foster care. Surveyed youth described challenges related to maintaining custody of their infants and accessing financial resources that would allow them to care for themselves and their child. Parenting youth need more independent living housing and day care options in order to support continued educational and training opportunities and to lower the risk of current foster care youth being investigated for neglect. Running away is a serious issue that does not receive enough research, practice, or policy attention. These youth are often, but not always, vulnerable while on the run. Often they are known to “run to” family and friends where they want to live instead of a foster home or group care placement where they do not want to live. Running from care was not a core focus of this study but several components of the study indicated it to be a problem requiring attention. From the administrative data we learned that sizable percentages of youth run from care. Many in the survey or the qualitative interview spoke about their experiences running and the reasons for doing so. Generally, they had unstable living situations and were less likely to have consistent educational instruction. Furthermore, youth who run from care seem to have a history of running, and for some, running is linked to their desire to have voice about what happens in their lives. Efforts to increase attention to youth voice may help limit running behavior and thus keep youth connected to safe environments and educational systems. Some youth have relatively good experiences in foster care and in their connection with the child welfare system. Others do not. It is clear from the data that a “good worker” (whether DSS or private agency) can make an important difference. Our aim should be to insure that more youth receive the kind of concentrated and personal attention provided by some. Caseload size is a chronic problem that prevents the best of care. Additionally, some respondents (both youth and stakeholders) suggested, and we concur, there is a need for greater specialization in adolescent-focused child welfare work. Analyses of demographic data on gender, race, and sexual orientation suggested that DSS services were reaching young people in equal proportions to their distribution in the population; no apparent bias is seen in terms of one group getting more or less service than another. Some of the risks were not evenly distributed, however. For example, females were more likely to be parents and to express feelings of depression. Latino and Black youth were more likely to report recent unwanted sexual contact. Gay, lesbian, and bi-sexual youth appeared to be at risk for a variety of poor outcomes; consequently, enhanced intervention is needed by DSS and other service agencies. Data regarding risk behaviors suggest that these young people are vulnerable to violence and victimization. These appear to be much greater risks than illegal behavior, drug abuse, or heavy alcohol use. The reasons for this vulnerability may be many, including some of the unstable housing situations that may put youth at risk. The data also suggested that many youth are challenged by poor emotional health. These may not be problems specific to former foster youth; further efforts to support the protection and well-being of all young adults are needed. Some stakeholders addressed the issue of politics regarding children’s services; the tendency of various sectors and organizations to jockey for positioning on this issue. Although this is a reality of social service systems it is a danger to advancing the well-being of children and youth. One mechanism to withstand some of the politics of children’s services is greater attention to evaluation and outcomes, vii although we are well aware that evaluations can be used for political purposes rather than measuring and improving services. All of the agencies serving children and youth, especially the state agencies, must be more open to independently conducted evaluation of their services. Internal evaluations and those done in partnership will not suffice. If agencies are unwilling to do so voluntarily the legislature should mandate this. In conclusion, the data presented in this report suggest that some former foster youth are doing quite well; others are struggling in several ways. Additionally, services are available to many youth and there are indications that these services are needed, appreciated, and helpful. The data also clearly suggest that more might be done to assist former foster youth with the transition from care and have provided some guidance on next steps in policy and program development. The costs of assisting this population would likely be relatively small compared to the vast placement and therapeutic costs that have already occurred. Moreover, the potential pay-off in terms of long-term healthy, productive, engaged adults is substantial. viii Introduction Young adulthood is a challenging developmental time period even under the best of circumstances. For youth leaving foster care to transition to a life of independent adulthood this period has particular challenges. Although many of these young people have both the internal resilience and external support to successfully manage this challenge, for others serious obstacles can temporarily or permanently derail prospects for a healthy adulthood. Numerous studies have identified that former foster youth who leave care at age 18 are vulnerable to a wide variety of negative outcomes (e.g., Cook, 1994; Courtney, Piliavin, Grogan-Kaylor, & Nesmith, 2001; Festinger, 1983; Reilly, 2003). None of these studies, however, focused specifically on Massachusetts. The current study was designed to spotlight the situation in Massachusetts with the intent to produce data for use in developing enhanced strategies to assist transition-age foster youth with establishing a successful young adulthood. This study was conducted in response to a Request for Proposals (RFP) issued by the Massachusetts Task Force on Youth Aging Out of Department of Social Services (DSS) Care. The RFP indicated the desire for a study to gather information related to: the quantity and quality of transitional services youth received or utilized while in care; outcomes achieved within 1-2 years of leaving custody; relationship between services received and youth outcomes; and policy and program responses needed to improve outcomes for these youths. Thus, the cornerstone of this study was a retrospective, in-person survey of youth who turned 18 while in foster care. In addition to this retrospective survey, our study design included three other components: a qualitative study of youth who re-entered care after 18, after previously leaving; an examination of DSS administrative data; and interviews with key policy and program stakeholders. Each of these components addressed the transition issue with a slightly different focus. The use of multiple methods, including qualitative and quantitative components, provides a fairly comprehensive perspective on the issue of youth transitioning from care. We believe the data in this report identify both successes and continued challenges in effectively serving this population. Although some of the data may be critical of the child welfare system, other data identify aspects of excellent work on behalf of youth and families. We suggest the information provided be viewed from a broad non-political perspective. Like one of our stakeholder respondents we have “no time for blaming” and “believe people are trying.” The challenge is to use the findings and conclusions of the report for engaging in thoughtful and productive efforts to better serve former foster youth as they transition from care. Background Until recently, social policy attention to supporting adolescents and helping to guide them through the early years of adulthood has been virtually nonexistent. When adolescent needs are addressed the emphasis of intervention has typically been on the prevention of social problems such as teen pregnancy, substance use, and juvenile delinquency. In general, social policy targeted toward adolescents has lacked a proactive approach that promotes positive development. Young adults leaving care are an important population requiring intensive study and intervention for several reasons. First, the research that has been done on this population suggests that negative outcomes are common. Studies have consistently identified high rates of unemployment and homelessness, poor health, limited educational attainment, and other poor outcomes (e.g., Barth, 1990; Collins, 2001; Collins, 2004; Cook, 1994; Courtney & Dworsky, 2006; Courtney, Piliavin, GroganKaylor, & Nesbitt, 2001; Festinger, 1983; Iglehart & Becerra, 2002; Lindsey & Ahmed, 1999; McMillen & Tucker, 1999; Mallon, 1998; Reilly, 2003). Because they have spent large parts of their lives in 1 substitute care and generally come from families who experience multiple problems, these youth rarely have access to the type of sustained support provided by most families of origin. For these youth, families of origin may not exist or, if they do, may have limited capacity to provide support. There are, undoubtedly, many challenges that youth in Massachusetts face that are similar to those facing youth in other parts of the country. A recent report on this issue produced by the Massachusetts Society for the Prevention of Cruelty to Children (MSPCC, 2005) has been a helpful resource in summarizing the situation for former foster youth of the Commonwealth. In 2004, 624 youth “aged out” of DSS. Among the outcomes noted in the report were the following: foster care youth were twice as likely as other students to fail the MCAS and three times more likely to be special education students; a census of young adults in homeless shelters found one-quarter reported past involvement with DSS. The report noted that there is a lack of Massachusetts-specific data on rates of higher education, employment, housing status, and other key outcomes. Massachusetts has increasingly focused on the needs of adolescents in care and transitioning from care, and has developed several supports for older foster care youth. For many years, DSS has offered training to its workers, including foster parents and group home staff, on an independent living skills curriculum: Preparing Adolescents for Young Adulthood (PAYA). Use of PAYA modules by adolescents in care is designed to assist them in their preparation for adulthood. Topics include: financial management, health and safety, housing, education and employment, for example. Second, DSS offers an adolescent outreach program, funded from the federal Chafee program (Foster Care Independence Act, P.L. 106-169), to assist youth with the transition from care. Youth who receive services from this program have an outreach worker to assist with accomplishing tasks related to planning a successful transition (e.g., finding housing, enrolling in an educational program). The focus is on the experiential practice of gaining independent living skills. In keeping with the Chafee legislation, DSS has recently expanded its services to former foster youth who would like to return for services after age 18. Additionally, DSS has a well-established Youth Advisory Board that predates many such boards in other states. Other assistance that Massachusetts provides to this population includes educational support and Medicaid coverage for all youth who age out of DSS up to their 21st birthday. Even prior to the federal Educational and Training Voucher program, Massachusetts provided some financial assistance for higher education through state mechanisms: the Foster Child Grant Program, State College Tuition Waiver Program, and the William Warren Scholarship Program. All of these efforts are aimed to assist youth, and likely provide needed help for some young people. Given the level of need, however, it is probable that further support is needed. 2 Research Components: Purpose and Methods This study conducted four separate data collection activities to explore, explain, and understand the challenges facing youth leaving care in Massachusetts. In this section we describe the research methods used for each of the components. The data collection instruments are in Appendix A. 1) Analysis of administrative data for all youth who turned 18 in 2005 The purpose of this study component was to determine a descriptive profile of all youth turning 18 in one recent calendar year. Although administrative data generally lacks depth to tell a rich story about the circumstances of these youth, they can provide an overall picture of the entire population of transition-age youth. Administrative data were requested from the Department of Social Services on youth who turned 18 while in care during the calendar year 2005. Identifying information was stripped from the data files by DSS data staff prior to release of the data to the project team. Four data files were prepared by DSS: 1) demographic characteristics of youth; 2) home removal episodes (e.g., reason for removal, start and end dates of removal episode, reason for ending removal); 3) placement history (e.g., type and time period of placement); and 4) services received while in care. Each of the data files contained a unique code that was used by the project team to merge the data files. Additionally, the files were reconstructed so that the individual was the unit of analysis rather than the home removal episode, the placement, or the service provided. Data analysis primarily focused on providing a descriptive portrait of the sample. As is often the case with administrative databases, some variables had extensive missing data or had idiosyncratic codes which made it difficult to draw conclusions. 2) Retrospective survey of youth who turned 18 while in care The purpose of this component was to survey the experiences of young people post-18 to determine the services received, outcomes attained, and other experiences as they moved into adulthood. Target sample and recruitment methods: The Request for Proposals stated the interest in “outcomes achieved within 1-2 years of leaving custody”. Thus the target sample for the study was young people who turned 18 in calendar year 2005. Based on information provided by DSS, 660 youth turned 18 in 2005, and were the target sample for this component. Recruitment efforts began with two mailings to youth. The first was a formal letter outlining the study and requesting participation. The second was a more informal flyer. These letters were sent out by DSS to the 660 identified sample members. Approximately half were returned, however, due to currently incorrect addresses. DSS outreach personnel further assisted by attempting to use existing phone numbers to call youth whose letters had been returned. These phone numbers were typically disconnected, or otherwise did not lead to the youth, and after attempting approximately 40 with no success, this strategy was abandoned. At later points in the study, two additional mailings were conducted with the assistance of DSS. In spring of 2007, DSS assisted in using an internal locator database to identify more current addresses for those letters returned. Using these more current addresses a third mailing was conducted. In the 3 summer of 2007 another strategy was used involving cross-referencing the sample members with a Medicaid address database. Using these addresses a fourth mailing was conducted. Additional mailings were sent to a wide variety of social services agencies in Massachusetts. Early in the study we sent informational materials to 250 youth serving agencies. Later in the study we expanded our scope and sent materials to an additional 450 social service agencies including shelters, food pantries, health centers, job training centers, welfare offices and other settings that serve this population (e.g., student services offices of community colleges). These mailings included informational flyers about the study requesting interested youth to call the project hotline. We also requested agencies of the Task Force to provide information about the study to the eligible youth that they serve. Other efforts to recruit youth included the following: we requested the DSS Commissioner send an email to all DSS workers to inform them of the study and to encourage them to let eligible youth know about the study; we requested MSPCC to use their email networks of foster parents to post a notice of the study and request foster parents who know of eligible youth to refer them to the study; we posted flyers on college/university campuses throughout Massachusetts; we contacted by phone, letter, email, or in-person numerous agency personnel likely to be in contact with this population. To our knowledge the only successful recruitment efforts were the mailings conducted directly to the sample respondents. Posted flyers rarely resulted in phone calls, some of which were from young people not eligible for the study. Efforts to contact youth through agencies were not successful; although people often agreed to inform youth about the study we had no way to control these efforts to see if these contacts were made and participation appropriately encouraged. From the outset of the study we were aware that the passive recruitment strategies used would not result in a high response rate and we repeatedly argued for access to the contact information for the sample members so that we could conduct a high quality study consistent with known standards of survey research. A total of 105 young people called the project hotline and 96 interviews were completed. Of the nine youth who called and were not interviewed, this included: two youth who changed their minds and cancelled the interview, two who did not respond to interviewers’ multiple efforts to set up the interview, and five whose numbers were disconnected before the interview could be scheduled. Instrument: Consistent with survey design principles, the instrument consisted primarily of closed ended items. Some open-ended questions were included to allow the young person the opportunity to provide feedback in his/her own words and style. In developing the questionnaire we aimed to strike a balance between collecting needed information and making the survey experience relatively pleasant. Core content of the survey included: services received while in care, perceived helpfulness of services, feedback about experiences while in care, risk behaviors, current outcomes, goals, and demographics. With the exception of the risk behavior items, the survey was administered by the interviewer. The risk behavior items were self-administered by the young person and sealed in an envelope. Data collection and analysis: After a young person called the project hotline he/she was screened to insure they met the sample requirements 1 . The interview was then assigned to a trained interviewer 1 We did include youth (n=25) in the sample who did not turn age 18 in the target year 2005 (they turned 18 in either 2004 or 2006). In part, we did not want to disappoint the youth who called wanting to be interviewed. Because the recruitment strategies led to the use of a convenience sample for the survey, inclusion of these other young people did not damage the integrity of the sampling design. 4 who made arrangements to meet the respondent in person 2 . A half day training session was provided to all interviewers and covered topics such as: contacting the youth, obtaining informed consent, administering the interview, providing respondent payment, checking the interview for completeness, and procedures for insuring confidentiality. Interviews were conducted in-person and took approximately one hour. Written informed consent was obtained prior to the start of the interview. Additionally, respondents were given a letter describing DSS’ approval of the research project. Incentives included a respondent payment of $25 and inclusion in a raffle for iPods upon conclusion of the study. A list of human services resources was provided to all respondents in case they found themselves in need of further assistance. Follow-up phone interviews were conducted with 24 respondents 3-6 months after the first interview. An abbreviated version of the survey instrument was conducted with youth to ascertain changes in the youth’s situation (e.g., housing, employment, and personal well-being). We had planned to conduct six month follow-up interviews with all respondents. However, because most of the interviews took place at the end of the study period, we only collected this information for those interviewed at least three months prior. Univariate analysis of the survey items was the primary data analysis technique to provide a descriptive picture of the sample members’ experiences. These data are supplemented by brief qualitative summaries from open-ended items on the survey. In addition, bivariate analyses were conducted to address three questions: 1) Were there differences between those currently in care versus those not in care? 2) Were there differences for demographic groups (gender, race, sexual orientation)? 3) Were services received related to outcomes? 3) Qualitative interviews with a sample of youth who had left DSS but have since returned seeking services The purpose of this component was to understand the experiences of a sub-group of former foster youth: those who had left DSS care but have since returned voluntarily post-18 for assistance. Since the passage of the Foster Care Independence Act of 1999 (P.L. 106-169), states have been allowed to use federal money to provide services to youth beyond the age of 18 and to serve former foster youth. Massachusetts began extending services to this population in June 2006. Thus, we designed this qualitative component to understand the processes of leaving and returning to care. Target sample and recruitment methods: Youth who exited foster care (e.g., ran away, aged out, signed a voluntary but left) and later returned to care for voluntary services after turning age 18 were included in the qualitative sample. Youth who left care for at least two months were eligible for inclusion in this study component. Young people were recruited through the assistance of the DSS adolescent outreach unit. Letters inviting youth to participate in the research project were provided to the outreach unit for distribution to eligible youth. Letters to youth described the purpose of the research project, identified the toll free hotline number and incentive payment. In addition, youth who called the project hotline about the retrospective survey component of this research project were screened for their exits and entries from DSS care. If eligible for the qualitative interview they were offered the opportunity to participate in this qualitative interview as well. 2 Youth who lived out-of-state (n=4) were interviewed by phone instead of in person. 5 Instrument: The qualitative interview guide was designed to elicit a description of the lives of youth who leave but later return for services after age 18. The in-depth interviews were designed to collect data on: why youth left, why youth contacted DSS for voluntary services, what youth hoped to receive, what had been the planning process for their preparation for adulthood, youths’ current and past supports, youth’s involvement in decision-making while in care, and how their lives were currently (e.g., housing, employment, education, health, relationships). Appropriate probes were included to aid the youth in telling his or her story. Data collection and analysis: Qualitative interviews with youth were conducted in person primarily by the Project Director. Interviews were conducted at a location identified by the youth, including in homes, residential/school settings, restaurants and libraries. Prior to the interview, informed consent was obtained and respondents were given a letter describing DSS’ approval of the research project. Before commencing the interview the youth were asked: if the interview could be recorded, if they had any questions about the purpose of the research project; and to sign two copies of the informed consent form. One copy of the form was left with the youth. In addition, youth were given a two page community resource list and a $25 incentive payment. They were also entered into a raffle for an iPod. Interviews lasted approximately one hour. Tapes were later transcribed for analysis. Transcripts were reviewed and coded according to the core domains identified above. Analysis focused on the common experiences of the sample members as well as unique themes specific to individuals. 4) Key stakeholder interviews The purpose of this component was to collect information from a wide variety of policy and program stakeholders to understand the various issues related to assisting youth with transition from care. This study component was designed to provide some political and organizational context to other findings in the study. Target sample and recruitment methods: Interviews were conducted with 30 key stakeholders (youth transition task force members, state agency personnel [DSS, DMH, DTA, etc.], and private agency leaders). Several task force members were the starting focus of interviews. From there, snowball sampling methods were used to secure interviews with a wide variety of people from different roles and perspectives. All interviewed individuals were identified to be an expert in youth services by a member of the Task Force, by somebody previously interviewed, or by a member of the research team. An introductory letter was sent to each identified individual informing them of the study and requesting participation. Either phone or email follow-up was used to schedule the time of the interview. Two individuals never responded to efforts to schedule the interview. Instrument: A qualitative interview guide was developed to elicit respondents’ thoughts on the core domains of interest. The questions focused on: the perceived problem and potential solutions for assisting former foster youth, the status of programming in this area, potential for efforts to work in partnership with youth, the current policy environment for assisting the target population, perceived barriers to enhancing transitional services, suggestions for improved services, and other topics regarding youth transition. 6 Data collection and analysis: Interviews were conducted by the Principal Investigator or CoPrincipal Investigator. All but one were conducted in person; because of difficulty scheduling, one interview needed to be conducted by phone. Interviews were approximately one hour in length. Written notes were taken during the interview. Qualitative analysis techniques were used to categorize the data. In general, in our analysis and reporting we aimed to tell the “common” point of view, that is, perspectives that we heard repeatedly. We also brought to the fore perspectives that appeared particularly concise, insightful, and with a unique perspective that appeared relevant but might not always get full attention. We occasionally included rather specific comments, but identified them as such, so as not to give the same level of weight, or convey the impression they were common responses. Although less common, they may be equally, or perhaps more, important. 7