Children and Youth Services Review 28 (2006) 1459 – 1481 www.elsevier.com/locate/childyouth Educational and employment outcomes of adults formerly placed in foster care: Results from the Northwest Foster Care Alumni Study Peter J. Pecora a,b,⁎, Ronald C. Kessler c , Kirk O'Brien a , Catherine Roller White a , Jason Williams d , Eva Hiripi c , Diana English b,e , James White f , Mary Anne Herrick g b a Casey Family Programs, United States University of Washington, School of Social Work, United States c Harvard Medical School, United States d University of Alaska Anchorage, United States e Child Welfare League of America, United States f Portland State University, United States g Washington Education Foundation, United States Received 3 February 2006; received in revised form 29 March 2006; accepted 7 April 2006 Available online 5 July 2006 Abstract This study evaluated the intermediate and long-term effects of family foster care on adult functioning using a sample of 659 young adults from two public and one private child welfare agencies, case record reviews, structured interviews, and a survey response rate of 76%. Foster care alumni completed high school at a rate comparable to the general population, but a disproportionately high number of them completed high school via a GED. Alumni completion rates for postsecondary education were low. Consequently, many alumni were in fragile economic situations: one-third of the alumni had household incomes at or below the poverty level, one-third had no health insurance, and more than one in five experienced homelessness after leaving foster care. Two foster care experience areas were estimated to significantly reduce the number of undesirable outcomes in the Education outcome domain: positive placement history (e.g., high placement stability, few failed reunifications), and having broad independent living preparation (as exemplified by having concrete resources upon leaving care). For the Employment and Finances outcome domain, receiving broad independent living preparation (as exemplified by having ⁎ Corresponding author. Casey Family Programs, 1300 Dexter Ave. North, Floor 3, Seattle, WA 98109, United States. Tel.: +1 206 270 4936; fax: +1 866 322 7863. E-mail address: [email protected] (P.J. Pecora). 0190-7409/$ - see front matter © 2006 Elsevier Ltd. All rights reserved. doi:10.1016/j.childyouth.2006.04.003 1460 P.J. Pecora et al. / Children and Youth Services Review 28 (2006) 1459–1481 concrete resources upon leaving care) was estimated to significantly reduce the number of undesirable outcomes. © 2006 Elsevier Ltd. All rights reserved. Keywords: Educational and employment outcomes; Foster care; Northwest Foster Care Alumni Study 1. Introduction 1.1. The scope of foster care in the United States In any given year, about 800,000 children are served in foster care in family and non-family settings, with a daily census of 518,000 (as reported at the end of September 2004; U.S. Department of Health and Human Services, 2005c). This number represents about 1% of children in America.1 The numbers of children in foster care have risen substantially since 1980 and are only now just leveling off (see Fig. 1). Most of these children have suffered maltreatment, although not all are placed specifically because of abuse or neglect. Some are placed due to other parental dysfunction, parent death, or because of child mental health service needs that the family can not afford to pay for (U.S. Department of Health and Human Services, 2001). Even though preventing the placement of children in foster care and minimizing their length of stay is a child welfare priority, many children will spend a substantial amount of their childhood living in foster care (U.S. Department of Health and Human Services, 2005a; Wulczyn, Barth, Yuan, Harden, & Landsverk, 2005; Wulczyn & Goerge, 1992). Nearly half of the children who are placed in foster care will remain there for a year or longer with an average length of stay of 2 years. More specifically, of those children still in foster care as of September 30, 2003, 61% had been there for 12 months or longer. Of those leaving care in fiscal year 2003, 50% had been in care 11 months or less, but 20% had been there for 3 years or more (U.S. Department of Health and Human Services, 2005b). Over 21,000 older youth emancipate to adulthood from a foster care setting every year (U.S. Department of Health and Human Services, 2005b). To evaluate how youth have been impacted by foster care, this article focuses on the adult education, employment and finance achievements of young adults ages 20–33 years old who spent 12 months or more in family foster care as adolescents during the 10 years prior to the implementation of the Foster Care Independence Act of 1999 (1988– 1998). The study examines foster care experiences that are associated with educational achievement and a positive financial situation after leaving foster care. 1.2. Current goals, objectives, and key outcomes of foster care Given the large number of children placed and the extended time that many spend in foster care, systems have been instituted to provide for the well-being of these children. Current foster care practice and programs are governed by an intricate–although not necessarily coherent–set of 1 This figure is derived using the following statistics: 800,000 children in foster care divided by the total number of children under age 18 in the United States on July 1, 2003 (800,000/73,043,506 = 1.1%). For national foster care data, go to http://www.acf.hhs.gov/programs/cb/ and click on “Adoption and Foster Care Statistics.” See the “Trends in Foster Care and Adoption” table. The total number of children under age 18 was downloaded February 21, 2006 from http:// www.census.gov (Annual Estimates of the Resident Population by Selected Age Groups for the United States and States: July 1, 2003 and April 1, 2000). P.J. Pecora et al. / Children and Youth Services Review 28 (2006) 1459–1481 1461 Fig. 1. Children in foster care: 1998–2004. Sources: Trends in Foster Care and Adoption Chart. AFCARS data, Children's Bureau, Administration for Children and Families, HHS: based on data submitted September 2005 (http://www.acf.hhs. gov/program/cb/), Voluntary Case Information System statistics compiled by the American Public Human Services Association, and U.S. Census Bureau, Resident Population Estimates of the United States by Age and Sex: http://www. census.gov/popest/archives for 1988 through 1999 and: http://www.census.gov/popest/national/asrh/NC-EST2004-sa. html for 2000 through 2004. policies and laws at the federal, state, and local levels (Curtis, Grady, & Kendall, 1999; Lindsey & Schwartz, 2004; Pew Commission, 2004). According to professional and federal standards, child welfare agencies need to achieve a small but critical set of outcomes in three broad outcome domains: child safety, child permanence, and child and family well-being (U.S. Department of Health and Human Services, 2003). For children placed for a year or longer, more specific outcomes should be pursued related to emotional, physical, and cognitive development. These outcomes may vary by age of the child and length of stay, but could include reduction in the emotional trauma of child maltreatment; healthy physical development through regular check-ups and adequate medical, dental, and vision care; avoidance of teen pregnancy; life skills development and readiness for adulthood; high school graduation and enrollment in post-secondary education or training programs; healthy socialization and healthy adult relationships (American Academy of Pediatrics, 2000; Berrick, Needell, Barth, & Johnson-Reid, 1998; Casey Family Programs, 2001, 2003a). Wulczyn et al. (2005, p.180), however, have raised cautions about the concept of child well-being: … the term well-being is really shorthand for health, education, and mental health, facets of well-being that are for the most part programmatically beyond the scope of the child welfare system. By using a vague term such as well-being when something much more specific is intended, advocates for expanded services for children weaken their position. The child welfare system cannot be accountable for safety, permanency, and education, health, and mental health because the resources needed to influence the well-being outcomes are outside the boundaries of the system. Instead, Wulczyn et al. suggest that the mandate for the child welfare system should be expressed as achieving safety and permanency outcomes and ensuring the child welfare system 1462 P.J. Pecora et al. / Children and Youth Services Review 28 (2006) 1459–1481 engages the education, health and mental health systems. This will help the child welfare system rightfully take credit for working to create safe and stable families for children. It will also have a second important benefit: …separating well-being into its constituent parts makes clear that which is obvious to most child welfare administrators: When well-being is couched in terms of health, mental health, and education, the general public and policymakers alike quickly realize that the child welfare system has a limited range of options without using the health care system, schools, and the mental health system as collaborators. If children in the child welfare system are not moving along their age-appropriate trajectory, these other systems will have to shoulder their share of the responsibility in conjunction with, not in spite of, the child welfare system (Wulczyn et al., 2005, p. 180). 1.3. How effective is foster care? Despite the growing clarity about expected outcomes, little is known about the long-term outcomes for youth in foster care. But accountability for the effects of foster care services is of high concern, with pressure from private and public agencies, juvenile court judges, physicians, national commissions, and various other stakeholder groups, as well as from class action lawsuits (Pecora, Massinga, & Mauzerall, 1997; Pew Commission, 2004; United States General Accounting Office, 1999). Federal legislative action has focused on introducing key measures or outcome indicators emphasizing such important areas as length of care, safety from child abuse or neglect, placement history, and permanency (U.S. Department of Health and Human Services, 1999, 2001, 2003, 2005a). Even with $22 billion of federal, state and local funding annually (Scarcella, Bess, Zielewski, Warner, & Geen, 2004), there are reports that the foster care system is in crisis, that foster parent retention is low, workers remain overloaded with high caseloads; and that poor salaries, inadequate supervision and stressful working conditions result in high staff turnover and uneven job performance (Pew Commission, 2004; U.S. General Accounting Office, 2004). While it is true that there is some unevenness in agency performance, there are several major issues that need to be addressed when examining the effectiveness of foster care. First, about 50% of the children placed each year in foster care stay in care for less than 1 year—a very brief time for any one agency to show dramatic improvements in various areas of child functioning. Second, it is difficult to demonstrate that what happens to foster children is the result of being in foster care, and not merely something which happens as a consequence of pre-determined characteristics of those entering the foster care system: Their often severe difficulties make it unsurprising that the rate of emotional, social, behavioral and educational problems found in children in foster care is substantially higher than in the general population. This is not to say that foster care should not do more to improve these problems; merely that they pre-exist for most children and should not necessarily be seen as evidence of a lack of effectiveness or the failures of the state to be a good parent (Wilson, 2006, p. 7). Notwithstanding Wilson's comments, there is growing evidence that certain aspects of foster care negatively influence child outcomes such as maltreatment by foster parents and frequent P.J. Pecora et al. / Children and Youth Services Review 28 (2006) 1459–1481 1463 placement changes (Ryan & Testa, 2004). Conversely, there are data that youth placed in foster care have similar (and in some areas) more positive adult outcomes, as compared to youth in the general population from similar family backgrounds (Kessler & Magee, 1993; Buehler, Orme, Post, & Patterson, 2000). Some studies indicate that children who receive foster care services show positive improvements in physical health, emotional adjustment, school performance and behavioral functioning compared to the years before being placed into care (Berrick et al., 1998; Biehal & Wade, 1996; Coulling, 2000; Goerge, Wulczyn, & Fanshel, 1994). Other studies suggest children in foster care compared to children from poor and ethnic minority families are at greater risk for becoming involved in criminal activities, suffer from more frequent and debilitating mental disorders (Courtney, Terao, & Bost, 2004; Minty, 1999), or when compared to the general population, have higher homelessness and unemployment rates (Dworsky, 2005; Park, Metraux, & Culhane, 2005). Further complicating the ability to draw decisive conclusions about foster care effectiveness is that few studies have been designed to allow for valid comparisons to children in the general population. Additionally, use of brief follow-up periods (1 year after leaving care) and relatively small sample sizes of research studies involving children in foster care (often less than 150 subjects) prevent anyone from drawing consistent and generalizable conclusions (Barth, 1990; Cuddeback, 2004; Holdaway & Ray, 1992; Jacobson & Cockerum, 1976; Jones & Moses, 1984; Rice & McFadden, 1988). Findings are simply inconclusive. The ideal means to examine the effectiveness of foster care is to compare a random sample of maltreated youth that were either removed from the home or not removed from the home (but received in-home services). Because of the ethics involved in allowing children to remain in a home where maltreatment has occurred, this design has been used rarely. Only one experimental study compared the functioning of youth placed in foster care and youth served by alternative means while they remained with their birth parents, but that evaluation was compromised severely by sampling problems (Wald, Carlsmith, & Leiderman, 1988). Equally scarce are studies that compared youth raised in foster care with a group of general population youth matched on certain family or youth characteristics (Blome, 1997; Buehler, Orme, Post, & Patterson, 2000; Courtney et al., 2004; Minty, 1999; Runyan & Gould, 1988), studies that compared the effects of various foster parent payment and support patterns (Jaffee & Kline, 1970), and studies that have examined costs or cost–benefits in foster care (Barth, 1997; Barth, Lee, Wildfire, & Guo, in press; Kerman, Barth & Wildfire, 2004; Sedlak & Broadhurst, 1993; Young & Brandt, 1977). Another methodological limitation has been the lack of precision and consistency in measuring placement change, despite the importance of this variable for youth development. While research has shown that some changes in living situation can be beneficial for youth, greater disruption in placement has been associated with child behavior problems (Dore & Eisner, 1993; Newton, Litrownik, & Landsverk, 2000; Ryan & Testa, 2004, 2005; Smith, Stormshak, Chamberlain, & Whaley, 2001), and mental health problems (Rubin et al., 2004). For example, Newton et al. (2000, p. 1371) found that volatile placement histories “contribute negatively to both internalizing and externalizing behavior of foster children, and that children who experience numerous changes may be at particularly high risk for these deleterious effects.” In conclusion, a substantial number of youth enter foster care and are likely to remain there for an extended period of time, and are cared for by a patchwork system of care, consisting of child welfare agencies and local, state, and federal governments. Further, studies have demonstrated mixed results and few rigorous studies have been conducted to date. Understanding the outcomes of youth who have been placed in foster care has been encumbered by a lack of random assignment studies and other methodological issues. To help address these needs, the Northwest Foster Care 1464 P.J. Pecora et al. / Children and Youth Services Review 28 (2006) 1459–1481 Table 1 Demographic characteristics of the Northwest alumni Demographics Ethnicity Hispanic Non-Hispanic black Non-Hispanic other Non-Hispanic white Age at time of interview 20 to 22 years 23 to 25 years 26 to 33 years Mean age at time of interview Sample size a Gender Male Female Sample size a % (S.E.) 10.5 (0.9) 21.3 (1.2) 22.6 (1.2) 45.6 (1.5) 29.6 (1.4) 38.2 (1.4) 32.2 (1.4) 24.2 (0.1) 479 39.5 (0.7) 60.5 (0.7) 659 Age at time of interview and ethnicity report data drawn from alumni interviews. Alumni Study was designed to evaluate how young adults who had been placed in foster care were functioning. Three main research questions were examined for this article: 1. What were the educational achievements of the alumni? 2. What was the financial situation of these alumni? 3. What foster care experiences were associated with educational achievement and a positive financial situation after leaving foster care? 1.4. The Northwest Foster Care Alumni Study The primary purpose of the Northwest Foster Care Alumni Study was to evaluate the intermediate and long-term effects of family foster care on adult outcomes. The University of Washington, Harvard Medical School and the University of Michigan Survey Research Center collaborated with three social service organizations to conduct the study: 1. Casey Family Programs, a private operating foundation, with participating offices in Seattle, Tacoma and Yakima, Washington, and Portland, Oregon (abbreviated as Casey); 2. Oregon Department of Human Services, Children, Adults and Families, with participating offices in Portland, Oregon; and 3. The State of Washington Department of Social and Health Services, Children's Administration, Division of Children and Family Services, with participating offices in the areas of Seattle, Tacoma and Yakima, Washington. The investigation focused on adults who spent time in foster care in one of the three agencies from 1988 to 1998. There were a few differences in the child demographics and services received by the foster care alumni from each agency. For example, Casey alumni were older, placed at a younger age, and for a longer duration.2 To accommodate for these pre-existing differences, steps were taken to 2 Prior to entering Casey, nearly 9 in 10 (89.0%) of Casey alumni spent time in a state or a voluntary agency program. P.J. Pecora et al. / Children and Youth Services Review 28 (2006) 1459–1481 1465 adjust for differences between the Casey and State samples, as well as to account for the youth who were not interviewed. Propensity score matching was used to weight the data so that differences between the agencies, and between those interviewed and those who were not, did not bias the results (Braitman & Rosenbaum, 2002). In sum, weights were used to estimate data as if there had been no pre-existing differences between Casey and the state samples, and as if the entire sample had been interviewed. (This is why the full sample size of 659 is used for the demographics, risk factors and placement history variables.) Variables that contributed to the statistical weights included age, sex, and race. Combined, these techniques improved the ability to generalize to the population of youth from which the sample was drawn. 2. Method 2.1. Participants In addition to being placed by Casey or the state child welfare agency in Seattle, Tacoma and Yakima, Washington or Portland, Oregon, participants had to (1) have been served between January 1, 1988 and September 30, 1998; (2) have been placed for 12 months or more in family foster care between the ages of 14 and 18 years old; (3) not have a major physical or developmental disability (e.g., IQ scores of less than 70), and (4) have been placed due to reasons other than being an unaccompanied refugee minor. A total of 659 alumni fit these criteria. 2.2. Demographics Over half (54.4%) of the interviewed alumni were people of color (see Table 1). American Indian or Alaska Native alumni (15.7%) and Asian or Native Hawaiian/Polynesian/Pacific Islander alumni (5.8%) made up the largest proportion of the “Non-Hispanic other” ethnic group. The average age of the alumni was 24.2 years old, and 60.5% were women. 2.3. Materials 2.3.1. Case records Raters, with no knowledge of the hypotheses of the study, individually read and recorded the information from case records. Only variables which had acceptable inter-rater reliability (as determined by Cohen's Kappa or by inter-rater correlations) were retained. Case records provided information on living arrangements before foster care, parent functioning, child maltreatment by birth family, reasons for initial placement, mental and physical health problems, and placement information. Further, the study also collected data about youth disabilities and diagnoses from case records. Data focused on professionally-diagnosed medical, learning, and psychological issues that could have surfaced at any point in childhood, including before placement and up to case closure. Lastly, operational definitions of abuse and neglect variables as defined by the Barnett Coding System for type and severity of child maltreatment, and modified for use by the LONGSCAN project (Multiple Method Classification System) were used to record child maltreatment data (Barnett, Manly, & Cicchetti, 1993). 2.3.2. Placement history and experience Living situations and placements are defined differently depending on the federal rules, viewpoints (e.g., youth, agency, or researcher), and other conceptual frameworks being considered. The 1466 P.J. Pecora et al. / Children and Youth Services Review 28 (2006) 1459–1481 Northwest Alumni Study defined a child's living situation as the place where the youth lived, and what was viewed by the caseworker as the child's “home”—temporary or not. Following most of the Federal and CWLA National Data Analysis System work group definitions (Woodruff, 2004), the study considered the following living situations to be distinct placements: • • • • • • • • • Initial shelter care Foster care Kinship care Treatment foster care Group homes Residential treatment Independent living placements3 Adoptions Juvenile justice placements once the youth is under child welfare agency supervision (not as an initial placement). Although recorded in the case records, the following living situations were not counted as placements: • • • • • • Returning to or living with birth parents Running away from a current placement Visits to medical hospitals Respite care Living with unlicensed friends or relatives4 Unless recorded as the first placement in the log, stays at psychiatric institutions that were fewer than 30 days (i.e., stays at the beginning of the placement log or 30 days or longer were counted). • A stay in a juvenile justice or correctional facility that was recorded in the log as the first placement 2.3.3. Interviews Professionally trained interviewers from the University of Michigan Survey Research Center (SRC) administered the interview. In addition to educational attainment and information on the financial situation of alumni, the interview included questions concerning ethnicity, access and participation in educational, mental health, and independent living services, resources upon leaving care, and foster family and other nurturing supports while in care. 2.4. Procedure The study reviewed case records for the total sample of 659 alumni and interviewed 479 of these alumni between September 2000 and January 2002. Not every alumnus could be located 3 During the period covered by this study (1988 to 1998), few of the youth experienced formal supervised apartments or group home Independent Living (IL) placements. Because the youth were on an active child welfare caseload and were seen on a periodic basis, however, the researchers decided to include IL situations as placements. 4 Living with birth family or unlicensed friends or relatives is not counted as an official placement because this study, and many others, cannot distinguish the nature of these living situations (e.g., the degree to which the child welfare agency is involved in supervising the child's living situation). Instead of including this condition as a placement, it was included as one of the variables that described alumni placement history. P.J. Pecora et al. / Children and Youth Services Review 28 (2006) 1459–1481 1467 Table 2 Expanded hierarchical type of child maltreatment by birth family of the Northwest alumni a Child maltreatment by birth family % (S.E.) No child maltreatment Sexual abuse only b Sexual and other maltreatment (besides emotional maltreatment) Physical abuse only b Physical neglect only b Physical neglect and physical abuse only b Emotional maltreatment only Sample size 6.7 (0.4) 4.4 (0.3) 49.2 (0.8) 8.6 (0.5) 10.8 (0.4) 16.7 (0.6) 3.6 (0.3) 659 a b Excludes educational neglect. With or without emotional maltreatment. and interviewed. The minimum response rate (RR1) as defined by the standard definition manual of the American Association for Public Opinion Research (2000) was used to determine the response rate. Using this definition, 26 people (4.0%) of the sample were “ineligible” to participate in the interview. This included deceased alumni and those who were in prisons or mental institutions during the interview period. After removal of these alumni, the response rate was 75.7% (Pecora et al., 2005). With the exception of a landmark study in New York City (Festinger, 1983) and the more recent prospective cohort alumni studies in the Midwest (Courtney et al., 2004), this response rate is much higher than those that have been obtained in other longer-term alumni follow-up studies, which are typically about 60% or less. 2.5. Formation of outcome groups For some of the foster care experience and outcome variables that are used in the study optimization analyses, the scores for these variables were trichotomized using theory, the distribution of the data, and practice perspectives about what is more likely to result in positive outcomes. 3. Results 3.1. Risk factors In addition to demographic variables, risk factors are variables that may predict alumni outcomes. Because this study focused on the relationships between outcomes and the experiences while in foster care that agencies have some influence over (through policies, program approaches, and resource allocations), demographic and other risk variables were controlled prior to the main analyses. Some of the major risk factors are summarized below. 3.1.1. Types of child maltreatment experienced by the alumni Child maltreatment is the most frequent reason why children are removed from the birth family and placed in foster care. Table 2 categorizes maltreatment information recorded in the case records according to the most prominent types perpetrated by birth family members. Almost all (93.3%) of the alumni experienced some form of maltreatment by their birth family. Sexual abuse and another form of maltreatment (physical abuse or physical neglect) was the most frequent type of maltreatment reported for these youth. In this classification, emotional maltreatment was conceptualized 1468 P.J. Pecora et al. / Children and Youth Services Review 28 (2006) 1459–1481 Table 3 Risk factors of the Northwest alumni Risk factors Reason for initial placement Maltreatment Other a Birth parents' substance abuse problems Child behavior problems Birth mother Had substance abuse problems Had criminal problems Birth father Had substance abuse problems Had criminal problems Mental/physical health problems diagnosed before or during care ADHD Physical or learning disability Other impairments b Sample size a b % (S.E.) 64.3 (0.7) 49.2 (0.8) 28.5 (0.6) 19.6 (0.6) 64.6 (1.4) 35.0 (1.4) 45.1 (1.5) 36.7 (1.4) 13.7 (0.5) 13.1 (0.4) 6.4 (0.3) 659 Includes caregiver(s)' inability or unwillingness to provide care, family stress, and other reasons. Includes drug exposure, Fetal Alcohol Effects, Fetal Alcohol Syndrome, or visual/hearing impairments. as commonly occurring with other forms of maltreatment, but as a secondary type if it was the only from of maltreatment present. Of all types, emotional maltreatment (unaccompanied by any other form of maltreatment) was experienced least often by alumni. 3.1.2. Reasons for initial placement Table 3 provides data from case records regarding the reasons for initial placement into foster care. Because many alumni were placed for multiple reasons, the categories are not mutually exclusive. The most common reason for initial placement was child maltreatment (64.3%), while the least common was child behavior problems (19.6%). 3.1.3. Parents' substance abuse and criminal problems Table 3 also includes information about the alumni family situation before or during foster care. The highest proportion of parent problems was in the area of substance abuse (64.6% for mothers and 45.1% for fathers). Meanwhile, slightly over one-third of parents experienced criminal problems (35.0% of mothers and 36.7% of fathers). 3.1.4. Mental/physical health problems diagnosed before or during foster care The proportion of the sample that had mental or physical health diagnoses is presented at the bottom of Table 3. The most frequent diagnosis was ADHD (13.7%). 3.2. Foster care experiences 3.2.1. Placement experiences Alumni entered foster care on average at age 11.1 (SE = 0.1) and exited, on average, at age 18.5 (S.E. = b0.1). These average ages are older than some studies because Casey served some older youth as part of a transition program and all of the agencies did not discharge older youth until they had completed high school. P.J. Pecora et al. / Children and Youth Services Review 28 (2006) 1459–1481 1469 Table 4 Placement history and experience of the Northwest alumni Placement history and experience Number of placements Length of time in care Placement change rate Number of reunification failures Number of runaways Number of unlicensed living situations with friends/relatives Sample size % (S.E.) a Low (3 or fewer) Medium (4 to 7) High (8 or more) Low (fewer than 3.6 years) Medium (3.6 to 5.9 years) High (5.9 or more years) Low (fewer than 0.61 placements/year) Medium (0.62 to 1.23 placements/year) High (1.23 or more placements/year) Low (0) Medium (1) High (2 or more) Low (0) Medium (1) High (2 or more) Low (0) Medium (1) High (2 or more) 31.9 (0.7) 35.8 (0.7) 32.3 (0.7) 32.5 (0.7) 27.6 (0.7) 39.9 (0.7) 27.6 (0.6) 29.3 (0.7) 43.1 (0.8) 69.5 (0.7) 18.8 (0.7) 11.7 (0.6) 60.7 (0.8) 18.1 (0.6) 21.2 (0.7) 76.8 (0.7) 16.8 (0.6) 6.4 (0.4) 659 a The optimal level of each placement history and experience variable is bolded/italicized. These will be used in subsequent optimization analyses. Many youth had unstable living situations while in care: alumni had an average of 6.5 placements (S.E. = 0.1), an average length of time in care of 6.1 years (S.E. b 0.1), and an average placement change rate of 1.4 placements per year (S.E. b 0.1). Almost one-third experienced eight or more placements. While most youth did not have any reunification failures (a return home, followed by re-entry into foster care), over 1 in 10 had two or more failures, and over 1 in 5 had run away at least twice (see Table 4). 3.2.2. School changes, services and activities while in foster care In accordance with the placement instability noted above, nearly one-third of the alumni reported 10 or more school changes from elementary through high school. Some of these changes, however, may have occurred prior to and/or after discharge from foster care. The degree of youth access to services while in foster care is a concern of many advocates and staff members, but over 8 in 10 alumni reported access to “a lot of” therapeutic services during care. The proportion of alumni who reported that they had participated in fun activities with their foster family was similar (76.1%) (see Table 5). 3.2.3. Preparation and resources upon leaving foster care Slightly over half of the alumni reported that they had been somewhat prepared or very prepared for independent living. But as noted in Table 6, only about one-quarter to one-third reported having resources when they left care such as a driver's license, cash, or dishes and utensils (see Table 6). 3.2.4. Foster family and other nurturing supports while in care Over four in five alumni reported feeling loved while in care; over 60% found their foster parents to be some or a lot helpful; but slightly less than half reported having a close and 1470 P.J. Pecora et al. / Children and Youth Services Review 28 (2006) 1459–1481 Table 5 Services and activities while in foster care Services and activities while in foster care Education services and experience Had access to tutoring or other supplemental education services a Actually participated in tutoring or other supplemental education services Total number of school changes, elementary to high school (including any normal transitions from elementary to middle school, and middle to high school) Therapeutic services and supports Had access to counseling and mental health services Had access to alcohol and drug treatment programs Had access to group work or group counseling Had access to a lot of therapeutic services and supports Activities with foster family Participated in fun activities with foster family Participated in religious activities with foster family Participated in both fun activities and religious activities (sum of the two activities with foster family items above) Sample size % (S.E.) Low (3 to 6) Medium (7 to 9) High (10 or more) 89.1 (1.0) 48.1 (1.5) 35.0 (1.4) 34.8 (1.4) 30.2 (1.4) 95.6 (0.5) 93.9 (0.7) 86.3 (1.0) 83.6 (1.0) 76.1 (1.3) 54.5 (1.5) 45.9 (1.5) 479 a The optimal level of each services and activities variable is bolded/italicized. These will be used in subsequent optimization analyses. confiding relationship with an adult while growing up. About one-third of alumni reported some maltreatment while in care, but these data include alleged as well as substantiated reports and vary from the case record review findings (17.6% of the alumni were alleged to have been abused by a foster family member in the case record review). Nationally, rates of child abuse or neglect among youth placed in foster care vary widely (ranging from less than 1% to 6% or higher), in part due to measurement problems such as what behaviors are counted and the time period that is used (e.g., Poertner, Bussey & Fluke, 1999; U.S. Department of Health and Human Services, 2005b). So these data should be viewed with caution (see Table 7). 3.3. Outcomes and benchmarks: education 3.3.1. Education: high school completion Despite the fact that 65% of alumni experienced seven or more school changes from elementary through high school, they completed high school at similar rates (84.8%) as the general population rate of 87.3% for ages 18 to 29 (U.S. Census Bureau, 2000a, p. 1). GED completion rates were nearly 30% (see Table 8). 3.3.2. Education: postsecondary enrollment and completion rates Table 8 also indicates that although two in five alumni received some education beyond high school, less than half of these (20.6%) completed a degree or certificate. One in six completed a vocational/technical degree and only 1 in 50 completed a Bachelor's or higher degree. For alumni ages 25–33, the Bachelor's completion rate (2.7%) was much lower than for the general population in a similar age range of 25 to 34 years (24.4%) (U.S. Census P.J. Pecora et al. / Children and Youth Services Review 28 (2006) 1459–1481 1471 Table 6 Preparation and resources for leaving foster care Preparation and resources for leaving foster care % (S.E.) Preparation for leaving care Had access to employment training or job location services Had access to independent living training groups or workshops Alumni reporting they were somewhat or very prepared for independent living Alumni who had health insurance at exit Degree of preparation for leaving care Low (0 or 1) (sum of four preparation for leaving care items above) a Medium (2) High (3 or 4) Resources upon leaving care Alumnus had the following when leaving care: Sum of three resources upon leaving care above Sample size A driver's license $250 in cash Dishes and utensils Low (0) Medium (1) High (2 or 3) 84.2 (1.1) 67.9 (1.3) 56.9 (1.5) 47.4 (1.5) 17.7 (1.1) 24.8 (1.3) 57.5 (1.5) 33.3 (1.4) 38.4 (1.4) 23.7 (1.3) 43.5 (1.5) 27.7 (1.3) 28.8 (1.3) 479 a The optimal level of each preparation and resources for leaving care variable is bolded/italicized. These will be used in subsequent optimization analyses. Bureau, 2000b, p. 1). At the time of interview, over 1 in 10 alumni (11.9%) were enrolled in college. 3.3.3. Outcomes and benchmarks: employment and finances This section presents data related to four areas of economic well-being: Homelessness, employment, receipt of public assistance, and personal and household finances. 3.4. Homelessness More than one in five alumni experienced homelessness for 1 day or more within a year of leaving foster care (see Table 9). This rate is considerably higher than the rate of homelessness found in a Wisconsin study of alumni 12 to 18 months after they left foster care (12%) (Courtney, Piliavin, Grogan-Kaylor, & Nesmith, 2001), and the rate found in a Washington State study of 19to 20-year-old alumni who had been out of foster care for the past 12 or more months (11%) (Brandford & English, 2004). 3.4.1. Employment and receipt of public assistance The employment rate among the alumni who were eligible for work was 80.1%, which was substantially lower than the national average of 95% for ages 20 to 34 during 2000 (see Table 9). About one in six alumni (16.8%) was receiving cash public assistance from Temporary Aid to Needy Families (TANF) or General Assistance at the time of their interview. This rate nearly matches that of a foster care alumni study in Wisconsin (16.6%; see Dworsky, 2005), but was lower than what Casey Family Services found in a long-term follow-up study (26%; see Casey Family Services, 1999, p. 13). The Northwest Alumni Study rate, however, is more than five times higher than the general population rate in 2000 (3% of U.S. households with reported public assistance income in 1999; U.S. Census Bureau, 2000c, Table DP-3) (see Table 9). 1472 P.J. Pecora et al. / Children and Youth Services Review 28 (2006) 1459–1481 Table 7 Foster family and other nurturing supports while in care Foster family and other nurturing supports Positive parenting by foster parents % (S.E.) Low Medium High Felt loved while in foster care Overall, foster parents were helpful (rated from 1 to 7) A little (1 to 4) Some (5 to 6) A lot (7) Had a close and confiding relationship with an adult while growing up Foster family helped with ethnic identity Child maltreatment while in foster care Some child maltreatment by foster parent or other caregiver a Sexual abuse only Sexual abuse and other maltreatment (physical abuse or physical neglect) Physical abuse only Physical neglect only Physical neglect and physical abuse only Sample size 51.6 (1.5) 25.6 (1.3) 22.8 (1.2) 81.5 (1.2) 36.0 (1.5) 28.1 (1.4) 35.9 (1.4) 45.7 (1.5) 62.2 (1.5) 32.8 (1.4) 3.7 (0.6) 4.0 (0.5) 5.6 (0.7) 10.1 (0.9) 9.4 (0.9) 479 a The foster care variables for which optimal levels have been specified and used in optimization analyses are bolded/ italicized. The optimal level of child maltreatment was no child maltreatment. 3.4.2. Finances Many alumni were experiencing difficulty in finding jobs that paid living wages. One-third of the alumni lived in households that were at or below the poverty line, which was three times the national poverty rate (U.S. Census Bureau, 2001, pp. 2 and 5). More alumni also lacked health insurance coverage than the 18- to 44-year-old age group in the general population (33.0% vs. 18%) (Institute of Medicine, 2001, p. 2) (see Table 9). 4. What program changes could improve youth outcomes? Child welfare administrators and practitioners want to know the aspects of service delivery that they should improve to maximize success for youth in care. To address this need, this study conducted statistical simulations that estimated the degree to which optimizing certain foster care experiences might affect alumni outcomes. The first step in the simulation was to create a domain score for each alumnus on the Education and Employment and Finance domains. For example, the Education domain Table 8 Education outcomes of the Northwest alumni Education outcomes % (S.E.) Completed high school—high school diploma or GED Completed high school—high school diploma only Any education past high school (any type of postsecondary education) Completed any degree/certificate beyond high school (vocational, Bachelor's, etc.) Completed college or more (Bachelor's or higher) Sample size 84.8 (1.9) 56.3 (2.7) 42.7 (2.7) 20.6 (1.8) 1.8 (0.4) 479 P.J. Pecora et al. / Children and Youth Services Review 28 (2006) 1459–1481 1473 Table 9 Employment and finances outcomes of the Northwest alumni Homelessness, public assistance, finance and employment outcomes % (S.E.) Homelessness Homeless within a year of leaving care 22.2 (2.1) Employment and public assistance Employment among those eligible to be in the workforce a Received cash public assistance anytime after age 18 Currently receives cash public assistance (AFDC/TANF/General Assistance) b Alumni household had received cash public assistance in the past 6 months 80.1 (1.8) 51.7 (2.8) 16.8 (2.2) 47.8 (2.8) Finance Household income at or below the poverty level Household income greater than three times the poverty level Has no health insurance Owns house or apartment Sample size a b 33.2 (2.6) 21.3 (2.2) 33.0 (2.6) 9.3 (1.6) 479 Alumni who were not in the workforce included students, homemakers, and people with severe disabilities. AFDC: aid to families with dependent children; TANF: temporary aid for needy families. outcome score summed the five individual education outcome variables that are listed in Table 8. Scores could range from zero (no positive individual education outcomes) to five (attained all positive individual education outcomes). The same procedure was used for the nine Employment and Finance variables listed in Table 9. For both outcome domain scores, the simulation defined the individual outcome variables so that they were all in a positive direction (e.g., high school completion, not homeless after foster care, and so on). Therefore, outcome domain scores represented the number of positive items within Education and Employment and Finance, respectively. The second step in the simulation was to use the two outcome domain scores to create regression models that would estimate the number of positive outcomes in each domain that each alumnus would achieve based on the foster care experiences that the alumnus actually had in foster care (e.g., time in care, number of schools attended). Next, these foster care experiences were “optimized” in the simulation so that each alumnus had the most optimal foster care experience possible (e.g., a short time in care, fewer number of schools attended). The foster care variables and their optimal levels are bolded and italicized in Tables 4–7. The last step in the simulation used the optimized variables in a second regression equation to estimate the number of positive outcomes that could be achieved with these optimal experiences. The change in the predicted number of positive outcomes before and after optimizing the foster care experience variables represents the anticipated effect of optimizing these foster care experiences. (See Little, 1982 for more information on this statistical approach.) This statistical simulation was conducted using all foster care experience areas at once (to estimate the effects of optimizing all areas simultaneously), and on each area individually (to measure the effect of optimizing only a particular area). The latter was done because it is more likely that an agency could implement program changes for one area than all areas at once. Table 10 presents the estimated outcome domain scores before and after the simulated optimizations of the foster care experiences. For example, the Education domain scores before and after optimization of the foster care experience area of Placement History and Experience 1474 Outcome domains Estimated outcome score after optimization of foster Estimated outcome Placement Education Therapeutic score before history and services and services and optimization experience experience supports Education (highest 2.3 possible score: 5) Employment and Finances 5.2 (highest possible score: 9) care experience areas (percent change in negative outcomes) Foster family activities Preparation for leaving care Leaving care resources Foster family and other nurturing supports All variables optimized 2.8 (− 17.8) – – 2.4 (− 4.2) – 2.7 (− 14.6) 2.1 (7.0) 3.0 (− 25.5) 5.4 (− 6.8) 5.4 (− 7.2) 5.2 (− 1.5) – 5.3 (−3.0) 5.6 (− 12.2) 5.0 (3.2) 6.2 (− 27.9) A negative value in parentheses represents a decrease in the number of undesirable outcomes; a positive value represents an increase in the number of undesirable outcomes. Dashes [–] designate foster care experience areas that were not optimized because none of the individual variables within the areas significantly predicted the outcomes for the two major outcome domains. Furthermore, although some of the percentages in the parentheses appear negligible, some of the variables within the foster care experience area did significantly predict the outcomes for the domains. However, when examined in combination with other variables within that area, the effects cancelled each other out (i.e., some of the variables within the foster care experience area serve to increase positive outcomes, while others decrease positive outcomes.) P.J. Pecora et al. / Children and Youth Services Review 28 (2006) 1459–1481 Table 10 Outcome domain scores before and after optimization of foster care experience areas P.J. Pecora et al. / Children and Youth Services Review 28 (2006) 1459–1481 1475 were 2.3 and 2.8, respectively. This represents a 17.8% decrease in the number of undesirable outcomes. Thus 17.8% is presented in parentheses due to improving placement history and experience. This statistic is calculated using the following formula: ðnumber of negative outcomes after optimization−number of negative outcomes before optimizationÞ=the of negative outcomes before optimization 100 Note that (a) the number of positive outcomes must be subtracted from the highest possible score to calculate the number of negative outcomes; and (b) the number of positive outcome scores in the table will vary slightly due to rounding error in the estimated outcome scores before and after the optimization. But the percent change in negative outcomes score is based on nonrounded outcome scores. For the Education domain, optimization of two foster care experience areas reduced the estimated number of undesirable outcomes significantly: Placement History and Experience and Resources upon Leaving Care (− 17.8% and − 14.6%, respectively). The effect of Foster Family Activities was modest. Note that, in this analysis with this sample, optimizing Foster Family and Other Nurturing Supports was estimated to result in a 7.0% increase in undesirable outcomes. There were three variables within Foster Family and Other Nurturing Supports that were not conceptualized well, so those variables may have counteracted the effects of the other variables within that area. The first was parenting style where the authoritative, permissive, authoritarian and disengaged dimensions (Baumrind, 1995) may not have been well-defined or were interacting with other variables. The second problematic variable was whether the alumnus had experienced a close and confiding relationship with an adult while growing up. Many alumni had mixed scores on this variable—possibly because frequent placement change disrupted these relationships or the way the variable was interpreted. The third variable with mixed results was maltreatment while in foster care. Because we included unsubstantiated reports as well as substantiated reports for both foster parents and other caregivers, this variable may have produced conflicting results. Despite some concerns about three of the variables within this area, a dramatic reduction in undesirable education outcomes (− 25.5%) was estimated when optimizing all foster care experience areas simultaneously. For the Employment and Finances domain, optimizing the Resources upon Leaving Care foster care experience area reduced the number of undesirable outcomes (− 12.2%). The estimated effects of optimizing Placement History and Experience were generally modest. Note that, similar to the Education domain, optimizing Foster Family and Other Nurturing Supports was estimated to result in a 3.2% increase in undesirable outcomes. When all foster care experience areas were optimized simultaneously, there was a dramatic estimated reduction in undesirable employment and financial outcomes (− 27.9%). 5. Discussion 5.1. Summary of results Children placed in foster care face many educational challenges. Youth experience frequent school changes, which, along with other factors such as learning disabilities and child maltreatment, are associated with academic difficulties (Rumberger & Larson, 1998). Despite the challenges of child maltreatment, placement instability, and other adversities, many alumni demonstrated positive 1476 P.J. Pecora et al. / Children and Youth Services Review 28 (2006) 1459–1481 outcomes in the domains of Education and Employment and Finance. Many alumni did, however, face significant challenges in these areas: • Foster care alumni obtained a GED instead of a high school diploma at a rate nearly six times the rate of the general population (28.5% vs. 5%) (National Center on Education Statistics, 2003). • Completion rates for postsecondary education were low. • Alumni were in fragile economic situations: one-third reported household incomes that were at or below the poverty level and one-third had no health insurance. [Data related to outcomes in the domains of mental health, physical health, relationships, and parenting are reported in Pecora et al., in press]. While having a GED is more beneficial than not completing high school (Smith, 2003), research indicates that people who obtain diplomas instead of GEDs are more successful as adults; for example, GED recipients are more than twice as likely as those completing regular high school diplomas to not enroll in post-secondary education (Bozick & DeLuca, 2005), and have lower incomes than those with diplomas (Grubb, 1999). Many alumni are part of society's large group of marginalized youth ages 16–24 who are neither employed nor in school: 13% in the general population (http://childtrendsdatabank.org; Nelson, 2004); and nearly one-third in the Midwest foster care population (Courtney, Dworsky, Ruth, Keller, Havlicek, & Bost, 2005). Statistical simulations that estimated the degree to which optimizing certain foster care experiences might affect alumni outcomes indicated that certain areas of program improvement should substantially improve outcomes. Note that this assumes that the associations between placement characteristics and alumni outcomes found in the regression analyses simulations are indeed due to the effects of the placement experiences. A program experiment that systematically compared conventional child welfare service approaches to minimizing placement change (and other key placement experiences) with different approaches that achieved lower rates of placement change would be an essential next step to test these assumptions. 5.2. Recommendations for policy and program design The recommendations stem from the basic descriptive outcomes of the study, the foster care experience statistical simulations, and conversations with stakeholders. Stakeholders included alumni of foster care, foster parents, caseworkers, and agency executives, as well as clinical and policy specialists from each of the three collaborating organizations and other public child welfare agencies. 5.2.1. Education Although high school completion rates were quite high, the rates at which alumni completed high school with a GED were disproportionately higher than the general population. 1. Foster care programs should encourage youth to obtain a high school diploma and not just a GED. School personnel would also benefit from more training about the challenges that youth in foster care face, and ways they can advocate for these youth. (See the Endless Dreams and other curricula at www.casey.org.) 2. Improve identification and treatment of mental health problems that may act as barriers to classroom success. This would involve evidence-based treatment of social phobia, depression, and the sleep and attention problems that accompany Post Traumatic Stress Disorder (PTSD) found in a number of alumni studies (Courtney et al., 2005). P.J. Pecora et al. / Children and Youth Services Review 28 (2006) 1459–1481 1477 3. Minimize placement change. By optimizing all variables describing Placement History and Experience, the statistical simulations estimated a 17.8% decrease in negative education outcomes. If youth do not change homes and schools, there is no need to transfer school records and the youth are less likely to fall behind. Having fewer placement changes may allow youth in care to develop better social support networks, which can assist them to find employment and can serve as a safety net when they encounter financial difficulties. Placement instability, in part, is a result of poor administrative processes, lack of agency support of foster parents, and behavioral problems of youth (James, 2004). All of these factors need to be studied and addressed. 4. Provide concrete resources to youth as they leave care. Optimization of Resources upon Leaving Care predicted a 14.6% decrease in negative education outcomes. It may be that having concrete resources such as a driver's license, $250 in cash, and dishes and utensils results in more financial stability, allowing alumni to pursue their education goals. A more plausible explanation is that these variables described youth who had received many different opportunities to develop skills for independent living, and had positive relationships with foster parents, agency staff and other adults, as well as concrete resources. 5. Support better preparation for, access to, and success in postsecondary education programs. Caseworkers, foster families, and other stakeholders should encourage young people in foster care to plan for college or vocational school, and support them in being adequately prepared for higher education and training. Youth will benefit from information about local collegepreparatory programs, such as Gear-Up, TRIO, and Upward Bound, and help with enrollment in these programs.5 5.2.2. Employment and finances Many alumni were living in vulnerable financial and housing situations. 1. Overhaul independent living preparation. Alumni varied widely in their level of readiness for emancipating from foster care (as evidenced by the uneven findings for employment preparation, life skills preparation, education, and income). a. Federal and state funds are being spent on a variety of untested life skills training, employment services, and education supports (U.S. General Accounting Office, 2004). Some child welfare leaders advocate redirecting these funds to the most promising programs and rigorously evaluating them (Clark & Davis, 2000; Massinga & Pecora, 2003; Shirk & Stangler, 2004). b. Every youth in foster care for 6 months or more should be expected to develop a comprehensive transition development plan that includes planning for supportive relationships, community connections, education, life skills assessment and development, identity formation, housing, employment training and experience, physical health, and mental health (Casey Family Programs, 2001; Mech, 2003). c. The transition plans should increase youth access to Individual Development Accounts (IDAs), special “youth opportunity passports,” and asset accumulation strategies like debit accounts. (See www.jimcaseyyouth.org for example.) d. Provide youth who are exiting care with a broad foundation in life skills and some concrete resources. More extensive preparation for independent living and a critical mass of resources during exit from care will help alumni avoid homelessness, conserve and build their resources, and compete in the employment market. 5 See http://www.trioprograms.org/abouttrio.html, http://www.ed.gov/about/offices/list/ope/trio/index.html, www.ed. gov/print/programs/gearup/index.html, and Casey Family Programs (2003b). 1478 P.J. Pecora et al. / Children and Youth Services Review 28 (2006) 1459–1481 e. Foster care services should be extended to age 21 and independent living services to age 25. Or at a minimum, “booster session” programs could provide a toll-free phone number and various fallback services to alumni after they leave care. This service could also include ongoing access to special job and housing search assistance well beyond the current age limitations. 2. Provide targeted education support services and enrichment experiences. By increasing access to supplemental educational services and tutoring, and by minimizing the number of school changes, alumni employment and financial outcomes will be improved, along with completion rates for post-secondary education and training. 3. Strengthen housing programs and other supports to prevent homelessness after leaving care. a. Youth should be encouraged to develop and maintain lifelong relationships with foster parents and other supportive adults so alumni have a place to go during difficult times. This may require aftercare supports for the foster parents to help support this key activity. b. Transitional housing and public/community housing systems need to be strengthened. Government agencies can work with local Section 8 landlords to help allocate apartments for lowincome foster care alumni. As with other groups whose special needs have been recognized (such as battered women), alumni would benefit from these new housing models that provide not only housing subsidies but also home-based case management or other adult guidance such as Scattered-Site, sober living, Master-Lease Models, and HUD, HOME, and Section 8 housing assistance (Choca et al., 2004; Polcin, 2001; Van Leeuwen, 2004). 5.3. Conclusion This study found that many youth who were placed in foster care benefited from the protection, emotional care, and services that they received while they were in care, while some respondents did not benefit from this experience. It found that the service delivery systems were unable to prepare some alumni to secure and sustain jobs that pay a living wage with health insurance, and to help them complete vocational training or education. Using statistical simulations, certain program areas were identified that, when optimized, can improve alumni outcomes. 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