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					    Older Youth Leaving Foster Care:
Old Dilemmas, New Insights, Fresh Ideas
               Curtis McMillen, Ph.D.
       Louise and Abraham Makofsky Lecture
              UMB SSW, April 13, 2007

   The Center for Mental Health Services Research
        Outline


• 7 old dilemmas
• 7 “new” insights
• 7 “fresh” ideas
                    Some new data
                       sources
• VOYAGES Study in Missouri followed 404
  youth 17-19 with 9 interviews
• Midwest Foster Care Study (Illinois,
  Wisconsin, Iowa), interviewing 736 older
  youth at ages 17, 19 and 21
• Intersections Study in Missouri, qualitative
  interview study about mental health
  services in child welfare
             Persistent Dilemma 1

THE BIG QUESTION:
 How to help older youth and young adults,
 with very difficult backgrounds, move
 productively forward with their lives as
 they leave the foster care system.
          Persistent Dilemma 2

TROUBLING NUMBERS
   employment
   school completion
   early pregnancy
              High school Grad at 19

90                                                87
80
70
        58
60               48
50                                    38
40
                           29
30
20
10
 0
     3 MW      MO- in   MO-out    MO- total      Natl
     States   custody   custody               Estimates
               HS Grad or GED at 19

100
                                                  87 91
 90
 80
 70
       58 63         57
 60             48                         51
 50                             47
                                      38
 40                        29
 30
 20
 10
  0
      3 MW      MO- in    MO-out     MO- total      Natl
      States   custody    custody                Estimates
                      In college at 19

100
 90
 80
 70
 60
 50
 40
         27
 30              18
 20                                   12
                            6
 10
  0
      3 MW      MO- in   MO-out    MO- total      Natl
      States   custody   custody               Estimates
                      Employed at 19

100
 90
 80
 70
 60
                 46                   42
 50      41                39
 40
 30
 20
 10
  0
      3 MW      MO- in   MO-out    MO- total      Natl
      States   custody   custody               Estimates
                Past year earnings at 19

100                   95           96         96
           90
 90              79           81         80
      76
 80
 70
 60
 50
 40
 30
 20
 10
  0
      3 MW       MO- in    MO-out       MO- total      Natl
      States    custody    custody                  Estimates

                      < $5K        < $10K
               Females Given Birth by 19

100
 90
 80
                           66
 70
                                      55
 60
 50      44
                 37
 40
 30
 20
 10
  0
      3 MW      MO- in   MO-out    MO- total      Natl
      States   custody   custody               Estimates
            Persistent Dilemma 3
            What services to offer?
Most/all states offer:
    Life skills assessments
    Skills classes
    Youth advisory boards
    Teen conferences and retreats
              Persistent Dilemma 3
                What services to
                      offer?
Many states offer:
    Tutoring
    Mentoring programs
    Payment for normalizing experiences
    Financial support for crises (aftercare)
    Room and board at TLPs (aftercare)
               Persistent Dilemma 4
               The Dose of Service
Skills classes
       36 weeks (MO) 10 weeks (L.A.)
Tutoring
       30 hours at Sylvan (NC)
       50 hours (L.A. C.C.)
Youth empowerment
       Advisory board versus
       California Youth Connection
Biggest hurdle

   No evidence to
   date that any of
   these services
   work.
Persistent Dilemma 5
  Opportunity vs.
      structure
Persistent Dilemma 6
Getting adults to stop
 being so controlling
                Persistent Dilemma 7
                 Getting states to do
                   the right thing
When older youth must leave care (18, 21)

Participating in Medicaid option to cover older
  youth from foster care from 18-21.
                  Persistent Dilemmas

•   What services to offer
•   At what dose
•   To move problematic outcomes
•   How to get:
    – States to do the right thing
    – Adults to do the right thing
    – Adults to give up some control
    – Older youth to do the right things
   New Insight 1:
  Where Youth Live
Old assumptions
Youth who leave care
live independently
Youth who stay in care
stay in foster homes
                         Where Older Youth Live Who
                           have left the system -
                                percentages
100
                                                                  More
 90                                                               independent
 80
 70                                                               Family
 60
 50                                                               Nonkin Foster
 40                                                               Family
 30
                                                                  Congregate Care
 20
 10
  0
      17   17.3   17.6   17.9   18   18.3   18.6   18.9   Final
                     Where Older Youth Live (who
                      stayed in the the system -
                            percentages)
100
 90
 80                                                               More independent

 70
                                                                  Family
 60
 50                                                               Nonkin Foster
                                                                  Family
 40
                                                                  Congregate Care
 30
 20
 10
  0
      17   17.3   17.6   17.9   18   18.3   18.6   18.9   Final
  New Insight 2:
How and Why Older
 Youth Leave the
Foster Care System
                                      58% exited by age 19
450 404
        392 383
400             374 366 358
                            354 346
                                    338 331 322
350                                             317 312
                                                        281
300                                                         264 252
                                                                    237 230 220 209 203 195 185 179 175 170
250
200
150
100
 50
  0
       17 mo

              o




                                                        18 mo

                                                               o
        17 o
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        17 o
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        17 o
       17 mo




                                                         18 o
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                                                        18 mo
       17 mo

        17 o




                                                         18 18




                                                                                                      19
  BD




             m




                                                              m
           2m
           3m
           4m
           5m
           6m
           7m
           8m




                                                            1m
                                                            2m
                                                            3m
                                                            4m
                                                            5m
                                                            6m
                                                            7m
                                                            8m
            m




          10
          11




                                                           10
                                                           11
           9




                                                            9
          0
          1
17
     17




                                         in care   out of care
               Percentage Who Reported
                 This As Part of Their
                “How I Left Care” Story


40   39

35                                          Youth initiated
30        28                                System initiated
                                            No notice
25
                                            Thrown out
20             17                           Age related
                        15 17
                                            Achieved goals
15
                                            Circumstances
10                  8                       Live with family
                                6
                                    6       Adopted
 5
                                        2
 0
            How: Youth initiated

• “I left my foster home and never came
  back.”
• “I ran away from placement after
  placement so they released me when I
  was 18.”
             How: D/C no notice

• “They just sent me a letter telling me I was
  out of custody.”

• “My caseworker quit, but before she left
  she got me out of custody, but no one ever
  told me, so I called and they told me I was
  out.”
             How: System initiated

• “I’m not really sure. It is just what they
  recommended when I went to court.”

• “I went to court and it just happened.”

• “It just happened. My case manager went
  to court and come home and said I had
  been [released].”
                Wanting to Leave


90% of those who left the foster care system
  said that they wanted to leave the foster
  care system at the time of their exit.
          Percentage Who Reported
               as Part of Their
           “Why I Left Care” Story

     39                      Frustrated w
40                           system
35
               28            CD failure to
30                           provide
25        22        22
                             Sought
20
                             independence
15
                             Wanted change
10
                             in
 5                       3   circumstances
 0                           Other
New Insight 3:
  Academic
 Preparation
                                     Educational plans at
                                          age 17
          Beyond College             6

        Four-year college                                     44

         Two-year college                     18

Vocational/Military School                         25

          High school only           6

                GED only         2

  Not finishing high school 0

                             0           10   20    30   40        50   60   70   80   90   100
                                  Problems with Reading:
                                  Percentage with certain
                                  reading levels at age 17

Beyond high school           7

       High school                         23

     7th-8th grade                    17

     4th-6th grade                              38

       < 3rd grade               12

          Refuse d       3

                     0            20            40   60   80   100
                       New Insight 4:
                    Mental Health Services
                     Lifetime Service Use
100%
 90%
                        0.77
 80%   0.73
 70%
 60%
 50%                                                 0.42
 40%                                                             0.29
 30%
 20%                                   0.08
 10%
  0%
                         Residential




                                       Residential
       Outpatient




                                                                 school help
                                       Substance




                                                     Inpatient




                                                                   Special
          MH
                      Psychotropic Medication Use By
                      When Youth Leave Foster Care
50
45
40
35
30
25
20
15
10
 5
 0
  17 BD




                                    18 18




                                                                              19
         o




                                           o
  17 o
  17 o

  17 o
  17 o
  17 o

  17 o
  17 o
  17 o
 17 mo




                                    18 o
                                    18 o

                                    18 o
                                    18 o
                                    18 o

                                    18 o
                                    18 o
                                    18 o
                                   18 mo
 17 mo




                                   18 mo
       m




                                         m
       m
     2m
     3m

     4m
     5m
     6m

     7m
     8m




                                       1m
                                       2m
                                       3m

                                       4m
                                       5m
                                       6m

                                       7m
                                       8m
    11




                                      11
     9




                                       9
    10




                                     10
17

     1




     never left   left 18 .6-19   left 18 - 18.6   left 17 .6 - 18   left 17 - 17.6
       New Insight 5:
       Depression
Anderson & Simonitch (1981)
“Reactive depression appears to be a
  common reaction to emancipation” (p.
  385)
Barth (1990) 55 older youth from the Bay
  Area (CA) an “accidental sample”
The average score on the CESD was
  above the clinical cutoff for depression –
     3 Classes of Depression
     Trajectories from Growth
         Mixture Modeling
35

30

25                   class1 76%
                     class 2 7%
20                   class 3 17%

15

10
   .3
   .6
   .9


   .3
   .6
   .9
   17




   18




   19
 17
 17
 17


 18
 18
 18
  New Insight 6:

If you build it, they
   may not come.
              New Insight 7:
           Staying in Care Helps
100%
 90%
 80%
 70%
 60%
 50%        0.35
 40%
 30%                              0.15
 20%               0.06
 10%                                     0
  0%
       no pay rent              Evicted
         on time
       Out of custody n=71   In custody n=31
              Basic Idea: To 21 for
                  all 50 states
• Care options for youth in the FCS to age
  21 in all 50 states.
• Federal dollars to pay for foster care
  boarding to age 21.
• Full participation in Medicaid options
              Idea 1: Making Life in
                 Care Tolerable
POLICY CHANGES
• Clarified legal status for youth in system
  who are 18-21 years of age.
• Fewer decision makers.
               Idea 2: Making Life in
                  Care Tolerable

PROGRAMMATIC CHANGES
• High expectations without ultimatums
• Fewer contingencies
• Second chances
  Idea 3: Get Older
    Youth Out of
Residential Treatment
                Idea 4: Powerful
                   Programs
Programs that can change lives in many
  ways

Young adult owned businesses
 auto detailing business
Idea 5: True Youth
  Empowerment
    Programs
                   Idea 6: Quality
                  Outreach/Quality
                     Assurance
• Informed about options (emergency funds,
  tuition remission).
• Can’t trust workers to inform youth.
• Structured information shared at review
  hearings.
• Basic QA
              Idea 7: Fresh Look at
                  Permanency
• New look at birth families.
• Child specific recruiting
               Your ideas may be
                      better

• Lots of room for innovation.

• Lots of potential for new research that can
  really make a difference.
  Contact information

Curtis McMillen
Campus Box 1196
Washington University
St. Louis MO 63130
314.935.7517
cmcmille@wustl.edu

				
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