Evaluating the My Life self-determination model for older youth in foster care: Establishing efficacy and exploring moderation of response to intervention

Systematic Review and Meta-Analysis of Policies and Interventions that Improve Health, Psychosocial, and Economic Outcomes for Young People Leaving the Out-of-Home Care System

Young people who transition to adulthood from out-of-home care (OOHC) are more likely to experience a range of poorer outcomes relative to their same-age peers in the community. This systematic review assessed the effectiveness of policies or interventions (hereafter "interventions") aimed at improving housing, health, education, economic, and psychosocial outcomes for youth leaving OOHC (hereafter "care leavers"). Eleven databases of published literature were reviewed along with gray literature. Eligible studies used randomized or quasi-experimental designs and assessed interventions that provided support to care leavers prior to, during, or after they left OOHC. Primary outcomes were housing and homelessness, health and well-being, education, economic and employment, criminal and delinquent behavior, and risky behavior, while secondary outcomes were supportive relationships and life skills. Where possible, results were pooled in a meta-analysis. Certainty of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation. Fourteen studies published in 27 reports were identified that examined independent living programs (ILPs) (n = 5), intensive support services (n = 2), coaching and peer support (C&PSP) (n = 2), transitional housing (n = 1), health information or coaching (n = 2), and extended care (n = 2). All but one study was conducted in the United States. Twenty small meta-analyses were undertaken encompassing ILPs and C&PSP, with two showing results that favored the intervention with certainty. The level of confidence in each meta-analysis was considered very low. A significant risk of bias was identified in each of the included studies. While some interventions showed promise, particularly extended care, the scope and strength of included evidence is insufficient to recommend any included approach.

Study protocol for leaving care-A comparison study of implementation, change mechanisms and effectiveness of transition services for youth

INTRODUCTION

Youth placed in out-of-home care is a large and highly vulnerable group at high risk of negative developmental outcomes. Given the size and extent of negative developmental outcomes for youth placed in out-of-home care, interventions to help this vulnerable group navigate successfully towards independent living and promote wellbeing across a spectrum of outcome areas are needed. To date, there is a lack of such interventions, particularly in Sweden. Importing interventions from other societies and cultures is associated with difficulties. The aim of the research project is to implement, test, and evaluate interventions that have been recently developed in Swedish practice to close this gap.

METHODS

The project has an ambitious and complex data collection and analysis strategy using qualitative, quantitative, and multiple information methods (hybrid effectiveness-implementation study) over the course of two years. Both the implementation and effectiveness of the interventions will be evaluated. The recently developed My Choice-My Way! leaving care program for youth aged 15+ will be the primary focus of the project and will be compared to usual services.

CONCLUSIONS

The project has the potential to offer novel insights into how society can promote wellbeing across a spectrum of outcome areas for the high-risk group of youth transitioning from out-of-home care to independent living. As such, the project will have important implications for both research and practice.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT05813197.

Systematic Review of the Evaluation of Foster Care Programs

OBJETIVE

The aim of this study was to conduct an exhaustive synthesis to determine which instruments and variables are most appropriate to evaluate foster care programs (foster, kinship, and professional families). This evaluation includes the children, their foster families, their families of origin, professionals, and foster care technicians.

METHOD

The systematic review included randomized, quasi-randomized, longitudinal, and control group studies aimed at evaluating foster care interventions.

RESULTS

A total of 86 studies, 138 assessment instruments, 18 constructs, and 73 independent research teams were identified.

CONCLUSIONS

(1) although the object of the evaluations was the children, the informants were usually the people in charge of their care; therefore, effort should be made to involve the children in a more participatory way; (2) psychosocial functioning, behavior, and parenting are transversal elements in most evaluations, while quality of life and coping are not sufficiently well incorporated; (3) practical instruments (brief and easy to apply and correct) that are widely used and carry scientific guarantees should be prioritized to ensure the comparability and reliability of the conclusions; and (4) progress should be made in the study of evaluation models for all forms of foster care, including foster, extended, and specialized families.

How do academic and career services affect employment, education, and disability benefit receipt in the transition to adulthood for youth with disabilities who have aged out of foster care?

The transition to adulthood is an important process with implications for inequality. Both those with disabilities and those who age of out of foster care are vulnerable during this transition. This project examines the intersection of these groups, exploring employment, education, and disability benefit receipt, the supports these youth receive, and how these supports may mitigate risk in this transition. Findings suggest that those with emotional or mental disabilities face employment risks in the transition to adulthood, and that services may mitigate some of this risk and present unique benefits for youth with disabilities. For example, the odds of employment are greater and the odds of receiving disability benefits are lower among those who receive academic supports (orFTE=1.3, orSSI/SSDI==0.7), post-secondary supports (orFTE=1.3, orSSI/SSDI=0.8), education financial assistance (orPTE=1.3, orSSI/SSDI=0.7), and career services (orPTE=1.3, orSSI/SSDI=0.8). These services should be prioritized for funding, especially education financial assistance as a lower proportion of youth with disabilities receive than their non-disabled peers.

Mentoring Children in Foster Care: Examining Relationship Histories as Moderators of Intervention Impact on Children's Mental Health and Trauma Symptoms

Mentoring-based interventions show promise among children in foster care, but previous research suggests that some benefit more than others. Because children in foster care experience relationship disruptions that could affect mentoring effectiveness, we examined whether children's relational histories at baseline (i.e., relationship quality with birth parents, relationship quality with foster parents, caregiver instability, and previous mentoring experience) moderated the impact of a mentoring intervention on children's mental health, trauma symptoms, and quality of life. Participants included 426 racially and ethnically diverse children (age: 9-11; 52% male) who participated in a randomized controlled trial of the Fostering Healthy Futures program (FHF), a 9-month one-to-one mentoring and skills group intervention. Results showed that relationship quality with foster parents and prior mentoring experience did not moderate intervention impact. Relationship quality with birth parents and caregiver instability pre-program, however, moderated the effect on some outcomes. The impact on quality of life was stronger for children with weaker birth parent relationships and fewer caregiver changes. Likewise, the impact on trauma symptoms was stronger for those with fewer caregiver changes. Overall, FHF seems to positively impact children with varied relational histories, yet some may derive more benefits - particularly those with fewer caregiver changes pre-program.

Differential Risks: How Disability Shapes Risk in the Transition to Adulthood for Youth who Age Out of Foster Care

OBJECTIVE

This study examines how disability is associated with risk during the transition to adulthood for youth who age out of foster care and considers how experiences in the child welfare system contribute to these associations.

BACKGROUND

The transition to adulthood is important for later socioeconomic standing, health, and wellbeing. Youth who age out of foster care with disabilities may require a high level of support during this transition yet may lack support.

METHOD

This study employs linear probability models to estimate the association between disability and incarceration, homelessness, childbearing, and substance abuse between ages 17 and 21 using linked administrative data from the National Data Archive on Child Abuse and Neglect (N=5,221).

RESULTS

Having a physical or sensory disability is associated with lower risk in the transition to adulthood. Alternatively, having an emotional or mental related disability is associated with increased risk of incarceration and homelessness, but the association with homelessness is accounted for by child welfare experiences.

CONCLUSION

Due to the importance of foster care and child protective histories in explaining some risky outcomes for youth with emotional and mental disabilities, policy makers and practitioners should include those early stages of care when seeking it improve outcomes in the transition to adulthood for youth with disabilities who age out of foster care.

A systematic review of self-determination interventions for children and youth with disabilities

PURPOSE

Developing self-determination skills is an important component of youth's maturation. However, many youths with disabilities lack opportunities to engage in activities that can promote these skills. The purpose of this study was to conduct a systematic review of self-determination interventions for children and youth with disabilities.

METHODS

A systematic review was performed on seven international databases that identified 28 studies meeting our inclusion criteria.

RESULTS

Among the 28 studies, 5184 youth with disabilities (aged 9-29, mean age 16.8 years) were represented across three countries. The interventions varied in duration, length, number of sessions, and delivery format, which included curriculum-based, workshops, experiential or residential learning, peer coaching and mentoring, self-directed individual learning, computer games, and multi-component designs. 19/28 studies reported a significant improvement in self-determination. Of these 13/18 studies showed improvements as measured by Arc's self-determination scale, while 8/13 studies reported a significant improvement as measured by AIR self-determination scale. Other significant differences were reported in vocational skills self-efficacy and self-determination inventory.

CONCLUSIONS

Our findings highlight that there are several types of interventions that have the potential to improve self-determination for youth with disabilities. Further research is needed to understand what program components could help youth to obtain optimal outcomes.Implications for RehabilitationSeveral types of interventions (school-based, community, online) have potential to influence self-determination for youth with disabilities.Clinicians and educators should consider having multiple components including workshops, one-to-one and group-based learning, mentoring and coaching for optimal program outcomes.Interventions that are targeted to enhance self-determination for youth with disabilities should be theoretically informed and use a validated measure to assess their effectiveness.