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National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Division of Behavioral and Social Sciences and Education; Board on Children, Youth, and Families; Committee on the Neurobiological and Socio-behavioral Science of Adolescent Development and Its Applications; Backes EP, Bonnie RJ, editors. The Promise of Adolescence: Realizing Opportunity for All Youth. Washington (DC): National Academies Press (US); 2019 May 16.
The Promise of Adolescence: Realizing Opportunity for All Youth.
Show detailsThis chapter addresses the child welfare system, one of two legal systems that regulate the lives of adolescents and their families. The other system is the juvenile justice system, addressed in Chapter 9, which exercises jurisdiction over juveniles charged with delinquent acts. The purpose of the child welfare system is to protect children at risk of abuse or neglect from their parents or guardians (or from whomever the state defines as a perpetrator). Box 8-1 provides a glossary of child welfare terms used in this report.
BOX 8-1
Glossary of Child Welfare Terms as Used in This Report.
There is a third statutory category as well, which establishes court jurisdiction over children who are alleged to be truant, ungovernable, or in need of supervision. Children determined to be in this category are classified as having committed status offenses. Because many states define status offenses as grounds for involvement by the child welfare system, status offenses are also covered in this chapter.1
This chapter proceeds as follows. We set the stage by revisiting a key scientific theme explored in this report: the biological mechanisms through which child maltreatment can get “under the skin” to change the trajectory of child and adolescent development. We then present a brief overview of the child welfare system focused on older youth in care, augmenting the 2014 report, New Directions in Child Abuse and Neglect Research (Institute of Medicine and National Research Council, 2014), followed by a summary of the federal laws that specifically address the needs of adolescents in the child welfare system, including key provisions of the 2018 Family First Preventive Services Act. We then review developmental research on the effects of involvement in the child welfare system on youth outcomes, including mental health and educational outcomes and outcomes related to the permanence of placement and aging out of care. Next, the chapter reviews promising programs and program components for youth involved in the child welfare system. Finally, it concludes with a blueprint for a developmentally informed child welfare system.
CHILD MALTREATMENT AND THE ADOLESCENT BRAIN
There is a growing body of evidence that abuse and neglect—common precursors to involvement in the child welfare system—have effects on the adolescent brain. The majority of prospective research in this area has been conducted during early childhood, but there is a growing body of research on adolescence, and a sizable body of retrospective studies with adults that make use of their recollections of childhood abuse (see Chapter 3).
In a review of the brain imaging literature, McCrory and colleagues (2012) concluded that several structural and functional brain differences are associated with early adversity such as abuse and neglect. Specifically, they report on brain structural differences in three regions: the corpus callosum, cerebellum, and prefrontal cortex. These brain regions are important because they help the brain share information from one hemisphere to the other (corpus callosum), are responsible for higher brain functions such as thought and action (cerebellum), and are involved in planning, self-regulation, and decision making (prefrontal cortex). Further, their review of the literature suggests functional differences in brain regions associated with emotional and behavioral regulation, including the amygdala and anterior cingulate cortex.2 These brain differences may represent adaptations to early experiences of heightened stress that lead to an increased risk of psychopathology during adolescence and beyond.
One study of adolescents focused on neglect during childhood and examined its association with brain structure and cognitive performance (Hanson et al., 2013). The authors examined the brain's white matter (myelinated axions) and neurocognitive performance in early adolescent children who had previously experienced neglect, as compared to adolescents raised in typical environments. They found that the microstructure of prefrontal white matter differed between the two groups, with adolescents who had suffered childhood neglect showing more diffuse organization, which was related to neurocognitive deficits that they displayed relative to the comparison youth.
A long-term longitudinal study of female victims of sexual abuse, who were assessed at six points in time, from childhood through late adolescence and emerging adulthood, compared these young women with others who had no history of sexual abuse, and it too suggests that early experiences may modify an individual's biological response to stress (Trickett et al., 2010). In that study, cortisol levels, which are a biological marker of the ability to regulate stress, declined in young women who had experienced sexual abuse starting in adolescence, with significantly lower levels of cortisol evident by emerging adulthood among female victims. According to the authors, the experience of childhood abuse might disrupt the neurobiology of stress management, whereby victims of child abuse show a decline in their ability to release hormones responsible for effective stress regulation later in development, perhaps due to over-release of stress regulatory responses earlier in development, at the time when they were exposed to abuse.
Research also suggests that the timing of maltreatment may be important for brain development and may lead to different effects across childhood and adolescence (Pechtel and Pizzagalli, 2011). For example, in young adulthood, retrospective reports of childhood sexual abuse indicated that sexual abuse that occurred at ages 3 to 5 and ages 11 to 13 was associated with reduced hippocampal volume in young adults, while childhood sexual abuse that occurred at ages 9 to 10 was associated with reduced corpus callosum in young adults, and childhood sexual abuse that occurred at ages 14 to 16 was associated with attenuated frontal cortex (Andersen et al., 2008). As reviewed in Chapters 2 and 3, these brain regions are important for emotion regulation and memory (hippocampus), sharing of information between brain hemispheres (corpus callosum), and behavioral control, decision making, and planning (prefrontal cortex). The developmental differences, identified by Anderson and colleagues (2008), may reflect the fact that brain regions develop at different rates at distinct times in development and, accordingly, youth may be vulnerable to different degrees and for different outcomes based on the timing of maltreatment.
Similarly, a recent study on the impact of maltreatment on the brain volume of the amygdala, thalamus, and caudate by Pechtel and colleagues (2014) found timing to be important. When asked to recall specific periods of maltreatment during their childhood, Pechtel and colleagues (2014) found that exposure to childhood maltreatment (e.g., parental and peer verbal abuse, physical maltreatment, and non-verbal emotional abuse) was associated with increased volume in the right amygdala, which is important for emotion processing and regulation (Pechtel et al., 2014). Moreover, when moderate maltreatment occurred at ages 10 to 11, this exposure contributed to increased volume in the right amygdala.
There is some evidence that interventions delivered during early childhood can normalize some dimensions of brain function, including diurnal cortisol patterns (Fisher et al., 2007), although the potential benefit of interventions on neurobiological functioning for adolescents in the child welfare system has not yet been examined. Nonetheless, combined with the documented findings on adolescent brain plasticity presented in Chapter 3, interventions delivered during adolescence to improve brain and neurodevelopmental functioning may hold promise for adolescents who are or have been in the child welfare system.3
INTRODUCTION TO THE CHILD WELFARE SYSTEM
It is critical to understand that the child welfare system was not developed with adolescents at the center of the legislation. In 1962, Dr. Henry Kempe and his colleagues published their influential article, The Battered Child Syndrome (Kempe et al., 1962). In addition to describing characteristics of the injuries abused children suffer, the Kempe article identified other characteristics of the “battered child”:
The battered child syndrome may occur at any age, but, in general, the affected children are younger than 3 years. In some instances the clinical manifestations are limited to those resulting from a single episode of trauma, but more often the child's general health is below par, and he shows evidence of neglect including poor skin hygiene, multiple soft tissue injuries, and malnutrition. One often obtains a history of previous episodes suggestive of parental neglect or trauma. A marked discrepancy between clinical findings and historical data as supplied by the parents is a major diagnostic feature of the battered child syndrome. (Kempe et al., 1962, pp. 105–106)
The American Medical Association subsequently led a successful campaign to pass reporting laws in all states by 1967 so that physicians would be freed from confidentiality restrictions to report abuse and there would be a system in place to receive the reports. This led in 1974 to the first federal law governing the child welfare system, the Child Abuse Prevention and Treatment Act (CAPTA). These early origins make clear that, from the child welfare system's genesis, the physically abused infant/toddler was the paradigm that guided the system's processes and procedures.
Federal Child Welfare Legislation
Primary responsibility for protecting children from abuse and neglect rests at the state level, generally with county- or state-operated child welfare agencies governed by state law. However, the federal government has played an important role in funding and guiding state child welfare agencies, beginning with the enactment of CAPTA in 1974. CAPTA and all subsequent child welfare federal legislation have been codified as part of the Social Security Act provisions governing income maintenance. Federal mandates are imposed upon states in exchange for federal reimbursement for a portion of their child welfare funding. To be eligible for federal reimbursement for various aspects of the child welfare system, children must meet the eligibility guidelines for income maintenance.
In 1980, the Adoption Assistance and Child Welfare Act created title IV-E, an open-ended source of matching funds for foster care and adoption assistance for eligible poor children. However, the same law capped funding for prevention services. This meant that states were reimbursed no matter how high their placement or adoption costs for poor children but had only limited reimbursement available for prevention services. The most recent federal law, the Family First Prevention Services Act of 2018 (discussed below) has begun to change this funding paradigm, allowing matching funds to be used for preventive services, not just placement services, and removing the eligibility requirement linked to public assistance eligibility for those prevention services.
The intersectionality between poverty and abuse and neglect continues to plague the system and creates disparities in the system, as discussed throughout this chapter and in detail in Chapter 4. Reports of child maltreatment have increased far beyond the numbers imagined when the systems were first designed. When Congress held hearings before passing CAPTA, senators were warned that up to 60,000 children could be victims of child abuse and neglect nationally. In 2015, 4 million reports of abuse or neglect were made to state reporting systems (Children's Bureau, 2017). In that year, the rate of such reports for children under age 1 was 24 out of 1,000 children; the rate for youth ages 11 and older was less than 7 per 1,000. Consequently, the child welfare system and its resources remain focused on younger children. This committee's assignment is to envision how the child welfare system can be re-envisioned to support the needs of adolescents as well, given their developing cognitive, social, and emotional assets and development.
Status Offenses
Just as Congress was staking out a federal role to support states in preventing child abuse and neglect, states were also reforming their juvenile justice systems (as discussed in Chapter 9). One element of those reforms was to separate out noncriminal behavior such as truancy, running away, and “ungovernability” and assigning jurisdiction over these cases to the child welfare system. Illinois, the site of the country's first juvenile court in 1899, along with New York State, again led the way in the 1960s to establish jurisdiction over two categories of youth: minors in need of services (MINS) and children in need of services (CHINS). In 1967, a presidential commission recommended the Illinois and New York model, and most states created separate laws and procedures to govern status offenses. In 1976, the Institute for Judicial Administration—American Bar Association Juvenile Justice Standards Project emphasized the use of voluntary services to address status offenses rather than court involvement, a practice commonly referred to as “diversion.” Many states continue to encourage diversion rather than court filing. The services utilized to serve children and families in these cases are often the same services available for older youth in foster care.
Congress dramatically furthered the noncriminal distinction of the status offender system with the Juvenile Justice and Delinquency Prevention Act (JJDPA) in 1974, the same year CAPTA was passed to govern the child welfare system. Under JJDPA, youth adjudicated due to status offenses could not be held in secure detention. JJDPA was amended in 1980 to create a “bootstrapping” provision: if youth adjudicated as status offenders violated a valid court order, they could be detained in detention facilities, thus funneling them into the juvenile delinquency system. In October 2018, Pew Charitable Trusts issued state-by-state statistics showing that nearly one-quarter of all incarcerated youth never committed a crime: they were incarcerated for a status offense (Pew Charitable Trusts, 2018). These are youth who were runaways, truant, or adjudged “ungovernable,” and then violated a court order designed to address their adolescent behavior problem, the latter violation ultimately placing them in a juvenile facility.
Noncriminal misconduct is not unusual among adolescents, of course, and it can even be part of a normal developmental pathway to adulthood. Acknowledging this, and to reduce the unnecessary funneling of adolescents into the justice system, the American Law Institute has adopted a Restatement that recommends four principles to guide the courts in these cases.4 This Restatement is consistent with federal and state law, as well as best practices in responding to noncriminal misconduct by children, and the committee also endorses it (see the blueprint outlined at the end of this chapter).
Foster Care and Out-of-Home Services
Foster care is the term often used for a broad array of out-of-home services, including placement in a home with strangers, with relatives through kinship care, in congregate care facilities such as group homes, or in larger settings and inclusive of supervised independent living. Non-therapeutic group homes and supervised independent living are available almost exclusively to adolescents, but younger children with specific needs may also be placed in congregate care settings, including therapeutic group homes. According to the Adoption and Foster Care Analysis and Reporting System, on any given day approximately 443,000 children are in foster care. These figures have grown steadily from under 400,000 in 2012 to the present levels, although a slight decline in those entering foster care occurred from 2016 to 2017 (U.S. Department of Health and Human Services, 2018).
Historically and up to the present day, two defining aspects of the child welfare system have been the focus on young children and the focus on the prevention of serious physical abuse. These foci are coupled with a funding scheme that has provided unlimited funds for out-of-home placement of these endangered children. The result is a system that is under-resourced for efforts to prevent out-of-home placement (which requires support services) and for providing support to families, particularly families with adolescents. As described in Chapter 3, this approach is ill-suited to help adolescents involved in the child welfare system flourish, given their more advanced decision-making skills, their need for a balance of autonomy and healthy relationships, and their ability to use technology to seek solutions, relative to younger children. In addition, insufficient services are available to address acting-out behaviors that may bring adolescents before a court for status offenses, specifically services needed to address the underlying and presenting problems of these youth and their families.
In 2014, the United States spent $29.1 billion on child welfare services. This amount of spending has been roughly constant over the past 10 years, although the share provided by state and local governments has increased and now stands at 57 percent. Of the $29 billion, roughly one-half (46%) is spent on out-of-home placement, 15 percent on in-home preventive services, 19 percent on adoption and legal guardianship costs, and 15 percent on child protective services. Only 2 percent of the total is spent on services and assistance for older youth (Child Trends, 2016, p. 11). The low percentage of total cost expended on in-home prevention and services for older youth spotlights the challenge of properly serving adolescents in the child welfare system while avoiding adjudication for status offenses.
Over the past two decades, Congress has gradually reversed some of the harmful consequences of earlier laws to better serve the needs of adolescents by focusing attention on family reunification, prioritizing placement with kin over strangers, and including a specific focus on older youth and services for those aging out of foster care. There is a renewed emphasis on permanency for all children, not just younger children. Although additional innovations are needed to best serve adolescents in the child welfare system, these statutory changes are significant advances that align with the developmental assets and challenges that adolescents face, and are the subject of our review of Congressional initiatives further below.
Disparities in the Child Welfare System
Before describing recent legal changes, it is important to draw attention to statistics showing that poor children and children of color are disproportionately referred to the child welfare system. Black children represent 13 percent of the U.S. population but 23 percent of children identified by the child welfare system as victims. For non-Hispanic Whites the shares are 52 percent (population) and 46 percent (child welfare system), respectively, while for Asian Americans they are 5 percent and 1 percent, for Latinx they are 21 percent and 24 percent, and for Native Americans 0.9 percent and 1.3 percent (Children's Bureau, 2016). Moreover, a recent analysis of nationally representative data finds that LGBT youth are overrepresented in the child welfare system generally, in foster care, and in other out-of-home placements (Fish et al., 2019).
In general, both disproportionate need and differential treatment by both community members and the child welfare system play important roles in explaining these disparities. Research on the sources of these disparities has been summarized elsewhere (Annie E. Casey Foundation, 2011). As described in Chapter 4, observational data and experimental research data show that community reporters are more likely to report children of color to child welfare authorities. Although some studies suggest that this pattern is attributable to personal bias, others are consistent with a more systematic source of discrimination such as increased maltreatment surveillance in communities of color (Chaffin and Bard, 2006).
A second important source of systemic disparity lies in families of color being offered fewer in-home services that might prevent the placement of a child or adolescent in foster care (Annie E. Casey Foundation, 2011). As a result, children of color are both more likely to be removed from a home and more likely to remain in their placement longer, without permanent resolution.
To reduce such disparities, one should first consider policies and practices that ensure that families of color have access to the same levels of in-home preventative services as other at-risk families. A second and more involved policy response would require evaluation and determination of the appropriate level of surveillance in a community. Both under- and over-surveillance are problematic. Establishing guidelines and protocols regarding appropriate levels of surveillance would improve the overall efficiency and benefit of surveillance systems and likely reduce disparities.
As noted in Chapters 4 and 9, dual involvement in the child welfare system and the juvenile justice system is common, with the same adolescents disproportionately represented in both systems.5 Some have argued that the disproportionate share of minority adolescents in the child welfare system is one of the main drivers of the disproportionate share of minority adolescents in juvenile detention. Child welfare involvement is an especially important avenue or pathway to the juvenile justice system for female adolescents (Ryan et al., 2007), who often pass through the status offense system. As child welfare system innovations and legislative initiatives are launched, attention to strategies to reduce disparities will continue to be front and center.
ALIGNING THE CHILD WELFARE SYSTEM WITH THE NEEDS OF ADOLESCENTS
A child welfare system traditionally focused on child safety, permanency, and well-being is not aligned with the needs and capacities of adolescents as they develop their identities and begin to shape their own futures. The help and support they require differs markedly from the protective cocoon needed by the developing child. Cognitively, the adolescent brain is maturing, and adolescents are capable of more abstract thinking and problem solving than they were in childhood, including an understanding of cause and effect, perspective-taking, having a sense of agency, and increased planning/future orientation skills. These developing skills enable them to be active participants in planning for their future. Socially, adolescents have typically developed a network of relationships with other adolescents and young adults, in contrast to their more singular focus on their own family and parents during early childhood. These peer-based social connections often take center stage in adolescents' lives, impacting their well-being as well as providing important social connections that may not be currently available in their relationships with parents or other caregivers.
As noted in Chapter 1, adolescents are also astute users of technology, both to communicate with their peers and to seek information. These skills can be leveraged to help adolescents in decision making around career, housing, and health solutions. In addition, adolescents have greater awareness of their own and others' feelings and emotions than they did just a few years prior, enabling them to understand the perspective of others and contribute as productive members of society. Together, the higher-level cognitive, social, and emotional capacities that adolescents develop provide them with a toolkit of skills they can use to actively participate in creating their own futures, and to participate in and play a lead role in decision making about their education, residential and custodial situations, and treatment and health care needs.
There is a challenge, however, in reconciling the emerging capabilities of adolescents with the historical definitions of safety, permanency, and well-being that are in the child welfare system due to its origin in ensuring protection of young children. Concerns in the child welfare system about safety and prevention of death are relatively fewer for adolescents than for infants and young children; adolescents are better equipped emotionally, cognitively, and behaviorally to protect themselves in ways that young children simply cannot. Rather, the safety issues that are of a more central concern to adolescents in the child welfare system are issues related to maintaining their own health, including addressing medical concerns, preventing homelessness, and avoiding violent victimization by partners or gangs (e.g., Keller et al., 2007). However, mental health needs typically emerge in adolescence as well, and addressing them requires access to proper behavioral health professionals and community-based services that are not a primary focus for younger children in the child welfare system.
The needs of adolescents are associated with the challenge of making a successful transition to adulthood rather than the paramount need for a stable and permanent family placement. Their need for family connections and supportive adults continues even after adults are no longer legally “responsible” for supporting or protecting them. There is nothing magical about age 18 or even age 21 as a marker of adulthood, and few children outside the child welfare system are expected to be “independent” once they reach the age of majority. At the same time, the successful transition to adulthood does require that older youth have experience with making their own decisions that are developmentally appropriate.
There is no clear metric or measure of “well-being” that can be used across counties and states to determine whether the child welfare system is effective in improving youth well-being. However, it is clear that the definition of well-being as an outcome measure has to be adapted to the evolving developmental needs of welfare-involved youth as they mature from infancy to childhood to adolescence. For adolescents, well-being includes having family and supportive adults available for love and guidance, having self-efficacy and confidence, having a sense of meaning and purpose, overcoming distress or dysfunction from mental health problems that might have resulted from earlier trauma and maltreatment, achieving educational success, and making healthy decisions around their own substance use and sexual behaviors. Metrics such as those would be very different from the ones used in monitoring early childhood development, and the child welfare system has not established them as developmentally appropriate metrics of well-being.
Given the cognitive, social, and emotional skills of adolescents, our society is missing an opportunity to nurture well-being in adolescents when the child welfare system does not fully incorporate their more advanced developmental needs and abilities into its aims and methods. Fortunately, the major federal statutory changes that have been mandated and implemented in the past 20 years have begun to make headway in this area, although much more needs to be done, and implementation at the local level is far from consistent. Four such federal statutory changes are summarized next.
Recent Congressional Initiatives Focusing on the Needs of Adolescents
Fortunately, recent federal statutory initiatives aimed at addressing the needs, skills, and assets of adolescents in foster care have filled some of the gaps in a system originally designed for younger children. These adolescent-specific provisions include provisions authorizing assistance and support in developing a transition plan that is personalized at the direction of the child (Fostering Connections to Success and Increasing Adoptions Act of 2008), facilitating age-appropriate experiences for adolescents (Preventing Sex Trafficking and Strengthening Families Act of 2014), permitting federal support for youth to age 23 through a range of services, including housing (called “Chafee services”), and permitting states to provide eligibility for education and training vouchers to age 26 (Family First Prevention Services Act of 2018). These legislative initiatives are generally aligned with the developmental capacities and needs of adolescents while recognizing that adolescents continue to need protection and stability.
When implemented successfully, these statutory improvements can help support adolescents in learning skills such as how to secure and maintain employment, handle finances, and independently navigate social systems such as health and mental health care, education, and housing support. Adolescents' ability to navigate social media and the internet can be an asset in this regard, helping them to locate housing, education, and health and mental health care options if proper data are provided to them and resources are available in the community. In addition, given their increased cognitive and social skills, adolescents are capable of being active participants in their own permanency decisions—something that younger children cannot do, at least not to the same extent.
The Foster Care Independence Act of 1999
In its statutory “findings” written into the Foster Care Independence Act of 1999, also known as the “Chafee Act” (creating the John H. Chafee Foster Care Independence Program), Congress emphasized its concern for this vulnerable group of former children in foster care:
- (1)
States are required to make reasonable efforts to find adoptive families for all children, including older children, for whom reunification with their biological family is not in the best interests of the child. However, some older children will continue to live in foster care. These children should be enrolled in an Independent Living program designed and conducted by State and local government to help prepare them for employment, postsecondary education, and successful management of adult responsibilities.
- (2)
Older children who continue to be in foster care as adolescents may become eligible for Independent Living programs. These Independent Living programs are not alternative to adoption for these children. Enrollment in Independent Living programs can occur concurrent with continued efforts to locate and achieve placement in adoptive families for older children in foster care.
- (3)
About 20,000 adolescents leave the Nation's foster care system each year because they have reached 18 years of age and are expected to support themselves.
- (4)
Congress has received extensive information that adolescents leaving foster care have significant difficulty making a successful transition to adulthood; this information shows that children aging out of foster care show high rates of homelessness, non-marital childbearing, poverty, and delinquent or criminal behavior; they are also frequently the target of crime and physical assaults.
- (5)
The Nation's State and local governments, with financial support from the Federal Government, should offer an extensive program of education, training, employment, and financial support for young adults leaving foster care, with participation in such program beginning several years before high school graduation and continuing, as needed, until the young adults emancipated from foster care establish independence or reach 21 years of age.6
Congress's decision to allow states to extend care to age 21, launched nearly 20 years ago, marked a critical first step in recognizing the particular developmental needs of adolescents by mandating programming to support independent living skills of older children and adolescents in foster care as they strive for self-sufficiency often referred to as “Chafee services.” As noted below, the intent of these provisions has evolved in subsequent legislative mandates to recognize the interest of adolescents in acquiring the experiences they need for a successful transition to adulthood while maintaining connections to loving and supportive adults.
The Fostering Connections to Success and Increasing Adoptions Act of 2008
Approximately 10 years after the foregoing law was passed, a second law was enacted that provided additional supports for adolescents and young adults in foster care and recognized their more advanced cognitive abilities and needs, relative to younger children, as well as their employment needs. The Fostering Connections to Success and Increasing Adoptions Act of 2008 permits states to elect to continue federally supported foster care assistance to youth up to age 21 if the youth are in school, working, or meet other requirements. In addition, at least 90 days before a youth reaches age 18 (or up to age 21 if the state has chosen to extend foster care), the state must “provide the child with assistance and support in developing a transition plan that is personalized at the direction of the child, includes specific options on housing, health insurance, education, local opportunities for mentors and continuing support services, and work force supports and employment services and is as detailed as the child may elect.”7
Recognizing that “independent living” is not a realistic goal for many young adults, Congress adjusted the goal for youth exiting care as “Another Planned Permanent Living Arrangement” (AAPLA) or “Other Planned Permanent Living Arrangement” (OPPLA). This change recognizes that adolescents at age 18 or even 21 are not “independent” and is consistent with the large body of developmental research that highlights the growth in autonomy-seeking and decision-making capacities of adolescents, while recognizing that adolescents in foster care need loving and supportive adults and continue to have specific and substantial educational and health/health care needs that the child welfare system can address.
The Preventing Sex Trafficking and Strengthening Families Act of 2014
A third legislative change in the child welfare system was the Preventing Sex Trafficking and Strengthening Families Act of 2014. This act recognized that “typical adolescent experiences” are important stepping stones to a successful transition to adulthood (e.g., going to a friend's house, attending prom, taking a school trip, traveling with a sports team or participating in clubs, driving, and part-time employment). Participation in experiences such as these help adolescents develop interests, skills, and supportive and lasting relationships. However, because of real and perceived constraints, foster youth are often denied the chance to partake in these activities, which are important for their successful transition to adulthood. Consequently, the social and professional growth of youth as they age out of foster care may in turn be limited, thus leaving them ill-prepared and potentially vulnerable to experiencing negative outcomes, such as homelessness, unemployment, and poverty. One reason for these poorer life outcomes may be their lack of “normal” adolescent experiences (although research is needed to rigorously test this potential linkage).
The 2014 law promotes well-being and normalcy for youth in the foster care system by directing contracted providers, state child welfare agencies, and courts to facilitate experiences that are age- and developmentally appropriate and that support normalcy and promote permanency, particularly for those youth who are most likely to remain in foster care until age 18. The law establishes a “reasonable and prudent parent” standard for youth participation in activities, and thereby protects foster parents from liability so long as this “reasonable and prudent parent” standard is satisfied. As with the previous legal changes, the 2014 law recognized the differential challenges and opportunities for adolescents in the child welfare system, relative to young children, and aimed to support their healthy social development in the foster care system.
The 2018 Family First Prevention Services Act (FFPSA)
Most recently, Congress recognized the developmental challenges and needs faced by older adolescents in the foster care system with the Family First Prevention Services Act (FFPSA) of 2018. For many years, researchers, child advocates, and an increasing number of state and local policy makers have been focused on reducing the number of children in group care and expanding access to family-based placements. FFPSA represents the first major contribution to this effort at the federal level, restricting federal funding to most group care settings and imposing robust requirements on the limited group care settings that can continue to draw down federal dollars.
Both before and after the passage of FFPSA, Title IV-E funds could be used to fund placements in a “family foster home,” defined as a home with 24-hour care for six or fewer children (with some exceptions), or a “child care institution,” defined as an institution for up to 25 children that is not a detention center.8 Under FFPSA, a child's Title IV-E eligibility ends after 2 weeks of placement in a child care institution. Thus, placements in settings with more than six children lasting longer than 2 weeks generally are ineligible for federal funding once these provisions go into effect in each state.
FFPSA created several exceptions to this funding restriction to meet the needs of older youth and youth with special needs, consistent with adolescents' developmental skills and the tasks that they face in child welfare, in particular their emerging capacity to be self-sufficient. First, the act permits federal reimbursement for supervised independent living placements for youth ages 18 and older, allowing states with extended foster care to continue to offer an array of developmentally appropriate placements. It also exempts group care settings providing “high-quality residential care and supportive services” to youth who have been or are at risk of being victims of sex trafficking.9 Specialized settings for pregnant and parenting youth also retain Title IV-E eligibility beyond the 2-week cutoff.10
In addition to these exceptions, FFPSA created an entirely new placement type—Qualified Residential Treatment Programs—not subject to the 2-week cap.11 These programs must be designed to accommodate children with serious emotional or behavioral disorders, use a trauma-informed treatment model, incorporate family members proactively, and provide discharge planning and aftercare, among other requirements. The statute also provides that, prior to placement in a Qualified Residential Treatment Program, a child must receive an individualized assessment to identify his or her strengths and needs and to determine whether placement is consistent with his or her short- and long-term goals.
There is concern that limiting congregate care in the child welfare system may push more youth into the juvenile justice system or encourage overdiagnosis of behavioral health conditions in order to meet the congregate care exception. The 2018 statute attempted to avoid these potential pitfalls by requiring states to provide an “assurance of nonimpact on the juvenile justice system” and by imposing protocols to prevent inappropriate diagnoses.12
FFPSA directly impacts older adolescents, who are overrepresented in group care, by increasing the capacity of systems to support their successful transition to adulthood through modifications to the Chafee Foster Care Independence Program. First, by changing the name to the Chafee Successful Transition to Adulthood, the law recognized that support should be provided to help youth transition to adulthood, rather than overemphasizing “independence.” As described in Chapter 2, the latest adolescent brain development research shows that the developmental period from adolescence through emerging adulthood features the creation of new neural pathways and the enhancement of connections between brain systems and neural networks. This period of growth provides one of the greatest opportunities for the brain to heal from past maltreatment and trauma. For adolescents in the child welfare system, attaining independence gradually while maintaining connections to loving and supportive adults is key to maximizing the opportunities for brain development and resilience, increasing autonomy within a safe nurturing environment.
FFPSA provides states with extended foster care programs the option to extend Chafee supports and services to youth until age 23, and it extends eligibility for education and training vouchers to age 26.13 The education and training vouchers have a 5-year time limit, but this time does not have to be used consecutively. However, only 25 states and the District of Columbia currently offer extended foster care to youth over age 18 (National Conference of State Legislatures, 2017). Given the growing body of research on poor outcomes for older youth, FFPSA requires a report on the experiences and outcomes of older youth in care by October 2019 based upon the National Youth in Transitions database.14
Finally, agencies are now required to provide youth who have aged out with official documentation showing they were previously in care. This allows young adults to establish eligibility for special categories of benefits targeted at former foster youth, including Medicaid and financial aid for postsecondary education and training. Under the Affordable Care Act (ACA), if an adolescent previously received Medicaid while in foster care and remained in foster care until at least age 18, he or she will continue to be eligible for Medicaid until age 26. However, the ACA does not require states to continue Medicaid benefits for foster care youth over the age of 18 if they lived in a different state while in foster care.
An Unfinished Policy Transition
Taken together, these four statutes provide a suite of developmentally appropriate supports and legal provisions to help adolescents flourish and successfully transition to adulthood. However, despite the recent changes, many of these provisions are optional or are not implemented comprehensively in every jurisdiction in a state, or both (Juvenile Law Center, 2018b). As a result, society is missing an opportunity to help launch child welfare-involved youth into adulthood with sufficient skills, resources, and the connections to loving and supportive adults that all adolescents need to become productive, healthy, and thriving members of our society. The child welfare system has not changed sufficiently, and as a result, youth still want to exit the system before the maximum age of services in their state or do not receive the comprehensive, individualized service array that they need to successfully launch to adulthood.
As is described in the remaining sections of this chapter, additional system-level changes and broader uptake of the optional components of recent laws would further promote resilience and positive outcomes for adolescents involved in the child welfare system. To contextualize a blueprint for a future child welfare system that effectively supports the healthy development of adolescents, next we provide a brief review of the skills and capacities of adolescents in child welfare, alongside a description of the challenges they face and promising solutions.
DEVELOPMENTAL RESEARCH ON ADOLESCENTS IN THE CHILD WELFARE SYSTEM: CHALLENGES AND PROMISING SOLUTIONS
The known effects of maltreatment and trauma on the developing brain (see Chapter 3), together with the opportunity for recovery created by the development of new brain pathways and structural changes during adolescence, represent a challenge for the child welfare system that recent changes in federal law are helping to address. In this section, we present an overview of the challenges and promising solutions across multiple domains, including mental health, education, and placement permanency, and conclude with a section on common elements of evidence-based programs shown to improve the health and well-being of adolescents in the child welfare system.
Mental Health Challenges and Promising Solutions
As a result of the psychological impacts of abuse and neglect, as well as their impacts on the brain and other body systems (see Chapter 3), it is not surprising that adolescents who have been in the child welfare system have elevated mental health symptoms. In fact, mental health is perhaps the most widely studied outcome for adolescents in the child welfare system.
The National Survey of Child and Adolescent Well-Being (NSCAW), a landmark study that documented mental health outcomes for youth in the child welfare system over a 17-year period, provides compelling evidence of elevated mental health symptoms among youth with child-welfare system involvement in the United States. The NSCAW made use of a nationally representative sample of more than 6,000 children and families who were studied by public child protective services programs in the United States between 1997 and 2014. The information collected was gathered from youth, their parents, other caregivers, caseworkers, teachers, and administrative records. The resulting dataset has made possible a large number of technical reports and peer-reviewed publications to date (Institute of Medicine and National Research Council, 2014).
Analyses using the NSCAW dataset indicate that emotional and behavioral problems are present in more than 50 percent of the children in the sample (Burns et al., 2004). Specifically, for adolescents ages 11 to 14, the prevalence of clinical-level mental health symptoms was 65.7 percent (versus 46.8% for 6–10-year-olds and 32.3% for 2–5-year-olds). Numerous other publications using the NSCAW dataset have documented the prevalence of specific mental health problems in adolescents with child welfare system involvement (e.g., Orton et al., 2009; Southerland et al., 2009).
The findings from the NSCAW study are consistent with those from other studies that have found elevated mental health problems for adolescents in the child welfare system. Using a sample of adolescents ages 12 to 17 in the public-use file of the 2000 National Household Survey on Drug Abuse (n = 19,430, including 464 adolescents with a history of foster care placement), Pilowsky and Wu (2006) found that adolescents involved with foster care had a higher rate than other adolescents of past-year psychiatric symptoms. In particular, adolescents involved in foster care had more disruptive behavior disorder symptoms, suicide ideation and suicide attempts, and depression and anxiety symptoms, as well as more past-year substance use disorders, than those never placed in foster care. Conversely, some studies have found no differences between clinical-level depression for youth entering foster care and published norms, as measured in the Children's Depression Inventory for children between ages 8 and 16 (Allen et al., 2000).
In terms of criminal offenses, arrests of adolescents ages 18 to 21 in foster care occurred at more than four times the national rate for individuals ages 18 to 24 (RTI International, 2008). Similarly, between the ages of 17 and 24, 46 percent of former foster youth tracked in the NSCAW experienced at least one arrest; these arrests were evenly distributed across drug, nonviolent, and violent crimes (Cusick et al., 2012).
The negative mental health outcomes experienced by adolescents with a history of involvement in the child welfare system often extend to the next generation. Females exiting foster care are at heightened risk for multiple pregnancies (relative to their age-matched female counterparts), and they are also at higher risk than their male counterparts exiting foster care of maltreating their own children (Dworsky and DeCoursey, 2009; Kerr et al., 2009; Leve et al., 2013). The heightened rates of parenting for females exiting foster care (relative to their male counterparts) may play a role in the apparent sex difference in maltreatment rates. Caution is warranted in making conclusions about sex differences in maltreatment rates, however, because mothers more often retain custody of their child as compared to fathers. It is also important to consider that, although adolescents with child welfare system involvement have higher rates of mental health problems, this does not mean that the child welfare system causes mental health problems. As discussed earlier in this chapter, it is highly likely that many of these young people had mental health problems when they entered care due to the maltreatment and trauma they experienced earlier in life and the associated impacts on neurobiological and socio-emotional development.
The aforementioned studies document the significant need for mental health services for adolescents of all ages in the child welfare system, as well as a need for enhanced health literacy. Unfortunately, among early adolescent youth in the child welfare system, being Black and living at home significantly reduced the likelihood of receiving mental health services (Burns et al., 2004). This might reflect the stigma often associated with help-seeking behaviors, as well as underlying biases in the delivery of effective mental health services to all youth, regardless of race, income, or ethnicity. A study of differences in mental health service use among Latinx, Black, and White youth ages 17 and older in foster care examined their rates of mental health service use both while in foster care and upon exit from the foster care system, and found that Latinx youth had the lowest rate of service use before and after foster care exit (Villagrana, 2017). Specifically, Latinx youth were slightly less likely to use mental health services (33.9% of them using it) than Black (35%) and White (39.9%) youth while in foster care, and were also the least likely to use mental health services (41%) upon exit from foster care as compared to Black (50%) and White youth (50%).
However, Villegas and Pecora (2012) found that the race and ethnicity of foster families and children were less predictive in determining mental health outcomes or the need for mental health services later in life. Factors such as gender, age of entrance into foster care, number of placements, and maltreatment (prior to and while in foster care) were predictive of future mental health service needs. There is, however, a lack of data on this topic. Given that racial and ethnic minorities account for a significant portion of all children in the child welfare system, additional research is needed.
Despite the documentation of poorer mental health and increased behavior problems for adolescents who have been in the child welfare system, as well as disparities in access to services and outcomes, a range of interventions and programs have shown positive results. This suggests that resiliency is possible during adolescence when the right supports and services are provided. In their systematic review of interventions for foster and kinship families, Dickes and colleagues (2018) identified 17 unique studies of psychosocial interventions for this population, delivered between 1992 and 2015. The selection of these studies required that they all have been published in peer-reviewed journals, had more than 20 participants, and used a quasi-random or random allocation of participants to control for experimental conditions.
More than one-half (10) of the included studies in the review by Dickes and colleagues focused on adolescents who were between ages 9 and 18. The most common aim of the intervention across studies was to improve youth behavior outcomes, including their mental health. In fact, 88 percent of the studies reported improvements in behavior problems for youth in the intervention condition, whose problems ranged from externalizing behavior to aggression, oppositional behavior, and substance use. For example, the Middle School Success Program, an intervention for girls in foster care delivered across 9 months during the transition to middle school that included youth skill development and parenting support groups, resulted in increases in prosocial behavior, which led to reductions in externalizing and internalizing symptoms, which in turn led to reduced substance use 3 years later (Kim and Leve, 2011).
Another successful program, the Fostering Healthy Futures (FHF) intervention, combined one-on-one mentoring with therapeutic skills groups to promote well-being of foster youth ages 9 to 11 with a history of maltreatment by identifying and addressing mental health needs as well as preventing risk-taking and promoting competence and improve the overall well-being. The intervention was delivered over 30 weeks during the school year. Further, immediately following the intervention, FHF participants reported an improved quality of life, followed by a reduction in mental health therapy 6 months post-intervention (Taussig and Culhane, 2010).
Educational Challenges and Promising Solutions
Adolescents involved in the child welfare system often show worse educational outcomes than other adolescents; challenges related to educational disruptions, course credit transfer, lack of appropriate school placement and services, and transitions to higher education are commonplace. A study using the NSCAW data showed that connections to employment and education were associated with a lower risk for arrest (Cusick et al., 2012), suggesting a potential opportunity for child welfare policy and practice to improve outcomes for adolescents in care by promoting employment and education success.
Further, research suggests that educational challenges can continue to be a problem for youth when they leave the child welfare system. One study of pregnant or parenting foster care alumni in Chicago, for example, found that only 44 percent of females and 27 percent of males possessed a high school diploma or equivalent when they exited care (Dworsky and DeCoursey, 2009). More recently, a study of more than 600 youth in foster care indicated that 71 percent of youth had attained a high school credential by age 19, and half of foster youth had enrolled in a college (the vast majority of which were 2-year colleges) by age 19 or 20 (Okpych et al., 2017). Some of the predictors of high school completion were residing in rural or suburban counties (as compared to urban counties), completing 11th grade, reading proficiency, a lack of substance use problems, and a lack of prior sexual abuse.
Importantly, a study of foster youth's and their child welfare workers' perceptions of the youth's educational preparedness at age 19 found that one-half of the sample had enrolled in college by age 20, with enrollment in 2-year colleges being more common than enrollment in 4-year colleges (Torres-Garcia et al., 2019). Further, caseworkers' perceptions of the youth's educational readiness significantly predicted their odds of entering college by age 20, suggesting a potential opportunity for caseworkers to help advise youth in terms of selecting a college or career option that best matches their skills and interests.
Because educational attainment continues to be a significant factor in obtaining successful employment, adolescents aging out of the foster care system are ill-equipped to compete. Westat Inc. (1991), the largest study, found that 51 percent of former foster care youth were unemployed 2.5 to 4 years after they had transitioned out of care, and 62 percent were not able to maintain a job for a full year. According to Courtney and Piliavin (1998), 39 percent of former foster care youth were not employed within 1 to 1.5 years after aging out of the system. Barth (1990) found that 25 percent were unemployed 1 to 10 years after leaving foster care.
However, there is hope in the child welfare system's ability to turn these educational trajectories around, including by supporting youth in foster care to attend school and complete homework. For example, Treatment Foster Care Oregon is a program delivered to adolescents with a history of serious juvenile delinquency who are placed in out-of-home care by the juvenile justice system (Chamberlain, 2003). It includes a focus on school engagement by supporting youth to complete 30 minutes of homework each day and through use of a school report card whereby each teacher indicates the student's homework and assignments for the day, which is shared with the youth's foster parent, to increase parental knowledge and engagement in the youth's education. One study of this program found that the intervention had protective educational effects for girls ages 13 to 17; it increased school attendance and homework completion, which then reduced subsequent juvenile justice involvement as measured by days spent in locked settings (Leve and Chamberlain, 2007).
A second program, the Better Futures model, also showed potential educational benefit for older adolescents in foster care. This program is focused on improving postsecondary preparation and participation for youth in foster care with mental health challenges. In a small randomized controlled trial, 67 adolescents were assigned to participate in a Summer Institute, individual peer coaching, and mentoring workshops. Researchers found that, compared to the control group, adolescents in the intervention group had greater rates of improvement in postsecondary participation, postsecondary and transition preparation, hope, self-determination, and mental health empowerment. They also showed positive trends in the areas of mental health recovery, quality of life, and high school completion (Greenen et al., 2015).
These programs and the encouraging body of evidence on their effects provide great hope for improving educational outcomes for adolescents in the child welfare system, particularly when combined with the policy changes described above pertaining to the extension to age 26 of education and training vouchers for child welfare-involved youth.
Placement Permanency and Aging Out of Care: Challenges and Promising Solutions
As noted earlier, one of the primary goals of the child welfare system is to keep children safely at home or else reunify them promptly, either with their biological family, their kin or, if necessary, with new supportive, loving adults. The goal is to ensure a permanent home and caregiving solution for youth who have entered the child welfare system. This section discusses challenges and promising solutions to placement permanency as well as necessary supports for adolescents aging out of care without a permanent placement. Importantly, youth who have been involved in the foster care system emphasize the importance of including system-involved youth in permanency planning as well as the need to identify, initiate, and maintain supportive relationships with adults. (These youth perspectives appear in Box 8-2.)
BOX 8-2
Youth Perspectives: Permanency Planning and Relationships with Supportive Adults.
Placement Permanency
A two-pronged approach would support the goal of permanency for adolescents in the system: including effective supports for child welfare-involved parents with an open case in order to prevent an episode of maltreatment; and providing intervention services once documented maltreatment has occurred and a child is removed from the home. Distressingly, within 12 to 24 months of initial placement, approximately one-third to two-thirds of foster placements fail (Wulczyn et al., 2007). In addition to youth problem behavior, other factors, such as the age at placement, history of residential treatment, and number of prior placements, are predictive of placement failure (Oosterman et al., 2007). Similarly, Fisher and colleagues (2005) found that placement instability gives rise to further instability.
Placement transitions in foster care can also result from bureaucratic, administrative, and policy-led decisions. These can include changes in county contracts with foster care providers, as well as (for a child already in foster care) the subsequent removal from the birth parents of a sibling, which necessitates a new move for the previously placed sibling whose placement cannot accommodate the additional sibling. Moreover, even positive changes, such as reunification with birth parents or adoption, represent caregiver transitions that can be stressful. Thus, by the time a child reaches adolescence, if he or she remains involved in the child welfare system, there is a high likelihood that he or she will have experienced prior failed placements and have had multiple caregivers during childhood.
Regardless of the cause, caregiver transitions have the potential to compromise typical development, which can have sustained effects into adolescence and beyond. For example, when Rubin and colleagues (2007) studied placement instability among NSCAW children, they found that more than 25 percent did not achieve stable placement (rather than multiple placements or a temporary placement) within 18 months in out-of-home care. Placement instability was associated with a 63 percent rise in problem behaviors. Chamberlain and colleagues (2006) also found an association between problem behaviors in youth ages 5 to 12 and placement disruptions.
Although the evidence is clear that having multiple caregiver transitions, placement disruptions, and multiple home placements is harmful to the developing child, there is research evidence that interventions and programs from early childhood to adolescence can reduce the number of placement transitions a child experiences, thus promoting well-being for adolescents with a history of child welfare system involvement. In early childhood, the Multidimensional Treatment Foster Care for Preschoolers Program (TFCO-P) uses a behavior-management approach to train, supervise, and support foster caregivers to provide positive adult support and consistent limit setting through weekly parenting groups, individual therapy, family therapy, and 24/7 on-call support for 6 to 9 months. This program has been shown to improve placement stability across a 2-year period and mitigate the effect of multiple placements on later placement failures (Fisher et al., 2005).
In early adolescence, the KEEP-SAFE intervention showed a similar positive effect on improving placement stability. In a randomized controlled trial of 700 children ages 5 to 12 in the KEEP-SAFE Program, caregivers were assigned to either regular foster care services or the KEEP-SAFE parenting intervention (Chamberlain et al., 2008). The KEEP-SAFE intervention included 16 weeks of caregiver training focused on supervision and applying behavior management strategies. Like TFCO-P, KEEP-SAFE was found to improve placement stability and mitigate the risks often associated with mitigating the risk-prior multiple placements (Price et al., 2008). Further, adolescents in the intervention group were more likely to be either reunified with their biological parents or permanently placed with relatives or an adoptive family within the first year of placement.
Finally, in the Middle School Success study described earlier, the intervention resulted in fewer placement changes at a 12-month follow-up for middle school-age girls relative to children in a foster care as-usual condition (Kim and Leve, 2011). Thus, there is great potential to improve placement stability during early childhood and into adolescence for youth in the child welfare system, and ameliorate the negative behavioral and educational effects that are often associated with transitions in child welfare placements. Nonetheless, despite the positive effect of these intervention programs on placement permanency, most children are still not in permanent placements—that is, adopted or reunified—within 1 year of placement in foster care.
Aging Out of Care
For older adolescents in the child welfare system, “placement permanency” takes on a different meaning. Many foster youth who age out of care suddenly are often left without supportive family relationships and important life skills, which can result in negative outcomes that continue into adulthood: they are at high risk of becoming homeless after turning 18 and are less likely than other youth to graduate from high school, go to college, or get a job. The Jim Casey Youth Opportunities Initiative estimates that the lifetime social cost to taxpayers and communities is $300,000 for every youth who ages out of the system (Annie E. Casey Foundation, 2013).
This problem is compounded by the increasing number of youth aging out of foster care. Each year, more than 20,000 youth age out of foster care and lose their system of support overnight (U.S. Department of Health and Human Services, 2015). The John H. Chafee Foster Care program for successful transition to adulthood reports that in fiscal year 2017, 19,000 youth aged out of care. In addition, the percentage of exits due to aging out increased, from 7 percent in 2000 to 10 percent in 2012. Promoting normalcy (consistent with the 2018 FFPSA) has the potential to improve this trend in two ways: it can increase the opportunities to achieve permanency as well as improve a youth's readiness to leave the system as a young adult who is prepared for adulthood and connected to supportive and loving adults.
Studies of children who have aged out of foster care are scarce, but findings are consistently disturbing. For example, in a representative sample of foster youth in California, over one-third of aged-out 19-year-olds experienced homelessness and more than 40 percent couch-surfed (Courtney et al., 2016). In Washington State, analysis of administrative data showed that 28 percent of youth experienced a homeless episode within 12 months of aging out of foster care. Further, not all youth were equally vulnerable to homelessness; youth who were Black, had experienced prior housing instability, or were parents were at the highest risk of homelessness (Shah et al., 2016). A systematic review of the intersection between foster care involvement and homelessness found that most studies focus on either foster care or homelessness, rather than examining overlapping needs (Zlotnick et al., 2012).
According to Westat (1991), 25 percent of foster care alumni have experienced homelessness for one or more nights. Further, a study by Courtney and Piliavin (1998) found that 27 percent of men and 10 percent of women had been incarcerated one or more times within 12 to 18 months of leaving foster care. Another study by Barth (1990) showed that 35 percent of foster care alumni have experienced homelessness or housing instability. This study also found that 35 percent of foster care alumni have spent time in jail or prison.
A study with the NSCAW data emphasized the important role families play in encouraging housing stability, while critiquing the child welfare system's current focus on preparing foster youth for independent living (Fowler et al., 2017). In that study, youth reported on their experiences of housing problems at 18- and 36-month follow-ups. The data indicate that adolescents who reunited with their families after being placed in out-of-home care were less likely to experience homelessness, while youth who aged out of care experienced similar rates of homelessness as youth investigated by child welfare but who were never placed outside their homes. Exposure to independent living services and extended foster care was not predictive of homelessness prevention, but reunification with family had a positive effect.
Teenage girls in foster care are twice as likely to be parents by age 19 as non-foster care teens (17.2% to 8.2%) (Stotland and Godsoe, 2006). These teen mothers are also even more at risk of homelessness than other children in foster care when they age out:
The vast majority of such women are unmarried and receive little or no support from their children's fathers, who tend to be poor themselves. Friends and relatives who have a spare couch for one person may balk when that person brings along a toddler and a crying baby. Landlords who rent individual rooms and studios prefer single tenants to those with children. The cost of basic necessities for their children, such as diapers and baby formula, drains away what little income former wards may have to pay for housing.
Most disturbingly, examining the connection between homelessness and foster care reveals a generational cycle of foster care placement. Homeless parents in New York City who grew up in foster care are almost twice as likely as parents without such a history to have their children placed in the system. Similarly, a nationwide survey of homeless families in shelters showed that 77 percent of parents with a foster care history had at least one child who was or had been in foster care, as compared with 27 percent of parents without such a history. (Stotland and Godsoe, 2006, p. 55)
Many young people are emancipated from foster care to “independent” living. There is a natural push toward independence during adolescence and emerging adulthood; however, prioritizing interdependence and connecting young people with a consistent and supportive network are vital to healthy development. In a mixed-methods study, where data were collected from 404 youth transitioning from foster care who were interviewed nine times between ages 17 and 19, McCoy and colleagues (2008) found that youth, especially those with externalizing behavior problems, left their foster care placements before required—typically abruptly and because they were dissatisfied with their experiences within the foster care system. While some returned to the homes of their biological families, those that chose to remain in the system often lived in their own apartments.
Young people who are ready to live on their own need a range of housing options that can help them move toward independence in settings that support their needs and connect them with a network of family, mentors, and supportive peers. Supportive caregivers and social workers can help adolescents by providing advice on choosing safe and stable housing. Similarly, housing managers can help adolescents by creating materials that outline resident responsibilities using multiple communication platforms that are easily accessible.
A qualitative study that included focus groups with older adolescents in foster care echoed the potential value of connecting youth considering emancipation with supportive, non-parental adults from within the adolescent's existing social system (Greeson et al., 2015). In that study, coded transcriptions on the focus groups suggested that these young people were cautiously optimistic about the potential of child welfare-based natural mentoring interventions (using relationships within their existing social network) to promote their social and emotional well-being.
Overall, these findings highlight the developmental importance of families and supportive caregivers in promoting housing stability in the transition to adulthood, while also indicating that fundamental improvements are needed in the approaches the child welfare system is using to provide foster youth with the skills they need to secure housing and employment or education as they exit adolescence and enter young adulthood.
FLOURISHING FOR CHILD WELFARE-INVOLVED ADOLESCENTS
As indicated by the research reviewed above and elsewhere in this report, the evidence is clear that the experience of maltreatment during childhood can have lasting effects on the developing brain and behavior systems and can also precipitate instability in caregiving and family relationships. It is equally clear, however, that adolescence can be a period of resilience. The right supports and interventions for youth currently or previously involved in the child welfare system can help change the life trajectory for a child welfare system-involved adolescent.
A number of reviews have been conducted over the past decade that describe effective interventions for youth who have been involved in the child welfare system (see Dickes et al., 2018; Fisher et al., 2016; Leve et al., 2012). Most recently, a meta-analysis was conducted to identify effective components of maltreatment interventions (van der Put et al., 2018), and a systematic review was conducted of effective program components of psychosocial interventions for youth in foster or kinship care (Kemmis-Riggs, et al., 2018). Together, these last two reviews suggest a set of core supports that can be beneficial in improving outcomes for youth in the child welfare system.
To examine interventions aimed at preventing or reducing child maltreatment, van der Put and colleagues' (2018) literature search yielded 121 independent studies (N = 39,044). From these studies, 352 effect sizes were extracted (most studies examined more than one outcome). The overall effect size was significant, suggesting intervention benefits, although it was small in magnitude for both preventive interventions (d = 0.26, p < .001) and curative interventions (d = 0.36, p < .001). The most effective approaches and techniques included cognitive behavioral therapy, home visitation, parent training, family-based/multisystemic interventions, and substance abuse prevention.
Preventive interventions found larger effect sizes with short-term interventions (0–6 months), interventions aimed at increasing parental self-confidence, and professionally delivered interventions. Increased follow-up duration was also a factor in increased effect sizes, indicating that the positive effects of preventive interventions often appear later in development, possibly due to brain plasticity during adolescence. Larger effect sizes were found in curative interventions that sought to improve parenting skills and increase access to social and/or emotional support.
To examine interventions focused on youth in foster care, a systematic review was conducted to examine the components in foster and kinship care interventions, with the aim of exploring their potential benefits to youth and caregiver well-being. Seventeen studies published between 1990 and 2016 and describing 14 interventions were identified that each used a randomized or quasi-randomized trial focused on psychosocial outcomes for youth in foster care (Kemmis-Riggs et al., 2018). Effective interventions often included aims that were clearly defined, targeted domains and developmental stages, coaching, and role play. Further, interventions that were developed to reduce the effects of maltreatment and relationship disruption were often found to be successful. Behavioral problems were often successfully addressed by interventions that provided consistent discipline coupled with positive reinforcement, trauma psychoeducation, and skills development (e.g., problem solving). Parent–child relationships were often improved through interventions that aimed to develop empathy, sensitivity, and parental responses attuned to adolescent's needs. Together, these recent meta-analysis and research review studies suggest that there are both specific programs and more general attributes of programs that can help adolescents in the child welfare system thrive.
RECOMMENDATIONS
A challenge for the child welfare system is to extend the knowledge acquired from individual programs and program components to implement system-level change. In order to do so, the committee outlines below recommendations for improving the child welfare system to better support the process and outcomes of adolescent development. These recommendations center on adolescents within the child welfare system as needing services and supports that vary from their younger counterparts and as involved partners in decisions affecting their own housing, health/mental health, and education. Taken together, the recommendations constitute a blueprint for achieving an adolescent-oriented and developmentally appropriate child welfare system. Box 8-3 summarizes this blueprint for an adolescent-oriented and developmentally appropriate child welfare system. We next focus on the six recommendations of the blueprint and discuss them in turn.
BOX 8-3
Blueprint for a Developmentally Informed Child Welfare System for Adolescents.
RECOMMENDATION 8-1: Reduce racial and ethnic disparities in child welfare system involvement.
As described above, conditional on underlying risk, there is evidence that families of color are more likely to be referred to child protective services. Two proximate causes are the unequal provision of in-home preventative services and higher levels of surveillance for families of color. Thus, to reduce such disparities, state and local departments of child welfare should implement policies and practices that ensure that families of color have access to the same levels of in-home preventative services as other families. A second and more involved policy response would require evaluation and determination of the appropriate level of surveillance in a community. Both under- and over-surveillance are problematic. To reduce disparities, state and local departments of child welfare should establish guidelines and protocols regarding appropriate levels of surveillance in communities to improve the overall efficiency and benefit of surveillance systems, a practice also expected to reduce disparities. Responsible agencies should actively monitor implementation of these guidelines.
RECOMMENDATION 8-2: Promote broad uptake by the states of federal programs that promote resilience and positive outcomes for adolescents involved in the child welfare system.
As described above, a number of recent statutory changes embrace a developmentally informed approach to child welfare system practices and policies. However, many of these provisions are optional or not implemented rigorously or systematically. As a result, we are missing an opportunity to help launch child welfare system-involved youth into adulthood with sufficient skills, resources, and the connections to supportive adults that all adolescents need to become productive, healthy, and thriving members of our society. To better promote resilience and positive outcomes for adolescents involved in the child welfare system, all states should adopt the existing federal option to provide extended care to youth until age 21 and Chafee services to age 23 and provide comprehensive aftercare support to youth as they transition out of the child welfare system. In addition, all states should ensure that all youth who have experienced foster care are eligible for Medicaid until they reach age 26. Further, all states should ensure that child welfare system-involved youth are eligible for education and training vouchers until they reach age 26 and should facilitate and support youths' application process.
RECOMMENDATION 8-3: Provide services to adolescents and their families in the child welfare system that are developmentally informed at the individual, program, and system levels.
Adolescents' ability to problem solve, plan for the future, take the perspective of others, and weigh risks and benefits of actions increases dramatically across the span of adolescence. At the same time, their need for close relationships with caring adults and peers remains vital. Intervention and intervention practices discussed in this chapter offer promise in terms of the plasticity of adolescent development and the ability of intervention programs delivered during adolescence to improve socio-emotional outcomes. However, these interventions—and the child welfare system itself—have yet to incorporate a developmental approach to service provision and case management for adolescents with child welfare system involvement. Thus, state and local departments of child welfare should implement policies and practices that incorporate a developmental approach to service provision and case management for adolescents with child welfare system involvement, prioritizing family connections and supportive adults and taking maximum advantage of adolescents' increasing cognitive and social capacities. Further, state and local departments of child welfare should adjust the type and structure of services and the level of adolescent involvement in decision making related to their housing, education, and services to best align with adolescents' developmental capabilities and needs.
In light of the research evidence on the positive benefits of developing and maintaining a positive relationship with an adult (a family member, caregiver, mentor, or social support provider), services and programs should ensure that every system-involved youth is connected with a qualified and caring adult with ready access to advice and support from the responsible agency. Adolescents in the child welfare system also benefit when they remain engaged in the education system. Recognizing the growing capacity of adolescents for self-direction, case managers and courts should ensure that adolescents have the opportunity to fully participate in developing and implementing their service and transition plans, while maintaining critical ties with caring adults. To this end, adolescents should be involved as respected partners in decision making regarding their placements, education, and support services.
RECOMMENDATION 8-4: Conduct research that reflects all types and ages of adolescents in the child welfare system.
Most studies of adolescents who are involved in the child welfare system contain a heterogeneous set of participants ranging from those entering their first foster care placement to those who are 3 months into their fifth foster care placement, for example. Further, over the course of any given study (or intervention, in the case of intervention studies), adolescents may exit from care, terminate one placement and be placed in a new foster home, or be reunified with their parents. For the child welfare system to serve adolescents in a developmentally informed manner, services and programs must be designed specifically for adolescents, and those services must be evaluated. There is currently insufficient research on services designed specifically for adolescents, and the research that does exist generally does not span the full spectrum of adolescents involved in child welfare and is not reflective of the racial and ethnic composition of child welfare youth. Thus, the federal government, state and local child welfare agencies, and philanthropic institutions should fund research on service characteristics and outcomes for the full range of adolescents in the child welfare system in order to better design and evaluate services specifically for adolescents, depending upon their age, child welfare system history, and placement situation.
Although there is a general consensus that the child welfare system must be guided by trauma-informed and developmentally appropriate services, the effectiveness of such services has only been evaluated at the individual program level. Current child welfare system services are neither focused on adolescents nor delivered systemwide. The most effective approaches and techniques evaluated at the individual or program level have included cognitive behavioral therapy, home visitation, parent training, family-based/multisystemic interventions, and substance abuse prevention.
In order to make real progress and improve the well-being of adolescents in the child welfare system, successful programs and interventions delivered only at the individual level or the research-study level need to be delivered and implemented across the child welfare system, in sustainable ways. Further, individual and program successes identified through this research should be scaled to system-level change for adolescents in the child welfare system.
RECOMMENDATION 8-5: Foster greater collaboration between the child welfare, juvenile justice, education, and health systems.
Most adolescents in the child welfare system have experiences across multiple systems, including education, justice, status offense, and health and mental health care, yet most child welfare systems do not yet have access to an integrated data system that links information across systems while maintaining confidentiality. This is important, because effective services and best practices often require outreach to multiple systems. In addition, with the increased incorporation of predictive analytic tools, child welfare systems may have the ability to tailor services based on additional information about youth most in need of intensive services (and those in need of lighter or more targeted services), based on the constellation of their behaviors and outcomes across multiple systems (see Chapter 4). To best serve youth, child welfare, juvenile justice, education, and health agencies should collaborate to create an integrated data system that links information to track, evaluate, and provide an effective and integrated set of services to adolescents across these systems. However, an arrest, court petition, delinquency filing or other involvement in the juvenile justice system should not disqualify an otherwise eligible child from remaining in or re-entering foster care for the full period of eligibility.
Moreover, as described above, adolescents involved in the child welfare system often show worse educational outcomes than other adolescents, which is partly related to educational disruptions, problems with credit transfers, and a lack of appropriate school placement and services. They also show poorer physical health outcomes. Data from a nationally representative sample of noninstitutionalized children in the United States show that children placed in foster care are twice as likely to have asthma and three times as likely to have hearing problems and vision problems as those without foster care histories (Turney and Wildeman, 2016). State and local child welfare agencies, education agencies, and health care providers need to work together to ensure that child welfare system-involved youth are provided with appropriate health care and educational opportunities and are not hindered in pursuing their education by poor health or their involvement with the child welfare system. State and local child welfare and education agencies should collaborate to minimize educational disruptions for child welfare system-involved youth. This includes insuring proper transfer of credits, appropriate school placement and services, and school transportation services when continuation in the original school is desired.
An arrest, court petition, delinquency finding, or other involvement in the juvenile justice system should not disqualify an otherwise eligible child from remaining in or re-entering foster care for the full period of eligibility.
RECOMMENDATION 8-6: Provide developmentally appropriate services for adolescents who engage in noncriminal misconduct without justice system involvement.
Troubling behavior by children, such as truancy and running away, is often symptomatic of underlying issues in school or at home, but the court system is generally ill-equipped to resolve these issues. The state has a general interest in ensuring that a child and family receive supportive services, because a child's noncriminal misconduct can pose a danger to the child and others. However, the primary strategy for states and localities for addressing noncriminal misconduct (status offenses) should be the provision of services on a voluntary basis, wholly outside the legal system.
Drawing on the proposed “restatement of the law” relating to child welfare under consideration by the American Law Institute, the committee recommends that any legal response to noncriminal misconduct by children should draw a clear distinction between this misconduct and conduct that would be a crime if committed by an adult. Legal intervention for a CHINS is not intended to be punitive and instead should be focused solely on ensuring that a child and family receive needed services. Although noncriminal misconduct can lead to delinquent acts, for most children this behavior does not escalate to more serious misconduct. Thus, states should end the practice of treating a violation of a court order by an adolescent adjudicated as a CHINS as contempt of court and, thus, as a legal basis for initiating a juvenile delinquency proceeding.
When courts do become involved, the noncriminal misconduct of a child is most effectively addressed through community-based programs that emphasize the provision of services and keep the child at home. Courts should minimize the risk of a child's involvement with the juvenile justice system. Of particular concern is the practice in some states of treating a violation of a court order in a CHINS petition as criminal contempt of court and thus the basis for a juvenile delinquency proceeding. If adolescents are referred to the juvenile justice system for noncriminal misconduct, the disposition should be limited exclusively to placement in a community-based program that emphasizes the provision of services and keeps the child at home. This practice should be ended whenever possible. Similarly, children who are arrested should not be disqualified from child welfare services, but placement stability and the option of re-entry should remain available to them.
Footnotes
- 1
Youth who are truant or who run away from home or placement may also “cross over” into the juvenile justice system for violations of court orders controlling their behavior so information on status offenses is also relevant for a complete understanding of the relationship between the child welfare and juvenile justice systems.
- 2
See Chapters 2 and 3 for a more detailed discussion of these brain regions and the ways trauma can affect them and the pathways among them.
- 3
As an adolescent moves from a harmful environment to a safe one—such as from an abusive home into a supportive foster family—an opportunity is provided to leverage the power of observational research to prospectively examine how a supportive context can promote resilience and the generation of new and adaptive brain connections (this would require data collection on each youth before and after the new placement).
- 4
Restatement of the Law: Children and the Law, Preliminary Draft No. 5 (September 5, 2018), Sections 3.00, 3.10, 3.20 and 3.30, pp. 19–63.
- 5
Children involved in both child protective services and juvenile justice are referred to as crossover youth. Roughly 30 percent of children in the child welfare system have future involvement in juvenile justice system as well (https://www
.ncbi.nlm .nih.gov/pubmed/16233913/), but there do not appear to be any national statistics. All statistics come from individual studies of local areas. - 6
Pub. L. 106–169, § 101(a)(1)-(5).
- 7
Pub. L. 110–351, § 202; 42 U.S.C. § 675(5)(H). (The committee is unaware of any data on the quality and efficacy of the provisions states provide youth within the last 90 days of leaving foster care.)
- 8
Facilities that house more than 25 children are not eligible for federal Title IV-E reimbursement. See https://www
.acf.hhs.gov /sites/default/files /cb/title_iv_e_review_guide.pdf. - 9
FFPSA § 50741(a)(2)(D).
- 10
FFPSA § 50741(a)(2)(B).
- 11
FFPSA § 50741(a)(2)(A).
- 12
FFPSA § 50741(d); 50743.
- 13
FFSPA § 50753. Also see Juvenile Law Center, “Extended Foster Care,” at https://jlc
.org/issues /extended-foster-care. - 14
FFSPA § 50753.
- CHILD MALTREATMENT AND THE ADOLESCENT BRAIN
- INTRODUCTION TO THE CHILD WELFARE SYSTEM
- ALIGNING THE CHILD WELFARE SYSTEM WITH THE NEEDS OF ADOLESCENTS
- DEVELOPMENTAL RESEARCH ON ADOLESCENTS IN THE CHILD WELFARE SYSTEM: CHALLENGES AND PROMISING SOLUTIONS
- FLOURISHING FOR CHILD WELFARE-INVOLVED ADOLESCENTS
- RECOMMENDATIONS
- Child Welfare System - The Promise of AdolescenceChild Welfare System - The Promise of Adolescence
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- Leucadendron elimense subsp. vyeboomense partial caf1-6 gene for putative CCR4-a...Leucadendron elimense subsp. vyeboomense partial caf1-6 gene for putative CCR4-associated factor 1-homolog 6, specimen voucher ELMV_10_19_1gi|662241004|emb|HG424807.1|Nucleotide
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