Findings from the Northwest Foster Care Alumni Study

1. Findings from the Northwest Foster Care Alumni Study The NGA Center for Best PracticesInstitute on Supporting Youth Transitioning from Foster Care Tampa, Florida, October 27, 2005 Presenter: Peter J. Pecora, on behalf of the Northwest Alumni Study team.

2. Acknowledgements Dr. Peter Pecora is Principal Investigator for the Northwest and National Alumni studies, Senior Director of Research Services with the Casey Family Programs, and Professor at the School of Social Work, University of Washington. Mailing Address: Casey Family Programs, 1300 Dexter Avenue North, Floor 3; Seattle, Washington 98109-3547. Phone: (206) 270.4936. Website: www.casey.org Acknowledgements: This handout is based on research conducted by the staff of: • Casey Family Programs • Harvard Medical School • Oregon Department of Human Services • Washington Department of Health and Human Services • The Northwest Alumni Studies team is grateful to and has learned much from the youth, alumni, parents and Casey field staff

3. Investigators and Project Coordinators • Northwest Alumni Study Investigators • Peter J. Pecora, Ph.D., Principal Investigator, Casey Family Programs and Professor, School of Social Work, University of Washington • A. Chris Downs, Ph.D., Co-Principal Investigator, Casey Family Programs • Diana J. English, Ph.D., Co-Principal Investigator, Research Director, Child Welfare League of America (formerly with and representing the Washington Department of Social and Health Services, Children’s Administration, Division of Children and Family Services) • Steven G. Heeringa, Ph.D., Co-Principal Investigator, Institute for Social Research, University of Michigan • Ronald C. Kessler, Ph.D., Co-Principal Investigator and Professor, Department of Health Care Policy, Harvard Medical School. • James White, Ph.D., Co-Principal Investigator, Portland State University (formerly with and representing the Oregon Department of Human Services; Children, Adults, and Families) • Project Coordinators for the Northwest and Casey National Alumni Studies • Merrily Wolf, B.A., Casey Alumni Studies Coordinator (1995-1998) • Jason Williams, M.S., Casey Alumni Studies Coordinator (1998-2003); currently Research Analyst, University of Alaska Child Welfare Evaluation Program • Kirk O’Brien, Ph.D., Casey Alumni Studies Coordinator and Senior Research Analyst, Casey Family Programs

4. Presentation Outline • Study Methods • Foster Care Experiences • Outcomes • Optimizing Success • Recommendations • Appendix materials: NW Alumni Study Methods and Demographics, Overview of Casey Family Programs

5. “Nothing About Us Without Us”

6. I. Study Methods Research Questions • How are youth who were placed in foster care faring as young adults? • Are certain key factors or program components linked with better functioning in adulthood?

7. Study Methods: Sources of Information • Case record reviews. • Interviews with 479 alumni (76% response rate). • Comparison of alumni data with other foster care research and national benchmarks (e.g., National Comorbidity Study-Replication) • Public data bases

8. Study Methods: Demographics

9. II. Foster Care Experiences

10. Foster Care Experiences

11. III. Outcomes: Assessing Mental Health Composite International Diagnostic Interview • Non-clinician mental health instrument • World Health Organization-approved tool with high reliability and validity • Assesses mental health during lifetime and over the previous 12 months • Used as part of the Northwest Alumni Study and National Comorbidity Study-Replication (NCS-R)

12. Outcomes: Mental Health

13. Outcomes: Mental Health Twelve-Month Mental Health Diagnoses among Northwest Foster Care Alumni and the General Population Mental Health Diagnosis

14. Outcomes: Education a a (Mech 2003)

15. Outcomes: Education

16. Outcomes: Employment & Finances a a (Brandford & English 2004, Washington State data)

17. Outcomes: Employment & Finances a b a Homeless at any point since leaving foster care. b Homeless at any point in past year.

18. IV. Optimizing Success • Statistical simulations were conducted that estimated the degree to which optimizing certain foster care experiences might affect alumni outcomes.

19. Foster Care Experience Areas (Red fontand italics= factors that decreased negative outcomes the most in the simulations.) • Placement History and Experience • Low number of placements (3 placements or fewer) • Low length of time in care (3.5 years or fewer) • Low placement change rate (0.61 or fewer placement changes per year) • No reunification failures • No runaway episodes • No unlicensed living situations with friends or relatives

20. Foster Care Experience Areas • Education Services and Experience • Could participate in, or obtain, supplemental education services and tutoring • Low total number of school changes from elementary through high school (6 or fewer) • Therapeutic Services and Supports • Could participate a lot in therapeutic services and supports (i.e., high access to services) • Activities with Foster Families • Participated a lot in activities and supports • Preparation for leaving care • High degree of preparation for leaving care (3 or more types of preparation)

21. Foster Care Experience Areas • Resources upon Leaving Care (i.e., Broad IL prep.) • High amount of resources when leaving care (driver’s license, $250 in cash, and dishes & utensils) • Foster Family and Other Nurturing Support while in Care • Positive parenting by foster parents • Felt loved while in foster care • Overall, foster parents were helpful (7 on a 1-to-7 point scale) • Foster family helped with ethnic identity issues • Had a mentor while growing up • Low amount of child maltreatment while in foster care (1 or no incidents)

22. Optimizing Success: Drill Downs

23. V. Recommendations: Mental Health 1. Increase youth and alumni access to evidence-based mental health treatment.(More group work, and cognitive behavioral treatment approaches.) 2. Increase mental health insurance coverage.E.g., states can extend Medicaid coverage beyond age 18 by using the waiver clause in the Chafee legislation. (Has your state done this?)

24. Recommendations: Education 1. Encourage youth not to settle for a GED credential if possible. 2. Use the Judicial Checklist for education. 3. Minimize placement change. Ideas from alumni: • Successfully treat mental health problems. • Use alternative schools with smaller class sizes. • Focus tutoring and skills development on specific academic difficulties and strengths.

25. Recommendations: Education 4. Support better preparation for, access to, and success in postsecondary education programs: • Help young adults enroll in local college-preparatory programs. E.g., TRIO, GEAR-UP, and Upward Bound. • Ensure staff and youth are aware of good vocational options that pay well.

26. Recommendations: Employment 1. Help youth get employment experience with good supervision. 2. Strengthen agency and youth connections to vocational and employment services.

27. Recommendations: Current Innovations • Casey integrated transitional services and education frameworks. • It’s My Life employment and housing guides. • Judicial Checklist for educational planning • Transition service centers. • Implement the Jim Casey Youth Opportunities Initiative strategies for education and employment.

28. Internet/Web Resources Judicial Checklist: www.ncjfcj.org/content/view/340/322/ National Permanency Planning Resource Center: www.hunter.cuny.edu/socwork/nrcfcpp/ Evidence-based practice strategies in child welfare: • CWLA.org • SAMHSA.gov • campbellcollaboration.org • other related program areas: bris.ac.uk/Depts/CochraneBehav For key statistical summaries, child and family trend data: • www.childtrends.org or cwla.org U.S. Children’s Bureau for state outcomes and foster care statistics: www.acf.hhs.gov/programs/cb/publications Independent living resources: • Caseylifeskills.org • Daniel Memorial: danielkids.org • Jim Casey Youth Opportunities: jimcaseyyouth.org • National Resource Center on Youth and Independent Living at the University of Oklahoma: tel.occe.ou.edu/occe/professional_development/NRCYS/

29. References Berrick, J. D., Needell, B. Barth. R. B. & Johnson-Reid, M. (1998). The tender years: Toward developmentally sensitive child welfare services for very young children. New York: Oxford University Press. Chibnall, S., Dutch, N., Jones-Harden, B. Brown, A., Gourgine, R., Smith, J., Boone, A., & Snyder, S. (2003). Children of color in the child welfare system: Perspectives from the child welfare community. Washington, DC: U.S. Department of Health and Human Services Administration for Children and Families Children’s Bureau, Administration for Children and Families. Child Welfare League of America. (2003). Making children a national priority: A framework for community action. Washington, DC: Author.

30. For More Information Casey Family Programs: www.casey.org Search “Northwest alumni study” Principal Investigator: Peter Pecora: ppecora@casey.org Project Coordinator: Kirk O’Brien: kobrien@casey.org Co-Principal Investigators: Ronald Kessler, Diana English, James White, Chris Downs

31. Appendix: Study Methods Inclusion Criteria for Study Participants: • Placed in family foster care before age 16. • Spent a year or more in care between ages of 14 and 18, between 1988 and 1998. • Served in Seattle, Tacoma, Yakima, or Portland.

32. Study Methods: Alumni Interviewed Interviews with 479 alumni (659 case record reviews):

33. Study Methods: Data Weighting Data were weighted to adjust for: • Partial case record reviews. • Alumni we were unable to locate or interview due to death and institutionalization. • Differences between Casey and State alumni (e.g., age, gender, and race/ethnicity).

34. Study Methods: Demographics Race/Ethnicity

35. Risk Factors

36. Outcomes: Mental Health Lifetime Recovery Rates for Mental Health Diagnoses among Northwest Foster Care Alumni and the General Population Mental Health Diagnosis

37. Post-Traumatic Stress Disorder (PTSD) • Traumatic event leads to extreme distress and physiological activity • Restricted affect • Hypervigilance • Intrusive thoughts of trauma • Interferes with employment, relationships, etc.

38. Depression • “Period of two weeks during which there is depressed mood or the loss of interest or pleasure in nearly all activities” • May include: • Changes in appetite, sleep, or activity • Decreased energy • Difficulty in concentration or decision-making • Feelings of worthlessness or guilt • Often multiple etiological factors: • Genetics • Family stress • Other psychosocial stressors

39. Casey Family Programs Mission • To provide and improve—and ultimately prevent the need for— foster care Operates in Two Ways • We provide direct services and support to youth and families. • We promote improvements in child welfare practice and policy.

40. Casey Family Programs • Casey works directly with youth and families in seven states. • Casey provides tools and products to child welfare agencies in 47 states. • Casey provides a variety of services and support to families and communities.