Research That Matters (January 17 - 20, 2008)

Background/purpose: Placement into foster care has been associated with the development of many social problems in early adulthood, including low educational attainment, incarceration, mental health and substance abuse problems, and homelessness (Meier, 1965; Festinger, 1983; Cook, Fleishman & Grimes, 1991; Dworsky, 2005; Courtney & Dworsky, 2006; Pecora et. al., 2006). Findings from cross-sectional studies of homeless adults have found foster care placement to be associated with negative outcomes among homeless adults, suggesting that the risk of foster care treatment extends well into middle-adulthood (Susser, Struening & Conover, 1987; Mangine et. al., 1990; Koegel, Melamid & Burnam, 1995; Booth et. al., 2002). One question that has not been addressed in the literature is, “Are treatment outcomes of homeless adults negatively impacted by clients' childhood exposure to foster care?”. This is the research question addressed in this study.

Methods: Data from a national evaluation of a Veteran's Affairs (VA) supported employment treatment program for homeless veterans with mental health and substance abuse problems were used to compare treatment outcomes between those who had been placed into foster care as youth (N=65; 10%) and those who had not been placed into foster care (N=563; 90%). Mixed regression models were used to compare quarterly employment, income, mental health, substance use, incarceration, and quality of life outcomes for two years after entering VA treatment, adjusting for significant baseline differences between the two foster care groups.

Results: When compared with those who had not experienced foster care, foster care clients were less likely to be black, had fewer years of education, and were more likely to have been homeless for more than a year at program entry. Moreover, foster care clients were also less likely to be unemployed, yet more likely to hold casual/temporary jobs, spent fewer days living in someone else's place, had more psychiatric problems, drank alcohol more days during the prior month, and had smaller social support networks than non-foster care clients. After controlling for these significant baseline differences, foster care clients were found to have smaller social support networks (2.5 vs. 3.1 persons; p<.01) and were more likely to drink alcohol during the prior month (50% vs. 39%; p<.05) than other participants over the 2-year follow-up period. However, no significant differences were found on the other 34 treatment outcome measures examined. Thus, no negative impact of exposure to foster care to treatment outcomes was found among the homeless veterans who participated in the national evaluation study.

Implications: Homeless clients exposed to foster care as youth showed somewhat more serious problems at the time of entering supported employment treatment. Yet, clients placed into foster care showed comparable treatment outcomes on 34 of 36 measures examined. Thus, supported employment treatment may be especially helpful for middle-aged, homeless adults who were placed into foster care as youth.