Transition age youth aging out of therapeutic foster care: The relationship of placement stability and service use to psychosocial and developmental outcomes

Background and Purpose: The primary developmental tasks of the transition to adulthood revolve around acquiring the skills and resources necessary for the development of psychosocially healthy functioning in adulthood. For youth with psychiatric disorders and histories of out of home placement, this life stage is a particularly challenging and risky time, and their success in the transition to adulthood is likely compromised. We present findings from a naturalistic study of transition aged youth who were part of an NIMH funded trial of Therapeutic Foster Care (TFC), as they are on the verge of aging out of TFC . The purpose of the study was to examine the psychosocial and developmental characteristics, and patterns of service use, of transition aged youth aging out of TFC. We examined the association of these characteristics and patterns of service use with six and twelve month outcomes related to risk and protective factors in the transition to adulthood, namely criminal involvement, employment/training, school completion, placement stability, and post-placement residential stability.

Method: Data for this study are from longitudinal interviews conducted as part of a randomized trial of treatment foster care. In-person interviews were collected with the treatment parent (while in foster care) or a primary caregiver and the transition age youth at three times, baseline, six months and 12 months. The study sample reported here includes any youth who was 16 years old or older at the time of the baseline interview (N=84) in a state-wide sample of youth in Therapeutic Foster Care. The age range for the transition aged sub-sample was 16 to 18 years (mean 16.2, SD=1.2).

The interview protocol included a wide range of measures. For the current analyses, we report on data from standardized measures, including the Child and Adolescent Services Assessment (CASA), the Behavioral and Emotional Rating Scale (BERS), the Strengths and Difficulties Questionnaire (SDQ), and descriptive data from the study protocol.

Results: Findings indicated overall high rates of service use, primarily in the specialty mental health sector, during the TFC placement. However, post-placement service use dropped off significantly, including accessing specialty mental health services. Being in placement longer, both before baseline in the index placement, and post-baseline for the one-year follow-up, predicted more positive functional outcomes. Youth with stable placement histories were less likely to be involved with the criminal justice system, more likely to be attending or have completed school, be employed, and be receiving specialty mental health services. Race and gender were not predictive of any differences found in functional outcomes, but were associated with differences in patterns of service use.

Conclusion/Implications: There is scarce empirical evidence about older adolescents with psychiatric disorders who are entering the transition to adulthood from residential treatment settings. Evidence regarding these youth, including their status in terms of key psychosocial and developmental markers, as well as their patterns of service use while in the child serving system, is a critical link in understanding the policy and practice imperatives related to the needs of this at-risk population.