Ecological Considerations to Mental Health Services for Youth Aging out of Foster Care

Background and Purpose:  Nationally, more than 25,000 youth in foster care turn 18 and “age out” each year (DHHS, 2014).  As youth near the transition to independent living and aging out of foster care, exposure to stress increases, especially for youth with less than adequate support systems.  Although mental health symptoms among foster youth continue after they age out (Pecora et al., 2009), mental health service utilization decreases dramatically (Courtney et al., 2011; McMillen & Raghavan, 2009).  Longitudinal studies have been conducted with youth aging out, providing a comprehensive look at issues facing this population, yet there remains a gap in understanding the decision-making process regarding mental health services and how ecological factors play a role in service utilization.

Methods:  The current study utilized a mixed-methods sequential exploratory design to examine the challenges and supports youth aging out encounter in meeting their mental health needs.  Twenty-nine foster alumni were recruited in a southwestern state to participate in focus groups.  Eight professionals who work closely with youth aging out were also interviewed to obtain a multidimensional perspective.  Thematic qualitative analysis was used to sort and review the situations identified by participants in the first phase, to inform the development of a quantitative instrument.  The inventory was then administered to 224 foster alumni to establish the social validity of situations previously identified, by asking the frequency and intensity of experiencing the situations.  A series of factor analyses were conducted to identify underlying factors of the inventory.

Results: Participants indicated the most challenging situations foster youth experience during the transition are related to feeling overwhelmed and unable to ask for help when needed, which speaks to the importance of ecological considerations.  For example, two of the most challenging situations were, “You have too much to worry about after leaving care to focus on your mental health right away.  You have to figure out where you’re going to live, get a job, and manage your money” and “You didn’t feel prepared to be successful on your own, but you didn’t feel like you could ask for help because you’re supposed to be independent after 18.”  Young adults in this study also emphasized the importance of responsive engagement, self-efficacy, and consistency in relationships with friends, mentors, and agencies.  Other highly rated situations involved breaking down tasks and helping them prepare for adult roles gradually.

Implications:  Findings emphasize the importance of an ecological approach to providing support to youth aging out of foster care.  Foster alumni in this study identified challenges and supports on individual, community, and societal levels, which impact their decisions whether to seek services.  Practitioners should focus on individualized transition planning that is collaborative for youth involved in multiple service systems of child welfare and mental health.  Recognizing the impact of trauma and other systemic barriers, in addition to acknowledging the voice and choice of foster youth are important considerations to develop realistic transition plans and promoting successful outcomes.