Developing a Mental Health Service Experience Inventory for Transition Age Foster Youth

Background and Purpose:  Likely a result of traumatic experiences of maltreatment, youth in foster care have an increased likelihood of developing behavioral and emotional problems relative to youth of comparable backgrounds (McMillen et al., 2002). As youth near the transition to independent living and aging out of the foster care system, exposure to stress increases, especially for youth who have less than adequate support systems. Although mental health symptoms among foster youth often continue after they age out (Pecora et al., 2009), mental health service utilization decreases dramatically (Courtney et al., 2011; McMillen & Raghavan, 2009).  This study sought to explore the barriers and supports foster youth experience in meeting their mental health needs during the transition to adulthood, creating an inventory for assessment and effective intervention.

Methods:  Qualitative interviews and focus groups informed the development of a quantitative instrument in a mixed methods, sequential exploratory research design. To identify the mental health service problem situations and strengths most often encountered by youth aging out of foster care, focus groups were conducted with 29 young adults who had aged out of foster care with a history of mental health services.  Eight interviews were also conducted with professionals familiar with the population to obtain a multidimensional perspective.  Situations were cleaned to provide specificity and redundant situations were eliminated or combined.  The resulting instrument was tested for readability and piloted with 20 former foster youth.

The inventory was then administered to a larger sample of youth who had aged out of foster care (N = 224), as a method of assessing the social validity of the situations.  Exploratory factor analysis (EFA) was used to identify the underlying factors of the inventory and to refine the pool of situations.  Maximum likelihood extraction was used with varimax orthogonal rotation. Multiple indices were used to determine the number of factors to retain, including the Kaiser criterion of eigenvalues greater than one, visual scree test, minimum average partial (MAP) test, parallel analysis, and clear interpretability of factors with factor loadings great than .4 and at least three items per factor. 

Results: The EFA of the problematic situations revealed a five factor, 26-item solution.  Factors included receiving mixed messages, lack of voice and choice, barriers to accessing services, feeling overwhelmed with expectations of independence, and developing an identity beyond foster care. The EFA for supportive situations produced a four factor, 17 item solution.  These situations were categorized as responsive engagement, consistency through service transitions, ongoing mentorship, and self-efficacy in decision-making. 

Conclusions and Implications:  Findings from this study provide insight into the complexity of experiences for foster youth transitioning to adulthood with mental health services.  Understanding their perspectives as they transition to adult mental health systems or choose to disengage from services altogether provides a unique opportunity to understand their decision-making process. Identifying the most challenging and supportive situations these young adults encounter as they transition provides targetable strategies to improve current policies and programs to effectively meet the mental health needs of youth transitioning to adulthood.