Reunified but at Risk: The Role of Behavioral Health in Shaping Outcomes for Older Youth in Foster Care

Abstract

Background/Purpose: Family reunification is the preferred permanency outcome for children in foster care. However, few empirical studies have examined if different types of permanency outcomes—reunification, adoption, or aging out—are associated with outcomes in early adulthood. Existing evidence is mixed, but for older youth in particular, reunification has been linked to poorer outcomes in areas such as education, employment, behavioral health and incarceration. A critical gap in the research is understanding how these outcomes are shaped by individual, family, and environmental risk and protective factors.

This study focuses on one such factor—youth behavioral health needs. We use documented reasons for removing a child from home to identify behavioral health concerns and examine the associations between removal reasons, permanency outcomes, and adult outcomes of incarceration and homelessness.

Methods: Data are from the 2009-2021 Adoption and Foster Care Analysis System. The sample includes older youth who were in care at age 15 or older (N =475,225). Three mutually exclusive categories for removal reasons were created: (1) any child maltreatment reasons, (2) behavioral health (youth substance misuse and behavioral problems) and no child maltreatment, and (3) other reasons not related to behavioral health or maltreatment. Omnibus difference testing assessed prevalence of permanency outcomes across these groups.

To assess young adult outcomes, we used a subsample of youth who also completed the Wave 2 survey from the 2011, 2014, and 2017 cohorts of National Youth in Transition Database (N = 18,980). Logistic regression analyses assessed associations between removal reasons and exit types and incarceration and homelessness at age 19.

Results: Permanency outcomes varied significantly by removal reasons. Among youth removed for behavioral health concerns, 62.0% were reunified; 34.4% aged out, and 3.6% were adopted or placed in guardianship. In contrast, only 36.0% of youth with maltreatment removals reunified with their family, while 45.5% aged out and 18.0% were adopted or in guardianship.

Youth removed for maltreatment (OR= 0.43, CI= 0.39-0.46) or for other reasons (OR= .39, CI= 0.35, 0.45) had lower odds of incarceration compared to those removed for behavioral health concerns. Youth who aged out (OR= 0.60, CI= 0.55-0.66) or were adopted/placed in guardianship (OR= 31, CI= 0.25, 0.38) had lower odds of homelessness than those that returned home.

Similarly, compared to reunified youth, youth removed due to maltreatment (OR= 0.78, CI= 0.72, 0.85) or other reasons (OR= 0.74, CI= 0.66, 0.83) had lower odds of homelessness. Youth who aged out (OR= 0.80, CI= 0.72, 0.87) and were adopted/placed in guardianship (OR= 0.55, CI= 0.50, 0.65) experienced lower odds of incarceration than reunited youth.

Conclusions/Implications: A considerable proportion of older youth in foster care are removed because of behavioral health concerns with no co-occurring maltreatment concerns. These youth are more likely to reunify than other types of youth but also more likely to experience incarceration and homelessness. Findings suggest that older youth with behavioral health challenges may require more targeted, sustained support to improve support their transition to adulthood and mitigate risk of homelessness and incarceration and other consequential outcomes.