Youth Leaving Foster Care: A Developmental, Relationship-Based Approach to Practice

Youth Leaving Foster Care

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YOUTH LEAVING FOSTER CARE A Developmental, Relationship-Based Approach to Practice Wendy B. Smith

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1 Oxford University Press, Inc., publishes works that further Oxford University’s objective of excellence in research, scholarship, and education. Oxford New York Auckland Cape Town Dar es Salaam Hong Kong Karachi Kuala Lumpur Madrid Melbourne Mexico City Nairobi New Delhi Shanghai Taipei Toronto With offices in Argentina Austria Brazil Chile Czech Republic France Greece Guatemala Hungary Italy Japan Poland Portugal Singapore South Korea Switzerland Thailand Turkey Ukraine Vietnam

Copyright © 2011 by Oxford University Press, Inc. Published by Oxford University Press, Inc. 198 Madison Avenue, New York, New York 10016 www.oup.com Oxford is a registered trademark of Oxford University Press All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior permission of Oxford University Press. ____________________________________________ Smith, Wendy Benjamin, 1946- Youth leaving foster care : a developmental, relationship-based approach to practice / Wendy B. Smith. p. cm. Includes bibliographical references and index. ISBN 978-0-19-537559-6 (hardcover : alk. paper) 1. Foster children–Services for–United States. 2. Foster children—Psychology. 3. Foster children–Counseling of. 4. Foster children–Family relationships—United States. 5. Foster children—Deinstitutionalization—United States. 6. Ex-foster children—Social conditions--United States . 7. Ex-foster children—Education—United States. 8. Foster children—Government policy—United States. I. Title. HV881.S66 2011 362.73’3—dc22 2010049034 ____________________________________________

1 3 5 7 9 8 6 4 2 Printed in the United States of America on acid-free paper

For all children who have been in foster care

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ACKNOWLEDGMENTS

The idea for this book took shape some years ago, when I developed a course on youth leaving foster care, and could not find a text on the subject. I had treated alumni of foster care in my psychotherapy practice, had helped to design a transitional living program informed by attachment theory, and had long been active in a nonprofit organization that assistsyouth who have been in care. Most of what I had read focused on a single perspective—policy, program, outcomes, or youth narratives—and theoretical frameworks were largely absent. My goal in writing this book was to integrate these interpenetrating, overlapping elements and to ground them in theory. I was fortunate to have my idea met with enthusiasm by many individuals, including Maura Roessner of Oxford University Press. There are many people to thank for their contributions to this book. First, the young people who generously shared their time and their stories with me—many youth from California Youth Connection, and at greater length, “Robert,” “Marie,” “Ericka,” “Summer,” and “Jessica”—who provide the living heart of this book. I would like to thank the students and faculty at the University of Southern California School of Social Work, whose questions and interest spurred me on. Faculty members who deserve special thanks for their encouragement are Michalle MorBarak, Ron Astor, Dorian Traube, Devon Brooks, Jacquelyn McCroskey, Dean Marilyn Flynn, and Vice Dean Paul Maiden. I am grateful to Catherine Portuges, whose insight and keen editorial eye greatly improved the book proposal, as did the responses of reviewers. Thanks to Elizabeth Calvin and Carol Biondi, who provided invaluable comments on the juvenile justice system; to Adam Boltuch, vii

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for the design and creation of the Foster Care Timeline; and to Karl Calhoun for his interest and questions. Thanks also to Priscilla Roth, Judith Schore, Laura Parsons, and Elizabeth Forer, who offered helpful comments on early chapters. Jacqueline Mondros’s wholehearted support has been a sustaining presence. The insight and challenging questions of fellow members of the Center for the Study of Intersubjectivity contributed to the final version of the book. Many dear friends, my sister Roberta, and our parents, Alfred and Selma Benjamin, cheered me on throughout. A very special thank you is due to Catherine Conner, whose assistance has been a critical factor, first in putting the original course together, and then with research and manuscript preparation for the book. I am so grateful for her efficient, knowledgeable management of the logistics of this project, and for her serene intelligence. I want to thank my extraordinarily patient children and grandchildren: Rebecca, Alex, Jake, Matt, Erica, Elizabeth, Jesse, Aniela, Henry, Nate, and Marlowe. The time taken from them has been substantial and their support unwavering. My deepest gratitude goes to my husband, Barry. Without his complete and unstinting belief in me, I’m not sure I could have written this book. —Wendy Smith

CONTENTS

Introduction xi Part I

Part II

Setting the Stage Introduction to Part I 3 1. The Child Welfare System as Context 2. Theoretical Perspectives 20

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Development Introduction to Part II 35 3. Neurobiology and Development 37 4. The Importance of Early Attachments 52 5. Adolescent Development in Foster Care 68

Part III

Mental Health Introduction to Part III 85 6. Anxiety, Trauma, and Post-Traumatic Stress Disorders 93 7. Mood Disorders and Self-Harm 108 8. Substance Abuse 125 9. Mental Health Dimensions of Delinquency 146

Part IV

Program Considerations Introduction to Part IV 169 10. Populations Needing Special Attention 171

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11. Transition to Adulthood: Education, Employment, and Relationships 192 12. Transitional Living Programs: Best Practices 211 Part V

Future Directions 13. Policy Implications and Directions for Future Research 233 References 245 Index 289

INTRODUCTION

Whatever affects one directly, affects all indirectly. I can never be what I ought to be until you are what you ought to be. This is the interrelated structure of reality. —Martin Luther King, Jr.

Those who work with foster care alumni come from a wide range of backgrounds and perspectives: they may be staff in public or private child welfare agencies, transitional living programs, group homes, residential treatment settings, mental health or juvenile justice settings; school social workers, college counselors, lawyers, or youth advocates; staff or volunteers in community organizations; or policy makers. The kinds of experience and knowledge that individuals carry into their work with these young people are as diverse as the settings they represent. It is the purpose of this book to integrate new research and thinking from varied disciplines to provide a theoretical and practical foundation that will enhance the efforts of all those who work to improve the lives of youth who have been in care. Specifically, I argue that development in childhood and adolescence, attachment experiences and disruptions, and the impact of unresolved trauma and loss on development and relationships are important and, thus far, under-studied areas. The book proposes a biological-psychologicalsocial perspective that emphasizes the relational, experience-dependent nature of development, attachment, and resiliency. It is increasingly recognized that all youth need at least one relationship with a caring and committed adult, and attention to ensuring such a relationship is now included in legislation and programs. However, as I hope to demonstrate, the effectiveness of programs, services, and policies will benefit from a more comprehensive understanding of the interacting biological, psychological, and social forces that have influenced and continue to influence youth emerging from state care. In September, 2008, there were 463,000 children in foster care in the United States; 27,785 of them exited care at ages 18 to 20 (U.S. Department of Health and Human Services, Administration for Children and Families, xi

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Administration on Children, Youth, and Families, Children’s Bureau, 2009). Compared to a total number of American children under eighteen estimated at 76,000,000 (roughly one-quarter of the entire population) (U.S. Census Bureau, 2010), youth in foster care do not constitute a large percentage of the population. Despite their relatively small numbers, they are a population that compels our attention and concern—because their struggles are considerable and because they have been in our care. We are their “corporate parents” (Courtney, 2009), sharing responsibility for them, and they are our children. Younger children in care have been the subject of legislative and research interest for some time, but public attention did not focus on the problems of youth who turn eighteen and “age out” of care until the mid 1980s, when the Title IV-E Independent Living Program (ILP) was enacted to provide services to youth in care who are 16 to 18 and those recently discharged. Since then, as the data on poor outcomes for these youth accumulated, legislators increased funding to states and expanded the upper age limit of those served to 21. Currently, all fifty states and the District of Columbia receive Title IV-E Independent Living funds. The Fostering Connections to Success and Increasing Adoptions Act of 2008, passed unanimously by both houses of Congress, expands state options for keeping youth in care up to age 21 in certain circumstances, and there is some evidence from states where this has been the practice for a number of years that the outcomes of those who remain longer in care are improved (Courtney, Dworsky, & Peters, 2009; Dworsky, 2008). In general, however, in the nearly fifteen years since passage of Title IV-E ILP, the hoped-for improvements in outcomes for foster care alumni have not materialized to any significant degree (Dworsky, 2008). Along many dimensions, youth emerging from care are doing poorly as a group when compared with their peers in the general population (Courtney et al., 2007; Courtney et al., 2009). They face challenges in multiple domains: housing, education, employment, incarceration, early parenthood, mental and physical health, and health access (Child Welfare League of America, 2005). Outcomes are unlikely to get dramatically better in the absence of a deeper and more expanded understanding of the challenges facing these youth. The research literature has tended to emphasize the more easily quantifiable outcomes, but is gradually expanding to include interpersonal well-being, aspirations, satisfactions, and social supports (Pecora et al., 2010). Qualitative studies that attempt to explore the experiences of alumni of foster care in greater depth are beginning to appear (Samuels, 2008; Scannapieco, Connell-Carrick, & Painter, 2007), and hold the promise of greater insight into psychological sequelae that influence emotional and interpersonal adaptation in adult life. A brief overview (Figure 1) of some key outcome indicators shows where current societal support still falls short. Longitudinal and snapshot studies of foster care alumni report that 18% to 36% of them have

INTRODUCTION

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experienced homelessness since exiting care, and up to 35% have moved five or more times since discharge (Child Welfare League of America, 2005; Courtney et al., 2007; Courtney et al., 2009; Reilly, 2003). In California, children in foster care comprise less than 0.3% of the state’s population, yet 40% of those living in homeless shelters are foster care alumni (Packard et al., 2008); in national studies, 39% of homeless subjects say they have a history of foster care placement (Park et al., 2004). Educational outcomes are dismal: studies report a range of 25% to 50% of foster care alumni who have not completed high school, compared to 7% of peers in the general population, and only 20% to 30% have attended any college, compared to 53% to 60% of peers in the general population (Child Welfare League of America, 2005; Courtney et al., 2001; Courtney et al., 2007; Courtney et al., 2009; Packard et al., 2008; Reilly, 2003). Employment and economic well-being indicators are no better. Four years after exit from care, fewer than half are currently employed, compared to 76% of their peers, who also earn about $1.00 more per hour (Courtney et al., 2007; Courtney et al., 2009). Mean earnings of foster care alumni remain well below the poverty threshold at two and three years after discharge from care. The situation is even worse for African American alumni, who earn significantly less than whites and have a decreased likelihood of employment (Dworsky, 2008). Female alumni are about four times as likely as the general population to receive public assistance (Packard et al., 2008), and 50% of youth who have been in care experience material hardship, with 25% reporting low or very low food security (Courtney et al., 2007). Foster care alumni have significantly higher levels of criminal justice system involvement than peers. Four years after exit, 81% of males report having been arrested at least once since discharge, compared to 17% of their peers (Courtney et al., 2007; Courtney et al., 2009). In another study, 45% of foster care alumni report having had trouble with the law since leaving care; 41% have been in jail and 7% are in state prison (Reilly, 2003).

Outcomes Four Years After Exit

Foster Care Alumni General Population

90 80 70 60 50 40 30 20 10 0 No HS diploma

HS diploma only

2- or 4-yr college degree

Currently employed

Income Income Could not