Week 4: discussion 1

Research Review: Independent living programmes: the influence on youth ageing out of care (YAO)

Anna Yelick Lecturer, College of Social Work, Florida State University, Tallahassee, FL, USA

Correspondence: Anna Yelick, College of Social Work, Florida State University, 296 Champions Way, University Center Building C, Tallahassee, FL 32306, USA E-mail: [email protected]

Keywords: educational attainment, employment, independent living programmes, life skills, productive outcomes, youth ageing out of care

Accepted for publication: December 2014

A B S T R AC T

Independent living programmes (ILPs) aid in promoting productive outcomes for youth ageing out of care (YAO). This narrative review aimed to determine if sufficient evidence exists to substantiate state- ments regarding the effectiveness of ILPs based upon outcome studies published from January 2006 through December 2012. Are current ILPs effectively promoting independent living and productive out- comes among youth leaving foster care, relative to similar youth who do not participate in an ILP? Six studies published in English, in the USA and in peer-reviewed journals included non-experimental design (n = 1), quantitative designs (n = 2), mixed methods design (n = 2) and randomized design (n = 1). Five outcomes addressing education, employment, housing, mental health, and living skills emerged. Weak evidence that ILPs effectively aid YAO exists. Additionally, inconsist- encies exist in methodology. Finally, differences in important compo- nents in the ILPs exist, making comparisons difficult.

I N T R O D U C T I O N

Approximately 10% (23 396) of youth emancipated from the care system in 2012 (Adoption and Foster Care Analysis and Reporting System (AFCARS) 2011). These emancipated youth (youth who have aged out of the system, usually when they reach 18 years old) typically face disadvantages in terms of educational attainment and employment outcomes compared to non-fostered youth (Unrau et al. 2011). For example, 50% of foster youth obtain a high school diploma or general educational development (GED) degree compared to nearly 70% of non-fostered youth (Sheehy et al. 2001; Wolanin 2005; Unrau et al. 2011). Post-secondary education is not encouraged among the foster youth population as approximately 15% of foster youth enroll in college-preparatory classes compared to 32% of non-fostered youth (Unrau et al. 2011). Further, while nearly 79% of foster youth express an interest in attending a post- secondary education programme (Courtney et al. 2010), as few as 7–13% enroll in post-secondary edu- cation programmes (Casey Family Programs 2010) and fewer than 6% obtain post-secondary degrees (Pecora et al. 2010).

Youth ageing out of care (YAO) also face challenges in terms of housing and life skills. YAO are independ- ent, and as such, must find housing, pay bills and find employment shortly after leaving care.YAO often lack social and familial support, which arguably leads to a lack in life skills and resources to successful independ- ent living (Lemon et al. 2005; Montgomery et al. 2006; Collins et al. 2008; Avery & Freundlich 2009; Avery 2010; Harder et al. 2011). Additionally, YAO tend to live independently at an earlier age compared to non-fostered youth – many of whom return home or have financial and emotional support well into their 20s (Lemon et al. 2005; Montgomery et al. 2006).

Independent living programmes (ILPs) were estab- lished to aid YAO obtain productive positive out- comes, such as educational attainment, employment stability, housing and life skills (Montgomery et al. 2006; Petr 2006; Naccarato & DeLorenzo 2008; Uzoebo et al. 2008; Mares 2010; Kroner & Mares 2011; Mares & Kroner 2011; Powers et al. 2012). The Independent Living Initiative established ILPs, which was an amendment to the Social Security Act (Mares & Kroner 2011), and established aid for foster youth to live independently, as well as enabled states to develop life skills, academic achievement and

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vocational training programmes to circumvent home- lessness, dependence on public assistance and institu- tionalization after emancipation (Hardin 1987). ILPs were further develop with the enactment of the John Chafee Foster Care Independence Program of 1999 and the Foster Care Independence Act of 1999, which provided states with additional funding in response to independent living research findings and child welfare advocates calling for an amendment of the Social Security Act (Allen & Bissell 2004). The Fostering Connections to Success and Increasing Adoptions Act of 2008 improved outcomes for children in foster care by expanding the definition of child. This definition included youth ages 18–20, enrolled in secondary education, post-secondary education or vocational training programmes; employed 80 hours a month or more; or who are incapable of attending school or work because of a medical condition (Mares & Kroner 2011).

Approximately two-thirds of eligible youth receive independent living services (Courtney 2005; Avery 2010), indicating that ILPs are widely used by youth exiting the foster care system. ILPs aim to promote skills for independent living (Reilly 2003; Lemon et al. 2005; Montgomery et al. 2006; Geenen & Powers 2007), encouraging youth to become productive members of society and attain positive productive out- comes (independent living, education, employment and increased life skills) despite lacks in social and familial support (Montgomery et al. 2006; Mares & Kroner 2011).

Effectiveness of ILPs

Two systematic reviews have been completed (Montgomery et al. 2006; Naccarato & DeLorenzo 2008) assessing the efficacy of ILPs in accomplishing the projected aims discussed earlier.The Montgomery et al. (2006) review aimed to examine whether ILPs are effective at providing youth with skills that enhance their transition to independence.They included studies conducted prior to January 2006, which examined educational attainment, employment, housing, health and life skills for youth leaving the care system. They excluded any study that examined programmes specifi- cally designed for special populations (i.e. special needs, teen parenting, juvenile justice concerns).

The authors suggest evidence indicating that ILPs improved educational, employment and housing out- comes for YAO; however, the evidence was weakened by evaluation methodology – specifically, a lack of randomized control trials (RCTs), as non-randomized

studies are susceptible to bias. Confidence regarding the effectiveness of the ILP was low because of the inability to say with certainty that observed differences are attributable solely to the ILP. Despite this limita- tion, approximately 55% of the ILP group graduated from high school. However, discrepancies between YAO and the general population youth still exist. Approximately 86% of the general population youth graduated from high school, according to the US National Center for Education Statistics (Greene 2002). In addition, the national rate for employment differs between YAO and the general population youth, indicating that ILPs have yet to bridge the gap in positive productive outcomes for YAO compared to the general population youth.

The second systematic review by Naccarato & DeLorenzo (2008) aimed to examine studies regard- ing the effectiveness of ILPs in youth transitioning out of the care system from 1990 until 2006 in and outside the USA. However, the review only included studies in the USA and UK. The authors reviewed 19 articles, which met the four criteria: (i) the ILP aimed to increase readiness for youth leaving the care system; (ii) reported on education, employment, housing and mental health; (iii) published in a peer-reviewed journal and in English; and (iv) discussed transitional services.

The authors suggested that the studies they reviewed offered recommendations regarding improv- ing services to YAO. Some of the recommendations were to improve ILP practice, policy and research. The authors also suggested that the studies varied greatly in measurement of the ILP, specifically, in sample size, demographics, placement histories, support networks and outcome measures.The authors recommended a national database with input from researchers and practitioners in the field in order to design a functional information system. Non-uniform measurements make it difficult to determine the effec- tiveness of ILPs, indicating service goals and quality often vary among different ILPs (Courtney 2005; Avery 2010), making it difficult to formulate general assessments of ILPs and the effectiveness in aiding YAO.

Purpose of paper

This paper aims to examine newer literature published from January 2006 through December 2012 to deter- mine if sufficient evidence exists to substantiate state- ments made that ILPs effectively promote productive outcomes (i.e. educational attainment, employment,

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housing, mental health and life skills) for youth leaving the care system. The paper includes only studies conducted and published within the USA, in English and in peer-reviewed journals.

Research question

Are current ILPs effectively promoting independent living and productive outcomes among youth ageing out of the care system relative to similar youth who do not participate in an ILP?

M E T H O D S

Study selection

The present paper reviewed peer-reviewed studies published in the USA and in English. The review includes quasi-experimental and non-experimental group outcome studies. The review included several additional inclusionary and exclusionary criteria. The inclusionary criteria were as follows: (i) the study must contain information regarding an ILP; (ii) the study must have measureable outcomes (educational attainment, employment, housing, mental health/ special needs or life skills); and (iii) the study must examine ILPs for foster youth or residential care youth, or youth ageing out of the care system (YAO) only. The exclusionary criteria were (i) if the study did not examine ILPs; (ii) if the study was published prior to January 2006; or (iii) if the study was conducted outside the USA.

The electronic databases searched included the Cochrane Central Register of Controlled Trials, The Campbell Library, PsycINFO, Sociological Abstracts,

Applied Social Sciences Index and Abstracts (ASSIA) and Web of Science. The keyword search terms were (i) ab(Foster Care Youth) AND ab(Independent Living); (ii) ab(Foster Youth) AND ab(Independent Living Programs); (iii) ab(Independent Living) AND ab(Evaluation) AND ab(Randomized Control Trials); and (iv) ab(Foster Care) AND ab(Foster Care Youth) AND ab([Independent Living Programs OR ILPs]) AND ab(Outcomes).This resulted in an initial pool of 135 citations. Of these, 32 abstracts were examined, resulting in the inclusion of six primary studies (refer to Table 1 and Fig. 1).

Search results

The six primary studies utilized qualitative methods (one study), mix methods (two studies) and quantita- tive methods (three studies) to assess the effectiveness of ILPs from across the USA (Table 2 provides a summary of each study). The study participants were foster youth aged 16 and older preparing to leave the care system, or in the case of the qualitative study – the participants could include service providers. Out- comes of interest include secondary education, post-secondary education, employment, housing attainment, mental health or other special needs, and achieving life skills.

The study by Petr (2006) utilized a qualitative approach to evaluate the Kansas Independent Living Program in addition to five private contract agencies to assess youths’ perspectives (n = 27) regarding the quantity and quality of independent living services. This study utilized a convenience sample and included two groups: youth still in custody (n = 19) and youth out of custody (n = 8). Only youth aged 16 and up were included in the study (mean age of 17.3).

Table 1 Database search

Databases search

Database Date Results

Cochrane Library Since 2000 0 Campbell Library Since 2000 1 – Systematic review completed in 2006 –

restricted review to after 2006 Web of Science January 2006 through December 2012 51 PsycINFO January 2006 through December 2012 78 – These four databases were searched

simultaneously in order to reduce duplications. Another review was discovered; however, it also examined ILPs prior to January 2006

Sociological Abstracts January 2006 through December 2012 Applied Social Science Index

and Abstracts (ASSIA) January 2006 through December 2012

Social Services Abstracts January 2006 through December 2012

ILP, independent living programmes.

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Fifty-one per cent (n = 14) of the total sample were male (57% for in custody, 37.5% for out of custody). Approximately 51% (n = 14) of the total sample were Caucasian (42% for in custody and 87.5% for out of custody), while 33% (n = 9) of the total sample were African-American (47% for in custody). Of the eight participants in the out of custody group, six had a high school diploma (or GED equivalent) and two were in college. There were five outcomes assessed in this study: (i) education; (ii) mentors and support systems; (iii) life skills training; (iv) vocational preparation; and (v) knowledge of post-custody independent living benefits.The interviews were transcribed and analysed using Atlas ti, a qualitative software program. Petr coded units of the interview text according to the themes presented and then grouped the themes by commonality.

The study by Uzoebo et al. (2008) examined a spe- cific ILP, VISIONS, utilizing a mixed methods approach. It has been included in the review based upon the important perceptions discussed by youth receiving services. The quantitative data were col- lected using the Ansell Casey Life Skills Assessment (ACLSA). There were both pre-test and post-test assessments of the ACLSA for 89 participants. Quali- tative data were gathered using the Life Skills Evalu- ation Questionnaire for 24 participants. The average age of the participants was 16 years, with 63% female and 61% African-American. The average length of stay in the programme was 17 months. The outcomes of this study included determining perceptions of the

life skills received by the participants regarding the benefits of the programme, barriers to skills acquisi- tion and the role of the youth–mentor relationship in promoting skills development.

The study by Mares (2010) utilized a mixed methods approach using a focus group (n = 35) as well as administrative data from Lucas County in Ohio. The study included a sample of 108 youth who had emancipated from an ILP from 2005 through 2007. The information collected via the tracking data included demographic characteristics, clinical charac- teristics, foster home placements, outcomes at dis- charge and receipt of post-emancipation services. Five needs emerged during the focus groups: (i) higher amount for clothing vouchers; (ii) assistance obtaining a driver’s licence; (iii) provide home-based independ- ent living life skills training; (iv) ensure confidentiality of foster care placement packet; and (v) address the perception of unfair/unequal treatment by the foster parent(s) towards the foster youth. These themes included the expressed views of the participants and observations made by the research team. The modera- tor, a social work student, and the author discussed the observations during meetings. The transcriptions provided illustrative quotations for each theme iden- tified. In addition to the qualitative reports from the youth participants, surveys were collected from 83 public and private service providers using an online survey constructed by the author with input from the research team. The survey included 22 items contain- ing respondent information, programme information,

Potentially relevant studies identified and screened for retrieval (n=135)

Ineligible studies excluded based on title, language or date. In addition, studies using “grey” literature have also been excluded (n=103)

Abstracts of studies retrieved (n=32)

Studies excluded if not looking at independent living programmes/ transitions for foster youth (n=21)

Potentially appropriate studies for review; studies evaluated using the inclusion/ exclusion criteria worksheet (n=11)

Studies excluded from the review if there was no measurable outcome related to an independent living programme (n=5)

Primary studies with usable information by outcome (n=6)

Figure 1 Flowchart of the primary six studies included in this review.

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Table 2 Summary of the six primary studies included in the narrative review

Study Year Title Study population Study design Primary outcome

Kroner & Mares 2011 Living arrangements and level of care among clients discharged from a scattered-site housing-based independent living programme

Foster and former foster youth mean age 17.86

XO YO OXO

Housing outcomes: Three-fourths of youth were discharged to an independent level of care, 28% living by self, 13% living with friend, or 17% living with a relative. 55% of sample attained a status of independent living.

Mares & Kroner 2011 Lighthouse independent living programme: Predictors of client outcomes at discharge.

Foster and former foster youth mean age 17.9

OXO OYO

Educational outcome: They indicated that participants with mental-health problems were less likely to complete high school (0.60). In addition, participants who stayed in the programme longer were more likely to complete high school (0.96). Participants who were older at admission were also more likely to complete high school (1.55 and 2.35).

Employment outcome: Being 1 year older when entering into the programme predicated high rates of employment (1.55 to 2.35). Staying at least 1 month longer before exiting the programme also predicted high rates of paid employment (1.10). Participant without mental-health problems were also more likely to have paid employment (0.460).

Housing outcome: Participants who were older when entering the programme were more likely to live independently (1.55 and 2.35) at discharge. Participants who remained in the programme at least 1 month longer were also more likely to have independent housing (1.10). Participants who reported being parents also more likely to have independent housing at discharge (2.0).

Mental health/special needs outcome: Youth with mental-health problems are less likely to complete high school (0.61), find employment (0.64) or establish independent housing (0.68).

Uzoebo et al.

2008 Deconstructing youth transition to adulthood services: Lessons learned from the VISIONS programme

Foster and former foster youth mean age 16.0

OXO OYO

Life skills outcome: Participants reported higher mastery of skills in areas of daily living skills, work life, money management and budgeting, and self-care. At follow-up, participants demonstrated an increase in skills acquisition from 52% to 55%. Participants indicated receiving training in a class room setting was less efficacious to learning via a mentor or from ‘real-life’ experiences.

Petr 2006 Foster care independent living services: youth perspectives

Foster and Former Foster Youth mean age 17.3

– Educational outcome: 26% behind in educational progress and goals, one participant enrolled in GED programme. Increased number of placements often indicates a decrease in educational attainment.

Employment outcome: 10 participants were working at paid jobs in the community. Two participants in the out-of-custody group were working part-time and attending college.

Life skills outcome: 26% of the youth indicated that they had not received any life skills training. Two of the youth indicated it was offered but they refused. 63% of the youth who received the life skills training indicated they were in one of three settings: a class room setting, mental-health agency, or group home facility. These youth also indicated receiving life skills training from foster parents in a less formal, day-to-day basis.

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Table 2 Continued

Study Year Title Study population Study design Primary outcome

Mares 2010 An assessment of independent living needs among emancipating foster youth

Foster and former foster youth

– Educational outcome: Secondary education support was identified as one of the most common services available. However, financial support for college was among the least common service available or offered according to service providers.

Housing outcome: Housing assistance was among the most helpful service identified for youth aging out of care. However, affordable housing and structured transitional housing were identified as gaps for youth within ILPs.

Life skills outcome: Life skills training was identified as being among the most helpful for emancipating youth, however, hands-on life skills training was identified as a gap in service. This is also identified as one of the greatest unmet needs within ILPs.

Powers et al. 2012 My life: Effects of a longitudinal, randomized study of self-determination enhancement on the transition outcomes of youth in foster care and special education

Foster and former foster youth mean age 16.8

OXO O OYO O

Education outcome: 38% of the intervention group and 28% of the comparison group completed secondary education. At 1-year follow-up, 72% for intervention and 50% for comparison group completed secondary education. Three youth were participating in post-secondary education and 26% of youth were participating in post-secondary education at 1-year follow-up.

Employment outcome: 14% of the intervention group and 19% of the comparison group reported working paid jobs at baseline. At post-intervention, 34% of the intervention group and 16% of the comparison group reported working paid jobs. At 1-year follow-up, 45% of the intervention group and 28% of the comparison group had a paid job.

Housing outcome: At post-intervention, 63% of participants were still in foster care, six participants were adopted or reunited with birth family, 14 participants were living with friends or a partner in their own apartment, one participant had housing provided through Job Corps and two participants identified as being homeless. At 1-year follow-up, 57% of participants had exited care, 15 participants reported being reunited or adopted, 14 participants were living in their own apartment, four participants were residing in college dormitories, one participant was in military housing and one participant had housing through Job Corps. 60% of the comparison group reported having a different placement from the year before compared to 50% of the intervention group, indicating a trend toward placement stability.

Mental health/special needs outcome: 40% of the sample had emotional/behavioural problems, 10% of the sample had intellectual disabilities, 16% had speech/language problems, 26% had a learning disability, 5% were considered to be on the autism spectrum, and 26% developmental disabilities services. The youth who received the intervention fared better in high school completion and fared better in employment outcomes.

ILP, independent living programme; XO: indicates the research design included only an intervention and post-test (no pre-test); YO: indicates an alternative design with only an intervention (or treatment as usual) and post-test (no pre-test); OYO: indicates an alternative design with a pre-test, intervention (or treatment as usual), and post-test; OXO: indicates a research design with a pre-test, intervention, and post-test.

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and views on helpful and needed independent living services.The response rate for the survey was 28% (23 respondents).

The study by Kroner & Mares (2011) sampled youth who admitted into and discharged from the Lighthouse ILP from 2001 through 2006. The initial number of youth was 455; however, the final sample size included 367 participants because of the missing data. This experimental study compared two groups – youth with discharge living arrangements and youth without discharge living arrangements. The authors found no statistically significant differences between these two groups at the initial assessments.There were 22 different living arrangement categories divided into four levels of care from lowest (described as living in the most independent and stable housing) to the highest (described as living in the least independent and most unstable housing). The authors used inde- pendent samples t-test and chi-square tests in order to compare youth with living arrangement data to those without such data available. In addition, the use of an analysis of variance (ANOVA) compared characteris- tics of the youth entering the programme from the youth being discharged from the programme.

The study by Mares & Kroner (2011) sampled 385 youth admitted into the Lighthouse ILP during 2001 through 2005. The authors utilized an experimental study comparing youth with mental-health concerns to those without such concerns. The youth had an average age of 17.9 years, with a range from 16 to 20. The length of stay averaged 9.9 months with a range from 0 to 32 months. Sixty-nine per cent of the sample received some life skills training prior to dis- charge, including employment skills training (54%), vocational training (16%), GED preparation (8%) and violence prevention (8%). Originally, the authors examined 22 dichotomous risk factors; however, the six domains pertinent to the study only included 19 risk factors. The six domains included mental health and substance abuse, socialization, delinquency, teen parenting, cognitive impairment, and motivation and health. There were four dichotomous outcomes meas- ured: completing high school or GED, being employed or completing a vocational training pro- gramme, living independently (i.e. renting an apart- ment or home, either alone or with someone else), and completing high school, being employed, and living independently. An exploratory factor analysis identi- fied clinical risk factor groups using the principal component method of extraction.The authors utilized logistic regression to examine the association between clinical risk factors and client outcomes, controlling

for socio-demographic characteristics, length of stay and life skills training.

Finally, the study by Powers et al. (2012) examined an ILP specifically designed for foster youth who received special education services. While this sub- population differs from the general foster care popu- lation, this study was included because it fell within this review’s inclusionary criteria. This study employed a randomized methodology, comparing Foster Care Independent Living Program (FCILP) and TAKE CHARGE. There were four criteria for inclusion, youth must (i) receive special education services; (ii) be between 16.5 and 17.5 years of age; (iii) be under the guardianship of Oregon DHS; and (iv) attend a large school district. The approximate length of stay in the TAKE CHARGE group was 12 months; youth in the FCILP received services as normal. There were 69 participants at baseline (33 in the intervention group and 36 in the comparison group), enrolled over three study waves and randomly assigned to either the treatment or comparison group. There were several outcomes measured at baseline, post-intervention and 1-year follow-up; however, for the purposes of this review, only three will be exam- ined; high school completion, employment and living status. At post-intervention, 60 participants were assessed (29 intervention and 31 comparison), and at 1-year follow-up, 61 participants were assessed (29 intervention and 32 comparison). The attrition rate was 13% at post-intervention and 11% at 1-year follow-up. At baseline, the mean age for the partici- pants was 16.8 years, with 41% of the sample identi- fied as female. Approximately 40% of the participants attended an alternative school and approximately 26% of the participants received developmental disability services.

A R E V I E W O F T H E S I X P R I M A R Y S T U D I E S

Participants’ characteristics

The average age of the participants, calculated using reported mean ages across the six primary studies, was 17.1 years.The studies indicated that youth often have mental-health problems (64% for Kroner & Mares (2011); 47% for Mares & Kroner (2011); and 34% for Mares (2010)) when ageing out of the system, which likely influence post-secondary education, employ- ment, life skills and housing. Five of the six studies included race/ethnicity and gender characteristics of the sample. Three out of the five studies that reported

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race indicated that over 50% of the sample was African-American or non-Caucasian (61% for Uzoebo et al. (2008); 70% for Mares & Kroner (2011); and 62% for Kroner & Mares (2011)). Petr (2006) indicated that 55.5% of the sample identified as Caucasian, while 33.3% identified as African- American. Powers et al. (2012) also indicated a higher percentage of Caucasian participants (50.8%) com- pared to African-American participants (16.4%); however, this sample included only participants that used special education services, which influence the race distribution of this study. The three studies that indicated a higher percentage of African-American participants also indicated a higher number of female participants (63% for Uzoebo et al. (2008); 58% for Mares & Kroner (2011); and 55% for Kroner & Mares (2011)). Petr (2006) and Powers et al. (2012) indicated that fewer than 50% of the sample identified as being female (48.1% and 41%, respectively). Four out of the six studies indicated an average length of stay. Three of these four studies indicated that the average length of stay was 12 months or less: 9.9 months (Mares & Kroner 2011), 10.2 months (Kroner & Mares 2011) and 12 months (Powers et al. 2012). However, Uzoebo et al. (2008) indicated that the average length of stay for this programme was 17 months. The differences in length of stay could result from different requirements important to each of the programmes.

Outcome measures

Educational attainment

Four out of six of the primary studies (Petr 2006; Mares 2010; Mares & Kroner 2011; Powers et al. 2012) examined educational attainment. The most common theme discussed is secondary education completion (i.e. high school completion or obtaining a GED).

Petr (2006) indicated that seven youth (26%) reported being seriously behind in their educational progress and goals, with only one participant currently enrolled in a GED programme. Petr did not discuss post-secondary education goals; however, in order to complete post-secondary education, youth need to finish high school or obtain a GED.This study utilized focus groups, from which a theme of concern that an increased number of placements often leads to a decrease in educational attainment emerged. The trend that youth not finishing high school would have to re-take grade levels or enroll in a GED programme

surfaced during this study. The public school system increased the likelihood of poor educational attain- ment due to not offering credit for courses taken in residential care, resulting in youth falling behind in their educational pursuits.

Mares (2010) suggested that secondary education support was among one of the most common services available and offered to youth according to a group of independent living service providers. Conversely, however, financial support for college was among the least common service available or offered according to the same providers.

Mares & Kroner (2011) examined the differences in outcomes based upon mental-health concerns. They indicated that participants with mental-health prob- lems were less likely to complete high school com- pared to participants without mental-health concerns (0.60 decreased odds). In addition, those participants that stayed in the programme longer (even 1 month longer) were more likely to have completed high school (0.96 increased odds). In addition, students who were older at admission into the programme were more likely to complete high school (between 1.55 and 2.35 increased odds). The authors argued that while having a mental-health problem is a risk factor for not completing high school, spending more time in the programme and being older before entering the programme predicted a higher likelihood of finishing high school despite the risk.

Powers et al. (2012) indicated that at post- intervention, 38% of the intervention group and 28% of the comparison group had completed their second- ary education (via either a high school diploma or equivalent). At 1-year follow-up, this number increased to 72% for the intervention group and 50% for the comparison group. Three youth (one compari- son youth and two intervention youth) were partici- pating in post-secondary education after the intervention. This number increased, at 1-year follow- up, to 26% (6 comparison youth and 10 intervention youth) of youth attended post-secondary education classes at least part-time.

Employment

Three of the six primary studies discussed employ- ment outcomes: Petr (2006), Mares & Kroner (2011) and Powers et al. (2012). Seven of the 19 youth in custody (still in foster care; 37%) and 3 of the 9 out of custody (emancipated; 38%) were working at paid jobs in the community (Petr 2006). Of the three that were out of custody, two were working part-time and

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attending college. The youth in custody tended to work part-time jobs in areas such as food services.

Similar to the education results, Mares & Kroner (2011) indicated that being at least 1 year older when entering into the programme predicted higher rates of employment (between 1.55 and 2.35 increased odds). Additionally, staying at least 1 month longer before exiting the programme and not having a mental-health problem predicted a higher rate of paid employment (1.10 and 0.460 increased odds, respectively).

The Powers et al. (2012) study reported that 14% of the intervention group and 19% of the compari- son group worked paid jobs at baseline. At post- intervention, 34% of the intervention group indicated that they had a job that paid a wage or salary. In contrast, the rate of paid employment decreased slightly for the comparison group from 19% to 16%. At 1-year follow-up, 45% of the inter- vention group compared to 28% of the comparison group had jobs that paid wages or salaries, working at least part-time.

Housing

Four of the six primary studies – Mares (2010), Kroner & Mares (2011), Mares & Kroner (2011), and Powers et al. (2012) – discuss housing/living status after completion of the ILP. According to the percep- tions of the service providers, housing assistance was among the most helpful service offered to emancipat- ing youth (Mares 2010). Conversely, the service pro- viders identified two gaps in housing: affordable housing and structured transitional housing.

Kroner & Mares (2011) examined housing place- ments after the ILP and determined that three-fourths of youth went into an independent level of care: living by self (28%), living with a friend (13%) or living with a relative (17%). Additionally, just over half of the participants (55%) attained a status of independent living. Mares & Kroner (2011) indicated that partici- pants who were older when entering into the pro- gramme were more likely to live independently (between 1.55 and 2.35 increased odds). Specifically, female participants were more likely to have inde- pendent housing at discharge as well as participants who reported being parents (two times more likely). Participants who remained in the programme at least 1 month longer were more likely to have independent housing (1.10 increased odds).

The Powers et al. (2012) study indicated that at the time of enrolment in the study, all participants were in

foster care. At post-intervention, 63% of the partici- pants were still in foster care, 6 participants were adopted or reunited with their birth family, 14 partici- pants were living with friends or a partner in their own apartment, 1 participant had housing provided through Job Corps and 2 (both in the comparison group) participants identified as being homeless. At 1-year follow-up, 57% of the all the participants had exited care, 15 participants reported being reunited or adopted, 14 participants were living in their own apartment (either with a friend or partner), 4 partici- pants were residing in college dormitories, 1 partici- pant was in military housing and 1 participant had housing through Job Corps. In addition, 60% of the comparison group reported having a different place- ment from the year before compared to 50% in the intervention group.

Mental health/special needs

Mares & Kroner (2011) and Powers et al. (2012) are the two primary studies that examine outcomes for youth with mental-health problems or special educa- tion needs. Mares & Kroner (2011) indicated that youth with mental-health problems are less likely to complete high school (0.61 decreased odds), find employment (0.64 decreased odds) or establish inde- pendent housing (0.68 decreased odds). Powers et al. (2012) indicated that participants who received the intervention fared better in high school completion (38% compared to 26% at completion of pro- gramme and 72% compared to 50% at 1-year follow-up) compared to participants in the compari- son group. In addition, participants in the interven- tion group fared better in employment outcomes (14% compared to 19% at baseline, 34% compared to 16% at completion of the programme, and 45% compared to 28% at 1-year follow-up) compared to the comparison group.

Life skills

Three of the six primary studies – Petr (2006), Uzoebo et al. (2008) and Mares (2010) – reported life skills outcomes. Petr suggested that 26% (n = 7 out of 19) of youth indicated that they had not received any life skills training, while 2 (10%) out of 19 par- ticipants indicated it was offered, but they refused. The participants that received life skills training (63%) indicated that they were in one of three set- tings: a regular school setting, a mental-health agency or in a group home facility. In addition, participants

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also indicated receiving life skills training from foster parents in a less formal, day-to-day, basis. There were inconsistent reviews of the formal training sessions; some participants suggested they learned a great deal, whereas others insisted that the classes were boring and covered material already known.

Uzoebo et al. (2008) indicated that ILP partici- pants reported higher mastery of skills in the areas of daily living skills, work life, money management and budgeting, and self-care. In addition, at follow-up, participants demonstrated an increase in skills acqui- sition (52.6% at intake to 55.2%). Participants indi- cated that receiving training in a classroom setting was less efficacious to learning via a mentor or from ‘real life experiences’. In addition, participants sug- gested that modelling life skills was more productive and significant compared to learning about life skills in a classroom setting. Participants indicated a need for a curriculum that was hands-on and age appro- priate. In the Mares (2010) study, life skills training was identified as being among the most helpful for emancipating youth; however, hands-on independent living life skills training was identified as being a gap in services provided, viewed as both the most helpful independent living service and among the greatest unmet need.

D I S C U S S I O N

This review aimed to assess the effectiveness of ILPs in yielding productive outcomes (i.e. educational attainment, employment and housing) for YAO. There is a lack of consistency in the types of services provided by ILPs as well as no general standards that all ILPs follow (Courtney 2005; Naccarato & DeLorenzo 2008; Avery 2010). Therefore, some ILPs focused on housing issues but overlooked edu- cational attainment or employment, while other ILPs focused solely on secondary educational attainment but overlooked post-secondary educational services. Only four out of six studies reported outcomes for education, and each reported educational attainment differently. For example, Petr (2006) reported infor- mation regarding educational progress and goals as well as participant likelihood to finish high school or enroll in a GED programme. Mares (2010) reported the information regarding ILP service providers in the role of secondary education support and finan- cial support for post-secondary education. Mares & Kroner (2011) reported completion rates for high school among participants hindered by mental- health problems. Finally, Powers et al. (2012)

reported on completion rates for high school as well as entrance rates for post-secondary education; however, they focused only on youth with mental- health concerns enrolled in special education programmes.

In addition to the inconsistencies in reporting edu- cational outcomes, inconsistencies in reported out- comes of employment also existed; only half of the primary studies discussed employment outcomes. Petr (2006) and Powers et al. (2012) reported the percentage of participants that worked jobs that paid a salary; however, the Powers et al. (2012) study was the only one to discuss follow-up rates. While the studies reported outcomes similarly, only three studies addressed this outcome measure, and employment is important for YAO seeking independ- ent living (Donkoh et al. 2006; Mares & Kroner 2011; Unrau et al. 2011). In addition, there was a lack of information regarding the type of jobs the youth receive, how long youth maintain or stay in one job and the typical salary these youth receive. These aspects of employment are important for policy implications as well as help ascertain the pre- paredness of youth leaving the ILP and succeeding in independent living.

Independent living is an important outcome as four out of the six primary studies addressed housing out- comes. However, the housing outcomes were not reported in a consistent manner across studies. For example, two out of the four studies (Mares 2010; Mares & Kroner 2011) reported this outcome in terms of perception of the importance of housing assistance and housing outcomes of participants with mental-health problems compared to youth without mental-health problems. The other two studies (Kroner & Mares 2011; Powers et al. 2012) reported percentage of participants’ actual housing situations. Additionally, a lack of reporting the different aspects of housing existed. For instance, only one of the studies (Kroner & Mares 2011) indicated what type of housing these youth received after the ILP (i.e. low income, apartment, condominium, renting a house, owning a house and living with a relative). Powers et al. (2012) reported basic long-term follow-up of housing; however, none of the other studies reported follow-up results of housing (i.e. stability in housing, stability of the environment, stability of the neigh- bourhood).

Only two out of six studies addressed mental-health concerns or special education needs (Mares & Kroner 2011; Powers et al. 2012).These studies examined how having a mental-health concern or special education

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need could influence other outcomes (i.e. educational attainment, employment, housing and life skills). Lit- erature suggests that foster youth fall behind in education because of the pressure and instability of the foster care system, which can lead to possible mental- health concerns (Lemon et al. 2005; Montgomery et al. 2006; Collins et al. 2008; Avery & Freundlich 2009; Avery 2010; Harder et al. 2011; Unrau et al. 2011). However, only two of the six primary studies examined this outcome.

The final outcome examined in this review was life skills. Again, only half of the primary studies reported life skills outcomes. Many ILPs interpret and address life skills and life skills training differently. Petr (2006) and Uzoebo et al. (2008) reported percentage of par- ticipants’ knowledge of life skills. Uzoebo et al. (2008) discussed life skills in terms of daily living (i.e. work life, money management and budgeting, and self-care). In the Mares (2010) study, life skills were identified as being important for youth exiting care; however, often life skills are taught and discussed in a classroom or controlled setting. This was a concern for Petr (2006) and Uzoebo et al. (2008) as well, who indicated that many participants preferred a less formal, hands-on approach. In addition, the participants enrolled in the Uzoebo et al. (2008) study indicated that the use of mentors would benefit the participants, allowing the mentors to model life skills in order for the participants to learn from real-life experiences.

While these six studies are important, they bring up some limitations that need addressing. For example, not one of the studies used an RCT, which can better determine the effectiveness of an intervention. However, evaluating ILPs utilizing RCTs does not commonly occur (Montgomery et al. 2006). Four of the six primary studies utilized some comparison group, which allows for an increased understanding as well as a more confident assumption regarding the effectiveness of particular ILPs (Uzoebo et al. 2008; Kroner & Mares 2011; Mares & Kroner 2011; Powers et al. 2012).Two of the studies utilized mixed methods (using both qualitative and quantitative methodology; Uzoebo et al. 2008; Mares 2010).The inclusion of one study that utilized a non-experimental design and four others that utilized quasi-experimental designs indi- cates insufficient experimental outcome studies for ILPs.

Limitations

While this review of ILPs calls attention to the lack in consistency in ILPs for youth exiting the care system, it

only included published studies in peer-reviewed jour- nals. Grey literature, studies published in a different language and studies published prior to 2006 were not included in the review. Although this is a limitation, peer-reviewed studies are often highly regarded com- pared to all other literature. In addition, while includ- ing studies in different languages or in different countries can be illuminating, US policy-makers would most likely be interested in the studies published in the USA.

Next steps

The present review determined that insufficient outcome studies evaluating ILPs for YAO still exist. Future studies evaluating the outcomes of ILPs need to make use of stronger research designs, such as RCTs and high-quality quasi-experimental designs. While the RCT does not necessarily need to be inter- vention vs. no intervention (e.g. the RCT could be new ILP vs. standard ILP), the use of an RCT will expand the understanding of which ILP works better and potentially what types of interventions work better. For example, YAO may need more housing support and less employment support in order to have a sustainable lifestyle. However, this assumption cannot be made from the literature that currently exists. The most that can be said about the effective- ness of ILPs is that YAO who participate in ILPs obtain some productive outcomes. Comparisons about non-ILP youth cannot be made, comparison between certain ILPs cannot be made, and claims that ILPs effectively aid YAO to obtain productive out- comes cannot be made.

YAO are at an increased risk in terms of educa- tional attainment, employment, housing, mental health and life skills, yet the ILPs, which are adver- tised as aiding YAO in attaining productive out- comes, have failed to use methodologies that can adequately report on the outcomes. It is a disservice to these youth to inflate desired outcomes with documented, achieved results. Future studies also need to focus on comparative studies, which examine the effectiveness of different ILPs. It would also be desirable to promote some common core outcome measures to be used in evaluating ILP results, stand- ardized ways of reporting educational, employment and housing outcomes, for example. There are great groundwork studies out there, some included in this review; however, there needs to be a next step. Future studies need to include RCTs and compari- son studies in order to explicate the effectiveness of

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ILPs. Only then can policies be modified and cor- rected to fit the needs of the population.

R E F E R E N C E S

Adoption and Foster Care Analysis and Reporting System

(AFCARS). (2011) Preliminary FY 2011 Estimates as of July

2012. The AFCARS Report No. 19. Available at: http://

www.acf.hhs.gov/sites/default/files/cb/afcarsreport19.pdf

(accessed June 2013).

Allen, M. & Bissell, M. (2004) Safety and stability for foster

children: the policy context. The Future of Children, 14, 49– 73.

Avery, R.J. (2010) An examination of theory and promising

practice for achieving permanency for teens before they age

out of foster care. Children andYouth Services Review, 32, 399– 408.

Avery, R.J. & Freundlich, M. (2009) You’re all grown up now:

termination of foster care support at age 18. Journal of Adoles-

cence, 32, 247–257. Casey Family Programs (2010) Supporting Success: Improving

Higher Education Outcomes for Students from Foster Care. Casey

Family Programs, Seattle, WA.

Collins, M.E., Paris, R. & Ward, R.L. (2008) The permanence of

family ties: implications for youth transitioning from foster

care. American Journal of Orthopsychiatry, 78, 54–62. Courtney, M.E. (2005) Youth Aging Out of Foster Care: Network on

Transitions to Adulthood Policy Brief.The Network of Transitions

to Adulthood, Vol. 19. Available at: http://wispolitics.com/

1006/Chapin_Hall_Executive_Summary.pdf (accessed June

2013).

Courtney, M.E., Dworsky, A., Lee, J.S. & Raap, M. (2010)

Midwest Evaluation of the Functioning of Former Foster Youth:

Outcomes at Ages 23 and 24. Chapin Hall Center for Children

at the University of Chicago, Chicago, IL.

Donkoh, C., Underhill, K. & Montgomery, P. (2006) Independ-

ent living programmes for improving outcomes for young

people leaving the care system. Cochrane Database of Systematic

Reviews, 3, 1–9. doi: 10.1002/14651858.CD005558.pub2. Geenen, S. & Powers, L.E. (2007) Tomorrow is another

problem: the experiences of youth in foster care during their

transition into adulthood. Children and Youth Services Review,

29, 1085–1101. Greene, J.P. (2002) High School Graduate Rates in the United

States. Available at: http://www.manhattan-institute.org/html/

cr_baeo.htsm#14 (accessed June 2013).

Harder, A.T., Kongeter, S., Zeller, M., Knorth, E.J. &

Knot-Dickscheit, J. (2011) Instruments for research on tran-

sition: applied methods and approaches for exploring the tran-

sition of young care leavers to adulthood. Children and Youth

Services Review, 33, 2431–2441. Hardin, M. (1987) Legal Issues Related to the Federal Independent

Living Initiative. American Bar Association, Washington,

DC.

*Kroner, M.J. & Mares, A.S. (2011) Living arrangements and

level of care among clients discharged from a scattered-site

housing-based independent living program. Children andYouth

Services Review, 33, 405–415. Lemon, K., Hines, A.M. & Merdinger, J. (2005) From foster care

to young adulthood: the role of independent living programs in

supporting successful transitions. Children and Youth Services

Review, 27, 251–270. *Mares, A.S. (2010) An assessment of independent living needs

among emancipating foster youth. Child & Adolescent Social

Work Journal, 27, 79–96. *Mares, A.S. & Kroner, M.J. (2011) Lighthouse independent

living program: predictors of client outcomes at discharge.

Children and Youth Services Review, 33, 1749–1758. **Montgomery, P., Donkoh, C. & Underhill, K. (2006) Inde-

pendent living programs for young people leaving the care

system: the state of the evidence. Children and Youth Services

Review, 28, 1435–1448. **Naccarato, T. & DeLorenzo, E. (2008) Transitional Youth

Services: practice implications from a systematic review. Child

& Adolescent Social Work Journal, 25, 287–308. Pecora, P. J. (2010) Why current and former recipients of foster

care need high quality mental health services. Administration

and Policy in Mental Health and Mental Health Services Research,

37, 185–190. *Petr, C.G. (2006) Foster care independent living services: youth

perspectives. Families in society. The Journal of Contemporary

Social Services, 89, 100–108. *Powers, L.E., Geenen, S., Powers, J., Pommier-Satya, S.,

Turner, A., Dalton, L.D. et al. (2012) My life: effects of a

longitudinal, randomized study of self-determination enhance-

ment on the transition outcomes of youth in foster care and

special education. Children and Youth Services Review, 34, 2179–2187.

Reilly, T. (2003) Transition from care: status and outcomes of

youth who age out of foster care. Child Welfare League of

America, 82, 727–746. Sheehy, A., Oldham, E., Zanghi, M., Ansell, D., Correia, P. &

Copeland, R. (2001) Promising Practices: Supporting the Transi-

tion of Youth Served by the Foster Care System. Annie E. Casey

Foundation, Baltimore, MD.

Unrau, Y.A., Font, S.A. & Rawls, G. (2011) Readiness for college

engagement among students who have aged out of foster care.

Children and Youth Services Review, 34, 76–83. *Uzoebo, V., Kioko, M. & Jones, R. (2008) Deconstructing

youth transition to adulthood services: lessons learned from

the VISIONS program. Vulnerable Children andYouth Studies, 3, 37–41.

Wolanin, T.R. (2005) Higher Education Opportunities for Foster

Youth: A Primer for Policymakers. Institute for Higher Education

Policy, Washington, DC.

*Primary studies included in this review.

**Previous systematic review on this topic.

Research Review: Independent living programmes A Yelick

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