Remaining in Foster Care After Age 18 and Youth Outcomes at the Transition to Adulthood: A Review

Abstract

Many foster youth do not exit care for a permanency option and remain in foster care until they age out or are emancipated. Research findings have described the alarming circumstances of these former foster children’s adaptation to emerging adulthood. Public policy over the past three decades has sought various means of improving outcomes for these former foster youth. This review examines the legislative history leading up to extended care, the research on youth leaving foster care, youth preferences for extended care, the competition of extended care with permanency options, and the effects of extended foster care on transition-age youth. The benefits that can be had from such an extension are outlined.

Keywords

extended foster care transitioning youth emerging adulthood former foster youth age out of foster care

Purpose of this Article

This article reviews the research evidence on the relationship between remaining in foster care after age 18 and the subsequent adaptation of former foster youth (FFY) to early adulthood. Background information is provided on the concept of emerging adulthood that describes the changing nature of early adulthood in contemporary society and an overview of the policy response concerning youth who age out of foster care. There have been reviews published on what happens to youth after they leave foster care. The uniqueness of this review is the focus on identifying evidence on how extended foster care might help or hinder former youth in their adaptation to emerging adulthood. This information would be of value to child welfare practitioners and policymakers in helping youth make a successful transition from foster care.

Introduction and Background

Since the passage of the Adoption Assistance and Child Welfare Act of 1980, the primary public policy goal for child welfare is to provide children in foster care with permanency. Permanency means that children (or youth) leave foster care to go to a safe and long-term family (or family-like) living situation. The preferred permanency outcome is to reunify foster children with their family of origin after services are provided that are meant to assure the child’s safety in that home. Permanency can also take the form of adoption, a legal guardianship, or care provided by a relative (Adler, 2001; Wulczyn, 2004). In 2015, about 87% of foster children left care through one these four permanency options (Child Welfare Information Gateway, 2017b).

For many foster youth, finding permanency is elusive. Their stay in the system is long term, perhaps until they reach the age when they are legally considered to have achieved adult status. These youth exit care to go to independent living or another living arrangement. Youth exiting care in this manner are referred to as emancipated or aged out. In 2015, 22,392 youth left care in the United States in this fashion when they turned age 18. Emancipated youth represent about 9% of all exits from the system (Child Welfare Information Gateway, 2017b).

For most children, the experience of foster care is temporary. The mean length of stay for a child who left foster care in 2015 was 13.5 months, and they left care at a median age of 8 (Child Welfare Information Gateway, 2017b). Most of the youth who age out of foster care entered care at a later age and had longer stays in care than foster children who achieved permanence. Therefore, emancipating youth have had a greater opportunity to experience the effects of foster care, be they negative or positive. The longer stay in care can result in greater disruptions of their family life, living situations, schooling, and support systems (Pecora, 2007).

Youth who emancipate at age 18 must cope with significant challenges in meeting their needs for education, employment, housing, health care, and emotional support. All states provide independent living services (ILS) to ease this critical transition, and most states allow youth to remain in, or return, to foster care after they reach age 18.

Leaving Care in the Historic and Current Context

Changes in the Emergence Into Early Adulthood

For quite some time in our nation’s history, becoming economically self-sufficient and moving out of the family home were viewed as indicators that one was becoming an adult. One of the most striking changes in American society in recent decades has been the extended amount of time that youth are taking to prepare for full adulthood. This preparatory period can extend from high school graduation into a young person’s 20s and sometimes into their 30s. The freedom traditionally afforded youth of this age is restricted by the continued reliance on parents for financial support, housing, and child care when needed (Osgood, Foster, & Courtney, 2010). Arnett (2000) calls this new period of life emerging adulthood. Arnett (2000) conceptualized this time of life as a new developmental stage during which the youth is “in-between the restrictions of adolescence and the responsibilities of adulthood” (p.14).

The Challenges of Youth Leaving Care

All emerging adults share the needs to complete an education, to become employed, to achieve a degree of independence that includes the ability to make their own decisions, and to build intimate supportive relationships. Foster youth have different challenges than youth in the general population in fulfilling these tasks. Youth leaving foster care are making two transitions. The first transition is the one that they share with all youth, which is the movement into emerging adulthood. The second transition is exiting the foster care system to live independently (Avery & Freundlich, 2009).

FFY may not receive the extended time to prepare for adulthood that the theory of emerging adulthood implies. Most youth are not expected to become adults overnight just because they passed a chronological age marker, but that is what could, and often does, happen to youth leaving care. Public policies have as their foundation the belief that youth leaving care will shortly attain financial self-sufficiency and emotional independence. We do not expect this degree of autonomy from youth in general, but we have this unrealistic expectation of foster youth (Avery & Freundlich, 2009; Propp, Ortega, & NewHeart, 2003). Foster youth not only lose the support and protection of the child welfare system upon leaving care, but they also often do not have the supports from parents and family that most youth receive as they cope with the challenges of early adulthood. Ties may be weak or nonexistent because of prior maltreatment and the years spent in care away from the family of origin. When youth do have strong family ties, those families might not be able to help their transitioning offspring because of limited resources; furthermore, the problems that necessitated removal of the youth from the home in the first place may not have been resolved (Jones, 2014).

These challenges may account for why research studies have shown such poor outcomes for many youth leaving foster care. These studies show that youth leave care without the education or life skills needed to emerge as well-functioning individuals in the adult world. Some of these deficits are discussed in the next section.

The Existing Literature: Outcomes for Youth Leaving Care

All too often, youth leave foster care without completing their secondary education, and when they do earn a high school diploma, they are less likely to go on to a college or university than do their peers who were never in foster care (Batsche et al., 2014; Courtney, Dworsky, et al., 2011; Merdinger, Hines, Lemon, Osterling, & Wyatt, 2005; Pecora et al., 2003). When they do make it to college, they are less likely to graduate than are their nonfoster peers (Snyder & Tan, 2006).

Youth often leave foster care without a connection to the labor force, and when they are employed, it is likely to be in unskilled work, where wages are low (Berzin, 2008; Buehler, Orme, Post, & Patterson, 2000; Cook, 1994; Dworsky, 2005; Hook & Courtney, 2011; Pecora et al., 2003). Even when employed, they are more likely to be living in poverty than youth who were never in foster care (Macomber et al., 2008; Naccarato, Brophy, & Courtney 2010). These economic vulnerabilities have consequences in a number of areas. FFY are more likely to utilize public cash assistance or receive food stamps than is the general population (Berzin, 2008; Courtney, Piliavin, Grogan-Kaylor, & Nesmith, 2001; Needell, Cuccaro-Alamin, Brookhart, Jackman, & Shlonsky, 2002). They also have a greater chance of being homeless than were their peers who were never in foster care (Berzin, Rhodes, & Curtis, 2011; S. Brown & Wilderson, 2010; Dworsky & Courtney, 2009; Fowler, Marcal, Zhang, Day, & Landsverk, 2017; Pecora et al., 2003). Other problems noted with FFY include high pregnancy rates for women (Boonstra, 2011; Courtney et al., 2016; King, Putnam-Hornstein, Cederbaum, & Needell, 2014; Shpiegel & Cascardi, 2015) and frequent criminal justice involvement for men (Courtney et al., 2011; Courtney et al., 2016; Pergamit & Johnson, 2012).

Policy Initiatives on Youth Leaving Care

Beginning of Federal Involvement in Child Welfare Policy

The federal government had left child welfare policy to the states until the passage of the Child Abuse Prevention Act of 1974, which mandated that the states maintain a child abuse reporting system. Even more pivotal in developing the federal role in child welfare was the passage of the Adoption Assistance and Child Welfare Act of 1980. This legislation was aimed at ensuring that children would also have an exit strategy when they entered foster care. This Act defined the permanency options described earlier in this article and detailed the processes for achieving permanency. An oversight in this law is that it did not address what happens to youth who exit foster care through emancipation. Child welfare agencies treated youth who reached the age of majority as adults, and therefore they were no longer eligible for services (Ensign, 1989). The research just cited suggested that youth were leaving care unprepared for life after care.

These alarming outcomes led policymakers to the conclusion that better preparation for youth leaving care might alleviate some of the problems noted in the research. The U.S. Department of Health and Human Services (DHHS) issued a request for proposals (RFP) in 1983 to address these concerns called A Study of the Adaptation of Adolescents in Foster Care to Independence and Community Life. This RFP resulted in the funding of several ILS demonstration projects (Propp et al., 2003). Shortly thereafter, Congress began passing a series of legislative acts over a 21-year period that provided funding to the states to better prepare youth who did not have a permanency plan for leaving foster care. This legislation recognized that although foster care is supposed to be a temporary status, for many youth remaining in the system until they “age out” is the reality. The legislation recognized that the state and federal governments had responsibilities to prepare foster youth for emancipation.

The initial legislation, the Independent Living Initiative (Pub. L. No. 99-272), enacted by Congress in 1986, provided the states with US$45 million to develop independent living programs for foster youth aged 16 to 18 (Collins, 2004; Stott, 2013). The purpose of these programs was to help youth develop the skills that would enable them to adapt to life after foster care. The importance of the Independent Living Initiative was that the federal policy recognized for the first time that youth needed preparation for leaving foster care by dedicating funding for this purpose (Courtney, 2009).

The next landmark piece of legislation that addressed the needs of FFY, the Foster Care Independence Act (FCIA; Pub. L. No. 109-169) was enacted in 1999. The law is also known as Chafee in honor of former Rhode Island Senator John Chafee. This legislation increased funding for ILS by 200% (US$700 million over 5 years). States had to provide a 20% match to access funds. This legislation was a watershed event in the recognition of the need to provide services for youth beyond age 18 during this critical transition period (Collins, 2004). FCIA represented a policy shift from a focus on the teaching of independent living skills to a realization that certain material needs must also be met if youth were to be able to live independently. To begin meeting these needs, the states were given the option of providing Medicaid until age 21. States also could also use 30% of their FCIA allocation on housing for youth up to age 21 (Courtney, 2009; U.S. Government Accounting Office, 2004).

FCIA reaffirmed the permanency policy mandate. ILS were not supposed to replace the goal of finding adoptive homes for youth who could not be reunified with their family of origin. The states could double the incentive payments (from US$4,000 to US$8,000) for the adoption of older children to reaffirm the commitment to permanency (American Bar Association Commission on Youth at Risk, 2011). This provision lessened family income as one of the barriers to adoption for older youth. Despite these incentives, some evidence is available to support the claim that social workers do not seek permanency for older foster youth because they think it is unlikely a permanent home can be found for these youth (Avery & Freundlich, 2009). If the claim is true, these actions undermine a core principle of child welfare practice, finding permanency for its charges. The fact remains that many youth exit foster care without a crucial resource, parents (or at least a parent-like adult), and a family that could help the youth successfully negotiate the transition from foster care to emerging adulthood.

Chafee also mandated that states allocate 1.5% of their funding for evaluations of ILS, which addressed a criticism of the previous legislation that evidence needed to determine the effectiveness of ILS was lacking (Courtney, Zinn, et al., 2011). The need for the funding of demonstration projects with empirical support has gone unmet. FCIA also required the DHHS to develop a reporting system for the states to provide data to the federal government that could be used to assess each state’s performance in providing ILS by tracking youth to age 21 (National Youth in Transition Database [NYTD], 2012).

FCIA did provide FFY with housing and health care benefits. However, this support was much less than a parent might provide their children while they were transitioning to adulthood, and the aid ended at age 21. Hence, the termination of state care was still sudden, and many youth may be forced unprepared into an early adulthood. A major drawback to FCIA is that it did not extend Title IV-E reimbursement to eligible youth as an entitlement except for housing. Therefore, most states did not take part in the extension (U.S. Government Accounting Office, 2004).

The GAO issued reports in 1999 and 2004 on the effectiveness of ILS. Both reports found that many foster youth did not receive independent living skills training or that the preparation most youth received was inadequate (Courtney, Terao, & Bost, 2004; U.S. Government Accounting Office, 2004). Data from the Midwest Study concluded that it was unlikely youth would receive ILS after discharge from care (Courtney, Dworsky, & Pollack, 2007). Many states that provided services excluded many youth who might have benefited from extended services. As an example, Florida limited Medicaid participation to only those students who had a grade point average, which would have allowed them to be eligible for the state’s own independent living program for college students (U.S. Government Accounting Office, 2004).

FCIA required that ILS be coordinated with special education programs for foster youth with disabilities. However, guidelines for how this was to be accomplished were not provided, leading to the charge that the needs of disabled foster youth are basically ignored (Greenen & Powers, 2007).

The next major piece of landmark legislation on behalf of FFY was the Promoting Safe and Stable Families Amendment (PSSFA) in 2002 (Pub. L. No. 107-133). The intent of the PSSFA was not to teach independent living skills but rather to provide educational and economic assistance. This Act provided an additional US$60 million for educational training vouchers (ETVs), which made financial assistance available to youth who were pursuing post-secondary education or vocational training. Youth could receive up to US$5,000 a year to pursue college or training up to age 23, if they had been participating in the program when they were age 21 (Fernandes, 2006; Stott, 2013). One problem with the PSSFA was that the amount of funding was insufficient. Even if the states applied the entire US$140 million a year to educational assistance that would only translate into about US$2,000 a year per youth (Osgood et al., 2010).

Fostering Connections to Success Act (FCSA)

In 2008, President Bush signed the FCSA, which was the last piece of major federal legislation that supported foster youth leaving care. The law is also known as Fostering Connections. FCSA allowed the states to extend foster care up to age 21. Some critics have asserted that extending foster care, with a package of services and support, may discourage some youth from pursuing legal permanence, which is a core feature of child welfare practice and policy. Other critics have said youth might not want an extension. Cosner-Berzin, Singer, and Hokanson (2014) argued that many FFY view their treatment in foster care as a restriction on the autonomy that a typical adolescent would experience. Offers of continued assistance from the child welfare system may be viewed by youth as an attempt to keep them from reaching the independence that they associate with adulthood (Mares, 2010; Perez & Romo, 2011).

The states could also receive entitlement funding to provide these emerging adults with basic needs and case management services. The law recognized that youth are not ready for independence at age 18 and need a longer period of preparation than had been the custom in the past if they are expected to become independent and self-sufficient. The legislation represented an acknowledgment of the need for the state to act in loco parentis for a vulnerable group of youth into early adulthood. The law’s name is a recognition that the state must help youth make connections with others to become successful adults (Osgood et al., 2010). Fostering Connections extended FCIA, which only gave the states the option of spending funds on housing and Medicaid. Under Fostering Connections, the states were required to do so (Okpych, 2012). The trend with all of this legislation has been to allow the states to use ILS funds for youth at various ages and stages as they approach the transition to adulthood (National Foster Care Awareness Project, 2000a, 2000b).

Eligibility for services was contingent on the youth meeting at least one of the following conditions:

They attend school for the purpose of completing a high school diploma or general equivalence diploma,

or they attend a post-secondary institution or vocational program,

or they are employed for at least 80 hr a month,

or they are in a program meant to help them gain employment,

or they have a documented medical diagnosis that precludes their taking part in any of the activities just specified.

This legislation enhanced supports for FFY in three ways. First, more youth could receive ETVs because of the increased age eligibility. Eligibility for ILS and educational vouchers was extended beyond emancipated youth to include FFY, who were adopted or in guardianship at age 16 or later. This component of the legislation indicated a policy interest in the post-foster care needs of foster children other than just youth who were aging out of care (Child Welfare Information Gateway, 2014). Second, FCSA mandated that social workers speed up the time frame needed to complete the already required transition plan. This plan must be developed within 90 days of the youth’s 18th birthday. The plan must address the youth’s options in a number of specific domains (housing, health insurance, education, mentorship, and services) that would continue after discharge to support youth in these areas (Stott, 2013).

Finally, the law addressed the need for stable living situations by extending housing assistance. Housing aid was available prior to the passage of this Act, but only for youth attending high school or a vocational program with an expected graduation date before they turned age 20. States could decide to leverage federal money by using matching funds to house youth in supervised settings up to age 21. Housing difficulties have been identified to be a major problem for discharged foster youth. Providing housing stability is a necessary perquisite to enable youth to remain in school or continue to work (Hernandez & Naccarato, 2010). The provision of case management services means that child welfare agencies can play a coordinating role in connecting youth with the various and often fragmented public service systems (postsecondary education, workforce development, health, mental health, and housing) that provide the services necessary for a successful transition (Osgood et al., 2010). The Fostering Connections Act also required the state’s Medicaid agency, with input from pediatricians, to coordinate and monitor the provision of health care services using the medical home model and oversight of medication for each child (American Academy of Pediatrics, 2012).

By July 2017, 25 states and the District of Columbia had extended foster care through the Fostering Connections Act. However, most of the other states provided for state-funded extension of foster care benefits beyond age 18. Only three states (New Mexico, Ohio, and Vermont) did not provide services past age 19. The majority of states providing services under FCSA or state funds do not terminate benefits until age 21. These benefits include ILS, transitional living services, housing assistance, and educational assistance. Two states extended foster care services until age 22, and one state allows youth to receive benefits until age 23. Two other states end services at age 20 (Child Welfare Information Gateway, 2017a; Fowler et al., 2017; U.S. Department of Education, 2016). Thirty-states permitted youth who had left foster care to return. States vary on the age to which they will extend services and to the types of services provided. Okpych (2012) describes variations in the type of assistance given to FFY attending college or university by state. For example, some, but not all, states provide tuition waivers, scholarships, or grants for FFY so they can complete their education.

The Affordable Care Act (ACA)

The ACA was not designed as a child welfare policy, but it had considerable impact of FFY. The ACA mandated that youth who had been in foster care for at least 6 months on January 1, 2014, were eligible to receive Medicaid benefits until age 26. Youth could continue to collect benefits after that age if the state chose to do so. However, the 2014 start date for eligibility meant that there is a cohort of FFY who may not have any insurance coverage. Also, the DHHS issued a regulation that stated that Medicaid eligibility was not mandatory for FFY living in the state if they had not been in foster care in that state. Coverage of these FFY for Medicaid was optional for the state. As of October 2017, only 14 states had extended Medicaid eligibility to FFY from other states who were residing in their borders (State Policy Advocacy Reform Center, 2018).

Method

The research question examined in this review was “What were the outcomes for youth remaining in foster care past age 18 versus those who left care at age 18?” Outcomes were those defined by FCIA that the states were required to report to the DHHS Administration for Children and Families (ACF). These outcomes appear to be gauges of self-sufficiency. Outcome data included employment (status, skills, and income), education (finished high school or attending school including college or a training program), support from adults (had a mentor or adult they could depend upon), homelessness (housed or not), substance abuse (reported a problem, used treatment services), incarceration (arrest, incarceration), pregnancy (yes or no), and ILS receipt (yes or no, perceived quality) (Shpiegel & Cascardi, 2015).

To assure that as many relevant sources as possible could be identified, appropriate synonyms and related terms were identified. The search strategy began with the following keywords: (foster care OR foster children OR foster youth OR former foster youth OR out-of-home-care AND aging out OR emancipated OR emancipation OR independent living OR emerging adulthood OR extended foster care OR transition age AND adolescent OR teenager OR young adult, OR emerging adulthood, OR emerging adult).

Computerized databases were examined to identify relevant sources for this review. The databases included PsycLIT, Mental Health Abstracts, Social Work Research and Abstracts, Social Services Abstracts, Sociofile, and Medline. To provide the most complete evidence possible, additional online searches were done to identify evaluation reports, government documents, and other unpublished research. The reference lists of noteworthy articles were screened for additional sources. Inclusion criteria for the study included the following:

FFY were in the sample who were older than age 18,

addressed outcomes for foster youth after leaving care,

be published in English,

be published after 1986 because that was the date that legislation regarding the improvement of post-foster care functioning was first enacted.

This search process initially yielded 272 records. A review of the abstracts on the inclusion criteria whittled that number down to 59. The full texts of these studies were retrieved and further assessed for relevance and inclusion. This assessment further reduced the sample to 26 records that addressed at least one extended care. Table 1 describes the seven core studies which addressed the relationship between remaining care and the adaptation to emerging adulthood. It should be noted that many of these core studies yielded multiple manuscripts which were included in the sample of records. For example, 13 studies were identified that used Midwest Study data (discussed shortly). The studies in Table 1 went beyond small samples of convenience where data were collected at a single point in time. All the studies used large samples and were representative of either foster youth nationally, or of the state in which the data were collected. The one exception is the Casey Study which collected data from a single agency. However, this agency had offices in 23 states. Four of these studies collected data from youth at multiple time points. Five of the studies gathered data directly via in-person interviews from FFY. One study used a random sample of public child welfare social workers in Illinois, who provided data about youth who had been in their caseloads. Three of the studies used nationally representative studies of young adults as comparisons, and thus these studies could be used to estimate how foster youth compared with the general populations. Another research effort used an administrative database that included all youth in care in the state of Illinois. None of the studies used experimental design. Therefore, causality cannot be attributed on any outcome and extended care. These studies by and large constitute the knowledge base regarding the benefits of extended care; they will be briefly described later herein.

Table 1.

Selected Studies on Extended Foster Care.

Author	Study type	Sample size and characteristics	Geographic region	Data collection and years	Benefits of extended time in care
Courtney and colleagues (Courtney, 2009; Courtney & Dworsky, 2005, 2006; Courtney, Hook, & Lee, 2010; Courtney, Piliavin, Grogan-Kaylor, & Nesmith, 2001, 2011). Mid-West Evaluation of Adult Functioning; Youth Outcomes at Ages 17-18, 19, 21, 23-24, 25-26 (Midwest Study)	Data collection began before youth left care at age 17. Longitudinal data at age 19 provide a comparison between those who remained in care, and those who left care. Results were also compared with Adnd Health Survey, a nationally representative sample.	Baseline interviews with 732 former foster youth. Four additional waves of interviewing. N = 596 at the age 26 final interview.	Sample consisted of all foster youth eligible for emancipation in Iowa and Wisconsin, and a random sample from Illinois.	Interviews conducted between 2002 and 2011.	Associated with increased educational attainments. Youth had higher rates of employment and higher incomes. Youth had lower rates of homelessness. Increases the likelihood of having insurance and access to health care. Youth had fewer arrests and incarcerations. Females had fewer pregnancies. Males were more likely to be involved with their children.
Courtney, Charles, Okpych, Napolitano, and Halsted (2014, Courtney, Okpych, Charles, Dominique, Stevenson, Park, Kindle, Harty, & Feng, (2016). Findings from the CalYOUTH	Longitudinal survey CalYOUTH is an evaluation of the effect of the California FCSA on the transition to adulthood by California’s FFY. ADD Health used as a comparison.		Stratified random sample from 51 of 58 California counties. Seven counties had 0 eligible youth. 95% participation rate.	2013-2015	Associated with increased educational attainments.
McCoy, McMillen, and Spitznagel (2008). Missouri NIMH study	Longitudinal surveyWhat were the circumstances of leaving foster care? Where did youth go, and why did they want to leave? What were their living arrangements? Foster care history and conditions.No comparison group	404 formerly system involved youth: 45% White, 52% Black.	Missouri	Mixed methods. Interviewed 9 times between ages 17 and 19 in 2001-2003.	Reduction in alcohol and substance abuse problems.Youth were more likely to have received substance abuse treatment.Youth had fewer arrests and incarcerations.
National Youth in Transition Database (2012, 2013, 2014)	LongitudinalsurveyNo comparison group.	All youth in foster care during the years 2010-2012. Age 17: n = 29,565Age 19: n = 11,712	National database (50 states)	Administrative records and interviews2010-2012Youth at age 17 & 19	Youth had higher rates of employment and higher incomes.
Pecora et al. (2003) Casey National Foster Care Alumni Study	Cross-sectional analysisThe National Comorbidity Study used a comparison group.	1,082 of 1,609 eligible alumni interviewed. Covered a 32-year period.Youth interviewed had been placed with a Casey foster family for at least 12 months.Over 50% had been in care in the 1990s.Average age at interview was 30.5 years. 55% female & 65% White.Compared with youth in National Comorbidity Study (n = 3,547).	23 communities across the United States. Only one community was east of the Mississippi.	Data collected by interviews and case reviews.2000-2002	Youth had higher rates of employment and higher incomes.
Dworsky (2015)	Cross-sectional analysis.Examined child welfare system involvement of the children of foster care alumni.No comparison group	Administrative data from the Illinois Department of Children and Families Services and The Teen Service Network	Illinois	2000-2008	39% of alumni children had been investigated by child protective services (CPS) for suspected abuse of their children. 17% had at least one indicated report of child abuse. 11% were placed in out-of-home care at least once before the age of 5.
Leathers and Testa (2006)	Cross-sectional analysisNo comparison group	416 randomly selected caseworkers of former foster youth in Illinois.	Illinois	Interviewed the youth’s social worker	Youth had fewer behavioral problems.Youth were less likely to have job skill deficits.

Description of the Included Research Studies

Midwest Evaluation of the Adult Functioning of Former Foster Children

The Midwest Evaluation of the Adult Functioning of Former Foster Children, often called the Midwest Study (as it will be referred to in this article), is probably the most important study to date in establishing what we know about FFY. This study was the first large-scale investigation of youth who had aged out of care (Courtney et al., 2001). This longitudinal study used a representative sample of foster youth preparing to leave care in Illinois, and all youth exiting care in Wisconsin and Iowa in 2001. Seven hundred thirty-two out of 758 (97%) eligible youth were interviewed at age 17 as they were preparing to leave care. The same youth provided four biennial interviews between the ages of 19 and 26. Five hundred ninety-six of the original sample gave interviews at age 26, which represented 81% of the youth who participated in the initial interview. This aspect of the study enabled the tracking of youth progress through early adulthood.

This study provided an opportunity to examine the effect of extended care because Illinois was the first state to extend foster care until age 19. The other two states still had youth exiting care at age 18. Therefore, the outcomes in Illinois could be compared with what happened to FFY in the other two states. However, the researchers urged caution in drawing conclusions about extended care from these data, because of differences in demographics and other social characteristics between youth in foster care in each state, variations by state in terms of available employment and housing, and the policy differences between the states in their approaches to providing social services to FFY. These differences may account for variations in outcomes rather than the extended care.

California Youth Transitions to Adulthood Study (CalYOUTH)

The same research shop that completed the Midwest Study, Chapin Hall at the University of Chicago (led by Mark Courtney), carried out the CalYOUTH study. The study is an evaluation of the effect of the California version of the FCSA on transitioning foster youth in that state and is the only study specifically designed to assess the impact of extended care. The evaluation was a 5-year study (2012-2017), in which youth provided in-person interviews at ages 17 and 19, with an additional interview at age 21 still to be reported upon. ADD Health was also used as a comparison group in this study (Courtney, Charles, Okpych, Napolitano, & Halsted, 2014). Participation rates are high; 95% of eligible youth took part in the first interview (n = 2,700), and 84% took part in the second interview. Youth who remained in extended care are compared with those who left. Data for 727 FFY 17-year-olds and 661 19-year-olds have been reported. Finally, qualitative interviewing was done with both FFY and child welfare workers in a variety of different living arrangements to get their perspectives on extended care and youth’s adaptations to emerging adulthood after exiting foster care (Courtney et al., 2016). Although the authors do provide initial findings, they suggest interpretations of results be regarded as tentative because they are still collecting data, and further analysis remains to be completed (Courtney & Okpych, 2015). One aspect of the study that shows promise for future analysis of the impact of extended foster care is that the researchers have an administrative database of more than 100,000 transition-age foster youth who were in foster care both before and after FCSA. This database is of sufficient size to identify the impacts of FCSA in California (Meehleib, n.d.).

Casey Alumni Study

Kerman, Wildfire, and Barth (2002) used data from the Casey Alumni Study to complete a cost–benefit analysis on the effect of providing services after a youth left foster care. The Casey Family Program is a privately endowed, not-for-profit, high-quality, long-term family foster care agency. Data were gathered from a review of case files and direct interviewing of alumni who had spent at least 1 year in the care in a Casey placement. Youth were asked to report about their foster care experiences and their educational and employment attainments, social functioning, and subsequent life events after discharge. The large sample (n = 1,087) was gathered from Casey Family Programs across the United States. The proportion of the alumni interviewed was 73.6%. Respondents ranged in age from 20 to 51. Casey youth were matched on age, gender, and ethnicity with young adults participating in the nationally representative National Comorbidity Study, which collected data between 1995 and 1998 (Merikangas et al., 2010; Pecora, et al., 2003).

One problem noted by the researchers with this sample is that the wide age range of the FFY interviewed means they were in care under different policies and practices for preparing youth to leave care. Therefore, making comparisons between youth can be difficult. Outcome variations observed may be a result of these differences.

The Missouri National Institutes of Mental Health (NIMH) Study

The sample for this study was recruited from eight Missouri counties adjacent to and including the city of St. Louis: 404 FFY made up the sample, which represented 80% of eligible youth. Youth were interviewed 9 times at 4-month intervals between the ages of 17 and 19. Data were collected about demographics, maltreatment history, experiences in foster care, service utilization, substance use and abuse, criminal justice involvement, mental health diagnosis, and housing status. A unique feature and strength of this study was the frequency of data collection which allowed for a finely tuned description of FFY’s adaptation to emerging adulthood (McCoy, McMillen, & Spitznagel, 2008; McMillen & Raghavan, 2009).

National Youth in Transition Database (NYTD)

The FCIA mandated that ACF develop a database where all states, the District of Columbia, and Puerto Rico would be required to report findings on defined outcomes for the purpose of determining the effectiveness of independent living programs.

Beginning in 2010, the states began reporting the required administrative data to the federal government to track the delivery of independent living skills in 14 different domains. States were also required to collect outcome data from youth directly, though they had a choice as to how they would collect these data. Some states used face-to-face interviews; other states used phone interviewing, or self-administered online questionnaires (Shpiegel & Cascardi, 2015). These data collection efforts were intended to allow policymakers to determine how FFY compare, in the transition to adulthood, with other young people in the general population, as well to help policymakers gain a better understanding of the challenges that FFY encounter after they exit the child welfare system. Data were collected from youth at ages 17, 19, and 21.

A significant limitation of this study is that not all youth completed all three waves of interviews: 53% of eligible youth gave an interview at age 17, which increased to 69% of youth at age 19. At age 19 (n = 7,845) FFY participated. However, there was a wide variation in youth participation rates between states (26%-95%). This difference was partially explained by the various means of data collection employed by states. One state did not report outcome data. One suggestion for improving participation rates is to drop the online data collection option, which had particularly poor return rates (NYTD, 2014a, 2014b).

Findings: The Evidence on the Benefits of Remaining in Care Past Age 18

This section reviews findings from the studies that addressed the issue of extended care. Findings are arranged by specific domains relevant to emerging adulthood.

Education

CalYOUTH participants in extended care were more likely than those who left foster care to have earned a high school diploma (70.2% vs. 51.8%), and/or a vocational certificate or license (16.8% vs. 8.0%). Youth in this study who were still in care, and who pursued postsecondary education, were also more likely to receive financial aid than those FFY who left care at age 18 (65.6% vs. 33%; Courtney et al., 2016).

The Midwest Study found that FFY in the state with extended foster care had a greater likelihood of completing high school and proceeding onward to postsecondary education after age 18 than did youth not living in the two states that did not have this extension (Courtney et al., 2007). The Midwest Study youth in extended care who went on to college were more likely to finish their first year of college than did foster youth who did not have the option of remaining in foster care (Dworsky & Courtney, 2010).

Employment

A number of studies have linked extended time in foster care with an increased likelihood of employment and higher incomes when working (Barnow et al., 2015; Courtney, Dworsky, et al., 2011; Fallesen, 2013; Hook & Courtney, 2011; Kerman et al., 2002). Courtney, Hook, and Lee (2010) assert from their analysis of Midwest Study data that each additional year in care was associated with an 18% increase in the likelihood of employment.

Housing

Two longitudinal studies, the Midwest Study and the NYTD, found that youth who remained in care until age 19 were less likely to be homeless than youth who left care at age 18 (Dworsky, 2010; Prince, Vidal, & Connell, 2016). The Midwest Study data suggest that the protective effect against homelessness of an additional year of foster care wears off after time. At age 23, differences between youth were not observed on homelessness between those who left care and those who remained in care (Dworsky, 2010).

Health

Medicaid coverage declined for Midwest 19-year-old youth who had left care at age 18, when compared with those youth who remained in extended foster care (85% vs. 63%). As expected, youth without Medicaid coverage were more likely to report significant difficulties with health care access than did youth with Medicaid (Barth, 1990; Courtney, 2009; Courtney & Dworsky, 2005).

Mental Health and Substance Abuse

Data from two longitudinal studies (Midwest and Missouri studies) provide evidence that youth who are in extended foster care utilize mental health services more often than do youth who leave care to live independently. Courtney and Dworsky (2006) report that youth who remained in care until age 19 were twice as likely to receive mental health or substance disorder services as youth who exited care earlier. Both of these studies also indicate that longer stays in care is associated with fewer alcohol and substance abuse problems (A. Brown, Courtney, & McMillen, 2015; McMillen & Raghavan, 2009). A random sample of child welfare social workers in Illinois said that youth in extended care had fewer behavioral problems, educational deficits, and job skill shortfalls than youth who opted out of care (Leathers & Testa, 2006).

Criminal Justice Involvement

Data from both Midwest and CalYOUTH Studies indicate that for both men and women being in extended care at age 19 was associated with a reduced chance of arrest and incarceration. Thirty-four percent of Midwest youth who left care at age 18 had an arrest after leaving care versus 22% of the youth in extended care. Twenty-four percent of the early leavers had spent at least one night in jail. In contrast, only 14.4% of the youth in extended care had spent a night in jail (Courtney & Dworsky, 2006; Courtney et al., 2016). Similarly, CalYOUTH study participants who took advantage of the extended foster care option were less likely than those who left care to be arrested (25.1% vs. 11.6%), convicted of a crime (20.2% vs. 4.9%), or incarcerated (24.2% vs. 9.7%). The NYTD (2014b) reports findings that concur with previous findings that 26% of 19-year-olds in this database who remained in foster care had one-half the incarceration rate of youth who left care (13%). Youth who were not in extended care were also more likely to have been arrested for a drug-related problem. However, the protective features of extended foster care for avoiding legal entanglements appear to diminish for males over time. Findings from the Midwest Study reveal that for males after age 19, no differences were observed in criminal justice involvement between those who left and those who remained in the system. Rates of arrests fell for both groups. Part of the reduction in arrests for both leavers and stayers is that for all youth, the risk of arrest drops as they age (Lee, Courtney, & Tajima, 2014). Midwest Study findings indicate that for women extended foster care was associated with reduced arrests, involvement in property crimes, and marginally reduced incarceration. Unlike the men, this relationship continued after age 19 (Lee, Courtney, & Hook, 2012). Kreager, Matsueda, and Erosheva (2010) suggest that motherhood and its demands may act as a social bonding mechanism for women that limits their involvement in illegal activities.

Pregnancy

Courtney et al. (2007) used the state comparisons available on extended care in the Midwest Study to find that Illinois had 38% fewer pregnancies among FFY than the other two states that did not extend foster care. Reductions in pregnancies continued after age 19 when the youth left care, but these differences were not statistically significant. Hook and Courtney (2011) found that FFY who were fathers and who remained in care were more likely to maintain in contact with their children than youth who left care earlier.

Cost–Benefit Analyses

Discharging youth before they are ready for independent living has fiscal policy implications. Significant costs are generated when youth falter in their attempts to cope with emerging adulthood. These emerging adults may need extensive services and assistance as they cope with the demands of living independently. They may have criminal justice involvement, and they may have health care needs not covered by insurance. Their high levels of unemployment could also mean the loss of tax revenue.

A cost–benefit analysis carried out with Midwest Study data by Peters, Dworsky, Courtney, and Pollack (2009) found that if youth stayed in care until age 21, the cost to the state would be US$38,000 per foster child. However, the return on this “investment” would be 240%. This return is a result in increased educational attainments that lead to better jobs, less reliance on public benefits, and the higher tax revenues that result from higher incomes. They estimated that if youth earned a bachelor’s (BA) degree, their income would increase US$92,000 over their work life. Remaining in care until age 20 and having at least some college would result in an additional US$84,000 in lifetime benefits. In addition to increased earnings, a postsecondary degree provides other nonmonetary benefits, including the conferral of social status, better health for the worker and his or her family (Porter, 2002), an increase in the likelihood of marriage (Cherlin, 2010), a decrease in the occurrence of single parenting, and an increase in the chances that FFY offspring will receive an education. Therefore, benefits are probably even greater if one could put a dollar amount on these more intangible benefits (Peters et al., 2009).

A cost analysis completed with FFY from the Casey Program asserted that an expenditure of between US$4,000 and US$6,000 a year per youth over a 2-year period after youth left care would reduce health problems and housing difficulties, lead to better educational outcomes, and result in higher levels of well-being among FFY (Kerman, Barth, & Wildfire, 2004).

Extended Care and Competition with Permanency

Evidence from states that have extended foster care suggests that youth are more likely to remain in care past age 18, not at the expense of legal permanence but rather as an alternative to undesirable options such as running away from placement or emancipating at age 18 before they are ready (Courtney, 2009; Courtney & Okpych, 2015).

California noted a small decline in the number of youth reunified with their families after the extension of foster care was introduced in that state. However, the researchers note that reunifications had been declining in that state for some time prior to the introduction of extended care. Extended foster care in all states is voluntary. If youth wish to go home to their families, they can. In addition, the California law did not have an effect on the other permanency options of adoption and guardianship (Courtney et al., 2016).

Youth Attitudes Toward Extended Care

Results from qualitative studies of FFY suggest that many foster youth have a desire to “be out from under the thumb” of child welfare, or “to do for oneself” (Goodkind, Schelbe, & Shook, 2011; Mares, 2010; Perez & Romo, 2011). McCoy and colleagues (2008) reported that 90% of the 210 FFY they interviewed wanted to leave care. Their main reasons for wanting to exit care were a dislike of or frustration with the system (39%), a desire for independence (28%), not receiving promised services (22%), and a desire to change their circumstances (11%). Goodkind et al. (2011) also report that many youth were unaware that they could remain in foster care or did not understand what extended care was. These misconceptions may have been why youth were so negative about it.

Both quantitative and qualitative evidence from the CalYOUTH and the Midwest Studies give a more positive view of youth’s preferences about continuing in or leaving care. These data indicate that youth want to remain in the child welfare system after they turn 18 if that option is available. One piece of supporting evidence for foster youth’s preference for remaining in care comes from California. The California legislature estimated that 50% of eligible foster youth would take advantage of the extension of foster care when it became available in that state; in fact, 80% of foster youth opted into the extension (Delgado, 2013). Two thirds of the Illinois youth remained in foster care after that state passed its extension law at age 20 and one half of youth were still in care at age 21 (Courtney et al., 2007).

A subset of CalYOUTH participants reported in focus groups that they regarded extended foster care as an opportunity that allowed them to complete their education and meet their basic needs, rather than experience an abrupt end to state support (Napolitano & Courtney, 2014). However, those who did not take advantage of extended care gave reasons that were similar to those reported in other qualitative studies: primarily a desire for freedom and independence (Napolitano, Sulimani-Aidan, & Courtney, 2015).

Limitations of the Review

The research in general is mostly descriptive with only minimal effort directed toward identifying variables that might allow us to explain or identify better outcomes (Daining & DePanfilis, 2007). The most obvious weakness in the research is there has yet to be a completed evaluation of extended care. There are, however, studies that have collected data about when youth leave care, which allows for comparisons between youth who left care at age 18 and those who chose to remain. Variations in the measures used to operationalize variables can complicate the comparison of findings between studies. Researchers often utilized retrospective self-reports from youth and/or social workers or caretakers. These types of data may mean researchers cannot be certain that the information provided is accurate.

Data across studies were also gathered from youth at different ages. Samples consisting of older youth are more likely to show more youth with a high school diploma or GED than are the studies composed of younger informants. Even the more rigorous longitudinal studies such as the Midwest and Missouri Studies collected their data in a single state or geographic region. This limitation may make comparisons between studies risky, as states may operate on different policies and practices for discharged foster youth which affect outcomes. Also, economic and policy changes over time can affect the results reported in studies.

None of the studies used random assignment, which would appear to be difficult to operationalize in studies of extended care. Therefore, cause and effect cannot be attributed between outcomes and extended time in care. We are also faced with the conundrum that youth who chose to remain in care may be different in some way from those who chose to emancipate at age 18. This fact introduced an element of uncertainty about asserting the benefits of remaining in care. Leathers and Testa (2006) suggest that youth who opted to leave care without services were those with more problems which may account for the outcomes observed for those remaining in care. These researchers leave open the possibility that the positive findings regarding extended foster care could possibly be the result of a self-selection process. Youth without major problems, and who are somewhat more positive about foster care, are more likely to continue in care. Youth with difficulties may actively seek to disengage from care. Youth with a drug problem may want to leave care to escape surveillance by child welfare staff. These various weaknesses call into question the validity and generalizability of the findings of much of the research. Nevertheless, despite significant limitations in the literature, a review of the research on youth leaving care can give us a tentative understanding of how remaining in care can improve outcomes for FFY.

Discussion

Extended services for youth in foster care often end by age 21, despite the large body of evidence that there is still a great need for continued system support after that age. We are coming to an understanding that youth are not fully realized adults by either biological or social standards—until at least age 25 (Jim Casey Opportunities Initiatives, 2011). Courtney (2009) asserts that making a longer extension than is currently found is difficult because of the societal fear of dependency. This fear stands in sharp contrast to the willingness of families in the general population to supply their offspring with financial and emotional support into their early 30s (Schoeni & Ross, 2005). Specific examples of how providing extended support might aid in the transition for FFY are provided in the next section.

Implications for Practice

Housing and Education

Extended care with housing support would certainly be a preventive measure against homelessness. Providing housing assistance might enable other youth to remain in school or maintain a job. Extended care would also aid FFY in securing their education if they choose to go on to college. FFY students are on average older than the usual college student because they are more likely than nonfoster students are to have repeated a grade. They often need to take remedial course work without college credit. This additional course work may extend the time needed to complete school. Also, FFY must often go to school part-time because of financial problems, which adds to the time needed to complete an academic program (Merdinger et al., 2005). Thus, FFY may need the support of extended foster care to assist them with completing an educational program. For college students, the extended funding would be in line with recent data on how long it takes a student to earn a post-secondary degree. The U.S. Department of Education says that today it takes a little more than 6 years to complete a BA degree (Kertscher, 2013).

Criminal Justice

One concern for these youth is the high number of FFY, particularly males, who become involved with the criminal justice system. Allowing youth to remain in care until age 25 would take youth through the period of highest risk for criminal justice involvement. Midwest Study data indicate that for males, school attendance and/or working reduced criminal justice entanglements providing support for social bonds theory as a framework for reducing criminal justice problems. Social bond theory holds that youth who build significant attachments to the community are less likely to engage in criminal behavior. Over time, we acquire material possessions, status, relationships, and a sense of the future. Fear of jeopardizing any of these assets acts as a deterrent to violating societal rules through deviancy or criminal behavior. An argument can be made that extended care would facilitate a commitment to society by helping youth finish school and find employment where they can build social bonds (Hirschi, 1969; Lee et al., 2012).

Health Care

One improvement that would assist in meeting the health care needs of FFY is to extend Medicaid coverage until age 26 for all FFY, regardless of where they lived or currently live. Such a change would place FYY on an equal plane with youth who have eligibility for health care through a parent’s insurance policy. Eligibility for Medicaid could influence a youth’s decision about where to go to school or employment. Youth need help in accessing health care even at age 26; medical needs do not stop at that age (Houshyar, 2014).

Mental Health and Substance Abuse

The reduction in problems (be they mental health, substance abuse related, or criminal justice) possibly occurs because youth in extended care are still under some sort of system supervision, and they have easier access to services when there is a problem. Leathers and Testa (2006) also assert that it is important to engage high-risk youth with preventive services before they leave care, because they are difficult to track and reach once they are out of the system. Extended services are crucial for youth with substance abuse disorders or conduct disorders because these problems require longer periods of treatment. Relapse is an expected part of substance disorder recovery and treatment, and so youth suffering from these ills may need more time in care for them to fully recover. One flaw noted with the FCSA is that it may be difficult for youth with mental health and substance abuse problems to meet the employment and educational requirements needed to remain eligible for continued services (Courtney & Charles, 2015).

Pregnancy

Midwest Study data indicate that an additional year in foster care would delay pregnancy among female FFY (Courtney et al., 2007). Researchers have asserted that additional time in care beyond age 19 might allow for a more effective delivery of family planning and parent support programs (Putnam-Hornstein et al., 2015). Dworsky (2015) noted an unintended consequence of extended foster care is that the number of children of foster alumni in foster care may increase because of the continued surveillance by child welfare workers. She does leave open the possibility that the additional services that come from system involvement may help a young parent avoid abuse or neglect. A gap in the research that needs closing is to identify the effect of keeping parenting youth in care and to track their offspring’s subsequent child protective service (CPS) involvement.

Implications for Research

The research shows considerable benefits to remaining in care past age 18 or 21. However, the data to support the extension are correlational not causal. More rigorous research is needed before we can make definitive statements about the efficacy of extended care. What is needed is more sophisticated multivariate analyses that go beyond description to include potentially confounding factors such as mental health status and substance abuse before we can definitively assert the benefits of extended foster care.

As discussed earlier, some researchers suggest the benefits that they identified may be the result of a self-selection process, whereby high-risk youth are more likely to leave care because they wish to avoid system supervision, or high-functioning youth can see the advantage of receiving continued services (Leathers & Testa, 2006). These resilient FFY may have done well on their own without continued services. Further research is needed on this issue of who remains in care versus those who leave.

Implications for Policy

Cost–Benefit Analysis

Packard, Delgado, Fellmeth, and McReady (2008) provide a cost–benefit analysis proposal for extending transitional services to age 23. These researchers examined cost and savings over 40 years for a cohort of FFY in the areas of lifetime earnings, taxes paid, incarcerations, and Temporary Assistance for Needy Families (TANF: public cash assistance) use. These researchers estimate that such an extension would provide a benefit to cost ratio of US$1.5 to US$1.0. Such data might make policymakers more willing to extend services for FFY.

Concerns about costs of an extension could reduce the willingness of policymakers to extend services. The mechanisms for funding are already available. States could draw down Title IV-E federal funds for FFY to cover the costs; available evidence suggests that funding extended foster care could be a cost–effective way to reduce the problems that FFY experience after leaving care. Extended time in care would provide at least some of the support and stability needed for coping with the transition to adulthood. The question is for how long. Public child welfare agencies must end their support for youth at some point. However, policymakers must recognize and respond to the social and economic trends that are elongating the period of preparation for young people in the general population. Extended services would give FFY the same sort of supports afforded to youth in the general population and would be in agreement with the normative transition to adulthood in contemporary America (Osgood et al., 2010).

Reducing the Competition with Permanency

One answer for those who are concerned about a reduction in reunifications because of FCSA is to make older reunified adolescents eligible for transition services. This eligibility would reduce the perceived competition between permanency and the receipt of continued services. It may be inaccurate to assume that their parents have the resources to assist reunified youth with the transition. The same is true for youth who exit care through emancipation. Many states have provisions for reentering foster care. The trend with all of this legislation has been to allow the states to use ILS funds for youth at various ages and stages as they approach the transition to adulthood (National Foster Care Awareness Project, 2000b).

How Long Should Youth Remain in Care?

A year or two more of foster care is a good start, but may not be enough to ensure a successful emerging adulthood. Many of the gains shown for FFY in extended care had disappeared by age 23 or 24. For example, in the Midwest Study youth who remained in care after age 18 were less likely to be homeless at age 21 than were youth who left foster care. However, at age 23 or 24, the effect of extended care had dissipated, and youth in both groups had comparable rates of homelessness (Courtney et al., 2010). One should not conclude that the additional time in foster care did not alleviate homeless. The problems experienced in these youth’s mid-20s may mean that remaining in care until 19 or even 21 was too small a “dosage” to deal with the challenges of emerging adulthood. Services and support need to continue. It may not be any more realistic to expect someone to be self-sufficient at age 21 than it was at age 18. A case can be made that youth should remain in care and/or continue with ILS until age 25. The extended time in care would provide youth with continued services including housing support, ILS, and health care, including mental health and substance abuse treatment (Gardner, 2008). Youth might thus have more of an opportunity to complete an education program and prepare for employment.

Concluding Comment

Perhaps FFY are rushed through their adolescence to adulthood before they are emotionally ready. Samuels and Pryce (2008) called this phenomenon the premature conferring of adult status. Goodkind et al. (2011) also noted that FFY need for independence and autonomy acts as a significant barrier in recent efforts to extend the age eligibility for foster care assistance. FFY are proud of their ability to take care of themselves and reluctant to seek help when needed. In contrast, the experience of Illinois and California, states with extended care, suggests that if youth are given the opportunity to remain in care, many if not most youth will avail themselves of the additional time and services. Youth also said they had a sense of loss about relationships they might have had if circumstances had not brought them into foster care. They are aware that they lacked the security and ongoing support available to many youth in the general population. This loss of social relationships, and its effect on their life trajectories in their early 20s, is one of the strongest reasons for extending foster care support to at least age 21, if not later.

Footnotes

Disposition editor: Sondra J. Fogel

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

References

Adler

(2001). The meanings of permanence: A critical analysis of the Adoption and Safe Families Act of 1997. Harvard Journal on Legislation, 38, 1-25.

American Academy of Pediatrics. (2012). Health care of youth aging out of foster care. Retrieved from https://pediatrics.aappublications.org/content/early/2012/11/21/peds.2012-2603..info?versioned=true

American Bar Association Commission on Youth at Risk. (2011). Report from a National Summit on the Fostering Connections to Success Act. New York, NY: Roosevelt House Public Policy Institute at Hunter College.

Arnett

(2000). Emerging adulthood: A theory of development from the late teens through the twenties. American Psychologist, 55, 469-480.

Avery

Freundlich

(2009). You’re all grown up now: Termination of foster care support at age 18. Journal of Adolescence, 32, 247-257.

Barnow

Buck

O’Brien

Pecora

Ellis

Steiner

(2015). Effective services for improving education and employment outcomes for children and alumni of foster care services: Correlates of educational and employment outcomes. Child & Family Social Work, 20, 159-170.

Barth

(1990). On their own: The experiences of youth after foster care. Child and Adolescent Social Work, 7, 419-440.

Batsche

Hart

Ort

Armstrong

Strozier

Hummer

(2014). Post-secondary transitions of youth emancipated from foster care. Child and Family Social Work, 19, 174-184.

Berzin

(2008). Difficulties in the transition to adulthood: Using propensity scoring to understand what makes foster youth vulnerable. Social Service Review, 82, 171-196.

10.

Berzin

Rhodes

Curtis

(2011). Housing experiences of former foster youth: How do they fare in comparison? Children and Youth Service Review, 33, 2119-2126.

11.

Boonstra

H. D.

(2011). Teen pregnancy among young women in foster care: A primer. Guttmacher Policy Review, 14, 8-19.

12.

Brown

Courtney

McMillen

J. C.

(2015). Behavioral health needs and service use among youth who age-out-of-foster care. Children and Youth Service Review, 58, 163-169.

13.

Brown

Wilderson

(2010). Homelessness prevention for former foster youth: Utilization of transitional programs. Children and Youth Service Review, 32, 1464-1472.

14.

Buehler

Orme

Post

Patterson

(2000). The long-term correlates of family foster care. Children and Youth Service Review, 22, 595-625.

15.

Cherlin

. (2010). Demographic trends in the United States: A review of research in the 2000’s. Journal of Marriage and the Family, 72, 403-419.

16.

Child Welfare Information Gateway. (2014). Case planning for families involved with child welfare agencies. Washington, DC: U.S. Department of Health and Human Services, Children’s Bureau. Retrieved from http://www.childwelfare.gov/pubPDFs/caseplanning.pdf

17.

Child Welfare Information Gateway. (2017a, February). Extension of foster care beyond age 18. Washington, DC: Children’s Bureau, Administration for Children and Families, U.S. Department of Health and Human Services.

18.

Child Welfare Information Gateway. (2017b, March). Foster care statistics 2015. Washington, DC: Children’s Bureau, Administration for Children and Families, U.S. Department of Health and Human Services.

19.

Collins

M. E.

(2004). Enhancing services to youth leaving care: Analysis of recent legislation and its potential impact. Children and Youth Service Review, 26, 1051-1065.

20.

Cook

(1994). Are we helping foster care youth prepare for their future? Children and Youth Services Review, 16, 213-229.

21.

Cosner-Berzin

Singer

Hokanson

(2014). Emerging versus emancipating: The transition to adulthood. Journal of Adolescent Research, 29, 616-638.

22.

Courtney

(2009). The difficult transition to adulthood for foster youth in the US: Implications for the state as corporate parent. Fairfax, VA: Society for Research on Child Development.

23.

Courtney

Charles

(2015). Mental health and substance abuse problems and service utilization by transition age foster youth. Chicago, IL: Chapin Hall Center for Children, University of Chicago.

24.

Courtney

Charles

P.C.

Okpych

N. J.

Napolitano

Halsted

. (2014). Findings from the California Youth Transitions to Adulthood Study: Conditions at age 17. Chicago, IL: Chapin Hall Center for Children, University of Chicago.

25.

Courtney

Dworsky

(2005). Midwest Evaluation of the Adult Functioning of Former Foster youth: Outcomes at age 19. Chicago, IL: Chapin Hall Center for Children.

26.

Courtney

Dworsky

(2006). Early outcomes for young adults transitioning from out-of-home-care in the USA. Social Work, 11, 209-219.

27.

Courtney

Dworsky

Brown

Cary

Love

Vorhies

(2011). Mid-west evaluation of adult functioning of former foster youth outcomes at age 26. Chicago, IL: Chapin Hall Center for Children, University of Chicago.

28.

Courtney

Dworsky

Pollack

(2007). When should the state cease parenting? Evidence from the mid-west study. Chicago, IL: Chapin Hall Center for Children, University of Chicago.

29.

Courtney

Hook

Lee

(2010). Distinct subgroups of former foster youth during young adulthood: Implications for policy and practice. Chicago, IL: Chapin Hall Center for Children, University of Chicago.

30.

Courtney

Okpych

(2015). Memo from CalYOUTH: Early findings on extended foster care and legal permanency. Chicago, IL: Chapin Hall Center for Children, University of Chicago.

31.

Courtney

Okpych

Charles

Dominique

Stevenson

Park

Feng

(2016). Findings from the California Transitions to Adulthood Study (CalYOUTH): Conditions at age 19. Chicago, IL: Chapin Hall Center for Children, University of Chicago.

32.

Courtney

M. E.

Piliavin

Grogan-Kaylor

Nesmith

(2001). Foster youth transitions to adulthood: A longitudinal view of youth leaving care. Child Welfare, 80, 685-718.

33.

Courtney

Terao

Bost

. (2004). Mid-west evaluation of adult functioning of former foster youth: Conditions of youth preparing to leave care. Chicago, IL: Chapin Hall Center for Children, University of Chicago.

34.

Courtney

Zinn

Koralek

Bess

Stagner

Pergamit

Johnson

(2011). Evaluation of independent living—Employment service programs, Kern County California (Multi-Site Evaluation of Foster Programs, OPRE report). Retrieved from https://www.acf.hhs.gov/sites/default/files/opre/eval_kern.pdf

35.

Daining

DePanfilis

(2007). Resilience of youth in transition from out-of-home care to adulthood. Children and Youth Service Review, 29, 1158-1178.

36.

Delgado

(2013, December). California’s fostering connections: Ensuring that the AB12 bridge leads to success for transition foster youth. San Diego, CA: University of San Diego School of Law.

37.

Dworsky

(2005). The economic self-sufficiency of Wisconsin former foster youth. Children and Youth Service Review, 27, 1085-1118.

38.

Dworsky

(2010). Assessing the impact of extending care beyond age 18 on homelessness. Chicago, IL: Chapin Hall at the University of Chicago.

39.

Dworsky

(2015). Child welfare services involvement among children of young parents in foster care. Child Abuse & Neglect, 45, 68-79.

40.

Dworsky

Courtney

(2009). Homelessness and the transition from care to adulthood. Child Welfare, 88(4), 23-56.

41.

Dworsky

Courtney

(2010). Does extending foster care beyond age 18 promote secondary educational attainment? Chicago, IL: Chapin Hall at the University of Chicago.

42.

Ensign

(1989). The federal role in foster care: A paper on current priority issue areas. Washington, DC: US. Department of Health and Human Services. Retrieved from http://aspe.hhs.gov/daltcp/reports/frfoscar.pdf

43.

Fallesen

(2013). Time spent well: The duration of foster care and early adult labor market, educational, and health outcomes. Journal of Adolescence, 36, 1003-1011.

44.

Fernandes

A. L.

(2006). Child welfare: The Chafee Foster Care Independence Program (CRS Report to Congress. Congressional Research Service: The Library of Congress). Denton: University of North Texas.

45.

Fowler

P. J.

Marcal

K. E.

Zhang

Day

Landsverk

(2017). Homelessness and aging out of foster care: A national comparison of child welfare-involved adolescents. Children and Youth Service Review, 77, 27-33.

46.

Gardner

(2008). Youth aging out of foster care: Identifying strategies and best practices. Washington, DC: National Association of Counties.

47.

Goodkind

Schelbe

Shook

(2011). Why youth leave care: Understanding of adulthood and transition successes and challenges among youth aging out of child welfare. Children and Youth Service Review, 33, 1039-1048.

48.

Greenen

Powers

L. E.

(2007). Tomorrow is another problem. Children and Youth Service Review, 29, 1085-1101.

49.

Hernandez

Naccarato

(2010). Scholarships and support to foster care alumni: A study of 12 programs across the US. Children and Youth Service Review, 32, 758-766.

50.

Hirschi

(1969). Causes of delinquency. Berkeley: University of California Press.

51.

Hook

Courtney

(2011). Employment outcomes of former foster youth as young adults. Children and Youth Service Review, 33, 1855-1865.

52.

Houshyar

(2014). Medicaid to age 26 for former foster youth. The State Policy Reform Center. Retrieved from http://childwelfaresparc.org/wp-content/uploads/2014/10/Medicaid-to-26-for-Former-Foster-Youth7.pdf

53.

Jim Casey Opportunities Initiatives. (2011). The adolescent brain and its implications for young people transitioning from foster care. St. Louis, MO: Casey Opportunities Initiatives.

54.

Jones

(2014). The family and social networks of recently discharged foster youth. Journal of Family Social Work, 17, 81-96.

55.

Kerman

Barth

Wildfire

(2004). Extending transitional services to former foster children. Child Welfare, 88, 239-262.

56.

Kerman

Wildfire

Barth

(2002). Outcomes for young adults who experienced foster care. Children and Youth Service Review, 24, 319-344.

57.

Kertscher

(2013, August 11). On average, a college degree takes six years, U.S. Sen. Ron Johnson says. Milwaukee Journal Sentinel. Retrieved from https://www.politifact.com/wisconsin/statements/2013/aug/11/ron-johnson/average-college-degree-takes-six-years-us-sen-ron-/

58.

King

Putnam-Hornstein

Cederbaum

J. A.

Needell

(2014). A cross sectional examination of birth rates among adolescent girls in foster care. Children and Youth Service Review, 36, 179-186.

59.

Kreager

Matsueda

Erosheva

(2010). Motherhood and criminal distance in disadvantaged neighborhoods. Criminology, 48, 221-258.

60.

Leathers

Testa

(2006). Foster youth emancipating from care: Caseworkers report on needs and services. Child Welfare, 85, 463-498.

61.

Lee

J. S.

Courtney

Tajima

(2014). Extended foster care support during the transition to adulthood: Effect on the risk of arrest. Children and Youth Services Review, 42, 34-42.

62.

Lee

J. S.

Courtney

Hook

J. L.

(2012). Formal bonds during the transition to adulthood: Extended foster care support and criminal/legal involvement. Journal of Public Child Welfare, 6, 255-279. doi:10.1080/15548732.2012.683336

63.

Macomber

Kuehn

McDaniel

Vericker

Pergamit

Cuccaro

Barth

(2008, March). Coming of age: Employment outcomes for youth who age out of foster care through their middle twenties. Presented at the 11th National Child Welfare Data and Technology Conference, Washington, DC.

64.

Mares

(2010). An assessment of independent living needs among emancipating foster youth. Child and Adolescent Social Work, 27, 79-96.

65.

McCoy

McMillen

J. C.

Spitznagel

(2008). Older youth leaving the foster care system: Who, what, when, where, and why? Children and Youth Service Review, 30, 735-745.

66.

McMillen

J. C.

Raghavan

(2009). Pediatric to adult mental health service use of young people leaving the foster care system. Journal of Adolescent Health, 44, 7-13.

67.

Meehleib

(n.d.). Podcast with Dr. Mark Courtney on Extended Foster Care and the CalYOUTH Study. Retrieved from http://www.courts.ca.gov/documents/cfcc_podcast_calyouth_transcript.pdf

68.

Merdinger

Hines

Lemon

Osterling

Wyatt

(2005). Pathways to college for former foster youth: Understanding factors that contribute to educational success. Child Welfare, 84, 867-896.

69.

Merikangas

K. R.

Burnstein

Swanson

S. A.

Avenevoli

Cui

(2010). Lifetime prevalence of mental health disorders in U.S. adolescents: Results from the National Comorbidity Study Replication-Adolescent Supplement. Journal of the American Academy of Child & Adolescent Psychiatry, 49, 980-989.

70.

Naccarato

Brophy

Courtney

(2010). Employment outcomes of foster youth: The results from the Midwest Evaluation of the adult functioning of foster youth. Children and Youth Service Review, 32, 551-559.

71.

Napolitano

Courtney

(2014). Residential settings of young adults in extended foster care: A preliminary investigation. Chicago, IL: Chapin Hall at the University of Chicago.

72.

Napolitano

Sulimani-Aidan

Courtney

(2015). Extended foster care in California: Youth and caseworker perspectives. Chicago, IL: Chapin Hall at the University of Chicago.

73.

National Foster Care Awareness Project. (2000a). Answers to foster care independence questions. Seattle, WA: Casey Foundation. Retrieved from https://cbexpress.acf.hhs.gov/index.cfm?event=website.viewArticles&issueid=4&articleid=51

74.

National Foster Care Awareness Project. (2000b). Frequently asked questions II: About the Foster Care Independence Act of 1999 and the John H. Chafee Foster Care Independence Program. Seattle, WA: Casey Foundation.

75.

National Youth in Transition Database. (2012, September). Highlights from the state reports to the National Youth in Transition Database, federal fiscal year 2011. Washington, DC: Administration for Children and Youth.

76.

National Youth in Transition Database. (2013, August). Highlights from the state reports to the NYTB, federal fiscal year 2012. Washington, DC: U.S. Department of Health and Human Services.

77.

National Youth in Transition Database. (2014a, September). Comparing outcomes reported by young people at ages 17 and 19 in the NYTD Cohort 1. Washington, DC: Administration for Children and Youth.

78.

National Youth in Transition Database. (2014b, July). Highlights from the state reports to the National Youth in Transition Database, federal fiscal year 2013. Washington, DC: Administration for Children and Youth.

79.

Needell

Cuccaro-Alamin

S. C.

Brookhart

Jackman

Shlonsky

(2002). Youth emancipating from foster care in California: Findings using linked administrative data. Berkeley: Center for Social Services, University of California Berkeley.

80.

Okpych

(2012). Policy framework supporting youth aging out of foster care through college. Children and Youth Service Review, 34, 1390-1396.

81.

Osgood

D. W.

Foster

Courtney

(2010). Vulnerable populations and the transition to adulthood. Future of Children, 20, 209-229.

82.

Packard

Delgado

Fellmeth

McReady

(2008). A cost-benefit analysis of transitional services for emancipating foster youth. Children and Youth Service Review, 30, 1267-1278.

83.

Pecora

(2007). Providing better opportunities for older children in the child welfare system. Archives of Pediatric Adolescent Medicine, 161, 1006-1008.

84.

Pecora

Williams

Kessler

Downs

C. A.

O’Brien

Hiripi

(2003). Assessing the effects of foster care: Early results from the Casey National Alumni Study. Retrieved from https://www.casey.org/media/AlumniStudy_US_Report_Full.pdf

85.

Perez

Romo

(2011). “Couch surfing” of Latino foster care alumni: Reliance on peers as social capital. Children and Youth Service Review, 34, 239-248.

86.

Pergamit

Johnson

(2012). Extending foster care to age 21: Implications and estimates from youth aging out of foster care in Los Angeles: Final Report to the Stuart Foundation. Washington, DC: The Urban Institute.

87.

Peters

C. M.

Dworsky

Courtney

Pollack

(2009). The benefits of costs of extending foster care to age 21. Chicago, IL: Chapin Hall Center for Children, University of Chicago.

88.

Porter

(2002). The value of a college degree. Washington, DC: Clearinghouse on Higher Education.

89.

Prince

Vidal

Connell

(2016). Effects of independent living supports and subsequent housing instability after youth exit foster care. Washington, DC: Society for Social Work Research.

90.

Propp

Ortega

NewHeart

(2003). Independence or interdependent: Rethinking the transition from “ward of the court.” Families in Society, 84, 259-266.

91.

Putnam-Hornstein

Hammond

Eastman

McCroskey

Webster

(2015). Extended foster care for transition-age youth: An opportunity for pregnancy prevention and family support. Journal of Adolescent Health, 58, 485-487.

92.

Samuels

G. M.

Pryce

(2008). “What doesn’t kill you makes you stronger”: Survivalist self-reliance as resilience and risk among adults aging out of foster care. Children and Youth Service Review, 30, 1198-1210.

93.

Schoeni

Ross

(2005). Material assistance from families during the transition to adulthood. In Settersten

Furstenberg

Rumbaut

(Eds.), On the frontier of adulthood: Theory. research, and public policy (pp. 3-25). Chicago, IL: University of Chicago Press.

94.

Shpiegel

Cascardi

(2015). Adolescent parents in the first wave of the National Youth in Transition Database. Journal of Public Child Welfare, 9, 277-298.

95.

Snyder

T. D.

Tan

A. G.

(2006). Beginning postsecondary students. Digest of U.S. Educational Statistics. Washington, DC: National Center for Education Statistics.

96.

State Policy Advocacy Reform Center. (2018). Medicaid coverage for former foster youth—Fact sheet. Retrieved from http://childwelfaresparc.org/wp-content/uploads/2017/02/Medicaid-to-26-Fact-Sheet-pdf.pdf

97.

Stott

(2013). Transitioning youth: Policies and outcomes. Children and Youth Service Review, 35, 218-227.

98.

U.S. Department of Education. (2016). Foster Care Transition Toolkit. Washington, DC: Author.

99.

U.S. Government Accounting Office. (2004). Foster youth: HHS actions could improve coordination of services and monitoring of the state’s independent living programs (Report No. GAO-05-25). Washington, DC: U.S. General Accounting Office.

100.

Wulczyn

(2004). Family reunification. Future of Children, 14, 95-113.