Improving the Health, Safety, and Well-Being of Young Adults: Workshop Summary (2013)

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Foster Care, Welfare Services, and Services for Homeless Young Adults

A variety of public systems exist to assist vulnerable populations, including populations of young adults. This chapter summarizes presentations on three of those systems: services for homeless young adults, foster care, and welfare services.

SERVICES FOR HOMELESS YOUNG ADULTS

According to data from the National Incidence Studies of Missing, Abducted, Runaway, and Throwaway Children, about 1.7 million children have spent at least one night homeless, said Mark Courtney, professor in the School of Social Service Administration at the University of Chicago. More than 99 percent of those minors went home again, but approximately 380,000 remained away for a week, and 131,000 remained away for a month.

The Homeless Management Information System identifies about 150,000 young adults ages 18-24 as having been homeless. As with children, most are homeless for short periods, but 13,000 have experienced episodic homelessness and 15,000 chronic homelessness.

Homelessness typically results from a “constellation of challenges,” said Courtney. Research has shown that homeless populations tend to have strained or nonexistent relations with family, high self-reported rates of parental maltreatment, and disproportionate involvement with the foster care system and the juvenile and adult justice systems. They also tend to have low educational attainment, limited work experience, and limited human capital on which they can draw. People who are homeless often engage in risky behaviors or are victimized physically or sexually. Many of the homeless are parents: Households headed by a young adult under the age of 25 make up more than 25 percent of homeless families in the homelessness assistance system.

U.S. policy on homeless young adults includes a focus on prevention. The Runaway and Homeless Youth Act,¹ which is currently funded at slightly more than $100 million, includes three programs. The Street Outreach Program sends workers into the community to connect youth with services. The Basic Center Program funds drop-in centers for sheltering for up to 21 days and a variety of other services. The Transitional Living Program houses young people between ages 16 and 21 for up to 18 months with employment, education, mental health, and other services (ACF, 2013).

Little research has been done to compare the effectiveness of these interventions. Even less research exists on the comparative effectiveness of these programs for subpopulations such as homeless young people with significant mental health problems or homeless young parents. In general, Courtney, concluded, “there is clear mismatch between the resources provided … and the need” for homeless young adults.

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¹ The Runaway and Homeless Youth Act, Public Law 110-378, 42 U.S.C. § 5601.

YOUNG ADULTS WHO HAVE BEEN IN THE FOSTER CARE SYSTEM

About 400,000 children are in foster care on any given day. Most of these children will return home to their biological parents. “That is the way we want it,” said Gina Miranda Samuels, associate professor in the School of Social Service Administration at the University of Chicago. “We want to see kids have the opportunity to be returned to the families they were originally removed from.” About 60,000 children in the foster care system are available for adoption, she said. Those children who are not placed with permanent families age out of the system at 18, but this group represents only 11 percent of all the young people who exit from the foster care system.

In 2011, approximately 26,000 youth aged out of care, said Samuels. Youth in foster care often have highly complicated or fractured family networks, but even youth who age out typically retain family ties. These ties can be a major consideration as these young adults renegotiate, generally with intervention from a caseworker or institution, their own family relationships.

The Foster Care Independence Act of 1999,² which built on 1986 amendments to the Social Security Act, provides states with a dedicated funding stream for transitional services for older youth in foster care. Its main component is the John H. Chafee Foster Care Independence Living program, which is funded at about $140 million annually, said Samuels. It provides funding for education training, employment, life skills, and financial support services for youth up to age 21. In addition, education and training vouchers are authorized for $5,000 per year for postsecondary education and training.

The Fostering Connections to Success and Increasing Adoptions Act of 2008³ provides federal matching funds under Title IV-E to reimburse states for out-of-home care up to 21 (including relative care). It requires educational continuity, unless it is not in the best interest of a young adult to do so, and reimburses for associated transportation expenses. It also requires the development of a transition plan 90 days prior to youth exiting from care. Some states have laws requiring agencies to make diligent family-finding efforts to retain and build important connections, though, as Samuels pointed out, finding connections as young adults can seem counterintuitive. “Usually we want attachment to happen in infancy.”

Former foster youth tend to have poor outcomes in several key domains, Samuels observed. About one-quarter of former foster youth ages

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² The Foster Care Independence Act of 1999, Public Law 106-169, 42 U.S.C. § 1305.

³ The Fostering Connections to Success and Increasing Adoptions Act of 2008, Public Law 110-351.

23-24 do not have a high school diploma, compared with just 7 percent of nonfoster youth (Courtney et al., 2011; Golonka, 2010). Just 2.5 percent have a college degree, compared with 19.4 percent of others, and their median yearly earnings from employment are just $8,000, compared with $18,300 for nonfoster youth. They have higher rates of homelessness, pregnancy, receiving counseling or psychotropic medications, and substance abuse treatment (Courtney et al., 2011; Golonka, 2010).

Helping this population achieve well-being requires consideration of the negative experiences they had in their family of origin and while in foster care, said Samuels. Relational trauma and childhood adversity can have lifetime genetic, cognitive, physical, social, and emotional effects, Samuels said. Experiences as seemingly minor as changing schools repeatedly to major trauma, abuse, and neglect can cause major disruptions in the lives of young adults.

Neuroscience research also indicates that relationships during adolescence can either correct and restore neurological growth or deeply reinforce earlier disruptions caused by negative relational histories, Samuels said. Recent results about brain plasticity “provide both hope and some worry about what we are doing and not doing during adolescence.”

Finally, grief work and narrative construction can directly address maltreatment, losses, and relational disruptions. Without this kind of work on relational skills and healing, said Samuels, youth who age out of the foster system can flounder. Samuels quoted a young woman she interviewed in a study about the transition to adulthood: “Being in the system they’ll … teach you how to go to work, they’ll try to teach you how to go to school, how to do hygiene. But they don’t never teach you how to really grow up and deal with what you’ve been through so you don’t just crack up somewhere.”

Samuels pointed to several empirical and theoretical gaps in understanding well-being from a relational and developmental perspective:

• What is healthy and “normative development” for this population? What does it look like when young adults come through the foster system and are still resilient, healthy, and hopeful?
• What practices support healing from adverse family dynamics and enhance abilities to retain and create meaningful and mutually growth-fostering relationships into adulthood? These practices can occur within birth families, cultures of origin, foster families, adoptive families, or other settings.
• What are the processes of “returning home” for purposes such as identity work, family belonging, and connectedness? “Many of these young people return in various forms and shapes to the very people who we spent a whole lot of energy, money, and time

• keeping them from. How do we help them to make sense of these multiple parent figures and family identities in ways that serve them into adulthood?”

• What are the relational and emotional health components to outcomes such as unemployment, homelessness, crime, and educational attainment? “When I talk to young people who have not kept a job for long or [have moved] to seven places since the last time I talked to them, a lot of what they describe are relational issues that impair their ability to deal with a difficult boss, or whatever it may be.”
• What are the other risk and protective factors beyond those of the individual, such as familial, societal, policy, and practice factors, and how do all of these factors interact as dynamic intersecting processes?

Maltreatment and foster care are two distinct factors that can independently shape outcomes among foster youth, said Samuels. But research on these factors suffers from selection bias. Are outcomes primarily due to aging out, or does aging out complicate or exacerbate preexisting risks? Also, interventions that facilitate specific outcomes for young adults in care are lacking.

Finally, Samuels concluded, what is well-being for this group? It is not necessarily the absence of risk or negative outcomes, nor is it just the presence of jobs, assets, and social capital. Yet these things factor into considerations of well-being. “How do we employ methods and ways of thinking that are more complex … with the goal of having an integrated science and empirical base that allows us to make informed decisions to support the well-being of children and families?”

During the presentations by the young adults at the workshop, Isha-Charlie McNeely emphasized the importance of youth working with youth. In her counseling work with youth transitioning from foster care to post-secondary education, the young people she mentors tell her things that they will not tell an older counselor. “I tell them I was in foster care, and that rapport is already there…. I have a different credibility because I lived those experiences. There definitely needs to be more funding and support around peer-to-peer mentoring and being able to relate.”

McNeely has four siblings from the same parents, all of whom were put in the foster care system, yet she is the only one who graduated. Multiple factors gave her an advantage, she said, including the stability afforded by her adopted parents, strong relationships with others, and being able to communicate with people from different backgrounds. Without these skills, adolescents can be stuck in the transition to young adulthood forever.

McNeely also drew a distinction between grieving and trauma. When

she entered foster care, she was told to go to counseling, and based on one evaluation she was diagnosed with a mental health disorder and placed on medication. But she was grieving, not sick, she said. “I had a loss. I lost my family. Because I was put into a system and institutionalized, my case was medicalized instead of looking at it as me acting out…. Mental health is not a constant state. It is fluid…. I don’t think that any youth should be given a diagnosis off of one evaluation or one active behavior that they did. The whole circumstance, the whole case, their life, and where they are at that time needs to be taken into perspective.”

WELFARE SERVICES

Many young adults are poor, observed Elizabeth Lower-Basch, policy coordinator at CLASP. The official poverty rate for adults ages 18-24 is 20.6 percent, but it would be much higher if the rate included the approximately one-third of young adults who are living with roommates or with their parents (DeNavas-Walt et al., 2012). Many young adults are still in school, which is generally considered a good thing, though they can still lack enough income to achieve well-being. But many young adults are neither in school nor employed, and these rates are especially high among vulnerable groups.

The safety net in the United States varies greatly by family status. Parents can receive cash assistance and services under the Temporary Assistance for Needy Families (TANF) program, but nonparents cannot, said Lower-Basch (with the exception of some services for youth up to age 24 and noncustodial parents). The Supplemental Nutrition Assistance Program (SNAP), historically known as food stamps, is available to both parents and nonparents, except that able-bodied adults ages 18-50 without children generally are limited to 3 months of receipt in a 36-month period unless working or in a work activity for at least 20 hours per week or unless they are exempt, with additional rules applying for college students. Medicaid is more available to parents than to nonparents. However, beginning in 2014, low-income adults without children will be eligible for Medicaid in every state without need for a waiver, and additional benefits will be available in the states that adopt the Medicaid expansion (CMS, 2013). The earned income tax credit is a larger subsidy for people who have children than for people who do not, and childless workers under age 25 are not eligible for the earned income tax credit at all.

According to estimates prepared by CLASP, only about 40 percent of poor young adults ages 18-25 receive food stamps—the most widely available benefit (Lower-Basch, 2013). Only 4 percent of poor young adults receive welfare under TANF or Supplemental Security Income. Looking at absolute numbers, in 2010 about 302,000 teens ages 16-19 received case

assistance through TANF, along with 86,000 parents under age 20 and 557,000 parents ages 20-29 (ACF, 2010). Also, in 2011, SNAP served more than 6 million young adults ages 18-25. These benefits were not limited to parents, had higher income limits than other forms of assistance, and often were not subject to time limits, many of which were suspended during the recession.

More than half of the adults who receive TANF benefits are younger than age 30 (Falk, 2012). Under the program’s rules, teen parents under age 18 must live in an adult-supervised setting and attend school. Teen parents can be counted as engaged in work if they maintain satisfactory attendance at secondary school or the equivalent or participate in education directly related to employment for at least 20 hours per week. Education is much less emphasized for adults, who must average 30 hours per week of work participation or 20 hours per week if a single parent of a child under age 6. Vocational educational training can count as full-time activity for 12 months in a lifetime. Otherwise, education can be counted toward the rate only when combined with 20 hours per week of “core activities”—that is, work or work experience (HHS, 2013).

These statistics raise some interesting questions regarding young adults, Lower-Basch pointed out. First, how might TANF work programs change if they took into account the educational and developmental needs of young adults? Today, with the exception of a small amount of funding for employment and training services, neither TANF nor SNAP provides young adults with the kinds of skills and supports they need to succeed in the workplace. Given that it now takes longer than in the past to complete enough education to get a good job, TANF might have different features if it were more oriented toward young adults.

Second, how can programs serving youth and programs serving TANF recipients work more effectively together? Welfare programs and youth programs tend to be separated and not communicate with each other, even when someone is eligible to participate in both. (In the discussion session, Courtney and Samuels both pointed to some states and counties that have made progress in coordinating programs, including some states that have extended foster care to age 21 to better integrate education, workforce development, and health and mental health services.)

Finally, does the exclusion of young adults under age 25 from the childless worker earned income tax credit make sense? This provision was designed primarily to exclude students working part-time who were being supported by their parents, but it has the effect of excluding many others. “Given the low labor force participation rates for many young adults, this is precisely the group that you would like to see have more work incentives.”

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