oversight

Foster Care: Challenges in Helping Youths Live Independently

Published by the Government Accountability Office on 1999-05-13.

Below is a raw (and likely hideous) rendition of the original report. (PDF)

                          United States General Accounting Office

GAO                       Testimony
                          Before the Subcommittee on Human Resources,
                          Committee on Ways and Means, House of Representatives




For Release on Delivery
Expected at 10:00 a.m.
Thursday, May 13, 1999
                          FOSTER CARE

                          Challenges in Helping
                          Youths Live Independently
                          Statement of Cynthia M. Fagnoni, Director
                          Education, Workforce, and Income Security Issues
                          Health, Education, and Human Services Division




GAO/T-HEHS-99-121
Foster Care: Challenges in Helping Youths
Live Independently

               Madam Chair and Members of the Subcommittee:

               I am pleased to be here today to discuss the Department of Health and
               Human Services’ (HHS) Independent Living Program (ILP) and the needs of
               youths leaving the foster care system. While some foster care youths may
               be adopted or reunited with their families, each year approximately 20,000
               exit the foster care system with the expectation that they will be
               self-sufficient. Yet many of these youths face serious problems, including
               homelessness, lack of employment stability, incarceration, and pregnancy
               at an early age. Recently, the Congress has raised concerns that ILP,
               designed to help foster care youths transition to living independently, does
               not provide the necessary life skills to complete basic education, find and
               maintain employment, or to otherwise live self-sufficiently after leaving
               care.

               Today, I would like to focus my remarks on (1) the problems faced by
               foster care youths once they leave care, (2) what is currently known about
               the extent of services provided by ILP, and (3) what is known about the
               effectiveness of ILP. My testimony is based on our ongoing work for this
               subcommittee, including our visits to locations in California, Maryland,
               New York, and Texas and a preliminary review of about one-third of the
               1998 annual ILP reports submitted by states to HHS.

               In summary, the few available studies that track youths who have exited
               foster care reveal that many have a difficult time making the transition to
               living on their own. The studies found that a substantial portion of these
               youths have not attained basic education goals, such as completing high
               school, and are dependent on public assistance. In addition, many
               experience periods of homelessness after leaving care and have other
               difficulties that impede their progress toward self-sufficiency, such as
               being unemployed. In an effort to help foster care youths become
               self-sufficient, state ILPs offer a wide array of independent living services,
               including education and employment assistance; training in daily living
               skills, such as managing money, housekeeping, and personal hygiene; and
               additional transitional services, such as supervised practice living.
               However, program administrators acknowledge that independent living
               services fall short in key areas. These administrators report that
               developing appropriate employment opportunities for foster care youths,
               providing supervised transitional housing arrangements, and developing
               program activities that provide opportunities to practice the skills learned
               or enhance youths’ self-esteem has been difficult. Moreover, there are few
               evaluations that link program objectives to outcomes, leaving questions



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             Foster Care: Challenges in Helping Youths
             Live Independently




             concerning the effectiveness of the current array of independent living
             services.


             ILP was initially authorized by P.L. 99-272 and reauthorized indefinitely as
Background   part of the Omnibus Budget Reconciliation Act of 1993 (P.L. 103-66). The
             act authorized federal funding of $70 million per year for states to
             establish and implement services to assist youths aged 16 and over make
             the transition to independent living from foster care. Services are provided
             for a short period of time, and states have the flexibility to design services
             to meet a wide range of individual needs. A portion of the federal
             funds—$45 million—are distributed to states as an entitlement based on
             each state’s proportion of all youths receiving federal foster care payments
             in federal fiscal year 1984 across the United States.1 States are eligible to
             receive an additional share of the remaining $25 million in federal funds if
             they provide funds to match the federal dollars received. Recently, the
             Congress and the Administration proposed new initiatives designed to
             further help adolescents move from foster care to adulthood, including
             increased program funding, medical care coverage, and housing supports.

             HHS issued instructions to states in December 1993 outlining allowable ILP
             services. These services include education and employment assistance;
             instruction in daily living skills; and transitional support services, such as
             supervised practice living. In addition, states must provide youths written
             transitional independent living plans based on an assessment of their
             needs and may establish outreach programs to attract individuals eligible
             to participate to the program. Further, ILPs may include counseling and
             other similar assistance related to education and vocational training,
             preparing for a general equivalency diploma (GED) or higher education,
             and counseling and training to enhance basic living skills and
             interpersonal and social skills. Eligible participants for independent living
             services include all youths aged 16 and over for whom federal foster care
             payments are being made.2 At their option, states may also serve foster
             care youths not receiving federal assistance and former foster care youths
             who were in foster care after the age of 16. Likewise, states may provide


             1
              Under title IV-E of the Social Security Act, federal matching funds based on the state’s Medicaid
             matching rate are provided to states for foster care maintenance costs to cover a portion of the food,
             housing, and incidental expenses for foster care children from families eligible for benefits under the
             former Aid to Families With Dependent Children program using 1995 eligibility criteria. States incur all
             foster care costs for children not eligible for federal support.
             2
              States can receive federal foster care maintenance payments for eligible children while in foster care
             family homes, private for profit or nonprofit child care facilities, or public child care institutions.
             Youths become ineligible for federal foster care maintenance payments at age 18.



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                         Foster Care: Challenges in Helping Youths
                         Live Independently




                         services to any of these youths until the age of 21. Youth participation in
                         ILP services is voluntary.



                         Many foster youths have a difficult time making the transition from the
Research Suggests        foster care system to self-sufficiency. While there are few available studies
That Foster Care         tracking youths who have exited foster care, our review of these studies
Youths Struggle to       reveals some consistent findings. Research has shown that many former
                         foster care youths have serious education deficiencies and rely on public
Reach Self-Sufficiency   assistance. For example, a 1991 Westat study of foster care youths
                         interviewed 2.5 to 4 years after they left care found that 46 percent of
                         these youths had not finished high school.3 Additionally, almost 40 percent
                         were determined to be a cost to the community, such as being dependent
                         on some form of public assistance or Medicaid. Other research shows
                         similar results. A 1990 study of former foster care youths in the San
                         Francisco Bay Area who had been out of care at least 1 year but no more
                         than 10, showed that 55 percent left foster care without graduating from
                         high school and that 38 percent still had not graduated at the time of the
                         study.4 Similarly, the University of Wisconsin recently studied youths who
                         had been out of care between 12 and 18 months and found that 37 percent
                         had not finished high school and 32 percent were receiving public
                         assistance.5

                         In addition, former foster care youths often find themselves lacking
                         adequate housing. The Westat study reported that 25 percent of the youths
                         were homeless at least 1 night. Likewise, the University of Wisconsin study
                         found that, since leaving care, 14 percent of the males and 10 percent of
                         the females had been homeless at least once and 22 percent had lived in
                         four or more places in the previous 12 to 18 months. The connection
                         between homelessness and prior episodes of foster care can also be seen
                         in a 1997 study of 400 homeless individuals.6 This study found that
                         20 percent had lived in foster care as children and 20 percent had one or
                         more children currently in foster care.


                         3
                          Westat, Inc., A National Evaluation of Title IV-E Foster Care Independent Living Programs for Youth
                         (Washington, D.C.: HHS, 1991).
                         4
                          Richard P. Barth, “On Their Own: The Experiences of Youth After Foster Care,” Child and Adolescent
                         Social Work, Vol. 7, No. 5 (Oct. 1990).
                         5
                         Mark E. Courtney and Irving Piliavin, Foster Youth Transitions to Adulthood: Outcomes 12 to 18
                         Months After Leaving Out-of-Home Care (Madison, Wisc.: University of Wisconsin, 1998).
                         6
                           Homes for the Homeless, Homelessness: The Foster Care Connection (updated Apr. 1997),
                         http://www.opendoor.com/hfh/fostercare.html (cited Dec. 9, 1998).



                         Page 3                                                                         GAO/T-HEHS-99-121
Foster Care: Challenges in Helping Youths
Live Independently




Additional difficulties may further impede former foster care youths’
ability to become self-sufficient. For example, the Westat study found that
51 percent of the youths were unemployed and 42 percent had given birth
or fathered a child. Similarly, the University of Wisconsin found that
39 percent of the youths were unemployed and that 27 percent of the
males and 10 percent of the females were incarcerated at least once.

At the same time, research has shown that addressing these deficiencies
can have a positive effect on former foster care youths. The Westat study
found a connection between certain variables and the youths’ ability to
live independently. For example, the study showed that completing high
school prior to leaving foster care was related to stable employment, not
being a cost to the community, and overall self-sufficiency. Further, youths
who held at least one job during their stay in foster care were more likely
to maintain a job after care.

Findings from the three studies we reviewed are summarized in table 1.




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                                                Foster Care: Challenges in Helping Youths
                                                Live Independently




Table 1: Outcome Information on Former Foster Care Youths Reported in Three Recent Studies
Study and samples on which
percentages are based                    Outcome information on former foster care youths
Westat (1991) study of 810 former foster        Education:
care youths in eight states at 2.5 to 4 years   — 46 percent had not completed high school.
after leaving care                              Employment:
                                                — 51 percent were unemployed.
                                                — 62 percent had not maintained a job for at least 1 year.
                                                Other:
                                                — 40 percent were a cost to the community.
                                                — 25 percent were homeless at least 1 night.
                                                — 42 percent had birthed or fathered a child.
Courtney and Piliavin (1998) study of 113       Education:
former foster care youths in Wisconsin at 12    — 37 percent had not completed high school.
to 18 months after leaving care                 Employment:
                                                — 39 percent were unemployed.
                                                — 19 percent had not held a job since leaving care.
                                                Other:
                                                — 32 percent received some kind of public assistance.
                                                — 12 percent were homeless at least once (14 percent males and 10 percent females).
                                                — 22 percent had lived in four or more places.
                                                — 44 percent reported problems with acquiring needed medical care.
                                                — 27 percent of males and 10 percent of females were incarcerated at least once.
Barth (1990) study of 55 former foster care     Education:
youths in the San Francisco Bay Area at         — 38 percent had not completed high school.
least 1 year and no more than 10 years after    Employment:
leaving care                                    — 25 percent were unemployed.
                                                Other:
                                                — 53 percent reported serious financial hardships.
                                                — 47 percent received some form of public assistance or had problems paying for food
                                                or housing.
                                                — 35 percent were homeless or moved frequently.
                                                — 38 percent did not have health or medical coverage.
                                                — 13 percent reported hospitalization for an emotional problem.
                                                — 40 percent of females reported a pregnancy.
                                                — 35 percent had been arrested or spent time in jail or prison.



                                                To better ensure foster care youths are prepared to live as self-sufficient
Multiple Services                               adults, state ILPs provide an array of services, including assistance with
Assist Youths in                                completing education and finding employment; developing the basic skills
Achieving                                       needed to live independently, such as money management, hygiene,
                                                housekeeping, and nutrition; and transitional services, such as supervised
Independence but Fall                           practice living arrangements. However, state and local administrators
Short in Key Areas                              acknowledge that their current ILPs fall short in key areas. For example,
                                                some programs do not sufficiently seek out employment opportunities in
                                                the community and offer few opportunities for youths to participate in
                                                real-life practice opportunities or esteem-building experiences. Moreover,




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                        Live Independently




                        some programs could not provide adequate housing or other transitional
                        assistance for youths still in care and those who have left care.


Education and           Our review of annual state reports and our visits to four locations show
Employment Assistance   that states provide services to help youths (1) complete high school or a
                        GED, (2) prepare for post-secondary or vocational education, and
                        (3) prepare for employment. For example, in Contra Costa County,
                        California, an education specialist meets with youths to discuss education
                        goals, review grades, and assess education needs. If a youth is behind
                        academically, tutoring services are provided. The specialist also sets up
                        tours at local colleges and vocational programs and assists youths in
                        completing financial aid applications. A job development specialist assists
                        difficult to employ youths find self-supporting employment through such
                        means as coaching, counseling, and on-site job development training. The
                        specialist also coordinates career fairs. Youths in Baltimore receive
                        employment-related training that covers topics such as writing resumes,
                        preparing for interviews, conflict resolution, and job retention.

                        However, in the locations we visited, we found that the ILPs could not fully
                        provide services that matched the employment potential of foster care
                        youths to appropriate employment pathways. For example, officials in
                        three of the locations we visited cited a lack of vocational opportunities
                        appropriate for youths. State and local coordinators in Texas indicated
                        that few apprenticeship positions are available, while officials in Baltimore
                        and New York City reported a lack of affordable vocational programs or
                        funds to pay for such programs. Baltimore officials also reported that
                        culinary arts and technology-related programs—two programs popular
                        with foster youths—are very expensive. Of the four locations we visited,
                        only Texas offers statewide tuition waivers for all state-supported
                        vocational, technical, and post-secondary schools.

                        We also found that connections between ILP and potential employers are
                        not thoroughly developed. For example, ILP coordinators in one location
                        said they did not have time to establish relationships with many employers
                        and that employment development efforts in their locations were informal.
                        State officials in California and Maryland indicated that they recognize
                        more public-private partnerships to provide youths with employment
                        opportunities are needed. In addition, New York City officials reported
                        that they are just beginning to devise ways to link with employers to
                        enhance youth job prospects, such as developing internship opportunities.




                        Page 6                                                     GAO/T-HEHS-99-121
                         Foster Care: Challenges in Helping Youths
                         Live Independently




                         Several officials also pointed out that more staff need to be assigned to
                         accomplishing this task.


Assistance in Learning   Our review of annual state reports shows that many states help youths
Daily Living Skills      develop daily living skills. Each location we visited conducts
                         independent-living skills classes to teach youths tasks that are necessary
                         to live self-sufficiently. For example, youths in Contra Costa County,
                         California, attend a series of workshops that cover life skills such as
                         money management, health and hygiene, parenting and sexual
                         responsibility, and effective communication. Money management covers
                         topics such as how to prepare a budget and how to open and use a
                         checking account. In the San Antonio, Texas, area, life-skills classes meet
                         for 8 weeks and cover core areas, including personal and interpersonal
                         skills, health and safety, money management, and planning for the future.
                         In New York City, life-skills classes provide similar instruction as well as
                         instruction on housekeeping, health care, interpersonal skills, food
                         management, transportation, and family planning.

                         However, important hands-on activities to practice daily life tasks and
                         experiences to develop self-esteem were limited in some of the locations
                         we visited. Some state and local program officials acknowledged the
                         importance of allowing youths to attempt (and perhaps initially fail) daily
                         tasks—including cooking, cleaning, doing laundry, and comparison
                         shopping—until they become proficient at these tasks. Program officials in
                         two locations and foster care youths in three locations reported that
                         issues, such as safety regulations for group homes, inhibit or prevent
                         certain activities, such as practicing cooking. In some group homes,
                         laundry products and cooking utensils may be locked away from youths.
                         In addition, esteem-building experiences are often limited to a small
                         number of youths. For example, local officials in Texas reported that
                         opportunities for foster care youths to participate in post-secondary
                         school conferences or extended outdoor activities were limited. In
                         addition, programs offering adult mentors—in an attempt to build positive
                         and lasting relationships—serve a small number of youths. For example, a
                         foster care service provider in Texas—contracted by the state specifically
                         to develop mentor programs—reported difficulties finding mentors.
                         However, officials in all locations saw some type of mentor program as
                         one method to provide youths with a vocational role model and
                         opportunities to practice other independent living skills they have learned.




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                       Foster Care: Challenges in Helping Youths
                       Live Independently




Housing and Other      Based on our review of annual state reports and site visits, states offer a
Transitional Support   variety of additional services to further help youths transition to living on
Services               their own. These include supervised practice living arrangements—such as
                       transitional housing programs—and aftercare services for youths who
                       have left the foster care system. Transitional housing programs—while
                       designed slightly differently in each location—provide an opportunity for
                       youths to experience living independently while still receiving supervision
                       and financial support. In Baltimore County, Maryland, for example, the
                       Challengers Independent Living program seeks to provide youths who
                       have previously lived a dependent lifestyle with different or improved
                       means to cope with present and forthcoming independence once they
                       leave foster care. Foster care youths can reside for 18 to 24 months in
                       apartments furnished and supervised by the service provider and receive a
                       weekly stipend to purchase clothing, food, and household supplies. They
                       also are responsible for cleaning their apartments and doing their laundry.
                       Each youth’s foster care payment covers the cost of rent, utilities, and
                       administration of the program. Program staff also offer educational,
                       vocational, clinical, and home-life support, including additional
                       independent-living skills training.

                       Officials in the four locations we visited reported that the number of
                       supervised transitional housing sites is very limited and that they could not
                       provide adequate housing assistance for both youths in care and those
                       who have left the system. The programs we visited have a restricted
                       number of spaces available—from 6 to 12 spaces. One transitional housing
                       provider in Texas indicated that while the program has spaces for 6 youth,
                       an additional 80 to 100 youths with no housing upon exiting foster care
                       could benefit from this type of housing program. A transitional housing
                       provider in a second location explained that program staff carefully screen
                       youths for readiness and accept only the most promising teens into the
                       program. Current foster care youths in Texas and former foster care
                       youths in California also emphasized the need for additional transitional
                       housing arrangements.

                       Youths who have exited foster care face a number of obstacles in finding
                       housing, according to officials in the locations we visited. For example,
                       many landlords are reluctant to rent apartments to a youth without work
                       experience or credit history. In addition, foster care youths who live in
                       urban areas often do not earn a sufficient income to pay the rents found in
                       large cities and may find it difficult to save enough money to pay for a
                       security deposit. Officials in Baltimore reported that the local social




                       Page 8                                                     GAO/T-HEHS-99-121
                   Foster Care: Challenges in Helping Youths
                   Live Independently




                   services department often writes a letter to the landlord on behalf of
                   youths to help them obtain housing.

                   Finally, officials at the locations agree that youths who have left the
                   system often encounter hardships and need aftercare services from time to
                   time. Although all of the locations we visited provide such services, some
                   officials noted that their aftercare services are not extensive. For example,
                   in Texas, aftercare services are only available for 6 months after the youth
                   exits care. The services consist mainly of referrals to other service
                   agencies, visits to colleges, and a small stipend for 4 months. Aftercare
                   services in Baltimore County and New York City are limited to referring
                   the youths to other agencies that can assist them. However, at both of
                   these locations, youths have the opportunity to remain in foster care until
                   age 21 under certain circumstances. Contra Costa County, California,
                   previously offered aftercare to youths up to age 19 on a case-by-case basis;
                   new state legislation mandates that ILP now serve youths to age 21.


                   Given the significant challenges that foster care youths face in moving
Information on     from foster care to adulthood, it is important to understand how effective
Program            ILPs are in better ensuring positive outcomes. However, few data are

Effectiveness Is   available to help in understanding what outcomes are achieved through
                   these programs. States are required to report to HHS participant
Limited            achievement 90 days after program completion, such as the number of
                   youths who are employed, have completed high school or a GED, are
                   attending college, and are living independent of public assistance.
                   However, state and local officials reported much difficulty in finding
                   youths to determine their living status once they leave care. These officials
                   indicated they either do not follow up with youths after leaving foster care
                   or have little success finding youths. For example, a Maryland official
                   stated that response to follow-up contact in the past was very limited and
                   that only 15 percent of youths returned follow-up letters. Local officials in
                   Texas estimated that about 30 to 35 percent of youths disappear during the
                   initial 90-day period and that some can only be located through
                   word-of-mouth or sibling contacts. They noted that following up with
                   youths who received a stipend as part of aftercare is less difficult.

                   In addition, few formal studies have been conducted that measure ILP
                   effectiveness. We found three studies—from Baltimore County, Harris
                   County (Houston, Texas), and New York City—that linked participation in
                   ILP with improved education, housing, and other outcomes. In the
                   Baltimore County study, youths who received ILP services were more likely



                   Page 9                                                     GAO/T-HEHS-99-121
Foster Care: Challenges in Helping Youths
Live Independently




to complete high school, have an employment history, and be employed
when they left foster care.7 In the Harris County study, the authors found
that graduates of the Texas ILP achieved full-time employment earlier and
were more likely to complete high school or a GED at a younger age than
youths who did not receive independent living services.8 The New York
City study of independent living services provided by Green Chimneys
Children’s Services showed 75 percent of the youths had completed high
school or a GED, 72 percent had full-time employment when they left care,
and 65 percent had savings accounts.9 Another study linked certain foster
care placements with greater attainment of practical living skills.10 This
study found that foster care youths placed in apartment-type transitional
housing scored higher on life-skills knowledge assessment. Finally, the
Westat study found that youths who received training in money
management, obtaining a credit card, and buying a car, as well as help in
how to find a job and appropriate education opportunities were more
likely to maintain a job for at least a year. However, in some instances, ILP
did not have the desired effects. For example, in the Westat study,
researchers found that receiving independent living services did not
significantly reduce the probability of early parenthood. In addition, the
Harris County study found that program participants younger than 21 were
more likely to be dependent on different forms of public assistance—
specifically subsidized housing and food stamps—than the group of
nonprogram participants under age 21.

State and local officials indicate, however, that determining outcomes for
former foster care youths is important, and two locations have begun to
design strategies to capture this much needed information. Contra Costa
County, California, for example, has funded a 2-year study geared toward
measuring outcomes. The study will determine the status of youths at the
time they enter ILP—such as foster care placement stability, academic
performance, and living-skills assessment—and measure youth outcomes
after ILP services are given. One goal is to use the information to develop
better aftercare programs. Similarly, the Maryland Association of
Resources for Families and Youth—an association of private service

7
 Maria Scannapieco and others, “Independent Living Programs: Do They Make A Difference?” Child
and Adolescent Social Work Journal, Vol. 12, No. 5 (Oct. 1995).
8
 Jane T. Simmons, “PAL Evaluation Final Report,” unpublished report submitted to Harris County
(Texas) Children’s Protective Services (Mar. 6, 1990).
9
Gerald P. Mallon, “After Care, Then Where? Outcomes of an Independent Living Program,” Child
Welfare, Vol. 77 (Jan./Feb. 1998).
10
 Edmund V. Mech and others, “Life-Skills Knowledge: A Survey of Foster Adolescents in Three
Placement Settings,” Children and Youth Services Review, Vol. 16, Nos. 3/4 (1994), pp. 181-200.



Page 10                                                                         GAO/T-HEHS-99-121
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           Live Independently




           providers—recently began a project to provide the answers to three
           questions: Whom do we serve? What services do we provide them? and
           What are the outcomes of those services? The project requires data
           collection while the youths are still in care; upon exit from care; and at 6-,
           12-, and 18-month intervals after leaving care.


           In our continuing analysis of ILPs, we plan to explore in greater detail many
           of these issues, including any innovative strategies being implemented in
           the states. We also plan to look at HHS’ role in ensuring that performance
           measures are identified and implemented. This information will be
           presented in our final report to the Subcommittee.

           Madam Chair, this concludes my prepared statement. At this time, I will be
           happy to answer any questions you or the other Members of the
           Subcommittee may have.




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