Transitioning Out of Foster Care: Health Care Supports and Challenges

1. Transitioning Out of Foster Care: Health Care Supports and Challenges Michigan State U n I v e r s i t y School of Social Work Dr. John Seita, Primary Investigator Dr. Waln Brown, Co-Investigator Dr. Unrau Unrau, Western Michigan University Angelique Day, MSW, Project Coordinator Greg Pugh, MSW, Graduate Assistant Project funded by the W.K. Kellogg Foundation

2. Transitioning Out of Foster Care: Health Care Supports and Challenges Former Youth in Foster Care Describe Their Health Care Status and Experiences Navigating the Health Care System

3. Project Description-History • Recent research indicates: • Foster care alumni suffer from significant health disparities: • Physical Health concerns • Diabetes • High Blood Pressure • High Cholesterol • Thyroid Disease • Mental health Concerns • Anxiety • Depression • Post Traumatic Stress Disorder • Sexual Health concerns • STD’s • Early parenting • Dental Health • Alcohol and Substance Abuse • Social Health • Health Care Access • Navigating the health care system is largely understudied and unknown.

4. Why Conduct this research? • The purpose of this study was to investigate the health care status and quality of health care received by former foster care youth. • Health care status was defined broadly and included: physical health, dental health, mental health, substance abuse history, sexual health, and social/emotional health

5. Transitioning Out of Foster Care: Supports and Challenges Methods: • Administration of a questionnaire • Administration of the Network Orientation Scale • Focus Groups • Individual interviews The project identified the following: • Kinds of physical and mental health problems alumni had experienced prior to placement, during placement, at during the transition out of care • Health care safety net; i.e. access to health insurance • Quality of services received, access to services • Community assets that support health care • Degree/nature to which social relationships impacted health care status

6. Preliminary Findings: Demographics

7. Age of Participants

8. Race/Ethnicity (n = 71) 8.3% of total 91.7% of total

9. Foster Care Experience

10. Findings

11. Descriptives

12. Network Orientation Scale (NOS) • Vaux, A., Burda, P., & Stewart, D. (1986) • Based on social support theory, but does not focus on a lack of social support, instead measuring an individuals’ unwillingness to maintain, nurture, or utilize the supports that they have • Means of 40 and 42 reported as norms • Higher scores = more negative orientation

13. NOS Comparisons • Participants have significantly higher NOS scores than the general population norms (one sample t-tests, p < .001) • Simple linear regression found that the number of foster care placements was significantly predictive of NOS scores • Number of placements accounts for 12.3% of the variance in NOS Scores • For every five placements (the mean), NOS will increase by 2.88 points (p = .004)

14. Qualitative Data • Participants provided 30 transcripts (40+ hours!) of 19 interviews and 11 focus groups • Coding and analysis is ongoing • Preliminary themes include: • Both positive and negative experiences • In foster care, in transition, and in education • In accessing and receiving physical and mental health services • Impacts of experiences on life, work, school, health and relationships • Participant suggestions for improving foster care

15. Selected Case Studies-Maria • Age 38, Placed in care at 16 for parental neglect. Suffers from Anxiety and Depression, suicidal tendencies • Has never had access to health insurance since aged out at 18. Suffers from panic attacks in college, impacted ability to attend classes, had access to campus counseling services, lost access to services when graduated • Hasn’t seen a dentist in 6 years • Mental health conditions impact relationship with spouse • Currently employed as a foster care parent for a private agency

16. Case Study-Nathan • Age 24, Placed in care at age 11 due to sexual and physical abuse, aged out. Suffers from ADHD, bipolar, anxiety, insomnia, migraines, chronic sinus infections, learning disability, hasn’t seen a dentist since 2003. • Lacks social relationships, looking to enter college

17. Case Study-Lisa • Age 22, Removed at age 8, aged out. Suffers from Diabetes, and Asthma. Lost access to Medicaid in Dec. 2006 when she turned 21. Struggling to afford medications for physical disabilities. • Has not been able to complete college or secure or maintain employment because of side effects of not being able to take meds.

18. Case Study-Danica • Age 33, Removed at age 7, in and out of care through age 18. Suffers from Depression. • Currently employed at a social service agency • Due to frequency of moves while in care, Danica, who rents an apartment, moves frequently and chooses to live out of her suitcase-literally does not unpack, because that is her norm.

19. Case Study: James • Age 25, Entered foster care at age 3, aged out at 20. Suffers from obesity, chronic heart problems, and asthma • Identifies as a gay male • High school drop out, struggling with homelessness.

20. Case Study: Emily • Age 36, raised in Orphanage in China from 2 weeks to age 14, adopted in US at age 14, placed in U.S. foster care at age 15. Suffers from “severe allergies”, high cholesterol, auditory processing disorder, chronic urinary tract infections, anxiety, tried to get pregnant young, had 5 miscarriages before having her only son. • Currently divorced, suffering from STD’s . • Currently employed as an on-call, substitute elementary ed teacher

21. Health Care Policy and Service Gaps • Youths’ disabilities (including their mental & physical health challenges) are not consistently evaluated and defined within and between systems, and services and outcomes are not monitored consistently or recorded at all. • Youth do not have access to comprehensive assessments, immunizations and consistent medical, dental, mental health and other specialty care. • Health care providers are not willing to accept Medicaid.

22. Policy and Service Gaps (continued) • Youth are being placed on long wait lists for much needed services. • Services are not located in the communities in which youth are placed, resulting in increased use of costly emergency room visits to address non-emergent health care issues. • Youth exiting care do not receive services and supports to ensure their safety, stability and well-being.

23. Policy and Service Gaps (continued) • Youth lack coordinated transition plans do not have access to further education and training opportunities once their cases are closed. • Youth who have aged out receive little to no assistance finding housing, arranging for their health and mental health care or establishing themselves in their communities. • There is a general lack of information sharing, collaboration and communication among child welfare and other systems that serve this population.

24. Other Emerging Initiatives on campus • MSU Foster Child Summer Camp (August 6-8, 2008) • John Seita Scholarship, WMU • Comcast Initiative in partnership with the Michigan Campus Compact

25. Policy Development Efforts undergone to Improve Outcomes for the Population Foster Care Independence Act of 1999 • John H. Chafee Foster Care Independence Program (Services 14-21 year olds) • Increased youth asset limit for Medicaid eligibility • Tuition support • Transportation • Tutoring • Employment support (including interviewing and job retention skills training, uniforms, and apprenticeship fees) • Housing (18-20 year olds) including 1st month’s rent and deposit only

26. Policy Development Efforts Cont. • Michigan’s Program is called “Youth in Transition or YIT”. • Feb. 26, 2008 a final rules was published which amends the federal regulations that implements a data collection requirement of the Foster Care Independence Act of 1999 who are receiving YIT services and must address outcomes of youth. Final rule takes effect April 28, 2008.

27. Policy Development Efforts (continued) Promoting Safe and Stable Families Amendments of 2001 • Provided a sixth purpose to the Chafee program and in FY 2003, Congress appropriated $42 million for payments to states to implement the Education and Training Voucher (ETV) Program. • Youth may receive up to the lesser of the total cost of attendance or $5000 per year. A year is defined as a twelve (12) month period beginning with the month the youth is enrolled in a post-secondary education or training program. • Due to the great demand of this program in Michigan, ETV’s will be awarded at a reduced rate of $2500 per year. (Effective Feb. 2008).

28. National Efforts (continued) The cost of attendance includes: • Tuition and fees • Room and Board for Aftercare youth and youth between the ages of 21-23 • Rental or purchase of required equipment, materials or supplies (including a computer) • Allowance for books, supplies, transportation, etc • Special study projects • Can be used to purchase campus-provided student health insurance • Can be used to supplement daycare expenses

29. National Efforts (continued) Child and Family Services Improvement Act of 2006 • Reauthorizes the Promoting Safe and Stable Programs (Title IV-B Part 2) through 2011. • Support monthly caseworker visit to children who are in foster care with an emphasis on activities designed to improve caseworker retention, recruitment, training, and ability to access the benefits of technology. • Ensure that at least 90% of children in foster care are visited on a monthly basis and that the majority of the visits occur in the residence of the child~ this goal must be achieved by all states by October 1, 2011.

30. National Efforts (continued) Child and Family Services Improvement Act of 2006(continued) • Increase the well-being of and improve the permanency options for youth affected by methamphetamine or other substance abuse. Reauthorization of the Mentoring Youth of Prisoners program through 2011 Reauthorization of Court Improvement Programs have been extended through 2011 • Includes a requirement for a foster care proceeding to include, in an age appropriate manner, consultation with the youth that is the subject of this proceeding. 

31. National Efforts (continued) • Deficit Reduction Act of 2005 (DRA) -Provides opportunities for states to extend Medicaid coverage for youth who have emancipated from foster care. • New Regulations implemented by the Center for Medicare and Medicaid (CMS) (effective March 1, 2008) may impact how the DRA is implemented. How it will impact foster care youth in Michigan is currently unknown.

32. State Efforts to Improve Outcomes for the Population • Interdepartmental Task Force on Permanency for Youth Transitioning to Adulthood- Michigan has turned in their report card on September 2007. (updates in “Issues for Michigan’s Children” publication in your folders) • Also see Day/Watson article published in the Michigan Child Welfare Law Journal (Dec. 2007).

33. Transitioning Out of Foster Care: Supports and Challenges Questions?