Children and Youth Services Review 57 (2015) 50–59
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Children and Youth Services Review journal homepage: www.elsevier.com/locate/childyouth
Better Futures: A validated model for increasing postsecondary preparation and participation of youth in foster care with mental health challenges Lee Ann Phillips a,⁎, Laurie E. Powers a, Sarah Geenen a, Jessica Schmidt a, Nichole Winges-Yanez a, Isha Charlie McNeely a, Lindsay Merritt a, Candis Williamson a, Shannon Turner a, Harry Zweben b, Celeste Bodner c, The Research Consortium to Increase the Success of Youth in Foster Care 1 a b c
Pathways to Positive Futures Research and Training Center, Regional Research Institute for Human Services, Portland State University, PO Box 751, Portland, OR 97207-0751, United States Portland Community College, Cascadia, Disability Services CA SSB 150, 705 N. Killingsworth, Portland, OR 97217, United States FosterClub, 753 First Avenue, Seaside, OR 97138, United States
a r t i c l e
i n f o
Article history: Received 12 February 2015 Received in revised form 12 July 2015 Accepted 13 July 2015 Available online 26 July 2015 Keywords: Foster care Postsecondary education Peer delivered services Intervention research Mental health Randomized clinical trial
a b s t r a c t Higher education participation rates of young people in foster care are dramatically lower than their level of postsecondary education aspiration. Increasing attention to this disparity has stimulated policy and practice enhancements, however rigorously validated models for promoting postsecondary preparation and participation have not existed for young people in foster care, including those with mental health conditions. This article describes Better Futures, which is the first such model to be experimentally validated as effective for increasing the higher education participation and other related outcomes of young people in foster care with mental health challenges. Better Futures features a four day on-campus Summer Institute, coaching provided to youth by older peers who are in college and have shared experiences around foster care and/or mental health, and workshops that bring together youth, coaches and guest speakers for information sharing and mutual support. This article includes the theoretical and component features of the Better Futures model, findings related to intervention fidelity, participants' evaluation of the program, and discussion of implications for future model refinement and research. © 2015 Elsevier Ltd. All rights reserved.
⁎ Corresponding author at: Regional Research Institute for Human Services Portland State University 1600 SW 4th Ave Suite 900 Portland Oregon, 97201 Lee Ann Phillips, United States. E-mail addresses:
[email protected] (L.A. Phillips),
[email protected] (L.E. Powers),
[email protected] (S. Geenen),
[email protected] (J. Schmidt),
[email protected] (N. Winges-Yanez),
[email protected] (I.C. McNeely),
[email protected] (L. Merritt),
[email protected] (C. Williamson),
[email protected] (S. Turner),
[email protected] (H. Zweben),
[email protected] (C. Bodner). 1 The Research Consortium to Increase the Success of Youth in Foster Care is dedicated to experimentally identifying approaches that improve the outcomes of young people in foster care. Other co-authors from the Research Consortium are: Teresa Salinas,
[email protected], Linda Blanchette,
[email protected], and Wendy Palmer,
[email protected], Portland Community College; Diann Drummond, M.S.,
[email protected], Portland Public Schools; May Nelson, MSW,
[email protected], and Lawrence D. Dalton, MSW, larry.d.
[email protected], Multnomah County Division of Oregon Department of Human Services, Kevin George,
[email protected], and Rosemary Iavenditti, rosemary.iavenditti@ state.or.us, Oregon Department of Human Services; Elizabeth McHugh, L.C.S.W., elizabeth.e.
[email protected], Developmental Disability Services; Jackie Burr, M.A., M.S., Western Oregon University, Teaching Research Institute,
[email protected], and Amy Salazar, PhD, University of Washington School of Social Work,
[email protected]. Better Futures is a project of the Pathways to Positive Futures Research and Training Center at the Regional Research Institute for Human Services at Portland State University. Please contact Lee Ann Phillips for further information (
[email protected]). Preparation of this article was funded, in part, by the National Institute of Disability and Rehabilitation Research, the United States Department of Education (H133B090019), and the Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, United States Department of Health and Human Services (NIDRR grant H133B090019). Agency endorsement of the information or opinions expressed herein should not be inferred.
http://dx.doi.org/10.1016/j.childyouth.2015.07.010 0190-7409/© 2015 Elsevier Ltd. All rights reserved.
1. Introduction Evidence consistently underscores the multiple economic and social benefits of higher education (Coles, 2013). For example, Zaback, Carlson, and Crellin (2012) documented a median income of $50,360 for individuals with a bachelor's degree, compared with a median income of $29,423 for those with only a high school diploma; individuals with an associate's degree earn more than $9000 above those with a high school diploma. Further, individuals with only a high school diploma have been found to be twice as likely to be unemployed as those with a bachelor's degree (Baum, Ma, & Payea, 2010). Participation in higher education also is associated with better health (Baum & Payea, 2005), reductions in delinquency and smoking, and enhanced civic engagement and volunteerism (Goan & Cunningham, 2006). Of major societal impact, those with at least some college experience are incarcerated at one quarter the rate of those with high school diplomas alone (Stephan, 2004). Higher education is clearly a primary vehicle for moving out of poverty for underserved groups (Coles, 2013), among which youth from foster care are at exceptionally high disadvantage (Casey Family Programs, 2010). Seventy to eighty-four percent of the approximately 23,000 youth annually exiting foster care (U.S. Department of Health and Human Services, 2013) aspire to attend college or vocational school
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(Courtney, Dworsky, Lee, & Ramp, 2010; Courtney, Terao, & Bost, 2004; McMillen, Auslander, Elze, White, & Thompson, 2003; Tzawa-Hayden, 2004); however, most do not realize these dreams. For example, McMillen and colleagues found that only 20% of foster youth who successfully completed high school went on to college, in contrast to 60% in the general population. In the Midwest Evaluation follow-along study, Courtney and Dworsky (2006) found that 39% of former foster youth were enrolled in higher education at age 19, compared with 59% of youth in the general population. At age 21, only 25% of former foster youth were in postsecondary education, compared with 44% of young adults in the general population (Courtney et al., 2007). By ages 25–27, only 8% of former foster youth reported that they had graduated with two- or four-year postsecondary degrees, compared with a 46% graduation rate for young adults in the general population (Courtney et al., 2011). Additional research confirms that only 3–11% of young adults in foster care successfully obtain a bachelor's degree, compared with about 24% of those in the general population (Casey Family Programs, 2010; Pecora, Kessler, et al., 2006; Pecora, Williams, et al., 2006; Reilly, 2003). 1.1. Compounded disadvantage for foster youth with mental health challenges Many young people exiting foster care also experience mental health challenges, often associated with related histories of trauma, maltreatment, separation from bio family, multiple placement changes, and other stressors. For example, the Northwest Foster Care Alumni study found that 54% of young adults who had recently exited the foster care system had a diagnosed mental health condition, with 25% experiencing PTSD and 20% experiencing major depression (Pecora et al., 2005). Courtney et al. (2011) found that 33% of Midwest evaluation study participants had social anxiety, 25% had depression, 60% had PTSD, and 14.5% were taking psychotropic medications. While findings are not available on the postsecondary participation of youth in foster care with mental health conditions, studies document the associations of mental health challenges, maltreatment, and trauma with barriers to college success (Arria et al., 2013; Banyard & Cantor, 2004; Duncan, 2000), including increased risk of social isolation (Jivanjee, Kruzich, & Gordon, 2008), difficulty accessing adult mental health services (US Government Accounting Office, 2004), and concerns over stigma preventing disclosure of a mental health condition necessary for accessing postsecondary accommodations (Newman, Wagner, Cameto, & Knokey, 2009). Further, like youth exiting foster care, most youth with mental health conditions aspire to higher education at levels much greater than their actual opportunities for participation. Findings from the National Longitudinal Transition study revealed that over 80% of youth with emotional and behavioral disabilities expected to participate in higher education (Wagner, Newman, Cameto, Levine, & Marder, 2007). However, four years after high school, only 34% had actually participated (Newman et al., 2009). Thus, compounded disadvantage in higher education participation is likely for young people exiting foster care with mental health conditions. Major impediments to pursuing higher education for foster youth with mental health challenges include financial pressures and needing to work, housing insecurity, secondary education achievement gaps, low expectations by others, lack of information and opportunities to explore higher education, and restricted access to independent living activities and community participation (Courtney & Hughes-Heuring, 2005, chap. 2; Day, Riebschleger, Dworksy, Damashek, & Fogarty, 2012; Dworsky & Perez, 2010; Geenen & Powers, 2006; Hochman, Hochman, & Miller, 2004; Quest, Fullerton, Geenen, Powers, & The Research Consortium to Increase the Success of Youth in Foster Care, 2012; Schmidt et al., 2013; Singer, Berzin, & Hokanson, 2013). Anctil, McCubbin, O'Brien, Pecora, and Anderson-Harumi (2007) also found that foster youth with serious mental health conditions had poorer physical health and lower self-esteem than former foster youth without
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mental health challenges, each of which could pose barriers to accessing higher education. 1.2. Opening the higher education gateway to youth in foster care with mental health conditions Higher education is a critical strategy for fostering positive trajectories of foster youth, whom when able to obtain bachelor's degrees, achieve employment rates and individual incomes similar to young adults in the general population (Salazar, 2013). Likewise, higher education participation has been shown to promote autonomy, community participation, productivity, and quality of life for youth in foster care and/or those with mental health challenges (Peters, Dworsky, Courtney, & Pollack, 2009; Rönkäa, Oravala, & Pulkkinen, 2003; Scanlon & Mellard, 2002). Increasingly, policy and practice enhancements are aimed at promoting higher education access for youth in foster care, including the large proportion of youth who also experience mental health issues. Key federal policy initiatives include the 2014 Foster Care Independence Act of 1999 (Public Law 106 -169), which created the John H. Chafee Foster Care Independence Program, thereby increasing funding for states to provide foster care independent living services and, as part of the 2002 Promoting Safe and Stable Families Amendments of 2001 (Public Law 107 -133), providing Education and Training Voucher Program funds to help off-set the cost of college. The 2008 Fostering Connections to Success and Increasing Adoptions Act (Public Law 110–351) further gives states the option to extend foster care to age 21 for youth who are in college and/or working, and requires that youth preparing to exit foster care have a written transition plan. Also in 2008, The 2008 Higher Education Opportunity Act (P.L. 110 -315) was amended to make youth in foster care eligible for federally funded college TRIO programs. Finally, of particular relevance to youth with mental health conditions, the 2013 Uninterrupted Scholars Act amended FERPA to enable exchange of educational information between schools and child welfare, particularly useful for students receiving special education services. Complimenting these federal advancements, several states are providing tuition assistance for foster youth who enroll in college, and exciting campus programs are proliferating for current and former foster youth, such as Guardian Scholars and Renaissance Scholars (Dworsky & Perez, 2010), which are primarily aimed at supporting students who are in college. Supports are clearly expanding for current and former foster youth who are participating in college or vocational school; however, so far only relatively modest gains have been achieved in higher education enrollment (Fried, 2008). In comparison with the literature that exists on supports for foster youth already in college, there is less evidence to support approaches for increasing higher education preparation and enrollment. Nevertheless, a few promising approaches do stand out in the literature. For example, Kirk and Day (2011) evaluated a three-day transition to college summer camp program at Michigan State University, which was attended by 38 foster youth, ages 15–19, who were identified through child welfare agencies. Undergraduate students with previous experience in foster care served as peer leaders, most of whom were racially similar to the participants. Pre- and postcamp questionnaires and qualitative findings suggested that the camp experience enhanced participants' higher education knowledge and aspirations, empowerment, outlook and life skills, and that they valued opportunities for experiential learning and connections with peer leaders. Kirk and Day (2011) suggested that such a camp experience could be optimized if embedded within a longer experience that supported youth from high school through college, and called for further research with participants not already identified as college appropriate and includes a comparison group. As evaluated by Burley (2009), the Foster Care to College Partnership initiative in Washington state was a multi-component effort to promote the postsecondary participation of foster youth, including a college preparation website, mailed information for youth and foster parents,
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training for professionals, college preparation seminars, a mentoring program, and an intensive on-campus summer experience. Mentors for youth provided tutoring and help with postsecondary and career planning, and college applications. The summer experience introduced students to campus life and college alumni, provided information on admissions and financial aid, and facilitated career exploration. Adjusting for factors that differed between the non-randomized groups of mentored and non-mentored youth, including sex, grade point average, and emotional and behavioral disability status, Burley found significantly increased higher education attendance among those youth participating in the mentoring program (27% vs. 15%). Evaluation of the summer program, comparing participants with non-participants matched on sex, high school grade, GPA, and graduation rate, found that 55% of summer program participants attended college part or full-time vs. 32% of the comparison group. Likewise, approaches to promote the higher education preparation and enrollment of young people with mental health conditions have not been rigorously evaluated. However, studies have documented the effectiveness of TRIO Talent Search and Upward Bound programs for enhancing the higher education enrollment of youth from low-income families, youth whose parents did not attend college, and youth with documented disabilities, including emotional and behavioral conditions. Talent Search serves students in grades 6 to 12, providing information about college programs and financial aid, academic advising, and help with navigating admissions and financial aid applications. Evaluation of Talent Search with matched comparison groups has documented increased college enrollment and application for financial aid among participants (Constantine, Seftor, Martin, Silva, & Myers, 2006). Upward Bound serves high school aged youth and often includes an on-campus summer program for eligible students, providing academic instruction and work experience. The summer experience may be complimented by tutoring, mentoring, college visits or other supports offered during the school year. Quasi-experimental evaluation of Upward Bound has shown the approach to increase financial aid application, higher education enrollment, and degree completion (Seftor, Mamun, & Schirm, 2009). Unfortunately, findings are not reported on the effectiveness of these programs for students with emotional and behavioral disabilities or those in foster care. Further, similar to the previously described programs for youth in foster care, participation in TRIO is dependent on demonstration of academic potential, college aspiration, and nomination, which could lead to students being excluded who are not perceived as college bound and/or disconnected from referring teachers and counselors in their high schools, typical circumstances for many youth in foster care and those identified with mental health issues. In sum, the abovementioned review highlights promising approaches for increasing the postsecondary preparation and enrollment of youth in foster care and disadvantaged youth, including those with disabilities (e.g., on-campus summer programs and college visits, mentoring from college students with lived experience in foster care, higher education and career exploration, and assistance with financial aid and postsecondary school applications). However, intervention approaches with proven efficacy for increasing the postsecondary preparation and enrollment of young people in foster care with mental health challenges have been non-existent. 1.3. Better Futures The Better Futures model was developed in response to the urgent need for validated approaches to increase the higher education participation of youth in foster care with mental health conditions. Systematically incorporating some of the previously mentioned promising practices identified for youth in foster care and those with disabilities, and tailored to acknowledge and address mental health issues, the model features a four day on-campus Summer Institute, coaching provided to youth by older peers who are in college and have shared
experiences around foster care and/or mental health, and workshops that bring together youth, coaches and guest speakers for information sharing and mutual support. A randomized, longitudinal efficacy evaluation of the Better Futures model was conducted with 67 youth in foster care with mental health conditions who were recruited through a highly inclusive process (outcome study details provided in Geenen et al., 2014). Significant differences were found between the Better Futures intervention group and the control group from baseline to six-month postintervention follow-up on higher education participation (73% vs. 36%), as well as measures of postsecondary and transition planning, self-determination, mental health empowerment and hope; moderate to large effect sizes were observed for the differences between groups. Youth in the Better Futures intervention group also showed positive trends toward higher rates of high school completion, mental health recovery and quality of life, compared with the control group. While the overall sample size of the Better Futures efficacy study was relatively small, the findings are promising and the model represents one of the first to be experimentally tested, either for youth in foster care overall or for foster youth with mental health conditions in particular. The following sections provide an in-depth description of the theoretical and component features of the Better Futures model, findings related to intervention fidelity and participant's evaluation of the program, and discussion of implications for future model development and research. 2. Better Futures model 2.1. Theoretical framework The Better Futures model is grounded in self-determination enhancement, interrelating youth-directed support from older peer coaches, information and experiential activities that support learning and success related to higher education goals, self-determination skill development, and support from other cohort peers. Several generally congruent definitions have been used to frame the construct of selfdetermination. For example, Deci and Ryan (2002) described selfdetermination in terms of intrinsic motivation driven by universal needs for competence, autonomy, and relatedness. Wehmeyer (1996) defined self-determination as “acting as the primary causal agent in one's life and making choices and decisions regarding one's quality of life free from undue external influence or interference” (p. 22). Powers et al. (1996) defined self-determination as “self-directed action to achieve personally valued goals” (p. 292). From these perspectives, self-determination means having the power to make decisions, to direct one's actions, to affiliate with chosen allies, and to exercise rights and responsibilities, within the context of one's culture, experiences, and aspirations. Associations have been documented between increased self-determination and improved educational and transition to adulthood outcomes for young people with disabilities (Cobb, Lehmann, Newman-Gonchar, & Alwell, 2009), and the concept is regarded as a key aspect of positive youth development overall (Catalano, Berglund, Ryan, Lonczak, & Hawkins, 2004). Experimentally tested self-determination enhancement interventions for young people in foster care with mental health conditions and other disabilities have been shown to increase self-determination, higher education planning and participation, quality of life, mental health empowerment, high school success, employment, preparation for independent living, and other outcomes (Geenen et al., 2013, 2014; Powers et al., 2012). The Better Futures model was adapted from the My Life selfdetermination enhancement model, which features youth-directed support from a coach around identification and pursuit of personal transition goals, integrated with learning to apply self-determination skills to achieve those goals (e.g., problem-solving, finding allies, managing discouragement), as well as transition-focused workshops with peers and older peer mentors who have shared experience around foster care (Powers et al., 2012). Model adaptation was accomplished through
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discussions with youth in foster care and FosterClub All-Stars, a national leadership group of young people from foster care, who shared their experiences and recommendations related to supporting youth in care with mental health issues to pursue higher education. Further refinements were drawn from promising practices in youth-centered postsecondary planning (Burley, 2009; Casey Family Programs, 2010; Kirk & Day, 2011), peer support in mental health (Jivanjee et al., 2008; Pistrang, Barker, & Humphreys, 2008), and peer coaching or mentoring around higher education for foster youth, provided through programs such as FosterClub (2014), Guardian Scholars and Renaissance Scholars (Dworsky & Perez, 2010), and Aim Higher (Foster Care to Success, 2014). In particular, the adapted model embraced the value of coaching and support from older peers who are young adults with lived experience relevant to youth (i.e., foster care, mental health issues), and are pursuing or have reached goals that youth aspire toward (i.e., higher education). 2.2. Better Futures Advisory Board Better Futures model design and implementation was guided by an Advisory Board, which was comprised of several young people having lived experiences with foster care, the mental health system and higher education, and adult professionals from education, child welfare, higher education, transition, and health and disability services. The Advisory Board met 4–6 times a year to share ideas and information that strengthened the intervention model and generated strategies for addressing barriers that youth were facing (e.g., paying for GED preparation and testing). Youth advisors provided further guidance on the development of intervention elements and assessment measures, they participated on panels at the Summer Institute, and assisted in dissemination of the findings from the study, such as co-presenting at conferences and co-authoring papers. 2.3. Intervention delivery The Better Futures intervention was delivered over approximately 10 months and consisted of: (1) a four day, three night Summer Institute on a university campus; (2) individual, bi-monthly peer coaching in identifying and pursuing self-defined postsecondary and related goals; and (3) five mentoring workshops attended by participants, peer coaches and professionals with expertise in foster care, mental health and postsecondary education. Intervention commenced with one or two peer coaching meetings which oriented youth to the intervention, helped them begin to identify their strengths and generate initial thoughts or dreams for postsecondary education. Youth then attended the Summer Institute where they learned about postsecondary education options and further explored their interests. Following the Summer Institute, participants resumed peer coaching for approximately nine months and participated in mentoring workshops, which were interspersed during this period. 2.4. Summer Institute Youth attended the Summer Institute for four days and three nights on a university campus, living in the dorms. Institute facilitation was provided by Better Futures staff, including peer coaches and two FosterClub All-Stars who were college students and had lived expertise with mental health and other issues common for young people exiting foster care. Peer coaches and FosterClub All-Stars also provided informal debriefing and coaching to youth following Institute sessions and in the dorms, sometimes during late night conversations. Youth participants had diverse backgrounds and varied levels of knowledge and interest in higher education (e.g., on track for modified and general diplomas, in restrictive and inclusive educational placements; demographics discussed in the Fidelity and social validity evaluation section). While a few youth had already decided they
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wanted to pursue postsecondary education, most others were passively willing to explore their interests and were questioning whether higher education could be a reality. Thus, the Summer Institute was flexibly designed to allow each participant to gain information and explore options that were relevant to their specific thinking around college or vocational school. The Institute featured informational sessions, scavenger hunt tours of both university and community college campuses, and a number of panels and discussion sessions on higher education experiences and preparation, high school completion and credit recovery, mental health and wellness, financial aid, and issues and decisions related to remaining in foster care and higher education. Speakers included successful college students with lived experience in foster care and /or with mental health issues, and professionals from Child Welfare, the local school district, community college and university, vocational education programs, and foster care Independent Living Programs. From the young adults and professionals, youth learned about educational options (e.g. vocational, trade and technical schools, community college, public vs. private universities), steps for higher education planning, strategies for wellness, managing barriers and stigma, and strategic disclosure of life history, identities and labels. Youth also were supported in reviewing their high school transcripts to determine where they stood relative to diploma type and graduation, as well as in creating personal higher education pathways, laying out key activities and experiences they would have on the way. Evening social activities more informally connected youth and peer coaches. At the conclusion of the Institute, youth shared their short-term goals for the coming months and they completed “tickets to career exploration” by listing a follow-up activity that they wanted to do with their peer coach. The Institute culminated with a graduation and certificate ceremony, which for many youth was the first time that they had experienced positive recognition for their interests, strengths, and willingness to participate in an intensive educationally focused experience. Topics introduced at the Institute were followed up with more in-depth discussions during peer coaching meetings and mentoring workshops. Throughout the Institute, explicit messages were offered to normalize the experience of mental health issues for many youth in foster care, acknowledging the reality of stressors and other challenges youth faced, contextual barriers such as others' low expectations, stigma and discrimination, and how their growing knowledge, personal strengths, resilience, and commitment to their futures would bolster their achievement of higher education goals. Another important theme was the universal conceptualization of accommodations and supports, which were presented as applicable to all people, regardless of whether they have a disability or mental health label. Most fundamental to the Summer Institute's success was the emphasis on youth direction; for example, medication information was gathered from each youth and foster parent prior to the Institute, however youth were responsible for taking their own medications, with check-ins and appreciation offered by staff. Likewise, youth were engaged in feedback sessions throughout the Institute, and they became increasingly involved in shaping the daily agenda, co-facilitating small groups, and supporting one another during youth-selected evening activities. A week or two following the Institute, each youth met with a staff member to debrief, to identify workshop topics that they would be interested in, and to discuss their goals and next steps. A permanent peer coach was assigned, based on the youth's interests and personality; in some cases, it was the same staff person the youth had met with prior to the Institute, in other instances it was a different coach. 2.5. Peer coaching Individual peer coaching was provided to youth approximately twice a month for nine months, with an average of 90 min a meeting and a minimum of 27 h total. Related activities of peer coaches included bringing youth together for peer workshops and assisting with the
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Summer Institute. Coaching was delivered by 8 undergraduate and graduate students having lived experience with foster care and/or mental health challenges and enrolled in area community colleges or the university where the Summer Institute was held (referred to as “near peers”). Peer coaches were recruited through the university, community colleges and youth-led foster care and mental health organizations. They were individuals with diverse racial and socioeconomic backgrounds, life experiences and professional training, all under the age of 28. Background checks through the state's child welfare system and the project's partnering school district were conducted for each coach. Qualifications for peer coaches included at least one year of experience as a postsecondary student and plans to continue in higher education for at least one more year. Having positive perspectives regarding the value of postsecondary education and the potential of young people with foster care and mental health experiences to successfully participate in postsecondary education were essential. Peer coaches participated in about 40 h of initial training on a variety of topics, such as current policies and supports in foster care, mental health recovery and resources for young adults, secondary education credit retrieval, and postsecondary requirements, resources and accommodations. They also reviewed intervention and fidelity protocols and coaching strategies, and resources related to topics such as self-determination promotion, higher education benefits for youth in foster care, enlisting allies, and use of strategic self-disclosure by coaches and youth. Applying a social justice lens, training integrated discussion of typical individual, service system, and societal challenges experienced by youth in foster care with mental health issues, including lack of confidence or hope in the context of recurrent life instability and sometimes failure experiences, others' low expectations, restricted access to opportunities, and stigma. Training also included observation of more experienced coaches and discussion of self-care strategies. Throughout the intervention, coaches participated in weekly in-person group supervision meetings and they received ongoing telephone support from the intervention manager. Following their match to youth, coaches sent out introduction emails to the caseworker and/or foster parent, alerting them that the
youth had been assigned as coach. To begin, the coach set up a meeting with the youth and foster parent to provide an in-depth orientation to the coaching process, confirm contact information, establish a schedule for coaching sessions and answer any questions. Coaching meetings were typically held with youth during unscheduled time at school or a neighborhood location the youth chose (e.g., library, coffee shop), and convenient for carrying out planned activities associated with working toward goals. On the day of a coaching meeting or planned activity, coaches contacted youth to confirm scheduling and transportation. Coaches offered a consistent, accepting, strength-based, and transparent relationship presence, based on getting to know the youth through interaction and honest discussion of the youth's experiences, perceptions and needs in contrast to traditional assessment and records review. Likewise, a coach's personal reflections and knowledge gained through experiences with college, foster care and mental health challenges were important sources of expertise that the coach strategically drew upon and shared with the youth during moments when sharing could foster relationship development, provide validation for the youth's experiences, or illustrate options or strategies for reaching goals or addressing issues. In most instances, coach–youth interaction extended beyond face-to-face meetings to include periodic texting, phone calls and sometimes social network communication. Coaches and youth also openly discussed and prepared for coaching to end and, as the youth demonstrated increasing ability to make decisions and carryout activities, the coach faded her involvement, highlighting the youth's growing capabilities and confidence, and fostering the youth's connections with supportive adults. Building upon their relationship foundation, coaches supported youth to engage in 17 interrelated experiences (discussion of targeted topics and performance of targeted activities) considered central to successful postsecondary preparation and reflected in the fidelity standards presented in Table 1 (e.g., review high school transcript, visit a postsecondary program, attend a college fair). Coaches also strategically introduced and supported youth in learning to apply 11 self-determination skills (see Table 1), incorporated in the previously validated My Life self-determination enhancement model (Geenen et al., 2013; Powers
Table 1 Fidelity requirements for peer coach-supported experiences and self-determination skill development. Experiences (discussion of targeted topics and performance of targeted activities)
Self-determination skills
Review high school transcript. Visit a college or vocational school and talk with a representative or attend a college fair. Explore postsecondary information and resources on the Internet. Discuss career interests and connections to postsecondary education/training. Activity to explore career interests and related postsecondary focus (e.g., job shadow, interview someone who has a degree of interest). Create a time line for exploring, applying, and attending higher education. Review application of at least one postsecondary program of interest. Research cost and enrollment requirements for at least one postsecondary program of interest. Activity to support selection of postsecondary program (e.g., observe at a vocational training program, talk to a student enrolled in a program of interest). Visit at least one local organization that supports youth around postsecondary participation. Activity to explore eligibility for financial support. Complete the FAFSA. Activity to clarify or develop plan for transportation. Discussion of identifying and responding to stigma and bias. Activity to consider options and plan accommodations and support around mental health and other self-care issues (e.g., visit a college accessibility office or health center). Activity to identify and compare housing options for college (e.g., talk with Independent Living Program case manager, visit a college dorm). Identify and complete a support plan with at least 1 adult ally. Identify personal strengths. Explore future dreams (for life as a whole and higher education). Set goals (consider, narrow down and identify priority short-term activity goals). Problem-solve (strategies to accomplish activities and to overcome barriers) Make decisions (weigh pros and cons). Schmooze (reach out and be friendly toward potential adult allies) Negotiate with others around pursuit of and support for goals. Identify accommodations. Hang tough in managing stress (identifying and using self-care strategies). Track and appreciate accomplishments. Establish agreements with adult allies for support during the coming year.
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et al., 2012). Discussion and practice of skills were integrated within natural opportunities that emerged. For example, a youth might be exposed to steps in problem-solving in conjunction with considering how to complete college applications. The coach might summarize and walk the student through application of the steps, describe how she applied the steps to complete her applications, model completion of the steps for the youth, etc. Similar coaching strategies were used to support youth in learning and applying other achievement, partnership development and self-regulation self-determination skills to reach their goals, build relationships and manage challenges that emerged. The final phase of coaching focused on supporting each youth to create a support plan with at least one adult ally, chosen by the youth for support in the year following intervention. Coaches and youth also discussed a variety of topics and issues with particular relevance for young people with mental health conditions, such as how to work with foster parents and professionals who questioned the youth's capabilities and were reluctant to allow him or her to pursue college; how to turn foster care and mental health experience into a strength in a college application; and options, timing, and strategies for strength-focused strategic disclosure of foster care and mental health experiences, and accommodation needs. Coaches also were encouraged to spend at least one meeting with their youth doing a fun relationship building activity, as well as time celebrating the youth's achievement of intermediate goals. Coaches implemented as many of the fidelity elements as possible, within the context of each youth's goals, life circumstances, and needs. However, to accommodate instability in the lives of many youth in foster care, flexibilities were offered. For example, rather than beginning with a systematic postsecondary goal-identification process, coaches sometimes needed to support youth in addressing their immediate needs and in learning to apply relevant skills during “learning” and “practice” moments in that context. Thus, a youth who was in a foster care placement crisis at the beginning of the intervention could be exposed to the steps of hang tough in managing stress before setting any goals. Further, while coaches were asked to introduce key elements of the intervention to all youth to achieve fidelity, peer coaching was individually tailored for each youth based on the youth's goals, strengths and interests. In addition to tracking whether certain skills and experiences had been introduced to youth, coaches also tracked the nature of their time with youth and how key elements of the coaching intervention were implemented (relationship, didactic, and experiential). Didactic minutes included time coaches spent with youth talking about goals, interests, activities, and barriers, and self-determination skills. Experiential minutes were recorded when coaches were supporting youth to participate in activities, such as touring a college, calling to set up an appointment, seeing an advisor or ally, learning the transit system, interviewing a professional, completing or picking up a job application, or investigating a housing option. Relational minutes were defined as the “getting to know you, emotional support or catching up” time that did not relate to the youth goals or activities, but instead focused on bonding and support. Better Futures fidelity requirements emphasized overall balance in the proportion of time devoted to each of these elements. 2.6. Mentoring workshops Youth were invited to attend up to five mentoring workshops with the peers in their cohort. In an effort to provide youth with scheduling flexibility, they were asked to attend at least four of the five workshops. Workshop topics were selected by participants and workshop activities were organized by peer coaches and other project staff. For each topic, a specific agenda, resource materials, and didactic, experiential and fun activities were created. Youth-selected workshop topics included completing high school (e.g., timelines for graduating high school, diploma requirements, credit retrieval and GED options); applying to postsecondary programs (e.g., deadlines, applications, essay writing); financial
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aid (e.g., Oregon tuition waiver and Chafee funds); accommodations and supports at college; balancing mental health and wellness; and Independent Living Program Services (e.g., support for resume development, housing options). Workshops focused on the college application timeline had the highest attendance (82% of youth), followed by workshops centered on self-care and wellness (79%); attendance was lowest for workshops focused on transition services (e.g. the Independent Living Program, 55%). Discussion of topics was generally guided by guest speakers (professionals and young adults) with expertise around child welfare, mental health or higher education, including members of youth-led organizations such as Youth M.O.V.E. All of the workshops included information sharing and a facilitated activity (e.g., application essay writing). Workshops also provided time for youth to share updates on their goals, to enjoy a recreational activity and to network with other youth, coaches, and young adults with previous experience in foster care. 3. Fidelity and social validity evaluation 3.1. Participants Participants were recruited from a list generated by the state child welfare agency of all youth in foster care, who lived in the project's targeted geographic area, who were one or two years away from completion of their secondary education, who had been identified as experiencing a diagnosed mental health condition and who were receiving services or treatment for the mental health condition (i.e., special education counseling, psychotropic medication). If a youth was determined to be eligible for the project, an in-person orientation with the youth and caregiver was arranged and the project was described in more detail. If the youth was interested in participating, assent was obtained; 87% of youth chose to enroll. The state foster care agency, as legal guardian, provided consent for all youth choosing to participate [see (Geenen et al., 2014) for more information on the sample and recruitment process]. A total of 36 youth were randomized to the treatment group and assessed at baseline (31 youth were randomized to control; youth were enrolled in 3 waves, with a new wave starting each summer; for more information about the larger randomized clinical trial, please see Geenen et al., 2014). All but one youth completed the Summer Institute (n = 35) and thirty-three youth finished coaching; of the 33 youth who completed the intervention, all but one completed a survey providing feedback and reflections around their experiences with different elements of the model. While overall attrition among the youth assigned to the intervention group was small, academically younger students may have been more likely to drop out; while 3 Juniors left the project early, all 20 Seniors completed the study. Information on participant's gender, race, age, engagement in mental health services and the Independent Living Program, and use of psychotropic medications was collected via youth self-report. Participants also were asked whether they had any children, if immediate family members had attended college, and the number and types of college preparation activities they had already completed. Data also was gathered from the state foster care system's electronic database on participant's experiences in foster care (e.g. why they entered, length of time in foster care, type of foster care placement) and school records, which confirmed grade level and special education status. The Developmental Disability Services Division further confirmed whether a participant was receiving services from that agency. As seen in Table 2, slightly more than half of the participants randomized to intervention were female, the mean age was just under 17, and of the 33 youth currently attending high school, 12 were Juniors. The majority of youth lived in a non-relative foster care placement and knew at least one immediate family member who had gone to college. Two youth reported they had at least one child and three youth had some involvement in the juvenile justice system. At the time of
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Table 2 Demographic characteristics of participants randomized to intervention. Characteristic
N = 36
Age (mean) Gender (% female) Race/ethnicity (%) Hispanic Native American Asian African American Caucasian Multi-ethnic Placement type % Non-relative foster care Relative foster care (kinship) Group home/residential treatment Other (with a friend/own apartment) Length of time in foster care (mean years) Experienced placement change in past year % Total number of placement moves past year Reason for entering foster care (% non-exclusive) Physical Sexual Neglect Threat of harm Parental substance abuse Parent not able to cope Other School status Working toward GED % Attending school % Grade Sophomore Junior Senior Taking mental health medication % Receiving mental health services % Receiving special education services % Receiving developmental disability services % Enrolled in the Independent Living Program Involved in juvenile justice/criminal justice system Parent Immediate family member has gone to college
16.78 52.8 5.6 16.7 2.8 22.2 44.4 8.3 63.9 27.7 8.3 0 5.6 30.6 2.82
54.3 25.7 68.5 42.8 31.4 14.2 28.6 8.3 91.7 3.0 36.4 60.6 48.6 72.2 30.5 8.3 61.1 8.3 5.5 61.1
enrollment, the majority of participants were receiving Independent Living Program (61%) and mental health services (72.2%). Approximately 30% were engaged in special education for an emotional or behavioral disability and 8.3% were receiving Developmental Disability Services; almost half of youth (48.6%) reported that they were taking mental health medication(s). 3.2. Fidelity Across the three waves was 100% for participation in the required 10 elements of the Summer Institute; 99.3% for exposure to the 11 self-determination skills; 90.4% for participation in the 17 experiential activities; and 71% for participation in four of five workshops, with participants attending an average of 3.47 workshops. Across the three waves, youth and their coaches had an average of 15 meetings. On average, 9.31 h were spent in experiential time, 10.92 h were spent in relational time, and 7.13 h were spent in didactic time. Overall, coaches spent an average of 27.37 h with youth. 3.3. Social validity At the conclusion of intervention, participants completed a project evaluation questionnaire that collected their feedback. Participants were asked to rate on a 4-point Likert-type scale (4 = a lot, 3 = quite a bit, 2 = a little, 1 = not at all) how much they enjoyed being in the Better Futures Project and how useful it was to them overall. They also were more specifically asked to rate the extent to which the project
Table 3 Item level mean ratings and standard deviations for youth completing social validity survey (n = 32). Social validity item
Mean SD
1. I enjoyed being in the Better Futures project. 2. Overall, how useful was the Better Futures project to you? 3. The Better Futures project helped me understand the benefits of and options for postsecondary education. 4. The Better Futures project helped me understand how participation in postsecondary education will help me achieve my career and other life goals. 5. The Better Futures project helped me identify and plan for how to successfully prepare for postsecondary education. 6. The Better Futures project helped me believe that I can enter and successfully participate in postsecondary education. 7. The Better Futures project helped me achieve my postsecondary education preparation goals. 8. The Better Futures project helped me identify adult allies and expand the number of supportive adults I have available. 9. How much did you learn from the one-to-one coaching sessions? 10. How much did you learn from the Summer Institute? 11. How much did you learn from the workshops? 12. How helpful were the written materials you received from the project?
3.69 3.78 3.53
.53 .49 .67
3.44
.80
3.50
.62
3.59
.61
3.37
.70
3.28
.68
3.62 3.56 3.13 2.97
.60 .56 .71 .89
helped them in a number of key areas (see Table 3). Further, participants rated how much they learned from the different model components (e.g. one-on-one coaching sessions, Summer Institute, mentoring workshops, written materials). 3.4. Results When asked generally about whether they enjoyed being in the project, all but one youth indicated quite a bit or a lot; similarly, all but one youth reported feeling that the overall project was either quite or very useful. When reviewing ratings for specific questions that examined the impact of the intervention in a particular area, participants assigned the highest ratings (M = 3.59, SD = .62) around the project's influence in helping youth believe in themselves; specifically, that they could enter and be successful in college. This was closely followed by the impact that the intervention had on participants' understanding the benefits and options around higher education (M = 3.53, SD = .67). The project's role in helping youth to identify and connect with adult allies who could support their educational goals received the lowest overall rating (M = 3.28, SD = .68), but was still highly endorsed (quite or a lot) by 87.5% of participants. Regarding the rating of specific intervention components and how much was learned through each element, peer coaching received the highest scores (M = 3.62, SD = .61), followed by the Summer Institute (M = 3.56, SD = .56) and workshops (M = 3.13, SD = .72); the usefulness of the written materials had the lowest score (M = 2.97, SD = .90) and, while still relatively positive, may suggest an area for improvement. To examine whether the experiences and feedback of participants varied by different socio demographic characteristics, t-tests comparing the mean rating for a particular item were calculated for the following groups: 1) White vs. non-white (i.e. Hispanic, Native American, African American, and multi-ethnic); 2) Seniors and students working on their GED vs. Juniors/Sophomore; 3) youth receiving special education services vs. general education; 4) participants who reported that they had completed a high number of college preparation activities (10 or more) at baseline vs. low completers (0–9) and 5) youth who were successfully enrolled in college 6 months after completing the intervention vs. those who were not. To account for multiple comparisons, only group differences meeting the stringent p ≤ .01 level are reported. Overall, participant responses around the intervention did not significantly vary, with a few exceptions. Specifically, Juniors (and the only Sophomore) had significantly higher scores when asked about the
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extent to which the project helped them understand the benefits and options of postsecondary education (3.75 vs. 3.40; t = 6.89, df = 30, p ≤ .01) and how useful the project was overall (3.92 vs. 3.70; t = 7.13, df = 30, p ≤ .01), as compared with Senior/GED students. Additionally, youth in special education reported significantly higher ratings when asked how much they learned from the coaching sessions (3.90 vs. 3.50; t = 14.54, df = 30, p ≤ .01). 4. Discussion While further testing on a larger scale is needed, initial findings from the randomized clinical trial suggest that the Better Futures holds promise in promoting the postsecondary participation of young people in foster care with mental health challenges (Geenen et al., 2014). The model is theoretically and operationally grounded in self-determination-based peer coaching, goal pursuit, experiential learning, and validation and promotion of mental health wellness and inclusion. The overall high fidelity of model implementation achieved in intervention delivery, as well as generally positive social validity findings, suggests that the intervention is feasible to carry out and is generally perceived as useful and enjoyable by participants. Feedback from participants suggests that the Better Futures model had the greatest impact in fostering young peoples' beliefs in their capacities and potential for participating in higher education. In many cases, participation in Better Futures provided the first opportunity for youth to meet resilient young adults who shared their life experiences around foster care and mental health, and who were successfully pursuing their educational goals. Working with role models whose stories mirror their own complicated lives may help young people see that higher education can be attainable for them as well. The value in working with a slightly older peer who has similar experiences also may account for this component of the intervention being rated as most impactful by the participants. Also unique to the intervention was the explicit focus on mental health, including an emphasis on normalizing mental health issues, on the importance of self-care, and on communicating the perspective that living through life stressors and accompanying mental health challenges can lead to strength, resilience and unique wisdom. Explicitly addressing mental health from a strength perspective also freed youth and their peer coaches to directly address system barriers related to stigma around mental health, such as directly advocating and negotiating with mental health professionals, foster parents, and others to allow them to pursue higher education, even when the adults doubted their capacities for success and feared that their mental health issues would worsen if they tried new activities. Coaches also encouraged youth around selfcare and accessing effective mental health services, and as desired, youth were connected to empowering and developmentally congruent mental health resources, such as Youth M.O.V.E. During their 10 months in the Better Futures intervention, many youth experienced other stressful life events, which included placement changes or running away, pregnancy and parenthood, and/or mental health crises and hospitalization. Coaches tried to remain in contact with youth during these periods by offering a caring presence, continuing to highlight youth's strengths, helping youth consider their options and think through decisions, and supporting youth in continuing to work on their higher education goals, which sometimes enabled youth to preserve some degree of normality and hope in the midst of chaos. Youth and coaches also discussed the importance of strategic disclosure of mental health and foster care status; for example, in college application essays and to access higher education accommodations. These model foci underscore Better Futures aim of empowering and sensitively supporting youth in normalizing and addressing mental health issues as a facet of their overall process of preparing for and attending higher education. While initial experimental findings suggest that the model has promise in promoting positive postsecondary outcomes, as well as
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high intervention fidelity and social validity herein reported, further research would be beneficial. For example, future replication is essential with larger samples of young people having diverse foster care and mental health experiences, ideally within university and college settings and conducted in partnership with child welfare and secondary school programs. An important limitation of the current study is the small sample size and focus in one geographic area of the country, which limit the generalizability of the findings, as well as conclusions related to feasibility of implementation for a larger program, which would be needed to support youth in many large communities. In particular, effective methods for recruiting and supporting larger numbers of postsecondary peer coaches and accommodating larger groups of Summer Institute participants warrant study. Additional research on model adaptations that would be needed for implementation with youth in rural areas also is needed. Finally, the small sample most likely resulted in the study being underpowered to detect some significant differences, which if more clearly understood, may have shed more light on factors affecting implementation success and participants' response to the intervention. Additionally, the social validity findings suggest that further testing is needed to learn more about when during the high school experience (e.g. Juniors vs. Seniors), students benefit most from the program. While Juniors were more likely to exit the project prematurely, the overall attrition numbers were very small and may be an anomaly. It is also important to note that the Juniors that stayed reported high levels of overall satisfaction with the intervention, and because they may have been earlier in their thinking around college, possibly could have found the project more impactful in helping them understand the benefits and options around higher education as compared with Seniors/ GED students. An additional follow-along period would be useful in ascertaining whether students who still have another year of high school at study completion do eventually enroll in college at rates comparable with their academically older peers who graduated high school earlier in the project and went on to enroll in college by the study's end. In the context of furthering model improvement, findings from the social validity measure suggest that the intervention had a positive but lesser impact on young people identifying and connecting with adult allies who could support their educational goals. Social isolation and disconnection from community that many young people in foster care experience have been well documented in the literature and may be especially true for foster youth with mental health conditions. For example, placement instability is a common barrier among young people in foster care, but particularly for those with emotional and behavioral disabilities (Geenen & Powers, 2006; James, Landsverk, & Slymen, 2004). As youth change foster homes, they often change schools and neighborhoods as well, limiting their access to relationships with peers and caring adults (Pecora, 2012). Studies have further documented the importance of strong social connections to college engagement and retention for young people in the general population, as well as for youth exiting foster care (Day, Dworsky, Fogarty, & Damashek, 2011; Merdinger, Hines, Osterling, & Wyatt, 2005; Robbins et al., 2004). Future research should consider Better Futures model enhancements that more effectively support participants in identifying and reaching out to potential supporters, as well as considering the addition of a community-building component that would involve identifying and connecting young people to formal and informal allies in high schools, postsecondary settings and the larger community, who would be willing to support youth in navigating their way to higher education. In sum, the study findings indicate that despite multiple disadvantages, most young people in foster care, including those with mental health conditions, want to pursue higher education and can successfully prepare for and participate in college or vocational school. Selfdetermination-based models are essential for supporting youth in recognizing and realizing their capacities for establishing successful postsecondary, career and life trajectories. It is essential that promising models, such as Better Futures, continue to be rigorously tested so that
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