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Easing the Transition Process for Youths in Foster Care:

A curriculum targeted towards increasing independent living skills.

Amelia Sterenberg, OTS

Doreen Jean Jacques, BA

Kaela DeSouza, BA

Kimberly Vehon, CEO Foster Arizona

Amy Armstrong-Heimsoth, OTD, OTR/L,BCP

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Our Community Partner: Foster Arizona

We partnered with Foster Arizona, a non-profit organization that was established, by Kimberly Vehon.

Foster Arizona provides housing and other services to youths and adolescents, who are aging out of the foster care system. Foster Arizona also aims to educate, empower, and encourage the children they serve.

Mission: To positively impact the lives of children within foster care through encouragement, education, quality staff, and resources.

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Youths And Adolescents in Foster Care

25% of children remain in the foster care system until they reach the age of majority.¹This references the transitional period where an individual, who was previously under state custody has reached between the ages of 18-21; and is in the process of being classified as a legal adult.²
The goal of foster care is to provide a stable nurturing environment; however, it presents barriers and the experience of foster care itself can exacerbate existing issues.
The challenges subject this particular population to enduring various adverse outcomes such as being at an increased risk of homelessness, psychological health conditions, victimization, poverty, early pregnancy, and incarceration.¹

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Youths And Adolescents in Foster Care

Approximately more than 20,000 youths and adolescents age out of the foster care system annually.² Young adults exiting foster care are expected to be self-sufficient and capable of navigating the complexities of former dependency to becoming independent agents. This expectation should be deemed unrealistic due to the fact that as children, they are rarely involved in the decision making process regarding choices that relate to their foster care experiences.¹
Although faced with higher risk of negative outcomes (e.g. homelessness, low education attainment, inadequate employment and income, early parenthood, and overall general negative health outcomes), transitioning into adulthood can be perceived as a potential opportunity to make choices that result in positive change, experience and obtaining stability.²

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The Importance of Independent Living Skills

Independent living skills are defined as daily tasks and functions that individuals need to master, in order to live autonomously.

Independent living skills include being able to obtain and maintain housing, sustain employment, create budgets, have access to physical and mental health care, and the ability locate other resources.²
By teaching independent living skills to youths and adolescents, we can help them achieve self-sufficiency.

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Purpose

Our study seeks to address the critical need to develop an innovative interdisciplinary transitional support intervention for youth aging out of foster care.
The purpose of the study was to evaluate the effectiveness of a community vetted content expert paired with the use of Behavioral Skills Training (BST) to teach life skills.
Behavioral Skills Training is an evidence-based strategy, that contains four components. BST is used to teach new behaviors or skills.

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Methods

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Participants

The inclusion criteria for participants of this study include being enrolled in the community Housing Project at Foster Arizona, previously housed within the foster care system, and having aged out. �
As of October 2021, total program enrollment is 27, with an average population age of 19 years old. This population is diverse, representing a variety of races and ethnicities. �
Number of participants that completed the survey was n=8�

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Procedural Design

Recruitment was on-going during scheduled life skills sessions due to the rolling admission of the program. Our research consent was conducted prior to each life skill session if new participants desired to join. �
For the consent process, researchers explained the purpose of the study and that signing the consent form indicated participation in the study. Participants were informed that this contract was not binding and they were able to withdraw from the study at any time if necessary. �
Participation was incentivized with receiving a $5.00 gift card for completing each survey. ��

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Behavioral Skills Training

Process

→ This portion of the research took place following the ending of the instructional session by the community content expert.

→ First, participants were instructed on teachable skills that related to the content from the evening's session.

→ After this instruction, the skill was then demonstrated by the researcher to complement the associated instructions.

→ The next step involved participants practicing the skill while the researcher observed their returned demonstration. Based on their demonstration of the skill, the researcher provided corrective feedback to the participant in order to improve their performance of the skill.

Definition

→ Behavioral Skills Training (BST) was used by researchers to deliver life skills curriculum activities to the young adults in the program. Behavioral Skills Training involves a four-step process:

1) Instructions

2) Modeling

3) Roleplay/Rehearsal

4) Feedback.

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Data Collection

Quantitative data was collected through surveys regarding the information that was taught to participants in life-skills sessions. It specifically focused on the hands on portion of session.�
A retrospective pre-post survey was used to minimize self-bias and increase accuracy as an overall program pre-post change.³�
This design presents pre-and post-tests at the same time following the sessions, and participants answer the questions based on their comfortability with the material presented.�
A paper version of the survey was distributed to the consented participants following the end of a session.�
We intended to collect qualitative data with a phone interviews regarding the sessions, but due to time constraints this was not able to take place.

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The retrospective pre-post survey is self-rated and reflects the level of comfortability that the participants felt with the material that was taught that day. Life skill courses were taught on Sundays and lasted a duration of approximately an hour.

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Data Collection Sessions

Life Skills Sessions 1- Arizona Health Care Cost Containment System

Young adults were instructed on how to get to the AHCCCS website and create an account on the website/ access their already created account. They were given a hand-out with instructions and pictures and recalled the skills.

Life Skills Session 2- Finances

Participants were instructed on how to calculate the cost of repaying a loan (initial loan amount and calculating interest). They were given a worksheet that had them practice this skill.

We had 4 life skills sessions scheduled to collect data, however due to our community partner’s schedule changes, these sessions were reduced two data collection opportunities.
Technical difficulties when it came down to the “hands-on” portion of the first session, the internet went out and so the young adults were not able to practice actually getting to the site. They instead repeated the steps back to the instructor as we walked through the hand-out. Creating more options for hands-on, potentially a fill-in-the blank sheet that is more engaging, focus on a different skill. Time limitations in this session due to the fact that the CCE went over time, the atmosphere was not exactly conducive to teaching this skill.
Hands on elements were very important to this community content expert and so the environment felt different and the engagement of the participants was higher.

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Results

-Due to the nature of the population that were were working with, it is important to build rapport and earn the trust of the young adults who were are working with. We recognized a lack of presence of our team in the community at Foster Arizona, and therefore recommend more prior involvement in the future when working at this site.

-There was a time limitation during life skills sessions, resulting in a less than optimal window of time for researchers to complete BST portion and to distribute the survey.

-The lack of physical proximity of the team members required increased effort to schedule meetings and consider the time change when planning. There was lack of team representation at the site due to two team members being located in Florida and lack of technological availability at the site that could have been used to include the team members.

-What would a more community-based participatory research approach look like with this population and project? Community-based participatory research (CBPR), with its emphasis on joining with the community as full and equal partners in all phases of the research process, makes it an appealing model for research with vulnerable populations (Holkup, P. A., Tripp-Reimer, T., Salois, E. M., & Weinert, C. (2004). Community-based participatory research: an approach to intervention research with a Native American community. ANS. Advances in nursing science, 27(3), 162–175. https://doi.org/10.1097/00012272-200407000-00002)

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Session 1 Data

Shows that there was an average .93 increase across all areas.

Most increase in the ability to engage in activities that pertain to the topic when in the community.

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Session 2

Shows that there was an average 2.0 increase across all areas. Again, there was the largest increase in ability to engage in the activity.

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Research Strengths & Limitations

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Strengths

The community organization’s familiarity with the ITRE contributed to increased participation.�
The community content experts were willing and open to having us participate in the life-skills session by implementing a hands-on component. �
We chose a instructional methodology that has not been studied amongst this population before. �
The relevant life skills information was a learning incentive for participants

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Limitations

Limited number of sessions

Sessions were cancelled due to change in plans and the holiday season

Distance between team members:

The lack of physical proximity of the team members required increased effort to schedule meetings and consider the time change when planning.

Accuracy of responses/ low response rate

Some surveys did not reflect differences between before and after the sessions, but showed a consistent score for all questions.�

*4-5 young adults choose not to participate/ answer the survey

*This research study would benefit largely from in-person collaboration amongst research team members as it would encourage unanimous decision-making in the need to adapt research design within a short moment’s notice.

Limited number of sessions: Sessions were cancelled by the organization due to change in plans and the holiday season, which resulted in limited data collection opportunities and, minimal room for error. This also impacted rapport building with the research population.�
Distance between team members: The lack of physical proximity of the team members required increased effort to schedule meetings and consider the time change when planning. There was lack of team representation at the site due to two team members being located in Florida and lack of technological availability at the site that could have been used to include the team members and foster feelings of involvement for team members out of state. �
Accuracy of responses/ low response rate: The researcher group discussed the potential low response rate due to generally negative attitudes caused by previous research, lack of interest, and limited time to participate in research after life skills training on Sunday evenings if the sessions ran over. Some surveys did not reflect differences between before and after the sessions, but showed a consistent score for all questions.�

*physical proximity

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Implications and Outcomes

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Implications For Adolescent Behavioral Healthcare

Research and research limitations can provide insight and inform the development of independent living skills for foster programs.
Data collected and research experience supports the need for life skills training among former foster youth.
Under improved conditions more research should be conducted to support a body of research regarding the need for independent living skills.
Further research is needed to understand the benefits of using the BST with this population.

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Community-based Participatory Research

Community-based participatory research (CBPR), with its emphasis on joining with the community as full and equal partners in all phases of the research process, makes it an appealing model for research with vulnerable populations. (Holkup et al., 2004) �
An alternative to the typical research model that might seem to exclude its subjects from the planning and organization, data analysis, outcomes and dissemination of results. �
Members of the study are active and equal participants�
This could provide more motivation since study participants are actively engaged in all aspects of the study that will have results directly impacting them.

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What We Learned

IRB Proposal Experience Our IRB approval process took longer than expected due being supported by two academic institutions through the process. This delay significantly impacted project timeline. We learned to adapt quickly to unexpected changes in the IRB process and what is required to make the process go smoothly. �
Being able to adapt to changes. Despite an organized research workflow and collaboration with our community partners on project planning difficulties were present in data collection and analysis. Unforeseen circumstances due to schedule changes, as well as the physical distance between the team members, our plan was shifted many times resulting in decreased amount of data collected than intended.

-This project brought awareness to many important elements of the research process and what is required of a research team who is collaborating on a project with a community partner.

-Due to the nature of the population that were were working with, it is important to build rapport and earn the trust of the young adults who were are working with. We recognized a lack of presence of our team in the community at Foster Arizona, and therefore recommend more prior involvement in the future when working at this site.

-There was a time limitation during life skills sessions, resulting in a less than optimal window of time for researchers to complete BST portion and to distribute the survey.

-The lack of physical proximity of the team members required increased effort to schedule meetings and consider the time change when planning. There was lack of team representation at the site due to two team members being located in Florida and lack of technological availability at the site that could have been used to include the team members.

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Key Takeaways

Building rapport among young adult populations and the community partners who work with them is beneficial to research process.
Adding interactive components rather than lecture format during life skills session can increase retention of material.

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How can BST be used in the future?

Behavioral Skills Training is essential in foster services administration.
By implementing improved life skills training methods, foster youth will display improved comprehension of life skills training.
This transition will improve former foster youth’s outcomes by equipping them with the tools to lead successful adult lives.

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References

Samuels GM, Pryce JM. “What doesn’t kill you makes you stronger”: Survivalist self-reliance as resilience and risk among young adults aging out of foster care. Child and Youth Services Review. 2008; 30:1198-1210.
Lee C, Berrick JD. Experiences of youth who transition to adulthood out of care: Developing a theoretical framework. Children and Youth Services Review. 2014; 46: 78-84.
Nimon K. Explaining differences between retrospective and traditional pretest self-assessments: competing theories and empirical evidence. International Research & Method in Education. 2014;37(3):256-269.
Holkup, P. A., Tripp-Reimer, T., Salois, E. M., & Weinert, C. Community-based participatory research: an approach to intervention research with a Native American community. ANS. Advances in nursing science. 2004;27(3):162–175. https://doi.org/10.1097/00012272-200407000-00002.

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ACKNOWLEDGEMENTS