Journal Articles

Behavioral Health And Legal System Involvement Among Transition-age Youth In Foster Care: A Longitudinal Analysis Of Youth In California

Keunhye Park, Michelle R. Munson, Mark E. Courtney, Kierra Blair, Andrea Lane Eastman

Significance: The transition from childhood to adulthood can pose challenges for young people in foster care because many are disconnected from supports that families typically provide to adult children (e.g., material support, guidance). Additionally, they may lose access to child welfare services (e.g., housing and behavioral health care services). An added complication is that young people transitioning from foster care experience higher rates of behavioral health problems compared to peers who are not in foster care. Behavioral health conditions (both mental health and substance use disorders) may be more common, given that these young people may experience the trauma of child maltreatment and factors associated with being in foster care (e.g., removal from home, separation from family). Research suggests that unmet behavioral health needs may increase the risk of incarceration for young people with histories of foster care, potentially leading to lasting effects into adulthood. Involvement with the legal system can complicate the transition to adulthood, impeding employment opportunities, social relationships, and the formation of identity. This study used longitudinal survey data from young people in foster care at age 17 to examine the relationships between 10 distinct behavioral health conditions and their involvement with the legal system during early adulthood.

Method: The current study involved prevalence and regression analyses using data from a longitudinal study of transition-age youth in the California foster care system—the CalYOUTH Study. Participants included young people at the onset of the transition to adulthood (ages 16.75–17.75) and who had been in the foster care system for at least 6 months. Young people were interviewed again at ages 19 and 21. Behavioral health disorders were measured at the Wave 1 interviews (age ~17), and legal system involvement was measured at follow-up interviews (Wave 2 at age 19 and Wave 3 at age 21).

The presence of mental health and substance use disorders was assessed using the Mini International Neuropsychiatric Interview for Children and Adolescents to capture 10 diagnoses: major depressive episode, mania, social phobia, posttraumatic stress disorder, attention deficit hyperactivity disorder, conduct disorder, oppositional defiant disorder, psychotic thinking, alcohol abuse or dependence, and drug abuse or dependence.

Later legal system involvement was based on three measures of self-reported legal system involvement, capturing arrests, incarceration (for at least one night), or convictions of a crime between ages 19 and 21.

Covariates included demographic characteristics (race and ethnicity and gender), maltreatment history (severity and type), child welfare context (living arrangement, total foster care placements, time in extended foster care as a nonminor), and history of juvenile legal system involvement.

Findings:

1. More than half of the young people screened positive for a mental health or substance use disorder at age 17.
   • Among those who later experienced legal system involvement, the most common behavioral health conditions were drug use disorders (40.2%), depression (23.8%), and alcohol use disorders (22.6%).
2. Rates of nearly all behavioral health disorders were higher for young people who later reported legal system involvement than for those who did not.
   • Significant differences were documented for drug use disorder (40% vs. 16%, respectively; p < .001), alcohol use disorder (23% vs. 10%; p < .01), oppositional defiant disorder (15% vs. 5%; p < .05), conduct disorder (12% vs. 3%; p < .05), and any behavioral health disorder (66% vs. 46%; p < .001).
3. A diagnosis of drug abuse or dependence was a salient predictor of later legal system involvement, even after accounting for other factors.
   • Results showed that having a drug abuse or dependence diagnosis as a minor increased the estimated odds of later legal system involvement in adulthood by a factor of 2.4.
4. Time spent in extended care after age 18 reduced the odds of later legal system involvement.
   • Each additional month spent in extended foster care after participants’ 18th birthday was associated with a 2% decrease in the odds of involvement with the legal system in adulthood.

The Role of Enduring Relationships on Youth Outcomes

Nathanael J. Okpych, PhD; Sunggeun (Ethan) Park, PhD; Jenna Powers, PhD; Justin S. Harty, PhD; Mark E. Courtney, PhD; Astha Agarwal, MA

Significance: Child welfare policies for transition-age youth (TAY) are the subject of two significant critiques. The first is that policies strongly emphasize helping TAY build skills for independent living, even though research has found interdependent living to be healthy and normative in emerging adulthood. Second, child welfare policies prioritize legal permanence even though many legally “permanent” relationships do not last, and youth tend to define permanence in terms of the love, care, and dependability of a relationship, rather than in biological or legal terms.

Method: This study analyzes data collected by the CalYOUTH Study, which included a representative sample of over 700 TAY in California foster care at age 17 who were interview multiple times as they transitioned to adulthood. When youth were interviewed at ages 17 and 21, they were asked to name specific people they could turn to for emotional support, tangible support, and advice. In this study we identified “enduring relationships”, that is, individuals TAY named as a support person at both age 17 and age 21. Importantly, these individuals were present in TAYs’ lives as they made the transition out of foster care.

Findings: About half of study participants (48%) had an enduring relationship. Enduring relationships tended to be with biological family members, foster and adoptive parents, and individuals they described as family-like. Having an enduring relationship protected TAY from several hardships. Enduring relationships with specific types of people sometimes had specific effects on their outcomes.

Keywords: foster youth; child welfare; enduring relationships; poverty; transition-age youth