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Supporting youth aging out of foster care.

Almost 428,000 children nationwide are in the United States foster care system (U.S. Department of Health and Human Services [DHHS], 2016). Over one-fourth of these children, approximately 112,000, are waiting to be adopted. Yet only 15,000 (4%) are in pre-adoptive foster homes, the term for a foster family planning to adopt a child (DHHS, 2016). Some children are also in foster families who will adopt them, even though the family's status has not been officially changed to "pre-adoptive" (S. Punnett, personal communication, November 11, 2016).

Social workers/adoption recruiters unfortunately have difficulty finding adoptive families for many children, particularly older children, in foster care. As children age, the amount of time a child waits to be placed with an adoptive family markedly increases, and the percentage placed for adaoption decreases dramatically (Family & Youth Initiative, n.d.). In fact, after spending 12 to 18 months in foster care, the chance of leaving care decreases "rapidly," and after 36 to 42 months in care, the chance of leaving care before emancipation is "incredibly low" (National Survey of Child and Adolescent Weil-Being [NSCAW], 2013, p. 5).

In 2015, the mean age of children in foster care waiting to be adopted was 7.6 years, and 43% of these children were age 8 years or older (DHHS, 2016). Over half of these waiting children had been in foster care more than two years, and nearly one-third had been in foster care for three years or more (DHHS, 2016). According to Ritter (2005), "researchers estimate that by age 8 or 9, a child is more likely to turn 18 in foster care than to be adopted" (p. B1). Children 12 years or older in foster care for this long are "nearly certain to age out of foster care ... before finding a permanent placement" (NSCAW, 2013, p. 5). Thus, most teens in foster care will leave the child welfare system by "aging out" of care without an adoptive family, many without even having formed a caring, consistent relationship with an adult. In 2015, the number of teens emancipated from foster care in the U.S. was a sobering 20,289 (DHHS, 2016). See Figure 1 for the story of one man's decision to leave foster care on his own terms.

Teens "Aging Out" of Foster Care: Outcomes

According to Reilly (2003), "a significant portion of youth exiting the foster care system face serious difficulty transitioning to life on their own" (p. 727). Based on interviews with 100 youth (mean age 20.16 years) who had aged out of foster care, Reilly (2003) reported the following difficulties:

* Limited education (50% of youth left foster care without a high school degree).

* Failure to obtain and/or maintain regular employment (although 63% were employed at the time of the study, 26% had not had steady employment; 24% had dealt drugs at some time since leaving care; 11% had used sexual intercourse for money; and 55% had been terminated from employment at least once).

* Lack of funds to meet basic needs (41% of respondents).

* Early pregnancies (38% of youth had children; over 70 pregnancies had occurred, some miscarried, and some aborted).

* Inability to obtain healthcare services (only 54% of youth rated their health as very good or excellent; 30% reported a serious health problem since leaving care; 32% reported needing health care but being unable to obtain it). (These numbers may have improved in recent years due to the extension of Medicaid to this population in some states [S. Punnett, personal communication, November 11, 2016].)

* Homelessness (almost 33% of young people left foster care without a place to live; since leaving foster care, 36% had experienced periods of homelessness).

* Involvement with the criminal justice system (41% had spent time in jail since leaving foster care).

Figure 1.
After 20 Years, Young Man Leaves Foster Care
on His Own Terms

Noel Anaya was in foster care from age 1 through 21 years.
In a story on Youth Radio he shared his thoughts on exiting
the foster care system, including a letter he read to the court
in his final appearance as a foster youth. Some excerpts:

"I've been with multiple foster families, I've been with
multiple shelters. How does a person like me not end
up with a family. "

"I used to dream of [adoption]. Having a mom and dad,
siblings to play with ... a dog. But when I hit 12, I realized
that I was getting old. That adoption probably
would never happen for me."

"I'm relieved to finally get away from a system that ultimately
failed me on its biggest promise. That one day it
would find me a family who would love me."

For Anaya's full Youth Radio story, visit http://www.npr.

For additional information and stories from youth on the journey
through foster care, visit

These difficulties occurred despite these young people having had preparation and training for the transition before aging out of care. Similar outcomes have been confirmed in other research (Courtney, Dworsky, Brown, Cary, Love, & Vorhies, 2011; Courtney, Dworsky, Ruth, Havelick, & Bost, 2005; NSCAW, 2007b).

In fact, Courtney et al. (2011) followed 732 youth ages 17 and 18 years, when they were still in foster care, to age 26 (83% of youth remained in the study at this point), examining a wide range of variables, including "living arrangements, relationships with family of origin, social support, education, employment, economic well-being, receipt of government benefits, physical and mental wellbeing, health and mental health service utilization, sexual behaviors, pregnancy, marriage and cohabitation, parenting, and criminal justice system involvement" (p. 5). The researchers concluded that while some young adults had "beat the odds," and many youth remained optimistic about their futures, "unfortunately as a group, [these youth] are faring poorly" (Courtney et al., 2011, p. 113).

In terms of health concerns, children in foster care are significantly more likely than children reported as maltreat ed but not in care to have a chronic health condition, and both groups have a higher prevalence of special needs than children in the general population (NSCAW, 2007a). As compared with other young adults, youth aging out of foster care are twice as likely to report their health as fair or poor, and that a health condition or disability limits their daily activities, are significantly less likely to have health insurance, and are less likely to obtain medical care when needed (Courtney et al., 2011).

In terms of mental health, due to their histories, these youth experience high rates of post-traumatic stress disorder (PTSD), reactive attachment disorder, depression, and other mental and behavioral health concerns (Lohr & Jones, 2016; NSCAW, 2007b; Samuels & Pryce, 2008). As many as one-half to two-thirds of children in foster care may meet criteria for a mental health diagnosis (Lohr & Jones, 2016; NACSW, 2007a, b; Shipman & Taussig, 2009); however, a large majority of young adults in need of mental health services do not obtain them (NSCAW, 2007b). Only half of those with symptoms of drug or alcohol dependence receive substance abuse services (NSCAW, 2007b), and only about one in five emancipated young adults reported receiving any mental or behavioral health services during the past year (Courtney et al., 2011).

Supportive Adult Relationships Matter

It is widely understood that a stable family life - or alternatively, the presence of an adult who has taken an interest in, reached out to, and created a bond of affection with a young person - is a key factor in ensuring adjustment, school success, and preparation for adulthood (Family & Youth Initiative, n.d.). In fact, Courtney and colleagues (2011), introduce their comprehensive report on young adults formerly in foster care as follows:

   For most young people, the transition to adulthood is a gradual
   process ... Many continue to receive financial and emotional
   support from their parents or other family members well past age
   18. This is in stark contrast to the situation confronting youth in
   foster care. Too old for the child welfare system, but often not
   yet prepared to live as independent young adidts, the approximately
   28,000 foster youth who "age out" of care each year ... are
   expected to make it on their own long before the vast majority of
   their peers (p. 1).

Research indicates that many youth aging out of foster care have relationships with adults, but these relationships may not provide the type of support needed for successfully navigating the transition to adulthood. In a study of 44 youth exiting foster care, Samuels and Pryce (2008) found that over half of the young people had between two and four relationships they identified as "supportive" (p. 1201). Similarly, in their much larger study, Courtney et al. (2011) found that a majority of young adults emancipated from foster care reported having a positive relationship with a caring adult: approximately 53% reporting phone or email contact, 42% in-person contact weekly, and 73% report feeling "very or quite close" to an adult. Courtney et al. (2011) also found that several years after exiting foster care, young adults felt they had social support some or most of the time.

Despite these numbers, Samuels and Pryce (2008) indicate that identifying "supportive" relationships does not mean these young people actually turned to adults in their lives for tangible or emotional support; most felt very much on their own. Courtney and colleagues (2011) similarly note that affectionate support and positive social interaction were more highly scored on a social support measure than were emotional/informational or tangible support among foster youth; these latter two types of support may be most critical for success in adulthood. Sometimes, relationships teens or young adults identify are with biological parents or other relatives, who the young person feels a need to take care of in some way. Additionally, as Samuels and Pryce (2008) explain, adult relationships are impacted by the fact that their pasts have led many youth emancipated from foster care to feel that emotional autonomy is synonymous with strength.

These data suggest what is well understood: supportive adult relationships are important in promoting optimal outcomes in adult life. As an example, Reilly (2003) found that among youth emancipated from foster care, those with smaller social support networks were more likely to have been homeless at some point after leaving foster care (r = -0.233, p < 0.02). Hook and Courtney (2010) reported that social capital facilitates employment: youth with little support are less likely to find employment and more likely to have lower wages. In Illinois, where youth can remain in care from ages 18 to 21 years, and thereby, have more support, educational attainment is greater, and post-care wages are higher, even when educational attainment is omitted from the statistical model (Hook & Courtney, 2010). Reilly (2003) also found that youth leaving foster care with larger social support networks reported more overall satisfaction with their lives (r = 0.20, p < 0.05).

Family & Youth Initiative: An Innovative Program

Research demonstrates what Schroff and Tresniowski (2011) described in their book about befriending a boy with a very unstable family. An Invisible Thread: The True Story of an 11-Year-Old Panhandler, a Busy Sales Executive, and an Unlikely Meeting with Destiny shows how one caring, committed adult in the life of a child can make all the difference between struggle and success. Little research has examined approaches to helping older children and teens find adoptive families or to support youth "aging out" of care in finding the adult support that can lead to improved outcomes. However, one promising approach is that of the Family & Youth Initiative (DCFYI), an innovative program in Washington, D.C., that helps youth ages 12 to 21 years in foster care find stable adult relationships, including mentors and adoptive families, through regular teen-adult social events, host family visits, advocacy, and outreach. DCFYI involves a cadre of adult volunteers in creating a supportive community around older youth in foster care waiting for families. At monthly "Family Events," both young people waiting for families and adults interested in potential relationships with these youth can meet and interact in a non-threatening environment.

These adult and teen events may be educational, such as learning how to budget, but are often purely social and involve activities such as kayaking, go-karting, pumpkin carving, making music, and playing games. By "hanging out" together in a non-threatening environment, young people and adults can gradually get to know each other. Often, these young people have been pushed into relationships with adults in ways that are out of their control and not of their choice (for example, with a new social worker, a new court-appointed special advocate, or a new foster parent). The opportunity to interact in a social environment and group context allows young people who may suffer attachment issues as a result of early traumas and/or multiple foster placements to relate to adults on their own terms and in their own ways. These young people who have suffered multiple losses and disappointments gradually become comfortable with adults who show up regularly and then begin to let their true selves shine through. As relationships develop over time at frequent events, adults also begin to develop a more realistic idea of who each young person is.

Over time, individual relationships may form around shared interests, such as cooking or basketball, or around geographic proximity because an adult frequently gives a teen a ride to events, giving them a chance to get to know each other, or simply because personalities may "click." When this happens, either a teen or an adult can approach the program director about the possibility of a mentoring relationship, typically a long-term commitment. These relationships involve spending regular time together every week or two, continuing to develop trust, and often also exposing the young person to a variety of new experiences, such as a museum visit, a trip to a game of a favored sports team, a concert or play, or even family-style dinners. Mentors may or may not offer help with homework, help looking for a job, or advice. They may also step into a mentoring role by providing support and caring in other ways.

In an article about DCFYI in the blog Bittersweet Monthly, Lahr and Baker (2016) share the story of one teen who got involved with DCFYI. Robert had been living in a group home and started going to DCFYI events because, as he put it, "I just wanted to do something, wanted to get out of the house. It was fun to do something different. There were other kids there, and we had something in common" (para. 41). He began talking with Brian, a DCFYI volunteer at some events, and the DCFYI director suggested a mentoring relationship to them. Robert recalled:

When we first started hanging together, it was kind of weird because I didn't really know who he was. I just wanted to go out to eat or something, but not because I wanted to get to know him. But then it became more of a friendship ... we talked about family and school. I asked him questions. It became more personal (Lahr & Baker, 2016, para. 45).

Six years later, the two still meet, and Robert describes the impact Brian has had on his life over the years, helping him with homework, encouraging application to an arts high school, taking him to auditions, helping him apply to colleges and for financial aid, assisting him in choosing a major--all the kinds of things a parent might do (Robert and Brian are pictured in Figure 2). As Lahr and Baker (2016) report, "Robert hasn't always wanted to hear what his mentor had to say. 'There are a lot of times like that,' he explains. Brian pushes him to do more, to work towards his potential, to stay on track and accomplish his goals" (para. 55). Robert is currently pursuing a college degree and looking at grad schools, with plans to become a physical therapist.

Adults participating in the program can be mentors like Brian, but also "host parents," who welcome a young person into their home for a series of weekend visits. Children in foster care often have limited contact with adults who could learn about their need for an adoptive family and pursue their adoption. Yet older children are more likely to be adopted by people who already know them. Host families fill this gap by using their circles of friends to help a teen meet people who might be potential adoptive families. For older children, traditional recruitment approaches are not as effective as a personalized approach like this. Host families can also be a critical support to a teen.

Lahr and Baker (2016) interviewed Dayar, a young adult who had a host family when he started college. Dayar described feeling totally overwhelmed and ready to quit college after receiving a syllabus on the first day. "I didn't even know what [a syllabus] was. Then, the professor starts telling us we have to read a couple hundred pages. After my first two classes, I had decided college wasn't for me and planned to drop out" (Lahr & Baker, 2016, para. 22-23). But when his host family asked if he had a "Plan B," he realized he didn't. So they encouraged him to stay in school. "It was really them pushing me that kept me in school initially. They told me, 'You're capable, you're able.' I was overwhelmed, but it turned out I was more prepared than I realized" (Lahr & Baker, 2016, para. 29).

At times, Family & Youth Initiative volunteers even adopt teens they meet in the program. In 2014, Motherlode, a parenting blog of the New York Times, had a "Charities that Inspire Kids" feature. Leah, a volunteer with the Family & Youth Initiative, thought the organization deserved recognition in this feature and emailed the Motherlode editor with her personal story (Dell'Antonia, 2014, para. 5):

   The most special thing for me, by far, about the Family & Youth
   Initiative is that I met my son at the first evrnt I attended ...
   (I had no inkling of what was to come.) He was pursuing a degree in
   nutrition and culinary arts, and I like to cook, so we shared
   opinions on our favorite Food Network shows.

Leah and this young man got to know each other over time, first at Family & Youth Initiative events and then when he began stopping by Leah's office for lunch dates. At one point, this young man asked Leah to be his mentor and later, his foster parent. Eventually, as he and Leah grew more comfortable with each other, Leah adopted him. Leah described the experience:

While adjusting to being a first-time mom to a 20-year-old was a bit of an undertaking, the rewards have dramatically outweighed the effort.... I [am] thrilled to get his calls from college and hear what's going on with him, and [I] savor his visits. He and I are wonderful traveling companions and have had incredibly fun adventures. And he has [even] taught me ... a great recipe for turkey barbecue sliders (Dell'Antonia, 2014, para. 6).

Leah's son is Dayar, whose host family had encouraged him to stick with college (see Figure 3 for a picture of Leah and Dayar). Dayar is pursuing a career as a hotel food and beverage manager after completing a degree in Hospitality Management at Penn State, one of the top five programs in the country (Lahr & Baker, 2016).

The Family & Youth Initiative has facilitated other success stories, including numerous teen-adult friendships, satisfying mentoring relationships, and other adoptions resulting from connections built through this program's unique approach. For more information on Family & Youth Initiative visit the organization's website ( A short video is also available on their website (www.dcfyi. org/about-need). Other programs focused on the needs of youth aging out of foster care are identified in Tables 1-3.

As the Family & Youth Initiative demonstrates, adults can make a difference, one teen at a time. Pediatric nurses aware of the special needs of young people aging out of foster care can use the resources identified in Tables 1-3 to begin to explore referral and support options for such teens in their own locales. Nurses who may be interested in closer connections with this population can:

* Explore mentoring by selecting "Foster, Residential or Kinship Care" under "Population Served" by zipcode on the website of MENTOR: The Nation's Mentoring Partnership ( campaigns/in-real-life).

* Explore the Court Appointed Special Advocate program, a type of mentoring, at and search for local programs by zipcode in the upper left hand corner of the website (http://www.casafor children.Org/site/c.mtJSJ7MPIsE/b.5301321/k.6FCl/ State_and_Local_Programs.htm).


Courtney, M.E., Dworsky, A., Brown, A., Cary, C., Love, K., & Vorhies, V. (2011). Midwest evaluation of the adult functioning of former foster youth: Outcomes at age 26. Chicago, IL: Chapin Hall Center for Children at the University of Chicago. Retrieved from Report_4_10_12.pdf

Courtney, M.E., Dworsky, A., Ruth, G., Havlicek, J., & Bost, N. (2005). Midwest evaluation of the adult functioning of former foster youth: Outcomes at age 19. Chicago, IL: Chapin Hall Center for Children at the University of Chicago. Retrieved from https://www.chapin

Dell'Antonia, K.J. (2014, December 31 ). Charities that inspire kids: The Family & Youth Initiative, motherlode: Living the family dynamic. The New York Times. Retrieved from http://parenting.blogs. /charities-that-inspire-kids-the-familyyouth-initiative/

Family & Youth Initiative, (n.d.). Too many children are growing up without families in the Washington DC Metro area. Washington DC: Author.

Hook, J.L., & Courtney, M. (2010). Employment of former foster youth as young adults: Evidence from the Midwest Study. Chicago, IL: Chapin Hall Center for Children at the University of Chicago. Retrieved from B3_Employment,pdf

Lahr, A., & Baker, E. (2016, November). Connecting teens, creating families, changing lives: Family and Youth Initiative. Bittersweet Monthly. Retrieved from stories/family-and-youth-initiative#chapter-nav Lohr, W.D., & Jones, V.F. (2016). Mental health issues in foster care.

Pediatric Annals, 45(10), e342-e348. National Survey of Child and Adolescent Well-Being (NACSW). (2007a). NSCAW, No. 7: Special health care needs among children in child welfare, research brief, findings from the NSCAW

Study. Retrieved from national-survey-of-child-and-adolescent-well-being-nscaw-no-7special-health

National Survey of Child and Adolescent Well-Being (NACSW). (2007b). NSCAW, No. 11: Adolescents involved with child welfare: A transition to adulthood. Retrieved from http://www. cent-well-being-no-11 -adolescents

National Survey of Child and Adolescent Well-Being (NACSW). (2013). NACSW, No. 19: Risk of long-term foster care report. Retrieved from

Reilly, T. (2003). Transition from care: Status and outcomes of youth who age out of foster care. Child Welfare League of America, 82(6), 727-746.

Ritter, K. (2005, November 24). Homes full of thanks. Philadelphia Inquirer, B1, B4.

Samuels, G.M., & Pryce, J.M. (2008). "What doesn't kill you makes you stronger": Survivalist self-reliance as resilience and risk among young adults aging out of foster care. Children and Youth Services Review, 30, 1198-1210.

Schroff, L., & Tresniowski, A. (2011). An invisible thread: The true story of an 11-year-old panhandler, a busy sales executive, and an unlikely meeting with destiny. Brentwood, TN: Howard Books.

Shipman, K., & Taussig, H. (2009). Mental health treatment of child abuse and neglect: The promise of evidence-based practice. Pediatric Clinics of North America, 56, 417-428.

U.S. Department of Health and Human Services (DHHS). (2016). The AFCARS report #23: Preliminary estimates for FY 2015 as of June 2016. Administration for Children and Families, Administration on Children, Youth and Families, Children's Bureau. Retrieved from

Additional Reading

U.S. Department of Health and Human Services (USDHHS). (2011). The AFCARS Report #18: Preliminary estimates for FY 2010 as of June 2011. Administration for Children and Families, Administration on Children, Youth and Families, Children's Bureau. Retrieved from research/afcars/tar/report18.htm

The Family Matters series focuses on issues, information, and strategies relevant to working with families of pediatric patients. To suggest topics, obtain author guidelines, or to submit queries or manuscripts, contact Co-Editors Elizabeth Ahmann, ScD, RN, PCC; or Deborah Dokken, MPA, Pediatric Nursing; East Holly Avenue/Box 56; Pitman, N] 08071-0056; (856) 256-2300 or FAX (856) 589-7463.

Elizabeth Ahmann, ScD, RN, PCC, is a Pediatric Nurse, an ADHD Coach specializing in work with college students and young adults, and an Adjunct Faculty Member, Maryland University of Integrative Health, Laurel, MD. She is Co-Editor of Pediatric Nursing's "Family Matters" Series.

Caption: Figure 2. Robert and Brian

Caption: Figure 3. Leah and Dayar

Table 1.
Organizations Supportive to Youth in or Aging Out of Foster Care

Foster Club

National Foster
Care Alumni

Foster Care to

The nsoro

Foster Club        The Foster Club website is developed specifically
                   for kids in care and is written in collaboration
                   with foster youth. Foster Club also offers:
                   * Training events that include teen
                     conferences and workshops,
                   * An "all star internship" that provides a way
                     for young leaders to reach out to other youth
                     through conferences, trainings, and events.
                   * A network of Youth Boards across the nation
                     to connect and collaborate, leveraging their
                     voices, building the capacity of their members,
                     and creating better public awareness
                     and community connections.

National Foster    FCAA connects foster care alumni to reduce
Care Alumni        isolation and so that their voice can impact
Association        policy and practice with the goal of ensuring
(FCAA)             greater opportunity for people in and from
                   foster care.

Foster Care to     Foster Care to Success is the oldest, largest
Success            national nonprofit organization working solely
                   with college-bound foster youth, providing
                   tuition grants, book grants, living stipends,
                   and emergency funding for foster youth
                   seeking higher education.

The nsoro          The nsoro Foundation provides college
Foundation         scholarships for teens in foster care.
                   Additionally, nsoro provides guidance to children
                   in foster care, in kinship care, and those who
                   have aged-out of care, offering mentoring
                   programs, internships, and scholarships.

Source: Family & Youth Initiative, n.d.

Table 2.
Organizations Helping Teens in Foster Care Find Families *

You Gotta Believe


Kidsave Weekend
Miracles               host-a-child-weekends

A Family For Every
Child                  kids/AdoptingATeenager.php

New York Council
on Adoptable
Children (COAC)

The Adoption 
Exchange in            children/choice

Family and Youth

Project 1.27 

You Gotta Believe      You Gotta Believe, in the New York City Metro
                       area, focuses on finding permanent parents
                       and families for young adults, teens,
                       and pre-teens in the foster care system.

Ampersand              Based in Minnesota, Ampersand Families is a
Families               resource for youth, families, and
                       professionals with the goal of meeting the
                       permanency needs of youth in the child
                       welfare system.

Kidsave Weekend        Based in Los Angeles County, the Kidsave
Miracles               Weekend Miracles Program supports older
                       children in foster care in finding long-term
                       mentors and adoptive parent(s) through
                       weekend "host family" experiences.

A Family For Every     This organization, based in Eugene, Oregon,
Child                  serves families, children and agencies

New York Council       Based in New York, COAC's mission is to
on Adoptable           ensure a permanent family for every child
Children (COAC)        legally free for adoption.

The Adoption           In Colorado, the Adoption Exchange, in
Exchange in            Partnership with the Colorado Department
Colorado               of Human Services, is starting a mentoring

Family and Youth       In the Washington DC metropolitan area,
Initiative             this organization matches youth who will
                       be aging out of foster care with host
                       parents and mentors and helps them find
                       adoptive families.

Project 1.27           This Christian faith-based organization,
                       based in Colorado, trains families to become
                       foster and adoptive families for children
                       and teens. Their website lists similar
                       ministries in several other states.

* Several of these organizations focus exclusively
on teens/young adults, while others have teen-focused
programs within a context of services to children of all ages.

Source: Family & Youth Initiative, n.d.

Table 3.
Organizations Assisting Youth Who Are or
May Be Aging Out of Foster Care

Youth Villages
YVLifeSet          what-we-do/yvlifeset/about-yvlifeset.

Jim Casey Youth

Covenant House

Youth Villages     YVLifeSet assists young adults aging out of
YVLifeSet          foster care to identify their goals; make
                   decisions about education, employment,
                   relationships and health; access resources;
                   find employment; and establish relationships
                   with caring adults.

Jim Casey Youth    The Opportunity Passport program organizes
Opportunities      resources to create financial, educational,
Initiative         vocational, health care, entrepreneurial,
                   and recreational opportunities for youth
                   who are leaving or have recently left
                   foster care.

Covenant House     Covenant House, fundamentally a service for
                   the homeless, has "houses" in 22 cities
                   throughout the United States, Canada, and
                   Latin America providing transitional housing
                   and other resources to help prevent
                   homelessness among transitioning youth.

Source: Family & Youth Initiative, n.d.
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Title Annotation:Family Matters
Author:Ahmann, Elizabeth; Dokken, Deborah
Publication:Pediatric Nursing
Article Type:Report
Geographic Code:1U3IL
Date:Jan 1, 2017
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