Transition Readiness, Perceived Health, and Health Services Utilization in Transitional Age Foster Youth Compared to Controls
Many transitional age foster youth (TAFY) emancipate from the foster care system with little or no support or resources, experience higher rates of homelessness, unemployment and worse physical and mental health. However, factors related to health outcomes, readiness to transition and health services utilization (HSU) in TAFY and young adults without a history of foster care remains unclear. The purpose of this study was to compare health-related outcomes among TAFY and young adults without a history of foster care and determine the differences between transition readiness and HSU outcomes among TAFY. This was a cross-sectional, comparative study of 206 young adults (103 TAFY and 103 controls), ages 18 to 26 years, recruited from local foster youth centers in the Los Angeles area. Controls were matched for age, gender, and ethnicity from the California Health Interview Survey (CHIS) database. TAFY participants completed health interview questions from the CHIS and the Transition Readiness Assessment Questionnaire (TRAQ). In addition, the TAFY group provided written responses to open-ended questions to assess preparations for independent living, future goals and aspirations.
The TAFY group was 63% female, mean age 21 ï¿½ 2.6, African American (40%), 7 or more years in foster care (56%), 7 or more foster placements (35%), income of less than $5,000 per year (39%), living in unstable housing (40%), and having at least one child (38%). There was no statistical significance between TAFY and CHIS controls except for variables related to socioeconomic status such as income, housing and employment. Foster youth reported statistically significant higher Emergency Department (ED) services use and lower perceived health status compared to controls (41% vs 17%, p <.001; 56% vs. 83%, p <.001), respectively. Mean transition readiness scores were assessed using the TRAQ which rates transition readiness on a 1 to 5 scale, with higher numbers indicating better transition readiness. Higher mean TRAQ scores were found when TAFY were grouped according to having a primary care provider (PCP) or no PCP (3.1 vs 2.1, p < .001), receiving preventative health care or no preventative care (3.0 vs 2.1; p <.001), and having no lapse in health insurance coverage or no insurance (3.0 vs 2.3; p <.001) within the past 12 month. Three themes emerged in the open-ended questions were: 1) the need for support in the transition process, 2) desire for success or financial wealth, and 3) to be part of a family or have their own family.
The findings from this study suggest that TAFY living in Los Angeles showed decreased transition readiness and self-perceived health, increased physical and mental health conditions and HSU related to ED use compared to youth without a history of foster care. Routine screening for depression and early referral to mental health care and assessment of transition readiness is warranted to identify youth that lack independent living skills. Future research is needed to assess independent living skills educational programs and its impact on perceived transition readiness, HSU and health outcomes in this high risk vulnerable population.