Foster Care: Challenges in Helping Youths Live Independently (Testimony,
05/13/99, GAO/T-HEHS-99-121).

Pursuant to a congressional request, GAO discussed the Department of
Health and Human Services' Independent Living Program (ILP) and the
needs of youths leaving the foster care system, focusing on: (1) the
problems faced by foster care youths once they leave care; (2) what is
known about the extent of services provided by ILP; and (3) what is
known about the effectiveness of ILP.

GAO noted that: (1) the few available studies that track youths who have
exited foster care reveal that many have a difficult time making the
transition to living on their own; (2) the studies found that a
substantial portion of these youths have not attained basic education
goals, such as completing high school, and are dependent on public
assistance; (3) in addition, many experience periods of homelessness
after leaving care and have other difficulties that impede their
progress toward self-sufficiency, such as being unemployed; (4) in an
effort to help foster care youths become self-sufficient, state ILPs
offer a wide array of independent living services, including education
and employment assistance; training in daily living skills, such as
managing money, housekeeping, and personal hygiene; and additional
transitional services, such as supervised practice living; (5) however,
program administrators acknowledge that independent living services fall
short in key areas; (6) these administrators report that developing
appropriate employment opportunities for foster care youths, providing
supervised transitional housing arrangements, and developing program
activities that provide opportunities to practice the skills learned or
enhance youths' self-esteem has been difficult; and (7) moreover, there
are few evaluations that link program objectives to outcomes, leaving
questions concerning the effectiveness of the array of independent
living services.

--------------------------- Indexing Terms -----------------------------

 REPORTNUM:  T-HEHS-99-121
     TITLE:  Foster Care: Challenges in Helping Youths Live
	     Independently
      DATE:  05/13/99
   SUBJECT:  Foster children
	     Public assistance programs
	     Disadvantaged persons
	     Program evaluation
	     Education or training
	     Program graduation
	     Youth employment programs
	     Youth
IDENTIFIER:  HHS Independent Living Program
	     Contra Costa County (CA)
	     New York (NY)
	     Texas
	     Baltimore (MD)

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Cover
================================================================ COVER

Before the Subcommittee on Human Resources, Committee on Ways and
Means, House of Representatives

For Release on Delivery
Expected at 10:00 a.m.
Thursday, May 13, 1999

FOSTER CARE - CHALLENGES IN
HELPING YOUTHS LIVE INDEPENDENTLY

Statement of Cynthia M.  Fagnoni, Director
Education, Workforce, and Income Security Issues
Health, Education, and Human Services Division

GAO/T-HEHS-99-121

GAO/HEHS-99-121T

(116028)

Abbreviations
=============================================================== ABBREV

  GED - test
  HHS - test
  ILP - test

FOSTER CARE:  CHALLENGES IN
HELPING YOUTHS LIVE INDEPENDENTLY
============================================================ Chapter 0

Madam Chair and Members of the Subcommittee: 

I am pleased to be here today to discuss the Department of Health and
Human Services' (HHS) Independent Living Program (ILP) and the needs
of youths leaving the foster care system.  While some foster care
youths may be adopted or reunited with their families, each year
approximately 20,000 exit the foster care system with the expectation
that they will be self-sufficient.  Yet many of these youths face
serious problems, including homelessness, lack of employment
stability, incarceration, and pregnancy at an early age.  Recently,
the Congress has raised concerns that ILP, designed to help foster
care youths transition to living independently, does not provide the
necessary life skills to complete basic education, find and maintain
employment, or to otherwise live self-sufficiently after leaving
care. 

Today, I would like to focus my remarks on (1) the problems faced by
foster care youths once they leave care, (2) what is currently known
about the extent of services provided by ILP, and (3) what is known
about the effectiveness of ILP.  My testimony is based on our ongoing
work for this subcommittee, including our visits to locations in
California, Maryland, New York, and Texas and a preliminary review of
about one-third of the 1998 annual ILP reports submitted by states to
HHS. 

In summary, the few available studies that track youths who have
exited foster care reveal that many have a difficult time making the
transition to living on their own.  The studies found that a
substantial portion of these youths have not attained basic education
goals, such as completing high school, and are dependent on public
assistance.  In addition, many experience periods of homelessness
after leaving care and have other difficulties that impede their
progress toward self-sufficiency, such as being unemployed.  In an
effort to help foster care youths become self-sufficient, state ILPs
offer a wide array of independent living services, including
education and employment assistance; training in daily living skills,
such as managing money, housekeeping, and personal hygiene; and
additional transitional services, such as supervised practice living. 
However, program administrators acknowledge that independent living
services fall short in key areas.  These administrators report that
developing appropriate employment opportunities for foster care
youths, providing supervised transitional housing arrangements, and
developing program activities that provide opportunities to practice
the skills learned or enhance youths' self-esteem has been difficult. 
Moreover, there are few evaluations that link program objectives to
outcomes, leaving questions concerning the effectiveness of the
current array of independent living services. 

   BACKGROUND
---------------------------------------------------------- Chapter 0:1

ILP was initially authorized by P.L.  99-272 and reauthorized
indefinitely as part of the Omnibus Budget Reconciliation Act of 1993
(P.L.  103-66).  The act authorized federal funding of $70 million
per year for states to establish and implement services to assist
youths aged 16 and over make the transition to independent living
from foster care.  Services are provided for a short period of time,
and states have the flexibility to design services to meet a wide
range of individual needs.  A portion of the federal funds--$45
million--are distributed to states as an entitlement based on each
state's proportion of all youths receiving federal foster care
payments in federal fiscal year 1984 across the United States.\1
States are eligible to receive an additional share of the remaining
$25 million in federal funds if they provide funds to match the
federal dollars received.  Recently, the Congress and the
Administration proposed new initiatives designed to further help
adolescents move from foster care to adulthood, including increased
program funding, medical care coverage, and housing supports. 

HHS issued instructions to states in December 1993 outlining
allowable ILP services.  These services include education and
employment assistance; instruction in daily living skills; and
transitional support services, such as supervised practice living. 
In addition, states must provide youths written transitional
independent living plans based on an assessment of their needs and
may establish outreach programs to attract individuals eligible to
participate to the program.  Further, ILPs may include counseling and
other similar assistance related to education and vocational
training, preparing for a general equivalency diploma (GED) or higher
education, and counseling and training to enhance basic living skills
and interpersonal and social skills.  Eligible participants for
independent living services include all youths aged 16 and over for
whom federal foster care payments are being made.\2 At their option,
states may also serve foster care youths not receiving federal
assistance and former foster care youths who were in foster care
after the age of 16.  Likewise, states may provide services to any of
these youths until the age of 21.  Youth participation in ILP
services is voluntary. 

--------------------
\1 Under title IV-E of the Social Security Act, federal matching
funds based on the state's Medicaid matching rate are provided to
states for foster care maintenance costs to cover a portion of the
food, housing, and incidental expenses for foster care children from
families eligible for benefits under the former Aid to Families With
Dependent Children program using 1995 eligibility criteria.  States
incur all foster care costs for children not eligible for federal
support. 

\2 States can receive federal foster care maintenance payments for
eligible children while in foster care family homes, private for
profit or nonprofit child care facilities, or public child care
institutions.  Youths become ineligible for federal foster care
maintenance payments at age 18. 

   RESEARCH SUGGESTS THAT FOSTER
   CARE YOUTHS STRUGGLE TO REACH
   SELF-SUFFICIENCY
---------------------------------------------------------- Chapter 0:2

Many foster youths have a difficult time making the transition from
the foster care system to self-sufficiency.  While there are few
available studies tracking youths who have exited foster care, our
review of these studies reveals some consistent findings.  Research
has shown that many former foster care youths have serious education
deficiencies and rely on public assistance.  For example, a 1991
Westat study of foster care youths interviewed 2.5 to 4 years after
they left care found that 46 percent of these youths had not finished
high school.\3 Additionally, almost 40 percent were determined to be
a cost to the community, such as being dependent on some form of
public assistance or Medicaid.  Other research shows similar results. 
A 1990 study of former foster care youths in the San Francisco Bay
Area who had been out of care at least 1 year but no more than 10,
showed that 55 percent left foster care without graduating from high
school and that 38 percent still had not graduated at the time of the
study.\4 Similarly, the University of Wisconsin recently studied
youths who had been out of care between 12 and 18 months and found
that 37 percent had not finished high school and 32 percent were
receiving public assistance.\5

In addition, former foster care youths often find themselves lacking
adequate housing.  The Westat study reported that 25 percent of the
youths were homeless at least 1 night.  Likewise, the University of
Wisconsin study found that, since leaving care, 14 percent of the
males and 10 percent of the females had been homeless at least once
and 22 percent had lived in four or more places in the previous 12 to
18 months.  The connection between homelessness and prior episodes of
foster care can also be seen in a 1997 study of 400 homeless
individuals.\6 This study found that 20 percent had lived in foster
care as children and 20 percent had one or more children currently in
foster care. 

Additional difficulties may further impede former foster care youths'
ability to become self-sufficient.  For example, the Westat study
found that 51 percent of the youths were unemployed and 42 percent
had given birth or fathered a child.  Similarly, the University of
Wisconsin found that 39 percent of the youths were unemployed and
that 27 percent of the males and 10 percent of the females were
incarcerated at least once. 

At the same time, research has shown that addressing these
deficiencies can have a positive effect on former foster care youths. 
The Westat study found a connection between certain variables and the
youths' ability to live independently.  For example, the study showed
that completing high school prior to leaving foster care was related
to stable employment, not being a cost to the community, and overall
self-sufficiency.  Further, youths who held at least one job during
their stay in foster care were more likely to maintain a job after
care. 

Findings from the three studies we reviewed are summarized in table
1. 

                                     Table 1
                     
                       Outcome Information on Former Foster
                       Care Youths Reported in Three Recent
                                     Studies

Study and samples on
which
percentages are based      Outcome information on former foster care youths
-------------------------  -----------------------------------------------------
Westat (1991) study of     Education:
810 former foster care     --46 percent had not completed high school.
youths in eight states at  Employment:
2.5 to 4 years after       --51 percent were unemployed.
leaving care               --62 percent had not maintained a job for at least 1
                           year.
                           Other:
                           --40 percent were a cost to the community.
                           --25 percent were homeless at least 1 night.
                           --42 percent had birthed or fathered a child.

Courtney and Piliavin      Education:
(1998) study of 113        --37 percent had not completed high school.
former foster care youths  Employment:
in Wisconsin at 12 to 18   --39 percent were unemployed.
months after leaving care  --19 percent had not held a job since leaving care.
                           Other:
                           --32 percent received some kind of public
                           assistance.
                           --12 percent were homeless at least once (14 percent
                           males and 10 percent females).
                           --22 percent had lived in four or more places.
                           --44 percent reported problems with acquiring needed
                           medical care.
                           --27 percent of males and 10 percent of females were
                           incarcerated at least once.

Barth (1990) study of 55   Education:
former foster care youths  --38 percent had not completed high school.
in the San Francisco Bay   Employment:
Area at least 1 year and   --25 percent were unemployed.
no more than 10 years      Other:
after leaving care         --53 percent reported serious financial hardships.
                           --47 percent received some form of public assistance
                           or had problems paying for food or housing.
                           --35 percent were homeless or moved frequently.
                           --38 percent did not have health or medical
                           coverage.
                           --13 percent reported hospitalization for an
                           emotional problem.
                           --40 percent of females reported a pregnancy.
                           --35 percent had been arrested or spent time in jail
                           or prison.
--------------------------------------------------------------------------------

--------------------
\3 Westat, Inc., A National Evaluation of Title IV-E Foster Care
Independent Living Programs for Youth (Washington, D.C.:  HHS, 1991). 

\4 Richard P.  Barth, "On Their Own:  The Experiences of Youth After
Foster Care," Child and Adolescent Social Work, Vol.  7, No.  5 (Oct. 
1990). 

\5 Mark E.  Courtney and Irving Piliavin, Foster Youth Transitions to
Adulthood:  Outcomes 12 to 18 Months After Leaving Out-of-Home Care
(Madison, Wisc.:  University of Wisconsin, 1998). 

\6 Homes for the Homeless, Homelessness:  The Foster Care Connection
(updated Apr.  1997), http://www.opendoor.com/hfh/fostercare.html
(cited Dec.  9, 1998). 

   MULTIPLE SERVICES ASSIST YOUTHS
   IN ACHIEVING INDEPENDENCE BUT
   FALL SHORT IN KEY AREAS
---------------------------------------------------------- Chapter 0:3

To better ensure foster care youths are prepared to live as
self-sufficient adults, state ILPs provide an array of services,
including assistance with completing education and finding
employment; developing the basic skills needed to live independently,
such as money management, hygiene, housekeeping, and nutrition; and
transitional services, such as supervised practice living
arrangements.  However, state and local administrators acknowledge
that their current ILPs fall short in key areas.  For example, some
programs do not sufficiently seek out employment opportunities in the
community and offer few opportunities for youths to participate in
real-life practice opportunities or esteem-building experiences. 
Moreover, some programs could not provide adequate housing or other
transitional assistance for youths still in care and those who have
left care. 

      EDUCATION AND EMPLOYMENT
      ASSISTANCE
-------------------------------------------------------- Chapter 0:3.1

Our review of annual state reports and our visits to four locations
show that states provide services to help youths (1) complete high
school or a GED, (2) prepare for post-secondary or vocational
education, and (3) prepare for employment.  For example, in Contra
Costa County, California, an education specialist meets with youths
to discuss education goals, review grades, and assess education
needs.  If a youth is behind academically, tutoring services are
provided.  The specialist also sets up tours at local colleges and
vocational programs and assists youths in completing financial aid
applications.  A job development specialist assists difficult to
employ youths find self-supporting employment through such means as
coaching, counseling, and on-site job development training.  The
specialist also coordinates career fairs.  Youths in Baltimore
receive employment-related training that covers topics such as
writing resumes, preparing for interviews, conflict resolution, and
job retention. 

However, in the locations we visited, we found that the ILPs could
not fully provide services that matched the employment potential of
foster care youths to appropriate employment pathways.  For example,
officials in three of the locations we visited cited a lack of
vocational opportunities appropriate for youths.  State and local
coordinators in Texas indicated that few apprenticeship positions are
available, while officials in Baltimore and New York City reported a
lack of affordable vocational programs or funds to pay for such
programs.  Baltimore officials also reported that culinary arts and
technology-related programs--two programs popular with foster
youths--are very expensive.  Of the four locations we visited, only
Texas offers statewide tuition waivers for all state-supported
vocational, technical, and post-secondary schools. 

We also found that connections between ILP and potential employers
are not thoroughly developed.  For example, ILP coordinators in one
location said they did not have time to establish relationships with
many employers and that employment development efforts in their
locations were informal.  State officials in California and Maryland
indicated that they recognize more public-private partnerships to
provide youths with employment opportunities are needed.  In
addition, New York City officials reported that they are just
beginning to devise ways to link with employers to enhance youth job
prospects, such as developing internship opportunities.  Several
officials also pointed out that more staff need to be assigned to
accomplishing this task. 

      ASSISTANCE IN LEARNING DAILY
      LIVING SKILLS
-------------------------------------------------------- Chapter 0:3.2

Our review of annual state reports shows that many states help youths
develop daily living skills.  Each location we visited conducts
independent-living skills classes to teach youths tasks that are
necessary to live self-sufficiently.  For example, youths in Contra
Costa County, California, attend a series of workshops that cover
life skills such as money management, health and hygiene, parenting
and sexual responsibility, and effective communication.  Money
management covers topics such as how to prepare a budget and how to
open and use a checking account.  In the San Antonio, Texas, area,
life-skills classes meet for 8 weeks and cover core areas, including
personal and interpersonal skills, health and safety, money
management, and planning for the future.  In New York City,
life-skills classes provide similar instruction as well as
instruction on housekeeping, health care, interpersonal skills, food
management, transportation, and family planning. 

However, important hands-on activities to practice daily life tasks
and experiences to develop self-esteem were limited in some of the
locations we visited.  Some state and local program officials
acknowledged the importance of allowing youths to attempt (and
perhaps initially fail) daily tasks--including cooking, cleaning,
doing laundry, and comparison shopping--until they become proficient
at these tasks.  Program officials in two locations and foster care
youths in three locations reported that issues, such as safety
regulations for group homes, inhibit or prevent certain activities,
such as practicing cooking.  In some group homes, laundry products
and cooking utensils may be locked away from youths.  In addition,
esteem-building experiences are often limited to a small number of
youths.  For example, local officials in Texas reported that
opportunities for foster care youths to participate in post-secondary
school conferences or extended outdoor activities were limited.  In
addition, programs offering adult mentors--in an attempt to build
positive and lasting relationships--serve a small number of youths. 
For example, a foster care service provider in Texas--contracted by
the state specifically to develop mentor programs--reported
difficulties finding mentors.  However, officials in all locations
saw some type of mentor program as one method to provide youths with
a vocational role model and opportunities to practice other
independent living skills they have learned. 

      HOUSING AND OTHER
      TRANSITIONAL SUPPORT
      SERVICES
-------------------------------------------------------- Chapter 0:3.3

Based on our review of annual state reports and site visits, states
offer a variety of additional services to further help youths
transition to living on their own.  These include supervised practice
living arrangements--such as transitional housing programs--and
aftercare services for youths who have left the foster care system. 
Transitional housing programs--while designed slightly differently in
each location--provide an opportunity for youths to experience living
independently while still receiving supervision and financial
support.  In Baltimore County, Maryland, for example, the Challengers
Independent Living program seeks to provide youths who have
previously lived a dependent lifestyle with different or improved
means to cope with present and forthcoming independence once they
leave foster care.  Foster care youths can reside for 18 to 24 months
in apartments furnished and supervised by the service provider and
receive a weekly stipend to purchase clothing, food, and household
supplies.  They also are responsible for cleaning their apartments
and doing their laundry.  Each youth's foster care payment covers the
cost of rent, utilities, and administration of the program.  Program
staff also offer educational, vocational, clinical, and home-life
support, including additional independent-living skills training. 

Officials in the four locations we visited reported that the number
of supervised transitional housing sites is very limited and that
they could not provide adequate housing assistance for both youths in
care and those who have left the system.  The programs we visited
have a restricted number of spaces available--from 6 to 12 spaces. 
One transitional housing provider in Texas indicated that while the
program has spaces for 6 youth, an additional 80 to 100 youths with
no housing upon exiting foster care could benefit from this type of
housing program.  A transitional housing provider in a second
location explained that program staff carefully screen youths for
readiness and accept only the most promising teens into the program. 
Current foster care youths in Texas and former foster care youths in
California also emphasized the need for additional transitional
housing arrangements. 

Youths who have exited foster care face a number of obstacles in
finding housing, according to officials in the locations we visited. 
For example, many landlords are reluctant to rent apartments to a
youth without work experience or credit history.  In addition, foster
care youths who live in urban areas often do not earn a sufficient
income to pay the rents found in large cities and may find it
difficult to save enough money to pay for a security deposit. 
Officials in Baltimore reported that the local social services
department often writes a letter to the landlord on behalf of youths
to help them obtain housing. 

Finally, officials at the locations agree that youths who have left
the system often encounter hardships and need aftercare services from
time to time.  Although all of the locations we visited provide such
services, some officials noted that their aftercare services are not
extensive.  For example, in Texas, aftercare services are only
available for 6 months after the youth exits care.  The services
consist mainly of referrals to other service agencies, visits to
colleges, and a small stipend for 4 months.  Aftercare services in
Baltimore County and New York City are limited to referring the
youths to other agencies that can assist them.  However, at both of
these locations, youths have the opportunity to remain in foster care
until age 21 under certain circumstances.  Contra Costa County,
California, previously offered aftercare to youths up to age 19 on a
case-by-case basis; new state legislation mandates that ILP now serve
youths to age 21. 

   INFORMATION ON PROGRAM
   EFFECTIVENESS IS LIMITED
---------------------------------------------------------- Chapter 0:4

Given the significant challenges that foster care youths face in
moving from foster care to adulthood, it is important to understand
how effective ILPs are in better ensuring positive outcomes. 
However, few data are available to help in understanding what
outcomes are achieved through these programs.  States are required to
report to HHS participant achievement 90 days after program
completion, such as the number of youths who are employed, have
completed high school or a GED, are attending college, and are living
independent of public assistance.  However, state and local officials
reported much difficulty in finding youths to determine their living
status once they leave care.  These officials indicated they either
do not follow up with youths after leaving foster care or have little
success finding youths.  For example, a Maryland official stated that
response to follow-up contact in the past was very limited and that
only 15 percent of youths returned follow-up letters.  Local
officials in Texas estimated that about 30 to 35 percent of youths
disappear during the initial 90-day period and that some can only be
located through word-of-mouth or sibling contacts.  They noted that
following up with youths who received a stipend as part of aftercare
is less difficult. 

In addition, few formal studies have been conducted that measure ILP
effectiveness.  We found three studies--from Baltimore County, Harris
County (Houston, Texas), and New York City--that linked participation
in ILP with improved education, housing, and other outcomes.  In the
Baltimore County study, youths who received ILP services were more
likely to complete high school, have an employment history, and be
employed when they left foster care.\7 In the Harris County study,
the authors found that graduates of the Texas ILP achieved full-time
employment earlier and were more likely to complete high school or a
GED at a younger age than youths who did not receive independent
living services.\8 The New York City study of independent living
services provided by Green Chimneys Children's Services showed 75
percent of the youths had completed high school or a GED, 72 percent
had full-time employment when they left care, and 65 percent had
savings accounts.\9 Another study linked certain foster care
placements with greater attainment of practical living skills.\10
This study found that foster care youths placed in apartment-type
transitional housing scored higher on life-skills knowledge
assessment.  Finally, the Westat study found that youths who received
training in money management, obtaining a credit card, and buying a
car, as well as help in how to find a job and appropriate education
opportunities were more likely to maintain a job for at least a year. 
However, in some instances, ILP did not have the desired effects. 
For example, in the Westat study, researchers found that receiving
independent living services did not significantly reduce the
probability of early parenthood.  In addition, the Harris County
study found that program participants younger than 21 were more
likely to be dependent on different forms of public assistance--
specifically subsidized housing and food stamps--than the group of
nonprogram participants under age 21. 

State and local officials indicate, however, that determining
outcomes for former foster care youths is important, and two
locations have begun to design strategies to capture this much needed
information.  Contra Costa County, California, for example, has
funded a 2-year study geared toward measuring outcomes.  The study
will determine the status of youths at the time they enter ILP--such
as foster care placement stability, academic performance, and
living-skills assessment--and measure youth outcomes after ILP
services are given.  One goal is to use the information to develop
better aftercare programs.  Similarly, the Maryland Association of
Resources for Families and Youth--an association of private service
providers--recently began a project to provide the answers to three
questions:  Whom do we serve?  What services do we provide them?  and
What are the outcomes of those services?  The project requires data
collection while the youths are still in care; upon exit from care;
and at 6-, 12-, and 18-month intervals after leaving care. 

--------------------
\7 Maria Scannapieco and others, "Independent Living Programs:  Do
They Make A Difference?" Child and Adolescent Social Work Journal,
Vol.  12, No.  5 (Oct.  1995). 

\8 Jane T.  Simmons, "PAL Evaluation Final Report," unpublished
report submitted to Harris County (Texas) Children's Protective
Services (Mar.  6, 1990). 

\9 Gerald P.  Mallon, "After Care, Then Where?  Outcomes of an
Independent Living Program," Child Welfare, Vol.  77 (Jan./Feb. 
1998). 

\10 Edmund V.  Mech and others, "Life-Skills Knowledge:  A Survey of
Foster Adolescents in Three Placement Settings," Children and Youth
Services Review, Vol.  16, Nos.  3/4 (1994), pp.  181-200.

-------------------------------------------------------- Chapter 0:4.1

In our continuing analysis of ILPs, we plan to explore in greater
detail many of these issues, including any innovative strategies
being implemented in the states.  We also plan to look at HHS' role
in ensuring that performance measures are identified and implemented. 
This information will be presented in our final report to the
Subcommittee. 

Madam Chair, this concludes my prepared statement.  At this time, I
will be happy to answer any questions you or the other Members of the
Subcommittee may have. 

*** End of document. ***