Children and Youth Services Review

Children and Youth Services Review 33 (2011) 1749 1758 Contents lists available at ScienceDirect Children and Youth Services Review journal homepage: www.elsevier.com/locate/childyouth Lighthouse Independent Living Program: Predictors of client outcomes at discharge Alvin S. Mares a,, Mark J. Kroner b a The Ohio State University, College of Social Work, United States b Lighthouse Youth Services, Inc., Lighthouse Training Institute, United States article info abstract Article history: Received 26 February 2011 Received in revised form 12 April 2011 Accepted 19 April 2011 Available online 28 April 2011 Keywords: Foster care Independent living Outcomes This study examined clinical risk factors and their association with client outcomes at discharge among 385 emancipating foster youth in Cincinnati, Ohio, who entered the Lighthouse Independent Living Program during the period 2001 2005. These youth averaged 18 years of age and remained in the program an average of 10 months. At the time of discharge at age 19, 58% of these young adults had completed high school, 32% were employed, and 38% were living independently; 11% had achieved all three aforementioned outcomes. An exploratory principal components factor analysis of nineteen dichotomous risk factor items assessed by clinical staff at the time of admission yielded four types of risk: mental health problems, delinquency issues, teen parenting, and cognitive impairment. Logistic regression analysis revealed a number of significant relationships between each of these four clinical risk factors and client outcomes after adjusting for demographic and program characteristics. Those with mental health problems were only half as likely as others to have attained all three outcomes. Parenting youth were only half as likely to have completed high school or to be employed as others. Those with delinquency issues were only one-fourth as likely than others to be independently housed at discharge. Finally, older youth and those remaining in the program longer showed more favorable outcomes than others. Implications for child welfare policy and practice pertaining to independent living are discussed. 2011 Elsevier Ltd. All rights reserved. 1. Introduction Three common outcomes of interest among youth aging-out of foster care include completing high school, being employed, and living independently. Among emancipated youth ages 18 to 21 years, reported high school completion rates have ranged from 37 to 75%, employment rates have ranged from 39 to 60%, and independent housing rates have ranged from 22 to 44% (Barth 1990; Cook 1994; Courtney et al. 2005; Courtney et al. 2007; DHHS, 2008a; Fowler & Toro 2006; Georgiades 2005; Lindsey & Ahmed 1999; Mallon 1998; McMillen & Tucker 1999; Mech & Che-Man Fung 1999; Reilly 2003; Scannapieco, Schagrin, & Scannapieco 1995). Recent findings from the Midwest Evaluation of the Adult Functioning of Former Foster Youth (or the Midwest Study) an on-going, longitudinal study of 732 emancipated foster youth from Iowa, Wisconsin, and Illinois identified four subgroups of emancipated foster youth at 24 years of age: accelerated young adults (36%), struggling parents (25%), emerging adults (21%), and troubled and troubling adults (18%) (Courtney, Hook, & Lee 2010). These subgroups were developed based upon living arrangement, educational attainment, employment, childbearing, and criminal conviction outcomes 2 to 6 years after aging-out of care. Corresponding author at: College of Social Work, The Ohio State University, 325-Q Stillman Hall, 1947 College Rd., Columbus, OH 43210, United States. Tel.: +1 614 292 0425; fax: +1 614 292 6940. E-mail address: mares.2@osu.edu (A.S. Mares). To promote self-sufficiency and more positive long-term outcomes among youth aging-out of care, Congress has passed three pieces of legislation: the Independent Living Initiative (1986), Chaffee Foster Care Independence Program (1999), and Fostering Connections to Success and Increasing Adoptions Act (2008). In 1986, Title IV-E of the Social Security Act was amended to establish a new federal initiative, named the federal Independent Living Initiative (ILI) (42 U.S.C. Sec. 677), to help foster youth ages 16 or older to live independently after reaching adulthood by enabling states to develop life skills, academic achievement, and vocational training programs to avoid homelessness, dependence on public assistance, and institutionalization after emancipating from care. Those new funds were not, however, allowed to be used for room and board (Hardin 1987; Mech 1988). In 1999, Congress responded to independent living research findings and child welfare advocates by amending Title IV-E of the Social Security Act and redesigning the federal ILI by enacting the Foster Care Independence Act of 1999 (FCIA; H.R. 3443/P.L. 106 169) and the John H. Chafee Foster Care Independence Program (CFCIP). This Act and Program provide states with more funding and greater flexibility in carrying out programs designed to help children make the transition from foster care to self-sufficiency, including for the first time authorization for states to use up to 30% of their allotted federal independent living funds to provide housing assistance for current and emancipated foster youth (Allen & Bissell 2004). In 2009 the federal government provided $140 million in CFCIP grant funds to states. In 2007, all 52 states received CFCIP grants, which averaged $3.9 million per state, and ranged from a minimum of $500,000 0190-7409/$ see front matter 2011 Elsevier Ltd. All rights reserved. doi:10.1016/j.childyouth.2011.04.028

1750 A.S. Mares, M.J. Kroner / Children and Youth Services Review 33 (2011) 1749 1758 awarded to less populated and smaller states (e.g., Alaska, Delaware and six other states) to $12 million for New York and $21 million for California (NRCYD, 2010). More recently, the Fostering Connections to Success and Increasing Adoptions Act of 2008 (H.R. 6893/P.L. 110 351) was enacted to improve outcomes for children in foster care, in part by authorizing states to expand the definition of child for Title IV-E reimbursement purposes to include youth ages 18 20 years of age who are enrolled in secondary and post-secondary education and vocational training programs, who are employed at least 80 h per month, or who are incapable of attending school or working due to a medical condition. Moreover, this Act requires caseworkers to develop individualized post-emancipation transition plans for emancipating youth including specific options regarding housing, health insurance, education, local opportunities for mentors and continuing support services, and work force supports and employment services at least 90 days prior to leaving care (H.R. 6896, Title II, Sections 201 and 202). The effectiveness of these three federally funded, state and locally administered programs is largely unknown. An evaluation of Independent Living Initiative-funded programs conducted by Westat involving 810 youth in eight states found that skills training in budgeting, credit, consumer skills, education, and employment lead to positive outcomes in those areas (Cook, Fleishman, & Grimes 1991). Recent evaluations of Chafee Foster Care Independence Act-funded life skills training and mentoring programs in Los Angeles County found no demonstrable benefits (DHHS, 2008a; DHHS, 2008b). Preliminary findings from a third evaluation of an outreach intervention for emancipating youth in Massachusetts found more positive outcomes in the area of postsecondary educational attainment. Findings from a fourth Chafee Foster Care Independence Act-funded program have not yet been reported. Finally, evaluations of more recently implemented independent living programs or services following the enactment of the Fostering Connections Act in 2008 have yet to be conducted. Few studies have identified predictors of educational attainment and/or employment outcomes among emancipating or emancipated foster youth. Surprisingly, there have not been any published studies identifying correlates of independent housing. Nor have any published studies identified predictors of client outcomes for a specific independent living program. This study addresses this gap in the published literature by identifying predictors of client outcomes at discharge for a specific independent living program which began operating in southwestern Ohio in 1981, 5 years prior to enactment of the Independent Living Initiative, and has continued operating without interruption to the present day. More specifically, we first identify the major types of clinical risk factors presented by youth at the time of admission into the program and then examine the relationships between these types of clinical risk factors and outcomes at discharge, adjusting for key demographic and programmatic characteristics. This approach is similar to the one used by McMillen and Tucker (1999), except that it is applied to a sample of clients from a specific independent living program rather than to a broader sample of emancipating foster youth from a given state. In doing so, we attempt to test the hypothesis that differences in client outcomes reported in the literature may be at least partly attributed to differences in clinical risk factors presented by youth upon admission into independent living. 2. Literature review To our knowledge, the study reported here is the first to identify predictors of client outcomes for a specific independent living program using multivariate analysis. Two recently published experimental evaluation studies of specific independent living programs in Los Angeles (DHHS, 2008a; DHHS, 2008b) contain data allowing for such analyses, but focus on the comparison of treatment and control group subjects' receipt of services and outcomes, somewhat like earlier effectiveness studies which utilized quasi-experimental research designs (e.g., Georgiades 2005; Lindsey & Ahmed 1999; Scannapieco et al. 1995). Other studies have described longer-term outcomes among emancipated foster youth (e.g., Courtney et al. 2005; Courtney et al. 2007; Courtney et al. 2010; Daining & DePanfilis 2007; Fowler & Toro 2006; Lorentzen, Lemley, Kimberlin, & Byrnes 2008; McCoy, McMillen, & Spitznagel 2008; Reilly 2003). There have, however, been seven studies which have identified predictors in multivariate models of educational attainment and employment outcomes among young adults who either emancipated from foster care or who experienced foster care at some time during their youth to which the findings of this independent living program-specific study may be compared. While non-equivalent, these previously studied populations and samples offer the most nearly equivalent populations/samples that are currently available to the housing-based independent living program sample examined in this paper. These previously studied foster care-related populations/samples and the salient findings pertaining to predictors of educational and employment outcomes during early adulthood are summarized in Table 1, and described briefly below. Worth noting, none of these studies identified predictors of any type of independent living housing outcome. 2.1. Casey Alumni Study The Casey Alumni Study was the largest study spanning the longest timespan identifying predictors of completing high school. In 1998, as the federal Independent Living Initiative era of independent living was coming to a close, Casey Family Programs identified 979 emancipated foster youth clients served by 23 field offices operating in 13 states during the period 1966 1998. Multivariate analysis of case records and alumni interview data identified the following positive predictors (a.k.a., protective factors) for completing high school before leaving foster care: age at first placement into foster care, time in family foster care, time in group care, time between first placement into foster care and entry into Casey long-term foster care, receipt of tutoring and any independent living training, employment experience, and a good relationship with last foster family after entering Casey Family Program. In contrast, negative predictors (a.k.a., risk factors) included placement changes after entering Casey Family Program, criminal activity, and having a school-related diagnosis (e.g., ADHD) (Pecora et al. 2006). 2.2. Westat evaluation of Title IV-E (independent living initiative) independent living programs Perhaps the most extensive, nationally representative study identifying predictors of both completing high school and being employed prior to discharge conducted to-date is the national evaluation of Independent Living Initiative programs conducted by Westat. This study involved 810 youth who emancipated from care during the one-year period 1987 1988 in eight states. Receipt of any life skills training was positively associated with completing high school, but not for being employed before leaving care (Cook et al. 1991). 2.3. Missouri study A cross-sectional study of 252 emancipating foster youth in Missouri during the one-year period 1992 1993, mid-way through the Independent Living Initiative era, utilizing state administrative data and case records review data identified several predictors of both completing high school and being employed at the time of discharge. Age at exit was found to be a positive predictor, and psychiatric placement, running away, and mental retardation were found to be negative predictors for completing high school. Primary predictors for being employed included number of foster care placements (negative) and completing high school (positive). Secondary predictors of being employed, namely significant predictors without including high school completion in the regression model, included living in an urban area and placement due to

Table 1 Summary of previous studies identifying predictors of completing high school and/or being employed among emancipated foster youth. Authors Sample and data source(s) Years and IL Era Predictors of completing high school Predictors of being employed (Berzin 2008) (Cook et al. 1991) (Dworsky 2005) (Goerge 2002) (Macomber et al. 2008) (McMillen & Tucker 1999) (Pecora et al. 2006) Random national sample of foster (n=126) and matched non-foster youth (n=126) ages 12 25 born between 1980 and 1984 National Longitudinal Survey of Youth 1997 Random national sample of foster youth discharged from care at the age of 16 or older from 8 states during a one-year period (1987 88) (n=810), both prior to discharge (Phase I) and 2 4.5 years post-discharge (Phase II) State administrative data, case records review and interviews Former foster youth who were discharged from Wisconsin's out-of-home care system between 1992 and 1998 and were at least 16 years old at the time they were discharged (n=8511) followed 2yearsafterdischarge State administrative data Emancipated foster youth (n=4213) and reunified foster youth (n=5415) from IL and SC (1996 97) and CA (1995 96), IL and SC followed for 2 year. after 18th birthday State administrative data Foster youth ages 17 years and above who were in care at the end of 1998 in CA (n=, MN, and NC, and who eventually aged out of care (n=3301) State administrative data Random sample of foster youth in Missouri (n=252)) who emancipated from care during 1-yr. period 1992 93 and who were at least 17 year. of age (mean age 18.4 year. at discharge) State administrative data and case records review Youth served by Casey Family Programs long-term family foster care programs operated by 23 field offices in 13 states (as of 1998) during the previous 32-year period who aged-out of care after 17 year. of age (n=979) Case record reviews and interviews 1997 2005; last 2 years of ILI through first 6 years of CFCIP At or below poverty for h.s. diploma Foster status, race, gender, and age all not significant predictors Source: Table 4 1987 1991; years 2 6 of ILI Receipt of any life skills training for com pleting h.s. prior to discharge) Source: Table 2 3 1992 2000; last 6 years of ILI to first 2 years of CFCIP 1995 1999; last 3 years. of ILI to first year of CFCIP N/A N/A N/A Receipt of any life skills training not significant predictor of being employed while in foster care Source: 2 3 Age at discharge and employment while in foster care were positive predictors for time to employment post-discharge Gender (male), race (minority), adjudication status (child welfare other than abuse/neglect and voluntary), and type of discharge (aging-out, runaway or transfer out of state) were negative predictors for time to employment post-discharge Source: Table 7 Predictors of any employment during first 2 year. post-discharge varied by state: IL: male, minority and urban county negative predictors SC: aging-out (vs. reunification) positive predictor CA: Hispanic, age entering foster care, aging-out positive predictors; urban county negative predictor Source: Table 7a 1999 2005; majority of CFCIP N/A Predictors of any employment at age 24 varied by state: CA: group home, unspecified exit, urban Los Angeles negative predictors; Hispanic, work experience before age 18 positive predictors MN: number of placements, sexual abuse negative; female, rural positive NC: other abuse negative Source: Table 5 1992 93; middle of ILI Positive predictor: age at exit Negative predictors: psychiatric placement, running away, mental retardation Source: Table 5 1966 1998; pre-ili to end of ILI Positive predictors for completing h.s. before leaving care: age at first placement, time in family foster care, time in group care, time between first placement and entering Casey, tutoring, IL training, employment experience, good relationship with last foster family Negative predictors: placement changes while in Casey, criminal activity, school-related diagnosis Source: Table 3 Primary predictors: number of foster care placements (negative) and completing school (positive) Secondary predictors: urban area and placement due to sexual abuse (negative); participation in IL skills group (positive) Source: Table 5 N/A A.S. Mares, M.J. Kroner / Children and Youth Services Review 33 (2011) 1749 1758 1751

1752 A.S. Mares, M.J. Kroner / Children and Youth Services Review 33 (2011) 1749 1758 sexual abuse (negative) and participation in independent living life skills group (positive) (McMillen & Tucker 1999). 2.4. Secondary analysis of National Longitudinal Survey of Youth (NLSY 1997) A secondary data analysis of NLSY 1997 data involved a nationally representative random sample of 126 foster youth and 126 matched non-foster youth control subjects who were born between 1980 and 1984 and who were interviewed annually during the period 1997 2005, during the last 2 years of the Independent Living Initiative through the first 6 years of the Chafee Foster Care Independence Program era. Multivariate analysis of longitudinal data aggregated across the eightyear follow-up period for youth ages 12 25 found that poverty status was a negative predictor for completing high school which eclipsed foster status, race, gender, and age, none of which were found to be significant predictors after adjusting for poverty status (Berzin 2008). 2.5. Employment studies Three studies have been conducted identifying predictors of employment outcomes 2 to 6 years after emancipating from foster care. All three studies utilized administrative data collected by the state agencies responsible for monitoring foster care and employment and unemployment benefits. The first study examined predictors of employment among 8511 foster youth in Wisconsin who emancipated from care during the six-year period 1992 1998. Positive predictors of being employed 2 years after discharge included age at discharge and predischarge employment. Negative predictors included gender (male), race (minority), adjudication status (child welfare other than abuse/neglect and voluntary), and type of discharge (aging-out, running away, or transferring out of state) (Dworsky 2005). Goerge (2002) conducted similar analyses among 9628 emancipated and reunified foster youth from three states Illinois, South Carolina, and California who were discharged during the period 1995 1997 and followed for 2 years after their 18th birthday. Predictors of any employment at age 20 were found to vary across states. In Illinois, gender (male), race/ethnicity (minority) and living in an urban county were all negative predictors. In California, living in an urban county was also a negative predictor, while being Hispanic was a positive predictor, along with age entering foster care. In South Carolina, the only predictor was aging-out of care (positively, versus reunification). The only study to identify predictors of employment during the more recent Chafee Foster Care Independence Program era was conducted by the Urban Institute (Macomber et al. 2008). Emancipating foster youth (n=3301) who were in care at the end of 1998 in three states California, Minnesota, and North Carolina were followed for 6 years (e.g., through 24 years of age). As with the Goerge (2002) study, predictors of any employment varied by state. Once again, being Hispanic was a positive predictor of any employment at 24 years of age, and living in an urban area (i.e., Los Angeles) was a negative predictor for youth in California. Other employment predictors among California youth included living in a group home and an unspecificexit(negative) and having work experience while still in care (positive). Among Minnesota youth, the number of placements and sexual abuse were negative predictors, while being female and living in a rural area were positive predictors. The only predictor found among North Carolina youth was a type of abuse other than physical or sexual. 3. Description of Lighthouse Youth Services and the Lighthouse Independent Living Program Lighthouse Youth Services is a private non-profit organization established in 1969 in Hamilton County, Ohio. The agency has seven divisions which served over 4000 children, youth, and families in 2008, employed a staff of over 370, and maintained an annual operating budget of $18 million. The seven service divisions include: Homeless and Runaway Youth, Early Childhood Service, Juvenile Corrections, Foster Care and Independent Living, Home Based Service, Community Based Residential Treatment, and Education. The Lighthouse Independent Living Program (ILP) began in 1981 in order to help youth leaving the child welfare and juvenile justice systems, who were unable to return home, to make the transition to self-sufficiency. In Ohio, most youth are discharged before the age of 19. In response to this Lighthouse accepts most youth into its scattered-site apartment program at 17.9 years of age. Youth often come from the agency's foster or group homes or a correctional program Lighthouse operates in rural Ohio. The ILP has served over 2400 youth since then and has served as a model program for many new programs around the country. Among the 455 clients admitted into the program between 2001 and 2006, 83% were referred by Hamilton County, including 59% who entered the program from either a foster care home (40%) or from a group home (19%) (Kroner & Mares 2009). Most of these 455 youth referred to the program presented with a range of risk factors. The average Global Assessment of Functioning Scale (GAF) a common measure of overall functioning used within the mental health field ranging from 1 to 100, with a higher score indicating a higher level of functioning (DSM-IV-TR, 2000) was 60.9 for all referred youth indicating moderate difficulty in social, occupational or school functioning (e.g., few friends, conflicts with peers or co-workers). Youth scored an average of 76.7 on a 130 point self-sufficiency skills scale created by the program for case managers to assess client's knowledge and skills in a variety of independent living life skills domains, similar to the Ansell Casey Life Skills Assessments. Nearly half (47%) had chronic mental health issues, 41% had a history of chronic truancy and school problems, 41% had a history of delinquency, 42% had little or no work experience and 27% had been violent toward people in the last several years (i.e., any indication of fighting or domestic violence, either at home or at school, documented in clients' clinical records) (Kroner & Mares 2009). Lighthouse decided years ago that it would accept high risk youth into the ILP, knowing that many had never shown much success in previous placements. The agency felt that high risk youth needed at least a chance to learn to live independently with hope that new challenges directly related to the youth's survival would serve as a source of motivation for learning. To meet the needs of these clients the Independent Living Program (ILP) program provides the following services: basic, direct treatment, independent living life skills training, and referral. Basic services include shelter, food, clothing, transportation, and education. All youth are assisted with finding an appropriate living arrangement. The ILP rents apartments from private landlords in the county in neighborhoods that are affordable and close to the client's school, job, and social supports. The program also operates two shared-homes, one for males and one for females, which have 3 4 beds and a live-in resident manager. The program pays the security deposit and furnishes the apartments with necessary supplies and a telephone. If the client does well and has a job at termination, s/he can keep the apartment and all of the furnishings and assume responsibility for the lease. The ILP also provides a weekly allowance of $55 for basic support, $10 of which is saved in an aftercare fund. This money is used for food, personal items, cleaning supplies, etc. The agency also covers utility, phone, and rental payments until the last few months in the program, when bills are taken over by the client, if possible. The ILP assists clients with work clothing, minor school fees, and miscellaneous expenses. Most clients are expected to work a parttime job and purchase any items beyond the basic necessities. Direct treatment includes case management and clinical treatment provided by ILP and Lighthouse staff. Each youth is assigned to a licensed social worker with a caseload of 8 14 clients. Other program staff members also assist with client problems as they arise. Clients are usually seen or contacted several times during each week including regular phone contact. Vulnerable or new clients are asked to call in daily. Program staff maintain a 24 hour on-call system. Specific needs

A.S. Mares, M.J. Kroner / Children and Youth Services Review 33 (2011) 1749 1758 1753 are addressed depending on the client's situation. For example, 18% of all clients received some type of group counseling, 12% had tutors, 11% were monitored for medication compliance. ILP staff provide 24- hour crisis management, which can involve hospital runs, resolving client/tenant problems, apartment maintenance issues, confronting client friends/family who are causing problems at the apartment, and so forth. This activity is time consuming but is a critical part of the process of learning responsible behavior. Independent living life skills training is provided, in collaboration with the local county child welfare system to provide 13, four hour classes on self-sufficiency, hopefully completed prior to the youth's placement in an IL arrangement. Topics include an assessment of current level of functioning, money management, time-management/planning ahead, use of community resources, apartment management, nutrition/food preparation use of public transportation, social skills, employment skills/finding and holding a job, problem solving and decision making, self-care, and building a support network. A portion of referred youth have already completed the county's life skills training program and focus more on education and employment activities than life skills. Other referred youth have completed some life skills training before entering the ILP. Still others have not completed any life skills training. After entering the ILP, clients may or may not receive such formal, classroom-based life skills training. Among the 455 youth who entered the program between 2001 and 2006, 67% had received at least some formal life skills training before leaving the ILP program. Types of training provided either prior to admission or during their stay in the program included parenting classes (16%), employment/vocational training (54%), and educational and vocational interests and skills assessments (24%) (Kroner & Mares 2009). Referral for relevant educational, vocational, therapeutic, medical, dental, and other needed resources and services provided by other service agencies is arranged by ILP staff as-needed. Everyone works toward the goal of the youth gaining maximum self-sufficiency given the time available and the developmental capabilities of the youth. Fifty-nine percent (59%) of all youth were connected with outside community resources such as mental health (20%), GED (19%), Child care (5%), and legal help (6%) (Kroner & Mares 2009). 4. Methods 4.1. Sample The sample consisted of all 385 youth who were admitted into the Lighthouse Independent Living Program during the five-year period 2001 2005. Overall, clients averaged 17.9 years of age upon entry into the Independent Living Program, with ages ranging from 16 to 20 years. Female and non-caucasian youth represented 58% and 70% of the sample, respectively. The average length of stay in the program was 9.9 months, ranging from 0 to 32 months. Sixty nine percent had received at least some life skills training prior to discharge, including training pertaining to employment skills (54%), vocational training (16%), GED preparation (8%), and violence prevention (5%) (Kroner & Mares 2009). Life skills trainings were typically provided in a classroom setting during weekly two-hour meetings over a ten-week period. 4.2. Measures Client-level administrative and clinical records were used to assess whether the youth had exhibited each of 19 clinical risk factors at the time they entered the program and to measure their outcomes at discharge. Twenty two dichotomous clinical risk factors or barriers/challenges facing foster youth preparing for emancipation were developed by the second author, who served as director of the IL program for nearly 18 years. Two Lighthouse staff then checked all applicable risk factors for each subject, based upon a review of various records, including: (a) intake/admission records (i.e., the Referral Sheet, Social History Form, and Intake Screening Form; (b) treatment records (i.e., Diagnostic Assessment Form, Incident Report, and progress notes; and, (c) discharge records (i.e., Termination Summary Form). A detailed summary of the operational definitions used during this chart abstraction process has been previously reported (Kroner &Mares 2009). The abstraction process required over 100 total person hours of effort, spread over a five-month period (January through May 2008), and divided between two abstractors. The first abstractor served as Administrative Assistant for the ILP for over 15 years. The second was a licensed clinical social worker (LSW) who had worked at Lighthouse for several years. Cases were split between these two abstractors, with one taking those clients admitted during the period 2001 2004, whose records were archived in paper form, and the taking clients admitted more recently (i.e., during the period 2005 2006), whose records were accessible in electronic form. Previous descriptive analysis of risk factors data by the authors based on observation (i.e., which factors appeared to belong together) based on 19 of the original 22 dichotomous risk factors might be classified into six risk domains, including 1) mental health and substance abuse, 2) socialization, 3) delinquency, 4) teen parenting, 5) cognitive impairment, and 6) motivation and health (Kroner & Mares 2009). In this study, bivariate analysis of these risk factors data was used to develop an empirically-based, four-factor classification of risk. Client demographic data (i.e., age at admission, gender, race/ethnicity) and program participation data (i.e., length of stay and receipt of any life skills training) were also collected. Four dichotomous client outcome measures included 1) completing high school or the equivalent (i.e., received either a high school diploma or GED), 2) being employed or completing a vocational training program, 3) living independently (i.e., renting an apartment or a private room in a house, either alone or with someone else), and 4) completing high school, being employed, and living independently. 4.3. Data analysis An exploratory factor analysis was conducted to identify clinical risk factor groups. The method of extraction used was principal components analysis (PCA) with varimax rotation and Kaiser normalization. PCA attempts to identify underlying variables, or factors, that explain the pattern of correlations within a set of observed variables. The first component explains the maximum variance. Successive components explain progressively smaller portions of the variance and are all uncorrelated with each other. Varimax rotation is an orthogonal rotation method that minimizes the number of variables that have high loadings on each factor. This method simplifies the interpretation of the factors. Logistic regression was then used to first examine the association between clinical risk factor cluster groups and client outcomes initially without any covariates (descriptively in Table 4 and bivariately in Table 5), and then after controlling for socio-demographic characteristics, program length of stay and receipt of any life skills training (multivariately in Table 6). 5. Results 5.1. Prevalence of risk factors The seven most common clinical risk factors included having a chronic mental health problem (49%), a history of truancy or school problems (43%), poor judgment (36%), violence towards others (29%), running away (18%), taking psychotropic medication (18%), and having one or more children (17%) (Table 2). 5.2. Risk factor cluster analysis A four-factor model produced the most interpretable solution. The results are shown in Table 3. Twelve of the 19 items loaded highest on the first factor, including four that had factor loadings greater than 0.50:

1754 A.S. Mares, M.J. Kroner / Children and Youth Services Review 33 (2011) 1749 1758 Table 2 Prevalence of individual (non-mutually exclusive) clinical risk factors among all ILP clients admitted between 2001 and 2005 (n=385). % n Clinical risk factors Mental health and substance abuse problems Chronic mental health issues 49 188 On psychotropic medication 18 68 Chemically dependent 10 39 Made a suicide attempt in last year 5 20 Socialization problems Chronic history of truancy or school problems 43 164 Ran away from a stable placement in the last year 18 68 No known social supports 12 46 Motivation and physical health problems History of poor judgment 36 138 Avoids responsibilities as much as possible 15 59 Chronic medical issues 12 47 Delinquency problems Violent toward people in last several years 29 113 More than two misdemeanors in last year 11 42 Committed a felony offense in last year 8 30 Involved in gang activities 1 3 Parenting One or more children 17 65 Pregnant 6 21 Cognitive impairment Limited intellectual abilities 7 25 Diagnosed developmental disability 4 16 Cannot read or write 1 5 having chronic mental health issues, taking psychotropic medication, having a history of poor judgment, and having a history of chronic truancy or school problems. We identified this first factor as mental health problems. Two of the items, involvement in gang activities and committing a felony offense in the last year, loaded highly on the second factor which we identified as delinquency problems. Two of the items, being pregnant and having one or more children, loaded highly on the third factor which we identified as parenting. Finally, two of the items, having limited intellectual ability and having a diagnosed developmental disability, loaded highly on the four factor which we identified as cognition. We used the ten items that had factor loadings greater than.5 to construct four dichotomous variables corresponding to the four factors. Each variable was assigned a value of one if the client had exhibited any of the characteristics that loaded highly on the corresponding factor and zero otherwise. For example, a client's score on the mental health problems cluster variable would be one if that client had any of the four characteristics that loaded highly on that factor (i.e., items 1 to 4 with factor loadings greater than.5) and zero if the client had none of those characteristics. The prevalence of risk factor clusters based on this short list of ten risk factor items among the subjects was 64% for mental health, 20% for parenting, 10% for cognition, and 8% for delinquency (Table 3). 5.3. Comparison of unadjusted client outcomes across clinical risk factor cluster groups A total of eleven non-mutually exclusive clinical risk factor cluster groups were observed among the total study sample of 385 clients, based on the use of those short list risk factor items described above. These included 31% (n=120) low risk clients who were not classified into any of the four risk cluster groups, 38% (n=145) moderate risk clients who were classified into only one risk cluster group (including 33% for mental health problems, 4% for teen parents, 0.5% for cognitive impairment), and 31% (n=120) high risk clients who were classified into two or more risk groups. The mental health problems cluster, in combination with one or more of the other three risk factor cluster groups, accounted for all of the 120 high risk clients. None of the clients Table 3 Results of principal component factor analysis identifying clinical risk clusters. Clinical risk clusters Factor loadings 1st 2nd 3rd 4th Mental health Delinquency Parenting Cognition Clinical risk factors (n=248, 64%) (n=31, 8%) (n=78, 20%) (n=37, 10%) Mental health and substance abuse problems Chronic mental health issues (1) 0.75 0.08 0.06 0.12 On psychotropic medication (2) 0.65 0.22 0.21 0.08 Chemically dependent 0.38 0.33 0.17 0.22 Made a suicide attempt in last year 0.34 0.01 0.06 0.29 Socialization problems Chronic history of truancy or school problems (3) 0.62 0.12 0.32 0.24 Ran away from a stable placement in the last year 0.49 0.03 0.30 0.06 No known social supports 0.37 0.26 0.08 0.04 Motivation and physical health problems History of poor judgment (4) 0.67 0.29 0.06 0.04 Avoids responsibilities as much as possible 0.43 0.20 0.03 0.01 Chronic medical issues 0.31 0.15 0.12 0.05 Delinquency problems Violent toward people in last several years 0.42 0.34 0.13 0.13 More than two misdemeanors in last year 0.49 0.09 0.11 0.01 Committed a felony offense in last year (5) 0.06 0.63 0.13 0.04 Involved in gang activities (6) 0.04 0.72 0.02 0.04 Parenting One or more children (7) 0.04 0.19 0.61 0.08 Pregnant (8) 0.02 0.04 0.67 0.14 Cognitive impairment Limited intellectual abilities (9) 0.07 0.12 0.02 0.79 Diagnosed developmental disability (10) 0.07 0.06 0.37 0.53 Cannot read or write 0.04 0.02 0.20 0.36 % Variance explained by all items in each factor 16.6% 7.8% 7.1% 6.8% % Variance explained by all four factors 38.3% Bolded factor loadings are 10 highest among 19 items (i.e., loading 0.50).

A.S. Mares, M.J. Kroner / Children and Youth Services Review 33 (2011) 1749 1758 1755 Table 4 Comparison of client outcomes at discharge (mean age 18.7 years.) across clinical risk factor cluster groups (descriptive and bivariate analyses, unadjusted for demographic or program participation characteristics). High school (S) Employed (E) Housed (H) All (S+E+H) n % n % n % n % No risk factor clusters (n=117; 32%) 76 65% 46 40% 51 43% 27 23% One or more risk factor cluster(s) (n=253; 68%) 141 56% 73 29% 92 36% 24 10% Single risk factor cluster Mental health problems (MH) (n=128; 35%) 82 64% 41 32% 47 37% 14 11% Teen parent (n=14; 4%) 11 79% 4 29% 8 53% 1 7% Multiple risk factor clusters MH and teen parent (n=58; 16%) 20 35% 15 25% 29 49% 8 14% MH and cognitive impairment (n=28; 8%) 13 46% 9 32% 6 21% 1 4% MH and delinquency issues (n=25; 7%) 15 60% 4 16% 2 8% 0 0% Total (n=370; 100%) 217 59% 119 32% 143 38% 51 14% Chi-square comparisons between no risk factor clusters vs. one or more risk factor cluster(s). pb.05. pb.001. Excluding ten clients classified into five less common risk factor cluster groups (i.e., groups having fewer than five clients), including: MH, delinquency and cognitive impairment (n=4); MH, cognitive impairment and teen parent (n=2); MH, delinquency and teen parent (n=1); cognitive impairment only (n=2); and, all four clusters (n=1)). Also excluding five clients with incomplete outcomes data. were classified into the delinquency risk group alone, rather 8% (n=31) of clients were classified into the mental health problems, delinquency issues, and possibly one or two other risk factor clusters. Only seven clients were classified into three risk cluster groups, and one client into all four risk cluster groups (data not shown). A comparison of client outcomes among the 370 clients (96% of the total sample) for whom complete outcomes data were available and who were classified into the six most common risk factor cluster groups (including the no clusters/low-risk clients) found considerable variability across risk factor cluster groups. No risk factors group/low-risk clients were significantly more likely to be employed (40% versus 29%, pb.05) and more likely to have successfully attained all three outcomes of interest (23% versus 10%, pb.001) than medium and high risk clients (Table 4, rows 1 and 2). Graduation rates ranged from 35% among teen parents with mental health problems to 79% among teen parents who did not belong to any other risk factor clusters (Table 4, Graduated column). Employment rates ranged from 16% among clients with both mental health problems and delinquency issues to 32% among those cognitively impaired clients with mental health problems and among clients with mental health problems alone (Table 4, Employed column). Housing rates ranged from 8% among clients having both mental health problems and delinquency issues to 53% among teen parents (Table 4, Housed column). Variability in client outcomes was greatest pertaining to achieving all three outcomes. While nearly one-fourth (23%) of no risk factor cluster clients had graduated, were employed and housed at discharge, only one-in-ten risk factor cluster clients had achieved all three desired outcomes. Among risk factor cluster clients, the total success rate ranged from 0% among those with mental health problems and delinquency issues to 14% among teen parents with mental health problems (Table 4, last column). Thus, unadjusted client outcomes were found to vary considerably by 1) type (e.g., education, employment, housing), 2) whether outcomes were examined alone or in combination, 3) level of risk, and 4) across risk factor cluster groups. 5.4. Bivariate correlates of client outcomes (preliminary logistic regression analysis results) Youth who were 1 year older when entering the program were between 1.55 and 2.35 times more likely to complete high school, be employed, and accomplished all three outcomes of interest (including being independently housed) at discharge than those who entered one year younger in age. Also, female clients were 2 times more likely than male clients to be independently housed at discharge. No differences in outcomes were found between Caucasian and non-caucasian clients (Table 5). Table 5 Results of bivariate logistic regression models (odds ratios) identifying demographic characteristic, program participation, and clinical risk cluster correlates of client outcomes at discharge (n=385). High school (S) (n=225, 58%) Employed (E) (n=122, 32%) Housed (H) (n=146, 38%) All (S+E+H) (n=53, 14%) OR p OR p OR p OR P Demographic characteristics Age at admission (years) 1.76 1.55 1.28 ns 2.35 Female.90 ns.91 ns 2.02 1.02 Ns Racial or ethnic minority.85 ns 1.26 ns.86 ns 1.07 Ns Characteristics of program participation Length of stay (months).96 1.09 1.11 1.09 Received any life skills training.64 ns 1.42 ns 2.10 1.89 Ns Risk factors cluster groups Mental health.61.64.68 ns.38 Delinquency 1.49 ns.38 ns Parenting.45.69 ns 1.75.79 Ns Cognitive impairment.79 ns 1.02 ns.50 ns.52 Ns p b.05. pb.01. p b.001. Odds ratios could not be computed due to the small number of cases in which clients with delinquency issues were independently housed (n=3) or had achieved all three outcomes (n=1) at discharge.

1756 A.S. Mares, M.J. Kroner / Children and Youth Services Review 33 (2011) 1749 1758 Those who remained in the program 1 month longer were about 1.10 times more likely to be employed, independently housed, and to have accomplished all three outcomes than clients with lengths of stay 1 month shorter. However, those staying 1 month longer were.96 as likely to have completed high school before leaving the program. Receipt of any life skills training was positively associated with being independently housed; youth who received such training were twice as likely to be housed at the time of discharge than those who did not receive such training (Table 5). Clients with mental health problems were about.60 times less likely to complete high school and to be employed, and.40 times as likely to achieve all three outcomes, than those without any mental health problems. Parenting youth were about half as likely to complete high school, yet nearly twice as likely to be independently housed at discharge, than non-parenting youth. Surprisingly, neither delinquency nor cognitive impairment problems were associated with any of the outcomes examined (Table 5). 5.5. Predictors of client outcomes in multivariate models (final logistic regression analysis results) After adjusting for client demographic characteristics, characteristics of program participation, and risk factor cluster classification, several predictors were identified. Age at admission continued to be the predominant demographic predictor. Indeed, this was the most consistent and strongest predictor of client outcomes found. Youth entering the program at an older age were nearly twice as likely to complete high school, be employed, and to be independently housed, and were three times more likely to achieve all three of these outcomes at discharge than those who were admitted at an earlier age. Neither gender nor race/ ethnicity, when defined as Caucasian versus non-caucasian, was associated with client outcomes, except for non-caucasian youth who were only half as likely as Caucasian youth to be independently housed at the time of discharge (Table 6). Length of stay in the program remained a positive predictor of both individual and combined outcomes, except for completing high school. In the final analysis, receipt of any life skills training was not associated with any of the client outcomes examined. After adjusting for demographic characteristics and program participation characteristics, the association found between clinical risk factor clusters and client outcomes appeared to be more varied. Clients entering independent living with mental health problems were only half as likely have attained all three outcomes, but no less likely to have attained any single outcome, at the time of discharge than clients entering without mental health problems. In contrast, parenting clients were less likely to realize the specific outcomes of completing high school and being employed, while being no less likely than non-parenting clients to realize all three outcomes. Youth with delinquency issues were only one-fourth as likely to be independently housed at discharged than other youth, but fared comparably in the outcome domains of education and employment, and on the measure that combined all three outcomes, than other youth. Similarly, clients with cognitive impairments showed comparable outcomes to those without such learning-related impairments (Table 6). 6. Discussion 6.1. Comparison of findings to previous studies While the findings of this independent living program-specific study are not directly comparable to previously published studies identifying predictors of outcomes among more general populations of emancipating and emancipated foster youth reviewed earlier, the following observations may merit some consideration: First, the finding from previous employment studies that males and non-caucasian race is negatively associated with employment was different than the current study. This may be due primarily to a difference in employment outcome measures used. Previous studies examined post-discharge employment (either time to any employment (Dworsky 2005) or any employment 2 years (Goerge 2002) or 6 years (Macomber et al. 2008) years post-discharge). Moreover, other significant predictors examined in those previous studies but not examined in this study include employment experience prior to discharge, foster care placement history, type of discharge, living in an urban area, and state. The Westat study (Cook et al. 1991) finding that receipt of any life skills training was associated with completing high school prior to discharge differed from this study, but was the same with respect to no association with being employed prior to discharge. Two possible explanations for the difference in completing high school findings are the difference in time periods (e.g., 1987 1991 versus 2001 2005) and the difference in geographic scope (e.g., eight states versus a single metropolitan area). Also, while participation in a life skills training group was found to be positively associated with employment at discharge in the Missouri study (McMillen & Tucker 1999), it was not found to be significant after completion of high school was added to the regression model. Neither was life skills participation associated with completing high school prior to discharge. While independent living training was found to be positively associated with completing high school before leaving foster care in the Casey Alumni Study (Pecora et al. 2006), a much wider range of foster care placement and living arrangement characteristics were examined among a more Table 6 Results of multivariate logistic regression models (odds ratios) predicting independent living client outcomes at discharge (n=385). High school (S) Employed (E) Housed (H) All (S+E+H) OR p OR p OR p OR p Demographic characteristics Age at admission (years) 1.78 1.80 1.70 2.96 Gender (female) 1.36 ns 0.85 ns 1.67 ns 0.87 ns Race/ethnicity (minority) 1.04 ns 0.92 ns 0.45 0.63 ns Characteristics of program participation Length of stay (months) 0.98 ns 1.11 1.12 1.13 Received any life skills training 0.69 ns 1.24 ns 1.50 ns 1.59 ns Risk factor cluster groups Mental health 0.65 ns 0.75 ns 0.72 ns 0.45 Delinquency 1.54 ns 0.55 ns 0.26 0.39 ns Parenting 0.52 0.47 1.12 ns 0.66 ns Cognitive impairment 0.81 ns 0.89 ns 0.48 ns 0.47 ns Bolded odds ratios are those which are statistically significant. ns p.05. p b.05. pb.01. p b.001.

A.S. Mares, M.J. Kroner / Children and Youth Services Review 33 (2011) 1749 1758 1757 heterogenous sample over a much longer period all possible reasons for the difference in this particular finding with this study. Moreover, another possible explanation in the association between client outcomes and independent living services is that said services are not clearly defined and the extent to which the content, dosage, frequency, duration, etc. of these services likely varies across programs and study populations. Finally, while poverty status was found to completely mediate the effects of foster care status, race, and gender in the secondary analysis study of NLSY 1997 data (Berzin 2008), this is unlikely to be a confounding factor in this study given that all of the emancipating foster youth studied are likely living in poverty. 6.2. Lessons learned and implications This study advances our understanding of the types of risk factors facing youth emancipating from foster care as well as the relationship between these risk factors and outcomes at discharge. We identified four risk factor clusters based on the results of our factor analysis: mental health, teen parenting, cognitive impairment, and delinquency. Three of four risk factor clusters are similar to those identified by McMillen and Tucker (1999), namely parenting, criminal problems, and mental retardation. The findings that pregnant and parenting teens were only half as likely to have completed high school and only half as likely to be employed underscores the importance of encouraging foster youth to avoid teenage pregnancy. The long-term costs to society, to young parents, and to the children born of young parents in terms of extended time spent as a single parent, poverty and dependence upon public assistance, and the perpetuation of the cycle of abuse and neglect and poor educational outcomes inflicted upon the children born to adolescent mothers have been well documented (Maynard 1996). Less clear is how to effectively intervene and influence the near doubling birthrate from 13% at age 18 to 34% at age 19, especially when these young adults are placed into their own apartments affording them with ample opportunity for sexual activity. At a minimum, family planning and safe sex discussions should be included in case management and life skills training for emancipating foster youth enrolled in housing-based independent living programs. And when pregnancy and teen parenting is not able to be prevented, it is likely that program staff will be required to place more emphasis among female clients on life skills parenting training, applying for public assistance benefits, and securing affordable and stable housing for her and her young child, rather than on seeking employment. Parenting may provide additional motivation for male clients to secure employment to help support themselves and their families. The finding that youth with delinquency issues were only onefourth as likely to attain independent housing as their peers is also cause for concern. This difference could be due to a combination of factors such as landlords avoiding renting to young adults with criminal backgrounds, and employers being reluctant to hire such youth. Although the difference between employment rates for delinquent youth and their non-delinquent peers was not statistically significant, the small number of delinquent youth in the sample (n=31) calls to question whether there was sufficient statistical power to detect such a difference. The fact that only one of 31 youth with delinquency issues was able to attain all three outcomes upon leaving the program raises a number of questions about their ability to make a successful transition to adulthood. What is to become of these young adults with histories of delinquency after they leave the independent living program? Might they be likely to return to state custody under the adult corrections system after emancipating from state custody under the child welfare system if they are unemployed and don't have a place of their own to live? More encouraging are the age at admission and length of stay findings. Now that states are authorized to extend the age of service and to partially fund supervised housing and other independent living services for emancipating foster youth up to 20 years of age under the Fostering Connections Act of 2008 using federal (Title IV-E) funds, the findings of this study suggest that housing-based programs such as the one studied here may improve housing, educational, and employment outcomes at the time of leaving care. The average age of admission of 18 and average length of stay of 10 months observed in this program may provide a useful model for other programs, counties, and states to consider as one means of improving client outcomes at the time of youth leaving care. Whether client outcomes could be further improved by extending the average length of stay and/or admitting older youth at ages 19 and 20 years of age is unknown given the current policy in Ohio to generally discharge youth from care within a few months of their 18th birthday, often during the summer after the end of the school year. These findings provide independent living program administrators, child welfare administrators, and magistrates with estimates of possible high school completion, employment, and independent housing returns on the use of federal independent living funds to provide, and possibly extend, housing-based independent living programming of the type described herein and elsewhere (e.g., Kroner & Mares 2009; Kroner & Mares 2011) to youth emancipating from foster care. Moreover, these findings may help to inform decisions made by state policy makers regarding conditions for providing housing-based independent living services to emancipating young adults policies which currently vary considerably across states (Dworsky & Havlicek 2008). The lack of significance finding regarding receipt of any life skills may be interpreted a number of different ways. One possible interpretation is that classroom-based life skills training for this population is ineffective, suggesting that the existing curriculum should be either revised or replaced with some other aspect of programming (e.g., case management, more individualized on-the-job or home-based skills training). Another possibility is that the life skills training measure was overly simplistic, failing to assess the intensity or quality of training provided. Third, the validity of this particular measure may be suspect. Unlike age at admission and length of stay measures which are more easily and accurately measured admission and discharge-related concepts, receipt of life skills training between admission and discharge over a five-year period of operation (i.e., 2001 2005) is a more complex and challenging concept to accurately measure. 6.3. Limitations These findings should be considered in light of several limitations. First, the absence of a non-treatment control or comparison group formed through random assignment limits our ability to attribute any of the outcomes observed to the program. Next, although the clinical risk factors data were collected by licensed clinical social workers with years of experience working in the independent living program, the validity and reliability of these data are unknown. Also, the validity and reliability of the four outcome measures is unknown. Data on client placement history (e.g., number and types of placements prior to entering the program) were not available, and therefore could be a source of confounding for the relationships observed. Also, the small number of clients presenting with delinquency and cognitive impairment problems raises the possibility of committing a Type II error, or failing to detect a true association for these two risk factor categories. Finally, although the four risk factor clusters we identified may be useful for classifying youth into clinical sub-groups, the external validity or generalizability of these findings to other independent living programs or emancipating foster youth populations is unknown. 7. Conclusion This study is among the first to examine predictors of client outcomes within a given independent living program a program considered by many within the field to be an exemplary housing-based program. As expected, those identified by staff as having mental health

1758 A.S. Mares, M.J. Kroner / Children and Youth Services Review 33 (2011) 1749 1758 problems, histories of delinquency, and teen parenting issues demonstrated poorer educational, employment and/or housing outcomes. In contrast, admitting youth into the program at a somewhat older age and extending their length of stay by a few months were both found to be associated with more favorable outcomes. Further research providing comparative data on clinical risk factors and outcomes of clients served by other programs, as well as non-systems American youth with similar issues would be helpful in establishing realistic expectations for treatment outcomes for programs serving the vulnerable youth in transition population. Acknowledgements This work was supported by a Research Enhancement Grant by the College of Social Work at The Ohio State University. The authors wish to acknowledge Joyce Cooper, Merry Paul, and Christi Watson for data collection assistance and Bob Mecum, Thad Parker, and Bonita Campbell for insights in interpreting data findings, Amy Dworsky, and anonymous reviewers for comments provided on drafts of this paper. Finally we wish to acknowledge the staff and clients of the Lighthouse Independent Living Program whose daily work and effort have made the collection and reporting of these data possible. References Allen, M., & Bissell, M. (2004). Safety and stability for foster children: The policy context. The Future of Children, 14(1), 49 73. Barth, R. P. (1990). On their own: The experiences of youth after foster care. Child and Adolescent Social Work Journal, 7(5), 419 440. Berzin, S. C. (2008). Difficulties in the transition to adulthood: Using propensity scoring to understand what makes foster youth vulnerable. The Social Service Review, 82(2), 171 196. Cook, R. J. (1994). Are we helping foster care youth prepare for their future? Children and Youth Services Review, 16(3 4), 213 229. Cook, R., Fleishman, E., & Grimes, V. (1991). A national evaluation of Title IV-E Foster Care Independent Living Programs for Youth: Phase 2. Final Report, Vol. 1,. Rockville, M.D: Westat. Courtney, M. E., Dworsky, A., Ruth, G., Keller, T., Havlicek, J., & Bost, N. (2005). Midwest evaluation of the adult functioning of former foster youth: Outcomes at 19. Chicago: Chapin Hall Center for Children at the University of Chicago. Courtney, M. E., Dworsky, A., Cusick, G. R., Havlicek, J., Perez, A., & Keller, T. (2007). Midwest evaluation of the adult functioning of former foster youth: Outcomes at age 21. Chicago: Chapin Hall Center for Children at the University of Chicago. Courtney, M. E., Hook, J. L., & Lee, J. S. (2010). Distinct subgroups of former foster youth during young adulthood: Implications for policy and practice. Chicago: Chapin Hall at the University of Chicago. Daining, C., & DePanfilis, D. (2007). Resilience of youth in transition from out-of-home care to adulthood. Children and Youth Services Review, 29(9), 1158 1178. DSM-IV-TR (2000). Diagnostic and statistical manual of mental disorders. Arlington, VA: American Psychiatric Publishing, Inc. Dworsky, A. (2005). The economic self-sufficiency of Wisconsin's former foster youth. Children and Youth Services Review, 27(10), 1085 1118. Dworsky, A., & Havlicek, J. (2008). Review of state policies and programs to support young people transitioning out of foster care. : Chapin Hall at the University of Chicago. Fowler, P. J., & Toro, P. A. (2006). Youth aging out of foster care in southeast Michigan: A follow-up study. Final report. Research Group on Homelessness and Poverty. Department of Psychology. Wayne State University. Georgiades, S. (2005). A multi-outcome evaluation of an independent living program. Child and Adolescent Social Work Journal, 22(5 6), 417 439. Goerge, R. M. (2002). Employment outcomes for youth aging out of foster care: Final report. Chicago: Chapin Hall at the University of Chicago. Hardin, M. (1987). Legal issues related to the federal Independent Living Initiative. Washington, D.C.: American Bar Association. Kroner, M. J., & Mares, A. S. (2009). Lighthouseindependent livingprogram: Characteristics of youth served and their outcomes at discharge. Children and Youth Services Review, 31(5), 563 571. Kroner, M. J., & Mares, A. S. (2011). Living arrangements and level of care among clients discharged from a scattered-site housing-based independent living program. Children and Youth Services Review, 33(2), 405 415. Lindsey, E. W., & Ahmed, F. U. (1999). The North Carolina independent living program: A comparison of outcomes for participants and nonparticipants. Children and Youth Services Review, 21(5), 389 412. Lorentzen, B., Lemley, A., Kimberlin, S., & Byrnes, M. (2008). Outcomes for former foster youth in California's THP-plus program: Are youth in THP-plus faring better? San Francisco: John Burton Foundation. Macomber, J. E., Cuccaro-Alamin, S., Duncan, D., Kuehn, D., McDaniel, M., Vericker, T., Pergamit, M., Needell, B., Kum, H. -C., Stewart, J., Lee, C. -K., & Barth, R. P. (2008). Coming of age: Employment outcomes for youth who age out of foster care through their middle twenties. Washington, D.C.: Urban Institute. Mallon, G. P. (1998). After care, then where? Outcomes of an independent living program. Child Welfare, 77(1), 61 78. Maynard, R. A. (1996). Kids having kids: A special report on the costs of adolescent childbearing. New York: Catalyst Institute. McCoy, H., McMillen, J. C., & Spitznagel, E. L. (2008). Older youth leaving the foster care system: Who, what, when, where, and why? Children and Youth Services Review, 30(7), 735 745. McMillen, J. C., & Tucker, J. (1999). The status ofolder adolescents at exit from out-of-home care. Child Welfare, 78(3), 339 360. Mech, E. V. (1988). Preparing foster adolescents for self-support: A new challenge for child welfare services. Child Welfare, 67(6), 487 495. Mech,E.V.,&Che-ManFung,C.(1999).Placementrestrictivenessandeducational achievement among emancipated foster youth. Research on Social Work Practice, 9(2), 213 228. National Resource Center for Youth Development (NRCYD) (2010). John H. Chafee Foster Care Independence Program, allotments for 2007. Accessed at. http://www. nrcyd.ou.edu/programs/pdfs/fy07_cfcip_alloc.pdf Pecora, P. J., Williams, J., Kessler, R. C., Hiripi, E., O'Brien, K., Emerson, J., Herrick, M. A., & Torres, D. (2006). Assessing the educational achievements of adults who were formerly placed in family foster care. Child and Family Social Work, 11(3), 220 231. Reilly, T. (2003). Transition from care: Status and outcomes of youth who age out of foster care. Child Welfare, 82, 727 746. Scannapieco, M., Schagrin, J. L., & Scannapieco, T. (1995). Independent living programs: Do they make a difference? Child and Adolescent Social Work Journal, 12(5), 381 389. U.S. Department of Health and Human Services (DHHS), Administration for Children and Families (2008a). Evaluation of the Life Skills Training Program: Los Angeles County. Washington, D.C.: Author. U.S. Department of Health and Human Services (DHHS), Administration for Children and Families (2008b). Evaluation of the Early Start to Emancipation Preparation Tutoring Program: Los Angeles County. Washington, D.C.: Author.