My Life: Evaluation of Self-determination Enhancement for Adolescents in Foster Care
| Status: | Completed |
|---|---|
| Conditions: | Psychiatric, Psychiatric |
| Therapuetic Areas: | Psychiatry / Psychology |
| Healthy: | No |
| Age Range: | Any |
| Updated: | 4/2/2016 |
| Start Date: | February 2012 |
| End Date: | December 2015 |
| Contact: | Sarah Geenen, PhD |
| Email: | geenens@pdx.edu |
| Phone: | 503-725-9604 |
My Life: Evaluation of Self-Determination Enhancement for Adolescents in Foster Care
The purpose of the study is to implement a full-scale efficacy trial of the My Life program.
Conducted in partnership with the Oregon DHS Foster Care Program, the impact of the
intervention will be being evaluated with a randomized experimental longitudinal design. Two
hundred and ten youth, ages 16.5-17.5, will be enrolled in 3 waves, and randomly assigned to
either a comparison group that receives typical foster care services or to a treatment group
that participates in the key elements of the model, including instruction in
self-determination skills, support in leading their own coordinated inter-agency transition
planning meetings, and participation in workshops with mentors. Outcomes, including youth
self-determination, quality of life, employment, mental health, educational achievement and
independent living, are assessed pre-intervention, at the conclusion of intervention, and at
12 months post-intervention. The proposed study will provide important information on the
efficacy of the model for all youth exiting the foster care system, yielding unequivocal
data on whether enhanced self-determination mediates, at least partially, various outcome
areas, including mental health, educational achievement, employment, independent living, and
quality of life; evaluating the effect of special education status, gender, and race as
moderating influences on the impact of the intervention. Foster care experiences, such as
trauma and placement instability, will be considered as covariates; direct effects of the
intervention on these key foster care experiences will also be explored.
Conducted in partnership with the Oregon DHS Foster Care Program, the impact of the
intervention will be being evaluated with a randomized experimental longitudinal design. Two
hundred and ten youth, ages 16.5-17.5, will be enrolled in 3 waves, and randomly assigned to
either a comparison group that receives typical foster care services or to a treatment group
that participates in the key elements of the model, including instruction in
self-determination skills, support in leading their own coordinated inter-agency transition
planning meetings, and participation in workshops with mentors. Outcomes, including youth
self-determination, quality of life, employment, mental health, educational achievement and
independent living, are assessed pre-intervention, at the conclusion of intervention, and at
12 months post-intervention. The proposed study will provide important information on the
efficacy of the model for all youth exiting the foster care system, yielding unequivocal
data on whether enhanced self-determination mediates, at least partially, various outcome
areas, including mental health, educational achievement, employment, independent living, and
quality of life; evaluating the effect of special education status, gender, and race as
moderating influences on the impact of the intervention. Foster care experiences, such as
trauma and placement instability, will be considered as covariates; direct effects of the
intervention on these key foster care experiences will also be explored.
Compared to their same age peers in the general population, youth who transition to adult
living from foster care are less likely to have stable housing, to be connected to a caring
adult, to graduate from high school, to go to college, or to be employed (e.g., Avery, 2001;
Pecora et al., 2003; Goerge et al., 2002). They are more likely to engage in risky sexual
behaviors, to become a single parent, and to be homeless or involved in the criminal justice
system (e.g., Courtney et al., 2006; Smithgall, Gladden, Yang & Goerge, 2005). While
consensus exists about the poor outcomes of these youth and policies have been adopted
(e.g., Foster Care Independence Act) aimed at improving their transition, evidence-based
practices have yet to be validated for achieving this goal.
Skill development focused on self-determination enhancement, shown to be associated with
transition success of young people in special education, could have unrealized potential to
prepare youth in foster care for the sudden independence they experience when they abruptly
age out of foster care. The overlapping nature of these at risk groups (approximately 40% of
youth in foster care receive special education services) further suggests that skill
development for self-determination enhancement could have cross-cutting benefits. To gather
preliminary efficacy and feasibility data for youth approaching transition from foster
homes, a pilot study using a randomized, 2 groups X 3 repeated measures design was conducted
in Oregon (entitled My Life). Sixty youth, ages 16.5 through 17.5, in foster care and
special education, were randomly assigned to either a control group that received community
as usual services (CAU) or an experimental group that received one-to-one coaching designed
to enhance self-determination (My Life). The My Life intervention group experienced a
statistically significant increase in self-determination (as measured by the ARC; Wehmeyer &
Kelchner, 1995) in comparison to the control group. Youth who participated in the
intervention were also more likely to exhibit improvement in employment outcomes and in
overall well being and to report greater involvement in the transition planning process over
time as compared to the control group. In addition to providing evidence of its efficacy,
the My Life pilot provided important feasibility information and estimates of effect size.
Given the promising findings of our randomized controlled pilot of the My Life intervention,
the goal of this R01 proposal is to undertake a full-scale efficacy trial of the My Life
program. We are proposing to expand the work conducted in our initial investigation to
include all youth preparing to exit foster care (i.e., youth receiving and not receiving
special education services), and to specifically assess the impact of the intervention on
mental health. The proposed study, which builds on the promising findings of our initial
work, will provide important information on the efficacy of the model for all youth exiting
the foster care system, providing data on the intervention's direct effects on critical
outcomes, including quality of life, mental health, education, employment, employment and
independent living, and whether enhanced self-determination mediates, at least partially,
the intervention's effects on these critical outcomes. Additionally, the study will
investigate whether disability, gender and race moderate the effect of the intervention on
distal outcomes. Trauma symptoms and placement instability experienced at baseline will be
considered as covariates; the potential direct effects of the intervention on these key
foster care experiences also will be explored at completion of treatment and follow along.
The proposed study has four specific aims: 1) We will recruit 210 foster youth, 16.5 to 17.5
years of age and randomly assign them to either the My Life intervention group or a
community as usual control group that receives typical services (CAU). The intervention is
designed to increase youth's self-determination in preparation for aging out of care and to
provide for follow along assessment of their outcomes during this challenging and high-risk
period. To recruit youth, we are collaborating with Oregon DHS and will target Oregon's most
densely populated area: Multnomah County; 2) We will use a multiple agent, multiple
indicator strategy for measuring key constructs to assess youth at baseline, intervention
termination (12-month post-baseline) and follow-up (12-month post-intervention completion).
We also will collect DHS Foster Care and school district archival records at these three
time points. Brief phone interviews will be conducted every 60 days with participating youth
regarding recent service and support utilization, global ratings in key outcome areas,
stressful events, and contact with supportive adults. Thus, a total of 13 60-day phone
interviews will be conducted over the entire 24-month period of study enrollment; 3) Using a
series of modeling analyses, we will test intervention efficacy and the key elements of our
theoretical model. Specifically, we will test for stability versus change of
self-determination, mental health adjustment, academic achievement, quality of life,
employment and independent living, with intervention group assignment (My Life vs. CAU)
modeled as a dummy variable with anticipated direct effects on outcomes for the key
constructs. In a second series of analyses, we will test the hypothesized mediator effects
of self-determination on mental health adjustment, academic success, quality of life,
employment and independent living, and explore whether disability, gender and race moderate
the impact of the intervention on key outcomes. The influence of trauma and placement
instability on distal outcomes will be examined, as will the intervention's impact on these
key foster care experiences. 4) We will track fidelity of implementation to document
adherence to intervention protocols and perform analyses to identify intervention components
actively associated with major outcomes as well as possible differences in intervention
components for foster youth with a disability versus those without. Oregon DHS has a strong
interest in this project and we anticipate that they will work to maintain delivery of
active intervention components.
living from foster care are less likely to have stable housing, to be connected to a caring
adult, to graduate from high school, to go to college, or to be employed (e.g., Avery, 2001;
Pecora et al., 2003; Goerge et al., 2002). They are more likely to engage in risky sexual
behaviors, to become a single parent, and to be homeless or involved in the criminal justice
system (e.g., Courtney et al., 2006; Smithgall, Gladden, Yang & Goerge, 2005). While
consensus exists about the poor outcomes of these youth and policies have been adopted
(e.g., Foster Care Independence Act) aimed at improving their transition, evidence-based
practices have yet to be validated for achieving this goal.
Skill development focused on self-determination enhancement, shown to be associated with
transition success of young people in special education, could have unrealized potential to
prepare youth in foster care for the sudden independence they experience when they abruptly
age out of foster care. The overlapping nature of these at risk groups (approximately 40% of
youth in foster care receive special education services) further suggests that skill
development for self-determination enhancement could have cross-cutting benefits. To gather
preliminary efficacy and feasibility data for youth approaching transition from foster
homes, a pilot study using a randomized, 2 groups X 3 repeated measures design was conducted
in Oregon (entitled My Life). Sixty youth, ages 16.5 through 17.5, in foster care and
special education, were randomly assigned to either a control group that received community
as usual services (CAU) or an experimental group that received one-to-one coaching designed
to enhance self-determination (My Life). The My Life intervention group experienced a
statistically significant increase in self-determination (as measured by the ARC; Wehmeyer &
Kelchner, 1995) in comparison to the control group. Youth who participated in the
intervention were also more likely to exhibit improvement in employment outcomes and in
overall well being and to report greater involvement in the transition planning process over
time as compared to the control group. In addition to providing evidence of its efficacy,
the My Life pilot provided important feasibility information and estimates of effect size.
Given the promising findings of our randomized controlled pilot of the My Life intervention,
the goal of this R01 proposal is to undertake a full-scale efficacy trial of the My Life
program. We are proposing to expand the work conducted in our initial investigation to
include all youth preparing to exit foster care (i.e., youth receiving and not receiving
special education services), and to specifically assess the impact of the intervention on
mental health. The proposed study, which builds on the promising findings of our initial
work, will provide important information on the efficacy of the model for all youth exiting
the foster care system, providing data on the intervention's direct effects on critical
outcomes, including quality of life, mental health, education, employment, employment and
independent living, and whether enhanced self-determination mediates, at least partially,
the intervention's effects on these critical outcomes. Additionally, the study will
investigate whether disability, gender and race moderate the effect of the intervention on
distal outcomes. Trauma symptoms and placement instability experienced at baseline will be
considered as covariates; the potential direct effects of the intervention on these key
foster care experiences also will be explored at completion of treatment and follow along.
The proposed study has four specific aims: 1) We will recruit 210 foster youth, 16.5 to 17.5
years of age and randomly assign them to either the My Life intervention group or a
community as usual control group that receives typical services (CAU). The intervention is
designed to increase youth's self-determination in preparation for aging out of care and to
provide for follow along assessment of their outcomes during this challenging and high-risk
period. To recruit youth, we are collaborating with Oregon DHS and will target Oregon's most
densely populated area: Multnomah County; 2) We will use a multiple agent, multiple
indicator strategy for measuring key constructs to assess youth at baseline, intervention
termination (12-month post-baseline) and follow-up (12-month post-intervention completion).
We also will collect DHS Foster Care and school district archival records at these three
time points. Brief phone interviews will be conducted every 60 days with participating youth
regarding recent service and support utilization, global ratings in key outcome areas,
stressful events, and contact with supportive adults. Thus, a total of 13 60-day phone
interviews will be conducted over the entire 24-month period of study enrollment; 3) Using a
series of modeling analyses, we will test intervention efficacy and the key elements of our
theoretical model. Specifically, we will test for stability versus change of
self-determination, mental health adjustment, academic achievement, quality of life,
employment and independent living, with intervention group assignment (My Life vs. CAU)
modeled as a dummy variable with anticipated direct effects on outcomes for the key
constructs. In a second series of analyses, we will test the hypothesized mediator effects
of self-determination on mental health adjustment, academic success, quality of life,
employment and independent living, and explore whether disability, gender and race moderate
the impact of the intervention on key outcomes. The influence of trauma and placement
instability on distal outcomes will be examined, as will the intervention's impact on these
key foster care experiences. 4) We will track fidelity of implementation to document
adherence to intervention protocols and perform analyses to identify intervention components
actively associated with major outcomes as well as possible differences in intervention
components for foster youth with a disability versus those without. Oregon DHS has a strong
interest in this project and we anticipate that they will work to maintain delivery of
active intervention components.
Inclusion Criteria:
- between the ages 16.5 to 18.5 years of age
- reside in Multnomah, Washington or Clackamas County, Oregon
- currently in DHS foster care custody and have accumulated at least 90 days in care.
Exclusion Criteria:
- Youth scheduled to move from Oregon within the next year.
- Youth who represent a safety risk to project staff or other participants
- Youth who experience a profound cognitive disability or are actively psychotic
We found this trial at
1
site
