My Life: Evaluation of Self-determination Enhancement for Adolescents in Foster Care
Condition: Mental Disorders
MeSH terms: Mental Disorders
Study type: Interventional

Summary: 
      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.
    

Detailed description: 
      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.
    

Intervention name(s): Self-determination enhancement
Intervention type(s): Behavioral
Intervention description(s): Self-determination enhancement through individual coaching and peer mentoring workshops
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Prevention
Keywords: Adolescents, foster care, self-determination