What happens to adolescents who are heavy mental health service users once they are no longer eligible for child service systems? The mental health service system changes considerably as youth move from adolescence to adulthood. There are fewer service options for adults, eligibility narrows, and affordability changes. These service system changes occur at a time of considerable stress as young people often change residences, jobs and learn to live more independently during this same time period. This is particularly true for youth leaving the foster care system. This study examines service use, mental disorder and functional early adult outcomes among older youth as they leave the foster care system. Youth in the foster care system are an ideal study population in which to study this transition because they tend to be extremely heavy mental health service users, and experience a particularly sudden and harsh transition out of foster care. This study examines 1) changes in service use among older teens as they leave the foster care system; 2) the correlates of service continuity and discontinuity as they leave the foster care system; 3) gateways to mental health service use for youth who have left the foster care system; and 4) the relationship between continued mental health service use and homelessness, unemployment, incarceration, high school graduation, college entrance, unplanned parenthood, psychiatric hospitalizations and traumatic events. Three hundred eighty youth in the foster care system in Missouri will be interviewed in person just prior to their 17th birthday, tracked with informed quarterly telephone interviews for two years and then re-interviewed in person two years subsequent to the first interview. The project will use the Diagnostic Interview Schedule to assess mental health and the Service Assessment for Children and Adolescents (SACA) to measure mental health service and psychotropic medication use. The study addresses several needs for mental health services research identified in the Bridging Science and Service report by characterizing the service use of an important population (young people who have left the child service system), by examining what happens to service users over time, and determining who is providing mental health services for a vulnerable population. This research should help public and private policymakers decide how to target their clinical resources, especially the federal dollars earmarked for preventing negative outcomes for youth leaving the foster care system.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Research Project (R01)
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Application #
Study Section
Special Emphasis Panel (ZMH1-SRV-C (01))
Program Officer
Ringeisen, Heather
Project Start
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Budget End
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Washington University
Schools of Social Work
Saint Louis
United States
Zip Code
Miller, Elizabeth A; Paschall, Katherine W; Azar, Sandra T (2017) Latent classes of older foster youth: Prospective associations with outcomes and exits from the foster care system during the transition to adulthood. Child Youth Serv Rev 79:495-505
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