A Platform for Social Action: Engaging and Supporting the Voice of Youth in Foster Care

NOVEMBER 30, 2022

Co-Principal Investigators:

Marianna Colvin, Ph.D., Associate Professor, Sandler School of Social Work, Florida Atlantic University

Morgan Cooley, Ph.D., LCSW, Associate Professor, Sandler School of Social Work, Florida Atlantic University

Co-Investigators:

Heather Thompson, Ph.D., LCSW, Associate Professor, Sandler School of Social Work, Florida Atlantic University

Heather Howard, Ph.D., LCSW, Associate Professor, Sandler School of Social Work, Florida Atlantic University

Significant Contributors:

Jill Carr, M.Ed., Director of Education & Community Outreach of Theatre Lab, College of Arts & Letters, Florida Atlantic University

Joy McClellan, DSW, LCSW, Master of Social Work Program Coordinator, Sandler School of Social Work, Florida Atlantic University

Introduction

The purpose of this participatory action research (PAR) study is to examine the experiences of youth in foster care who received independent living services in Southeast Florida using photovoice methodology. Photovoice is a qualitative methodology that is increasingly applied to engage, understand, and facilitate ways for participant voices to be heard and received by the stakeholders they identify as important. This study’s focus areas were developed collaboratively through multiple conversations between child welfare caseworkers, administrators, and youth in foster care in Southeast Florida to address the gaps in independent living services and needs of youth in care. Using photovoice methodology, youth were asked to explore their feelings and experiences with three focus areas: (a) self-determination, (b) connectedness to others, and (c) self-advocacy. Participants were given tools, a process, and a platform for communicating their experiences. In addition, participants were empowered as active co-researchers in identifying, analyzing, and telling their collective stories by producing documentary photography. One of the deliverables was a social action statement to address systemic issues identified by the participants to support their self-advocacy and translate findings into practice and policy change. The findings of this research were and will continue to be shared with child welfare administrators and professionals with the intent of translating youths’ voices in ways that will enhance future independent living services in the areas of self-advocacy, self-determination, and connectedness.

EVALUATION TEAM

Marianna Colvin, Ph.D.

• Associate Professor, Sandler School of Social Work, Florida Atlantic University

• Co-Principal Investigator — Project conceptualization; research team development; securing IRB approval; implementation planning and management; data collection; data analyses; report writing; dissemination.

Morgan Cooley, Ph.D., LCSW

• Associate Professor, Sandler School of Social Work, Florida Atlantic University

• Co-Principal Investigator — Project conceptualization; securing IRB approval; implementation planning; data analyses; report writing; dissemination.

Heather Thompson, Ph.D., LCSW

• Associate Professor, Sandler School of Social Work, Florida Atlantic University

• Co-Investigator — Project conceptualization and report writing.

Heather Howard, Ph.D., LCSW

• Associate Professor, Sandler School of Social Work, Florida Atlantic University

• Co-Investigator — Project conceptualization, data analyses, and report writing

Jill Carr, M.Ed.

• Director of Education & Community Outreach of Theatre Lab, College of Arts & Letters, Florida Atlantic University

• Significant Contributor — Project conceptualization, data collection, report writing, and dissemination

Joy McClellan, DSW, LCSW

• Master of Social Work Program Coordinator, Sandler School of Social Work, Florida Atlantic University

• Significant Contributor — Project conceptualization, data analyses, and report writing

Background

The life experiences of youth in foster care, such as separation from parents, family, and friends; changes in their school or community activities; and threats to their mental well-being due to experiences prior to or during foster care reinforce the need for strengths-based and empowerment-oriented approaches when working with this population.1, 2 Research suggests that youth who transitioned out of care may struggle with mental health, economic stability, ability to form healthy relationships, and academic or occupational success. 3 4 5 To better facilitate transition toward adulthood, attention to youths’ needs and their active engagement in planning prior to exiting care is a priority.

Youth engagement in all aspects of their care is important, and beneficial outcomes have been observed when youth are engaged in their case.6 One critical area for engaging youth is planning and preparation for independence.7 Independent living services are programs intended to prepare youth for the transition from foster care into adulthood and typically address skills, knowledge, and support for adulthood; however, there is a relatively limited number of evidence-based or evidence-informed programs available. 8 Despite a growing body of research related to promoting well-being among youth who are preparing to transition out of foster care, multiple scholars have called for additional research to examine contextual factors that may buffer or inhibit youths’ successful transitions as they participate in independent living services. 9 10 11,7 Recognizing the importance of various individual and relational factors, this study sought to inform this body of literature by focusing on youths’ experiences with selfdetermination, connectedness to others, and self-advocacy.

SELF-DETERMINATION

Self-determination theory proposes that behavior consists of two psychological factors, an individual’s perception of autonomy and competence concerning their behavior.12 Self-determination supports a person’s autonomy and competence for change. Olsson and colleagues (2020)13 noted the important role that self-determination, or the self-imposed or motivated action to accomplish goals, can play in youths’ ability to successfully transition. For example, Take Charge, an intervention designed to promote self-determination skills of youth in foster care, produced higher rates of high school completion, employment, and engagement in independent living activities compared to youth in traditional independent living programs.14 Participation in independent living programs, in general, can also indirectly promote self-determination, thus creating a cyclical pattern of benefits for youth who are transitioning.15

CONNECTEDNESS TO OTHERS

Another source of support for youth preparing to transition out of foster care is their ability to connect with others and build healthy relationships. Youths who have experienced

time in foster care often struggle with relationships and social connection due to their experiences and separation from important people in their life.16 17 Positive relationships with adults and foster caregivers are associated with better mental well-being for youth in foster care,18 ,19, 20 and social connectedness and support have been identified as critical for youth transitioning to adulthood (see sample from Denmark). 21 However, there are identified gaps in key types of social support available to youth when they are transitioning out of care. For example, Singer et al. (2013)22 found that transition-age youth reported adequate emotional support but insufficient instrumental or appraisal support. Further research is needed to better understand how youth preparing to transition from foster care feel connected and view and approach relationships as a future resource or support.

SELF-ADVOCACY

An important skill for youth in foster care is self-advocacy. Evidence suggests that youth who were involved in the planning of their transition experience and had the ability to self-advocate reported more satisfaction with the process.7 According to adults formerly in foster care, self-advocacy skills were likewise identified as important to successfully transition into adulthood. 23 This finding was repeated by a sample of youth with disabilities transitioning out of foster care. 24 However, it is important to note that youth in foster care also reported they learned how to self-advocate on their own with little help from professionals or adults in their life. 25

CURRENT STUDY

While several studies focused on transition-age youth and independent living, there is limited independent living research that prioritizes youths’ voices and perspectives to guide program and policy choices, 26 particularly in ways that are strengths- and empowerment-focused. Photovoice methodology is uniquely suited to fill this gap and improve our understanding of youths’: (a) self-determination, (b) connectedness to others, and (c) self-advocacy. It is a method of inquiry that visually documents and ‘honors the knowledge, voices, and experiences’ of community members about issues of importance to them. 27 Methods were grounded in a strengths-based approach that is theoretically informed by feminist theory, empowerment theory, and documentary photography. 28 , 29 By privileging youths’ voices, photovoice provides an opportunity to disrupt, inform, and improve the systems and practices that often fail to fulfill youths’ needs. 27 Data were also gathered through methods that youth identify as “fun” and “interesting” to facilitate insight into their social world. 30

Goals and Research Questions

A Participatory Action Research (PAR) design utilizing photovoice methodology was employed to explore the following project goals and guiding research questions. 31,29 Following the methodology’s framework, youth were co-researchers who contributed to identifying and refining the study’s research questions.

Goal 1: To explore youths’ experiences and perceptions with independent living services, with emphasis on:

1) What does self-determination mean to youth living in foster care? How have independent living services helped youth learn to develop selfdetermination? How can independent living services be improved to promote their self-determination?

2) What does the feeling of connectedness mean to youth in foster care? How have independent living services influenced youths’ ability to stay connected with the most important people in their lives? How can independent living services be improved to promote their connections and relationships?

3) What does self-advocacy mean to youth living in foster care? How have independent living services helped youth learn to develop self-advocacy skills? How can independent living services be improved to promote their self-advocacy?

Goal 2: Create a social action statement to address issues identified by the participants with the intent to (a) support the self-advocacy of youth in foster care and (b) translate findings into practice and policy change.

1) What are the needs youth identify as important to transition to independent living?

2) What do youth want specific stakeholder groups to understand about their experiences and needs?

3) What are the recommendations from youth for social/system change and action to better respond to their needs?

Methodology STUDY DESIGN

Photovoice is a qualitative methodology often used to engage, understand, and empower individuals. It has been applied with a variety of populations, across disciplines, to improve the representation and agency of marginalized populations (e.g., youth who are homeless, 32 immigrant populations, 33 and people with disabilities. 34 The design of the study herein, likewise, prioritized youths’ voices and sought to reduce the power differential routinely found in research inquiry and, often, in social service relationships. The primary objectives were for research participants to: (1) identify, record, and reflect on their lived experiences and community needs, (2) promote critical dialogue, and (3) engage with community stakeholders and policy-makers. 29 As a methodology that entrusts cameras to persons “who seldom have access to those who make decisions over their lives” (p. 1391), 35 its relevance is particularly profound for populations with limited power or authority. Participants were given the opportunity to communicate their experiences and were empowered as active co-researchers by telling their stories and producing documentary photography. One of the deliverables is a social action statement of recommendations identified by the participants to support their self-advocacy and translate findings into change-opportunities if they would be willing to participate in an informational interview.

The evaluation team sent emails to each contact stating the purpose of the evaluation, the purpose of the interview, the voluntary nature of participation, and a link to a Qualtricspowered enrollment survey. For contacts who were no longer employed with an agency, had switched positions, or felt they were the wrong person, the evaluation team asked for contact information and followed up with the person who would best be able to answer questions. Interviews were conducted with representatives from nine CBC lead agencies between December 2021 to February 2022.

SAMPLING

The sample for this study included youth in foster care between the ages of 13 and 17 who had experience with independent living services in Southeast Florida. All youth lived in residential foster care homes (i.e., group homes) and recruitment took place through a collaborative partnership with the local community-based care lead agency. Data collection occurred at two different group home sites, each enrolling a group of three youths for participation in the study (N = 6). Limitations due to infrequent overlap in the availability of youths’ schedules and events unique to each site kept groups small, yet group sizes aligned with recommended parameters. Creators of photovoice suggest approximately 3-8 participants, per group, to preserve the process of deep dialogue embedded in the methodology’s framework. 29, 36 Each group’s size and the overall sample size are consistent with published photovoice studies which frequently include samples less than 10. 28

To ensure diverse representation of voice among youth, sampling procedures included the recruitment of youth from different racial backgrounds and placement backgrounds. Three youths identified as Black, two as Hispanic, and one as White. The majority (n = 4) were 17 years old and two were 14 years old. Five of the youth in the sample identified as female and one as male. Of the six youths, five were in foster care for 1 to 2.5 years and the sixth youth reentered foster care four months before this study began. Of note, this youth and three others (n = 4) were adopted out of foster care or had permanent guardianship established before their current entry period. It is unknown how long they were in care originally. The number of placements ranged from 1-6 different homes/group settings. Current and past services received by youth in the sample included therapy, tutoring, and psychiatric treatment.

DATA COLLECTION

Florida Atlantic University (FAU) and Department of Children and Families IRB approvals were obtained before commencing the study and required consent forms were completed. Data collection occurred between February–March 2022. Two data collection groups were implemented across two data collection sites: Group A and Group B. Each group met in person for four sessions (duration: 1-2 hours per session). This resulted in seven hours of data collection with Group A and six hours of data collection with Group B, totaling 13 hours of time spent conversing and analyzing study topics with youth. Sessions occurred on-site at the youths’ group home program space. The basis of sessions combined image-based research methods and arts-based education activities to: (1) create a collaborative bond between participants and researchers, as well as among group members; (2) create powerful visual art expressions,

narrative reflection, and facilitate critical dialogue among youth; and (3) gain a deep understanding of the issues experienced in the youths’ lives. Throughout the study, youth were placed in the role of co-researchers to define and analyze the salient issues they identified. An overview of the sessions is provided below and procedures are visually displayed in Table 1.

Table 1. Data collection schedule and procedures

Week 1: Introduction & Team Building Session One (1 to 2 Hours)

Study information X

Informed assent/ consent forms 1 and 2

Week 2: SelfDetermination Session Two (1 to 2 Hours)

Week 3: Connectedness & Relationships

Session Three (1 to 2 Hours)

Week 4: Self-Advocacy Session Four (1 to 2 Hours)

X

Photograph training X Ethics training X Distribute reusable digital cameras X

Initial prompts X Collective interpretation of photographs and prompts

TO DO

X X X

Record participant dialogue X X X Informed consent form 3 X

Involve participants in generating themes and dissemination plan

Session One

X X X

The first session emphasized a team-building focus to build relationships among youth and relationships with facilitators. It included the following steps:

1) The purpose of the study and photovoice methodology was introduced.

2) The process of informed assent/consent occurred. There were three assent/consent forms. Project participants signed the first assent form during the first session

prior to the commencement of the study to signify their voluntary participation and to be audio recorded. The second form, termed the acknowledgement and release form, was given to the participants when cameras were distributed only if they elected to take pictures of adult persons as photo subjects. This consent form asks for the adult’s permission to be photographed and agreement to waive their rights to the photos if a subject’s image is taken. Numerous photovoice studies with youth populations were reviewed to inform assent/ consent procedures for the current study. 27,30, 37

3) A tutorial on camera use and photography techniques was provided.

4) Training on ethics when photographing was provided.

5) Digital cameras were distributed.

6) The research questions were presented, and youth were invited to provide input and refine the focus of inquiry. In the initial session, photograph prompts and other creative expression prompts were introduced for youth to share their responses with the group the following week.

Sessions Two - Four

Session two focused on self-determination, session three on connectedness and relationships, and session four on selfadvocacy. In each session, two through four, youth reconvened to share and discuss their photographs and other creative forms of expression. Through these discussions, themes were generated. Two facilitators with expertise in arts-based education and qualitative research methods guided each session using a creative expression curriculum that included photograph prompts, self-reflection exercises, and creative writing, among other activities. A mix of prompts were used to ground discussion on each primary research question. For instance, to begin exploring self-advocacy, the following photograph prompts were applied: (1) Through your images, convey what it means to have a voice or speak your mind and (2) Through your images, represent places in your life that make you feel empowered/places that make you feel silenced.

Discussion in groups was also guided by a semi-structured interview guide. Youth selected topics to explore in-depth and youths’ reflections on experiences and perceptions of independent living services were connected. During discussion, youths’ identification of their needs and recommendations for improving services were prioritized. A dedicated dialogue took place to explore platforms that would engage community stakeholders youth identified as important. Avenues to give youth platforms to share their perspectives, detailed in the implications section of this report, are a core component and product of the research methodology. For example, through a partnership created with the Theatre Lab in the FAU College of Arts & Letters, youths’ narratives and photography formed the basis for a student theatre company and professional artists to tell youths’ stories through performance art for community stakeholders (e.g., caseworkers, judges, attorneys, foster parents, service providers, etc.) to attend. The third consent form was given after the photos were developed to ask each participant’s permission to use their photos for publication and other forms of public distribution. This ensured that participants retained control to censor the images and decide which ones the researchers could access and disseminate. 38 No images with identifiable features of individual youth are included in public or publication forums.

Session Incentives

Pizza, sandwiches, or other refreshments were provided in each session to engage with youth and facilitate their comfort during after school/early evening hours. At the recommendation of community partner administrators, youth were provided gift cards at the end of the program. Gift cards increased in $5 increments for each session in which they participated (i.e., $10, $15, $20, and $25), totaling $70. The type(s) of gift card(s) was(were) determined with input from group home staff and administrators in order to align with the interest of specific youth, promote youth safety, and match vendor options local to the youths’ community.

DATA ANALYSIS

Analysis procedures followed the stages of photovoice methodology described by Wang and Burris (1997). 29 The youth (1) selected photographs created representing their experiences, (2) contextualized each image, sharing what it means to them in their own words, and (3) discussed the issues that emerged from the data. Participants were active in data analysis during sessions. Participants pointed out common experiences, reiterated what resonated with each other’s stories, clarified interpretations, and identified shared priorities and recommendations. Grounded theory procedures were also used between and after sessions for researchers to bring emerging ideas back to the group and were used by the research team to clarify themes through a constant comparative method. 39 The co-researchers practiced trustworthiness using the principles of validity in qualitative studies.40 Additionally, to promote researcher reflexivity and decrease researcher bias,41 session facilitators debriefed after each session to share reactions and interpretations and refocus on the youths’ expressions.

Results

Participants were asked through their photos, various prompts, and emerging discussions to consider their preparation and experiences with independent living within the following domains (deductive themes): (a) self-determination, (b) connectedness to others, and (c) self-advocacy. Youths’ photos and responses are organized within these categories in the body of results. However, two inductive themes emerged in the dialogue and imagery shared by youth that fundamentally shaped our understanding of each domain: (1) an interdependence among the primary domains and (2) the impact of trauma experienced by youth. Results begin with an introduction of the two inductive themes and then follow with the three deductive themes. The authors wanted to add that, although some of the youths’ expressions represent their criticism, unmet needs, and struggles in a critical manner directed toward components of the child welfare system, the youth also expressed empathy for their child welfare workers and other system professionals on several occasions related to the difficulty, chaos, and stress of child welfare work.

INTERDEPENDENCE AMONG

EACH OF THE PRIMARY DOMAINS

The first emerging theme was the salient interdependence observed among each of the primary domains (selfdetermination, connectedness to others, self-advocacy). Figure 1 provides a graphical representation of interdependence among domains and introduces each domains’ subthemes. It also represents how the three domains were observed to occur within the context of trauma [Inductive Theme 2] which permeates youths’ experiences and preparation for independent living. Youths’ connectedness with others was the central, prominent domain observed to intertwine with youths’ self-determination and self-advocacy. Specifically, youth revealed that self-determination and self-advocacy have relationally-based components. For example, youth needed or had made connections with others in order to develop motivation or be able to speak on behalf of their own needs and interests. Likewise, acting with self-determination and practicing self-advocacy was often connected to feeling supported or encouraged by others. Each domain is presented separately in the body of results. However, these and other examples of the interdependence observed among the three domains is inextricably described throughout youths’ images and narratives.

THE IMPACT OF TRAUMA

Through youths’ dialogue across each session, it was evident that youth in care are frequently navigating experiences of personal, interpersonal, or systemic trauma in ways that cannot be separated from their

Figure 1.

experiences in the three study domains. Examples included experiences with grief and loss in the form of family separation and parental death, juvenile incarceration, and extensive disruption in placements and relationships. One youth reflected, “I’ve been locked up in jail and in and out of programs since I was 12-years-old. Stuff like that changes you. ”

Another listed living with their mom, an aunt, another aunt, their first foster home, another foster home, a group home, their dad, and then back to a group home in the last four years, summarizing: “That’s a lot of placements. ” The same youth expressed the effects of multiple moves, explaining: "Parents are not supposed to talk about future plans with us [on phone calls] because it gets our hopes up. [But] I don’t give in to it, obviously. I’ve been in several different homes and my hope has been given up a lot. So now I’m just like ‘bring it on.’”

Taken together, even when exploring strengths-focused or growth-related topics for their future, the impact of trauma cannot be ignored when understanding the youths’ journey toward independent living.

Figure 2 provides an image to contextualize youths’ experiences of self-determination, connectedness to others, and self-advocacy within their prior and ongoing life experiences of trauma. It is an original drawing that one youth created on the back of scrap paper during session four. In her description, she offers a vivid representation of the ‘scars’ that youth are trying to close, but that often reopen.

Figure 2. "The Scars" (Original Artwork by Youth)

SELF-DETERMINATION

The first domain presented is self-determination. When asked to define their perception of self-determination in their own words, youth listed the following descriptions: “strength,” “resiliency,” “hard work,” “what keeps you pushing,” “motivation,” and “ telling people this is who I want to be.” After coding the narratives and imagery shared by the youth, two subthemes emerged that represent their views, experiences, barriers, and support for self-determination: (a) environmental barriers contribute to vulnerability and stress (limiting youths’ ability to exercise self-determination) and (b) motivation occurs in high stakes environments.

Environmental Barriers that Contribute to Youths’ Vulnerability and Stress. In the first subtheme, each youth portrayed experiencing high levels of vulnerability and stress in ways that influence their self-determination. Instead of exercising self-determination, youth alternatively described environments in which things happen to them, depicted ways in which they are vulnerable to the choices of others, and reiterated the presence of high stress. Two photographs shared by youth in Figures 3 and 4 offer illustrative examples. Their imagery and narratives raise the question, how do youth successfully achieve self-determination in the midst of what youth describe as “The Fires” and “The Unknown”?

Figure 3. "The Fires Keep Coming" (Original Artwork by Youth)

I used to draw out my feelings because I would just shut down. What this [picture] means…that's the hand and then that's the chain. It's holding you there. Then your heart's just going through a lot and it's pouring out into the hourglass and basically you got to act like you're fine because you're the second adult. You're the older sister. And they [case managers] are waiting on you. They're waiting for you to give the information. They're waiting for you to give out your emotions, what you're going through. Like, “What's up with your parents?

What do they have to work on? What's your trauma?” That was really hard for me when I first came here [to foster care]. And, then you got the scars. Those are the scars that were going to close and you thought you were going to be okay. But then they reopened…

So this is life, right? This is your body [in the center]. These are challenges, you know, those bomb things, firework things [the small dots]? That's the fire starting. But you don't know what it is because it's so small. So you don't even know it's coming. And there are just SO MANY of them [fires]. They just keep coming. [Moderator: You're saying the fires keep coming?] What would an example of a fire be? That they would put me back into this [system].

Speaker 1: It [court] is a big room! They have double doors. Once they close that door, you're done. I feel like... I don't know a better way to put it. When they close those doors. You have no idea what’s about to happen. It could be a good thing or a bad thing.

Speaker 2: Because kids are scared when it happens. When the parents are up there and you feel like, "Oh snap, this is about to happen. I'm about to go somewhere where I'm never going to see my parents again."

Another component compounding youths’ vulnerability was the perception among youth of looming negative repercussions and the presence of high stakes that may make asserting their self-determination even more difficult. In one case, a parenting-youth explained feeling vulnerable to having her own newborn removed from her custody and feeling like she had no room for error:

You are trying to put on an act, like you’re perfect, and everything is so great - because you don’t want to have your child taken… You make one wrong decision, the wrong move, [even though] we’re still growing [as kids ourselves], they literally hold it against you, try to take your children. [Moderator: When you say “they,” who are you talking about?] DCF, the umbrella.

Youth in the non-parenting group also communicated feeling pressure and vulnerability with an emphasis on possible negative repercussions. In one example, they relayed how the initial arrival process at their group home can feel like a test, explaining:

A key component of youths’ vulnerability was conveyed through a lack of involvement in decision-making and autonomy in ways that limit their self-determination. A relational undercurrent in this subtheme was, as youth described, control being exerted onto them by ‘others’ (e.g., caseworkers, court professionals, and others with decisionmaking power). One youth shrugged as she said: “They [case managers] control your papers; they’re the ones who have access to tell the judge stuff.” Another emphasized the lack of choice experienced in care, explaining that “anything they throw at you, you gotta do.” Even well-intentioned decisions made on behalf of youth illustrated a lack of participation from youth themselves. One youth reflected:

Somebody put my picture on there [the adoption website] and I'm so pissed about it. [Moderator: Did you have a choice in that?] No, they didn't tell me. And it [the picture used] was like two years ago and my room was a mess. That's [what made it] even worse. And I was wearing the most, ugh! [Someone] looked it up and was like, look what I found. I found you on the freaking adoption thing. [Moderator: How did that feel when you realized what happened?] I was so upset.

You have a trial. Usually if you come, a lot of times it’s on a Friday, so then you have the weekend that decides if you stay or not… It never happened to me, but I’ve seen it happen. [Moderator: Like kids come in and then what?] [They] leave because of messing up the trial.

Importantly, youth expressed understanding the need for a fit between a youth and the rules of the group home and expressed shared accountability on the part of the youth in achieving that fit. Yet, youth reiterated how hard the timing of this decision point is at the very onset of placement, explaining: “You can be acting any kind of way because you’re coming into foster care.” When asked how it feels for kids during the trial period, they reinforced feeling vulnerable and reiterated the weight of the repercussions at stake: “It feels like you’re being watched and you can easily go to a shelter after that, which is like being in jail ”

Throughout this subtheme, youths’ narratives and imagery also depicted ways their efforts to exercise self-determination occur in environments of high stress. Examples include the stress derived from their vulnerability, but two additional visual depictions are provided in Figure 5 and Figure 6. In Figure 5, one youth described attempting positive strategies to feel calm and focused, yet their narrative highlights an already established pattern in their young life of being in environments where being relaxed and unstressed is a challenge. In Figure 6, two other youths used the image of a chess board in ways that conveyed their perception of life as stressful, particularly due to navigating all the moving pieces and just trying to make it across the board "in one piece.”

Figure 5. "Breathing Room"

This is part of my room. They’re sitting next to my bed. I have my candles and my diffusers because when I was locked up, when I would take a shower, that was the only time I got space from other people or was even somewhat relaxed. And staying here [in the group home] comes with a lot of stress. So, I just turn all my candles on and my diffusers and just lay in my bed and watch a movie or something and I feel better. Taking showers and smelling good stuff and feeling warm and cozy just helps me clear my mind.

Figure 6. "All the Moving Pieces"

Speaker 1: Your life is made of a whole bunch of different pieces and they're moving around. And you TRY to make it across the other side.

Speaker 2: In one piece!

Motivation in High-Stakes Environments. In the second subtheme under the domain of self-determination, youths’ motivations were observed to occur in the context of the high-stakes environments they navigate. Importantly, when asked, “ What motivates you? ” one youth responded plainly, “This is my first time hearing that question.” This particular youth and all youths in the study, however, identified multiple forms of motivation that included both a frequent focus on internal or self-motivation, as well as an emphasis on relationally-based motivation (e.g., people or relationships that influenced their perspective, desire, effort to set or achieve goals).

First, internal or self-motivation was observed through a pervasive assertion of self-reliance among youth. For example, one youth explained, “I’ve been in foster care so long that I raised myself.” When asked follow-up questions such as “where did you learn to do that ” or “who did you depend on '' or “was there anybody who helped make a difference ” the response from youth was almost universal: “myself. ” The stark pattern of perceived self-reliance and converse absence of relational support was likewise evident in another youth’s conceptualization of the independence presented in Figure 7.

"Myself"

I took a picture of “independent.” I was just thinking, don't depend on anybody... [Moderator: Are there people that you can really depend on in your life?] No. Myself. [Moderator: What does that feel like, depending on yourself?] It feels like being an adult.

Despite the prevalence of self-reliance, relationally-based motivation was simultaneously observed in youths’ stories. In particular, all youth who were parenting or preparing to parent identified their current or future child as either the sole or a significant motivator. One youth illustrated this motivation through a photograph of the wall art she created to represent how her baby keeps her focused (see Figure 8).

Figure 8. "Motivation"

That's my baby's name. I painted them and decorated them. It's right on my wall. So…I'll just look at it and it keeps me focused… Because my baby is, besides money, my baby is the only thing that motivates me. If a situation might get me upset right now —it's not as bad as it could be. I have bigger priorities and stuff.

Youths’ descriptions of their children as motivators reinforced the vulnerable, high-stakes environment in which their motivation occurs. One parenting-youth explained, “ We have kids, we have to be strong even though everything [around us] might be failing.” Another exemplified the magnitude of the stakes she perceived and her motivation to succeed: “I don’t want my baby to be in foster care.” Descriptions of motivation by non-parenting youth likewise emphasized the high stakes context in which their motivation occurs. In one youth’s photograph of a Rubik’s cube, they represented different pathways for navigating their future and used shadows to visually depict the threat of taking the “wrong path.” Their narrative includes candid recognition of the high-stakes consequences they perceive in their future: “If I fail…I’ll probably be homeless ” (see Figure 9).

Figure 9. "The Dark Side or the Light Side?"

My picture is descriptive of how I think my life is sort of like a Rubik's cube. So, as you see, it's all mixed up. There are many different options to choose from. Like in life, you have many different options, pasts, anything, and they can take you to the dark side or the light side in your future. But, if it's solved, it would take me to the right path. I want to become a software engineer, a graphic designer. I'm trying to figure out which path I should go because I don't want to suffer. Like if I fail at doing my thing (being a software engineer), I'm going to become in bad shape and probably be homeless. I've just got to, you know…[paused]… there are many different ways and I'm trying to pretty much fit out in this world.

CONNECTEDNESS TO OTHERS

Connectedness to others is the second and most prominent domain. Youths’ definitions for the word relationship included “ family,” “ friends,” “quality time,” “[sharing] jokes,” “being together,” “understanding,” “being there for me,” “someone who hears you out,” and “second chances.” Definitions also included firmly skeptical definitions like “iffy ” and “untrustworthy.” The volume and depth of their conversations in this domain illustrated (a) the critical importance of connections with family, friends, culture, and those they have encountered through the foster care system, and (b) the deep distrust that pervaded youths’ desire and ability to connect with others. Overwhelmingly, youth characterized their relationships as broken, negative, hurtful, hard, or fully absent. The positive relationships that were described were a minority, but the presence of positive relationships did illustrate that youth who had very difficult, non-trusting relationships with most professionals did trust the “right” adult. Positive connections with other youth who had similar experiences as their own were also prevalent and appeared to be opportunities for youth in care to develop and experience trust.

Critical Importance of Connections. One youth's description of her “grandpa as her gated community '' poetically and practically represents the importance youth place on relationships. It likewise reiterates the tenuous reality of lost protection (see Figure 10). In Figure 11, the same youth describes carrying a Cuban flag with her from place to place as a “piece of home.” The enduring pride for family and culture that she conveyed in the photograph’s narrative reiterates the value she places on keeping family connections. Yet, her narrative likewise hints at challenges youth in care face (e.g., lost belongings and limitations on cultural/language expressions).

Figure 10. "My Grandpa was My Gated Community"

I always loved my grandpa. I grew up in the hood. It's not like I lived in a suburban community. [Suburban communities] are gated for a reason. You get what I'm saying? It's blocked off from real life stuff. So yeah, I didn't really understand that until I came to foster care, because in a way my grandpa was my gated community. He was just the one. Growing up, my mom didn't have a good life. But my grandfather never let me have that type of life… my grandpa always protected me. I think I was twelve [when he died]

Figure 11. "A Piece of Home"

[This picture] It's just my family. So... Yeah. I take it wherever I go. That's my flag. Because I'm Cuban. It just makes me feel like I have a piece of home. When I grew up, there's always a flag. People will tell you that's the most Hispanic thing to do, have a huge flag from your country in your house. So, I always keep it there just to... For me, it makes me feel I'm with my family

There was a lot of stuff my family went through, a lot of what's it called? Adversity. My grandpa swam over here during that phase where all the Cubans and Caribbeans were coming to Miami. So, yeah. That's why I have it. I had another one at my other placement. But they took it. So, I just bought a new one. When I moved, I didn't move my own stuff because I was locked up, so they did it. But they threw a lot of stuff away because my foster mom was the one who packed my stuff up and she didn't like the fact that I was Hispanic. I wasn't even allowed to speak Spanish in the house or anything. I think she threw it away.

Although the presence of positive relationships with adults was the exception, not the rule, examples of trusting relationships were also shared by youth. One youth described her house parents saying, “They are like real parents .” She expressed her love and trust in them without reservation. As a second example, original artwork shared in Figure 12 represents the “bond ” described by one youth with their guardian ad litem and the feeling of having someone to support their success.

Figure 12. "That Bond" (Original Artwork by Youth)

As a second example, after initially not having a response when asked to describe relationships that have mattered to them, one youth circled back to the question. They reflected on a friendship with another youth who was previously placed in the same group home, sharing: “He was like a brother to me. It’s weird because now he got adopted so I’m pretty much all by myself.” The adoption occurred “years ” before, but this youth still identified the “brother ” as their primary example of a relationship that mattered and highlighted the significance of peer-to-peer connections among youth in care.

In Figure 13, another youth’s photograph representing what “connectedness” means to them portrayed a relationship with a young friend at school with the explanation: “ We’ve been through a lot of the same stuff ”.

Figure 13. "This is my friend"

So, my GAL, she's really close to me. So, we're kind of like family friends now because we've created that bond. Her dog is so cute and it looks like a little coyote. This is Dakota. And oh my God, I love her so much. She reminds me of my dog. Whenever we're going out for things, she [my GAL] is like, "Whatever you want to try I'll take you to. Whatever you're interested into, I'll take you to it because I want to see you succeed or try stuff out of your comfort zone." She's like an aunt. She's like... I don't know. She's there. She's someone that can make me focus and stuff like that and go over the top. She nags me and she threatens me with a tutor. But she wants to just see me succeed.

Of note, youth were more likely to describe positive relationships with other young people compared with adults, particularly young people who had similar experiences as their own. Examples included a reflection by one youth on her relationship with a long-time friend:

I’ve been friends with her since I was 12 years old. We were locked up together and stuff, so she has seen the good, bad and ugly of me and the reciprocate. She’s the only person who I trust.

So this is my friend. She is... She's kind of serious. She's been through stuff, but she hasn't been through DCF or anything. She's lived in hotels, she's slept in cars before. I think that's why we're really close, because we've been through a lot of the same stuff. And she's like one of my bestest friends.

Deep Distrust. The examples of positive relationships were noteworthy given the second observed subtheme under this domain - a deep distrust that pervaded youths’ desire and ability to connect with others. Youth in the study had to pause and frequently replied ‘no ’ (e.g., “Not that I know of.”) when prompted to identify people who are there for them emotionally, people they depend on, people who care for them, etc. Of note, distrust dominated this subtheme that was either derived from or was reinforced by professional interactions. One youth reflected on their attorney saying, “They say they’re going to call you and they never call.” Another described getting a call from their case manager when they were hospitalized,

relaying: “That fake shit. That’s what my case manager does. He called me [at the hospital] talking about ‘Are you okay,’ but after that he just didn't contact me anymore unless he wants something done.” A different youth explained:

It’s like they come and do their job when they’re supposed to. They don’t talk to us for a whole month and don’t respond. They have this thing where they have to talk to us every month and that’s the only time they ever call. They’ll be like, ‘Do you need anything,’ and we’ll tell them. But they don’t really do nothing.

Multiple youth repeated the perception that professionals are motivated by job requirements rather than interest in their well-being. Example quotes included: “[Therapists] are just doing it because the court told them to do it ” and “All of them [caseworkers] are in it for the money.” Other descriptions from youth emphasized examples of broken trust or the anticipation of broken trust. One youth reflected on her privacy being violated by a foster parent, recalling:

She read my blue book, basically like a whole binder, so when you move homes they have all your information in one binder, and she read out all my information to her family. That pissed me off.

The same youth also reiterated the need to keep her guard up, explaining: “You got to be careful what you do here because they [professionals] go against you, too.” Even teachers were included in youths’ references of mistrust. One youth explained: “Certain teachers run their mouths to other teachers and some teachers are just close to students…they would tell [my story]. I don’t trust them.”

Three illustrative photographs are provided to visually represent the deep distrust youth expressed (see Figures 14, 15, & 16). In their images, one youth reflected on feeling like they are ‘ the problem ’ in relationships. Others reiterated their hesitation to give trust a try, instead reiterating their anticipation that it will be broken.

Figure 14. "I don't know what love is."

I meditate in my room. I'll be thinking about something and I can't get it off of my mind. And people think I do voodoo, but that's not the case. It's just meditation. It's just sitting there and clearing your mind. But I focus on these two the most [points to head]. For the heart, love, and all that stuff, I don't focus on it. I don't do that. I don't really know what love is . I don't do relationships. I try so many times, but it just doesn't work out. I don't know. Maybe it's... Maybe I'm the problem. That's how I feel. Maybe I’m the problem. I can't be close to people because I can't trust people.

Figure 15. "Never Trust!"

Everyone is always pretending to be someone they're not or acts a certain way when they first meet you. Then when they get comfortable with you, they change. That's what that [this picture] means. Everyone's wearing a mask!

Figure 16. "Can you trust it?"

So people always say you'll never fail, never give up, all this stuff. But [look to the left side of picture]. See all that [shaded space]? That's your life, all the struggles you've been through. And then you come up [move to look at the text on the wall] to somebody telling you this. “You will never fail.” Should you trust that now? Why should you accept it now, if you haven't been told that in the beginning?

SELF-ADVOCACY

The third study domain was self-advocacy. Definitional descriptions from youth were limited in this domain, however when introducing the topic one youth exclaimed, “Your voice has power. People need to hear what you got to say.” Youth represented their experiences with selfadvocacy in two primary subthemes, specifically: (a) feeling unknown, unheard, and misunderstood and (b) the need for people, places, or other platforms to assert their voice.

Feeling Unknown, Unheard, and Misunderstood.

Youth in the study described a feeling of being unknown, unheard, and misunderstood in their interactions with professionals, adults, and even other youth in their lives. Sometimes their expressions conveyed ways that this was intentional. One youth described faking energy to keep people from asking questions, explaining: “I don’t like being asked what’s wrong.” Another expressed hesitation in sharing herself fully with case managers. She explained: “I want to tell them everything, but not tell them everything because that would be showing my weak side.” In other examples, youth portrayed being on the receiving end of the choices from professionals who they perceive do not hear them. In one exchange, two youth explained: Speaker 1: “They [case managers] don’t really care what you’re saying sometimes .” Speaker 2: “They just do their job and they go on.” Another youth reiterated: “[They’re] not listening to me because I'm a child.”

Youths’ descriptions of not feeling known, heard, and understood, intentionally or otherwise, were heavily centered around case managers, but examples also included judges, youth attorneys, and therapists. In particular, youth shared examples of not feeling known well enough by professionals relative to the high degree of the professional’s influence. Two examples from different youth include: “You have the judge who’s trying to control your life and you don’t even know him ” and “They [case managers] try with my brother, but they don’t take the time to get to know him.” This youth explained, “My brother doesn’t want to be there [another placement.] My brother wants to be with me.” In the following quote, another youth described how it feels when adults and professionals misunderstand her:

She [the therapist] thought she understood what I meant, but I was grieving and she put me in extra time for therapy. [Moderator: How did that feel having that choice made for you?] I’ve been through therapy since I was little. Every adult thought they knew what was going on with me or they felt what they felt and reflected it on me. Even though it was true [in some ways], in some ways it wasn’t. It’s suffocating!

An underlying observation in youths’ descriptions of not always feeling known, heard, or understood included perceptions that professionals in their lives and others in the community have preconceived notions about youth in care that may make asserting their self-advocacy difficult. One youth summarized this feeling bluntly: “Being in foster care is not a flex! ” (i.e., not something in which you feel proud or want to bring attention).

Youth expressed having to overcome negative labels and assumptions to be seen and known for who they are. The perception of being labeled as other-than was reiterated by one youth with the declaration: “You should just be called another kid [not a foster kid]. Just because you're somewhere without parents, it doesn't make you another person.” A different youth said, “ My name is not ‘foster kid,’ it’s ‘____’.” Examples extended to having to fight low expectations and assumptions of being less-capable. One youth explained: “They look down on us. They feel like because of our past records we’re not able to take care of our children.” In youths’ observations of their case events and interactions with professionals, the perception of being thought of and treated as less-than pervaded. One youth observed plainly: “Kids who get the good foster parents are babies…nobody wants a teenager. When I came into care it took me two months to get placed.” Another framed their experiences with being heard with the following interpretation: “You can speak up for yourself a million times, and they'll still try to down talk you.”

Need for People, Places, or Platforms to Assert their Voice.

The second subtheme under self-advocacy revealed that youth in care described needing platforms to assert their voice. Figure 17 grounds this subtheme and presents one youth’s analogy of feeling silenced, without a voice, like an animal: “Animals don’t have their own voice, they can’t speak to you.” In youths’ stories, two platform types were illustrated: (a) needing someone to listen and (b) needing more opportunities to self-advocate during case events and in professional spaces.

Figure 17. "Silenced"

Animals don't have their own voice. They can't speak to you. And you know how there's those commercials where the dogs are upset? That's what that face is making. Like they're being abused and they can't speak. They're silenced. And I feel like it's messed up that people do that to their dogs. And kids are abused, just like a dog. And they're locked up, chained up like a dog. And then they put them into a pound. Like we're put into foster care. And I feel like it's messed up. Shouldn't be happening. Needing

Someone to Listen. Youth shared how a receptive person was critical, yet are often a missing platform they need to express their voice. As introduced in the first subtheme under self-advocacy, the experience of not feeling heard was extensive. In response to the prompt “Do you feel you get the opportunity to be heard? ” one youth replied, “No, never! ” She then emphasized that the lack of a receptive audience is the key factor: “[Case workers] don't listen to us.” Another youth echoed: “98 out of 100 [case workers] will not listen.” The following exchange by two youth highlights the hesitation of youth to sometimes speak-up with emphasis on how much the reactions and receptiveness of those they are talking to matter:

Speaker 1: If I need something, I’m scared to ask them cause I don’t know what the outcome will be…probably the first reaction [is] probably making like a face. I’d be embarrassed. I mean, the answer I’m fine with, but the facial feature they’ll probably make is like…I don’t know.

Speaker 2: SO many faces! I worry about that all the time. I’m a kid!

In particular, youth described the challenge of finding a person they can be vulnerable with to share their needs or preferences. Youth communicated how the use of their voice can be inhibited by the person they are talking to being in a position of power and, similar to some of the barriers to their self-determination, not being sure about the ramifications. Figure 18 titled “Listen to me! ” tells the vivid story one youth shared of negotiating the vulnerability of asserting her voice and feeling like she must be aggressive to be heard.

Figure 18. "Listen to me!" (Original Artwork by Youth)

Yesterday, I had staffing for school for them to decide whether I'm going to school or what school I'm going to. He [my case manager] never showed up on the staffing and he knew I had staffing. That's basically showing me that I'm not as important as the other kids or your other cases. We kept trying to reach him, but he didn't answer the phone. When he comes to see me, I'm going to cuss him out. And you can put that as a quote, too.

But, [if I do] he'll try to get my baby took. That's how I feel. That's why I haven't cussed him out or lashed out on him yet because I know he's that type of person. Everybody here knows he doesn't do shit for me, but if I lash out on him, they will understand why I'm cussing him out because you're not showing up to the important things. That makes me feel a certain type of way. That's like saying you don't care about me, you don't care about my case. You just want the money. When he comes, in my head I’m saying, "Cuss him out, cuss him out, cuss him out, cuss him out," but me, I'm hesitating. I'm like saying, "What should I do? Should I cuss him out or should I not?" Because I don't want him to think I'm just being disrespectful even though he's disrespectful to me.

Every time I express myself to a person, they feel like I'm being offensive or something like that or defensive, whatever that word is. That's why I don't express myself to people. They feel like I'm being aggressive and all that stuff. I just keep all of my feelings to myself. I express myself in anger. When I'm mad, I'm expressing myself, I'm yelling, just lashing out on people. When I do that, then they want to listen to what I have to say, but if I'm oh, just a soft voice, they don't want to listen. I have to lash out on people for them to listen to me .

Professional Spaces and Case Events. In addition to needing someone receptive/trusted to listen, youth emphasized the need for opportunities to self-advocate during case events and in professional spaces. One youth’s positive example of being able to exert their voice occurred in the formality of the conference room. Their photograph emphasizes the importance of these spaces as opportunities for youth to be heard.

You said, "Where do you feel heard?” and I'm like, "That's the conference room." It's like, when you're there, you have meetings with people and stuff. Like court, staffings, you have parenting.

The fuller body of youths’ stories reinforced that practicing self-advocacy is a challenge in professional spaces and during case events. Two quotes below describe court experiences youth shared as examples. One youth explained:

When you go to court, there's like 50 other people there and they're just talking all over each other and it's just chaotic.” [Moderator: How does that feel?] Irritating because if you try to talk to the judge about something, they're just cutting each other off and then by the time court's over, you didn't get to ask what you wanted

Another youth reflected on the strategies they have tried to be heard in court, saying:

Speaker 1: I used to cuss my judge out a lot, but then I needed to get stuff done [to be ready to age out]. And she's helping me. I went into her breakout room. I asked to go talk to her privately and that worked better.

[Moderator to the group: Do you get those opportunities often to talk privately?]

Speaker 1: If you ask.

Speaker 2: Nope.

Other examples shared by youth emphasized a lack of self-advocacy or challenges with self-advocacy during removal events and case plan determinations (e.g., their expressed desires being met with perceived excuses during case staffings).

SOCIAL ACTION STATEMENT

As part of the analysis and results of this study, a social action statement was developed to address the needs that youth expressed as they transition into independent living with the intent to (a) support the self-advocacy of youth in foster care and (b) translate findings into practice and policy change. Overarching expressions by youth about independent living services are emphasized first. Second, a call for social change in the form of recommendations emphasized by youth is presented in Table 2.

Independent Living Youth highlighted financial and employment-related needs and challenges navigating current independent living services, such as the need for more decision-making or autonomy within programs and not being rushed at the very end of their time in care. Of note, despite some of the negative connotations of “aging out” and uncertainty about the future, youth across both groups defined independent living as “freedom” and expressed hopeful visions and plans for their future. Three example photographs and narratives that speak to the barriers with independent living youth expressed and youths’ hopes for the future are included in the appendix for reference (see photographs “Being Prepared,” “Navigating,” and “My Future”).

Call for Social Change

As a core deliverable of photovoice methodology, Table 2 is presented that shares the fuller body of recommendations, preferences, needs, and desires youth in this study articulated and the target audiences they identified. Language was altered slightly to frame each expression as an “I need ” statement, however the intent of each expression was preserved. Two example photographs and narratives that align with youths’ recommendations are included in the appendix (see “5 Minutes” and “A House Like That”).

Audiences Learning from Youth

I need a caseworker who cares; Who puts themselves in my shoes; Who shows up for the important stuff.

I need a caseworker who follows through; Who does what they say they are going to do; Who will actually help.

I need a caseworker who listens; Who hears me out; Who cares what I have to say; Who asks for my input; Who wants to know how I feel.

I need a case worker who answers their phone; Who is avail-able when I need them; Who talks to me more than just when things are going wrong; Who visits and calls more than once a month.

I need a caseworker I trust; Who I can be open with; Who doesn't judge me; Who doesn't hold one wrong move against me; Who doesn't make me feel embarrassed when I ask ques-tions.

Caseworkers

I need a caseworker who helps me talk to my family and see my family; Who keeps me informed about my siblings.

I need a caseworker who has enough job experience to know what they're doing; Who doesn't make excuses.

I need a caseworker who doesn't flip the script when we go to court; Who doesn't switch up my words; Who doesn't lie; Who doesn't look down on me; Who doesn't interrogate me.

I need a caseworker who doesn't tell me to pack enough for a weekend when I'm leaving home forever.

I need a caseworker to give me time when I'm leaving [being removed]. I need more than 5 minutes.

I need the choice to go to court.

I need court to be less scary; Less chaotic; With fewer people.

I need to be able to talk to the judge; I need a judge who hears me out; I need to be able to ask my questions.

Judges/Court

I need a judge who knows me well-enough to make decisions about my life.

I worry that the judge who's making decisions is in a bad mood. What if they're having a bad day?; I need judges to know that when they say "no", it's more than just a word. It's my life.

I need to know what other professionals are going to say about me at court ahead of time.

I need to know who my attorney is; I need an attorney who talks to me.

Attorneys

Guardians ad Litem

I need an attorney who's part of my team, not one who only shows up at court.

I need an attorney who calls when they say they will.

I need a GAL who wants to see me succeed.

I need a GAL who understands that I have other things to do and may want you to get a visit over with.

I need foster parents to not assume they understand how I feel.

I need foster parents who don't throw away my belongings.

Foster Parents/ Houseparents/ Residential Staf f

I need foster parents who don't treat me differently than their own children in the house.

I need foster parents who keep my information confidential.

I need foster parents who make me feel respected.

I need foster parents who let me know somebody's there for me.

I need foster parents who let me eat out of the refrigerator.

I need a therapist who knows what they're doing.

I need a therapist who understands that I may not want to be there.

Therapist

I need a therapist who doesn't try to get into all the crevices of my life and understands that they have to gain my trust first.

I need a therapist who gets to know me and doesn’t just do what they do with every other person.

I need a therapist who doesn't think that what they are feeling is what I am feeling.

I need teachers who don’t share my whole situation in front of other people.

Teachers/ Schools

My Family

I need teachers who don’t pity me when they find out I'm in foster care and treat me "like a cat with one leg on the street."

I need kids at school to not assume the absolute worst, "like do y'all have cars" in foster care.

I need kids at school to not make fun of me and say things like "Oh, you have no parents" or "you're a legit orphan."

I need my family to hear me out instead of coming at me and trying to attack.

I need my family [relative placements] to know what they put me through when they talked crap about my parents.

I need my family to not throw away everything, like my mom's stuff, my brother's stuff, everything in my house.

I need my family to believe me.

Audiences Learning from Youth

I need a child welfare system where it's not REALLY hard to get back to your family. They always find reasons for it to not work out.

I need the child welfare system to get better workers; To get people who are qualified.

I need a child welfare system that gives me a say in who my caseworker is. I want to meet them first.

I need a child welfare system that gets me clothes and shoes and underwear when I come into care.

I need a child welfare system that doesn't put kids in 'the shelter'. Kids deserve a nice house.

I need a child welfare system that gives parents just a little bit of mercy before removing.

I need a child welfare system that listens to kids who are making reports.

Child Welfare System

I need a child welfare system that trains their people on how to work with teenagers.

I need a child welfare system that places me close to my fam-ily so it's not like "hey family, do you want to come visit?" and the response is "No, you're too far away."

I need a child welfare system that tells me the truth.

I need a child welfare system where my first call with my mom and sister isn't after being separated for a year.

I need a child welfare system that gives families one more chance and enough time to make a change before removal. You can't do a 180 in two weeks.

I need a child welfare system that gives me warning before being removed.

I need a child welfare system where kids in care have a clean car and a house that looks nice.

I need to start independent living services sooner, so it's not a rush to the finish line.

I need a way to get to services (e.g., transportation to the Flight Center).

I need more financial support to afford care for a newborn.

Independent Living Services

I need a copy of my basic documents.

I need education on financial stuff; taxes; how to pay bills; types of accounts.

I need someone who helps me navigate college prep.

I need a person to help me practice for life.

I need someone to go to if things don't work out.

Discussion

As indicated in the Results, multiple subthemes emerged that demonstrated youths’ perspectives of self-determination, connectedness, and self-advocacy as they navigate the path to independent living. Researchers also recognized that youth frequently process prior and current experiences of trauma and that the three proposed domains are interdependent. When reflecting on their self-determination, youth discussed a number of environmental barriers that influenced their self-determination, as well as how they perceived their motivation within the high-stakes environment of foster care. These responses can be further explained within the context of self-determination theory (SDT). SDT is a theoretical framework that is used to understand why humans behave in various ways, their motivation (intrinsic and extrinsic), their personality, and the impact of their environment.42 ,43 ,44,45 SDT specifically proposes that selfdetermination is driven by whether people feel competent, connected, and autonomous; additionally, it suggests that people need to feel ready to grow and be internally motivated.42,43,44 On the other hand, if a person perceives their environment to be controlling, judgmental, or punitive, this may discourage the development of intrinsic motivation and can decrease a person’s perceived competence.42,43,44

The youth in the current study shared multiple barriers that inhibit their practice of self-determination. They portrayed foster care as an environment that is often uncertain, autonomylimiting, or perceived to be stressful, or unsupportive. In addition, a number of youth reported feeling that they were completely reliant on themselves. This may indicate strong intrinsic motivation and research supports that self-imposed motivation is highly important for youth in their achievement of goals.13 However, it also raises concern that youth may not feel like they can reach out to or depend on others - a concern that is elevated given the state of youths’ vulnerability and uncertainty about their future that is conveyed in the results. Interestingly, independent skills programming was not a prominent topic of discussion among the youth in this study despite direct prompts and repeated opportunities for specific reflection. Prior literature supports that independent living programs can be helpful in promoting self-determination;15 however, youth in this study were more prone to discussing the role of social connections (whether with family, friends in school, or supportive adults met through foster care) and access to resources or knowledge (e.g., how to accomplish their goals or get their needs met) when discussing their self-determination needs or motivation to succeed.

As a primary finding, youth in this study emphasized the importance of their connections with family of origin, other youth in foster care, friends at school, and a couple of youth noted the connections they made with child welfare partners (e.g., GAL and house parents). Youth reported these connections to be comforting, normalizing, instrumental, and

empowering, which also reinforces the emerging theme of interdependence among the three study domains explored within this project (e.g., relationships are a mechanism for self-determination and self-advocacy to occur). Attributes of relational permanence or connectedness have also been reflected in prior literature. Youth in foster care value qualities such as stability of relationships, multidimensional support, opportunities to advocate, honesty and genuineness, commonalities with others, trust, and having access to small core groups of familiar people.46 Relatedly, the youth in this study reported various levels of connectedness and experiences of relational permanence in their interpersonal relationships; however, there was a pattern where nearly all youth reported more negative perceptions of relationships with their caseworkers, attorneys, judges, GALs, or therapists. When asked to consider their needs for building relationships or expanding their social support, all youth reported significant challenges and distrust in connecting with others.

Difficulty trusting or forming relationships is echoed in prior literature, and youth in this study also encountered challenges getting their social support needs met due to the issues with trust.16,22 One consideration is some of the distrust may be due to the effects of trauma, which can cause disruptions across multiple domains of well-being and functioning. For example, experiences of trauma have been associated with a range of internalizing and externalizing behaviors of youth, including depression,47 anxiety,48 substance abuse, and delinquency. 2 Relationships with caregivers, other adults in authority positions, or even peers may also be impacted.49 However, given the findings that youth in this study perceived transactional relationships and a number of broken trust opportunities by their child welfare professionals (e.g., missed meetings by professionals, insufficient attempts by professionals to get to know the youth, feeling that their needs or wishes were ignored or devalued by professionals), it is also possible that experiencing ongoing relational challenges in foster care could exacerbate youths’ reluctance to engage with others. No youth made a point to say they did not want relationships with their caseworker or other child welfare professionals. However, it may be important to consider that the current child welfare system is not always tailored to the needs of individual youth, and that youths’ need for attentive consistency could be elevated from prior or ongoing trauma.

When asked to reflect upon self-advocacy, youth in the current study described experiences in which they perceived the nature of the foster care system, as well as their interactions with child welfare professionals, as inhibiting their voice. They also expressed the desire for platforms (generally a person or place) to share their needs, preferences, and desires. One way to better understand this finding is to look at it through the lens of empowerment research and theory. Empowerment is typically characterized by the means in which individuals, groups, or communities gain power over their own lives or over the contexts that shape their lives. 50 Theories of empowerment typically describe the problems that people face within the context of systemic or environmental oppression, and persons with less advantages typically experience the most challenges to their freedom. 51 Empowerment is particularly relevant for youth in foster care as they generally lack significant control over their lives due to the structure of the system, loss of natural or familiar connections, and ongoing surveillance and support until they age out of the child welfare system. Research suggests

that youth who report higher involvement in the process of planning their case and transition into adulthood report more satisfaction with their experiences; however, youth may not consistently be experiencing the opportunity to participate.7

The field of empowerment research and theory is relatively diverse or varied in its exact application of specific terminology or concepts to youth; however, the themes of power, participation, and education are most commonly addressed in youth empowerment literature. 50 A systematic review of youth empowerment research also found that there are a number of attributes of youth empowerment, such as (a) promotive of growth and well-being, (b) relational, (c) educational, (d) political, (e) transformative, and (d) emancipative aspects of empowerment. 50 Foster care research echoes these themes. For example, adults formerly in foster care and youth with disabilities transitioning out of care have reported that gaining self-advocacy skills were markedly important for transitioning into adulthood. 23,24 The attributes of youth empowerment are relevant to the findings of this study in that youth reported different perceptions of factors that they felt were linked to future success. For example, youth noted that positive and supportive relationships provided a means for growth and development and that access to education and information were key aspects of their individual success as they transitioned into adulthood.

LIMITATIONS

The intent of photovoice methodology is to represent and elevate the voices of the specific study participants. It is possible that participants may have unique experiences that may or may not be shared with other youth in foster care or living in group care settings. However, the expressions across this diverse group of youth and the detail in which they shared their stories and self-created photographs supports the interpretation and transferability of findings. Sample sizes are generally small to facilitate the feasibility and depth of data collection, however this limits the study’s generalizability. The sampling was composed of five females and only one male participant all of whom were from the state of Florida. Although there were other youth interested in participating, the researchers were limited in who could participate due to scheduling conflicts (e.g., overlapping treatment/activity appointments) and delays hearing back about parental or child welfare system consent when youth were placed out of county. Despite the small size, the sample composition of the current study is one of its strengths. The study’s sample included youth from diverse racial groups, youth from two different group home sites, youth with experiences in multiple county child welfare systems, youth with both lived experience in child welfare and juvenile justice systems, as well as youth who were parenting or preparing to parent and those who were childfree.

Finally, the domains or topics were pre-selected based upon conversations and interest with the supporting child welfare agency. Although emerging themes were identified and included in this report, there are other aspects of transitioning into adulthood or independent living that may not be captured.

IMPLICATIONS AND RECOMMENDATIONS

This section builds upon implications for practice, research, foster care and independent living programs, and policies based on the findings of this study and context of the youths’ social action statement. One of the major implications and recommendations that emerged from these findings is the need for child welfare and associated professionals to understand that youth often internalize negative feelings that come from the high-stakes nature of foster care. Youth recognize their vulnerability and feel vulnerable due to real and perceived limitations in support, autonomy, and increased challenges faced when navigating toward adulthood. To compound the reality and feeling of being vulnerable, professionals may need to consider that current trauma-informed care practices may not be sufficient or equitably meeting the needs of youth who are facing continued adversity and/or those processing prior and ongoing trauma. For example, the reality of the child welfare system is often influenced heavily by policy, which was echoed in the youths’ experience of more transactional relationships with many of their foster care system professionals. Youth felt that control was exerted on them by their child welfare professionals in most cases rather than feeling like they had a significant voice or authority in their own day-to-day decisions, case events, or path toward independent living. Riebschleger et al. (2015) 52 presented a number of youth-driven recommendations for creating a trauma-informed foster care system such as providing family preservationlike services earlier (preventing foster care as much as possible), creating a context for youth to pursue or maintain caring connections with their loved ones or child welfare professionals, ensuring foster parents are skilled enough to handle youths’ mental health and trauma-related needs, and promoting leadership opportunities for youth in foster care.

Shared decision-making (SDM) can provide a set of principles and guidelines for professionals to better collaborate with youth. Although a number of models and variations exist, SDM generally involves professionals collaborating with clients, in this case youth, using the best available evidence and options to help youth make decisions in their own best interest. 53 , 54 Elwyn et al. (2012) 55 recommended a three step model that was slightly adapted to fit the context of working with youth: (a) introduce youth with their choice(s); (b) discuss options with youth and ask for their perspective and understanding; and (c) support youth in getting more information and making the best decision for them. As an example, youth in this study specifically mentioned that they would like the opportunity to select their child welfare worker or at least meet their worker before the assignment is finalized. Perhaps this could be extended to other areas such as input in choosing their GAL or therapist.

Research has also indicated that professionals using SDM must embody multiple values, including support for the self-determination, preferences, and knowledge of youth or families they are working with while also recognizing the importance of relationships and relational autonomy. 55 While SDM is not new in the context of child welfare and there are multiple efforts to include or engage youth in their case planning or other aspects of their care, there is evidence that a majority of youth do not feel included or have a large voice in decision-making. 56 Thus, there is a need for more research on which SDM approaches are most effective/ preferred for youth in foster care and how these approaches are successfully implemented in complex child welfare systems.

However, with growing attention being paid to the inclusion of youth voices in foster care, it appears that progressive efforts in SDM are increasing and ought to continue. 57

Findings from the current study also highlight that professionals need to maintain a high level of awareness of what it takes to meet the needs of youth in foster care, particularly those facing higher levels of trauma or adversity. Youth may require support above or beyond what would meet the standards of what professionals consider typical or normative. For example, it is developmentally appropriate for youth to be involved in planning for adulthood and making decisions about their future; however, the level and types of stress that youth experience may cause emotional arousal and impulsive behavior that can inhibit positive decision-making. 58 This may be particularly salient for youth in foster care who report prior and potentially ongoing trauma. 52 Although the resulting behaviors and consequences of impulsive behavior can appear or become negative, researchers have identified that youth who are trying to get their needs met are still engaging in adaptive behavior and can experience positive development when given appropriate support. 58 Thus, creating a healing and trauma-informed environment that is supportive of selfdetermination for youth in foster care means professionals may need to focus on addressing the needs of youth in autonomy-supporting ways, providing for more than just youths’ basic developmental needs, and including high levels of warmth or support. Essentially, youth need more of a voice in making decisions and identifying the types of support or resources needed to transition into adulthood. A high level of understanding is needed from professionals that youth are in an autonomy-limited environment which may also reinforce their prior trauma through broken relationships (with professionals, family, or other loved ones), or ongoing uncertainty.

Another important consideration is that youth in this study viewed the child welfare system as a source of broken trust due to ongoing negative interactions with professionals or other unfulfilled expectations. Unfortunately, the vast majority of youth reported their relationships with caseworkers, foster parents, GALs, attorneys or other court professionals, and even child welfare therapists to be conflicted or insufficiently supportive in working toward their goals of independent living. These aspects are important given the critical role that relationships play in youths’ self-determination and transition out of care, 21 as well as their mental health and well-being.18,19,20 It is recommended that child welfare professionals receive training, coaching, or other types of support (e.g., time or opportunities for relationship-building or self-care) to learn how to balance the compliance aspects of working within the child welfare system with the needs for building transformative relationships with youth who are in a vulnerable environment and at a high stakes point in their life.

Although professionals must be compliant with laws and regulations, emphasis should be placed on building positive, consistent, realistic, and collaborative relationships between foster care system professionals and youth. In-service training and ongoing supervision may be a helpful means of providing continued support, education, and accountability to professionals for building relationships (see CWIG, n.d. for additional resources on engaging with youth in various aspects of their experience in foster care). 59 In addition, foster parents caring for older youth who are more likely to be preparing for independent living may also need additional skills or support to provide a positive and supportive environment.60

Another consideration is youth were all in group home settings where there may be a rotation of different caregivers. Staff in residential care may not get the same training that foster parents do so they may need to receive helpful support to promote healthy relationships and improve outcomes for youth.

Another consideration is frontline workers cannot bear the brunt or responsibility for making change when the system is not always set up to support or reinforce SDM, healthy attachments, relationships or connections to family or culture, and other important aspects of a healing environment. Given the continued challenges youth face while transitioning into adulthood and more negative outcomes as adults, enacting change is a priority.1,3 With the challenges voiced by those impacted by foster care services and growing reports supporting the inclusion of those with lived child welfare expertise to have a role in decision-making, there are a number of opportunities presented to address the needs identified in this report. 52,61 Some specific examples of systems change derived from the youth in this study include finding ways to reinforce the importance of relationships as a foundation for self-determination and self-advocacy. For example, when youth are moved, how does the child welfare system support prior connections and new connections youth may need? Child welfare systems could consider programmatic and policy changes such as foster parent training to help understand youths’ cultures or how to build relationships, limiting the distance of placements from home (unless it is in the youth’s best interest to move further away), or develop and implement policies/procedures that demonstrate abundant respect for youths’ objects/belongings throughout removal and additional moves in foster care (e.g., some youth have lost meaningful personal items during placement moves/ disruptions or felt that their belongings were not respected). Similarly, relationships with other youth in and out of foster care were vital to those who participated in this study. These relationships are developmentally appropriate and can help youth prepare for and transition into adulthood. Finding ways for youth to experience normalcy and get support for maintaining these connections is important. In summary, it appears that youth both need and desire more than independent living services or programming in order to prepare for their future. Finding ways for the child welfare system to build and support the capacity for relationships may be a key aspect of supporting youths’ self-determination and self-advocacy.

FAU THEATRE LAB PERFORMANCE AND DISSEMINATION

Following approval of this final report, the findings of this research will be shared with child welfare administrators, professionals, and policymakers with the intent of translating youths’ voices in ways that will enhance future independent living services in the areas of self-advocacy, self-determination, and connectedness. In addition to the benefit of informing potential practice, legislation, and priorities for independent living services, primary implications of this study include (1) self-advocacy and empowerment for participating youth and (2) achieving community change through social action. Photovoice studies with youth allow for deep and meaningful explorations of young people’s lives,62 particularly those who may be underrepresented.63 Research has shown that photovoice has been an empowering process for participants in learning more about themselves, promoting self-reflection, making important

social connections with various types of stakeholders in the community, educating others, and becoming more aware of their community overall.64 A core component of photovoice methodology is the communication of findings with practice and policy stakeholders to shift power and amplify the voice of study participants in community settings. Because of the social action piece that allows participants to share their work with decisionmakers or others with power, this type of methodology has been used to influence program development and policymaking efforts – particularly locally or regionally.65 66 Likewise, community engagement platforms to facilitate youths’ voice being heard is designated as a core deliverable of the research process. Example potential platforms include (1) invitation photography exhibits with community stakeholders identified by youth; (2) exhibits in policy venues; (3) exhibits with university student populations and learning communities; (4) panel discussions pairing youth with caseworkers/administrators; foster parents; and policy-makers; (5) agency-based, youthguided training; and (6) state and regional presentations.

Theatre Lab. A primary and unique platform option was also developed in collaboration with FAU’s Theatre Lab in the College of Arts & Letters. Theatre Lab @Center partners with organizations serving at-risk youth to put concerns of today’s youth in the most prominent position they have —theatre. This partnership provided an opportunity for the perspectives, photographs, and recommendations created by youth in the study to become the material for a devised piece of theatre developed and performed by a student theatre company in conjunction with professional artists to create a deeper community understanding of the lives and experiences of youth in care. Youth and community partners (e.g., judges, caseworkers, administrators, foster parents, teachers, service providers, etc.) were invited to attend to hear and receive youths’ stories through this medium and engage in dialogue about direct practice and policy implications; two youth, a couple of housemates, and their house parent were able to attend, as well as an audience of approximately 60 other community members. Using information from the youths’ social action statement, additional venues will continue to be identified in collaboration with youth and child welfare partner groups.

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INDEPENDENT LIVING EXAMPLE PHOTOGRAPHS

Figure 20. "Being Prepared"

That's the teddy bear that I keep in my baby's crib. She's not here yet, but I like to be organized and just have stuff prepared. That's my biggest thing. I just don't like being stuck in the moment or anything. I'm going to keep that there until she comes. Technically this is a good placement for moms, because they help you out more than some of the other placements that you could go to down south, but I'm technically not... I'm not going to be here [when I deliver]. Because on my birthday [turning 18], I'll be 37 weeks. Which is two months from now. So, I'll be 37 weeks and I'll have to go. So, I just like to have everything prepared before I leave.

Figure 21. "Navigating"

Some people say, "Oh, they don't need phones.” But you really do to be honest. If you have to call from work, you have to use your phone, or call my ACCESS Florida, or daycare. What if the daycare needs something? Or family. Just communication. [Moderator: How does it feel balancing all of that stuff? Where did you learn the skills to do that?] [I learned] from some of the other girls who were here. When I first got here, some of the older girls, they told me about SSI, food stamps, cash assistance. I never knew that it’s easy to apply for or what it is. At first, I was trying to get them [caseworkers/ life coaches] to help me. That's when I didn't know that they shouldn't even have a job [expletive]. If they were our only source, I would be shit out of luck. But yeah. Then some of the other girls helped me.

Figure 22. "My Hope!"

I want to get pregnant. I want to give my kid a life...

My mom could give me a good life. My dad gave me a good life, too. But they're also people who were just kids and just weren't ready for that. My mom had me at a young age, so I understand.

But I want to have my kid at the right age and be able to take care of them and stuff. Which is why I want to finish college and then do whatever I want to do, like becoming a [named career] for a while. Then I want to get pregnant, like in my late twenties.

Figure 23. "5 Minutes" (Original Artwork by Youth)

Figure 24. "A House Like That"

Speaker 1: I think that they need to stop telling you to pack for a weekend, knowing that you're not going to get your clothes for a long time. My second time I packed as much as I can, because it was my second time around. I cried when I packed, like I was like about to throw up, I was crying so hard.

Speaker 2: They told me to take [pack] for like a weekend. And then I left with only three sets of clothes and that's the only clothes I could use. I was two months at this shelter place. And then they never gave me back my stuff. So they threw everything [away]. Like my mom’s stuff, my brother’s stuff, everything out of that house.

Those big houses right there. When I get older I want to be in a big house like that.

And sometimes I feel like here [our group home] should have been like that. Like the houses that we have should have been looking like that house. A two story. Because we have so many girls and we don't have enough rooms. I understand it's two sides of the house, but it could have been a big house, a house full of girls and babies. Not a mansion, but just a regular two-story house. That [the house in this picture] looks nice, [living] in a gated community.