Implications and Recommendations

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