- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02113085
My Life: Evaluation of Self-determination Enhancement for Adolescents in Foster Care
My Life: Evaluation of Self-Determination Enhancement for Adolescents in Foster Care
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Compared to their same age peers in the general population, youth who transition to adult living from foster care are less likely to have stable housing, to be connected to a caring adult, to graduate from high school, to go to college, or to be employed (e.g., Avery, 2001; Pecora et al., 2003; Goerge et al., 2002). They are more likely to engage in risky sexual behaviors, to become a single parent, and to be homeless or involved in the criminal justice system (e.g., Courtney et al., 2006; Smithgall, Gladden, Yang & Goerge, 2005). While consensus exists about the poor outcomes of these youth and policies have been adopted (e.g., Foster Care Independence Act) aimed at improving their transition, evidence-based practices have yet to be validated for achieving this goal.
Skill development focused on self-determination enhancement, shown to be associated with transition success of young people in special education, could have unrealized potential to prepare youth in foster care for the sudden independence they experience when they abruptly age out of foster care. The overlapping nature of these at risk groups (approximately 40% of youth in foster care receive special education services) further suggests that skill development for self-determination enhancement could have cross-cutting benefits. To gather preliminary efficacy and feasibility data for youth approaching transition from foster homes, a pilot study using a randomized, 2 groups X 3 repeated measures design was conducted in Oregon (entitled My Life). Sixty youth, ages 16.5 through 17.5, in foster care and special education, were randomly assigned to either a control group that received community as usual services (CAU) or an experimental group that received one-to-one coaching designed to enhance self-determination (My Life). The My Life intervention group experienced a statistically significant increase in self-determination (as measured by the ARC; Wehmeyer & Kelchner, 1995) in comparison to the control group. Youth who participated in the intervention were also more likely to exhibit improvement in employment outcomes and in overall well being and to report greater involvement in the transition planning process over time as compared to the control group. In addition to providing evidence of its efficacy, the My Life pilot provided important feasibility information and estimates of effect size.
Given the promising findings of our randomized controlled pilot of the My Life intervention, the goal of this R01 proposal is to undertake a full-scale efficacy trial of the My Life program. We are proposing to expand the work conducted in our initial investigation to include all youth preparing to exit foster care (i.e., youth receiving and not receiving special education services), and to specifically assess the impact of the intervention on mental health. The proposed study, which builds on the promising findings of our initial work, will provide important information on the efficacy of the model for all youth exiting the foster care system, providing data on the intervention's direct effects on critical outcomes, including quality of life, mental health, education, employment, employment and independent living, and whether enhanced self-determination mediates, at least partially, the intervention's effects on these critical outcomes. Additionally, the study will investigate whether disability, gender and race moderate the effect of the intervention on distal outcomes. Trauma symptoms and placement instability experienced at baseline will be considered as covariates; the potential direct effects of the intervention on these key foster care experiences also will be explored at completion of treatment and follow along. The proposed study has four specific aims: 1) We will recruit 210 foster youth, 16.5 to 17.5 years of age and randomly assign them to either the My Life intervention group or a community as usual control group that receives typical services (CAU). The intervention is designed to increase youth's self-determination in preparation for aging out of care and to provide for follow along assessment of their outcomes during this challenging and high-risk period. To recruit youth, we are collaborating with Oregon DHS and will target Oregon's most densely populated area: Multnomah County; 2) We will use a multiple agent, multiple indicator strategy for measuring key constructs to assess youth at baseline, intervention termination (12-month post-baseline) and follow-up (12-month post-intervention completion). We also will collect DHS Foster Care and school district archival records at these three time points. Brief phone interviews will be conducted every 60 days with participating youth regarding recent service and support utilization, global ratings in key outcome areas, stressful events, and contact with supportive adults. Thus, a total of 13 60-day phone interviews will be conducted over the entire 24-month period of study enrollment; 3) Using a series of modeling analyses, we will test intervention efficacy and the key elements of our theoretical model. Specifically, we will test for stability versus change of self-determination, mental health adjustment, academic achievement, quality of life, employment and independent living, with intervention group assignment (My Life vs. CAU) modeled as a dummy variable with anticipated direct effects on outcomes for the key constructs. In a second series of analyses, we will test the hypothesized mediator effects of self-determination on mental health adjustment, academic success, quality of life, employment and independent living, and explore whether disability, gender and race moderate the impact of the intervention on key outcomes. The influence of trauma and placement instability on distal outcomes will be examined, as will the intervention's impact on these key foster care experiences. 4) We will track fidelity of implementation to document adherence to intervention protocols and perform analyses to identify intervention components actively associated with major outcomes as well as possible differences in intervention components for foster youth with a disability versus those without. Oregon DHS has a strong interest in this project and we anticipate that they will work to maintain delivery of active intervention components.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
Oregon
-
Portland, Oregon, United States, 97207
- Oregon DHS
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- between the ages 16.5 to 18.5 years of age
- reside in Multnomah, Washington or Clackamas County, Oregon
- currently in DHS foster care custody and have accumulated at least 90 days in care.
Exclusion Criteria:
- Youth scheduled to move from Oregon within the next year.
- Youth who represent a safety risk to project staff or other participants
- Youth who experience a profound cognitive disability or are actively psychotic
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Prevention
- Allocation: N/A
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Self-determination enhancement
Self-determination enhancement through one-on-one coaching and mentoring workshops
|
Self-determination enhancement through individual coaching and peer mentoring workshops
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change from baseline Arc's Self Determination score at 12 and 24 months
Time Frame: Baseline (enrollment), post-intervention (12 months), post-follow-along (24 months)
|
The Arc (Wehmeyer, 1996; Wehmeyer & Kelchner, 1995) is a 72-item self-report measure that provides data on four components self-determination as well as providing a global overall score of self-determination.
|
Baseline (enrollment), post-intervention (12 months), post-follow-along (24 months)
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in baseline Child Behavior Checklist t-score at 12 and 24 months
Time Frame: Baseline, Post-intervention, Post-follow along
|
Child Behavior Checklist (CBCL, Achenbach & Rescorla, 2001).
The CBCL is a parent report of child behavioral and emotional problems based on the child's activities, social relations and school success.
A foster parent will complete the CBCL in reference to a youth's behavior during the prior month and includes scales for withdrawn and anxious-depressed behavior, attention problems, delinquent behavior and aggressive behavior.
|
Baseline, Post-intervention, Post-follow along
|
Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in baseline Quality of Life Questionnaire Score at 12 and 24 months.
Time Frame: baseline, post-intervention, post-follow along
|
The Quality of Life Questionnaire (QofLQ) is a widely used standardized measure of quality of life.
It has been used with older children and adolescents with behavioral and educational impairments, and has well established validity and reliability.
The instrument provides information on a young person's connections with others, social inclusion, individual control, community integration, productivity and over all satisfaction and well-being.
|
baseline, post-intervention, post-follow along
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Sarah Geenen, PhD, Portland State University
Study record dates
Study Major Dates
Study Start
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- 5R01HD064854-02 (U.S. NIH Grant/Contract)
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