Being a teenager or young adult is difficult for anyone, even under the best circumstances and in the most stable and supportive home environment. In the best-case scenario, parents have been a guide for their children, teaching them the life skills they will need as they advance to independent adult life. Helping them learn from mistakes and sometimes being a safety net in times of uncertainty. Of course, this is not always the case, and for youth in foster care, the connection to an adult to guide and teach life lessons may not exist. Learning the skills to navigate the young adult and adult world can be surrounded by barriers, uncertainties and emotional turmoil. This is especially true for youth who have had multiple foster homes and little stability with schools, family, or community. Many case managers will not have had extended interaction with youth preparing to age out of the foster care system as part of the direct care team. Opportunities to engage with youth may be during medical or behavioral health visits, in the community, or through interactions with case workers and foster parents. Whatever the case manager’s role, staying aware of and acknowledging the struggles and challenges these youth face can help the case manager be an active member of the support team for youth preparing to leave the system for independent adult life.

THE GOAL

According to the Adoption and Foster Care Analysis and Reporting System (ARCARS) Dashboard, in the United States, more than 45,000 youth between 17 and 23 experienced foster care during the 2024 fiscal year. Foster care or out-of-home care is defined as a temporary, court-monitored service provided by states to promote the safety, permanency, and well-being of children and youth (Child Welfare Information Gateway, n.d.). Children and youth can receive out-of-home care in several forms, including:

  • kinship care (a family member or relative assumes the role of foster parent)
  • non-relative foster parent care
  • congregate care, such as a residential or group home placement

Reasons for entering the foster system and the duration of time in the system vary with each family circumstance and can range from neglect and abuse to parental absence or parental need to deal with their own personal circumstance. Whatever the reason or location of care, the aim and ultimate goal is to provide a permanent, stable home environment for the child. Reunification with parents is preferred but may not always be possible. According to ARCARS, reunification and adoption together account for only 10% of permanency plans for this age group. For children who have been in the foster care system for an extended period or have entered as teenagers, permanency may not occur prior to age out. Lack of permanency impacts transition out of the system by making youth more susceptible than those who have established permanency to depression, low self-esteem, health and socio-economic challenges such as housing issues and homelessness, difficulty accessing mental and physical health care, educational challenges, low employment and income, and potential involvement with the criminal justice system (Ahn, Gil, & Putnam-Hornstein, 2021).

BASIC NEEDS

When children enter the foster care system, the state takes on the parental responsibility of providing food, shelter, healthcare, and education to that child until they leave the system. Child welfare policies and programs exist to help make the material transition out of foster care easier. Provisions for housing, education, and life skills training are in place, such as the John H. Chafee Foster Care Program for Successful Transition to Adulthood, Educational and Training Vouchers (ETV) Program, Foster Youth to Independence Initiative and Transitional Living Program. Phan and Klurfield (2024) list federal support for housing and education, including a description:

  • John H. Chafee Foster Care Program for Successful Transition to Adulthood, known as the Chafee program, supports education, employment, financial management, housing, emotional support, and establishing a connection with an adult. Educational and Training Vouchers (ETV) is a subprogram of Chafee and provides funding for the postsecondary education and training needs of young adults who have experienced foster care after age 14.
  • Foster Youth to Independence Initiative: FYI housing vouchers for youth 18-24 for 36 months.
  • Transitional Living Program This program awards grants to nonprofits and public service organizations to provide long-term residential services to homeless youths ages 16 to 22. Grantees provide a range of services from transitional housing and youth development skills to educational support and career training.

DISCONNECTED

The much-needed financial, housing, and educational support for youth aging out of foster care is imperative as they move to independent adult living. However, what else do these youth need to be successful and experience positive outcomes? There is little research to demonstrate evidence-based methods to prepare youth for this transition (Nesmith, 2024). What do the youth themselves have to say about what they need? In a word, they need connection.

Caleb, an 18-year-old young man who has been in the foster system most of his life and who currently lives in congregant care, shared some of his thoughts on being an 18-year-old in the system. During a recent informal interview, Caleb shared the need for people to be there when youth need them. He expressed having good connections from time to time, none were long-term, and voiced the need to have a personal connection, a bigger support system, and a mentor to talk through life experiences. Caleb shared the importance of finding an alternative to family in mentors, case workers, or care team members (Caleb, personal communication, September 18, 2025). Rebuilding a sense of connection becomes more difficult when youth experience changes in schools, moving from foster home to foster home or changes of staff within their care team.

Todd Kline, an older child matching initiative recruiter who has worked with youth in the foster system in many roles throughout his career, shared his thoughts on the importance of connections.

“I have found over the years that many youth develop a connection and trust with certain workers. In a teaming environment, this can be very useful to help guide the youth. The key is that the team recognizes the worker and makes that person the point person on the team. There is really no logic how the youth connects to the worker; they could be any of the workers regardless of agency or position.” (Todd Kline, personal communication, September 18, 2025).

Others have shared Caleb’s insight around the need for connections. Loss of connections may trigger grieving that is often left unacknowledged, leaving the child or youth without support to move through the grieving process. Children and youth entering the foster system experience loss of parents, siblings, family, friends, and community. Even if those connections and environments were not in the child’s best interest or were far from ideal, they are losses nonetheless. Finding a solid connection where children and youth feel they can share their feelings about loss can lead to positive outcomes and better relationships in the future (Mitchel, 2018).

The foster care system is multifaceted, and the impact of loss of connections and permanency on children and youth is complex and outside the scope of this short article. The realities of youth aging out of the foster care system are daunting. The visible aspects of being an adult, such as employment, higher education, a place to live, budgeting, and financial well-being, are significant challenges. The less visible emotional struggles are just as impactful to a successful transition, if not more. Addressing the physical, behavioral, and mental health needs of youth in foster care takes patience, persistence, and knowledge of multiorganizational teams. Preparing youth in foster care takes a team of professionals to bring all the pieces together and create that connection to a stable adult.

THOUGHTS FOR THE CASE MANAGER

All youth need the support and guidance of caring adults to help them learn life skills, develop goals, understand their emotions and behaviors, and understand how those behaviors can impact their relationships. The next time you have the opportunity to interact with a youth in foster care, keep in mind what they are facing in the months to come. If they have a support person that they have a connection with, respect that connection as you would that of a parent. Don’t be afraid to acknowledge their loss and offer your support. Who knows, you just may end up being that connection they are seeking.

REFERENCES

Ahn, E., Gil, Y., & Putnam-Hornstein, E. (2021). Predicting youth at high risk of aging out of foster care using machine learning methods. Child abuse & neglect, 117, 105059.

Child Welfare Information Gateway. (n.d.). Foster care. U.S. Department of Health & Human Services, Children’s Bureau. https://www.childwelfare.gov/topics/permanency/foster-care/?top=122.

Mitchell, M. B. (2018). “No one acknowledged my loss and hurt”: Non-death loss, grief, and trauma in foster care. Child and Adolescent Social Work Journal, 35(1), 1–9. https://doi.org/10.1007/s10560-017-0502-8.

Nesmith, A. A. (2024). Managing Major Life Changes: An Exploratory Study Using the Bridges Transitions Framework to Help Foster Youth Prepare for Discharge. Children, 12(1), 22.

 

Theresa M. Litzinger, BA, MSN, RN, CCM, has over 30 years of experience in pediatric nursing and 10 years of pediatric case management and management experience in various post-acute settings. She holds a BA in elementary and special education as well as MSN in nursing administration.