Objectives: Youth who age out of the child welfare system are among the most vulnerable group of young people entering adulthood today. Unlike their generational peers, foster youth lack the familial supports necessary to postpone major life decisions and gradually enter adulthood. Although there are notable differences between Canadian and American child welfare contexts, young people exiting both systems experience a compressed transition and are tasked with quickly managing adult responsibilities. Few studies have examined pre-transition factors that correlate with adolescents’ readiness skills prior to exiting out-of-home care. Methods: This dissertation presents two studies that examine factors associated with transition-age foster youths’ readiness skills for adulthood. In the first study I used cross-sectional data (n = 278) from Illinois, United States to assess the impact of adverse childhood experiences (ACEs) on youths’ independent living skills and life domain functioning. I hypothesized that exposure to ACEs would predict lower transition readiness, and that trauma-related stress symptoms and strengths would moderate this association. In the second study I used cross-sectional data (n = 1,026) from Ontario, Canada to identify youth-, placement-, and agency-level factors that predicted youths’ self-care and financial literacy skills. I hypothesized that factors most proximal to individuals would impact readiness (e.g., academic performance, self-esteem). Results: Hierarchical regression analyses indicated that ACEs predicted lower transition readiness. Traumatic stress symptoms moderated these relations, and engagement in risky behaviours partially mediated these relations (study 1). Hierarchical linear modelling indicated that agency-level differences did not impact readiness. In contrast, general linear modelling indicated that a subset of individual- and placement-level factors did impact readiness. Specifically, higher academic performance, higher self-esteem, a greater number of developmental assets, older age, an older age of entry into care, a greater number of placement transitions, and kinship care placement predicted higher transition readiness. A greater number of socioemotional difficulties, a greater number of long-term mental and/or physical health conditions, and a lower frequency of problematic parenting practices combined with a higher frequency of effective parenting practices predicted lower transition readiness (study 2). Conclusion: Findings illustrated that although ACEs exposure predicts lower adult readiness among transition-age youth, whether youth engage in risky behaviours and possess developmental strengths may be better predictors of their readiness to age out of care (study 1). Findings also illustrated that a subset of individual- and placement-level factors predict self-sufficiency skills among transition-age youth (study 2).

No description available.

Background: Transition readiness is a critical set of skills that youth must acquire as they prepare for managing their healthcare in adulthood, for both youth with and without special health care needs (SHCN). Currently much of the literature pertaining to transition readiness focuses youth with special health care needs (YSHCN). However, all youth, including those without special healthcare needs, should develop skills for managing their health as they transition into adult healthcare. Additionally, youth from rural areas may face additional barriers to acquiring the skills for transition, yet a paucity of information on transition readiness among this population. Objective: We examined transition readiness among youth in two rural high schools in South Central Appalachia. Specifically, we examined differences in readiness among youth with and without SHCN. Design/Methods: We used data from a 2016 school-based survey of adolescents ages 16-18 at two high schools in rural South Central Appalachia Tennessee (n = 437). Using a validated screener, we identified 23% of youth as YSHCN. Compared to healthy youth, a greater proportion of YSHCN were female (68% vs. 49%) or non-Hispanic white (96% vs. 83%). We assessed differences in transition readiness as measured by four subscales (managing medications, appointment keeping, tracking health, and talking with providers) of the the Transition Readiness Assessment Questionnaire (TRAQ). Responses were collasped into two categories, yes/no, for each item and summed to create scale scores. We conducted MANOVA models predicting transition readiness by YSHCN status and demographics as potential covariates. Results: YSHCN scored significantly higher than youth without SHCN on all four measures of transition readiness (p<.01). In multivariate analyses YSHCN (versus other youth) had significantly greater transition readiness for the four subscales: F(4, 401= 5.36, p<.001), controlling for age. Table 1 displays overall and group means, and p-value for the TRAQ subscales. Conclusion(s): Rural YSHCN scored higher on the scale, perhaps due to their increased exposure to the health care system. Readiness skills for the transition to adult health are necessary for all youth however, findings from this study suggest that many rural youth—particularly those often thought of as “healthy”—may not be fully prepared for this transition. Findings point to the need for the development of interventions to help all youth effectively make transition to adult healthcare

Background: Measuring the acquisition of self-management skills are part of evidence based health care transition practice. Youth with Spina Bifida have significant demands for self-management and high self-care burden. We developed an 11 item Spina-Bifida -TRAQ to assess self-management skills specific for Spina Bifida including urine, stool continence management, and skin and shunt maintenance. A detailed description of the SB-TRAQ, its reliability and criterion validity are presented elsewhere. Objective: To examine the predictive validity of the Spina Bifida-TRAQ among youth with Spina Bifida. Design/Methods: Participants include 90 youth with Spina Bifida who attend a clinic participating in the National Spina Bifida Patient Registry (NSBPR) (see Table1 for demographics). Youth completed the newly developed 11-item SB-TRAQ. De-identified NSBPR data from the electronic medical record (EMR) was linked with participants’ responses from the SBTRAQ. Two separate regressions were conducted using: age, sex, race, ethnicity, insurance, lesion level, lifetime # of shunt revisions, and SB-TRAQ to predict urinary incontinence (UI) episodes/month, and stool incontinence (SI) episodes/month. Results: Two separate multiple linear regressions were calculated to predict frequency (times per month) of UI and SI based on age, sex, race, ethnicity, insurance, having an IEP, spinal cord lesion level, lifetime number of shunt revisions, and SB-TRAQ. For UI, a significant regression equation was found (F(9,77) = 2.44, p<.001), with an R2 of .22. SB-TRAQ and IEP were significant predictors of UI; youths’ UI decreased 1.15 days/month for each point increase in SB-TRAQ; youth with an IEP had .83 more episodes of UI/month than did youth without an IEP. The model for SI had a significant regression equation (F(9,75) = 3.18, p<.001), with an R2 of .28. SB-TRAQ and lesion level were significant predictors of SI; youths SI decreased .58 days for each point increase in SB-TRAQ; each lower lesion levels (.13/level) had fewer SI episodes/month than did those with higher lesion levels. Conclusion(s):

Background: Measuring the acquisition of self-management and health care utilization skills are part of evidence based transition practice. The Transition Readiness Assessment Questionnaire (TRAQ) is a validated 20-question and 5-factor instrument with a 5-point Likert response set using a Stages of Change Framework. Objective: To improve the performance of the TRAQ and allow more precise measurement across the full range of transition readiness skills (from precontemplation to initiation to mastery). Design/Methods: On data from 506 previously completed TRAQs collected from several clinical practices we used MPlus v.7.4 to apply a graded response model (GRM), examining item discrimination and difficulty. New questions were written and added across all domains to increase the difficulty and discrimination of the overall scale. To evaluate the performance of new items and the resulting factor structure of the revised scale we fielded a new version of the TRAQ (with a total of 30 items) using an online anonymous survey of first year college students (in process). Results: We eliminated the five least discriminating TRAQ items with minimal impact to the conditional test information. After item elimination (k = 15) the factor structure of the instrument was maintained with good quality, ?2 (86) = 365.447, CFI = 0.977, RMSEA = 0.079, WRMR = 1.017. We also found that a majority of items could reliably discriminate only across lower levels of transition readiness (precontemplation to initiation) but could not discriminate at higher levels of transition readiness (action and mastery). Therefore we wrote 15 additional items intended to have higher difficulty. On the new 30 item TRAQ, confirmatory factor analysis, internal reliability and IRT results will be reported from a large sample of college students Conclusion(s): Using IRT and factor analyses we eliminated 5 of 20 TRAQ items that were poorly discriminating. We found that many of the items in the TRAQ could discriminate among those in the early stages of transition readiness, but could not discriminate among those in later stages of transition readiness. To have a more robust measure of transition readiness we added more difficult items and are evaluating the scale’s psychometric properties.

No description available.

Background: Especially important in the transition process is the role of the providers and parents shifting from that of a manager of health to more of a coach. In group work, as in healthcare management, there is the opportunity for social loafing to occur, which could impede one’s competence in performing the desired task. Social loafing is the reduction in motivation and effort when individuals work collectively compared with when they work individually. Specific to social loafing is the free rider effect —when a person lacks putting forth effort because they believe someone else will pick up the slack which has been demonstrated in parent-child and student-teacher relationships. Objective: In this study we examined the prevalence of social loafing as defined by whether youth report that they know how to perform specific transition readiness skills but report that others do the tasks for them (as opposed to doing it themselves). Design/Methods: We surveyed 161 youth from two different schools in South Central Appalachia about their transition readiness using anchors from the TRAQ with revised response categories. The response categories assessed 1) whether they know how to do the specific task or not and 2) whether youth perform the task themselves or if someone else does the task for them. Results: We were specifically interested in those who responded “No, someone else does it but I know how”. Of the 21 items on the TRAQ, the rate of endorsement of the “social loafing” response varied between 11% and 53%. For 14 of the 21 items, the rate of endorsement of the “social loafing” response was greater than 30%. Table 1 displays the rate of endorsement of the social loafing response for each TRAQ item. Conclusion(s): Our results demonstrate that although many youth “know” how to perform various transition related tasks, very frequently they allow someone else to perform the task for them. In order for transition to adulthood to be successful, youth should be challenged to accept responsibility for performing task with the support of adults—called scaffolding. This will enhance the youth’s competence and autonomy. Similarly, in healthcare settings, clinicians can implement a scaffolding approach to reduce social loafing and promote more autonomy and gain competence in managing their health.

Background: Measuring the acquisition of self-management and health care utilization skills are part of evidence based health care transition practice. Youth with Spina Bifida (SB) have significant demands for self-management and high self-care burden. To complement HCT skills assessed in the TRAQ, we developed an 11 item SB-TRAQ to assess self-management skills specific to Spina Bifida. Similar to the TRAQ, the SB-TRAQ uses a 5-point Likert responses using Stages of Change. Objective: To develop and assess the reliability and validity of a questionnaire to measure independence and skill acquisition for youth with SB. Design/Methods: Working with a multidisciplinary team of experts in the care of youth with SB we developed a twelve item questionnaire specific to the main facets of SB self-care and -management including urine and stool continence, prevention of skin breakdown and awareness of signs of shunt malfunction. The items were reviewed and revised through several iterations by healthcare providers and patients. The SB-TRAQ was fielded in an SB Specialty Clinic participating in the National Spina Bifida Patient Registry (NSBPR). Ninety youth with SB completed the 20-item TRAQ and the 12-item SB-TRAQ. Item response means, and distributions were assessed. A principal component analysis (PCA) was conducted with oblique rotation (promax). We also assessed criterion validity by examining the correlation of the SB-TRAQ supplement with the TRAQ and age. Results: Sample characteristics and scale information for the TRAQ and SB-TRAQ supplements are displayed in Table 1, including a Cronbach alpha of 0.9 for the SB-TRAQ. The item characteristics are provided in Table 2. Results of the factor analysis show eleven items loaded onto one factor, with almost all items loadings > 0.7 . One item did not load, resulting in an 11 item solution. The primary factor explained 62% of the variance. Intraclass correlations of the SB-TRAQ supplement with the TRAQ overall scale and subscales demonstrated good criterion validity (TRAQ overall ICC = .74; ICCs varied among the subscales and the SB-TRAQ). Additionally, the SB-TRAQ, as hypothesized, was significantly and positively correlated with age (Pearson correlation .29, p<.01). Conclusion(s): Results of our analyses demonstrate that the SB-TRAQ had good internal reliability and excellent criterion validity as demonstrated by strong correlation with age and the validated TRAQ. The SB-TRAQ can be a useful tool to help youth with SB achieve independence and self-management.

Objective: The purpose of the current study was improving the measurement precision of the Transition Readiness Assessment Questionnaire (TRAQ 5.0–20 item) in order to gain better decimation of transition readiness skills across the 5 Stages of Change–from Precontemplation to Mastery. Methods: In stage 1, starting with the TRAQ 5.0 20-item, 5 domain subscale questionnaire, we eliminated the five lowest discriminating items using Item response theory (IRT) in MPlus v7.4,which eliminated the domain subscale Managing Daily Activities, and we e added 15 more difficult and better discriminating items. We added items to both to the remaining 4 domain subscales and created a new domain subscale entitled Future Planning. The revised 30-item TRAQ was piloted among 386 youth between 16 and 24 years old (mean = 20 years; 54% female; 87% White). Results: After examining the model fit, discrimination and difficulty coefficients, and modification indices, we eliminated 10 items and the new Future Planning domain subscale we eliminated. The resulting questionnaire has 4 domain subscales and 20 items. It exhibited good to excellent fit to the data, χ2(164) = 887.239, p <.001, CFI = 0.943, TLI = 0.93, RMSEA = 0.0942 (90% CI: 0.090, 0.114), WRMR = 1.111. All items have acceptable discrimination coefficients. Each of the 4 domain subscales have improved reliability as compared with the original TRAQ 5.0 20 item scale. Conclusions: The revised 20-itemTRAQ 6.0 has 4 domains subscales; Managing medications, keeping appointment, tracking health issues, and Talking with providers and has good construct validity as demonstrated by model fit. By adding more difficult items to the 4 resulting domain subscales, we have demonstrated improved item discrimination and difficulty, and therefore can better measure acquisition of transition readiness skills across the five stages of change from pre-contemplation to contemplation to initiation to action and finally to mastery.

Title: Helping or Hovering: Examining Social Loafing and the Free-Rider Effect in Youth’s Transition Readiness Author: Mekyala Williams, East Tennessee State University Co-author(s): Kiana Johnson, MS, PhD Department of Pediatrics Quillen College of Medicine East Tennessee State University Lindsay Ellis Lee, PhD Department of Pediatrics Quillen College of Medicine East Tennessee State University Introduction Transition readiness in youth has been hard to study because parents and providers have served as managers rather than coaches hindering the process. Social loafing is a phenomenon that explains why people are more prone to exert less effort in group settings. We decided to observe the prevalence of social loafing in youth we examined if students knew how to perform specific transition readiness skills but allowed their support systems to do the task for them. This would be measured in opposition to them performing the tasks themselves since they do have the necessary skillset. The present study aims to validate the 4 domain subscales (i.e., managing medications, keeping appointments, tracking health issues, and talking with providers) found in the revised 20-item Transition Readiness Assessment Questionnaire (TRAQ). Additionally, the study will evaluate youth reliance on familial support systems for healthcare through the lens of the social loafing phenomenon. Methods To obtain demographic information, participants were asked on the survey to report their sex, age, ethnicity, and race (i.e., White, Black or African American, Asian, Native Hawaiian/Pacific Islander, Hispanic/Latino, American Indian, or Alaska Native, or other). Once all the surveys were completed, participants were categorized into white and non-white. We surveyed 161 youth from two different schools in South Central Appalachia about their transition readiness using anchors from the TRAQ with revised response categories. The response categories were whether they know how to do the specific task or not and whether youth perform the task themselves or if someone else does the task for them. Using confirmatory factor analysis, the revised 20-item version of the TRAQ will validate with the present sample. All statistical analyses will be conducted in R. Anticipatory Results and Conclusions Preliminary results based on the 161 participants found that youth can perform these tasks but very frequently allow someone else to do them. Out of the 20 items listed on the TRAQ, the endorsement rate of social loafing response varied between 10% and 52%. Fifteen out of the 20 items had a 30% response rate for social loafing. For the transition to adulthood to be successful for youth, they have to learn to accept different roles and responsibilities without the help of anyone else. This emphasizes the importance of shifting parents and providers to a coaching role rather than a managing role. Doing so will help enhance the youths’ ability and independence as they get older. This can also be applied to healthcare settings as using a coaching approach will minimize social loafing and allow more competence in managing their health.