Youth At-Risk of Homelessness: Design for an Implementation Study of “Pathways to Success”: A Coach-Like Case Management Program for Youth and Young Adults in Foster Care

Publication Date: September 21, 2021
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  • Published: 2021

Introduction

Research Questions

  1. How are services under the Pathways service model distinct from services available in the comparison condition?
  2. What did the Pathways sites do to support initial (that is, start-up activities) and on-going (for example, continuous quality improvement) service delivery with fidelity? What factors (facilitators and barriers) contributed to or hindered initial and ongoing service delivery in Pathways sites?
  3. What were youth and young adults’ perceptions of the Pathways services? What services were delivered to youth and young adults in Pathways? What strategies did Navigators use to promote and maintain youth and young adult engagement? How did engagement vary among youth and young adults participating in the Pathways service model?

Preventing homelessness among young people who have been involved in the child welfare system remains an urgent issue for child welfare policymakers and practitioners. Housing stability is essential for achieving self-sufficiency and promotes health and well-being, particularly during the transition to adulthood. A combination of disadvantages places youth with a history of foster care, especially those aging out of care, at a higher risk of homelessness compared with their peers.

To expand the evidence base on interventions to prevent homelessness among youth and young adults who have been involved in the child welfare system, the Administration for Children and Families (ACF) of the U.S. Department of Health and Human Services launched the Youth At-Risk of Homelessness (YARH) multiphase grant program. YARH grantees received funding to develop interventions for youth and young adults with child welfare involvement who are most likely to experience homelessness. The grant program specifies three target populations: (1) adolescents who enter foster care from age 14 to 17; (2) young adults aging out of foster care; and (3) homeless youth and young adults, up to age 21, with foster care histories.

The Office of Planning, Research, and Evaluation contracted with Mathematica in the first two phases of YARH to provide evaluation technical assistance to grantees, support them in articulating and refining the design of their service models, assess the evaluability of each service model, and disseminate the knowledge developed. ACF is now in the third phase of YARH (or YARH-3) and is conducting a rigorous summative evaluation of a policy-relevant comprehensive service model developed and refined during the first two phases of YARH.

The summative evaluation conducted under YARH-3 will examine the effect of Colorado’s Pathways to Success comprehensive service model (Pathways). Pathways is an intensive, coach-like case management model for youth and young adults in foster care. A large, cluster quasi-experimental impact study design will be used to test the effectiveness of Pathways in 37 counties in Colorado. 

The Pathways implementation study will support interpretation of the model’s impacts on outcomes and identify factors that contributed to or inhibited implementation of Pathways services in different counties; these findings will aid in the replication or improvement of future Pathways service delivery. The implementation study will systematically assess different contexts in which Pathways is being implemented and the fidelity to which Pathways is being implemented. 

This report describes the design of the Pathways implementation study. A separate report describes the impact study for this summative evaluation (Cole et al. 2021).

Purpose

The Pathways implementation study will address two broad objectives. First, it will support interpretation of Pathway’s impacts on outcomes. Second, it will generate information about factors that contributed to or inhibited implementation of Pathways services in different settings, to support replication or improvement of future Pathways service delivery. The study is guided by research questions and conceptual frameworks to assess different dimensions of Pathways implementation. These frameworks will support analysis of factors that facilitate or hinder Pathways implementation in different settings and the extent to which the intervention is delivered with fidelity to the service model.

Key Findings and Highlights

  • Conceptual framework comprised of two implementation frameworks: We will adapt the Consolidated Framework of Implementation Research to guide clear conceptualization and systematic assessment of the range of contextual factors that facilitate or hinder implementation of the Pathways service model (Damschroder et al. 2009). We will draw from a theoretical model of fidelity to ensure comprehensive measurement of the various dimensions of fidelity and for the multiple of Pathways components (Carroll et al. 2007).  
  • Sample of six Pathways and six comparison sites: We will document business-as-usual service provision by a Chafee worker for comparison with service provision by Pathways.
  • Two rounds of in-depth qualitative data collection to assess facilitators of and barriers to initial implementation and full implementation: We will conduct two rounds of site visits to each site in the implementation study sample. During these site visits, we will speak with a range of stakeholders involved in Pathways services and comparison services. The site visits will occur approximately 4 to 6 months after enrollment begins and 18 to 20 months after enrollment begins. After each site visit, we will conduct “check-ins” by telephone with leadership in counties delivering Pathways services and leadership in counties delivering comparison services. The goal of the telephone check-ins is to collect current information about service delivery in Pathways and comparison sites, in particular, any changes to services available to youth and young adults eligible for the study.
  • Program administrative data to examine fidelity to the Pathways service model: We will collect and analyze program administrative data to assess patterns of service delivery and describe the extent to which Pathways services are delivered with fidelity. 

Carroll, C., M. Patterson, S. Wood, A. Booth, J. Rick, and S. Balain. “A Conceptual Framework for Implementation Fidelity.” Implementation Science, vol. 2, no. 40, November 2007. Available at https://doi.org/10.1186/1748-5908-2-40 Visit disclaimer page .

Damschroder, L.J., D.C. Aron, R.E. Keith, S.R. Kirsch, J.A. Alexander, and J.C. Lowery. “Fostering Implementation of Health Services Research Findings into Practice: A Consolidated Framework for Advancing Implementation Science.” Implementation Science, vol. 4, no. 50, August 2009. Available at https://doi.org/10.1186/1748-5908-4-50 Visit disclaimer page .

Methods

The implementation study will use multiple methods to collect, analyze, and report on comprehensive data to address the study’s two broad objectives, supporting interpretation of Pathway’s impacts on outcomes and assessing Pathways implementation. We will collect data from a range of stakeholders using interviews and administrative data. We will take a structured approach, guided by the conceptual framework, to analyze the data across Pathways sites.

Citation

Keith, R., R. Selekman, and A. Burwick. “Youth At-Risk of Homelessness: Design for an Implementation Study of “Pathways to Success”: A Coach-Like Case Management Program for Youth and Young Adults in Foster Care” OPRE Report #YYYY-2021-153. Washington, DC: Administration for Children and Families, Office of Planning, Research, and Evaluation, June 2021.  

Glossary

OPRE:
Office of Planning, Research & Evaluation
YARH:
Youth At Risk of Homelessness, acronym used to represent the initiative funded by Administration for Children & Families to support communities in addressing homelessness among youth and young adults with child welfare involvement