Trends and needs in programming for independent living.

This report, from a national survey, pictures what presently exists on this important part of the foster care continuum, and sets forth the specifics of policy and practice that should characterize preparation for independent living.

Federal legislative support for independent living.

This article details the federal legislative background, development, and outlook, and current activities by the states, in relation to establishing services to help adolescents in foster care prepare for independent living. The authors also specify directions that future legislation should take to expand assistance.

New legal options to prepare adolescents for independent living.

New legal alternatives are needed to assist older adolescents living apart from their families to make the gradual transition to self-sufficiency. At present, there are only two legal alternatives for such adolescents in most states: agency legal custody (foster family or group care) and emancipation. Two new alternatives are needed to allow mature young persons to practice limited independence and to receive some continued aid and supervision from child welfare agencies: independent-living arrangements and special programs for young adults formerly in agency custody.

Evaluation of independent-living programs.

The program report that states must submit to the federal government under the federal Title IV-E Independent-Living Initiative is, in essence, a program evaluation report and will require comprehensive program and evaluation data to complete. Because the program report will be a key factor in determining the future of this federal initiative, it is important that states improve their information system capability to generate the range of necessary data. This article offers detailed suggestions for ways in which states could establish their independent-living program information systems to produce program and evaluation data; and presented two examples of approaches to evaluating the Title IV-E independent-living program, one in Pennsylvania and another in Texas. These states were selected for the purpose of illustrating two different approaches and not necessarily for the presentation of exemplary evaluation practices.

Aftercare services.

The author discusses the need for postplacement or "aftercare" services for youth leaving placement to live on their own, and explains how a statewide pilot project is helping to meet that need.

Prevention: rhetoric and reality.

No single strategy is capable of preventing untimely deaths and disabilities. In the United States in particular, the contribution of medical care is limited by inadequate provision of services (particularly to the poor), inappropriate training of physicians, and unnecessary costs. Lack of knowledge about disease universally limits medicine's effectiveness. Among nonmedical strategies, campaigns for life-style change are most likely to succeed in those with the lightest burden of illness. Efforts to increase individual responsibility might well reduce health expenditures, but at the same time the disparity in health between rich and poor will increase. Restrictions on the use of harmful substances and on the manufacture of toxic or hazardous products, along with humanization of the work process itself, would reduce deaths from cancer, heart disease, and violence; however, resistance to these changes is, and will remain, great. The socioeconomic and environmental changes that are necessary to afford each citizen an equal opportunity for optimal health will be adopted slowly, if at all. Considering the limited acceptability of these nonmedical strategies, the prospects for prevention are less than what has been promised. Despite its perfections, medical care can contribute to the prevention of early death and disability. Attempts to disparage it could delay the adoption of the changes needed to improve its effectiveness.