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This is the first in a series produced under a 2020 National Fellowship, focusing on the stories of vulnerable communities.

Last October when Larry Malcolm Smith Jr. approached his 21st birthday -- the year most foster youth in New York City leave the system -- he thought he would be linked to healthcare, housing, and job opportunities before gaining his independence.

Instead, he walked out of his agency's doors with a MetroCard allowing a single round trip on the city's buses and subways.

"I was in college, living in my school dorm, when I got a phone call that said I had to come to SCO Family of Services on Jamaica Avenue," Smith told MedPage Today. "They were like, 'You're leaving.'"

By December, Smith was homeless. A few months later, the first wave of COVID-19 surged through the city, killing more than 18,000 people in New York City by June and leaving the largest recession in decades in its wake.

As the pandemic forced most employees to work remotely and put public assistance services on hold, it robbed many foster youth of the preparatory services typically provided in the 6 months before aging out. But pediatricians, social workers, and foster care advocates told MedPage Today that the transition process was already failing many teens in the foster system before the pandemic.

Jim Czarniak, former deputy commissioner for the Onondaga County Department of Children and Family Services in New York, said the last 5 to 6 months adolescents spend in foster care are "crucial in terms of setting up employment safety nets and housing."

"Losing case management is going to have a lot of irreparable harm done to these kids who didn't have any opportunity for service," Czarniak told MedPage Today.

Some young people who aged out have gone hungry for days because social services were unavailable during the pandemic, said Felicia Wilson, founder of . A former employee of the New York City Department of Juvenile Justice and the Administration for Children Services (ACS), she went through 63 homes in the city's foster care system herself before aging out at 21.

Youth have also come to her because they couldn't apply for food stamps without access to laptops, she said. Some who did apply have waited 90 days with no reply.

"When COVID happened, everything was panic mode," Wilson told MedPage Today. "For youth in foster care in NYC, there was nothing set in place for emergencies like this."

While some states like California during the public health emergency, a bill extending foster care for 6 months has

'Aging Out' During COVID

Children typically age out of foster care at age 18, but the majority of states, including New York, permit extension services for transition-age youth up to age 21. Before the pandemic, this group of "transition age" adolescents between 18 to 23 faced increased risk for homelessness, food insecurity, pregnancy, and incarceration -- all of which have been exacerbated.

The number of young people living at home right now eclipses the number during the Great Depression, said Celeste Bodner, head coach at Foster Club, a national network for youth in foster care.

"We know that our young people, as a population, do not have the safety net of going home," Bodner told MedPage Today.

In one conducted in April, 55% reported being food insecure because of COVID-19, 48% said they were laid off or had their work hours severely cut, and 72% reported having no more than one month's worth of expenses available.

Just over half of respondents reported symptoms of depression or anxiety and nearly half reported housing instability.

Johanna Greeson, PhD, managing faculty director for The Field Center for Children's Policy at the University of Pennsylvania and co-author of the report, said what struck her most was the hopelessness she heard in participants' responses to open-ended questions.

Young people who were in foster care or who had recently aged out wrote about struggling to pay rent, losing access to housing and mental health supports, and battling to succeed at online schooling.

Greeson also asked whether these young people had at least one adult, other than a caseworker, who they could turn to for support during the pandemic. About 20% had a formal mentor through their foster agency and another 28% had "natural mentors" such as a relative, teacher, or pastor.

But 14% said they had no such mentor at all, and that they were "almost entirely alone," Greeson noted.

Overall, the pandemic burst a "protected bubble" for many current and former foster youth, leaving them floundering, Greeson said.

In other words, youth were left asking, "Who is going to look out for me?" Greeson said.

Budget Cuts & Resource Challenges

ACS, which provides services to New York City children in foster care, has endured repeated budget cuts in recent years. For fiscal year 2021, Gov. Andrew Cuomo reduced the reimbursements that the state's child welfare funding stream can provide the city by That follows a $30-million reduction in state funding for juvenile justice programs enacted in 2019. That in turn followed a annual budget cut in ACS' funding in 2018 as a result of reduced funding from the statewide Foster Care Block Grant, which reimburses localities for foster care expenditures.

An ACS spokesperson told MedPage Today in an email that New York's Office of Children and Family Services (OCFS) allocated one-time Families First Transition Act Aging Out Funds to ACS for youth turning 21 between March 1 and December 31, 2020. However, those funds will expire at the end of the year.

OCFS also allowed counties outside of New York City to originally intended to prioritize family preservation and reduce placements in group homes, to older youth with "imminent need" aging out during the pandemic.

But in some counties, that money was already spent, or is running out, said Czarniak.

"It's something to help bridge gaps, but what I think they're missing is the additional case management and the side by side case worker support to help them through those things," Czarniak said.

Independent Living Programs (ILP) for foster youth, which provide transitioning youth with the tools they need to become independent -- like housing, employment, and financial literacy training -- are available to most foster youth through age 21.

The ACS spokesperson said the agency extends foster care beyond the age of 21 when necessary to ensure a young person has stable housing and other supports they need, "despite the lack of state or federal support."

Adolescents who ultimately transition out of foster care to independent living complete a transition plan when they are 17 or older, and subdivisions of ACS work with them to secure housing, education, or employment opportunities, the spokesperson said.

But this year, many of those services were disrupted. For example, the Summer Youth Employment Program, which provides paid internships for over 1,100 youth throughout the year, was suspended in April due to COVID-19, although it was later revamped online.

Greeson argues that foster youth should have a longer glide path to adulthood than they're given. If she had her wish, foster youth would be able to stay in care until 26.

In a released by the University of Chicago-based research group Chapin Hall, each year in extended foster care was associated with a 10%-11% increased chance of enrolling in college, $404 extra in their bank accounts, and 28% lower odds of being homeless or couchsurfing in transition years.

Mackenzie Fierceton, a former foster youth, social worker in training, and staffer for Philadelphia City Council member Helen Gym, is currently helping to craft child welfare and juvenile justice policy. She agrees with Greeson, her former research mentor.

Fierceton was forced out of foster care at age 18 after moving from her home state of Missouri to enroll at the University of Pennsylvania. If she had stayed in Missouri, she may have been able to access extended services, but instead, she went through college alone.

"No one at 18 or even a lot of times at 21 is ready to just completely on their own take on the world with absolutely no support," Fierceton told MedPage Today.

Yet that is the reality for a lot of young people who don't have birth families and who haven't been able to develop meaningful relationships with caring adults because they've moved around so much.

Fierceton is lobbying Congress to pass the which would place a moratorium on youth aging out of foster care and allow others to re-enter care during the pandemic.

It would also increase funding by $400 million, waive education requirements necessary for youth to access this funding, and extend the program to youth through age 26. In New York, Chafee funding can go toward young adults who have aged out of foster care up to age 23.

Services Disrupted

While ACS is the government agency responsible for children in foster care in New York City, dozens of private agencies that ACS oversees are tasked with linking young people to care and ensuring they know what resources are available to them. These plans are carried out by social workers and case workers.

When a child ages out of the system without adequate support in place, it's usually a result of some disconnect between the numerous people involved in the process, Wilson said. Sometimes, services are in place for youth, but they do not utilize them, she said.

ACS is responsible for holding nonprofits that govern services for young people accountable, Wilson said. "When you look at someone like [Smith], there is no reason why he aged out of foster care with a MetroCard and a few dollars."

ACS relies on programs like NYC Housing Authority (NYCHA) to provide Section 8 housing waivers, allocating affordable housing to low-income residents, to eligible transition age youth. But when many youth struggled to access them, despite ACS' efforts.

"As well intentioned as workers are, they weren't going to homes, they weren't taking kids to get IDs, jobs weren't hiring, housing, finding apartments was closed," Czarniak said. "These kids who have to leave the system because of a time limit have been failed immensely by the system to begin with."

Disruptions in the child welfare workforce are also common, with a and 54% among trainees.

In one qualitative survey of Florida Health and Human Services staff and caseworkers conducted during the pandemic, the most common concerns involved challenges to service delivery and functioning, along with exacerbated vulnerability of clients.

About one-third of respondents said they had suffered financially in the pandemic, including being furloughed or losing supplemental income, said study author Lisa Magruder, PhD, MSW, of the Florida Institute for Child Welfare in Tallahassee.

Many also had family members lose their jobs, which created additional stress on the worker as a financial provider, Magruder told MedPage Today.

In Greeson's study, 14% of young adults said their case workers poorly communicated with them during the crisis.

Joymara Coleman, a former foster youth who worked with the Department of Children and Family Services in Alameda County, California, before going on to pursue a social work license herself, said her caseload reached 30 children before the pandemic. The Child Welfare League of America recommends caseloads

In New York City, the average caseload per child protective specialist is 8.2, and most workers have no more than 3 years of experience, according to the agency's

"In my experience, the workload was really demanding of my time and did not allow for me to be present with youth in ways that I really would have liked to be," Coleman told MedPage Today.

Lasting Impacts

Growing up in the foster care system is a unique experience that some argue can be an adverse childhood experience itself.

Anthony Mannarino, PhD, director of the Center for Traumatic Stress in Children and Adolescents in Pittsburgh, to label the adversity of removing children from families.

Some children later want nothing to do with their biological families once they are removed. But others, even after suffering neglect or emotional or physical abuse, develop attachment disorders, post-traumatic stress disorder, or other manifestations of trauma resulting from this separation, he said.

"Separation from family of origin for many kids we see in our center rivals the trauma or other abuse they experienced in their family of origin as being the most significant stressor for them," Mannarino told MedPage Today.

Children in foster care also have a higher risk for obesity, mental health disorders, and other health problems compared to children not in foster care.

Smith had eating disorders growing up because of maltreatment from his foster parents. He has been sexually assaulted and racially profiled.

Today, he has post-traumatic stress symptoms and suicidal thoughts, but he can't afford to see a mental health provider. He also has asthma and attention-deficit hyperactivity disorder (ADHD).

"I have to hop the train. I'm in an overdrawn bank account," Smith said. "I'm scared to ask people for money or help because as a foster child, that has been thrown back in my face."

Coleman said it's this complex lived experience that is missing from child welfare employees toolkit, through no fault of their own.

"The challenge is, there are child welfare workers who aren't necessarily taking care of themselves and they are a part of a system with unreasonably high demand that doesn't allow for folks to be human in their work," Coleman said. "They have to be street level bureaucrats -- robots -- to meet the deadline."

Challenges for College Attendees

Sarah Mountz, PhD, a social welfare professor at the University at Albany, said connecting with social workers and accessing services has been a chronic problem for foster youth who go to college. Nationally, 3% of children who have been in the foster care system will graduate from a 4-year college. Because of this, many caseworkers are inexperienced with what supports college-bound youth need, Mountz said.

"I don't want to say this about every case worker because there are definitely students who have had different experiences, but in general, that is an issue for youth who go to college," Mountz told MedPage Today. "A lot of the time, case workers who are overstressed and have very large caseloads, it's like one less person to have to think about."

Selena Snow, now a 20-year-old student at the University at Albany, experienced this first hand when she graduated from high school. At 18, she was living in a group home after cycling through 21 placements and several secure detention centers over 17 years in the system. In high school alone, she had three different placements.

When she went to college, she was signed out of the group home but she wasn't given another placement. Snow arrived on campus with a bag of essentials, but no blankets, books, or money.

During holidays when dorms closed, she carried all of her belongings downtown to an alumni quad, where there was no kitchen or microwave, and survived off canned food.

Although UAlbany's dorms stayed open during the pandemic, Snow stayed with a friend last spring because she didn't feel comfortable staying on campus alone.

"I've experienced the loneliness," Snow told MedPage Today. "It's like a ghost town with no one there to talk to."

Snow, now back on campus, has still not been officially reinstated into the foster care system. In order to do so, she must print out some forms and complete paperwork, but UAlbany is on winter break, the library is closed, and she hasn't been able to.

"No one is providing me with the stuff I am supposed to have," Snow said. "I should be getting an allowance if I'm back in care, but no one is saying anything to me. Every time I email my aftercare or a DHS worker, there is no response. It's like playing cat and mouse with them all the time."

This year, Snow was let go from three jobs, but has been able to maintain a position as a sales associate at a shoe store. She should get an ILP that teaches her the skills she needs to leave the system before she is discharged in May 2021. But she feels she has already been independent for years.

"I feel like if I've been taking care of myself in care the whole time, I'm going to be just fine whenever I'm officially out," Snow said. "At this point, I just want them to leave me alone."

Snow and Smith, who attended SUNY Old Westbury, are among the small minority of transition age youth who go to college. Although attending college has been associated with better outcomes for foster youth, sometimes it still isn't enough to stave off the uphill battle they are set on early in life.

Alexis Obinna, a 24-year-old undergraduate at California State University Los Angeles who aged out of foster care at age 21, has spent most of the pandemic homeless and struggling to access food.

Until recently, she was living out of her recreational vehicle, taking showers at her former foster mom's home when she could, and finding electricity sources to power her laptop through temporary work gigs.

Many of the food banks she normally relied on pre-pandemic now prioritize multi-person households, and she struggles to find stable internet service to complete her schoolwork and attend virtual classes. She recently rented a room with three other people for the month of December because it was too cold to live in her RV.

Obinna was diagnosed with a heart murmur and is thus at higher risk of complications from COVID-19, so she is limited in the jobs she can apply for. In the past couple of months, she has been delivering food through PostMates and collecting census data for the state door-to-door.

She's also a paid intern for East Los Angeles College and a consultant for California Youth Connections, where she helps conduct research and outreach related to helping foster youth.

About 5 years ago, Obinna helped develop a live annual event called "Independent City" where foster youth are given a profile with a stated income and education level, then asked to "age out" in a mock city, where they have to navigate locking down a house, job, groceries, and transportation while sticking to a budget.

For Obinna, the lessons most youth learn at the event are a reality.

"This is my life at 24," Obinna told MedPage Today. "I spent the whole 24th [year] in the pandemic, and there were so many opportunities and things I missed."

Fighting for Others

Foster youth need financial support and help managing any benefits they receive, but they also need mentors, said Greeson. For youth in foster care, the presence of one caring adult can in that individual's outcomes, Greeson said.

Fierceton found that support when she was younger, in her fourth-grade teacher.

"She listened to me in a way that I was not used to before," Fierceton said. "She just really made me feel seen and heard and sort of accepted for who I was."

Other teachers encouraged her as well, convincing her she could go to college. Many youth in foster care, however, don't find that support, and the mindset then becomes, "Well, I guess that's not a thing that we do.... We don't finish high school, let alone go to college," and it becomes a self-fulfilling prophecy, Fierceton said.

Snow has advocated for herself and her college foster youth peers to the New York Senate about the adversity she has faced as a foster youth in college. She is also vice president of Fostering Leaders of Our World (FLOW), a coalition of foster youth on the UAlbany campus.

Smith is also an avid activist heavily involved in the Black Lives Matter movement in New York City. In September, he led a protest for Black foster youth where he spoke about his experience growing up in 23 foster homes and a group home.

Despite her heart murmur, Obinna also spent two months of the summer marching for Black lives in California.

"I was ready to die to protest," Obinna said. "There was no way I could sit back with the whole thing with Breonna Taylor and George Floyd and my personal experience with the police. It was just too much, so I had to go out."

Black children are overrepresented in foster care. In New York City, 48% of children in the system as of June 30, 2020, were Black, double the proportion of Black individuals in the city's population. In comparison, white children account for 37% of the foster care system and 43% of the population.

Smith demanded that ACS develop more housing specifically for transition-age foster youth; improve foster parent recruitment in Black and brown communities; and reallocate funds from New York City's police department to go toward homeless youth.

The protest got ACS' attention, and the agency is working with Wilson to create pre- and post-assessment cases so officials can better understand the needs of transition age youth and how best to guide them, Wilson said.

Smith has been living in a homeless shelter for sexual assault victims and undocumented immigrants since May, where he currently shares a "quad" with three others. He gets supplemental meals through volunteering at a soup kitchen and works as a youth advocate in a children's community center in Queens.

Wilson is working to get Smith housing through a U.S. Department of Housing and Urban Development that he qualifies for with his job. The program, the Foster Youth to Independence Initiative, began last year and has since in 24 states.

"I have been through so much, and I feel like God is telling me he is going to give his toughest battles to his strongest soldiers," Smith said. "I will get out of this shelter and make everyone proud, and once I do I want to make sure there's no other foster care kids going through what I'm going through."

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