Addressing Health Equity for System-Involved Youth

The intersection of healthcare and child and family well-being

All children deserve access to quality healthcare, including those involved with foster care and the juvenile justice system. For optimal health outcomes, healthcare, child welfare, and other important stakeholder agencies must operate in unison and work toward the same goal, enhancing quality, equity, and access for system-involved youth. This population faces various adversities and trauma that lead to complex health needs the child welfare and juvenile justice systems alone cannot solve. In this way, there’s immense opportunity for healthcare and Medicaid to play a transformative role in addressing equity for system-involved youth and provide this population with the quality care that they deserve. By leveraging a restorative, strength-based approach, and embracing collaborative stakeholder relationships across the child and family well-being landscape, we can help advance health equity for children to live healthy and full lives.

Understanding System-Involved Youth

System-involved youth may refer to children and adolescents who have experienced or are affected by the child welfare and/or juvenile justice systems. These youth are a high-risk and vulnerable population, often due to the adversity they’ve experienced including abuse, neglect, and more. The drivers of system involvement are deeply rooted in social determinants of health (SDOH). This includes poverty in the home, mental health issues, substance use disorders, family violence, and more.

They often have complex health needs.

Drivers of system involvement can impact a child’s physical and mental well-being. According to the American Academy of Pediatrics, about 50% of children in foster care have chronic physical problems such as asthma, anemia, visual loss, hearing loss, and neurological disorders. Additionally, about 10% are considered medically fragile or complex, and many have histories of prenatal substance exposure and premature birth.

As of 2019, up to 80% of children and youth in foster care experience significant mental health issues compared to 18-22% of the general population. For the youth in foster care who experience mental health issues, only one in three turns to community-based behavioral health services for treatment.

Systemic challenges: racial disparities and “aging out”

According to the Government Accountability Office, relative to other children, African-American children spend more time in foster care and are less likely to reunify with their families. Also, African-American and American Indian or Alaska Native children are more likely than other children to be removed from their homes and to experience a termination of parental rights.

Regardless of race, young people living in or who have experienced foster care will all, at some point, transition to adulthood and be required to live independently, often far before they’re fully prepared to be self-sufficient. Depending on the state, specific rules dictate when the child will “age out” of foster care. Fortunately, many states offer an array of services including academic support, career preparation, transitional housing, health care and more to support youth during this transition as they work toward self-sufficiency.

For example, the Chafee Education and Training Voucher (ETV) program provides financial support for young people currently or formerly in foster care to attend college or participate in vocational training programs. Data shows that ETV utilization was correlated with increased college persistence and young people who received ETVs enrolled in college for at least two semesters more often than young people who did not use ETVs.

How do we overcome these challenges? Healthcare as a solution…

While the challenges affecting system-involved youth seem surmounting, healthcare plays an instrumental role in addressing the health equity gap. For stakeholders in child and family well-being, the following considerations are important to keep in mind.

Collaboration is key.

Quality healthcare for system-involved youth relies on robust collaboration between child welfare agencies, Medicaid programs, healthcare providers, and home- and community-based behavioral health services. These partnerships are essential for ensuring that youth receive consistent and comprehensive care. By breaking down silos and fostering open communication, we can create a more cohesive support system that addresses the specific needs of this population.

The Family First Prevention Services Act (FFPSA), which was signed into law in 2018, enhances support services for families to help children remain at home, reduce the unnecessary use of congregate care, and build the capacity of communities to support children and families. The Act helps facilitate cross-system coordination between state Medicaid and child welfare agencies and allows states to redirect federal funding from high-cost out-of-home care to prevention-oriented services such as evidence-based mental health programs, substance abuse prevention and treatment, kinship navigator programs, and more. This helps preserve families and ensure children remain in a home setting whenever possible.

Cross-system collaboration can also be utilized to ensure prompt health screenings for children entering the foster care system. State Medicaid agencies can require that Early Periodic Diagnosis and Treatment screenings include a comprehensive physical, developmental, and behavioral health assessment that must occur within a stipulated timeframe. For example, in New Jersey, children entering foster care are required to have a physical health exam within 30 days of placement, which is covered by Medicaid. Mental health screening is also required for children in out-of-home placements and must be completed within the first 30 days. This type of collaboration can help enhance health outcomes for children across the country.

Data sharing across agencies.

It’s important to note that cross-system collaboration includes data. Data sharing across state agencies can support the timely delivery of healthcare for children and youth in foster care. We can see a great example of effective data sharing that aims to improve health outcomes in Oregon where the state’s incentive metric for children and youth entering foster care requires a physical, oral, and behavioral health screening within 60 days of a child entering the system. This requires data sharing between the child welfare agency and the state’s coordinated care organizations (CCOs).

To work towards this metric, Oregon also automated its case management technology system When a child is placed in foster care, the child welfare agency enters their information into the child welfare database and it automatically sends the information to the state’s Medicaid Management Information System (MMIS). This automated system allows for real-time data exchange which helps improve the timeliness of care for children and youth.

Apply a holistic approach to improve care coordination.

Addressing health equity requires a holistic approach that integrates physical, mental, and behavioral health. Comprehensive healthcare systems should be designed to treat the whole child, recognizing that their needs often span multiple domains. By ensuring that medical, psychological, and behavioral health services are coordinated, we can provide a seamless and supportive healthcare experience.

We can see a great example of a state prioritizing the holistic health of children in foster care in Texas, where the state implemented its “3 in 30” approach. This approach states that “all children who come into the Texas Department of Family and Protective Services’ (DFPS) care need a good review of their physical and behavioral health needs right away.” With the help of the state’s medical partners and caregivers of children in foster care, Child Protective Services uses three critical tools in 30 days for assessing the medical, behavioral, and developmental strengths and needs of children and youth entering DFPS custody. Within 30 days, children must see a doctor for a complete check-up and any needed lab work. This ensures that the state addresses medical issues early, that children are growing and developing as expected, and that caregivers know how to support strong growth and development.

Embrace a restorative, strength-based approach.

A restorative, strength-based approach in healthcare is a patient-centered method that focuses on leveraging the existing strengths and resources of the patient to promote health and well-being. Strength-based healthcare empowers people to be active participants in their healthcare decisions. By training case workers and the people who are in direct contact with system-involved youth in restorative, strength-based approaches, they can help children and families help themselves, equipping them with long-term well-being and resilience.

The U.S. Children’s Bureau released an article on strengths-based strategies to support mental health and well-being for youth and families. The article shares personal stories of individuals who’ve experience system involvement and how strength-based approaches can benefit their overall well-being. One story conveys a caseworker’s commitment to being genuine and transparent and how it helps a youth overcome years of distrust stemming from earlier traumatic experiences while in foster care. Strength-based approaches have immense potential for positive impact, it’s just a matter of implementing them into existing systems.

Ready to make an impact?

Sellers Dorsey helps bridge the gap between healthcare and child welfare. Whether it’s training, technical assistance, consultation assessments, solution development, implementation, and more, our subject matter experts have decades of experience across the full continuum of child and family well-being.

Connect with, Senior Director, Katie Renner Olse  to learn more about our child and family well-being solutions. Simply click here and select her name in the dropdown!