Katie Renner Olse, Sr. Director at Sellers Dorsey
All children deserve access to quality healthcare, including those involved with the foster care and juvenile justice systems. Health equity for system-involved youth, individuals who have been impacted by the child welfare or juvenile justice systems, is critical for children to lead fulfilling lives. System-involved youth face incredible challenges that make them a uniquely vulnerable population.
Often, their health needs are complex, influenced by significant trauma, and exacerbated by the systemic barriers they encounter. Despite these challenges, there is an immense opportunity for the healthcare system, particularly Medicaid, to play a transformative role in addressing health equity for this population. By fostering cross-system collaboration, leveraging healthcare data and technology, and adopting a restorative, strength-based approach, we can ensure that system-involved youth receive the quality care they deserve.
Understanding system involvement
System-involved youth often endure significant adversity including abuse, neglect and family violence. Such experiences not only increase their risk of entering these systems but also profoundly impact their physical and mental well-being.
Social determinants of health (SDOH) are key drivers of system involvement, for example, poverty. Studies from the Center on Budget and Policy Priorities examine the intersection of public assistance programs and child welfare system involvement. The studies show that state policies that increase access to assistive programs like Temporary Assistance for Needy Families (TANF), which is designed to help low-income families with children achieve economic self-sufficiency, play a role in reducing child welfare system involvement.
Impacts on physical and mental health
Because so many system-involved youths experience significant trauma, their physical health needs are multi-faceted and often more complex than those of their peers. According to the American Academy of Pediatrics, nearly 50% of children in foster care suffer from chronic physical health problems such as asthma, anemia, and neurological disorders. Moreover, about 10% are considered medically fragile, requiring specialized care due to conditions like premature birth or prenatal substance abuse exposure.
Mental health issues are also prevalent among system-involved youth. As of 2019, up to 80% of children in foster care were reported to experience significant mental health challenges, a stark contrast to the 18-22% prevalence in the general population. Despite the high need, only one in three of these children access community-based behavioral health services for treatment. This not only highlights the connection between system involvement and physical and mental health but also the critical need for enhanced integration and coordination of healthcare services for this vulnerable population.
Systemic Challenges: Racial Disparities and “Aging Out”
Racial disparities are a significant concern within the child welfare and juvenile justice systems. Youth from marginalized communities, particularly African American and Native American populations, are disproportionately represented in the child welfare system due to historical and systemic inequities. 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 foster care will, at some point, transition to adulthood and be required to live independently, often long before they’re fully prepared to be self-sufficient. This is often referred to as “aging out.” This transition is fraught with challenges, including finding stable housing, securing employment, and accessing healthcare. Fortunately, many states offer an array of services including academic support, career preparation, transitional housing, healthcare and more to support youth during this transition as they work toward self-sufficiency.
Regarding services to help children in foster care succeed academically, 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 young people who received ETVs enrolled in college for at least two semesters more often than young people who did not use ETVs. These types of programs are essential to ensuring system-involved youth lead fulfilling lives even after “aging out” of the system.
Healthcare as a Solution: 3 Approaches to Addressing Health Equity
While the health equity challenges facing system-involved youth may seem insurmountable, healthcare plays a vital role in narrowing these gaps. Here are three ways it can make a difference:
Collaboration is key to improving care coordination.Given the complex needs of system-involved youth, healthcare systems must collaborate closely with child welfare and juvenile justice agencies to ensure consistent care that addresses individuals’ physical, mental, and behavioral health needs.
One significant legislative effort to promote such collaboration is the Family First Prevention Services Act (FFPSA), signed into law in 2018. FFPSA encourages states to use federal funds for prevention services that help keep children with their families and remain at home, increasing the capacity of communities to support children and families. FFPSA also promotes cross-system coordination between state Medicaid and child welfare agencies, allowing states to redirect resources from expensive out-of-home care to community-based services such as mental health programs and substance abuse treatment.
Moreover, prompt health screenings are crucial for children entering the foster care system. State Medicaid agencies can play a vital role by requiring Early Periodic Screening Diagnosis and Treatment (EPSDT) services that include comprehensive physical, developmental, and behavioral health assessments. This is demonstrated in New Jersey where children entering foster care must receive a physical health exam within 30 days, a mandated service covered by Medicaid. Mental health screenings are also required within the first 30 days for children in out-of-home placements. Such measures ensure that health issues are identified and addressed early, improving health outcomes for vulnerable children.
Leveraging healthcare data and technology to enhance quality of care.Data sharing is another critical component of cross-system collaboration. Effective data exchange between state agencies can significantly enhance the timeliness and quality of healthcare delivery for system-involved youth. Oregon provides a notable example with its incentive metric for children entering foster care. The state mandates physical, oral, and behavioral health screenings within 60 days of a child’s entry into the system, facilitated by data sharing between the child welfare agency and the state’s coordinated care organizations (CCOs).
Oregon has also automated its case management system, allowing real-time data exchange between the child welfare database and the Medicaid Management Information System (MMIS). This technological integration ensures that children receive timely care, demonstrating the potential of data-driven, technological solutions in improving health outcomes for system-involved youth.
Embracing a holistic, strength-based approach can help improve health outcomes.To address health equity effectively, it is essential to adopt a holistic approach that integrates physical, mental, and behavioral health services while leveraging the inherent strengths and resources of system-involved youth and their families. A strength-based approach to healthcare intends to empower people to take an active role in their healthcare decisions, helping individuals help themselves. Training child welfare caseworkers and healthcare providers in this approach can significantly impact the lives of system-involved youth, helping them overcome their challenges like trauma, abuse, and neglect.
The U.S. Children’s Bureau has highlighted the benefits of strength-based strategies in supporting the mental health and well-being of youth and families. One story conveys a caseworker’s commitment to being genuine and transparent and how it helps an individual 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.
The potential for positive change is immense, and with a concerted effort, we can ensure that every child—regardless of their background or system involvement—receives the quality care they need to thrive and live a healthy life.
About Katie Renner Olse
Katie Renner Olse currently serves as Senior Director of Child and Family Well-Being at Sellers Dorsey. Before joining Sellers Dorsey, Katie served as the CEO of the Texas Alliance of Child and Family Services (TACFS) where she supported the work of community organizations serving children and families in the child welfare system. Katie also served as the President of the National Organization of State Associations for Children (NOSAC) where she worked with top leaders in state child welfare, juvenile justice, and mental health associations.
Prior to her experience at NOSAC, Katie served as Deputy Commissioner for the Texas Department of Family and Protective Services (DFPS), a state-based agency with over 12,000 employees responsible for protecting Texas children from abuse, neglect, and exploitation. Additionally, Katie was the Chief of Staff for the Texas Health and Human Services Commission (THHSC), an agency within the Texas Health and Human Services System that has hundreds of programs helping more than 7.5 million Texans each month live healthier lives.
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