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Ensuring Health Care Access for Youth in the Child Welfare System

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Mathematica and UConn’s Innovations Institute partner to advance policymakers’ understanding of how Medicaid and child welfare agencies ensure youth in the child welfare system receive access to health care

The Medicaid and CHIP Payment and Access Commission (MACPAC) has awarded a 10-month contract to Mathematica to help the commission better understand the role and responsibilities of state Medicaid and child welfare agencies in meeting the health care needs of children and youth served by the child welfare system. Mathematica has partnered with the University of Connecticut School of Social Work’s Innovations Institute to shed light on the current state-specific child welfare landscape.

This report will inform MACPAC’s deliberations on policies and strategies for ensuring that Medicaid- and CHIP-eligible children in the child welfare system have timely access to quality care. Partnerships between state Medicaid agencies and state child welfare agencies are key to achieving access to health care for children and youth in child welfare systems. However, coordination is challenging and financing is complex, with systematic, historical, and structural issues contributing to the complexity of this coordination.

Mathematica and Innovations Institute bring extensive expertise to the intersection of Medicaid and child welfare services at the federal, state, and local levels across the country. Through this project, Mathematica and Innovations Institute will identify current federal rules that require state Medicaid and child welfare agencies to ensure health care access for Medicaid-enrolled children and youth in foster care. They will select, profile, and interview Medicaid and child welfare agencies in seven states that are diverse in demographics, Medicaid systems and structures, child welfare systems and structures, and levels of innovation and system-reform initiatives. They will provide MACPAC with information on how states implement federal requirements around health care access and the issues they face in ensuring the delivery of all necessary health services. They will also identify opportunities to address gaps in access and care through changes in federal policy.

MACPAC is a nonpartisan federal legislative branch agency responsible for policy and data analysis and recommendations to Congress, the secretary of the U.S. Department of Health and Human Services, and the states on issues affecting Medicaid and CHIP. The agency, comprising 17 commissioners from diverse regions across the U.S., is an independent source of information on Medicaid and CHIP. MACPAC publishes issue briefs and data reports throughout the year to support policy analysis and program accountability and to make recommendations to Congress on access to and quality of care, among other issues.

 

About Mathematica

Mathematica  collaborates with and advises partners in the public, private and philanthropic sectors. We use data science, social science, and technology to address pressing social challenges— from the effects of climate change on communities around the world to disparities in health care, education, and employment across the U.S. We are driven by our mission to improve the services and programs that people rely on, strengthen evidence-based policy, and advance equity in the areas of health, human services, and global development. As an employee-owned company, we not only share our clients’ commitment to impact, we also share a stake in the outcome.

About Innovations Institute, UConn School of Social Work

Innovations Institute at the UConn School of Social Work advances research-based, inclusive, culturally responsive, and transformative solutions for child-, youth-, and family-serving public systems, and supports the workforce within these systems. Its work, in collaboration with partners and stakeholders at the federal, state, and local levels, touches nearly every state and territory in the country. The impact of this effort is improved quality and effectiveness of public-serving systems that are responsive to the unique needs of young people and their families from diverse communities, cultures, identities, and experiences.

 

 

Supporting the Mental Health Crisis Workforce to Address the Needs of the LGBTQ+

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The UConn School of Social Work’s Innovations Institute has launched a new training program for crisis counselors and first responders.

A Pride flag in the foreground, with a mental health professional seated in the distance.

As the nation works to build the systems and services necessary to respond to the U.S. mental health crisis, the workforce within those systems require support and specialized training to effectively address the needs of vulnerable populations and to meet the growing demands for care.

The UConn School of Social Work’s Innovations Institute leads a Center of Excellence for LGBTQ+ Behavioral Health Equity (COE), funded by U.S. Substance Abuse and Mental Health Services Administration, to provide behavioral health practitioners with vital information to support LGBTQ+ people.

Innovations—experts in instructional design and in behavioral health—has launched a new COE training designed to provide crisis counselors and first responders with in-depth knowledge to address the specific needs of and improve outcomes for LGBTQ+ populations.

In October of 2020, Congress passed the National Suicide Hotline Act, designating 988 as the new nationwide number for suicide prevention and mental health crisis. And in Spring of 2022, the U.S. Department of Health and Human Services announced $35 million in funding opportunities to strengthen and expand community mental health services and suicide prevention efforts.

These groundbreaking efforts paved the way for expanded services and support 24/7—important for LGBTQ+ people—a community that has been markedly impacted by negative mental health outcomes due to stigma, prejudice, and inequitable access to care.

“The current data on LGBTQ+ communities highlight the need for tailored and culturally responsive mental health services, particularly at times of mental health crises. Through trainings like this one we are implementing change strategies to directly address behavioral health disparities in the LGBTQ+ community and improve outcomes,” says COE Principal Investigator Marlene Matarese.

The Trevor Project’s 2023 National Survey on the Mental Health of LGBTQ+ Young People found that 41% of LGBTQ+ young people between the ages of 13 and 24 seriously considered attempting suicide in the 12 months preceding the survey. Their findings also highlighted that 56% of respondents were not able to access mental health care when they needed it in the preceding months.

Research also found that LGBTQ+  adults are at higher risk to suicide when compared to their straight and cisgender peers, and that older LGBTQ+ adults report high levels of isolation and loneliness, contributing to negative health and life outcomes. Disparate mental health outcomes are compounded for LGBTQ+ people of color who face multiple forms of discrimination.

Designed to improve mental health outcomes for LGBTQ+ people, the new self-paced online training was developed by the COE in partnership with Vibrant Health—administrators of the 988 Suicide and Crisis Lifeline. Titled Introduction to LGBTQ+ Populations with Special Considerations for the 988 Suicide & Crisis Lifeline the training addresses disparities; introduces accurate and respectful terminology, mental health considerations, the coming out process; and outlines the ways that 988 crisis counselors can support LGBTQ+ people over call, chat, and text.

Crisis counselors responding to those reaching out through 988 can build their knowledge and skills to address the needs of LGBTQ+ populations, thereby ensuring everyone who reaches out through crisis lifelines feel supported. The course takes approximately 60 minutes to complete and provides 1.0 CECs or a certificate of attendance.

Data Experts at School of Social Work’s National SOGIE Center Take Lead Role in Supporting Justice-Involved LGBTQ+ and Two-Spirit Youth

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The National SOGIE Center, at the School of Social Work’s Innovations Institute, has partnered with The National Council of Juvenile and Family Court Judges in a new U.S. Department of Justice grant to develop a National Resource Center to support Justice-Involved LGBTQ2S+ Youth

people walking with a large rainbow flag

The National Council of Family Court Judges (NCJFCJ) received a newly established $1 million grant from the U.S. Department of Justice, Office of Justice Programs, Office of Juvenile Justice and Delinquency Prevention (OJJDP) to establish a National Resource Center to support LGBTQ2S+ youth and their families. The National Center for Youth with Diverse Sexual Orientation, Gender Identity, and Expression (National SOGIE Center), based at the UConn School of Social Work’s Innovations Institute, is partnering with NCJFCJ in the development of this National Resource Center to support essential youth justice reforms and address the needs of underserved populations within youth justice systems across the U.S. The Center will advance positive youth development practices and be a clearinghouse on policies and practices related to justice impacted LGBTQ2S+ youth. They will also support the workforce within youth justice systems by providing comprehensive training and technical assistance.

Building on the Biden Administration’s support for LGBTQI+ rights, OJJDP Administrator Liz Ryan has stated “Our Office and our programs embrace all youth. We honor every young person’s right to live their truth—openly and in safety.” In receiving this newly established grant, NCJFCJ partnered with the National SOGIE Center, and with the Coalition for Juvenile Justice, the Gault Center and the Tribal Law and Policy Institute. The National SOGIE Center, a partnership of multiple organizations, coordinates a national approach to addressing the needs of LGBTQ+ youth involved in public systems and their families.

The National SOGIE Center’s work on this grant is led by the Innovations Institute team of Marlene Matarese, Principal Investigator, and Angela Weeks, Director. Matarese and Weeks will lead the development of content for justice and community stakeholders around best practices when working with LGBTQ2S+ populations to be disseminated through webinars, office hours, tools. Matarese explains The National SOGIE Center’s interest in this project, “We have been developing innovative programs for LGBTQ+ youth in child welfare that serve to create positive outcomes for young people and their families. We are now turning our attention to youth justice systems, using our experience and our understanding of LGBTQ+ populations to ensure best practices, policies, and protocols are utilized, and to support the workforce interacting with young people.”

National consultants on SOGIE data collection, Matarese and Weeks conducted a pivotal study in 2021 with the Division of Children and Families in Cuyahoga County, Ohio, finding that fully 32% of youth in foster care in the Midwest were identifying as LGBTQ+—almost four times the national average of youth ages 13 to 17. This study built on two previous studies in Los Angeles in 2014 and New York in 2020 and highlights a nationwide overrepresentation of LGBTQ+ youth in public systems. Matarese and Weeks have recently launched a learning community with the National Association of State Mental Health Program Directors for leaders in youth-serving systems to learn how to collect SOGIE data safely and respectfully to better understand and serve the populations in their care.

Weeks notes, “Our data show a disproportionate number of Black and brown youth who identify as LGBTQ+ within child welfare and behavioral health; this overrepresentation is even greater in the youth justice system. Young people involved in these public systems are often harmed by racism, anti-LGBTQ+ bias, and a lack of trauma-informed care. Across our systems work, we try to address disparities through that lens. Through this new center, we strive to positively impact these young people through the support, training, and resources we provide to the adults who serve them.”

The more likely that child welfare and behavioral health systems can provide affirming support for young people of diverse SOGIE, the less likely they will be to encounter the youth justice system. For those young people who do enter the justice system, the National SOGIE Center are working to train the workforce to address the needs of young people to ensure they receive support toward a brighter