Disconnected Youth: Negative Personal, Social, and Economic Impact

Disconnected youth—teens who are neither enrolled in school nor working—may be more likely than their peers to experience poor health, lower incomes, and unemployment as adults. They are also more likely to become involved in illegal activity and become dependent on public aid. In 2013, disconnected youth cost U.S. taxpayers an estimated $27 billion in costs related to incarceration, public assistance, lost tax revenues, and lost earnings.

In 2011-2015, eight percent of California teens ages 16-19 were neither in school nor working. The percentage of disconnected youth in counties ranged from a low of three percent in Yolo County to a high of 14 percent in Mendocino County.

Trends in the rates of disconnected youth varied among counties, cities, school districts, and legislative districts, while the statewide trend saw little change.

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Cities Re-Connecting Their Youth

Daly City and Madera are among cities that have seen substantial improvement in re-engaging their youth since 2005-2009. Daly City has improved by five percentage points and Madera has improved by eight percentage points, both dropping below the California state average.

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Cities with Increasing Rates of Disconnected Youth

West Covina and Yuba City are among cities that have seen an increase in percentages of disconnected youth since 2005-2009. West Covina has increased by five percentage points and Yuba City has increased by six percentage points, both near or above the California state average.

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Policy Implications

Policy solutions range from those that prevent youth from becoming disconnected in the first place to those that re-engage disconnected youth with school and work.

Since teen engagement is related to early school achievement and positive early learning experiences, effective solutions include home-visiting programs for struggling families, quality preschool, and safe and supportive K-12 schools to ensure children have access to quality education and stable, caring environments. To engage older youth, their participation in youth advisory councils, volunteer or community projects, and service learning allows them to become active decision-makers, take on leadership roles, and contribute to the community. Help in creating such opportunities can come from improved statewide coordination and cross-sector community collaboration, both of which can foster integrated approaches to support at-risk and disconnected youth.

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A Smarter System: Addressing Social Determinants of Health as a Cost-Saving Measure

by Edward Schor, MD, Senior Vice President at the Lucile Packard Foundation for Children’s Health

The importance of social factors in determining individuals’ health status and their use of health care services has been receiving increasing attention. A recent report from the Bipartisan Policy Center suggests that opportunities to control health care costs reside primarily in addressing patients’ social and behavioral care needs. The report lays out the arguments for integrating social and medical services and, ideally, their funding, to better serve vulnerable patients with complex care needs.

To date, most of the experimentation within the health care system to address underlying social determinants of health has occurred within the framework offered by Medicare. Such interventions have focused on home-based, patient-centered care, supportive housing, in-home meal delivery, and community-based assistive services. They have yielded improvements in the health of the individuals served and some reductions of health care use. Some states have used Medicaid waivers to allow provision of certain community-based services. Within child health there have been experiments offering similar service options, such as intensive, comprehensive case management to patients and families, housing assistance, and referral for social and legal services.

With a very few, notable exceptions, all of these early efforts to address social determinants of health were built on a medical model, i.e., identifying and treating specific factors contributing to the individual’s poor health. Our existing service delivery systems, which are designed to hew to this traditional model, have had some success but at unsustainable costs.

A public health approach to better serve populations as opposed to individuals would be more efficient and effective. Implementing broad changes in social programs can reduce potentially adverse circumstances that contribute to poor health and harmful health behaviors. Fee-for-service payment schemes perpetuate an individual-based approach to solving health problems. Adopting a capitated model in which all costs are covered by a single advance payment, such as those used by accountable care organizations, can encourage but does not necessarily assure that population-based, integrated approaches will be adopted.

Some health care systems, guided by their own cost-benefit analyses, are addressing social determinants of health, not as their mission but rather as cost-saving strategies for individual or targeted groups of high-risk patients, under the rubric of value-based purchasing. This is a step toward, but still a long way from, adopting the changes in social policy that are necessary to improve the standard of living and quality of life of Americans. Until such changes occur, health care costs will continue to rise and the health of the nation will remain poor in contrast to the rest of the developed world.

 

Data on Social Determinants of Health

There is substantial evidence that children’s health is directly correlated with income and inequities in access to resources and services. The American Academy of Pediatrics has called for an effort to reduce childhood poverty and to mitigate the adverse outcomes of challenging social circumstances in order to obtain and maintain good health.

Many indicators on kidsdata.org describe social determinants of health, the family and community factors that affect individuals’ health and well being. Social determinants can help make individuals’ health better or worse. Examples include economic well being, housing stability, community connectedness, and parents’ physical and mental health.

 

Helpful Links

Healthy People 2020—Social Determinants of Health

Poverty and Child Health

Beyond Health Care: The Role of Social Determinants in Promoting Health and Health Equity

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Black youth experience highest felony arrest rate in California

The felony arrest rate among African American/black youth in 2015 was substantially higher than other racial and ethnic groups in California. At 24 arrests per 1,000 youth, the rate among this group is about 8 times higher than the felony arrest rate among white youth.

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Encouragingly, nearly all of the 21 counties with data have seen improvements in felony arrest rates for African American/black youth over the past 17 years. Since 1998, San Francisco County saw a particularly sharp, though volatile, decrease, while San Joaquin County experienced the second largest rate drop since that year.

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Policy Implications

Youth who have contact with the juvenile justice system are at increased risk for a number of negative long-term outcomes when compared with the general youth population. For example, an estimated 30 percent of the youth who enter California’s juvenile justice system have mental health issues and those who have been held in detention have higher rates of attempted suicide and psychiatric disorders than youth who have not been detained. Additional long-term outcomes include injury, substance use and dependency, dropping out of school, and early pregnancy.

Policymakers within the justice, education, and social services systems can play a role in improving the way we address juvenile crime. Policy options include redirecting young offenders toward rehabilitative programs instead of the juvenile justice system and conducting case-specific assessments of an individual’s circumstances.

Currently, there is not a minimum age for entering the juvenile court system in California. If passed, Senate Bill 439, under review by the legislature, would establish 12 years of age as the minimum age over which the juvenile court has jurisdiction in California.

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Learn more about SB 439 »

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Racial and ethnic gaps persist in child cancer survival rates

In California, gaps persist in net five-year survival rates among children and youth ages 0-19 diagnosed with cancer between 2003 and 2013. The survival rate among white children is 85 percent, compared to 80 percent for Hispanic/Latino children, 79 percent for Asian/Pacific Islander youth, and 76 percent for African American/black children.

Data at the county level are limited, however variation in gaps across counties is wide. A few counties, such as Sacramento and Contra Costa, show less than a five percentage point gap in cancer survival rates across racial/ethnic groups, but most counties show wider gaps.

The figures below show a selection of counties with data that had a gap wider than 10 percentage points for three race/ethnic groups in California.

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Survival Rate Gap: Hispanic/Latino

The gap in cancer survival rates between white and Hispanic/Latino children is four percentage points at the state level. Counties with gaps greater than 10 percentage points include Napa, Placer, and Tulare.

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Survival Rate Gap: Asian/Pacific Islander

The gap in cancer survival rates between white and Asian/Pacific Islander children is six percentage points at the state level. Counties with gaps greater than 10 percentage points include Riverside, San Joaquin, and Los Angeles.

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Survival Rate Gap: African American/Black

The gap in cancer survival rates between white and African American/black children is nine percentage points at the state level. Counties with gaps greater than 10 percentage points include San Diego, Alameda, Solano, and San Francisco.

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Policy Implications

Early identification of affected children and ready access to pediatric specialty centers for diagnosis and ongoing care are key to cancer survival. Public policy ensuring that all children with cancer have adequate health insurance is essential to providing them with access to equitable, appropriate, and affordable care.

The Affordable Care Act (ACA) addresses cancer and other chronic illnesses by requiring regular, comprehensive preventive care without copayments and by eliminating lifetime caps on care and denials of coverage based on pre-existing conditions. Additional policies could assure that all pediatric cancer patients, regardless of race/ethnicity or family income, have consistent access to affordable health care that is evidence-based, well-coordinated, family-centered, and provided in the context of a medical home. Access to care coordination services is especially important as these children and their families need to navigate and align an array of services.

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Protecting water and air protects children’s health

Children are at greater risk of developing health problems due to pollutants compared to mature adults. Their small body size and developing organs make them more vulnerable to environmental contaminants.

In 2015, California had 1,533 Maximum Contaminant Level (MCL) violations, meaning contamination of drinking water supplies exceeded public health limits. Four Central Valley counties (Fresno, Kern, Madera, and Tulare) were issued 40% of all such violations.

Exposure to contaminants in drinking water can result in numerous adverse health effects for children, such as gastrointestinal disorders, damage to developing organs (particularly the liver, kidneys, and brain), and cancer.

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Five Central Valley counties (Fresno, Kings, Plumas, Tulare, and Kern) averaged particulate matter concentrations that are considered to be potentially harmful, among counties with data in 2014.

Long-term exposure to high levels of particulate matter, commonly found in diesel exhaust, may be related to heart and respiratory disease, along with adverse reproductive or pregnancy outcomes, among other health problems.

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Policy Implications

To protect children’s health, federal and state environmental laws and regulations that limit harmful waste and byproducts of agricultural, industrial, and other practices should be enforced and strengthened. Environmental safeguards can be bolstered by maintaining funding for national, state, and local agencies; increasing collaboration across agencies; and requiring reporting of environmental data to the public. The Environmental Protection Agency has a leadership role in ensuring that we are all protected from environmental risks.

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Over 14,000 CA foster youth facing end to critical services

For more than 14,000 California foster youth between the ages of 16 and 20—nearly a quarter of all those in care in 2015—the transition to adulthood is especially challenging. At age 21, if they had not been reunified with their families or adopted, youth "age out" of the state’s foster care system, and services often end abruptly. Without effective transition planning, these young adults are at increased risk for negative outcomes including unstable housing, low educational and career attainment, early parenthood, substance abuse, physical and mental health problems, and involvement with the criminal justice system.

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Policy Implications

Policies that could enable youth aging out of the foster care system to thrive as adults include ensuring effective implementation of the Federal Affordable Care Act, which extends Medicaid coverage to foster youth until age 26, and the California Fostering Connections to Success Act, which extends foster care services to age 21. In addition, strengthened educational and workforce supports, including support to pursue secondary education, can improve outcomes for youth transitioning out of care.

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May Is National Foster Care Month

National Foster Care Month is a time to acknowledge the foster parents, family members, volunteers, mentors, policymakers, child welfare professionals, and other members of the community who help children and youth in foster care find permanent homes and connections. It is also a time to focus on ways to create a bright future for the more than 400,000 children and youth in foster care in the US.

See resources from the US Department of Health & Human Services »

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April Is Child Abuse Prevention Month

In 2015, two-thirds of California children (67 percent) involved in a substantiated case of maltreatment suffered general neglect. General neglect occurs when a parent, guardian, or caregiver fails to provide adequate food, shelter, medical care, or supervision for a child, but no physical injury happens. More severe types of maltreatment—severe neglect, physical abuse, and sexual abuse—were inflicted upon 18 percent of children involved in substantiated cases in 2015.

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Policy Implications

Providing an accessible system of mental health, substance abuse, and other supportive services for families with children at risk of maltreatment could help prevent child abuse and neglect. In addition, increasing collaboration across public and private sectors such as local and state government, education, health care, nonprofit, and the media could help ensure that all children have safe, stable, nurturing relationships and environments.

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See resources from the Office of Child Abuse Prevention »

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Webinar Q&A: Childhood Adversity—Data to Help Advocate for Change

In a March 29 webinar, panelists from kidsdata.org and the California Department of Public Health discussed how to describe the burden of childhood adversity in your community, how to frame your message most effectively, and how to engage and mobilize your community to address the roots and effects of childhood adversity. Attendees responded to the panelists’ presentations with questions about how best to integrate the information into their work.

Panelists:


Marissa GTW headshotMarissa Abbott, MPH
 – California Epidemiologic Investigation Service (Cal-EIS) Fellow, Injury Surveillance and Epidemiology Section, Safe and Active Communities Branch, California Department of Public Health

 

Turk-Bicacki_Lori GTW headshotLori Turk-Bicakci, Ph.D. – Senior Manager, Data and Research, Lucile Packard Foundation for Children’s Health

 

Q&A:

Download the full list of responses to questions that were posed during both the live March 29 webinar and the registration period. The first five of 26 responses are below.

How do we best begin a community dialogue about Adverse Childhood Experiences (ACEs)?

ACEs provide a valuable frame to highlight how trauma is an intersectional issue. When approaching various stakeholders, you can try to frame your presentations in terms of how ACEs might matter to them in their personal and professional domains. It is also important to stress the idea that addressing adversity is not simply a personal issue but also a broader community responsibility.

There are several different ways to begin a community dialogue about ACEs. One approach is to start by identifying champions who can help you think about how to engage the community in conversations about adversity and trauma. Another important step is to convene and engage these champions and “supporters” around the issue, build baseline awareness about ACEs in the community, and leverage relationships in order to expand and engage your target audiences.

 

Can you give us an example of how you integrate values with ACEs facts?

We are trying to create a “new” public narrative grounded in values and beliefs that support safe, stable, nurturing relationships and environments for all parents and children. In contrast, the current dominant value frame for child maltreatment includes value statements such as: 1) parenting is a family issue–not a government or community problem; and 2) bad parents and children are to blame.

To create a “new” public narrative, we need to propose another set of values that focuses on our shared responsibility for the wellbeing of children and the possibility for pro-active solutions.  The ACEs “facts,” as seen in the broader set of adversity indicators, support the notion that parenting is not simply an isolated family matter.  Instead, the data suggest that the toxic stresses and traumas experienced by children and families are shaped not only by family history and the immediate family dysfunctions, but also by the cumulative past and present environments in which they live, work, grow, and play. Adverse environments include unsafe and violent neighborhoods, poor quality education, persistent poverty, lack of opportunity, and limited job prospects.

The value of shared responsibility can be premised on the notion that we are all responsible for recognizing and addressing these unjust and preventable inequalities. This premise allows us to re-frame the dialogue from simply blaming parents to looking at the potential structural and systemic ways that families are affected.  In this frame, government has an important role to play to address these inequalities and provide families and children with the supports they need to prevent, stop, mitigate, and recover from adversity and toxic stress.

 

What are some sample messages grounded in values and beliefs that help shift from an individual to a community frame?

Some of the messages grounded in shared responsibility start with value frames stressing a shared worldview: 1) we all want the best for our children; 2) parenting can be difficult–we all need help at some time; 3) investing in children is good for all of us/we all benefit when children succeed (e.g., paying into social security); 4) America’s “can do” spirit should prevail (we can solve these problems if we work together); and 5) focus on innovative solutions (we can find creative ways to solve problems).

 

Are there future plans to incorporate into kidsdata.org additional adversities that are not classified ACEs per se, such as neighborhood violence, housing, or employment discrimination?

In addition to indicators in the Childhood Adversity and Resilience topic, kidsdata.org has over 550 other indicators of children’s health and wellness, and many of them measure the extent of adversity. For example, we have data on poverty, housing instability, food insecurity­­­­, and child abuse/neglect. This summer, we expect to add additional community-level indicators related to poverty.

We would also like to add indicators that demonstrate resilience and that measure types of resources that support children’s health and wellness. An example of a supportive resource is school-based health centers, for which we currently show counts on our site. Please let us know if you are aware of a data source that measures resilience or quantifies supportive resources for counties in California.

 

Does kidsdata.org provide tangible materials for organizations to share with their community?

Kidsdata.org does not provide tangible materials about childhood adversity and resilience such as screening tools. However, you can generate fact sheets for any county, city, school district, and legislative district for which we have data that include a variety of indicators related to childhood adversity, health, and wellness.

For additional materials specifically related to adversity and resilience, we recommend reviewing the Research and Links section at the bottom of each indicator page and checking the Centers for Disease Control and Prevention (CDC) Essentials for Childhood website.

 

Download the full list of responses to questions that were posed during both the live March 29 webinar and the registration period.

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Health care for 7 in 10 CA children funded by Medicaid or CHIP

Proposed cuts and changes to public health insurance programs would have a disproportionate effect on California kids compared with kids in the nation as a whole. During fiscal year 2016, more than 7 in 10 California children used federal funds from Medicaid or the Children’s Health Insurance Program (CHIP) for health care coverage, according to the latest data now available on Kidsdata. Nationwide, fewer than 6 in 10 children used Medicaid or CHIP funds during the same time period. In California, both sources of funding support the Medi-Cal program.

Loss of Medicaid or reductions in benefits could lead to higher insurance premiums and out-of-pocket costs for low-income families, increased numbers of uninsured or underinsured children, more emergency room visits and hospitalizations, increased school absences and resultant lower academic achievement, and, invariably, lost lives.

Decisions in Washington, DC impact California children. Policy options that could improve children’s health care include supporting efforts to ensure continuous, comprehensive insurance coverage for all children and reinforcing the capacity and financial viability of safety-net providers. On March 24, legislative leaders decided to discontinue advancing the American Health Care Act, a replacement for the Affordable Care Act (ACA or Obamacare), but changes to health care and other social services remain a probability. Voice your opinion and contact your U.S. Representatives and Senators to #KeepKidsCovered.

Helpful Links

Enrollment in Health and Nutrition Safety Net Programs Among California’s Children, Public Policy Institute of California

Children’s Health Insurance Program (CHIP): Accomplishments, Challenges, and Policy Recommendations, Pediatrics

Children’s Health Programs in California: Promoting a Lifetime of Health and Well-Being, California Budget and Policy Center

Medicaid Block Grant Would Slash Federal Funding, Shift Costs to States, and Leave Millions More Uninsured, Center on Budget and Policy Priorities

Kidsdata Tip

Are you interested in learning how to use childhood adversity data to advocate for change? Our recent webinar has information that you won’t want to miss. Download the slides or watch the recording on our blog.

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Archived Webinar: Childhood Adversity—Data to Help Advocate for Change

The recording and slides for the March 29 webinar, Childhood Adversity: Data to Help Advocate for Change, are now available.

In this webinar, panelist Marissa Abbott of the California Department of Public Health discussed how to describe the burden of childhood adversity in your community, how to frame your message most effectively, and how to engage and mobilize your community to address the roots and effects of childhood adversity.

In addition, panelist Lori Turk-Bicakci of kidsdata.org led participants on a virtual tour of Kidsdata’s Childhood Adversity and Resilience data, research, and policy recommendations.

View the webinar recording:
View the webinar slides:

Download presentation slides.

Already using Kidsdata to address childhood adversity in your community? Share your story with us.

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